Young People and Mental Health ( for Base 51 at opening of Mental Health Awareness Week)
Introduction
Increasing number of young people are being admitted onto psychiatric wards. Increasing numbers of young people are killing themselves. In this paper I look at why there are growing numbers of young people with mental health problems. I have tried to look at young people's lives in all dimensions: relationships, income, employment, habitat and environment. These need to be thought about in the context of the transition from dependent to independent living. What matters is, on the one hand the economic and social vulnerability of young people if they find it difficult to get a stable income, adequate independent accommodation and satisfying relationships and, on the other hand, the family background - how far this background has equipped the young person with the practical skills, allowed their emotional independence and supports practically, emotionally their transition to independence.
The medical way of understanding mental health problems often leaves us with the impression that the practical and relationship chaos in the lives of people with mental health problems is a result of their mental health problems. The young person is lonely, suspicious, isolated and dressed in rags because he is a schizophrenic according to this medical way of thinking. I argue that this medical viewpoint turns the reality upside down. When we see young people like this then in this it is more likely that they are lonely and suspicious because they have been bullied by their parents and have walked out or been chucked out of home, they are lonely and suspicious because of this and are deeply hurt. They are also probably lonely because they have no money - which is also the reason they are dirty and dressed in rags. Their emotional turmoil and confusion is the result of what has happened to them. To describe this turmoil and confusion as the ultimately the result of faulty brain chemistry and defective genes and treat it with powerful tranquilising drugs, which is the explanatory model the mental health services work to, and uses for "treatment", is outrageously innappropriate. What it does, in effect, is blames the young victims of an increasingly vicious society for their own plight and even coins their suffering into profits for drug companies. I may say add that a service whose main response to suffering and confusion is medical drugs is also giving a ludicrously innappropriate message to people who turn to illegal drugs as an mental escape from their confusion and suffering.
Deteriorating Economic and Social Trends Effecting Young People
Since 1982, in a period in which it has been claimed a British economic miracle took place, suicide among young men has risen by 75%. In the same period an increasing number of young people with a psychosis and an addiction problem are ending up on acute psychiatric wards. Why should this be so? Behind each of these personal tragedies is a unique story and we should beware of generalisations based on statistics which never tell us enough about what has happened to each individual. Nevertheless statistical studies can sometimes help us pick out the essence of the truth and statitistical studies have shown that suicide rates and death rates go up when unemployment goes up. Think about that - when economic policy makers put up interest rates and decide that unemployment will rise, it is a decision that some people will die. This is connected to what is happening among young people. When one remembers that young people are particularly badly effected by unemployment, when one remembers that young people's welfare rights have been done away with, when one remembers that the availability of cheap accommodation has declined we get a pretty good understanding of what is going on. Rarely mentioned in all this, although I suspect it is another trend to be noted, is that in the 1960s and 1970s many slum clearance programmes peaked. While they demolished many substandard houses such programmes often dispersed long established communities and thus demolished community support networks. This has stressed the conditions in which young people have been brought up.
Some psychiatrists are prepared to give these things proper prominence, but there are not many. Let me give you a quote from a book published in the USA ten years ago called Recovery from Schizophrenia by Richard Warner. It is subtitled the Political Economy of Schizophrenia:
"Clinical experience shows us that economic uncertainty is a serious stress for many patients. As social security regulations were tightened during the Reagan administration, for example, many stable psychotics whose disability payments were abruptly terminated suffered relapses of their illnesses. The mental condition of many psychotics similarly becomes worse when their most basic needs are not provided for. In the United States homeless, male, schizophrenics are admitted to hospital hungry, dirty, sleepless and floridly psychotic. When after some meals and a good nights sleep, their mental condition improves dramatically hospital staff claim that the patient 'manipulated' his way into free board and accommodation. More benign observers argue that the patients improvement is evidence of the efficacy of the dose of anti-psychotic medication he received on admission. In fact, such patients often improve as readily without medication. The florid features of their psychosis are an acute response to the stress of abject poverty and deprivation". (Warner p 132).
