The Story of Childhood

by Libby Brooks

She didn’t appreciate the scale of adolescent unhappiness until she got there herself. ‘When I went into hospital I started hearing about how many teenage psychiatric units there are, and how there’s this underworld of depressed teenagers,’ she says. ‘Everyone in these different units knew each other, and there was this whole scene of depressed people. So maybe it is happening more, and our culture alienates a lot of people too, people who don’t want to be part of that gangsters crowd and can’t find any other good friends. Loads of teenagers don’t really know who to try and be.’

  In 2004, the Nuffield Foundation published a detailed assessment of the mental well-being of three generations of fifteen-year-olds. The most authoritative study of its kind to date, it found that behavioural problems had doubled between 1974 and 1999, while emotional problems rose by 70 per cent. Comparable work in the United States and the Netherlands has not identified similar trends.

  The deterioration of children’s mental health in the UK has been stark. Since the mid-1980s, emotional problems like depression and anxiety have increased for both girls and boys. Adolescent conduct disorders showed a continuous rise over the whole twenty-five-year period, though the study found that this related to non-aggressive behaviour such as lying and disobedience, rather than fighting or bullying. The researchers ruled out the possibility that these results were attributable to changes in the thresholds for what was counted as a problem. Teenagers were not simply being rated as more disturbed; there were real changes in the numbers experiencing poor mental health.

  The Nuffield researchers offered a range of possible causes for their findings. While expectations of academic achievement have increased, opportunities for children who struggle with testing have been restricted. Young people are finding it harder to enter the job market, which may affect how they see themselves and their economic role.

  As young people spend many more years in full-time education, and remain financially dependent on their parents for longer, the transition to adulthood has become increasingly mutable. Perhaps we parent differently from families in other countries, the researchers suggested. Or maybe something has changed in non-familial socialisation over the past twenty-five years.

  Identification of risk factors is at an early stage. But the Nuffield study did conclude that family breakdown and poverty made only modest contributions. Although children in stepfamilies and single-parent families are unhappier than those with two natural parents, mental health has become dramatically worse in all three categories, and the deterioration has in fact been fastest among children in conventional families. Similarly, although teenagers from wealthier backgrounds had better mental health, the decline was significant across all social classes, and particularly for middle-class children.

  The psychiatrist Professor Peter Hill, who worked at Great Ormond Street Hospital and is now in independent practice, notes that although children’s experience of physical abuse and deprivation has decreased over the generations, ‘other more shadowy influences, certainty of personal identity, security of career structure, have taken their place’. In particular, he points to work carried out in the United States, which found that adolescents who were able to adopt a social or professional identity handed down to them by their parents tended to be happier.

  ‘We are more alert to young people’s distress now, and more inclined to see it as distress rather than as reprehensible behaviour. But,’ he cautions, ‘we don’t like children in this country, even though we’re going to be so dependent upon them with the current demographic shifts.’ He argues that the position of the Children’s Health Tsar has been serially emasculated, and that we need a Children’s Minister in the Cabinet with the power to veto.

  Despite the Nuffield study’s gloomy prognosis, Hill remains hopeful about this generation. ‘I think that today’s fifteen-year-olds are much more impressive than fifteen-year-olds in the 1950s. I don’t think that they are less resilient, but that they are more emotionally literate. Soap operas, for example, have been wonderful for that. Young people are much more aware of the impact of arrogance and prejudice, and much more able to be sensitive to those sorts of things.

  ‘The problems arise when other influences make them less likely to display that. For example, the amount of alcohol consumed by the young is terrifying, and once you’re drunk it’s hard to be sensitive to other people.’

  Hill says that one of his greatest concerns is the abuse of skunk. ‘It’s emerged in the past three or four years as a major problem, and I don’t think that parents realise that they didn’t smoke the same stuff that’s around now. I’ve seen a number of youngsters going quite seriously mad on it, and the parents are indulgent because they think they know what their children are buying.’

  The increase in alcohol and drug abuse, especially of the stronger types of cannabis now available, must certainly have an impact on mental well-being. A variety of other factors also play their part. Hormonal changes are generally thought to have a small impact, though they can be significant for a minority, and research continues into the effect of adolescent brain development on mental health. Deteriorating diet may have a direct biological impact. In one study, young offenders who were given multivitamins and fatty acids over a two-week period showed a 34 per cent drop in antisocial behaviour.

  Parenting clearly makes a major contribution to children’s psychological well-being, particularly the quality of care received in the earliest years of life. There is also ample evidence that increased consumer choice and affluence has been accompanied by a general decrease in levels of satisfaction.

  Like all young people, Laura and her friends are bombarded with messages about celebrity and wealth. She says that ‘loads of teenagers don’t really know who to try and be’. The tyranny of absolute choice can make the universal struggle for identity feel like a personal failure. And the people who teenagers best know how to emulate are those they watch on MTV, guiding them round their luscious mansions. When expectations reach this level of extravagance, the ordinary disillusionments of growing up become infinitely harder to bear.

