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Niall McCrae: A word of warning about pathologising teenage angst

Like all her friends, Hermione spends her evenings fixated on her mobile device. ‘Can’t you put that down for a while?’ asks her mother, with a sigh. Five minutes later the phone is on again, because WhatsApp never sleeps. For Hermione, virtual reality is preferable to that French essay she’s supposed to be writing, or the biology project, although she regrets posting some photos earlier on Instagram. Mum finds her so stroppy, and thinks she should see someone – does she have depression?

This week Theresa May announced the government’s priority to provide better mental health services. Undoubtedly, this is of good intent, and society should not accept the persistent stigma towards mental illness, or the heavy toll of suicide in young men, or the high incidence of self-harm and eating disorders in teenage girls. Common psychological problems deserve attention because they profoundly detract from the sufferers’ quality of life.

Adolescence is a tough time. Modern society exacerbates the difficulties, with pressure for educational attainment, constant contact on social media with the problems of sexting and body shaming, and confusing messages about gender identity. Mental health problems appear to be increasing in adolescence, without adequate service response. And yet, as a mental health lecturer, I am wary of the momentum towards a major funding boost for child and adolescent mental health services. Here are four pitfalls.

Pathologising children. Since the Diagnostic and Statistical Manual (DSM) psychiatric classification system began, with each revision it has grown substantially. More and more behavioural patterns are medicalised, resulting in more and more people with a psychiatric diagnosis on their health record.  New disorders are being added for internet-related activity, but who does this really help? See below.

Professional projects and Big Pharma. These are closely related, as seen with policy fordementia: expensive ‘memory clinics’ have front-ended resources into assessment and diagnosis, to the benefit of the more prestigious professions, and the pharmaceutical companies with their costly but barely effective ‘anti-dementia’ drugs. Foucault wrote about this tendency – the heroic experts of the clinic. Money should go into enduring care and support for people with dementia andtheir families (who pay for this, as it’s classed as social care). Rates of depression in the young are rising, boosting the massive market for antidepressants, despite significant flaws in their evidence.

Middle-class moral panic. As Laura Perrins suggests, ‘this is driven by anxious middle-class feminist mothers in the media, who have stressed-out, over-pressured yet brittle middle-class girls who are cracking up’. Meanwhile, unfavoured but vulnerable groups such as inner-city black boys are likely to be left to their lives of brutality, drug addiction and emotional void.

The NHS is at breaking point, isn’t it? Obviously nipping psychological problems in the bud is a worthwhile endeavour, but there are more pressing priorities.

Expansion of child and adolescent mental health services is surely positive, but to achieve its goals the policy must be steered carefully. Otherwise, resources simply add to the prosperity of psychiatrists, psychologists and the profits of pharmaceutical companies, while a growing proportion of children are pathologised. There are other ways of treating society’s ills.

(Image: Victor)

Niall McCrae

  • Bik Byro

    Simon Sinek explains it all. It is a long video but worth your time to watch all the way through https://www.youtube.com/watch?v=5MC2X-LRbkE

    • Niall McCrae

      Thank you, Bik. Watched the video, and highly recommend. Brings the world of my fictitious Hermione to life.

  • Nick

    Dysfunctional and broken families, weak social networks, lack of faith and outward-looking moral structure are the basis for many self-absorbed and rudderless teenagers who exhibit/feel mental issues. You won’t find that many of these adolescents come from religious ethnic communities. Many of the drugs prescribed have serious negative side effects, cause dependency and result in additional drugs being prescribed to mitigate the effects.

  • weirdvisions

    Yet the Millennial snowflakes seem to think we the well balanced over 50s, who didn’t even have 24/7 TV when we were kids and so had to find or create our own amusement, are the problem.

    • Vera

      I can’t help feeling we encourage children to be self obsessed. In my school years in the 1950s in a west London suburb I can’t remember any children with mental health issues. Admittedly it was a very different world then, much less crowded, we had more freedom to explore our neighbourhoods, we cycled, played more running and ball games and had no contact with drugs apart from the odd Woodbine. We did not give ourselves much thought nor did we keep comparing ourselves to others. Our differences were accepted without comment. We had far less in material possessions but seemed far healthier mentally, more outward looking.
      I recently read of a patient who needed a kidney transplant, a kidney was found but her operation was cancelled because there were no beds. The last two beds in the hospital had been taken by two youngsters who had attempted suicide and now had breathing problems. The kidney died. Sadly it makes their suicide attempts seem somewhat self indulgent.

