2 Adolescent Development:
Junk Science Run Wild
For the most part, the distinction between adolescence and adulthood is a matter of cultural expectations and restrictions rather than a matter of intrinsic psychological characteristics ... Adolescence may best be construed as the first phase of adulthood.
-David Moshman, Adolescent Development: Rationality, Morality, and
Weird behavior is natural in smart children.
-Hunter S. Thompson, JD, Kingdom of Fear, 2003
Chapter 2 is where standard texts take up “adolescent development,” depicting it as a time of body- and mind-shattering transformation. Hormones erupt, breasts sprout, fluids flow, peers rule, music throbs, sarcasm and moodiness take over. The sweetest children abruptly metamorphose into brain-damaged parent-hating monsters, careening daddy’s Jetta at 100 miles per hour trailed by littered wine-coolers, transforming school hallways into geek-torturing bully fests, hauling babies under one arm (the boys) and Uzis under the other (girls). That’s the normal teens; “at risk” kids are really messed up.
The good news is that suddenly, on their 21st birthday, teen lunatics suddenly revert to amiable, tasteful, taxpaying adults, except for fraternity boys.
American adults do not like adolescents. Studies by University of Oklahoma Health Sciences professors Robert Hill and J. Dennis Fortenberry (1999) reported that “adults perceive adolescents in largely negative ways, and these negative images are consistent among a wide social spectrum.” They found more than half of the adults they surveyed held negative views of teenagers, three to four times more than held positive views, while one-third viewed teens neutrally.
My own study of University of Oklahoma public health graduate students (average age 34 and largely politically moderate or conservative) and University of California, Santa Cruz, undergraduates (average age 23 and overwhelmingly liberal) in 1993 found similar results. Both sets of adults across the age and political continuum were overwhelmingly likely to endorse negative stereotypes of teenagers and even the most extreme estimates of teenage mental illness, drug use, suicide, and sexual behavior. In a particularly telling example of anti-youth prejudice, respondents were more likely to rate an unplanned pregnancy among a couple consisting of two 17 year-olds as the result of immaturity, while an identically-described unplanned pregnancy among two 24 year-olds was largely attributed to mere bad luck that “could happen to anyone.”
Adults are not neutral observers, not objective weighers of fact, any more than, say, male medical researchers can be presumed objective about women. The difference is that while biases against other groups based on race, gender, religion, or homosexual orientation are at least treated with the veneer of disapproval, adult biases against adolescents typically are ignored or are praised as insight and “realism.”
The bias of adults against adolescents infects research findings, as well as institutional and media commentary, on youth. The dislike of youth is reflected in both the attitudes of many social science theorists and the choice of the media and political authorities to feature those with the most negative views. As noted, Northwestern University psychiatrist Daniel Offer studied medical and psychological researchers and found a large majority vastly overestimate the degree of pathology among teenagers based on the primitive biases introduced by generalizing doctors’ and therapists’ contact with diseased, clinically disturbed teens to the entire teenage population.
The American public is equally hostile. In 1997, the Washington polling group Public Agenda announced--as if this were something new and startling--that two-thirds of adults thought “kids these days” typically are “rude, irresponsible, and wild” and portend a bleak future. This poll was actually quite funny, revealing a large majority of American adults accusing a large majority of their peers of raising rotten kids! (Interestingly, teenagers did not return the hostility--70% preferred to judge adults on their individual merits rather than blanket stereotypes, a much more cognitively complex attitude.)
“I have often believed that part of the underlying dislike that Americans have towards their young is due to the tremendous fear they have of getting old,” Offer observed. The view of adolescence as an extreme, wrenching, miserable time of life is surprisingly widespread among Americans. The New York Times’ science editor Barbara Stauch’s best-selling The Primal Teen (2003) argues that the push-pull of brain development--in which childhood processes mature into adult ones--accounts for teenagers “radical mood swings” and irrational behaviors. Color-coded brain scans are deployed by neurobiologist Richard Restak in The Secret Life of the Brain (2001) to argue that teen brains process information in more primitive ways than adults--which is why, he argues, all teens are “difficult,” “unpredictable,” “moody,” suffering “biological tumult,” “impulsiveness,” and “disregard for consequences,” and adults, representing “the culmination of human brain development,” are “mature,” “likable,” and “courteous.”
The narrow-minded brain arguments are becoming more extreme. Dr. Jay Giedd of the National Institute of Mental Health argues in the March 2005 National Geographic that “brain anatomy” justifies stripping away the rights of persons under age 25. (Of course, he doesn’t mention more compelling studies, such as in Nature, June 2004, showing adult brains deteriorate rapidly, producing significant learning and memory impairment by age 40.) In the 2005 blowup over 16 year-old drivers, psychologist Marvin Zuckerman accused teens of rampant “sensation seeking” involving an innate desire to take risks and act impulsively to argue for banning driving until age 21.
This “biological determinism” (the argument that the supposedly unique biological characteristics of one’s race, gender, or age invariably determine one’s behavior) is simply a theory. It does not result from empirical (that is, real-world) tests comparing behaviors of groups judged biologically different to determine whether the average teenager behaves in ways significantly different than the average adult in ways the theory would predict. Biological determinists also do not factor out variables such as socioeconomic status, which (as will be shown in Chapters 6-9) has a profound effect on what are typically referred to as “teenage risks,” especially traffic crashes, firearms assaults, pregnancy, and crime.
The problem with biological determinist theories is that teens and adults do not behave in the real world in ways that they predict. If biology determined teenage behavior, teens would act like other teens and very differently from adults. This is not the case, as later chapters will detail. Teens behave very much like the adults around them, and very unlike teens of societies not around them. For example, you can predict the birth rate for teenage mothers with 90% accuracy if you know the birth rate of adult mothers of their culture and the culture’s poverty rate; you can predict nothing about one culture’s teen birth rate from the teen birth rate of another culture. The same adult-teen correspondence is found for homicide, violent death, criminal arrest, suicide, HIV infection, drinking, heavy drinking, drug use, smoking, obesity, and other key behaviors. If teenage brains functioned in fundamentally different ways than adult brains, these close adult-teen parallels would not occur.
Nor have practical tests of cognitive development and problem-solving exercises administered to teens and adults shown distinct divergences in thinking. Perhaps the best summary of these is by the University of Nebraska’s David Moshman, in his 1999 text, Adolescent Development: Rationality, Morality, and Identity:
Development does continue over the course of adolescence and early adulthood, and many individuals construct concepts and forms of reasoning that go far beyond the competencies they had in early adolescence. I am not aware, however, of any for or level of knowledge or reasoning that is routine among adults but rarely seen in adolescents. On the contrary, there is enormous cognitive variability among individuals beyond age 12, and it appears that age accounts for surprisingly little of this variability. Adolescents often fail to adequately test and revise their theoretical understandings, but adults fail in the same ways. Adolescents often show simplistic conceptions of knowledge and primitive forms of social and moral reasoning, but so do adults. Adolescent reasoning is frequently biased. but so is that of adults... Adolescents, it may be argued, are still developing, but the sorts of developmental trends seen in adolescence typically extend well into adulthood (p. 118).
The difference arises from the fact (also noted in my 1993 survey) that the same behaviors are interpreted very differently if committed by adolescents than if committed by adults. For example, studies by Offer and colleagues indicate that physicians and mental health professionals are much more likely to attribute adolescent behaviors to “developmental age” and identical adult behaviors to individual proclivities. This, put simply, is prejudice.
Similarly, a 2005 study by physicians at St. Jude Children’s Research Hospital of cancer patients ages 10 to 19 who were participating in complex, wrenching decisions involving their own deaths found:
These children and adolescents with advanced cancer realized that they were involved in an end-of-life decision, understood the consequences of their decision, and were capable of participating in a complex decision process involving risks to themselves and others. The decision factors most frequently reported by patients were relationship based...The factors that were most frequently identified included the following: for patients, caring about others (n = 19 patients); for parents, the child's preferences (n = 18 parents).
Contrary to those who view teens as incompetent, narcissistic, and unable to make far-reaching decisions, the St. Jude researchers found the young patients clearly understood that they would die and were concerned primarily for how their decision would affect other people (overwhelmingly, their parents), even when that concern came at their own personal cost. “This finding is contrary to existing developmental theories,” the research team reported dryly (Hinds et al, 2005, abstract). Indeed, just about any time “developmental theories” and claims of teenage brain deficiency are empirically tested, youths are found to be far more competent than the theorists claim--in fact, as competent as adults.
Are teens, then, exactly like adults in every respect? The answer is “yes,” in that adolescents’ individual (in-group) variations far exceed the general variation between teenagers and adults (between-group variation). The answer is “no,” in that there are some general differences between teens and adults--but they are not the sort that can be classified as gradations of maturity. For example, teenagers are more likely than adults to die in accidents involving transportation, water sports, and firearms, as well as homicide, an age-based vulnerability that is often cited as proof of their immaturity. What is not cited is that adults are more likely to die from drug abuse, falls, and most other types of accidents, as well as from suicide--does this mean adults are more at risk?
Often adolescent risk is exaggerated by commentators who state that accidents, suicide, and homicide are the leading causes of deaths for young people. This is true, but only because teens are far less likely than adults to die from heart disease, cancer, and strokes. Taken as a whole, in fact, adolescence is one of the safest times of life, with death rates considerably lower than for any adult age group, as the table on the next page shows.
Not only are teens age 15-19 less than one-third as likely to die as their parents (say, age 40-44), teens are safer even from violent death than every adult age group. Teens age 15-19 are safer from accidents and suicides than any adult age group and have a risk of homicide equivalent to 30 year-olds. Younger teens ages 10-14 are safer still--in fact, younger teens enjoy the lowest overall risk of death of any age group, including the second lowest risk of violent death (only age 5-9 is safer, slightly).
Note that deaths among persons ages 15-34 are more likely to be from violent causes. Two-thirds of the deaths among teens are from violent, not natural, mishaps, leading to the oft-repeated statement that accidents, homicide, and suicide are the leading causes of deaths in adolescence. But this is not because teens have a high rate of violent death; in fact, risk of dying by violence rises after age 20, as do natural deaths. While adolescents are depicted as in dire peril of dying in careless accidents, or by suicide or murder, the violent death rate for older teens (age 15-19) is actually 30% lower than for adults of age to be their parents (say, 45-49), while the violent death rate for younger teens (age 10-14) is just one-eighth that of their parents.
Nor, as we will see in Chapter 3, has danger to adolescents risen. In fact, adolescents today are much less likely to die from both natural and violent causes today than 30 years ago (see discussion of Carnegie Council report below).
It is not correct to depict adolescent years as a time of high risk, nor to claim today’s teens face unheard-of dangers. Further, adolescent risk of both natural and violent death varies widely by socioeconomic status, suggesting the phenomenon is not age-based so much as environmental in nature.
Another example of age-based differences: adolescents are more likely than adults to be arrested for public crimes, such as robbery, property crimes such as burglary and shoplifting, arson, and other offenses that occur outside the home. However, adults are more likely to be arrested for private crimes: domestic violence, drunken driving, credit-card and check forgeries, and white-collar offenses such as embezzlement and corporate frauds. (Interestingly, the most policed offense, homicide, shows equivalent rates of adolescent and adult arrest.)
The result is that adolescents display a higher overall arrest rate, leading primitive criminologists to declare teenagers innately crime-prone. However, this discrepancy may result from the simple fact that public offenses are more likely to result in arrest than private ones--street violence is more policed than domestic violence, robbery more than securities fraud. The different environments and social statuses adolescents and adults occupy as a result of their ages influence their patterns of crime and arrests--not the age difference itself. Finally, once again, poorer teens are far more likely to be arrested than middle-aged and affluent ones, due both to higher crime rates and biases in policing. That social scientists should make such a fundamental mistake of equating higher arrest rates with natural-born criminality is inexcusable.
“Researchers have found adolescence an increasingly complex age range” (Moshman 2000, p 49). Indeed it is, which makes the ubiquitous claims about “typical teenagers” found in the media and among social scientists absurd. There are “typical stereotypes” of teenagers invented by adults (and internalized by some youths), all negative, but there is no such thing as a typical teenager.
Stages of development: Physical
We all went through it; the physical stages of adolescence do not require detailed description. Height and weight gain, breasts, voice changes, facial hair, pubic hair, menstruation, ejaculation, all occur with respect to their genders around ages 11-14. The most striking aspect of adolescent development are (a) the reaction to them, and (b) they occur at earlier ages today.
Americans seem to have severe difficulty with the idea that children and teenagers are sexual beings. The illusion of “children’s innocence” dominates American thinking, with strange and contradictory results: teens are simultaneously misdepicted as hormonal sex maniacs and innocent ingenues, both eliciting their own brand of shock. Adults and popular media sources depict sexual development as excruciatingly humiliating for young teenagers, then publicly highlight teen sexuality in highly personal ways--scantily clothed child fashion models, seventh-graders dragged on to talk shows to for hosts and audiences to berate for sexual precocity, public discussions by political candidates of their teen daughters’ sexuality, porn sites advertising teen debauchery, and incessant, explicit surveys and mainstream press exposes on “teenage sex.”
Yes, kids do grow up faster today--and it’s a good thing. The age of puberty--female menarche (first menstrual period) has been most actively measured--has dropped from around age 17 in 1800 at a rate of three months per decade, to around 12.5 today. Boys spermarche (first ejaculation) occurs about six months later than girls’ menarche (13 today, on average). The ability to reliably get pregnant and impregnate arrives about a year after the “arche”. Why doesn’t great-grandmother remember 13 year-old mothers back in her day? Not so much because of greater chastity, but because they COULDN’T get pregnant back then.
