Dr. Brad Sachs
Winnie the Pooh has remained one of my favorite books ever since I was a child, and I enjoyed it even more when I read it to my children, and, more recently, to my grand-daughter. The tales are sweet and poignant, the wisdom embedded in the characters’ brilliantly innocent observations is timeless, and the patient, affectionate acceptance that reveals itself in their interactions with each other provides us with a tender and inspirational model for relatedness in its highest form. (If you are able to find better words to live by than, “Some people care too much. I think it’s called love,” be sure to let me know.)
So I have to confess that it troubled me when a patient whose child had been diagnosed with ADHD enthusiastically brought in some information she had found on-line that reduced each of the characters from Winnie the Pooh into exemplars of different versions of attention deficit disorder: Winnie himself, for example, embodied “inattentiveness and distractibility”, Tigger embodied “impulsivity and hyperactivity”, Eeyore embodied “inattentiveness with dysphoria”, and so on.
I am not doubting, from a clinical perspective, the existence of neurologically-based attentional deficiencies, nor am I ignoring the likelihood that there are specific sub-types of these deficiencies (although I do believe that ADHD is frequently over-diagnosed and that there is a veritable epidemic of unnecessary psychopharmacological treatment—neurochemical nips and tucks—when it comes to addressing what are often quite normal childhood behaviors). But how, exactly, had A.A. Milne’s lovely, ageless tales about a compellingly anthropomorphic teddy bear and his devoted friends been drained of their essential humanity and dwindled down into nothing more than a dingy, humdrum diagnostic manual?
What increasingly worries me when I listen to contemporary families struggle with academic and behavioral problems has to do with our growing inability to distinguish between psychological discomfort and a psychological disorder. We have so narrowed the definition of what is normal that the slightest deviation from that highly restrictive norm is now framed as some sort of emotional disturbance, with a diagnostic classification all its own.
Mental illness does, indeed, exist, but as Aldous Huxley wryly noted decades ago, “Medical science has made such tremendous progress that there is hardly a healthy human left.”
What I have repeatedly seen as a result of the now ubiquitous medicalization of human behavior is that parents have gradually lost the sense that there is any value to discussing behavioral problems with their children. After all, if these problems all have purely genetic and/or neurobiological roots, why bother? For many of the mothers and fathers who consult with me, it appears to make no more sense to apply thought and consideration to the origin of their child’s problem behavior than it would for them to apply thought and consideration to the origin of a broken leg or the flu.
The result is that parents find it easy to abdicate any responsibility for addressing these matters since, after all, an “expert” has determined that their child has something immutably and irreversibly “wrong” with her.
I frequently hear this way of thinking in the choice of words used to describe children. For example, going back to ADHD for a moment, many a parent has announced to me during an intake session that, “My child is ADHD,” rather than, “My child has ADHD.” The difference is a significant one—the latter suggests that the child has a condition, the former suggests that that condition defines who s/he is.
With this context in mind, it should come as no surprise that numerous teachers have now begun to report to me that they have had students enter class and blithely announce that they should be excused from any schoolwork that day because they forgot to take their medication for ADHD. In these situations, the reality that ADHD is a weakness or a vulnerability that can be compensated for, even without medication, has been banished from the realm of the possible. The concept of summoning her resources and marshalling her strengths in the service of overcoming this weakness simply disappears.
What parents need to keep in mind when it comes to the majority of pediatric and adolescent mental health diagnoses is that it’s not that the child is unable to control her behavior but that the child finds it harder than she would like for her to control her behavior. The distinction between these two realities is a profound one, and emphasizing the latter rather than the former exerts limitless positive impact on children’s self-respect and self-confidence.
I have seen the same kinds of passive, helpless parenting as a result of neuroscientific developments. Because there is now evidence that the human brain is still maturing up until the age of 25, I have listened with astonishment as intelligent parents explain that there’s nothing much for them to do about their child’s disreputable behavior except to basically sit back and wait.
One parent reported to me, “I know that he’s gotten several speeding tickets already, and had one fairly serious car accident, but I’ve read that his frontal lobe hasn’t matured yet—after all, he’s only 19—so it doesn’t really make sense for me to punish him by not letting him drive our car. I guess he’ll eventually figure this out.” I was left scratching my head, wondering what irreversible tragedy awaited this young man, and his prospective victims, while everyone patiently waited for further myelination and synaptic pruning to take place in his prefrontal cortex.
As I noted above, I am not downplaying the significance of careful diagnostic work-ups, ignoring the painful reality of the serious mental illness that some individuals do suffer from, or dismissing the fact that psychotropic medication has relieved unnecessary suffering for many. But when we earnestly find a way to reduce and pathologize so much of the essentially normal behavior that children display, we quickly lose both the motivation and the capacity to talk to them in meaningful ways about why they do what they do, and how they might make changes for the better.
The bottom line, from my vantage point, is that we need to shift the conversation away from “What is wrong with my child and how shall we go about fixing her?” to “What is my child trying to say, and how can I help her to say it?”
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Dr. Brad Sachs is a family psychologist who lives and works in Columbia, Maryland, and the best-selling author of numerous books, including THE GOOD ENOUGH CHILD: HOW TO HAVE AN IMPERFECT FAMILY AND BE PERFECTLY SATISFIED and WHEN NO ONE UNDERSTANDS: LETTERS TO A YOUNG ADULT ON LIFE, LOSS, AND THE HARD ROAD TO ADULTHOOD. He can be contacted atwww.drbradsachs.com.