The Transition from Dependent to Independent Living
As already said it helps our understanding to see people as the victims of social and economic trends but it never tells the full story for each individual who lives out this drama uniquely in their network of relationships and activities. "Youth" is the period in which people expect to make the transition from dependent to independent living. Our practical living arrangements, by which I mean the routine way in which we wash, eat, sleep, and spend our day, are embodied and take place in our family, friendship and work relationships, in habitats (our homes) and work places or schools. The cultural expectation is that the young person will start a new family of their own which means finding a sexual partner, they are expected to find and establish their own routine in relation to eating, sleeping, washing etc - i.e. they have not only to find accommodation they must equip and manage their own domestic routine and, of course, they must have an income, and therefore a job, to make all of this possible. In this process they will separate from their parents.
For those who have a family, and many young people with mental health problems have lived in institutions, this is the period when they move away from it. It hardly seems possible to discuss youth and mental health without reference to the often enormous emotional turmoil that follows this process in the relationships between parents or guardians and their offspring (recognizing that brothers and sisters can play a big role in family dramas). In this respect I recall hearing a broadcast by a psychologist I knew personally at University. He had organised a radio series which described research which had been looking into what was socially normal in our society in parent child relationships. It was research to find the social average. In the broadcast he said that the lead up to a young person leaving home was almost always a period of conflict and emotional crisis. This needs to be repeated. Conflict with someone walking out or being chucked out was far from being the exception.
It seems to me self evident that such a period of great change can also be a period of stress, emotional turmoil and vulnerability. The vulnerability will be that much the greater if young people do not have the skills, nor the emotional independence, nor the economic means to manage the transition. (When I left home I knew nothing or cooking or washing my clothes. I was a machine for passing examinations serviced in a University Hall of Residence but did not have a GCSE in talking to young women. I coped by joining a political sect which gave me a family where I could be clever and rebellious at the same time. I hoped that being clever would make me desirable - an illusion typical for manic depressives.)
The difficulties of making this transition are that much the greater where the economic and social conditions means that it is difficult to get a job, where young people can no longer bring in welfare benefits to their family, where it is difficult to get new accommodation and where the communities and neighbourhoods in which young people grow up are demoralised or even worse wracked by drug wars. These things are not to be regarded merely as the contexts which makes a family emotional drama more difficult to cope with. These things are sources of fear, tension, stress and disappointment in their own right. However, how well young people cope with these stresses, how they respond to their situation, cannot be separated from how parents respond. Sometimes parents, particularly single parents, are too weary, demoralised and struggling to contain their own sense of hurt, to give any support whatsover leaving young people feeling abandoned, unsupported and unloved, and coping perhaps by acting up and getting into trouble to feel real and to get noticed or turning to drugs or prostitution or both.
Other parents react differently. They attempt to control and steer with power moves, with control, with authority, even with violence, which starts from a claim to knowing better, in a way which gives young people no space to find their own orientation and make their own choices. Ultimately to be independent is to make your own choices, to organise things for yourself according to your own feelings. Where the family is a prison that always denies that possibility then it creates pathology because the feelings of the child are not seen as a valid starting point for decision making compared with the supposed worldly wisdom of adults. There is then no possibility of transition to adult life because no independence is allowed. Because change in the modern world is so rapid and virtually nothing is the same one generation later it can be argued that the claim of parents to know better, if it every had any truth, is probably less true today than it has ever been. For example in career choices most young people are far smarter and knowledgeable about modern communications and computing technologies than their parents.
What are mental health problems anyway? What happens in a breakdown.
In my view the best way to understand mental breakdown is as one aspect, the psychological dimension, of a larger crisis, - a life management breakdown. The emotional chaos and apparently strange thinking are the garbled reflection of a crisis of transition in one life pattern to another.
Mental health problems are where the thoughts, emotions and actions of a person are not understandable to those around him or her and that person is not coping - or others are not coping with that person. Behind the jargon which psychiatrists use - words like hallucination, mania, delusions, confusional states, paranoia, thought disorders etc. are really more powerful versions of what most people do in their day to day life - flashback memories to traumatic experiences, periods of excitement, wishful thinking, over pessimistic thinking or panicky interpretations about reality, over suspiciousness, impulsive behaviour, looking for 'signs' to be able to predict the future, fixations on ideas which seem to explain, or explain away, highly charged emotional problems or issues. These are all ways in which people react to situations of extreme emotional stress, particularly when their previous lives and childhoods have not prepared them to deal with the particular problems they have, or when earlier life is not rich enough in positive experiences to help a person ride through these periods of stress with an appropriate level of optimism.