  Gender is another factor. As a middle-class female, Laura may be particularly vulnerable to psychological distress. In a study of fifteen-year-olds over a twelve-year period, published in 2003, the Medical Research Council found that girls with professional parents were more stressed, particularly in relation to their academic achievement, than those from the lower social classes and boys. It suggested that these girls were doubly disadvantaged by a combination of newer educational concerns and more traditional worries about personal identity, in particular body image.

  Now it would seem that girls, especially middle-class ones, expect to excel at school, to go on to university, and to control their fertility whilst advancing in a more equal professional environment. But the advances of feminism only take young women so far. They have to wrestle not only with the extended pressures that these possibilities bring them, but with a culture that tells them they must still look and behave – particularly sexually – in a certain way in order to be truly successful. There are so many more hurdles to leap over in order to achieve perfection that the race must feel never-ending.

  Laura’s mum has been abroad for a conference, so her dad has been staying in the house. She prefers living with her mum but she does get really stressed and she only buys healthy food. ‘I think I’m as close to my dad as you could be to a dad, but because we don’t live together there’s not as much tension.’ She sniffles again. The pollen is high this morning.

  ‘I don’t like when people say, “Oh she comes from a broken family”, because it’s just stupid. I think it’s one in three or two in three people get divorced now. It’s not like any of us are hard done by ’cos we still see my dad on a regular basis. I think my sister was a bit upset when they got divorced but I was too young. It doesn’t really matter to me at all. I can’t even imagine my parents being together.’

  Laura admits that she’s kind of given up on school. She has been off
ered a place at Fitzroy House in September and, when she turns sixteen, she will apply to the London School of Beauty where you can learn to be a make-up artist. She’s really looking forward to that, because make-up’s something she really wants to do. ‘I think if later on in life I need GSCEs or A levels I can go back and do them ’cos there are all sorts of colleges for that. I’d like to get a job related to beauty and make-up. If not I’d like to have something to do with writing. I might be unfulfilled by just being a makeup artist. Ever since I was really little I wanted to write novels and stuff.’ What would be ideal would be writing for a magazine about beauty. There are many contradictions in Laura’s world.

  It is now later in the summer, and she has been on holiday to Cuba with her mother, sister and mother’s friends. It was nice, but her tan is fading. The builders are here, and the front of the house is encased in scaffolding. There are dust-sheets all the way up the stairs and a van blocking the back driveway. One of their jobs is to convert the attic into a new bedroom for Laura, with a private bathroom. She is wandering around, half-dressed, in shorts and an airtex vest. It’s weird having all these workmen in your home.

  She hasn’t seen Kevin for ages, because she went to Cuba and now he’s gone to New York. But he said that he was missing her so much that he’s changed his ticket, so he’s coming back a whole week early. Laura wraps her arms around her bare legs and stares ahead, preparing her caveats. ‘It’s cute but – not in a mean way, it’s probably just me being an idiot, I really like him – I feel like being single. But now because he’s paid £150 out of his own money to come back early … you can’t break up with someone after they’ve done that.’ Her voice will always be light, but today it has gained some resonance.

  Laura missed her last appointment with the psychologist. She has her own problems within the system, but for many others a postcode lottery of services means that they are never referred in the first place. The National Collaborating Centre for Mental Health estimated in 2005 that only a quarter of children with a depressive illness were receiving treatment. Although one in ten school-age children has a diagnosable mental disorder, a minority are seen in specialist out-patient clinics, and referrals are driven largely by how much trouble the child, or its parents, are causing to other people.

  Until very recently, drug prescription to children has been escalating. At the end of 2003, more than 50,000 children were taking antidepressants. Prozac is still approved for use with young people, although, in the autumn of 2004, other antidepressants of its kind were withdrawn after concerns were raised about their side-effects, including self-harm and suicide.

  Then, in the autumn of 2005, the government’s National Institute for Clinical Excellence (Nice) responded by telling doctors to stop prescribing antidepressants to people under the age of eighteen. (Previous Nice guidance had already cautioned against using antidepressants as a first resort.) Children with mild to moderate depression should be given advice on diet and exercise, the guidance told GPs. In moderate to severe cases, a three-month course of individual cognitive behavioural therapy or family therapy should be offered, with psychotherapy provided for the most serious instances. Only if there has been no improvement after four or five sessions should the doctor – and by this stage it would be a psychiatrist – consider prescribing a fluoxetine such as Prozac.

  Although welcomed by campaigners, health professionals have pointed out the significant shortage of trained NHS staff to provide these therapies. The availability of drugs had, one psychiatrist suggested to me, made doctors less willing to consider the complexity of a child’s individual situation. Drugs are far easier to prescribe and control, and much less expensive, than cognitive behavioural or talking therapies. Similar criticisms have been made regarding the use of Ritalin to treat ADHD, and some believe that it is over-prescribed because adults are prepared to tolerate an increasingly narrow band of behaviour in children.

  When Laura talks about her suicide attempts it is as though she is describing another person and, she would argue, she is. ‘It just occurred to me one day in school. I was sitting in Spanish and I was thinking sad things, and it just snowballed. So I thought “I’m looking ugly today”, and then I thought, “I bet everyone else is feeling really disgusted by me”, and then slowly it goes into “No one really likes me, my family doesn’t like me” and you can’t see any way out.’

