[He] was co-director of the Harvard Mind/Brain/Behavior Interfaculty Initiative. He is a pioneer in the study of the cognitive and emotional development of a child during the first decade of life, focusing on the origins of temperament, and is author or co-author of more than 20 books, including the classic Galen’s Prophecy: Temperament in Human Nature (Basic Books 1995).This a great article on the prevalence -- or lack thereof -- of childhood mental illness. Kagan believes it has much more to do with how kids are being raised these days. I tend to agree, with some reservations.
The Meaning of Psychological Abnormality
Widespread diagnoses of childhood disorders trouble scientists such as Dr. Jerome Kagan, who argues here that social conditions, not biology, are often to blame. Kagan elucidates possible reasons for the increase, citing, among other explanations, pressures on parents to raise flawless children. He concludes by proposing ways to avoid misdiagnoses in the future.
The recent increase in the number of children diagnosed with autism, bipolar illness, or attention-deficit/hyperactivity disorder (ADHD), widely reported in the media, has created worry both among the public and among health officials. It is important, therefore, to ask whether this troubling trend reflects a true rise in mental illness or is the result of changes in the definition of childhood psychiatric disorders. The latter explanation is likely because the concept of psychopathology is ambiguous, and physicians have considerable latitude when they classify a child as mentally ill. Because a diagnosis of ADHD, bipolar disorder, or autism allows parents to obtain special educational and therapeutic resources that would not be forthcoming if the child is called mentally retarded, incorrigible, or uninterested in academic progress, doctors are motivated to please the distraught parents who want to help their child.
Psychiatrists diagnose a mental disorder when a set of behaviors or emotions is infrequent (usually possessed by less than 10 percent of the population); when the child or family is distressed by the symptoms; or when the symptoms interfere with the child’s adaptation to his or her society. Often distress and poor adaptation occur together. But because both the frequency of a symptom and its adaptive qualities change with history and across cultures, the prevalence of many mental illnesses also changes. For example, most children living in the American colonies during the 17th century were not required to maintain attention on an intellectual task for five or six hours a day—and there was no concept of ADHD. Social phobia also was less common because youths knew almost everyone in their village or small town. Although a Puritan child who resisted most parental requests would be classified as deviant and in need of help, psychiatrists today would not have classified a 6-year-old who resisted most parental requests as having oppositional disorder if neither the parents nor the child was concerned with the latter’s autonomous behavior and the child performed relatively well in school.
Changing Social Challenges
Each historical era within a society poses special adaptive challenges for its members, and traits that would be regarded as maladaptive and possible signs of a disorder in one era might be more adaptive in another. For example, adolescents who wore sexually provocative clothing and rejected the existence of God would have been both rare and a source of parental worry in 17th-century Massachusetts, but today these traits would not be regarded as signs of pathology.
In addition to changing definitions of pathology, three other factors are contributing to the apparent epidemic of childhood psychopathology in economically developed societies.
First, the contemporary American economy requires every child to complete high school with adequate language and mathematical skills, and preferably go on to receive a college degree, in order to obtain a job with some financial security. These were not requirements in the 18th century; Benjamin Franklin did not have the advantage of a high school education. The pragmatic requirement for academic accomplishment generates worry in parents who are concerned about their child’s future. Hence, they become anxious if they believe their preschool child shows signs of future academic difficulty.
Second, the availability of technologies that detect serious biological problems in the unborn child enables parents to make the legal choice of aborting these embryos. Because many do so, the proportion of severely abnormal children today is smaller than it was a century ago. Hence, a child with an obvious abnormality, such as Down syndrome, has become more conspicuous, leaving parents more vulnerable to a blend of anxiety, shame, and guilt if they sire a child with observable symptoms that are stigmatizing. It is not surprising, therefore, that many parents, especially those not considering abortion, are eager to take advantage of diagnostic techniques that might reveal a potential problem; if there is one, therapeutic interventions might then be implemented early in development.
The American ethic of egalitarianism, which obligates each individual to award dignity and respect to all citizens independent of their values or practices, is a third factor contributing to the increase in diagnoses with a genetic cause. This moral imperative makes it more difficult to blame parental neglect or ineffective socialization practices as contributors to aggressive behavior or poor academic performance and easy to award power to genes for which no one is responsible. Such an attitude frees parents of excessive guilt for the undesired symptoms and protects them from community criticism. The availability of technologies that assess genomes, along with the media’s advocacy of biological determinism, has persuaded many Americans that genes must be exceedingly potent, even though no scientist has found any particular gene, or cluster of genes, that is a consistent correlate of poor attention skills, hyperactivity, aggressive behavior, academic failure, chronic disobedience, or excessive shyness, independent of the child’s social class, ethnicity, cultural background, gender, and history of experiences.1
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