The lead up to a life management breakdown is inevitably involves emotional arousal and often a tendency to withdraw from relationships. This alone makes it difficult for the person to "reality check". Confrontational isolation generates powerful hopes and fears about how others are responding to the person in crisis. These powerful emotional concerns can become uppermost in the mind to the extent of driving out an ability to cope with practicalities. If a person is very isolated and experientially deprived their phantasies may be more compelling than any external reality. (Rather as if put in an extended sensory deprivation experiment the absence of other activities and relationships throws their mental and emotional contents into greater prominence in their stream of consciousness.)
When one interprets an ink blot test or "consults the tea leaves" one projects one's private concerns into what one sees. The crisis person may interpret everything in this way - traffic signs, advertising hoardings, even the pattern of the clouds. The traffic lights on red signal personal danger. This personal reading of their surroundings in terms of the hopes and fears works in the mind by "emotional association" in a way familiar to advertisers. Objects can become like the props used in the play of a child. The behaviour of the isolated person becomes akin to childhood play.
The breakdown in relationships and practicalities will now be accentuated by the strange metaphorical thought patterns of the person in crisis which others do not understand. The crisis person may also be disorientated by new settings they are foreced to use - e.g. what to do and how to relate to people in a homeless hostel or how to organise food and shelter. They may be new anxieties as the person improvises unfamiliar ways of washing, eating, sleeping in new settings. Such experiences accentuate powerful memories of childhood when keeping warm, dry, clean and safe were things the person needed support with, bringing to the surface long buried feelings of the humiliations of being small and helpless.
As relationships and life routines break down the feelings are those of powerlessness and vulnerability - recreating the mind state of a vulnerable infant that feels powerless or vulnerable. The most difficult to interpret experiences in madness are like the incoherent thought patterns which the crisis person had before they could speak - e.g. the terror that one will cease to exist without another heart beat close by - the terror of a new born baby separated from its mother. If as a child the crisis person was abused, or neglected, of quite unintentionally traumatised (for example by moving at a critical age and having emotional roots ripped up) they may have been left with a buried sense of horror, terror and despair, which re-emerges when their life goes into crisis, overwhelming remaining coping abilities. Paranoias are like the hyper aware terror of a baby trying to predict what on earth "being naughty" will mean next. It is not born knowing or expecting such horrific responses from its parents to what to it are entirely innocent exploratory actions.
In our society these reactions are seen as symptoms of illness - and given a diagnostic label. This is a totally unhelpful. It does not respond to the need to help the crisis person develop the resources and ability to independently manage their life. When person is in desperate distress and confusion it is because their day to day world is distressing and confusing and probably their past was also. They need support to understand what has gone wrong, develop the skills to cope and find the places and positions that would help them stabilise their world. What the diagnosis does however is to invalidate the distress as an understandable reaction to appalling life circumstances. In the process the young person loses more autonomy and is often then subjected to even more control, making their progress to greater autonomy and independence even more difficult.
In this respect the mental health services serve to reinforce the power of those families who tend to create pathology because they will not let go.
Families that will not let go
It ought to be possible to live together in ways where we can be free to be ourselves and enjoy the benefits of being together as well. Where we do not the consequences are almost inevitably tragic.
I do not know if you have seen the film The Dead Poets Society. In it a young person kills himself because he wants to be an actor and finds exhilaration and excitement in that but runs up against the flat opposition of his father who has his own fixed and unmovable ideas about what his son will be. In my own person experience I have known something like this to happen. As the therapist Dorothy Rowe puts it, the most dangerous people of all, are those who claim to know what is good for us. Unfortunately there are a lot of these people and a lot of them are parents. Then there are teachers, social workers, psychiatrists. Often they exercise this control in very subtle ways.
A friend of mine has a parable on her wall. It tells the story of a king who, noticing that his son has started to wander off the normal roads in the kingdom and beginning to discover life afresh gives him a present of a coach and horses. He tells him that it is so that he does not need to travel off the roads. Of course, what he intends is that his son will only travel on the normal roads and what he achieves is that his son becomes incapable of traveling anywhere else so that most of the country remains closed to him. Far from widening his possibilities the present was designed for, and achieved, a restriction of his opportunities.