If we were able to travel two centuries back in time, we would see 17 year-olds in early America that resembled, physically and intellectually, 13 year-olds of today. Most 17 year-olds of 1803 would be smaller in size, flat-chested, and more childlike in every respect than 17 year-olds of 2003. It is something of a surprise to learn that Mark Twain’s Tom Sawyer and Huck Finn were around 14--their conversations, play, and preoccupations seemed more attuned to what a 10- or 11-year-old would find interesting now. (In the later Tom Sawyer Abroad and Tom Sawyer Detective, however, Twain matures teenage Tom remarkably into a super-adult.)
Abigail van Buren and other commentators lament that the downward trend in puberty is a “cruel trick of nature” that, thankfully, appears to be leveling off. In fact, the falling age of puberty is nature’s reward to societies that can feed their children adequately, since the age of sexual reproduction is directly related to body weight. It shortens the period of dependent childhood, a burden on societies, and accelerates the arrival of productive adulthood. In fact, it is American society’s “cruel trick” that insists on juvenilizing adolescents rather than developing pathways to incorporate increasingly mature teenagers into adult culture, responsibility, and opportunity.
Early views of adolescent development
Historian Joseph Kett pointed out in Adolescence in America the unscientific nature of American scientists theories about teenagers:
To speak of the “invention of the adolescent” rather than of the discovery of adolescence underscores... (that) adolescence was essentially a conception of behavior imposed on youth rather than an empirical assessment of the way in which young people actually behaved... A biological process of maturation became the basis of the social definition of an entire age group (1977, pp. 215, 243).
In fact, prejudice and anxiety concerning the fact that adolescence itself is defined by puberty--that is, s-e-x--has led to extraordinarily irrational notions of adolescence. Adolescence is defined as a high risk period of life due largely to the traditional myth that transition from childhood “innocence” to adult sexuality (like Adam and Eve’s fall from grace in the Old Testament) must entail great debilitation and corruption. Americans seem unable to get beyond fearful, negative stereotypes of the second decade of life.
Psychologist G. Stanley Hall is credited with pioneering the study of teenage years as a distinct time of life, delineated in his 1904 volume Adolescence. His depiction invoked outgrowths of Darwinian biogenetic notions, including the disputed theory of recapitulation. Recapitulation holds that the development of each human individual mirrors the development of humans as a species, so that infants are similar to prehistoric humans, children to more advanced anthropoids, and adolescents as a transitional evolutionary stage to the modern humans represented by adults--perhaps the bumbling, hypersexed Pleistocenes depicted in Quest for Fire.
Hall had an unhappy boyhood, suffering abuses from a brutal father, intense shame over sexuality, enshacklement in anti-masturbation devices, and a humiliating diagnosis of unfitness for military service. These experiences may have contributed to his dire view of adolescence and, like Teddy Roosevelt (also a sickly boy turned macho advocate of war and rugged manhood) Hall pushed for the strong discipline of military service and regimented industrial schools to control and shape boys:
The momentum of heredity often seems insufficient to enable the child to achieve this great revolution and come to complete maturity, so that every step of the upward way is strewn with wreckage of body, mind, and morals. There is not only arrest, but perversion, at every stage, and hoodlumism, juvenile crime, and secret vice... Home, school, church fail to recognize its nature and needs and, perhaps most of all, its perils (p. xiv).
Thomas Hine’s history, The Rise and Fall of the American Teenager, is apt: Hall extended even the meager research farther than warranted, included studies of adults, and displayed that combination of fear, envy, and sexual attraction toward teens that characterizes the most bizarre works. “This volatile mix of ideas and emotions was present at the creation of the modern adolescent,” Hine opined (1999, p 159), “and it haunts us all, young and old, still.”
Hall’s recapitulation syntheses merged age, race, and gender into a unified theory which classified nonwhite peoples as “adolescent races”--that is, at a more primitive stage of human development than white northern European men. “An undeveloped race, which is incapable of self-government... is like an undeveloped child who is incapable of self-government,” wrote another theorist. American Medicine, the nation’s major medical journal, reported in 1907 that “the Negro...(displays) instability of character incident to lack of self-control, especially in connection with the sexual relation;” being “without brains” due to undeveloped frontal brain lobes, the editors argued, blacks could not comprehend the consequences of their actions and therefore did not deserve expanded rights (see Gould 1981). Prevailing theories of crime during this period centered on phrenology--the belief that criminals were atavistic throwbacks to primitive humans and could be recognized by skull shape and body configurations--which predicted their anti-social behavior as an inborn characteristic.
Another major medical theorist reported in an 1895 “state of the knowledge review” that “all psychologists who have studied the intelligence of women...recognize today that they represent the most inferior forms of human evolution and that they are closer to children and savages than to an adult, civilized man. They excel in fickleness, inconstancy, absence of thought and logic, and incapacity to reason.” These 1900-era declarations by leading scientists of black and female inferiority are resurrected by today’s biodeterminists virtually verbatim to describe adolescent inferiority.
Hall’s and others’ biogenetics theories--“a kind of mystical Darwinism with a racist tinge,” Hine wrote--caught fire because they fit perfectly into the politics of an era in which the United States was making a transition to a major colonial power, and great public concerns were being raised over immigration, civil rights, and women’s suffrage. A major implication of their theories was that white American women and children were the weak link in the white race’s superiority, at constant risk of being seduced into regression by the depravities of primitive, nonwhite and non-native races to which they were naturally drawn. Nothing less than civilization itself depended on protecting white women and children from the drugs, language, and morals of the Negro, Indian, Chinese, Mexican, and other non-northern-European immigrants, leading scientists argued.
Like other biological determinists then and now, Hall relied on anecdotes and assertions rather than systematic effort to match his theories to real-world behavior. As a result, later researchers had little trouble debunking his drastic views. Despite “the widespread myth that every child is a changeling who at puberty comes forth as a different personality,” psychologist Leta Hollingworth wrote in The Psychology of the Adolescent (1928), adolescent development is characterized by “gradualness” and is governed more by social mores than by biology. As researchers moved away from supposition and anecdote and began studying real teenagers in real life, they “were struck by the absence of storm and stress among young people in the communities which they studied” (Kett 1977, p. 259).
Anthropologist Margaret Mead’s studies of numerous cultures found that Hall’s and traditional notions of adolescence as an extreme period of sturm und drang (storm and stress) is unique to Western, particularly American culture; adolescence in most cultures is not seen as stormy or stressful. Though Mead’s work has been disputed (and defended), her finding that “the stress is in (American) civilization, not in the physical changes through which our children pass” has been amply validated. Literally hundreds of studies over the following century found the vast majority of adolescents did not find puberty a traumatic time, that changes were gradual, that hormonal influences on behavior “though real and pervasive, account for only a small part of the multiple changes that characterize adolescence” (Feldman & Elliott 1993, p. 487), and that teen values tended to match those of the adults around them (see Offer 1987). Nevertheless, new fields of popular thinking and research would emerge after World War II seeking to define teenagers as a very different, and not at all pleasant, sort of creature.
What is “adolescent psychology”?
Sociologically, youth often are depicted as a monolithic group that is different and separate from adults, forming a separate and feared “youth culture.” Modern researchers have failed to find such a singular culture. “The monolithic youth culture” is a “myth,” human development professor Bradford Brown reported. “... For better or for worse, adults and adult institutions do intervene in teenage peer cultures” (Feldman & Elliott 1993, p. 195, emphasis original).
Even “antisocial peer groups,” assumed to be pivotal influences corrupting teens, do not “redirect members’ behavior patterns but reinforce predispositions that predated group membership,” Brown noted:
Serious delinquency, along with heavy drug use, is concentrated in a small number of adolescent cliques and crowds. Yet, although they make up a small proportion of the teenage population, such antisocial peer groups are a matter of grave concern. In most cases, however, it does not appear that they are composed of “all-American kids turned bad by peer influence. Instead, aggressive children, who are readily labeled as such and rejected by most of their peers, gravitate toward one another and coalesce into cliques well before adolescence.
...Researchers have consistently shown that similarity stems primarily not from processes of peer influence but from adolescents’ inclination to choose like-minded peers as friends and the tendency of peer groups to recruit as new members individuals who already share the group’s normative attitudes and behaviors (pp. 191, 193).
While “peer pressure” is universally depicted as negative, Brown’s research found that “adolescents perceive more pressure toward self-enhancing activities (school achievement, peer socializing) than antisocial or self-destructive behavior” from their fellow teens. “In fact, pressure to finish high school was the single strongest influence from friends that respondents reported” (p. 194). Consistently, youths report little pressure from their peers to drink, use drugs, smoke, or have sex.
As we’ll see in Chapter 3, adults have striven to prevent a distinct youth culture from arising even as every action they took to separate youths from adults, from laws to get teens out of the labor force to the segregation of youths in high school, ensured that distinct youth cultures would develop. By the 1950s, the buying power of teenagers made it impossible to deny that many if not most adolescents did have different tastes in music, language, dress, and associations--that is, a separate, youth culture. In following decades, it would become apparent that there were many youth cultures, so that today fragmentation and niches are more accurate.
It followed that underlying a distinct youth culture must lie a separate teenage way of thinking--that is, an “adolescent psychology.” Hall provided the academic basis, flawed as it was, for the belief that there was some particular, separate psychological state that adhered to teenagers that was not found in adults or children.
In the 1950s, however, many theorists liked the traits associated with adolescents and saw them as an antidote to the rising conformity of corporate culture. “Juveniles deal with each other with a crudity unparalleled in later life,” wrote sociologist Edgar Friedenburg in The Vanishing Adolescent (1959) from his study of high schoolers. “It is not altogether terrifying if one is a little savage oneself...”. “Adolescent spontaneity frightens and enrages” adults, who find “something in adolescence itself that both troubles and titillates” them (pp. 20, 115). Friedenburg also delighted in adolescents’ capacity for self-parody, which adults often dismissed as silliness. Friedenburg identified a major anxiety among American adults that would intensify over the next 40 years: “fear of aging.” “It is no paradox, certainly, that people who are determined to stay young should resent people who actually are young.” In short, “adult response to the way adolescents act seems often to be influenced more by the adults’ own unconscious needs and tensions than by what the adolescents are actually doing” (pp. 114, 116, 117).
However, for most theorists there was and is a different, hidden psychology behind the development of adolescent psychology--the desire of adults to distinguish themselves from adolescents as much as the other way around. For, none of the natural traits attributed by experts to adolescents turned out to be flattering--in fact, “adolescent” defines a laundry list of undesirable qualities no self-respecting adult would admit to having.
While theorists demean adolescents as suffering from unusual tendencies toward conformity, group pressure, criminal behavior, materialism, preoccupation with outward appearance, psychic fragility, simplistic idealism, sullenness, volatility, hyperness, rudeness, insensitivity, disregard for risks, apathy, and similar flaws (many traits ascribed to teenagers are contradictory, and none seem to be positive), no one has convincingly shown that adults are not equally afflicted. There is so much variation between teenagers that literally no psychological traits are unique to them.
No matter; adolescent psychology has evolved into a strong academic discipline, with distinct bodies of research, textbooks, university wings, and specialists, even though, peculiarly, most multi-age studies find that in real life, adults display the same psychosocial traits that teenagers do. Ignoring these, leading theorists seem to regard adolescents as a tragic mistake of nature. Psychologist David Elkind, for example, argues that two “cognitive distortions” characterize adolescent “egocentric” thinking: the imaginary audience, and the personal fable. Adolescents are unusually self-conscious because they believe they are the focus of everyone’ else’s attention and are hypersensitive to criticism from the imaginary audience, Elkind (1979) said. Teens, believing everyone is observing and thinking about them, develop a personal fable involving an inflated sense of importance accompanied by an exaggerated sense of despair at any personal failing, which they presume is also the preoccupation of others, he argued. Adolescents thus have difficulty distinguishing the real from the unreal and may develop an exaggerated sense of invulnerability or immortality, according to egocentric theory.
These presumed traits of “adolescent egocentrism,” in effect, accuse teens of being narcissistically delusional. Most of Elkind’s research used teens in clinical treatment, hardly a typical population, or examination of adolescents’ diaries for incriminating statements, hardly an objective procedure since comments that support the researchers’ hypothesis can be selectively cited. Elkind did not show that these traits are universal across cultures or that they are not also found in adults--that is, that they are individual rather than age-based. In particular, dozens of studies comparing adults and adolescents have found great similarity in cognition between the age groups and great individual variation with the groups. Several, cited below, shows that adults actually believe themselves more invulnerable than adolescents do, arguing against a uniquely deluded teenage mental state. Nevertheless, Elkind’s theories still tend to be cited as fact in adolescent psychology textbooks.
Taken at face value, then, theories that adolescents suffer from exaggerated self-absorption and peer-preoccupation, obsession with appearance and audience, and anxious sense of place in the world would explain a lot of things about “youth culture.” Teens were not like adults, the theory went. They spend vast sums maintaining style and vast hours before mirrors arranging the presentation of self to fit the critical eyes of peer judgers. Their dramatic “sooooooo happy/could just die!” mood swings, hyper-embarrassments, and super-sensitivity to any critical remark or look could be managed by careful attention to outward pose. Youths are rebellious and oppositional toward adults--their desire to establish an adult identity rather than being perceived as childlike, to affirm their new identity by peer approval, put teens at opposition to adult values.