  Her mum’s been really good lately. ‘Sometimes she gets too worried about me, checking in my room all the time, or calling me every five minutes.’ Laura takes a moment to connect why her mother might be especially concerned about her youngest daughter. ‘You’d think someone who took an overdose would think about what their family were feeling. But I just thought I was going to die and I didn’t think of anything else happening. I woke up the next day and I was really confused. I didn’t understand. I did feel bad about them. They were crying and stuff.’

  It’s a sunny lunch-time and despite, or perhaps because of, the builders’ presence, silence covers the house. Laura talks about the second time she tried to die. ‘That time, it was in a back alley. I was on observation, but the staff nurse must have forgotten and she let me out. It was actually really bad because the chemist is only supposed to sell you thirty-six paracetamol but they sold me two boxes of thirty-six which is actually illegal,’ she notes primly.

  She was throwing up loads. ‘Because that time it was just paracetamol but the first time I didn’t know anything about overdoses and I was taking antibiotics and hay-fever tablets and that’s why I messed up.’ She yawns discreetly, covering her lovely mouth.

  Autumn arrives early this year, and on my next visit the builders are still here. The fire is flickering in the sitting-room, and Laura is making herself tiny in the corner of the sofa, hugging a russet cushion into her chest, chewing at the corner like a comforter. Her skin is terribly pale. It’s a working day, but her mother is at home, offering her daughter tea, juice, the yoghurt she likes. There are invisible eggshells in this house today. Laura doesn’t say that she tried to hang herself at the weekend.

  She watches the rainy day through the front window and says she feels cosy. She’s started at Fitzroy House four days a week. They have school in the morning, though it’s really basic, and then therapy in the afternoon. She’s had a couple of one-to-one sessions, and then they have all these different groups, when they just talk: cooking group, girls’ groups, one called ‘problems on a plate’. At least it’s something to do with your mind, though they gave her a book to read at home that was for ages twelve and under. She’s been accepted on to the beauty-therapy course. So that’s really good, she says, as though uttering it will make it so. She wants to start in January but might have to wait until next September because she’s too young.

  She split up with Kevin. It had been up and down for ages, but he was really sad and that made her feel a bit guilty. He’s got loads of mates, but they’re boys so they don’t really talk about girl stuff, she whispers. Her voice has been charmed away again. ‘Me and Kevin, we were breaking up and getting back together so much I don’t feel sad about it any more. I’d been expecting it for a while.’

  Laura isn’t sure what shape this season will take. ‘Keep going to Fitzroy House, do my room.’ The thought of her room, her turret at the top of the house, enlivens her. ‘I want it to be all white. Me and my mum have already bought a really nice bed and a nice wardrobe. I’m going to have it white but flowery in places, quite girly. I’m going to have just floorboards, and a really, really, really nice but really expensive dressing-table I’ve seen. It’s white, and it looks really antiquey, and it’s got curved legs and then two upright wooden poles with a big swing mirror in between them. It’s £400 but I’m going to get it for my birthday from Mum and Dad.’

  This birthday, Laura will be sixteen. ‘I always think I’ll feel different after birthdays, and sixteen does sound a lot different to fifteen with it being like growing up, and not being a little girl any more. But then I always
think that and when it gets to my birthday I don’t feel any different. I already smoke, I don’t have sex, and I don’t really care about driving.’

  Laura says she just wants to stop being unhappy. ‘Like when I had my first meeting with my therapist [at Fitzroy House], they said that you have to get worse before you get better, and that I’d probably be OK by January. But I want to be better before then.’

  Any society’s well-being can be measured according to the gap between the aspirations of its members and their attainability. Such invidious comparisons dominate the contemporary understanding of what it is to be happy. The economist Richard Layard explores in his book Happiness what he calls ‘the First World paradox’ of a society which seeks and delivers greater wealth than ever but is little happier. He argues that the gospel of individualism has proved to be a false one. It is based on the self-defeating notion that having more than others makes you happier, which then conversely makes those others unhappier. Layard advocates a return to the Benthamite notion of ‘the common good’, but how might that be achieved in a society adrift from shared moral or spiritual values?

  Freud believed that the two central components for a happy life were love and work. A few years ago, the psychiatrist Anthony Clare offered an interviewer a more detailed prescription for happiness: ‘One, cultivate a passion. How important it seems to me in my model of happiness to have something that you enjoy doing. Next, be a leaf on a tree. You have to be both an individual, you have to have a sense that you are you and that you matter, and at the same time you have to be connected to a bigger organism, a family, a community … My third rule, avoid introspection. Next, don’t resist change. Change is important, people who are fearful of change are rarely happy. I don’t mean massive change, but enough to keep your life stimulating. And finally, live in the moment, live now.’

  Many childhood psychiatric disorders are eminently treatable, and doing so can furnish young people with skills that will serve them a lifetime. A more holistic approach to mental health, placing it on equal footing with physical well-being, would pave the way to a better understanding of how psychological distress affects other problematic aspects of growing up, like criminality or educational underachievement. But improving children’s mental well-being requires much more than action on specific risk factors, like diet.