How in a Progressive Society we use this to Minimize the Excessive and Erroneous Diagnostic Labeling of Childhood Behaviors.

Image courtesy of photostock / FreeDigitalPhotos.net

Image courtesy of photostock / FreeDigitalPhotos.net

A starting point for all my professional involvements with children to help engage them positively in the process, is what I call the Normalising Conversation. This is an ongoing process which one revisits and develops each time you meet with children, reinforcing aspects of Normality rather than Pathologising their existing patterns of behaviour.

I start by asking if they understand the difference between a Psychiatrist and a Psychologist, as this can often be a cause of confusion and distress, due to their perceived negative labeling by significant people in their lives. I start by explaining that one is a doctor who treats the mind, when people are temporarily unwell, in various ways using a range of clinical therapies or drugs.

I then say a Psychologist is not a Doctor and talks to normal people, in various settings such as schools or offices, who are having typical ‘ups and downs.’ I explain that everybody around them has ‘ups and downs’, even their head teacher, their boss, their parents, their favourite musician or celebrity etc. Wherever possible I illustrate this by using the real names of these significant people, which I elicit from them and talk about their possible ‘ups and downs’ in a jokey but reframing way.

Sometimes you can visibly see their breathing slow down as they become reassured by what I am saying and this is, I strongly believe, is the power of a Normalising Conversation.

Why are normalising conversations important?

— to reduce pathologising and erroneous labeling of childrens’ normal range of behaviours.

– to demonstrate clearly that their current behaviour pattern falls within a normal range and is definitely not abnormal in nature.

– to motivate them to revise their thinking and/or ‘mind set’, to consider alternative explanations and to visualise an achievable preferred future.

– to promote inclusive and solution focussed approaches to their situation.

– to fundamentally reduce the number of children who proceed down the ‘conveyor belt’ of diagnostic stigmatisation and consequently the over-prescription of psychotropic drugs to children.

– to enhance life opportunities and positive outcomes through our childrens’ improved wellbeing and mental health.

– to avoid giving children any of the plethora of new diagnostic labels to hang around their necks as a toxic and false categorisation of their unique humanity.

– to re-evaluate treatment responses in various countries and the impact this has on an individual or on societal values and outcomes.

So instead of starting by categorising children, so frequently, as having clinical ‘disorders’ of the mind or personality, we need to see them as being fundamentally unique and different human beings with the opportunities for positive change in a life that is all ahead of them.

Rather than thinking that these human variances of behaviour and mood are distributed on the ‘normal distribution curve’ that we are all used to see being used to justify the spread of different attributes we are more likely to see a ‘normal scatter diagram’ of scores or views around a continuum line of difference. Standard deviations are not a helpful concept for behaviour patterns that are by no means standard in nature.

A normal curve may well work for height and other physical features but is unlikely to be a successful explanation of such complex and interactive dimensions as ‘intelligence’ or ‘deviance’ from behavioural norms or expectations. Indeed Psychology’s leading role in the use ‘the normal distribution curve, over the last century, has been a cause of deep regret to many humanistic psychologists who have ethical concerns about the inappropriateness of such a divisive and limited construct and how it has been used in the guise of IQ to segregate children who may well have been better educated within a full spectrum and inclusive provision.

If we normalise behaviour without patronising clients and unduly minimising the significance of certain behaviours then we have millions of people in society, as they naturally mature as individuals, feeling they are thought to be normal and not abnormal, by those around them. So institutional social control via Psychiatric institutions and/or prison for the normal range of behaviours is avoided. This may include minor ‘offenses’ such as finding a ‘roof over your head’ by squatting or ‘fending for yourself’ by retrieving and  eating packaged food which is still edible from shop bins and means that less people are potentially ‘retraumatised’ by the system we have in place to deal with their personal distress. We would automatically be more holistic in the way we look at the complex interactive variables that occur in a child’s life such as childhood trauma, attachment difficulties, family breakdown or violence, environmental stressors, and intrapersonal issues all of which may be contributing to the way the child is behaving at that particular point in time.

The range of societal responses, around the world, is enormous to these issues. Let’s take ADHD and psycho-stimulant medication as one example – in Italy and France 0.15% of children are medicated, in the U.K. it is at least 1.5% with many seeking an increase and in America it is at least 15% with many there saying that 25% of all children there will need medication for a mental health condition. This systemic lunacy illustrates that the behaviours we are defining as abnormal are not a true medical phenomena but are instead socially constructed and developed for another more controlling agenda than the welfare of children.

Indeed this rapidly expanding situation is, in my opinion, the biggest Child Safeguarding issue of our time and dwarfs some of the other important issues that are regularly featured in our media and courts.

If our shared intent is to be a caring, progressive society that actively promotes the mental health and wellbeing of individuals at all levels then this is where we need to start. “Communication is the art of intent,” is a great unattributed quote that I have found very helpful in my career and so the Trillion Dollar Question, for that is the potential cost to society of getting it wrong, is what do we collectively want to communicate to the future about the way we have deliberately chosen to treat our children today?

Is it an agenda of Inclusion in a Fair Society or Exclusion and Stigmatisation?

Is it a Comprehensive Education and Health Care System for all or an elitist schooling and medical health system for the ‘chosen few?’

Is it mental health and wellbeing for individuals and society as a whole or mental illness with the focus on ‘within person’ causation?

Is it a future of hope and creatively addressing difficulties or despair and categorising differences into arbitrary divisions for us all?

These choices are real and some societies are on very different philosophical and practical journeys to our own hence giving us all an opportunity to reflect and learn.

Where do we want to start this new journey as a society and what is our collective aspirational destination for children in particular?

The debate continues. Please participate.

Acknowledgement: Thanks to Lucy Johnstone for her ideas about Psychological Formulation and ‘Retraumatisation’ of clients.

Dave Traxson

About Dave Traxson

I am a Chartered Educational Psychologist (BPS),who has seen the questionable practice of over-diagnosis and prescription of psychotropic drugs for children, increase exponentially in my thirty year career. I am a member of the Division of Educational and Child Psychologists Committee of the British Psychological Society. Now is the time to appropriately challenge doctors in cases where psychologists have ethical concerns about the Emotional Wellbeing of the children with whom they work. This is supported by the Health Professionals Council "Duties as a Registrant."(2009) = "You must not do anything or allow someone else to do something that you may have good reason to believe will put the health or safety of a service user in danger." We all therefore have a "Duty of Care to be Aware" of these issues in the schools where we work and to discuss concerns with a linkworker there and with the prescribing doctor. The National Committees of the Association of Educational Psychologists and the Division of Educational and Child Psychology of the British Psychological Society actively support my position of raising concerns about the impact of psychotropic drugs on the Safeguarding of Children in the U.K. from the potential short and longer term physical and psychological harm. I believe this is a key issue in promoting wellbeing of children within a progressive society. I was pleased to contribute to the BPS response to the American Psychiatric Association's consultation on DSM-5 and the paper was called "The Future of Psychiatric Diagnosis," (BPS 2012.)