What is ‘wrong’ with them?

Written by: Anna Scarr | Published:
Anna Scarr, a registered mental health nurse and independent trainer and consultant in children and young people’s mental health

Is this pupil mentally ill or just human? Anna Scarr asks why we are too willing to convey the dangerous message that something is ‘wrong’ with a child...

Schools are in danger of slapping mental health labels on youngsters whose problems lie elsewhere.

Looking back over the many years I have spent as a clinician in Child and Adolescent Mental Health Services, I have lost count of the number of times that children or young people have been brought into the system by parents or professionals, including school staff, desperate to discover “what is wrong” with the child.

Because the young people present with significant emotional or behavioural disturbance, the adults around them are often convinced that there must be some underlying pathology that needs to be unearthed, or a missing piece to the puzzle which if they could only discover, would enable the young person to be “sorted out” by a mental health professional.

A complex story

The difficulties are very often seen as located in the child or “patient”. However, mental health issues are usually far more complex than this. Individual characteristics of the young person are usually one part of a much bigger picture.

Of course, some might inherit a genetic vulnerability, may have a neuro-developmental or learning disorder, a difficult temperament or one of a wide range of other individual factors, but in most cases there will also be a host of other environmental precipitating and maintaining factors at play in their presentation.

We need to start adopting more of a systemic perspective which takes into account the young person’s context rather than focusing on them as isolated beings.

Young people’s distress

I am often staggered by how parents and professionals can overlook hugely significant factors when wondering why a young person is presenting the way they are. Factors such as a history of bullying, struggling academically (and seeing things come a lot more easily to their peers), exposure to domestic violence or other traumatic events, or experience of an acrimonious parental separation can all take a heavy toll on young people.

While children might present their difficulties in unexpected ways, for example with aggressive behaviour when they are actually highly anxious, we often fail to make connections between what we observe and the young person’s history or environment.

Take the example of 12-year-old Joe, brought into CAMHS by his mum and a concerned teacher due to threats of self-harm and explosive angry behaviour. They were both perplexed and desperate to find out what was “wrong” with him.

Joe’s parents separated when he was four, and he lived with his mum although had some contact with his dad who was remarried with two children. However, contact with Dad was sporadic and, according to mum, Joe was often let down by him. Mum had recently ended a relationship with a man who she admitted had been violent towards her and Joe had been exposed to this.

As if this was not enough stress for one 12-year-old to deal with, Joe was also struggling academically.

When interviewed on his own, he admitted that he hated being in a class where things seemed to come much more easily to his peers. Even worse, teachers would frequently ask the class to swap their work with a partner to be marked. Joe clearly felt completely humiliated and ashamed on these occasions. It was no coincidence that his outbursts often occurred around these times.

Why do we continue to have a myopic reductionist view which focuses on the perceived defects of an individual child?

Well, for a start, it absolves the adults around them of responsibility for some of the issues. Of course, parents themselves are often struggling with their own emotional or mental health difficulties, and it can be difficult for them to fully meet the needs of their children. Support for parents is often as desperately needed as support for the young person.
Sometimes the school environments which young people find themselves in are far from conducive to positive mental health.

Focusing exclusively on the individual child also fits with the notion that improving a child’s mental health is like fixing a broken leg – find the problem and sort it with a wave of the wand. Unfortunately, it is often not that straightforward. Sometimes, even with intensive support, it can take a long time before things start to improve.

Seeing the bigger picture

The widespread pathologizing of children and adolescents is extremely damaging. We bring them into a mental health system and convey the message that there must be something wrong with them, when the way they are presenting may actually be a very appropriate reaction to the circumstances in which they find themselves, or difficult life events they have experienced.

The behaviours they display can at times be highly challenging for their families or professionals, and sometimes, they will meet the criteria for specific clinical disorders. However, we need to always hold in mind the bigger picture.

Mental health issues need to be viewed as resulting from the interplay of a number of factors, both individual and environmental.

Rather than locating the difficulties within the young person, it is crucial that we also reflect on how the environments we create for our children might be contributing to their expressions of distress.

Let’s stop the search for labels and start seeing them as human beings with understandable reactions to the challenges they face.

  • Anna Scarr is a registered mental health nurse and independent trainer and consultant in children and young people’s mental health.


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