A recent reincarnation of teenage-rebellion notions is textbook writer Judith Rich Harris’s Group Socialization theory which postulates “teenagers versus adults” (emphasis hers):
Delinquent acts during adolescence are extremely common, even among individuals who were well-behaved children and who will become law-abiding adults... Adolescents are not aspiring to adult status -- they are contrasting themselves with adults. They adopt characteristic modes of clothing, hairstyles, speech, and behavior so that, even though they are now the same size as adults, no one will have any trouble telling them apart. If they truly aspired to adult status they would not be spraying graffiti on overpasses, going for joyrides in cars they do not own, or shoplifting nail polish from drug stores. They would be doing boring adult things, like figuring out their income tax or doing their laundry (emphasis hers) (p. 471).
Harris won a prestigious American Psychological Association award and vast publicity in the mid-1990s for a theory which begins with crude, and long debunked, stereotypes of the supposed differences between adolescents and adults that are of no more sophistication than prejudices holding Jews to be money-hungry or blacks prone to steal watermelons. (And, as is often the case, Harris was trying to rationalize a personal dilemma: why her adopted daughter was so rotten.) It would be difficult to explain under her theory, which holds that teens are socialized solely by their peers, why teens and adults around them so closely share values and behaviors.
Nevertheless, the dubious “teenager versus adult” notion has proven popular for decades, and it follows from it that teens needed a separate culture that would assimilate and assuage their separate, messed-up traits. These presumed traits of millions of teenagers are ones that can be marketed to, as will be seen in Chapter 3--though not in the way many culture critics suppose.
Of course, a separate, more benign explanation is that youth cultures arise because, in a rapidly changing society, teens grow up in a very different world than their parents did. In that light, youth cultures may be adaptive. However, neither the public nor authorities have ever been inclined to view youth culture (often spoken of as if it were a monolithic entity) benignly. The confused fear about “youth culture” is reflected in the Carnegie Council on Adolescent Development’s 1995 report, Great Transitions:
Many parents see their teenagers drifting into an amorphous, risky peer milieu, popularly termed "the youth culture." This culture is heavily materialistic and derived mainly from the adult world and the commercial media. It has its own cultural heroes, made up of rock and film stars and prominent athletes, and its own preoccupations ‑‑ cars, clothes, being part of the crowd, being physically attractive. As a result, adolescents spend little time with their families. With more money of their own, whether from earnings, an allowance, or illegal activity, adolescents do not need to go home even for dinner; they can buy their meals at a fast‑food place.
Often parents become perplexed, even angry, as they feel their authority weakened and their values challenged (1995, pp. 29, 63).
The report by the Carnegie Council (comprised of some the nation’s leading experts on adolescent development as well as institutional and political luminaries) brims with alarming statements (“since 1960... the continuing decline in the health status of American adolescents is deeply disturbing... the casualties are mounting”) that are patently absurd. As seen in the figures, nearly all health risks--violent death, natural death, and disease-- have declined sharply for teens over the last 30-40 years, especially for the younger teens (age 10-14) Carnegie’s study concerned.
example, the violent death rate for American 10-14 year-olds declined sharply,
from 20 per 100,000 population in 1960 to 14 per 100,000 in 1995 (the year of
the Carnegie report) and to an all-time low (9) by 2002. The biggest decline
was in those types of deaths that involve personal risk taking (suicide and
accidents), which dropped radically from 12 per 100,000 in 1960 to 6 per 100,000 in 1995, directly contradicting Carnegie’s claim that younger teens were acting in riskier and deadlier ways.
But admitting that teens actually are safer and healthier today than in the past would wreck the report’s main thesis--that teens were being raised more by a dangerous “youth culture” today than by parents and were therefore in more danger. The Carnegie Council approach is typical of prominent institutional reports on teenagers--though not, as we will see, of scientific studies. Similarly, an analysis by the University of Minnesota’s Adolescent Health Program of the National Longitudinal Study on Adolescent Health (an ongoing health and behavior survey of thousands of teenagers) published in the Journal of the American Medical Association (September 10, 1997) blamed the decline in parents’ time spent with kids over the last 40 years and urged greater adult supervision of youths to prevent “risky behavior.” However, the study’s detailed tables showed that teens who smoked, took illegal drugs, drank alcohol, and contemplated suicide tended to come from homes where parents did likewise. Adding in the fact that teens today take fewer risks with their health than teens of the past might seem to suggest that spending even less time with parents would improve adolescent health still more.
The latter is not a political acceptable conclusion, however, and the vast majority of “teen risk” studies of the 1990s were uniform--to the point of being verbatim--recounts of supposedly rising, dire risk to adolescents and demands for more parental supervision and remedial programs. Right up to the present day, the conclusions about the risks teens face derive not from real analysis of trends, but from theoretical biases about “adolescent psychology” and “youth culture.”
For more scientific reviews of the body of research does not find a unique teenage psychology or oppositional peer culture. “Taken as a whole,” reported an extensive review by University of Michigan psychologist Joseph Adelson of the standard stereotypes researchers have disproven, “adolescents are not in turmoil, not deeply disturbed, not at the mercy of their impulses, not resistant to parental values, not politically active, and not rebellious” (emphasis original). “Empirical tests have shown that adolescents are no less rational than adults,” reported another. “...adolescents are consistent in their reasoning and behavior... and no more biased in their estimates of vulnerability to adverse health consequences than are their parents.”
Northwestern University psychiatrist Daniel Offer, the nation’s leading researcher on adolescents, studied 30,000 teenagers and adults from the 1960s to the 1990s. He and his colleagues found 85% to 90% of teens held attitudes and risk perceptions similar to that of their parents, were not alienated, did think about the future, were coping well with their lives, and did not display psychological disturbances. “Decision making for adults is no different than decision making among teenagers,” Offer reported in 1987 in the Journal of the American Medical Association. Offer’s 1993 review of 150 recent studies in the Journal of the American Academy of Child and Adolescent Psychiatry concluded that “the effects of pubertal hormones are neither potent nor pervasive” on emotions.
In another, 40-year longitudinal study of adult development of men (now in middle age) first interviewed as adolescents in 1962, Offer and colleagues classified development in three ways:
· Continuous growth: teens progressed through adolescence in stable, smooth, and self-assured fashion and experienced few traumas in school and with families or friends.
· Surgent growth: teens who progressed through adolescence in developmental surges rather than continuously and who showed minor behavior problems, but who also experienced few traumas.
· Tumultuous growth: teens experienced considerable turmoil during adolescence, showing overt behavior problems in schools and conflicts with parents.
· Mixed group: teens who showed combinations of the above growth patterns and could not be placed into any one category (2003, pp. 3-8).
Three-fifths on the teens studied fell into the continuous or surgent categories, displaying “good coping and expressing the core values of their families of origin” (2003, p. 3). In contrast, the one-fifth classed as tumultuous were “more likely to come from disrupted or disturbing backgrounds” such as divorced or abusive families” (p. 7). Rather than finding adolescence an exceptional or changeling time of life, Offer and other researchers found “relative stability of personality traits from adolescence into early and middle adulthood” (p. 4). That is, stable teens tended to remain stable in adulthood and to establish stable marriages and lives, while troubled teens tended to repeat the behaviors of their troubled families, in turn showing more marital and personal behavior problems as adults.
Psychologist Laura Berk’s definitive text, Child Development, concludes from the consensus of research:
A few adolescents experience identity crises that are traumatic and totally preoccupying. However... for most, identity formation proceeds in a very gradual, uneventful way... For most people, adolescence is not a period of intense emotional upheaval that brings with it an increased risk of adjustment difficulties, although it has often been thought of in this way. In fact, the incidence of serious psychological disturbance increases only slightly from childhood to adolescence (by about 2 percent), at which time the rate is about the same as it is in the adult population (1997).
Nonetheless, lamented University of Michigan psychologist Joseph Adelson, a leading researcher on adolescents, “a stubborn, fixed set of falsehoods” continues to dominate discussion of adolescents. So many “continue to believe many of the myths about adolescence,” Offer agreed in 1993, despite solid research debunking them. Chief among these, as noted, are psychological and medical researchers, Offer’s studies found.
The political agenda in depictions of adolescents
Currently, Hall’s notions are themselves being recapitulated in recent neurobiological theories. Despite the vast range of theories of teens over time, teens themselves have not changed much, indicating the unreal world in which much American theorizing about teens take place. Nor is mistheorizing about teenagers accidental. A fascinating five-decade University of Wisconsin-Madison study found that scientists miraculously pronounce teenagers “capable and adultlike” when adolescents are needed for wars and economic booms--and “immature and slow to develop” during peacetime and economic recessions. The study, led by human development professor Robert Enright, concluded:
Whether youth will be portrayed as competent to assume adult roles, or a psychologically incapacitated to warrant their exclusion from adult roles, will depend largely on the labor and economic requirements of the society in which they live.
Theorists view the adolescent very differently in wartime than in economic depressions... When youths’ labor was needed, they were viewed as quite capable and adultlike.
When youth were not needed in the work force, they were viewed as more immature and slow to develop by psychological theorists.
Note that Enright is referring to theorists rather than to practical studies of adolescent competence, the latter of which are typically ignored during times in which the view of teenagers is manipulated to depict them as incompetent. Enright further found that shifts in social scientists’ views tended to match those of politicians as reflected in congressional legislation:
There is a strong correspondence between the ideas of adolescent psychology and the legislation passed by the U.S. Congress... One cannot retreat from the implication that such theories mask an ideological purpose... What are our current ideological stereotypes of youth and what societal/economic conditions are we trying to aid by holding such views?
The most striking recent example is the Vietnam War era, in which hundreds of thousands of young people too young to legally vote or drink alcohol in most states were sent to combat. In fact, half of the 55,000 American troops killed in Vietnam had reached only the “attained age” (in quaint Pentagon terminology) of 20 or younger. During the 1970-75 period, Congress and many states lowered the age of legal adulthood, including for voting and in many cases for drinking, from 21 to 18, reflecting Enright’s finding that maturity is ascribed to adolescents when society needs their labor or soldiery.
Since 1975, states largely have dismantled the rights of adolescents (while retaining their legal obligations) and imposed much harsher conditions, often equating 17 year-olds with 3 year-olds in legal status (see Chapter 9). As millions of factory and other formerly stable, higher-status entry-level jobs have been eliminated by automation and relocate to overseas sites in recent decades, replaced by large zones of unemployment and temporary low-status service economy jobs, the political status of adolescents has declined precipitously. There has been no change in the capabilities of adolescents themselves, of course; only a shift in adult society toward seeing teenage labor as unneeded, and youth, therefore, as a control problem rather than a resource. As social conditions have changed, political attitudes toward youth have changed as well, and so have social scientists’--the most prominent of whom today are announcing “new” discoveries that teenagers are incompetent, just as their colleagues of past eras did when similar political and economic conditions required that view.
Stages of development: Cognitive and Moral
What, then, does happen during adolescence? Stage theories developed by Freud and refined by Swiss biologist Jean Piaget, psychiatrist Erik Erikson, psychologist Lawrence Kohlberg, and numerous later researchers, argue that development occurs sequentially, with vast individual variations. Where Freud postulated five basic stages:
Oral (birth to 1 year) mouth/feeding
Anal (age 2-3) self-control of elimination and other behaviors
Phallic/clitoral (age 4-5) sexual discovery, gender awareness, especially in relation to parents
Latency (age 6-7) control of primitive behaviors, social rules
Genital (age 13-18) sexual energy, expansion of world beyond home, parents
Erikson refined these into eight “psychosexual” stages extending into adulthood:
Stage Good outcome Bad outcome
Oral-sensory (birth to 1 year) trust mistrust
Muscular-anal (age 2-3) autonomy shame/doubt
Locomotor-genital (age 4-5) initiative guilt
Latency (age 6-12) industry inferiority
Puberty/adolescence (age 13-18) identity role diffusion
Young adulthood (age 19-25) intimacy isolation
Middle adulthood (26-40) generativity stagnation
Older adulthood (41-older) integrity disgust/despair
Unlike biological determinists, the cognitive development theorists such as Piaget looked for real-world confirmations of stage theories and came up with practical stages of their own:
Sensorimotor coordination (age 0-2) early concept of space, time, causality, intentionality, permanence
Pre-operational thinking (age 2-6) understanding of symbol: language,
conservation of properties, proximate
Concrete operational thinking (age 6-11) understanding of rules, hierarchy
Formal operational thinking (age 11-15) conceptualization of historical time,
geographical space, complex symbol, proposition, experiment
Concrete thinking (which Piaget called “first order”) is direct, applying logic to solve real problems; formal thinking (“second order”) is abstract, applying logic to analyze logic. For example, unlike very young pre-operational thinkers, a concrete thinker typically understands that a quart of water in a tall container is the same quantity as a quart of water in a flat container, or that a pound of clay is the same whether formed into a block or a roll.
In a standard test of concrete thinking ability, subjects of various ages are asked to evaluate which of the following sets of arguments is the most logical:
1. a. Elephants are bigger than mice
b. Dogs are bigger than mice
c. Therefore, elephants are bigger than dogs
2. a. Mice are bigger than dogs
b. Dogs are bigger than elephants
c. Therefore, mice are bigger than elephants
Fourth graders choose the first set of arguments as the most logical because it is obviously true, even though argument 1(c) does not follow from premises 1(a) and 1(b). No amount of supplemental explanation about the difference between truth and logic is able to convince fourth graders that their answers are based on the possession of outside information (that elephants are bigger than dogs in fact) rather than the logic of the arguments themselves. College students, on the other hand, typically choose the second set of arguments, since its conclusion follows logically from its premises even though both its premises and conclusion are factually false.
In between are seventh graders, who typically split down the middle in choosing whether the first or second argument is the most logical--that is, some reason like fourth graders, some like college students. However, given a simple explanation that truth and logic are distinct issues, seventh graders improve their answers to the level college students display. This is a good example affirming that adolescent thinking benefits significantly from education and experience--that is, the acquisition of additional information--rather than denial of information based on the assumption that their cognitive development is insufficient to handle it (Moshman 1999).