Not all of our parents give us generous presents to keep us from wandering from the roads they have chosen for us. A lot do not have the money and poverty can give rise to another set of problems altogether. For one thing the family might live in one of those impoverished areas where crime, addiction and vandalism in the neighbourhood leads to continual pressure and worry about who you are mixing with. Or where the struggle to make ends meet stresses everyone so much that the tension explodes and in particular is directed against those costly teenagers who cannot get a job so do not bring any income in.
Different ways of being got at
The ways that young people can be got at are many. Parents can ruthlessly worry about them so that they do not dare to say what they really feel - what do you say to people who get at you by worrying about you because they "love you". It's so ungrateful to feel angry but the parental worrying just magnifies your problems. At other times to show feelings would unleash parental hysteria, or a torrent of suffocating protectiveness, or the same old lecture of unquestionable family truths, the same alliance against you as the family black sheep. Perhaps the young person never feels they have any privacy in the family. They are under pressure all the time because they are always being checked up on. They are being interrogated about what they are thinking and feeling so they can be more tightly regulated in their best interests. In the end they revenge themselves by telling the truths that the others in the family refuse to recognize - provoking a family crisis in which they pack their bags and run away, a refugee from your own family.
As I have said, leaving as a family crisis is not unusual, it is now the norm. Sometimes such young people get away successfully. Many end up homeless. Others are diagnosed as having a breakdown. ("He had always been rather quiet and withdrawn, but he was well behaved and sensible, we didn't understand what had come over him to act so out of character and stupidly until the doctor explained about schizophrenia"....)
Others do not run away from home because they have never had one. All their life has been institutions and, while it is difficult enough to become independent of people who organise your life for you under the slogan of parental love, it is even more difficult to get independent of the regimentation imposed for the convenience of shift workers with certificates in social work. As they struggle to cope with desperately hurt children abandoned by their parents it is the ones that act up that get the attention. The ones that don't might as well disappear........
Still breathing and walking but without a life that is really your own
Perhaps the greatest tragedy of all is to be breathing, to be eating, to be walking, but not to be taking your own decisions, making your own initiatives, following your own feelings. It is to be alive but without a life that is really your own. One can be alive without having a life of one's own because your life always seems to run on rails set for you by parents, teachers, carers in institutions, careers officers. Assuring you that they love you, or that they have your best interests at heart, their worrying, their decisions, their control never allows you the space to take decisions for yourself. So you get older but you are still dressed according to your mother's sensible taste and you are still eating baked beans on Mother's Pride toast. Perhaps as a result you are a complete non entity with the opposite sex - something that hurts but you don't know what to do about it. Or if you did know what to do about it you couldn't get in the right emotional frame of mind because you hurt all the time. People might sympathise with hurt people for a while but they are not sexy.
Other young people feel that they have to be in constant rebellion to assert their independence and end up doing the things that parents, teachers, the residential social worker said they shouldn't because they said that the young person shouldn't. The defiance is to prove that they are not doormats. It seems like this way of behaving is the only option to be not what someone else wants them to be. Such young people, having been told often enough that you are bad, come to believe it, and don't give a damn about that anymore, perhaps relieving their frustration by beating up vulnerable people, just like their parents beat them up. At least when they get into a fight they can feel real, they feel noticed and powerful, if only for a short while.
For the young people who do not respond agressively like this some will grow up wondering almost as if they really exist. They feel their own identity and sense of boundedness is totally fragile because there has never been space in their life where they did something for themselves rather than because other people expected or wanted.. It's even worse if you are in a minority group and your subjugation at home contrasts so strongly with what the white kids can do.
Acquiring a diagnosis
So when it comes to getting yourself a girlfriend or a boyfriend it is a mystery what you actually do, just as it is a mystery what to do with your time when you are not studying or working. Perhaps then you hope that work or study, achievement and performance will win you affection and admiration - being alternatively depressed when it doesn't and on a high when you think it will which ends in angry, irritated and frantic behaviour because people do not recognise you as brilliant. Then they end up diagnosed as a manic depressive. Alternatively, if you are not hooked on this illusion, but entirely without hope, you drift into a dream world with or without the help of various kinds of drugs, ending up with an addiction, a diagnosis of schizophrenia or both..
