What happens when we focus on child ‘mental illness’ and not on the whole family’s lived experience?

Hearing the stories of distress or sitting with the sadness and despair in the room, or the feeling that no one can help because everything has failed before is not the most challenging aspect of working therapeutically with young people and families. 

Even confused and terrified parents do not make my job more challenging.

What makes my job tough, is breaking down the entrenched beliefs that young people (and their parents) are being taught in school, in mental health awareness/first aid campaigns (both adult and child) and on TV and social media, that has been set up and perpetuated by our medicalised and diagnostic view of mental health.

I have had conversations with young people where they have asked if I can diagnose them; “Do I have clinical depression?” or “Am I bipolar?” After talking with me, will you be able to tell me what I have wrong with me?”. There is an expectation that I will offer a diagnosis of their problem. What I want to do instead is tell them (despite what TikTok says) that their response is completely normal given what they are experiencing (consciously, or most often, unconsciously).

Instead of the headline "3 children in every classroom will suffer from a diagnosable mental illness", why do they not say that 3 children in every classroom may be living with loss, family breakdown, parental mental health difficulties (often caused by parent’s childhood trauma), bullying, poverty, abuse, redundancy or anything which may cause distress within a family? After all, there can be recovery in all these issues.

And I want to add, none of us are immune from the issue I have raised above.  I also want to add that we are far too quick to assume a child has something wrong with them, rather than look to ourselves to investigate what is going on for us, as we experience our child’s ‘uncomfortable’ behaviours; Dr Shefali makes the point, “we are triggered not by their behaviour, but by our own unresolved emotional issues”.  

My clinical experience tells me the same.

Our values, attitudes, and family stories (whether we are aware of them or not) will greatly impact what we find acceptable in another. After all, we all respond differently to different people and different situations. It is our historic life events, early relationships and social contexts which greatly influence whether we reflect on a situation or whether we react.

Under the 'medicalisation of distress' model (basically meaning how our mental health services are set up in the UK) we prioritise the use of medical language to understand emotional distress, which potentially takes us away from the afore mentioned underlying issues which may be causing the symptoms, that is, acting out, outbursts, emotional dysregulation, disruption, noncompliance etc.

Having a diagnostic label does not explain the behaviour, it stops us looking underneath the behaviour.

As a result of these dominant and limiting narratives, we now have a struggling child, anxious parents, lots of conversations around what's going on, and less autonomy in parents to support their child, (we encourage referrals to GPs, CAMHS etc, and schools have a hit list of diagnostic labels to measure behaviour against, with little thought to what the child may be trying to communicate or what they need).

Potentially, we now have a child who now feels responsible for the wellbeing of everyone. We can only wonder what this burden can feel like for a young person, which often leads to an increase in behavioural problems, along with other symptoms, as the child/young person struggles to articulate what they are experiencing.

In addition, a significant dynamic begins to emerge within the family system. This is an important aspect to consider, the family context and relationships undoubtedly change with the conversations about the ‘child having an issue’ because whether you say it out loud, this is what you, and those around you will be thinking, further impacting the dynamic.

People begin to relate differently to the child, they may be identified as the 'challenging one' at school, parents may try to overcompensate, siblings become affected, grandparents make comments (after all they are of a different generation and will have their own ideas about what is ‘wrong’) parental stress increases and as a result, the child’s identity begins to skew, paving the way for the child to employ additional coping strategies and a clear inability to regulate 'like a ‘normal’ child'.

The original issue now feels monumental, the family system has adjusted to include child mental health issues and the distress is now attached to an impending label. 

The sadness here is that situation/trauma/incident to which the child was initially responding to (the key to recovery if we are secure enough in ourselves to notice it, and not follow a medicalised narrative), ebbs further away, out of sight, maybe to emerge 15/20 years later in adult counselling.

If you have experienced counselling yourself as an adult, you may be able to make more sense of that last statement.

In my experience of understanding and working with system dynamics, its often easier for family members to focus on the child than address the reoccurring and often uncomfortable pattern (which is often subconsciously) playing out within the family system.

Let’s remember, mental health/illness is a not something that develops externally with no cause. It's born out of life events, adversity, intergenerational traumas, beliefs, attitudes, relationships, family narratives and of course social issues.

There is always a story behind suffering, but we need to create space for this to emerge, for the child and for the family. This is not about parent blaming; parents are most often, doing their best, and it should not be about child blaming either.

Let’s stop raising wellbeing as a list of labels/diagnosis and as something that takes place within individuals. Let’s instead encourage young people to talk, connect, and make meaning from adverse and challenging life events, and most importantly, consider our role as family members in these.

Children are not the problem; problems are the problem. Family stories are the problem. Unresolved trauma in the family is the problem.

There is much truth in the notion that trauma gets handed down until someone in the family is ready to feel it.

Often it is that one family member which everyone thinks is the problem, is actually communicating, ‘we have a problem’.

“If there is anything that we wish to change in the child, we should first examine it and see whether it is not something that could better be changed in ourselves.”
― Carl Gustav Jung