Formal operations employ more abstract ability to generate and test alternative hypotheses to solve complex problems containing hidden assumptions. For example, consider the following classic test of formal thinking, called the “selection task.” Subjects are asked to examine four cards, below
| E | | K | | 4 | | 7 |
and to test the following simple hypothesis: “If a card has a vowel on one side, then it has an even number on the other side.” The subject is asked to test this hypothesis by devising the most efficient strategy--that is, the one that turns over the LEAST number of cards--necessary to prove or disprove the hypothesis. Which card(s) should be turned over?
Test showed that even given time to consider, most adolescents and adults employ an inadequate verification strategy that seeks to find evidence to verify the hypothesis (turning over the card E, or the cards E and 4), rather than the most rigorous falsification strategy that seeks most efficiently to disprove it (turning over cards E and 7--do you see why?). This and similar tests led researchers to conclude that most adults do not employ mature formal operational thinking.
Piaget’s experiments led him to classify children and teens as follows:
Note that by age 13, almost all the cognitive marbles have been acquired--three in four display operational thinking, and one-fourth formal, mature thinking. Lesser maturation takes place, mostly within the stages, over the next five years--by 18, two-thirds display operational, and one-third mature, cognition.
Piaget’s research led him to great confidence in the cognitive abilities of adolescents, which he found in some ways slightly superior, and in other ways slightly inferior, to that of adults he studied. The real problem with teenagers, he argued in the 1950s, was that they are too unsure of themselves to use their idealism to reform society--that is, teens are not rebellious enough.
Theorists such as Lawrence Kohlberg delved even deeper into the practical manifestations of mature thinking with “moral reasoning” studies. How, exactly, did child, adolescent, and adult thinking translate into real-life choices? These require not simply cognitive ability, but the skill to apply it to abstract situations. The great individual variations make it more feasible to talk in terms of levels, not stages:
Level Moral reasoning governed by:
Preconventional authority, self-interest, reward/punishment
Conventional rules to maintain social order
Principled abstract, universal principles
At age 10, four-fifths test in the preconventional range, falling to a little more than half by age 14 and one-fourth by 18. What is most striking is the stability of conventional thinking--about 50% are at this level by age 14, 80% by 18, with little improvement at older ages except modest maturing within the conventional range. Very few adolescents or adults (fewer than one in 10) test in the principled range, not an optimistic finding. (For whatever reason, Kohlberg disappeared and is listed as a suicide.)
A great deal of real-world research and simulations confirm practical cognitive theories. “Minors aged 14 were found to demonstrate a level of competency equivalent to that of adults” in standard cognitive measures, reported a typical Child Development study. Carnegie Mellon University researchers reviewed 100 studies and found adolescents actually harbor FEWER delusions of invulnerability than adults do. Likewise, University of California, San Francisco, psychologist Nancy Adler studied adolescents (average age 15) and their parents (average age 41) and found the two groups expressed very similar attitudes toward risk. Delusions of invulnerability “are no more pronounced for adolescents than for adults,” she concluded.
These are typical findings in hundreds of studies. Affirmations of the cognitive competence of adolescents--and even younger children, who lack the abstract reasoning capabilities of teens and adults but can nevertheless apply rules to reach adult-like conclusions--are standard in multi-age studies and research reviews by psychologists such as the University of Nebraska’s Gary Melton and the University of Virginia’s Lois Weithorn.
The most impressive recent research as of this writing, a 2002 MacArthur Foundation-sponsored study of hundreds of teens and adults led by Temple University psychologist Laurence Steinberg, assessed whether juveniles are competent to stand trial as adults. The study found:
· Overall competence: 88% of young adults (age 18-24), 89% of 16-17 year-olds, 80% of 14-15 year-olds, and two-thirds of 11-13 year-olds were found to meet adult standards of responsibility for criminal acts. Note that 12% of adults failed the competency standard.
· Youths age 16-17 were as competent as adults when tested for abilities in understanding of rights, reasoning, appreciation of risk, future orientation (i.e., ability to anticipate consequences of acts), compliance with authority, and resistance to peer influences.
· Youths ages 14-15 were found nearly as competent as adults in all of these measures as well--20% versus 12% incompetence rate, on average. Interestingly, 14-15 year-olds scored as high as adults on future orientation--an area younger teens are incessantly berated for their failings.
· Youths age 11-13 were generally competent, though not as much as older ages.
· Intelligence heavily impacts competence, regardless of age--40% of those in the lowest IQ range (60-74) were incompetent, compared to just 5% of those with IQs of 90 and above. Because IQ reflects accumulated knowledge and experience, younger teens are at a natural disadvantage here.
· The most interesting age-based finding was that younger teens are more trusting in authority than older teens and adults (and whites are more trusting than nonwhites)--that is, youths and whites are more likely to confess, be honest, and “trust the system.” Interestingly, the study authors judge (correctly, in my estimation) that trust in the system evidences incompetence! This, ironically, is a very damaging finding for the juvenile justice system, which relies heavily on the willingness of youths to confess their offenses (Grisso et al 2003).
Bottom line: 16-17 year-olds are as competent as adults, flatly so, and in a few cases, superior. There is no reason not to follow the rest of the Western and Latin world to permit youths age 16 and older entry into adulthood. Younger teens are surprisingly competent, and where they fail, it appears due more to inexperience than to cognitive deficiency.
What is the upshot of such stage research? The average 14 year-old is capable of adult reasoning, and half are able to apply it situationally. The average 18 year-old, a bit more so, The average 30 year-old, little improvement. Adolescents’ cognitive capabilities are similar to those of adults, but teens lack experience in applying principles. Whether the experience that comes with age improves moral reasoning and its application to real-life situations depends on how it is perceived. When placed in real-life situations, teenagers beginning around age 13, and nearly all by age 16-17, display reasoning and behavior similar to that of adults.
Even if competent, are teens today miserable and alienated?
Many of today's adults, especially institutional authorities, seem to want young people to feel hopeless and self‑hating (see discussion of school problem lists in Chapter 1). Institutions who treat adolescents for suicide, mental disturbances, addiction, delinquency, and other afflictions have a financial stake in depicting teens as uniquely troubled and have had no trouble selling that dubious image to the media, as we shall see. Whether adults have a psychological stake in imagining the next generation as inferior to their own, and younger ages as a vexation to the old, is also an intriguing question.
For example, a May 1998 poll by USA Today's tabloid USA Weekend of a quarter‑million teenagers in grades 6‑12 reaffirms how trapped the media are in their own concocted image of the miserable '90s wastrel. The poll's questions and youths' responses are as follows:
· “In general, how do you feel about yourself?” GOOD, 93%; BAD, 7% (VERY BAD, 1%).
· “Do you consider yourself healthy?” YES, 89%.
· “About how often do you have a conversation with one of your parents that lasts longer than 15 minutes?” A FEW TIMES A MONTH to EVERY DAY, 83%; ALMOST NEVER, 17%.
· “Do you have an adult you can confide in, inside or outside the family?” YES, 80%.
· “How pressured do you feel to do the following...?” NOT AT ALL: drink alcohol, 77%; smoke, 77%; take illegal drugs, 84%; have sex, 72%; look a certain way, 45%.
· “How much influence does each of the following have on your life?” A LOT: parents, 70%; religion, 34%; teacher, 25%; girlfriend/boyfriend, 24%; other kids, 21%; celebrities, 21%; TV shows, 8%; advertising, 4%.
· “Which do you think describe you...?” Kind, 78%; honest, 75%; good sense of humor, 69%; smart, 66%; self‑confident, 65%; creative, 63%; good at sports, 53%; not influenced by others, 53%; attractive, 40%; tough, 40%; popular, 32%; rich, 10%.
Note that the eight most‑claimed teenage traits are those of personal achievement while the four least‑claimed are of dubious, and/or outside‑awarded, distinction. Boasting or not, kids are proud of themselves. Even when the poll deliberately tried to elicit negative responses, such as by the following biased questions...
· “Two million teens suffer from severe depression, according to one estimate. Do you ever feel really depressed?”
· “Have any of your friends ever tried to commit suicide, or discussed it?”
... only 16% of the youths reporting feeling depressed “often.” Even though youths may be aware of the grapevine news on hundreds of students in school, only one‑third had ever heard of a peer who discussed or tried suicide. When asked directly “which of the following would make you feel better about yourself,” teens did volunteer some shortcomings: half wanted better grades, a third wanted to look better and to get along better with their parents. Imagine in all cases what 40 year-old adults might answer to the above questions, if they did so truthfully.
USA Weekend would have to bend its poll results completely out of shape to present a negative image of youths. Warp it did. Here is how it headlined the findings: “Teens tackle their identity crisis... teens are riddled with self‑doubt about everything from their looks to their relationships with adults...Looks are key... Teens find lots of imperfections... Depression is common... Families aren't communicating...” Ironically, the most abruptly negative response by teens was about grownups, when asked, “do you think adults generally value your opinions?” Thirty‑six percent said “no.” That percentage probably rose after they saw how the newspaper relentlessly negativized their overwhelmingly positive poll responses.
This result is consistent with other polls as well. The April 1998 New York Times/CBS News poll of 1,000 youths ages 13‑17 (supposedly the most rebellious age) found 97% got along with their parents ‑‑ 51% “very well” and 46% “fairly well.” It is doubtful that any other kind of family relationship would produce such a positive response.
Naturally, the press, given a generally upbeat poll of teens, accentuated the negative. The Times' story's lead sentence, on page 1, read: “They carry beepers, prefer permanent tattoos to body piercing and are as likely to take lessons in shooting guns as they are to play musical instruments.” Whad did the poll really find? That 18% of teens carry pagers, 5% have tattoos, 4% have body piercings, and 31% took shooting lessons at some time in their lives ‑‑ hardly strange, since the poll found 38% of their parents owned guns.
The most comprehensive survey of youth attitudes and behaviors, the 2000 Monitoring the Future survey, consumes dozens of pages. It, too, asked 2,200 high school seniors to rate “the way you get along with your parents.” Seventy percent were favorable, including one in four who said “completely satisfied.” Fifteen percent were neutral, 16% were negative‑‑and only 5% “completely dissatisfied.” (Spouses should rate each other so positively.)
Ask to rate themselves, three‑fourths of the teens had a good self‑image (33% thought themselves nearly perfect), 16% were neutral, and 11% unfavorable. As for their supposedly mean, backstabbing, gossiping teenage friends, 87% of the boys and 84% of the girls said they were satisfied (41% were completely satisfied) with their friendships and the people they spend time with. Only 5% were dissatisfied in any way, and only 1% to 2% were completely dissatisfied. Their friends, in fact, were the aspect of life teens rated most favorably.
Also interesting, teens were positive about their educational experiences (two-thirds rated it positively, one-fifth neutrally, and 16% unfavorably). That may be dismaying to those who wish teens were more critical of their schooling. The Monitoring survey also disputed the image portrayed in a rash of liberal books of the obsessively materialistic adolescent envious of peers’ consumer possessions. Three-fourth of teens were satisfied with their standard of living, housing, car, furniture, recreation, and other possessions; only 11% were dissatisfied; 15% didn’t have an opinion.
Recent polls have confirmed these findings. The Horatio Alger Association’s “The State of Our Nation's Youth” survey, of 1,055 high school students released on August 5, 2003, found three-fourths saying they get along very well or even extremely well with their parents or guardians, one-fifth termed the relationship “just OK;” only 3% say they don’t get along with their parents. Fewer than one in 10 reported pressure to try drugs or have sex.
So, in self portrait, high schoolers are not miserable, obsessed with self doubt, backstabbed by their friends, hostile to parents, pressured by evil peers, or caught up in runaway consumerism. We may find teens’ optimism and self-confidence unrealistically bubbly, but this is not an alienated, miserable generation. The question is: why are adults, including experts, so adamant about trying to make young people appear troubled--even to the point of portraying depression and suicide as normative to adolescents?
One answer is financial self-interest: there is vast profit in treating troubled teens, and therefore great incentive to expand the market to an ever-growing number of adolescents.
The old adolescent “diseases”
On April 21, 1896, Sigmund Freud made one of psychiatry’s most startling and incisive addresses to the Society for Psychiatry and Neurology in Vienna. Titled “The Aetiology of Hysteria,” misbehaviors which might be called “adolescent acting out” today, the address concerned Freud’s conclusions from case studies of dozens of male and female patients:
I therefore put forward the thesis that at the bottom of every case of hysteria, there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood... In the first group it is a question of assaults--of single, or at any rate isolated, instances of abuse, mostly practised on female children, by adults who were strangers... The second group consists of the much more numerous cases in which some adult looking after the child--a nursery maid or governess or tutor or, unhappily all too often, a close relative--has initiated the child into sexual intercourse and maintained a regular love relationship with it... which has often lasted for years. The third group, finally, contains child-relationships proper--sexual relations between two children of different sexes, mostly a brother and sister... In most of my cases I found that two or more of these aetiologies were in operation together; in a few instances, the accumulation of sexual experiences coming from different quarters was truly amazing.
...I am inclined to suppose that children cannot find their way to acts of sexual aggression unless they have been seduced previously. The foundation for a neurosis would accordingly always be laid in childhood by adults... All of these grotesque and yet tragic incongruities reveal themselves as stamped upon the later development of the individual and of his neurosis, in countless permanent effects... the fit of crying, the outburst of despair or attempt at suicide... behind all of which there lies in addition the memory of a serious slight in childhood which has never been overcome (Masson 1985, pp. 271, 276, 277, 284, 286).