You are only young once
So you can be alive without really having a life of your own and you become most aware of this at periods of major transition in life. We cannot always be doing new things, in new places, with new people. Our life usually has some degree of routine regular pattern with the same faces, in the same places, doing the same daily activities including household, school and or work tasks. But growing older is to recognise that there are new places, new faces, new activities and experiences, new music and young people are entitled to get a share of living before they "settle down". The statement "You are only young once" is not a merely a phrase. It is the starting point for the human rights of young people. But that's not how many highly qualified sensible older people see it. They know the risks they assure you and they want you to get a job, get a marriage, get a house, to give up your dreams of being a rock star and start studying accountancy. Of course they are right that you stand little chance of becoming a rock star but what these undertakers of your dreams fail to realise is that by trying to become a rock star you go down a path that later lands you an interesting job as a sound engineer, or that on your mediocre European tour you make new friends and get a job setting up a music studio in an Eastern European county. The people with blinkers do not understand that and they want you to come back for 10.00, do your homework and button your lip. They want you to live in a state of chronic boredom, an open ended living death, a sensory deprivation horror chamber shaped like the family living room.
Young people's suicide, intergenerational rights and sustainability
Earlier I pointed out how suicide had risen in the last few years and how it had been clearly established that suicide rates had been shown to be statistically connected to unemployment rates. There is a cruel irony here because in 1992 most of the World's leaders put their signature to the Rio Earth Summit Agenda 21. This environmental political conference was a promise of policies to ensure that development would occur in such a way that future generations inherited the world in a shape that was not inferior to what it is now. This would have had more credibility if Brazil did not have a reputation for death squads who murder street children and our own government had not cut the welfare rights of young people forcing many to beg on the streets. It is not credible to speak for intergenerational rights and then attack young people.
Holistic strategies and young people
To really protect the needs of young people social and community redevelopment strategies are needed that rebuild community life and regenerate communities currently in states of demoralised collapse because the local economies which they serve cannot compete in the international economy. This is the broader context which is needed to compliment more specific youth policies.
More specific youth policies should tackle the problems directly not claim that the problems of young people will be solved, indirectly, if "the market" is allowed to operate. By "tackling problems directly" I means that if young people are homeless and unemployed then what are needed are programmes to train young people in building skills renovating or rebuilding houses. If they are hungry then what are needed are courses in cooking and growing food and projects to make these possible. If they are isolated then what are needed are opportunities to get to know people working towards these goals.
The unemployed labour of young people can be organised in projects which meet their own needs directly and as far as possible should be organised by young people.
It is also a right of young people to enjoy life and experience the world so it is important to have settings which help young people make their contribution to the re-creation and recreation of communities. It is true that older people have rights to peace, quiet and a feeling of security. This is really an issue of planning and design - where some people want gregarious high spirited energetic activity and other people want peace and quiet then the homes and neighbourhoods and towns need to be planned and zoned appropriately. There is no problem here if young people are treated equally also in regard to matters of spatial planning and design - something which often does not happen in impoverished neighbourhoods. Specifically catering for the need for adventure, exploration and finding ones feet also means giving young people signposts and possibilities to explore the possibilities to be found in other countries. This was entirely ordinary a few centuries ago when not only the sons of the aristocracy but apprentices were expected to travel to pick up the influences and ideas to be found at different other places. Those who choose to come back can use what they have learned to the later renewal of local life and culture.
These are long term processes and policies that are needed. There are examples of these kind of projects - though not nearly enough of them. Above all there are not enough projects in which young people are helped to learn how to run the show - where the social and community entrepreneuralism of young people is encouraged and nurtered. Where they are supported in efforts to organise it for themselves - not to have it handed to them - which is the only way anyone can ever guarantee their interests will get met, not by leaving it to others.
More immediate crises services
But more immediately many young people need more support now. What will help in the short term? What are the starting points for these longer term policy responses? Firstly someone who will not take decisions for them but will give them the information and help to take their own - that means genuinely independent counselling and support. Secondly someone to stick up for you, to give you support for what you want, not what they think you ought to have - that means advocacy.. Thirdly contact with other people like yourself who know how it feels because they have been there, because they have suffered the same things, so that you no longer feel so alone. That means self help, mutual aid and peer advocacy.
Brian Davey
September 1996
© BRIAN DAVEY