Psychopathology at School

Theorizing mental disorders in education

Valerie Harwood, Julie Allan

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781135093815
• Edition: 1
• Topic: Education
• Subtopic: Education General

Psychopathology at School provides a timely response to concerns about the rising numbers of children whose behaviour is recognised and understood as a medicalised condition, rather than simply as poor behaviour caused by other factors. It is the first scholarly analysis of psychopathology which draws on the philosophers Foucault, Deleuze, Guattari and Arendt to examine the processes whereby children's behaviour is pathologised. The heightened attention to mental disorders is contrasted with education practices in the early and mid-to-late twentieth century, and the emergence of a new conceptualization of childhood is explored.

Taking education as a central component to the contemporary experience of growing up, the book charts the ways in which mental disorders have become commonplace in childhood and youth, from birth through to college and university, but also offers examples of where professionals have refused to pathologise children's behaviour. The book examines the extent of the influence of psychopathology on the lives of children and young people, as well as the practices that infiltrate education and the possibilities for alternative educational responses that negate the diagnosis of mental disorder.

Psychopathology at School is a must read for anyone concerned about the growing influence of psychopathology in education and will be of particular interest to educated readers and to scholars, students and professionals in education, psychiatry, psychology, child studies, youth studies, nursing, social work and sociology.

Chapter 1

Introduction

My mate Liam he got discriminated just because he’s in a special class and he doesn’t want to learn. He just wants people to leave him alone. He has the same thing as me; I go crazy on them.

(Tony, 13 years old, IUE Tasmania, Australia, emphasis added)¹

When asked about discrimination this young person’s immediate response was to tell a story about schooling. It is a story involving himself, his friend Liam, his former primary school and, significantly, the experience of having a ‘thing’. Liam had experienced discrimination in primary school because he was in the ‘special class’ and, as Tony reveals, both he and Liam shared the same thing. This ‘thing’, as we will explore in this book, is psychopathology.

Psychopathology is a phenomenon that is firmly entrenched, if not ubiquitous, in schooling. We use the term psychopathology to refer to the range of mental disorders used in schools and education and to the discourses and practices tied to psychopathology that allow significant proportions of children and young people to be identified and treated as mentally ill. We are concerned with how psychopathology is marked out in concrete ways via designations of mental disorder, what we might term the archetypal diagnosis and what Tony called the thing. The presence of psychopathology in schools, however, occurs in other more complex ways, the most obvious of which is the medication of children and young people. As a practice in schools, medicating can occur in very public forms, with the lines of children in primary schools awaiting their medication observed and remarked upon by children and staff (Harwood 2006). This type of practice has effects that not only circulate local school knowledge about the children with the thing, but create opportunities for the production of knowledge about psychopathology. Schools are sites of significance in the contemporary production of psychopathology. The consequences of psychopathology for the children and young people who are ‘captured’ in the diagnostic gaze and pronounced mentally ill are both profound and far-reaching. Principally, the recourse to medical diagnosis takes the place of considerations of the education of these children. We seek, in this book, to show how this displacement takes place and to explore the possibilities for recovering pedagogy over pathology.

It is difficult to dismiss the degree to which mental disorders have become part of the mechanism for interpreting children and explaining their educational failure. Problems such as too much activity or too little, fighting, problems making friends, or failure to meet developmental milestones can be candidates for speculation about mental disorder. Phrases such as ‘he’s ADHD’ or ‘that’s so ADHD’ are popular metaphors for ‘hyperactivity’ and bring the language of mental disorders into everyday colloquial vocabulary. As we will maintain, these ways of talking about children have effects on how children are understood and contribute to the medicalization of children.