Freud’s electrifying finding was that abuses in childhood, which he bluntly termed “rape” and “assault,” underlay most of what psychiatrists had been calling mental illness, especially in children and adolescents. Freud’s brilliant exposition of his “seduction theory” detailed all of the features of child sexual abuse now known to be common (some 125,000 children are confirmed victims of family members every year in the U.S.), especially the “neuroses of defense” which children employed to deal with brutal exploitations. These included many behaviors--depression, self-harm, anger displays, aggression and criminal behavior, paranoia, and more serious psychoses--which had been, and are today, classed as mental diseases. A century later, as will be discussed below, leading experts on teenage “conduct disorder” would point out that conduct-disordered youths and abused youths were one and the same.
Freud called for “a psychology of a kind for which philosophers have done little to prepare the way for us” to treat neuroses of defense, or later disturbances caused by violent and sexual abuse of children. As we know, that was not what psychoanalysis turned out to be. In the face of bitter denunciations by psychiatric colleagues and threats to end his career, Freud revised his theory into a safer mode that held that children merely fantasized sexual experiences with adults (especially the opposite-sex parent), the Oedipal and Electra complexes of which became the foundation of psychoanalysis.
Freud’s capitulation, under intense pressure, exonerated adult abusers and returned responsibility for mental disorder back to the fantasizing young person, whose troubles were seen as the result of developmental turmoil. As such, the adolescent rather than the maltreatments and conditions with which he or she lived became the focus of the emerging field of adolescent psychology.
Efforts to describe behaviorally disordered youth according to objective criteria were pioneered by American criminologist Richard Jenkins and colleagues in the 1940s, who classified three types of delinquents: socialized, unsocialized aggressive, and overinhibited. These descriptors were based on manifest behaviors: aggressive stealing, running away, cruelty, and obscenity. Clinician factors included emotional immaturity, overdependence, and vengefulness. In other words, disordered kids had bad attitudes that explained why they acted badly.
The later definition of adolescent disorders found in psychiatric codifications continued Jenkin’s “bad attitude” framework, “with its aggressive‑nonaggressive and socialized‑unsocialized subtypes and its minimizing of neuropsychiatric factors” and “is a direct descendent" of his earlier models (Lewis, Lewis, Unger, and Goldman, 1984, p. 514). These behavior‑driven models are strongly influenced in practice by a youth's response, and level of aggressivity in responding, to adult authority and can be distinguished, though weakly, by testing (Matson and Nieminen, 1987). Thus, the manifest‑behavior factors so categorized may ignore the types of traits relating to neurological, and familial and environmental, patterns (Lewis et al, 1984).
The new “adolescent diseases”
Nowadays, Dennis the Menace would be on Ritalin, Charlie Brown on Prozac.
-Strauss & Howe, Millennials Rising, 2000, p. 154
In the last three decades, millions of children and youth have been diagnosed, treated, and even institutionalized under new mental disorder criteria that barely existed in the past. Several investigations, by the American Psychological Association, American Medical Association, Blue Cross, and Congressional committees have found gigantic increases in the numbers of adolescents diagnosed and prescribed psychiatric medication, and a six-fold increase in teenagers committed to psychiatric hospitals from the 1970s to the 1980s.
While various, vague and unofficial diagnoses such as “adolescent adjustment disorder” surface now and then, three principle psychiatric disorders of childhood and adolescence are listed by the American Psychiatric Association (not affiliated with the Psychological Association) in its Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), under Pervasive Development Disorder. These are Attention-deficit/Hyperactivity Disorder (abbreviated ADHD; without hyperactivity, ADD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD).
ADHD, The DSM-IV lists the criteria for diagnosing the four subtypes of ADHD (see box). What does ADHD look like in practice? The National Institute of Mental Health says:
They may be unable to sit still, plan ahead, finish tasks, or be fully aware of what's going on around them. To their family, classmates or coworkers, they seem to exist in a whirlwind of disorganized or frenzied activity. Unexpectedly--on some days and in some situations--they seem fine, often leading others to think the person with ADHD can actually control these behaviors. As a result, the disorder can mar the person's relationships with others in addition to disrupting their daily life, consuming energy, and diminishing self-esteem.
ADHD, once called hyperkinesis or minimal brain dysfunction, is one of the most common mental disorders among children. It affects 3 to 5 percent of all children, perhaps as many as 2 million American children. Two to three times more boys than girls are affected. On the average, at least one child in every classroom in the United States needs help for the disorder. ADHD often continues into adolescence and adulthood, and can cause a lifetime of frustrated dreams and emotional pain.
Mark, age 14, has more energy than most boys his age. Starting at age 3, he was a human tornado, dashing around and disrupting everything in his path. At home, he darted from one activity to the next, leaving a trail of toys behind him. At meals, he upset dishes and chattered nonstop. He was reckless and impulsive, running into the street with oncoming cars, no matter how many times his mother explained the danger or scolded him. On the playground, he seemed no wilder than the other kids. But his tendency to overreact--like socking playmates simply for bumping into him--had already gotten him into trouble several times. His parents didn't know what to do. Mark's doting grandparents reassured them, "Boys will be boys. Don't worry, he’ll grow out of it." But he didn’t.
The NIMH admits ADHD behaviors may not always originate with the youth:
The fact is, many things can produce these behaviors. Anything from chronic fear to mild seizures can make a child seem overactive, quarrelsome, impulsive, or inattentive. For example, a formerly cooperative child who becomes overactive and easily distracted after a parent's death is dealing with an emotional problem, not ADHD. So can living with family members who are physically abusive or addicted to drugs or alcohol. Can you imagine a child trying to focus on a math lesson when his or her safety and well-being are in danger each day? Such children are showing the effects of other problems, not ADHD.
In other children, ADHD-like behaviors may be their response to a defeating classroom situation. Perhaps the child has a learning disability and is not developmentally ready to learn to read and write at the time these are taught. Or maybe the work is too hard or too easy, leaving the child frustrated or bored.
...Research shows that a mother's use of cigarettes, alcohol, or other drugs during pregnancy may have damaging effects on the unborn child. It appears that alcohol and the nicotine in cigarettes may distort developing nerve cells. Other research shows that attention disorders tend to run in families, so there are likely to be genetic influences. Children who have ADHD usually have at least one close relative who also has ADHD.
And at least one-third of all fathers who had ADHD in their youth bear children who have ADHD. Even more convincing: the majority of identical twins share the trait. At the National Institutes of Health, researchers are also on the trail of a gene that may be involved in transmitting ADHD in a small number of families with a genetic thyroid disorder.
Then, having warned that other things such as family disruption, parental addiction, violent homes, and bad schools may cause youths to express what appear to be ADHD symptoms, NIMH then turns around and advises parents and other adults to ignore them--lest they feel guilty--and focus on getting “the right help” to treat the child:
What Causes ADHD? Understandably, one of the first questions parents ask when they learn their child has an attention disorder is "Why? What went wrong?" Health professionals stress that since no one knows what causes ADHD, it doesn't help parents to look backward to search for possible reasons. There are too many possibilities to pin down the cause with certainty. It is far more important for the family to move forward in finding ways to get the right help.
Scientists, however, do need to study causes in an effort to identify better ways to treat, and perhaps some day, prevent ADHD. They are finding more and more evidence that ADHD does not stem from home environment, but from biological causes. When you think about it, there is no clear relationship between home life and ADHD. Not all children from unstable or dysfunctional homes have ADHD. And not all children with ADHD come from dysfunctional families. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child's behavior.
ADHD Is Not Usually Caused by: too much TV, food allergies, excess sugar, poor home life, poor schools...
But there is help...and hope. In the last decade, scientists have learned much about the course of the disorder and are now able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem, and function in new ways (emphasis added).
It is strange advice that holds the causes of a disease are unimportant. Or to assert that scientists don’t know what does cause ADHD, but they do know what doesn’t cause it--the home, the school, or society. The evidence NIMH cites to back these conclusions isn’t very logical--true, not all youths from dysfunctional homes get ADHD, and not all youths with ADHD come from troubled environments. (That is like saying: unprotected sex doesn’t cause HIV infection. After all, not all people who have unprotected sex get HIV, and not all people with HIV got it from unprotected sex.)
And there’s something even more peculiar about ADHD:
One of the most exasperating and frustrating features of ADD, and one reason it has been so difficult to diagnose, is the inconsistency of its symptoms. A boy may be a terror in the classroom but no trouble on the playground; his homework is excellent one week and totally neglected the next. Children with ADD can often concentrate effectively when they are intensely interested in something, and they often behave better in small groups or situations with few distractions...
It is often difficult for a doctor or mental health professional to diagnose the disorder in an office consultation and even laboratory tests of attention and impulsiveness... because the symptoms often disappear when the child is with another person who is scrutinizing him closely as he confronts a novel situation or performs an interesting task.
Aside from the fact that ADHD must not be that exasperating and frustrating to diagnose, given the 4 million children, youths, and a smaller number of adults medicated for it, this is puzzling. If ADHD really is a biological brain disorder or genetic condition unrelated to environmental factors such as home or classroom or the behavior of adults around the child, why does it change so radically--even to the point of disappearing altogether--when the environment (including the adults at hand) changes? After all, true biological or genetic disorders such as Tourette’s or Down Syndrome may change a bit from time to time or environ to environ but remain clearly evident no matter where the child is.
Further, if ADHD is a “natural” brain deficiency that occurs across diverse social environments, why is it diagnosed so much more in the United States than in other comparably wealthy countries? The U.S. Drug Enforcement Administration reports that “the U.S. produces and consumes five times more methylphenidate (Ritalin) than the rest of the world combined” (Breggin 1998, p. 184). Roughly 90% of the entire world’s prescriptions for Ritalin, used to treat ADHD, are issued in the U.S., in fact. Are kids’ brains just physiologically different here than in the UK, Japan, or Italy?
ADD/ADHD typically are treated with stimulants, the most common of which is Ritalin. Ritalin is classed with cocaine and amphetamine as a psychostimulant; that is, it is a lower-dosage “kiddy speed.” Breggin, whose psychiatric practice includes work with disordered children, reports the effects of Ritalin:
Within an hour after taking a single dose, any child will tend to become more obedient, more narrow in his or her focus, more willing to concentrate on humdrum tasks and instructions... At the doses usually prescribed by physicians, children and adults alike are ‘spaced out,’ rendered less in touch with their real feelings and hence more willing to concentrate on boring, repetitive tasks (1998, p. 76).
These chemically-induced traits are an advantage for schoolwork as well as at-home behavior improvement. NIMH studies find Ritalin generally is effective in reducing “classroom disturbance” and improving “compliance and sustained attention” in hyper children and adolescents. Unfortunately, NIMH continues, the drug is “less reliable in bringing about associated improvements, at least of an enduring nature, in social-emotional and academic problems, such as anti-social behavior, poor peer and teacher relationships, and school failure” (Breggin & Breggin 1998, p. 77).
In short, Ritalin is a quick fix for disruptive youths. It does not produce long-term or large-scale improvement in behavior or school achievement. However, it does has some serious long-term side effects if taken for many years, as often prescribed: tardive dyskinesia (permanent facial tics), brain shrinkage, and greater risk of later abuse of cocaine and other stimulant drugs. Whether drug abuse is a consequence of taking Ritalin (which produces unpleasant withdrawal symptoms when not taken) or of the personality that is treated for hyperactivity is in dispute.
Prescription of Ritalin, Prozac, and other psychotropic drugs to persons under age 18 rose from 1.1 million in 1985 to 3.7 million in 1994 (80% to 90% to boys), the American Medical Association News reported in its February 23, 1998 issue. Ritalin prescriptions alone rose 8-fold from 1990 to 1999 and are now taken by an estimated 3 million youths.
Pharmaceutical companies now publicly advertise ADHD-control drugs as promoting family harmony and improved schoolwork. In the back-to-school themed Sunday newspaper inserts USA Weekend and Parade magazines of August 10, 2003, Shire pharmaceuticals promotes ADDERALL XR, “a single-entity amphetamine product,” under a smiling child and the adline, “Already Done with my Homework Dad!” The ad promises that ADDERALL XR “works fast for the start of the school day--with or without food,” “offers all-day ADHD symptom control,” and “helps improve academic performance.” The ad admits that side effects include “decreased appetite, stomachache, difficulty falling asleep, and “emotional lability” (and warns that “abuse of amphetamines may lead to dependence”) but nonetheless urges parents to “talk to your doctor today” to see if the drug “can add new meaning to your child’s life.” The same magazines carried Lilly pharmaceuticals ads promoting its ADHD-control non-stimulant drug Strattera under a logo resembling a highway sign carrying the odd message, “Welcome to Ordinary.”
Peter Breggin, MD, and Ginger Breggin, veterans in the war against psychiatric drugging of children, argue in The War against Children of Color that medicating children and youth will increase further:
As a result of the efforts of the psycho-pharmaceutical complex, including the drug companies and the federal mental health establishment, many millions of children will be psychiatrically diagnosed and medicated in the future. Prozac, with its stimulant qualities, will probably prove itself able to space out and suppress children in much the same fashion as Ritalin. We fear it will soon rival Ritalin as a widely used agent for the biomedical suppression of children, especially older ones.
... Most children labeled DBD [diagnosed with Disruptive Behavior Disorder], including ADHD, are in fact suffering from ... conflict and stress due largely to the adult world around them (1998, p. 103).
The explosive growth in ADHD diagnoses in children and adolescents suspiciously parallels the growth in family instability, parental addiction, crowded classrooms, and intolerance for nonconformity in youths over the last couple of decades. “Ironically,” generational historians Strauss & Howe observed, “where young Boomers turned to drugs to prompt impulses and think outside the box, today they turn to drugs to suppress their kids’ impulses and keep their behavior inside the box” (2000, p. 154).