      • weirdvisions

        We certainly weren’t as introspective as today’s youngsters. And like you say. We had the freedom to be kids. Today’s kids seem to have the “freedom” to grow up far too quickly but without the maturity to do it successfully..

  • Groan

    “unfavoured but vulnerable groups”. A very important point as my observation is that services have a tendency to prioritise holistic work with people like themselves (broadly middle class and fundamentally “nice”) rather than the difficult customers such as big teenage boys who are a hand full. The latter usually seen as particular candidates for medication rather than sustained work. I can’t help but think that the current craze for drawing into “mental health” teenage angst and insecurities heightened by social media reflects that such patients are a lot easier to be with and to deal with (ditto their family) than those really at risk of blighted lives and criminal justice.

  • I suggest that many of the problems are self induced by children’s constant use of mobile devices and keeping up with others. For example, I can’t remember ever hearing or reading about anorexia until I was probably in my forties, but now we are constantly reading of young sufferers. Why? Peer pressure becomes an obsession, victims read about it on the internet and it all gets out of hand.

    Is ADHD a real disorder or is it a symptom of something else? In the case of my seven year old grandson, he spent all his time fidgeting in class and his teacher was concerned. But he was just totally bored, the pace was so slow. He’s now at an Independent school, no suggestion of illness, his new teacher says that he’s a quick learner and it’s hard to keep up with him. But I’m sure if my daughter had taken him to the doctor following the first teacher’s comments, he would, by now, be taking some pill.

    There is also a problem of ‘fashion’. To many it seems to be fashionable to have the latest disorder. Children with some of them can get extra funding in state schools, or special consideration in exams.

    • Colkitto03

      ADHD exists in a tiny fraction of kids. Otherwise it is massively over diagnosed.
      Well done to your grandson for getting on so well.

      • North Angle

        Tried to reply to this and it’s being approved… suffice to say, I totally agree.

  • Colkitto03

    Young people love certainty, they love order, they love guidelines, they love their strict parents.
    Yes they may tell their pals otherwise. Yes they may like to pretend to be a rebel.
    The problem here?
    The problem starts when soft headed middle class parents decide they want to be their child’s ‘mate’
    We are not here to be BFFs with our kids. No wonder kids today have problems.

    • weirdvisions

      I must have been fortunate. Both of my parents were far to busy working to keep a roof over our heads. Time to keep us on the straight and narrow and maybe join in board games or take us out at weekends. No time to revist their youth and “get down wiv da kidz”.

  • brainbiter

    ‘Unfavoured but vulnerable groups such as inner-city black boys’ have lots of outlets for their anxieties, notably beating and robbing white people. I don’t know how much you would know about this group anyway. You have precious little experience of them in your own country, whether Ireland or Scotland, since both have used extensive political connections to ensure they avoid the problem altogether while leaving mine on the verge of collapse. We can still provide the sort of fat salary that prompts parents of ‘vulnerable black boys’ to come to England in the first place of course. Opportunists together. No wonder you’re sympathetic.

  • Busy Mum

    My daughter told me that she and all her peers were desperate to be diagnosed with something because a) having a problem means you fit in (not having a problem makes you abnormal) and b) having a problem gives you a get-out clause and means you do not have to take responsibility for your actions or mistakes or failures.
    I know of a girl who deliberately cut her index finger in order to get out of doing a science assessment as she had not done any preparation for it. This should have been punished but no, it was all ‘poor little diddums, you have low self-esteem and that is why you are resorting to self-harm’. Self-harm did then become a habit with her. Those teachers and pastoral staff will have to answer for that.
    The wickedness lies with the adults who are taking advantage of this genuine teenage angst to build a whole industry. Secondary school pupils are introduced to all the mental disorders; I only found this out when my 13 year old daughter came home each week convinced she had the latest one they had learnt about – one week she thought she was bipolar, the next week she thought she had Tourettes, the next week she was sure she had been hearing voices etc etc. Teachers and pastoral staff are all on message and encourage the children to think they have ‘issues’.
    Call me a cynic if you like but I am sure that the mental health agenda is a deliberate ploy to – as I have said before – ‘wimpify’ our youth. And as with LGBT, physical disabilities etc etc, it is all about normalising the abnormal, in order to destroy the normal.

    • North Angle

      I totally agree. It is no longer correct to be ‘normal’ – we must all have something wrong with us. Frankly, too many disorders are over-diagnosed and over-normalised.