The cited rates of child mental disorders not only reveal the numbers that have mental disorders (or might be expected to have them); they reveal those most diagnosed, and at times identify those who are more likely to have mental problems. In the United States mental disorders are considered to affect ‘one in five children in their lifetime’ (Science Daily 2010), in the United Kingdom 10 per cent of children are estimated to have mental health issues (Mental Health Foundation 2012) and there are reports that ‘one in five children worldwide has a mental disorder’ (J. Smith 2011). Behavioural disorders such as ADHD are considered to be the most prevalent, with global estimates of this mental disorder across developed and developing countries placing rates as high as 5.29 per cent and contending that geographic location has limited impact (Polanczyk et al. 2007). Claims of worldwide or global prevalence are under dispute by some who maintain that geographic and cultural contexts are significant to interpretations of child behaviour and mental health (Amaral 2007; Alban-Metcalfe, Cheng-Lai and Ma 2002).

From the well-known ADHD to disorders such as bipolar disorder, learning disorder, depression and obsessive–compulsive disorder, mental disorders have become part of the common parlance of childhood. Increasing reliance on the medicines for mental disorders has brought the medicalization of children into focus and is the medium that has generated the most controversy. Children are now medicated at earlier ages than ever before and there are proliferating numbers of college and university students on depression-related medication. A recent opinion piece in the New York Times reports that three million children in the United States are using medication for ADHD (Sroufe 2012). Pills for childhood problems are a strong image of this medicalization and it is not surprising that there are considerable debates about uses of medication, especially with very young children.

Yet there are many outcomes of diagnosis that can slip under the radar when attention is emotively aroused by medication. One of these, as we outline in this book, is the fundamental change occurring in how children are understood. Developmental stages, for instance, now include navigating a narrow passage through the increasing proliferation of mental disorders. From this perspective, psychopathology at school further narrows the normalization of schooling and children (Baker 2002; J. Ryan 1991).

While developmentalism has had a discursive hold over how children ‘progress’ across childhood stages (Walkerdine 1984), we suggest that mental disorders contribute something more. Mental disorders create a radical shake-up of the influential discourses of developmental trajectories. This is because they are wildcards in the lexicon of childhood. The theories and practices that support mental disorders enable them to become manifest in ways that were once the domain of adulthood. For example, diagnoses such as bipolar disorder now affect children with regularity. In the United States some reports have cited bipolar disorder in children as reaching epidemic rates, with 800,000 diagnoses (Carmichael 2008).

Children and medication

Medication is one of the most prominent topics in discussions about children and mental disorders. Tony, and numerous other young men and boys (and it is becoming more common with young women and girls) can be counted among the young people who are taking medication as an alleged means to continue with schooling. Such is the attention to medication that pharmaceuticals figure prominently in discussions concerning children and medicalization. The attention to medication is readily apparent in the number of news media stories published about child behaviour. So, too, is the attention given to schools and medication. This interplay is evident in the news media excerpt below, taken from The Times newspaper in the UK:

New school year gives Shire Sales a boost

An unusually strong ‘back to school’ season helped Shire Pharmaceuticals to achieve a jump in sales of its drugs that help hyperactive children to concentrate in the classroom …

‘The nature of these kinds of psychiatric diseases is that people are always trying to see if they can get better control,’ Angus Russell, the chief executive, said. ‘When they’re not at school, some paediatric patients actually take a rest. They don’t need the same focus or concentration during a vacation period. When they’re back, for us, it’s a good opportunity to have patients try Vyvanse for the first time.’

(A. Clark 2011)

This news media story describes the increases in pharmaceutical sales, portraying children as paediatric patients. Yet while attention is placed on increased use of medication, very little is mentioned about the substantial changes that have occurred as mental disorders become part and parcel of schooling. Responding to this silence is one of our objectives in writing this book.

It is not unusual for children to have long school holidays or for colleges and universities to have breaks of several months. Neither is it, according to the news media story cited above, unusual for paediatric patients to not require consistency in medication levels over holidays and school terms. Describing the increase in prescriptions at school, this article from The Times quotes a pharmaceutical executive’s account of the logic for ‘paediatric patients’ to ‘take a rest … on the vacation period’ (A. Clark 2011). Once the holidays are over and school begins, medication rates greatly increase. So much so that Vyvanse, a new medication for attention deficit hyperactivity disorder (ADHD) produced by this UK-based pharmaceutical company, ‘rose by 32 per cent to US$ 199 million’ (A. Clark 2011). Booms in sales of school stationery or clothing might have been the expected markers of the seasonal change of children returning to school in earlier periods; with these newly available drugs, the return to school is signalled by increases in pharmaceutical sales.

