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HomeNewsNiall McCrae: A word of warning about pathologising teenage angst

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)

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