ODD and CD. While ADD and ADHD are seen as biological deficiencies or as of undetermined cause, Oppositional Defiant Disorder and the more serious Conduct Disorder are judged to result from teenage attitude problems. The DSM-IV criteria for diagnosing ODD are shown in the box.
Within this definition, clinicians need not consider why a particular adolescent might be angry, argumentative, defiant, annoying others, getting annoyed by others, blaming, resentful, spiteful, vindictive, hostile, or negativistic. Nor are criteria such as “behavior occurs more than expected for age and developmental level,” “clinically important distress,” etc., specific; stamping one’s foot or yelling at adults a few times in 6 months could be seen as establishing disorder. The DSM states that the first three criteria for ODD are the most “discriminating”--that is, they lead to the most diagnoses (Breggin & Breggin 1998, p. 69)--which reflects their vaguely worded indicia of conflict with adults.
While ODD pathologizes youth who annoy adults, Conduct Disorder contains serious behavior criteria. The criteria for CD mostly involve law violations: assault, assault with a deadly weapon, robbery, sexual assault, burglary, theft, vandalism, and arson. Thus, CD provides a method for wealthier youth to be institutionalized rather than convicted through the criminal justice system, and for the psychiatric industry to involve itself in treatment of youths who might otherwise be incarcerated.
Five to 15% of school-age children and youths--2 million to 6 million in all--have ODD, the American Academy of Child and Adolescent Psychiatry estimates (12/1999, http://www.aacap.org/publications/factsfam/72.htm). Not surprisingly, girls
get tagged with ODD the most (older diagnostic criteria for ODD included swearing, a disease sign only diagnosed in females.) Researchers have suggested that ODD and CD are the same diagnosis divided by gender (Reeves, Wherry, Elkind, and Zametkin, 1987), with higher standards (and therefore weaker criteria for disease diagnosis) demanded of girls.
Interestingly, past CD criteria such as “often lies,” “has run away from home at least twice,” and “is often truant from school” have been refined. Diagnosers found many youths have healthy reasons for lying and running away, and dropping out of high school to work is often an economic necessity for poorer youth, not a mental illness.
How common is CD? The National Mental Health Association reports:
Conduct disorder is
more common among boys than girls, with studies indicating that the rate among
boys in the general population ranges from 6% to 16% while the rate
among girls ranges from 2% to 9%. Conduct disorder can have its onset early, before age 10, or in adolescence. Children who display early-onset conduct disorder are at greater risk for persistent difficulties, however, and they are also more likely to have troubled peer relationships and academic problems. Among both boys and girls, conduct disorder is one of the disorders most frequently diagnosed in mental health settings (NMHA 2003, http://www.nmha.org/infoctr/factsheets/74.cfm).
These figures would mean that some 1.5 million to 5 million teens suffer from CD, one-third of them girls.
Adding up these three major child-youth disorders, some 5 million to 15 million young people would suffer from at least one--as many as one-third of the youth population. It’s far fewer than that, however, since these diseases overlap--a kid who has one usually has the other(s). Nine in 10 youth diagnosed with CD or ODD are also diagnosed with other disorders, the most common of which is ADHD (NAMH 2003; Horne and Sayger 1990). If criteria common to other diagnoses were eliminated, "the diagnosis of conduct disorder might even disappear," they contend ((Lewis et al 1984, p. 519).
In short, ADD/ADHD, ODD, and CD are largely the same “disease.” They turn out to be more diagnosable from family and economic conditions than from attitudes or behaviors presumed generic to adolescence.
How do youths “catch” these “diseases of adolescence”?
While the criteria and disease model are based on the assumption that the youth’s attitude and conduct are the sole factors in diagnosing disorder, in practice the biggest single predictor of child/adolescent ODD or CD diagnosis is a parent with anti‑social personality disorder. Parental rejection, inconsistent harsh discipline, absent father, large family size, frequent shifting of parental figures, involvement with delinquent subgroup, and parental alcohol or drug dependence are also associated with CD (American Psychiatric Association, 1987). These factors, except for alcohol and drug dependence, are found more often among lower socio‑economic groups (Horne and Sayger, 1990). It’s not surprising, then, that diagnostic criteria for CD and ODD, strictly applied, lead to disproportionately high levels of diagnosis of low‑income, youth.
Prinz and Miller (1991) point out that lower socioeconomic‑group families suffer from higher rates of parental insularity, lack of economic and educational opportunity, and “child exposure to criminal behavior”:
A pattern of child behavior that is labeled as ‘aggressive’ may in some contexts be interpreted as normative and adaptive. Children who live in an impoverished neighborhoods replete with high crime and frequent challenges develop survival skills to manage their environment. Verbal and physical aggression can be necessary to survival and coping... and can be construed as normative in the context of the peer culture of these youth (pp. 380‑381).
For middle-class cases, Horne and Sayger’s clinical practice and review of numerous studies pinpoint family environment as the chief variable:
The common belief that oppositional or conduct problems on the part of a child or young adolescent represent a form of rebellion against an otherwise well‑functioning family does not hold up under scrutiny... aggression is generally not isolated within one individual family member but is a family characteristic" (p. 89).
Horne and Sayger also recommend combining “the separate tracks of conduct disorder research and child abuse research” since “conduct‑disordered and abused children may overlap or are often the same.” Thus “a systemic approach is recommended, namely, addressing marital or spousal conflict, conflict with authorities or government agencies, social isolation, and poverty” (pp. 25‑26). That is, screwed-up kids tend to have screwed-up parents, and social conditions strongly affect whether behaviors are seen as mental illness.
Lewis et al (1984) found that youth diagnosed with conduct disorder had parents who themselves had been in a psychiatric hospital (35% of the cases), in trouble with the law (18%), alcoholic (47%) or drug‑addicted (30%), and one‑third of the youth had been physically abused. Horne and Sayger note:
Many children referred for treatment could not be differentiated from nonclinic children based on their behaviors, but mothers perceived their children to be deviant... If parents' perceptions of their children's behaviors are not always accurate, it is possible that other variables, such as parental adjustment, enter into the decision to label a child as deviant (1990, p. 34)
Of particular note, “90% of the clinic children and 90% of the nonclinic children could be correctly classified on the basis of the negativism and commanding behavior of the parent” (p. 34). That is, CD‑diagnosed children can be independently identified more accurately on the basis of their parents' behaviors than on the basis of their own behaviors. Such parents have more difficulty parenting and tend to be more critical of their children than non-disordered parents.
The overwhelming majority of youth in inpatient treatment, many having “serious problems with relationships with their parents,” are admitted on the basis of evidence provided by their parents (Select Committee, 1985, p. 9). Yet “all major psychological theories of the origins of conduct problems in children state that parent and family functioning play key etiological roles” (Frick, Lahey, Loeber, Stouthamer‑Loeber, Christ, and Hanson, 1992, p. 49). That is, conduct‑disordered children overwhelmingly tend to have conduct‑ disordered parents, although the latter may be defined under corresponding adult diagnoses such as anti‑social personality disorder. The result is that children may be diagnosed as disordered, and forcibly incarcerated for lengthy periods of time, based largely or wholly on the statements of parents who themselves may be self‑serving and even more disordered (Select Committee, 1985).
Breggin is more blunt. Disruptive disorders such as CD, ODD, and ADHD amount to an “illness” that “consists of being disruptive to the lives of adults,” he argues. “...It encompasses every kid in the world who’s got any gumption. It’s as if the committee members (who designed the disease criteria) added up all the things their own kids ever did to aggravate them and took revenge” (Breggin & Breggin 1998, pp. 67, 68).
As with ADHD, ODD and CD often manifests itself only when the youth is in certain environments or in the presence of certain people, the American Psychiatric Association acknowledges. “Typically, symptoms of the disorder are more evident in interaction with adults or peers whom the child knows well,” the APA notes. “Thus, children with the disorder are likely to show little or no signs of the disorder when examined clinically” (American Psychiatric Association, 1987, p. 56). Mysteriously, the disease “tends to go away during summer vacation” (Breggin & Breggin 1998, p. 71).
To what extent, then, do defiance of and hostility toward adult authority among children raised in abusive conditions and/or violent societies represent a maladaptive behavior pattern which by definition characterizes a “disorder,” and to what extent are such responses adaptive and even normative? Horne and Sayger (1990) point out that running away from home, one criteria for CD, may, on the one hand, represent a youth's “chronically maladaptive reaction;” on the other, it may be “fundamentally healthy reaction to a pathological environment” (p. 138). Critics charge that treatment facilities have been willing to take advantage vague diagnostic criteria in the interests of profit and of assisting parents who want their children removed from the family and treated because of their children's inconvenient reactions to deficient parenting (Talan, 1988; Select Committee, 1985).
Treating “diseases of adolescence”
Reviews are generally pessimistic regarding the effectiveness of institutional, residential, educational, and pharmacological (with the exception of lithium in cases of extreme outbursts) approaches to treating CD and ODD (Carson and Butcher, 1992; Horne and Sayger, 1990). Institutional treatment is particularly criticized. An initial evaluation and two‑ to four‑year follow‑up of 53 adolescent girls hospitalized for conduct disorder found the outcomes “poor; 6% had died a violent death, the majority had dropped out of school, one‑third were pregnant before the age of 17 yrs, half were re‑arrested, and many suffered traumatic injuries” (Zoccolillo and Rogers, 1991, abstract, p. 973).
Text authors Carson and Butcher, in Abnormal Personality and Modern Life, report that inappropriate treatment may worsen the anti‑social tendencies of CD‑diagnosed youth:
By and large, our society tends to take a punitive, rather than rehabilitative, attitude toward an antisocial, aggressive youth. Thus, the emphasis is on punishment and on “teaching the child a lesson.” Such “treatment,” however, appears to intensify rather than correct the behavior. Where treatment is unsuccessful, the end product is likely to be an antisocial personality with aggressive behavior (Carson & Butcher, 1992, p. 545).
Because CD and ODD are regarded, with few exceptions, as family‑based disorders, “therapy for the conduct‑disordered child is likely to be ineffective unless some means can be found for modifying the child's environment” (p. 544). The chief treatment recommended is outpatient family therapy, emphasizing self‑control skills for the parent(s) as the foundation of more effective discipline of children (Horne and Sayger, 1990).
Minority youth predominate in the public and university hospital and outpatient populations studied by researchers (see Frick et al, 1992; Atlas, DiScipio, Schwartz, and Sessoms, 1991; Lewis et al, 1984). Youth in public programs are typically referred by courts, agencies, schools, and other professional agencies (Horne and Sayger, 1990). Low‑income, primarily minority, youth are much more likely than higher‑income youth to be declared delinquent and channeled into the criminal justice system. In the 1980s, for the first time, a majority of youth incarcerated in detention centers were minority (Select Committee on Children, Youth, and Families, 1985).
While the greater diagnoses of ODD and CD among low‑income youth holds true for public facilities, the diametric opposite is the case for private hospitals which now handle a large majority of youth cases. Private‑facility diagnoses of ODD and CD are much higher among middle and upper‑middle income youth, and nearly all private placements are requested by parents rather than by courts or agencies (Metz, 1991; Select Committee, 1985).
During the last 15 years, the constellation of CD, ODD, and unspecified “transitional‑disorder” diagnoses is the key factor in the rapid increase in adolescents committed to inpatient psychiatric facilities. Juvenile admissions to a sample of private psychiatric hospitals rose from 10,764 in 1980 to 48,375 in 1984 (Select Committee, 1985). The number of youth confined in locked psychiatric wards rose from 6,452 in 1970 to 16,735 in 1980 and over 36,000 by 1986 (Talan, 1988).
The trend toward greater psychiatric commitment for children and youth is continuing, according to the latest (2002) National Association of Psychiatric Health Services (successor to the National Association of Private Psychiatric Hospitals):
According to NAPHS’ 2002 annual survey, occupancy rates for inpatient child programs have increased 30.8 percent between 1997 and 2001, and 33 percent for inpatient adolescent programs.
Occupancy rates in child/adolescent programs is at an alltime high, according to the NAPHS 2002 survey. The median occupancy rates within freestanding residential treatment centers was 93.5 percent, and in hospital-based residential treatment centers it was 83.9 percent. The NAPHS report states that these exceptionally high occupancy rates, coupled with high admission rates, shows the critical need for these services and their limited availability (2003, http://www.medaccessonline.com/articles/index.php?articleID=123&artcategoryID1=6).
But does it? Investigations by Blue Cross and other insurers indicate “at least 50 percent of the admissions in this inpatient psych and CD programs for juveniles were inappropriate.” Ira Schwartz, director of the University of Minnesota's Center for the Study of Youth and Policy, stated the percentage was “probably higher” (Select Committee, 1985). Studies by the Children's Defense Fund and American Psychological Association have reached similar conclusions of substantial over‑commitment of juvenile offenders based on vague diagnoses of ODD and CD (Metz, 1989; Talan, 1988).
As Schwartz argues from extended study of juvenile psychiatric admissions, the chief admitting criteria for private facilities is not behavior, but insurance coverage or other evidence ability to pay (Select Committee, 1985). A study of 2,000 California youth psychiatric admissions showed youth with insurance were held in treatment twice as long as uninsured youth (Metz, 1991). Further, youth in general were held in private treatment facilities twice as long as adults with similar disorders despite the lack of clinical evidence showing that “juveniles are twice as sick or that it takes twice as long to cure them” (Select Committee, 1985, p. 29). Schwartz found that even though youths are admitted for “far less serious problems” than are adults, children spend an average of 55.8 days, and adolescents 48.6 days, in psychiatric wards, compared to 25.5 days for adults (Talan, 1988, p. 1).
