Life is an illness waiting for a name
We are in the throes of a developing sanocracy. This is the utopianisticrule of therapists, well-being experts, health pressure groups and vested interests whose implicit mission is to eliminate suffering and turn us all into patients who can be treated endlessly but never cured. In fact, children are the group most vulnerable to this cultural current because they are less able to sign off and drop out, and doing so may actually be seen as symptomatic of disorder – disruptive mood dysregulation order or oppositional defiant disorder being the carespeak terms for this.
Children are unwittingly in the vanguard of the slow march towards universal patienthood. This is partly a function of the pressure, successfully applied recently on government, by organisations such as Young Minds which mistake the responses of young people to the manoeuvres of the market for illness and rely on a kind of insurance policy which states that to question increasing treatment and intervention in their lives is to be in favour of suffering.
The pathologising of difference and the growth of teacher-promoted disorders are the fallout from education (like healthcare) becoming just another instrumentalist service industry where any tendencies displayed by children which might affect income and the bottom line have to be smoothed away – and from parents wanting a return on their investment. Thus, for example, the counter-intuitive steep rise in the incidence of ADHD and autism spectrum disorders, both highly elastic constructs, runs in parallel with the introduction of penalties for schools which “underperform”. Such disorders always contain a conundrum, that is to say the question as to where on the spectrum the line between abnormal and therefore actionable, and not-abnormal (normal being a fast shrinking concept) should be drawn, the answer to which will be socially, culturally, ideologically and, increasingly, economically determined.
These currents are channelled by a powerful and pervasive narrative which reads that the prevalence of such disorders, along with depression, anxiety and eating problems, is growing inexorably and exponentially in response to the unavoidable pressures of the external world. Thus Tim Hands, vice-chair of the HMC and head of Magdalen College School, speaks of the “unique pressures” facing “this generation of pupils”, such as “24/7 social media, relentless exams, increasing debt and an uncertain job market”. Whether these time-bound phenomena should generate more stress than the prospect of being sent to the front in 1914 or 1939 or the very real threat of nuclear annihilation in the 1960s or, say, a life foraging for survival on the rubbish-tips of urban Kenya is an interesting question which maybe points to the transformation of grounded (but not necessarily passive) acceptance into narcissistic fantasies, fuelled by the market, where worth is assumed rather than earned.
This narrative is scripted in part by those who have a vested interest in its promotion. They are not necessarily, of course, cynical or malign but its hidden impetus is an economic rather than a clinical one – and it is telling that proposed solutions are never free or demotic but technical and coming with a financial cost.
Healthcare generally and over time has been finessed to the extent that it, too, is just another service industry with customers, consumers, service users or whatever the favoured terminology happens to be. This is not to deny the fact of, say, the increase in hospital admissions for children who have self-harmed or who have dangerous problems connected with eating, or the doubled incidence of diagnosis among children of what Young Minds call “clinically significant mental health problems”. But it is to bring attention to the need to unpick the lurking assumptions and murky language of the movement. Young Minds lists as problems and suitable cases for treatment a number of phenomena – anger, aggression, anxiety, bereavement, divorce, separation, family relationships, school problems, schoolwork, exam stress, physical illness, eating and sleep problems, stealing and lying (NB the recent research which suggests that children who lie tend to do well in life).
Keeping in mind the dictum that a problem equals a fact plus a judgement, it is hard to imagine a full and rewarding life without many of these features, though there will, of course, be a line in each of them beyond which degree or intensity would warrant external intervention – who draws that line being another key question. In fact, resistant or challenging behaviour and even embryonic difficulties in the relationship to food are normal but very easily become ingrained or fixed when parents or other significant adults lose self-confidence or become anxious – a particularly influential but corrosive state of mind – in their approaches to them: in this way, pathologising behaviour is in a sense self-fulfilling because intuitive, adaptive responses are easily inhibited as a result. That is to say, awareness of the pathological construction of certain behaviours can easily hamper or corrupt instinctive parental management of them. This dynamic is in step with the market’s facility for creating problems for which it then devises expensive solutions.
The rule of three governs illness and disorder as it does much of the rest of life. That is to say, some young people will develop mental health problems whatever happens to them. Some will never develop problems, whatever experiences they have. And the third group, which is by far the biggest, may develop problems depending on life events or experiences, their relationships with and responses from significant adults, and so on. Phenomena constructed as disorder have their own life history, as it were. Schizophrenia, for example, is generally an enduring condition, which means early, benign, supportive treatment is indicated. So called bipolar affective disorder (formerly manic depression) has a less predictable course and may, depending on what happens around the sufferer, ebb away and become a background risk. And there is a very wide spectrum of phobias, behaviours, personality traits, or relationships to food, alcohol and drugs which may fade or be transformed into more desirable, adaptive qualities which can be put to good use in adult life.