In the new pharmacological time, the seasonality of schooling can be flagged by shifts in sales patterns of children’s ‘school’ drugs. In this instance, the pharmaceutical company is reported to have ‘enjoyed a 28 per cent surge in quarterly revenue to US$1.02 billion (£637 million), aided by patients trying new dosage regimes for its attention deficit hyper-activity disorder drugs at the start of the school year’ (A. Clark 2011).

School holiday periods, however, have not always been seen in this light. More than a hundred years ago Charles F. Thwing was so concerned by long vacations that he published an article on the subject in the literary magazine The North American Review. The article, lamenting the problems long vacations can stir up, was titled ‘A too-long vacation’ and included appraisal of the negative effects on the young person:

The vacation becomes dissipation – moral, intellectual. Forces that are needed in college are not recruited. Hardihood, endurance, concentration, pluck, grit, are not nursed through so long a period of inactivity. Laziness is the direct result of summer listlessness.

(Thwing 1892: 761)

From this perspective, and quite at odds with the effect of holidays on paediatric patients, who need rest, long vacations were simply not good. Extended periods created ‘dissipation’ and contributed to ‘summer listlessness’; holidays produced rest, and rest is a cause of problems. Inactivity is the destroyer of the good ‘force’ of concentration, the virtue needed for schooling.

It is worthwhile considering why in the contemporary context a change in medication usage over vacation periods does not raise particular kinds of questions. It doesn’t, for instance, prompt queries about the status of the paediatric patient. Nor do changes in the need for medication raise doubts about the school. Rather, change is purely symptomatic of the disorder itself. What appears to happen is that the psychopathology that occurs within the school setting remains within the child. In this view the child has a mental disorder, with the spike in medication rates on returning to school confirming the existence of mental disorder.

The intersection between the school and the ending of holidays, where medication can be seen as naturally resuming, is a pertinent example of how the ideas of mental disorder have become mixed into schooling. While the contrast created by the historical example highlights differences that are characteristic of the time (such as between the ethos of work and leisure) (Harwood 2011), it draws attention to the anomaly of the current situation in schools in many countries. Indeed one of the defining characteristics of the intensification of psychopathology in schools is the way it remains effective in spite of such anomalies.

Characteristic of the rapidly expanding influence of psychopathology in schools, anomalies occur and yet psychopathology retains influence over how children and young people are understood. In the case of Shire Pharmaceuticals, it seems individuals with the mental disorder can seamlessly move as paediatric patients from school to long holidays and back to school again, with their status as subjects (here paediatric patients) remaining consistent. Because of this, the surge of medication as school resumes signals nothing more than the cessation of rest.

This capacity of mental disorder to be maintained across sites and within children is an example of the dominance of psychopathology in school settings. This is a dominance that has considerable effects. Significantly, it makes it possible for children to remain paediatric patients because they are identified as having mental disorders in school settings. Schools thus have a significant function not only as sites where mental disorders occur, but also as sites involved in the diagnosis of mental disorder. To grasp the influence of psychopathology on the contemporary lives of children and young people it is therefore imperative to look to the new practices infiltrating education.

One of the central arguments put forward in this book is that the schools have a significant bearing on the culture of mental disorder. Importantly, these ways of understanding are influential on how notions of normal/non-normal children are perceived. To better understand this phenomenon, our objective is to map the extent of psychopathology in schools as well as to outline the accompanying knowledge and practices that are deployed by the range of services affiliated with education. Our work in this regard is mindful of Appadurai’s (2009) challenge of being conscious of history as well as looking to the future. Acknowledging this challenge, we aim to provide an extended analysis of how knowledge of psychopathology has become part of, and continues to exert influence upon, education.