The growth in private psychiatric confinement of the young parallels the decrease in youth in detention and public facilities. The number of non‑delinquent youth held in detention facilities declined from 199,341 in 1969 to 22,833 in 1981, while those in residential care declined from 155,905 to 131,419 (nearly all are status offenders). “The intent of the Juvenile Justice and Delinquency Prevention Act [of 1974] was not to have status offenders removed from institutions in the justice system only to have them incarcerated” in psychiatric facilities, Schwartz notes (Select Committee, 1985, p. 12). Only 10% of the mental health facilities surveyed in 1973 were operated for profit; by 1977, that percentage had grown to 50%, many involving multi‑facility chains (Select Committee, 1985).
By the 1990s, The entry of private, for‑profit interests into youth imprisonment and treatment was booming, boasting a 45% annual growth rate over the last decade into a $25 billion per year industry. One chain, Res‑Care, Inc., a Kentucky‑based “entrant into the at‑risk field” (as Wall Street puts it), generated $300 million in revenues in 1997 and added $95 million in acquisitions in just the first three months of 1998. The chain employs 15,000 and cares for 17,000 clients. Securities analysts estimate "very conservatively" that tougher anti‑drug and juvenile justice laws will double the teenage lockup and non‑residential‑treatment population from 103,000 in 1995 to 200,000 by 2004.
The high cost of caging prisoners and treating clients is the big reason states want to privatize and private interests want to economize. Earl Dunlap, of the National Juvenile Detention Association, argues that only a tiny fraction of juvenile offenders (about one‑fourth of one percent) require incarceration and intensive supervision to protect public safety, while others are best treated in smaller residential settings and local community programs. But, Youth Today reported in 1998,
Such an approach flies in the face of the economies of scale on which private operators depend. They usually prefer 500‑bed or more facilities that they can build in out‑of‑the‑way sites where land and construction costs are low, and unions are weak or non‑existent.
...Some authorities estimate that over 20 years, a prison bed can cost about $1.25 million to maintain. If treatment and rehabilitation costs are added, the amount could come to between $1.4 million and $1.6 million. For‑profit companies believe they can turn a profit on those kind of numbers. Since they must shave costs to make money, they generally set out to hire fewer employees and pay less in wages and benefits than state, federal or non‑profit operations (Kearns 1998).
In the 1970s, sociologist Robert Chauncey (1981) documented how fledgling federal drug and alcohol abuse agencies fabricated a “teenage drinking” crisis to win attention and funding. In the 1980s, as discussed earlier in this chapter, the financially struggling psychiatric hospital industry whipped up a profitable “teen suicide” scare to fill empty beds. It is easy to predict that the 1990s expanding "at‑risk" industry's interest in mass referrals, cost‑cutting, and warehousing in out‑of‑the‑way facilities will predominate over community and individualized youth treatment. Note that at the investment costs projected above, each treatment center bed would have to generate $200 per day in revenue (that is, perpetually full capacity, no uninsured or poor kids admitted) just to break even (Kearns 1998).
No wonder, then, that private psychiatric hospitals have aggressively promoted greater treatment of youths through advertising and marketing techniques. Private psychiatric hospitals all over the country have displayed "sensationalistic and frightening ads" (Peele 1995, p. 125) designed to convince parents that only inpatient treatment lies between their disturbed child and suicide or violent death. Such ads have included scenes of teenagers putting guns to their heads and parents visiting graveyards (Talan 1988; Peele 1995). However, neither specific program studies nor outcome measures have substantiated the efficacy of in‑patient treatment of these conditions (Horne and Sayger, 1990). Most private treatments rely on ineffective behavior modification and drugs, not family‑based therapies (Talan, 1988; Select Committee, 1985).
As Schwartz and committee members pointed out, a strong publicity campaign by psychiatric interests has sought to portray large numbers of juveniles as troubled and in need of treatment (Select Committee, 1985; Peele, 1989). The American Psychological Association task force found that increased advertising and marketing “have led to the flux of adolescent admissions. ‘There were an awful lot of empty beds out there before they started pushing for teenagers,’ Wilcox said” (Talan, 1988, p. 1), referring to the American Psychological Association’s study, led by Brian Wilcox, of the excess capacity of overbuilt hospitals in the late 1970s.
The House select committee chairman, former Rep. George Miller, D‑California, noted:
... as it appears on the TV screen, the message is to bring your child in and we'll take him. It's sort of like getting your car repaired. No fuss, no muss. Show up at the care unit if you have insurance or means to pay. It's almost as if the only diagnosis you need is that the parent says, “I want my child placed here” (1985, p. 31).
Thus, “a growing number of children are being placed in mental hospitals by frustrated parents who are either unable or unwilling to cope with problems that have traditionally been handled at home or by mental health professionals in their offices,” the American Psychological Association task force found. In‑patient treatment often costs $16,000 per month, or more. “You get some pretty rapid cures when the insurance runs out,” noted Ira S. Lourie, M.D., director of child and adolescent services at the National Institute of Mental Health (Talan, 1988, p. 1).
In response to criticisms, the National Association of Private Psychiatric Hospitals defended its juvenile admissions and treatment criteria (Select Committee, 1985). The NAPPH reply did not directly address the specific abuses cited by critics, but generally defended the association’s admissions criteria, “appropriate assessment,” and “fully implemented quality assurance” (p. 78). The NAPPH statement contends that lax or profiteering policies are not at fault:
Child and adolescent admissions to psychiatric facilities are increasing because more of them are seriously psychologically disturbed. The most recent President's Commission on Mental Health Report (1979), estimated that 1.4 to 2.0 million adolescents have severe psychological problems. More current objective studies confirm these figures. Tragically, these severe psychological problems often manifest themselves in suicide. An American teenager takes his or her own life once [sic] every 90 minutes, and this year, an estimated two million young people between 15 and 19 will attempt suicide. Suicide is now the third leading cause of death among young Americans.
Fortunately, the American public is becoming increasingly aware of the problem and increasingly accepting of the need for appropriate treatment. Public education campaigns have contributed to this heightened awareness of the growing numbers of troubled youth (1985, pp. 78‑79).
Unfortunately, the NAPPH's statement itself does not inspire confidence that the public campaign to increase juvenile psychiatric admissions is based on calm, clinical evidence rather than scare tactics and overblown promises. NAPPH's claim that a teenager commits suicide “every 90 minutes” yields an annual toll of 5,840, three times the true annual toll (1,849 in 1985). The estimate that “two million young people between 15 and 19 will attempt suicide” is four times that predicted by even the highest survey estimate. NAPPH's claim that adolescent psychological problems “often manifest themselves in suicide” is dubious: by their own figures, fewer than one in 1,000 adolescents with “severe psychological problems” commits suicide. Adolescents are the least likely of any age group to commit suicide except pre‑teens, and the much‑publicized increase in teen suicide is more likely to be an artifact of changing death certification standards than real behavior change (Gist & Welch, 1989).
Teen suicide: no epidemic
Legions of commentators today continue to cite the psychiatric hospital industry’s 20 year-old, fraudulent consumer advertising figure of “5,000 teen suicides every year.” Major mental health organizations feature blatantly wrong information, all exaggerated. For a typical example, Kidshealth.org (2005) declares, “teen suicide is becoming more common every year in the United States.” In fact, rates have dropped dramatically in recent decades. And it gets loonier. HealthyPlace (which calls itself “the largest consumer mental health site”) wildly exaggerates teen suicide, estimating “300 to 400 teen suicides occur per year in Los Angeles County” and that “available statistics may well underestimate the... suicide epidemic among our young people.” Alternet, the largest progressive online news service, holds the record. Its youth magazine, Wiretap, declared in December 2003 that “every year, 10,000 Latino youth in California kill themselves.”
These are ridiculous statistics. In fact, the Los Angeles County coroner reported 39 teen suicides in 2003, the most recent year available, plus three more deaths for which intent was undetermined. In California, around 50 Latino teens commit suicide every year, Center for Health Statistics reports show. Alternet editor Tai Moses refused my repeated requests to correct the gigantic error.
In fact, a teen is 2.5 times more likely to have a suicidal parent than the other way around, and the rate of teens killing themselves in suicides or self destructive accidents has plummeted by 60% in California over the last 30 years. In 1970, a record 241 California teens committed suicide, and another 449 died in deaths ruled as “accidents” (self-inflicted poisonings, drug overdoses, gunshot wounds, hangings, drownings, falls, cuttings, and single-driver traffic crashes) indicating self-destructive intent--690 suicidal deaths in all. In 2002, when 1.3 million more teens lived in California, there were 143 teen suicides and 134 self-destructive “accidents”-- 277 deaths in all. By rate, then, teen suicide and self-destructive accidents have declined by 70% in California over the last three decades.
Among youths in other U.S. states, a similar though less striking patterns appears: suicides and related accidents dropped from around 5,000 in 1970 to 3,000 in 2001 even as the teen population grew, a rate drop of 35%. Today’s youth, by a variety of measures, are much less self destructive than those of past generations--especially in California. A number of interest groups--psychologists, psychiatric hospitals, school authorities, health lobbies--are treating this trend as terrible news.
But aren’t teen suicide “attempts” and gay teen suicide epidemic?
“For a number of years, researchers have known that one-third of all teenagers who commit suicide are gay,” reports HealthyPlace.com, a statistic the group calls “incredibly shocking” (Torres, 2005). Indeed, it would be, since, by various estimates, gays comprise only 3% to 10% of the population.
Indeed, a 1989 report by the Department of Health and Human Services’ Task Force on Youth Suicide estimated that gays comprise one-third of all youth suicides--a rate three to 15 times higher than straight youth. This estimate was based on a single study by San Francisco social worker Paul Gibson. His paper, “Gay Male and Lesbian Youth Suicide,” found that 30% of 500 gay and lesbian youths he interviewed at San Francisco foster care group homes, runaway shelters, and other treatment centers had attempted suicide at least once. Based on his estimate that 10% of teens are gay, Gibson judged that one-third of teen suicides are by gay youth.
Gibson admitted his report was not a research study. His sample was of particularly troubled youth populations not representative of all teens. Actual suicide figures did not substantiate his claims. From 1985 to 1989, San Francisco (home to the state’s highest proportion of gay youth) recorded 17 teen suicides, a rate substantially BELOW the state average.
In 1994, federal health authorities empaneled social analysts and mental health advocates to examine the figures. “There is no population based evidence that sexual orientation and suicidology are linked in some direct or indirect manner,” they concluded (see Teens at Risk, 2005).
Similarly, Peter Muehrer, chief of the Youth Mental Health program in the Prevention and Behavioral Medicine Research Branch of the National Institute of Mental Health, found the research studies most often cited to support a link between sexual orientation and suicide are “limited in both quantity and quality... there is no scientific evidence to support this (30%) figure.” In fact, “only two relatively recent community-based original research studies have examined the sexual orientation of individuals who completed suicide. Both found that between 2.5% and 5% of the suicides in their overall samples were by people believed to be gay.” Although a far cry from one-third, this lower estimate must be considered a minimum, since “it is not possible to accurately compare suicide attempt rates between gay and lesbian youth and non-gay youth in the general population” (Rios, 1997).
The most impressive studies challenging the claim that gay youth kill themselves in large numbers are by staunchly pro-gay psychologist Ritch Savin-Williams of Cornell University, published in the December, 2001, Journal of Consulting and Clinical Psychology. Savin-Williams notes that Gibson’s study exaggerated homosexual teen suicide because it focused only on the most troubled teens.
Savin-Williams (2001) surveyed a more representative sample of 349 students, ages 17 to 25. He found that over half of their reported “suicide attempts” actually amounted to just “thinking about it” rather than actually attempting it. A second survey of 266 college men and women found that teens who think they are homosexuals were not much more likely to have attempted suicide than straight students. Homosexual students were more likely to have reported “attempts,” but these turned out just to be “thinking” about suicide as well.
Savin-Williams argues that inflating homosexual teen suicide statistics unfairly “pathologize gay youth” as “suffering, suicidal, tragic.” Gay advocates “do a disservice to ‘gay’ teens” when they “paint them with one rather narrow negative brush stroke,” he declared:
When I solicit a broad spectrum of youths with same sex attractions, and not only those who openly identify as gay, lesbian, or bisexual while in high school, and asked in-depth questions about their suicide history, I found statistically no difference in the suicide attempt rate based on sexual attractions. Although same-sex attracted youths initially reported a higher rate of suicide attempts, on further probing this sexual attraction disappeared (Savin-Williams, 2001).
The activist homosexual rights group Human Rights Campaign spokesman David Smith admitted that the claim that gay teens kill themselves at vastly higher rates is probably wrong. Nevertheless, he told USA Today, “Nobody disputes the fact being gay or lesbian in high school is not a very pleasant experience. The core problem is prejudice and harassment that goes unchecked in school settings. School officials take no action. We need to address that problem head-on” (Teens at Risk, 2005; Rios, 1997).
Nor is there evidence that more teenagers are “seriously psychologically disturbed” today; baseline data is not available to make such a claim (Goleman, 1989). “There is no great reason to believe that adolescents have more serious problems today than they once did,” Wilcox of the American Psychological Association task force concluded (Talan, 1988). The rate of admissions of adolescents diagnosed with serious mental disorders‑‑schizophrenia and manic depression‑‑has remained stable. Further, the massive growth in psychiatric commitments of California teenagers beginning in the 1980s occurred after teen suicide and related self-inflicted deaths had been declining rapidly for more than a decade and is therefore not explained by rising adolescent self-destruction. Rather, the recent increase in juvenile psychiatric commitments is not due to serious mental troubles, but rather “minor and family problems” often diagnosed as conduct disorder or other vague disorders, Schwartz noted (Talan, 1988).
