The Department for Education has announced plans to run wellbeing trials in schools, but we should beware of too much talk of a “mental health crisis”’ in schools or it risks becoming a self-fulfilling prophesy, says Helene Guldberg
If young people are repeatedly told they have a disorder when they face challenging emotions and experiences, is it any wonder that many internalise a sense of victimhood and powerlessness, and therefore lose their capacity to cope?
Part of the problem is over-diagnosis. In his 2013 book Saving Normal, American psychiatrist Allen Frances warns of the dangers of labelling everyday emotions as “disorders”, a situation that has resulted in more and more people being deemed to be mentally ill.
Frances was chair of the taskforce that created the American Psychiatric Association’s Diagnostic and Statistical Manual-IV (DSM-IV), the book that psychiatrists use to track and describe mental disorders and conditions. His team expanded the number of disorders and changed the diagnostic criteria to include a wider variety of behavioural and emotional challenges.
We all feel deeply unhappy at times
Frances is particularly concerned about the consequent exponential increase in the diagnosis of psychiatric conditions in children, writing: “We have now moved from diagnostic inflation to diagnostic hyperinflation.”
Take attention deficit hyperactivity disorder (ADHD). This diagnosis is applied so promiscuously that 10 per cent of children in the US are given the label. In the US, boys born in December are 70 per cent more likely to be diagnosed with ADHD than boys born in January.
The reason diagnosing ADHD is so problematic is that it essentially is a description of immaturity, including symptoms such as “lack of impulse control”, “hyperactivity” or “inattention”. Boys born in December tend to be the youngest in their school year group (in the US) and thus they are more likely to be immature. In the UK, the youngest children in a school classroom are born in August, and so here, August-born kids are more likely to be diagnosed with ADHD. We have medicalised immaturity.
We need to ask ourselves whether we are helping or hindering the younger generations by increasingly encouraging them to view difficult emotions and challenging behaviours and life-experiences through the prism of mental illness. The normal range of emotions experienced by adolescents have become problems requiring professional support.
Life is not a bed of roses; we will all feel deeply unhappy at times. Growing up can be hard. For children and young people, relationships can cause immense heartache. But through heartache, we strengthen our character and deepen our understanding of our emotions and other people.
Our role should be to help children to put their difficulties in perspective, not to present them as “disorders”. We should help young people to understand that we can work through difficulties.
Children and young people will only develop resilience through facing up to and negotiating challenges and learning to handle a range of emotions – jealousy, envy, shame, humiliation, anger, disappointment, fear, anxiety, even dread. If children are to develop “grit”, adults need to stop presenting these everyday emotions as “disorders”, as something children need protecting from.
But, above all, by exaggerating the prevalence of mental disorders those who really do need help, who suffer from debilitating emotional or behavioural disorders, are increasingly losing out. If already sparse Child and Adolescent Mental Health Services (CAMHS) resources are diverted from more targeted intervention to an ever-increasing proportion of children, those children whose levels of difficulties substantially restrict their capacity to function socially may suffer further.
So let’s stop talking about a “mental health crisis”. It could become a self-fulfilling prophesy. We need to be vigilant and ensure that the children who desperately need psychiatric support get it. But let young people work through everyday problems and emotions without encouraging them to see themselves as mentally ill.
Helene Guldberg is author of Reclaiming Childhood: freedom and play in an age of fear