More than ADHD

As the most well known of the childhood mental disorders, ADHD has been named by some as a ‘global issue’ that could become, ‘the leading childhood disorder treated with medications across the globe’ (Scheffler et al. 2007). High diagnostic rates are cited across many countries, and, not surprisingly, it is the most debated of the childhood disorders. There have been calls for government investigation of ADHD, especially in relation to the spiralling use of medications. In the UK an inquiry was called into ADHD diagnosis and treatment (Lords Hansard 2007), and proposals for national ADHD guidelines by Australia’s National Health and Medical Research Council met with fierce debate.

While ADHD receives a great deal of attention, there is much more to psychopathology at school than ADHD. Indeed, the focus on ADHD as a dominant knowledge (Foucault 1980a) obscures the complex interplay of discourses that make psychopathology both a legitimate and desirable explanation applied to children and young people in educational contexts. For example, McMahon (2013) describes a kindergarten teacher, in NSW Australia, who strongly advocated diagnoses for children in her class as a means of acquiring resources to support their learning. Her class went from zero to ten different behaviour disorder diagnoses in as many months – additionally, another child in her class was being assessed for early onset schizophrenia. This teacher (together with the school principal) explicitly instructed parents at kindergarten orientation interviews to get behaviour or mental disorder diagnoses for their children before they start school so she could organize timely funding and support for them. This demonstrates that ADHD is only one of many childhood mental disorders; there are many others that children are being diagnosed with and some, such as bipolar disorders, are described as increasing in prevalence. One of the problems with the focus on ADHD is that other mental disorders can be overlooked. This is a problem because it can result in less critique of these mental disorders, especially of changes in diagnostic rates or treatments.

The mental disorders used for children and young people include the behavioural disorders (to which ADHD belongs). This group includes oppositional defiant disorder (ODD) and conduct disorder (CD). Other types of mental disorders include personality disorders, depressive disorders, bipolar disorder, emotional disorders, learning disorders and reading disorders (American Psychiatric Association 2013a) and this can occur from an early age, for example McMahon’s (2013) report on an Australian study which found diagnoses being sought for children in kindergarten, including disorders such as ‘early onset schizophrenia’. Asperger’s syndrome and autism are relatively well known and also firmly part of the range of childhood mental disorders. These mental disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association 2013a), and have the status of psychiatric disorders.

As well as psychiatric categories, there are other approaches for defining mental problems. In some countries or regions, problems with children are not always defined using the DSM, and the International Classification of Diseases (ICD) may be used (World Health Organization 2003). Approaches may also lean toward psychological constructs and associated assessments. Language can vary and children can be described as having behavioural difficulties or emotional difficulties. Such difficulties and problems can be defined using psychological tests and assessments, which might be used in tandem with the psychiatric categories of the DSM. Variation between the definitions is often due to differences in preferences between countries and within regions, as well as the type of service with which the child is engaged. In some instances this can also be down to the diagnostic preference of professionals (Allan and Harwood 2013).

At seeming odds with their specificity, mental disorders have effects on a broad societal and cultural scale. Descriptions of mental disorders are relied upon in many areas of society, such as in schools, as well as in government-funded services such as social security, child, family and community welfare, juvenile justice and disability services. These descriptions are not restricted to the public domain. Private sector companies such as insurance services, as well as employers, are linked to this network of diagnosis. For instance, this can occur via requirements such as for proof for childcare leave. In such scenarios parents or caregivers may be required to secure a diagnosis in order to get leave approval. This type of influence, together with its scale, is how the...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Series editors’ preface
• Acknowledgements
• 1 Introduction
• 2 A brief history of mental disorders in school
• 3 The risk factors? ‘Race’, social class and gender
• 4 From the cradle to the crèche
• 5 Primary school
• 6 Secondary school
• 7 Colleges and universities
• 8 Professionals’ interruptions
• 9 Conclusion: learning, teaching and the thrill of pedagogy
• List of legislation cited
• References
• Index