Private hospital spokespersons, such as Dr. Frank Rafferty, vice president for medical affairs of the Health Care International psychiatric hospital chain, argue that such “minor problems” as running away, truancy, or stealing are in reality “extreme behaviors... a sign of serious mental illness” which “can require hospitalization” (Talan, 1988, p. 1). Yet professional studies typically conclude that most childhood disorders cure themselves.
An example from a New York Times story illustrates the “headline hype” versus research reality: “As many as one in five children suffer from psychiatric problems serious enough to impair their lives in some way, according to the surprising findings of several new surveys of the mental health of children,” the article began. However, details of the surveys noted that 20% of all 10‑year‑old boys display CD (declining to 7% by age 17), as do 10% of all 15‑year‑old girls (declining to 1% by age 17).
What is called “conduct disorder” was “found to cool spontaneously,” the studies found. Reports the National Mental Health Association (2003): “Research has shown that most children and adolescents with conduct disorder do not grow up to have behavioral problems or problems with the law as adults; most of these youth do well as adults, both socially and occupationally” (http://www.nmha.org/infoctr/factsheets/74.cfm).
Controversy exists within psychiatric professions about labeling “delinquent or defiant children” as psychologically disordered. “While many emotionally disturbed adults had history of childhood disturbances, there are also many children with these problems who go on to be well‑adjusted adults,” Duke University Medical Center psychiatric epidemiologist Elizabeth Costello said. “...Conduct problems are counted as psychiatric in the United States, but that is not the case in Europe, England, or even Canada” (Goleman, 1989, pp. C1, C9).
Eating disorders: Too fat or too thin?
In 1993, Gloria Steinem’s book Revolution from Within: A Book of Self-Esteem (Little, Brown) stated that “in this country alone … about 150,000 females die of anorexia each year.” The same figure appeared in the earlier, best-seller by Naiomi Wolf, The Beauty Myth: How Images of Beauty Are Used Against Women (Perennial, reissued 2002), which compared eating disorder deaths to a holocaust. The number also appears in the women’s issues textbook, The Knowledge Explosion: Generations of Feminist Scholarship (Cheris Kramarae and Dale Spender, Teachers’ College Press, 1992). The figure received its widest publicity when syndicated columnist Ann Landers repeated it in an April 1992 column: “Every year, 150,000 American women die from complications associated with anorexia and bulimia.” The original source appears to be the earlier editions of Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease (Vintage Books, reissued 2000) by Joan Brumberg, an historian and former director of women’s studies at Cornell University. Brumberg attributed the figure to the American Anorexia and Bulimia Association.
But the association said it was misquoted; it had referred to 150,000 to 200,000 sufferers (not deaths) from anorexia nervosa (see Best 2001). In fact, the National Center for Health Statistics lists just 8,000 deaths a year from all causes, cancer to car wrecks among women ages 15-24 (the age thought most susceptible to eating disorders)! In California, eating disorders (including anorexia, bulimia, and all others) directly cause about 75 deaths a year and are implicated as contributing factors in another 25. Of these 100 or so annual eating-disorder fatalities, 90% are self-starvation deaths in the elderly; fewer than 5% occur in women under age 30. In 2000, 2001, and 2002, California medical examiners did not attribute a single teenage death, directly or indirectly, to anorexia, bulimia, or any other eating disorder.
That the “150,000 deaths” figure could gain widespread credibility among sensible scholars, authors, and media figures, and go unchallenged for more than a decade, shows how vulnerable Americans across the board remain to even the most obviously and wildly exaggerated claims about disorders afflicting the young. Clearly, there are political purposes at work. For perfectly good reasons, many Americans are concerned about our cultural favoritism for excessive thinness in women. Dieting and eating disorders, even if rarely fatal except to the old, are a serious and endemic problem afflicting most American women and fewer, though growing, numbers of men.
The issue is not that pathological thinness and eating disorders are trivial matters; they cause great psychological distress and some health problems among those who strive to achieve all-but-impossible body image goals. This striving occurs among all ages, from diet-pill popping high schoolers to liposucked middle-agers. Drastic diets occur among old and young alike, and cosmetic surgery to reduce weight is found particularly among women (and more and more men) over age 35.
Rather, the problem occurs when interest groups often tied to the “culture war” argue the growth of some especially acute, widespread insanity in the young to justify their political and social agendas. It is repeatedly stated as fact that “media images” of feminine beauty cause young girls to become anorexic (to restrict food intake and/or exercise heavily to the point of losing 25% of normal body mass) and bulimic (a compulsive cylcle of binge eating and purging). This image not only contributes to the misperception of young women as uniquely psychologically impaired and unable to cope with their environments without some kind of therapy, it contributes to misdiagnosis of the cause of serious disorders that do exist.
In fact, intensive studies have failed to tie serious eating disorders such as anorexia and bulimia to media images or cultural preferences for thinness. Sufferers from these diseases do not appear especially aware of or influenced by such images; they are most strongly associated with “family dynamics,” particularly rigidly controlling and ambivalent parents whose daughters attempt to establish autonomy by drastic control of food intake (Berk 2002; Carson & Butcher 2000). By trivializing such disorders as a cultural phenomenon caused by teenage girls watching too much television or reading skinny-model fashion magazines, political groups divert attention from these diseases’ real causes.
Excessive concern with achieving appearance ideals is a social problem afflicting Americans in general, not simply the young. America’s striking inability to design effective policies to reduce the nation’s difficult social problems derives directly from authorities’ penchant for “juvenilizing” every issue.
Another example, from the other end of the bathroom scale, is obesity. Americans are the fattest of any people worldwide, with six in 10 adults overweight (Body Mass Index of 25 to 29.9) and one-third clinically obese (BMI over 30, or 15% or more heavier than maximum ideal body weight).
No sooner had America’s obesity epidemic gained widespread publicity than authorities and the news media teamed up to blame it on the young. America’s youth have indeed gotten fatter; 5% obese in 1970, around 15% today. This level did not approach that of their parents’ Baby Boom generation, whose obesity rate now averages 35% to 40%. Nevertheless, the official focus was on the “alarming” increase in childhood obesity, with identical features appearing in mainstream and alternative media outlets wth titles like “Generation X-Large” and fat children were hauled on talk shows for audiences to disapprove. School boards and consultants won quick popularity for banning soft drinks and junk foods from schools (but not from their own office snack bars), and culture warriors positioned themselves firmly on the side of beleaguered parents against the fast-food, no-exercise lifestyles being sold to kids by the fast-food industries and easy-life advertising (see Newman 2004).
The emphasis on slimming down the young might not be a bad strategy if it had been approached honestly. However, distortions predominated. For years, American Baby Boomers boasted about our healthy switch to salad, aerobics, and granola, away from booze, loungers, and Macsnacks. Then the Centers for Disease Control’s National Health and Nutrition Examination Survey scales exposed our monstrous phoniness: Boomers led America’s fat explosion. Our megabellies now crash overloaded planes. Arenas widen seats to fit expanding whalebutts. The Surgeon General’s obesity reports honestly admit that fat parents have fat kids, but in popular media and forums, authorities take the easy way out: blame the youngsters.
The gutless wonder (among many) on fatness is the Hoover Institution’s widely published scholar, Mary Eberstadt, who brands adult obesity a “socially negligible” problem; chubby kids are the crisis. So much so, she advises in a slap at feminists, that working moms should quit their jobs, stay home, and slim down the kids. “Fat children tend to grow up into fat adults,” Eberstadt insists--a message other health authorities echo in their crusades to ban sodas and candy from schools (but not their own office junkfood bars). Adults, in short, are too weak to curb our gluttonies.
The convenient notion that grownups can keep swilling beer and driving to the mailbox while forcing tofu diets and jogging regimens on kids not only disregards how kids learn healthy habits, it grossly misrepresents how America’s obesity epidemic ballooned and calls into sharp question the ubiquitous assertion today that keeping kids skinny protects against future fatness. In fact, today’s middle-aged hippos can’t blame their rotundity on childhood pudginess. Only 5% of baby-boom children and teens growing up in the 1960s and ‘70s were obese:
From the above trends, one could reach a conclusion exactly the opposite from the experts. It is not childhood, but middle-aged obesity that is driving national girth expansion and needs to be scrutinized.
While, in past generations, waistlines modestly broadened from teen years to middle age, yet Boomer obesity exploded 600% as we aged from 20 to 50. It’s not really surprising that fatter parents would raise fatter kids, beginning around 1980. After all, five year-olds don’t pick their own meals; they mostly eat what their parents put in front of them. Those long lines at the Krispy Kreme Drive-thru and Grease Gourmet Buffet are multigenerational. Younger kids eat and exercise, or fail to, like their parents.
The problem, then, isn’t fat kids aging into fat adults, but fat adults raising fat kids in their image. Unfortunately, American health and prevention authorities are downplaying grownup obesity and focusing their alarms and crackdowns on children and teens--which, like past crackdowns on youths, won’t work, because youth habits are founded in adult habits. For both thinness and fatness, as well as a host of other social and health crises, the popular politics and self-righteous “culture war” tone of blaming younger generations has taken precedence over sound, though more difficult, measures to address these problems in an integrated fashion.
Minnesota: does mass-treating teenagers work?
But, for all the dubiousness of diagnoses and fraudulent advertising used to promote treatment, is it possible they played a role in the declines in teenage problems over the last three decades documented here? Correlation is not causation, however; the decline in youth problems occurred across broad populations, not just those most heavily treated. Small-scale studies have not found evidence that treatment for CD or ODD improves individual adolescent behavior. A larger-scale example also suggests mass psychiatric treatment of teens does not produce better youth at the societal level, either.
In the early 1970s, Minnesota pioneered laws requiring insurance companies to provide coverage for mental health and chemical dependency treatment, creating “an enormous potential for the growth of these programs as well as the potential for abuse” (Select Committee, 1985, p. 8). Results were soon forthcoming. In 1984, 3,047 juveniles, a number equal to nearly 1% of the 13‑17 year‑olds in the state of Minnesota, were admitted to psychiatric hospitals in the Minneapolis‑St. Paul area, spending a total of 83,000 patient days in treatment. This admission level, more than triple the rate of 1976 and a 50% rise from 1983, does not include all hospitals, nor juveniles admitted to substance abuse or other facilities (Select Committee, 1985). Even allowing for out‑of‑state placements, Minnesota youth were psychiatrically treated at levels three to five times higher than youth elsewhere in the nation.
Minnesota thus provides a laboratory for the study of the effectiveness of mass treatment of youth compared to measures treatment is supposed to affect. If psychiatric treatment is accurately targeted and effective in reducing youth disorders, we would expect to see significant reductions in suicide, unwed birth, violent death, violent crime, and other crime among Minnesota youth compared to youth nationally. These are the major complications of conduct disorders (American Psychiatric Association, 1987) and the consequences private psychiatric treatment center advertising vigorously claims to deter (Peele, 1995; Select Committee, 1985).
In a measure of six key CD‑related indices‑‑violent crime arrests, property crime arrests, suicides, violent accidental deaths, nighttime fatal traffic crashes (a standard index of drunken driving), and unwed births‑‑Minnesota youth generally fared worse over the 1970‑1989 period than did youth nationally. Of these indices, only accidental deaths showed a larger net decline among Minnesota youth than youth nationally; violent crime (including rapes and homicides), property crime, suicides, nighttime fatal crashes, and unwed births among Minnesota youth showed net increases compared to youth nationally.
The treatment industry has based its advertising and scientific justification for more juvenile admissions on claims that treatment reduces just such problems as suicide, violence, substance abuse, and sexual outcomes. These claims cannot be demonstrated for individual programs nor for general outcome measures such as those of heavily treated populations such as Minnesota youth. Nor can treatment automatically be blamed for the state’s poor experience without more specific study.
Promoting adjustment to maladjustment?
The question becomes a familiar one in psychological ethics: what right or obligation do psychological disciplines have to “diagnose” and “treat” patient “diseases” which consist of reactions against harsh environmental conditions of poverty, abuse, and anti‑social behaviors imposed upon them by authorities? Are youths being served by “treatment,” including mood-altering medication, which promotes or forces their adaptation to detrimental environments?
For ODD and CD are not usually solely youth diagnoses, but symptomatic of a constellation of familial (and often social) breakdown:
When we take a look at the underlying vulnerabilities, we are almost invariably faced with such a variety of intrinsic problems (e.g., psychotic, organic, psychoeducational) and such a dearth of external family and institutional supports that we may wish that we had never looked so carefully at the youngster in the first place (Lewis et al 1984, p. 518).
So we don’t look carefully. The earlier views expressed by Lewis and other therapists that getting to the root of the youth’s causes was the key to treatment has been supplanted by today’s view that making the youth conform is all that matters. As NIMH advises, “it doesn't help parents to look backward to search for possible reasons... It is far more important for the family to move forward in finding ways to get the right help,” mainly in the form of psychoactive medication.
For unlike their therapist forbears, but like other professionals who deal with youths now, there is little interest today in “root causes”--that is, why the youth is “acting out” and “annoying adults.” The point is to get the youth to stop being annoying “by means of a variety of medications, behavior-changing therapies, and educational options” (NIMH 2003). As we’ll see, the increasing refusal of institutional systems to examine their own behaviors, and the substitution of forcing youths to conform as the first and only order of business, is not unique to adolescent psychology but reflects larger modern trends toward insisting that youth problems are caused solely by youths themselves.
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