It follows that timing and, in particular, the hidden costs of intervention must be carefully and sensitively considered. The importance of timing is well-understood in physical health where potentially serious or even fatal conditions may be watched or even allowed to develop further. In the field of mental health, however, it is rarely considered, especially where professional disapproval or defensiveness is involved or staff are under pressure because of state infiltration into treatment or management. This happens most often where there is excessive or harmful use of alcohol or drugs and patients are subtly coerced into abstinence at a time when resistance is high and the potential for growth low.
The effective mental health professional will never forget that helping is a form of attack. However brilliant and benign he or she may be, intervention will always involve hidden damage. In the treatment of depression, for example, unsuccessful therapy or therapy whose benefits last only as long as the treatment (a version of what in psychoanalysis is called the transference cure) may well increase despair and fantasies of untreatability, thereby undermining the two most important cognitions in living with the condition, namely believing you will get better and feeling that the solution or key lies within you. Badly timed or well-meaning but oppressive interventions may also threaten identity, especially during adolescence when identity is being forged, or the preservation of behaviours which may be risky but are nevertheless, for the time being, integral to the ego.
The encroachment of clinical vested interests into childhood and key family relationships interferes with the organic development of resilience and confidence in self and, with the spectacular growth in the use of potent pharmachemicals such as methylphenidate (Ritalin) and aripiprazole (Abilify, an Orwellian brand name if ever there was and originally a drug for treating intractable negative symptoms in schizophrenia), risks causing permanent, disabling damage to the developing brain. It is underpinned by some dextrous linguistic sleight of hand – “asking for some support from your doctor or a referral to a counselling service is a sign of strength” or “you cannot help your child if you are not being supported yourself” (Young Minds 2015); and sustained by a therapeutic cognate of Karl Popper’s idea of non-falsifiability (a theory which can’t be hypothetically falsified isn’t a theory). That is to say, the therapeutic colonisation of everyday life (for example, the saturation of communities by therapists in the aftermath of a disaster or their growing and permanent presence in schools and colleges) is now an article of faith to the extent that questioning it seen as a cruel heresy.
Because culture is believed to be impervious to treatment, children are treated instead. Much psychological distress among children is a fallout from the toxic tie between parent and child, which is qualitatively different from the routine damage identified by Phillip Larkin (“they fuck you up, your mum and dad”). This relationship, in turn, is inescapably penetrated by the perverse ethics of the market with the result that the child becomes a neurotically powered extension of the parent and a vehicle or means for righting failure and mending disappointment.
We foist our neuroses on children who mirror them back to us in a different form so that we treat them rather than ourselves. At home they become a conduit for the aspirations of parents who want a return on their investment when instead they should focus on creating the right conditions for children both to thrive and to weather the disturbing capriciousness of the developing mind. Instead of consistent, quiet neutrality and confidence, there is paranoid anxiety about imagined and ubiquitous danger fostered by the market, its vested interests and the media. Parental responsibilities and duties, squeezed out by demands related to consumption, then travel in the lunch-box to school where fearful teachers jockey for space out of sight of punitive state surveillance disguised as targets and inspections, and hunker down to dodge retaliation and recrimination from parents who contemptuously refuse to honour their part of the implied contract with educators.
Therapeutic colonisation or expansionism is supply rather than demand led. Pharma staff will tell you off the record that, first, a disorder has to be exported to countries which handle or absorb the mind’s stress and distress in organic, non-invasive ways. Once it has taken root as a construct, a treatment in the form of medication (usually habit-forming and for the long term) can also be exported. The near-certainty that psychotropic drugs, especially when taken by children and young adults, cause permanent damage to the brain (which in turn will need further medication to mitigate it) is a scandal waiting for lawsuits.
Pathology fills the vacuum left when survival is sorted. So, when basic needs are met, others have to be imagined and posited with such hidden impetus that those primary needs mutate into secondary ones. These, if the market is allowed full rein, will be endlessly elastic since unhappiness, disappointment, failure, rejection, loss, the painful friction of the shifting plates of relationships and messy manoeuvres in the quest for identity are states which always fall short of resolution. To suffer will be to be sick. To be human will to be ill.