Promises, promises… We take it as a given that schooling is good for us, that overall population health increases with increased educational attainment. Indeed, from their founding, public schools have promised to improve population health as part of their basic mission. As a result, in the name of health concerns, schools have long held a powerful place in monitoring their pupils’ lives and habits, and have been granted the authority to place treatment requirements on pupils as a condition for continued school attendance.
It’s true that when a society first develops public schooling as a system, people generally experience better health. The move from a largely illiterate populace to a literate one reliably improves the conditions for pregnancy, birth, and early childhood, leading to reductions in both the birth rate and premature death. However, those early gains do not necessarily continue. Increasing years of schooling can actually produce diminishing returns and higher costs of entry — costs that may never pay off, especially for those who can least afford it. This break in the reward trend is not surprising. Paul Axelrod’s historical work shows that public education demands that students be socialized into upper-middle-class values, even if they can never expect to enjoy the privileges of the school founders.1 Indeed, with the largest North American population of university-educated graduates ever, there simply are not enough well-compensated and low-injury-risk professions to go around. Increased levels of education and longer years spent in schooling no longer reliably correspond to increased quality of life, nor to a “leg up” in the professional world.
In short, policy makers mistook the early 20th-century correspondence between a university degree, wealth, and vigorous health to be causative, with education as the cause.2 The assertion failed to understand that education for the elites was merely a marker of all the privileges they already enjoyed. But what is worse, standardized education exposes many of our children and youth to a new risk: medicalization of their learning, and a triage system that can actually threaten the well being of students who are simultaneously “gifted” with learning disabilities.
Increasingly, we permit schools to police multiple aspects of our habits. In particular, our efforts to create a compliant, work-ready youth population may actually be making mental health worse for some youth. Indeed, a significant and rising percentage of postsecondary students take anti-anxiety, anti-psychotic, and anti-depression medications at any given time, and swamp the resources of campus medical centers. So where does this begin?
Elementary and Secondary Schools: Normativity and Difference
From the earliest grades through postsecondary, children and youth are subject to surveillance and policy that privileges “normal behavior” without having a critical sense that what is normal is merely common, not necessarily good. As a result, some of the more sensitive children can be shunted as early as kindergarten into the world of mental health diagnosis and management.
Arguably, these “early interventions” are meant to ensure that our children grow up to be “healthy,” where health is defined by the state, comprised of its productively employed and happy consumers, being economically competitive on the global stage. To the extent that a diagnosis relieves pressure on parents (and children) otherwise accused by the school system of being incompetent, medicalization has some utility. However, many families lack access to the resources that would do anything other than provide a diagnosis. Basic psychotherapy, the sort that can be demanded as a condition of continued enrolment, reaches $200 per hour: well beyond the budgets of many families. And the bureaucracy of social welfare for people with identified disabilities remains an enormous barrier. So, they are left only with the stigma of a diagnosis, and the deteriorating health that results from having no support. These diagnoses may even be the imposition of system-wide failures onto individual students.
Anthropologist Margaret Lock has studied the medical transformation of difference into disease: a consequence of equating the statistically normal with the desirable good.3 Sociologist Claudia Malacrida proposes, for example, that AD(H)D is a symptom of poor educational structures and resources, not a personal sickness. Meanwhile, public “awareness” of ASD (Autism Spectrum Disorder) has rewritten the socially inward/awkward and highly focussed child not as one of our treasures, but as one of our troubles, turning our would-be Alan Turings and Jane Austens into cases of “mental illness.” This transformation has relabelled those who occupy the statistical tail of intelligence and introversion as Asperger variant autism (asserted that it is often co-morbid with AD(H)D) and has rendered “giftedness” as a form of pathology, a characteristic for ordinary teachers to squelch. The great bell-curve of averageness has become a deadening normativity that has actually been making some of us sicker.
For children and youth who exhibit both extreme giftedness and some form of learning difficulty, public education is squeezing the boundaries on “normal” and the institution is, arguably, doing more harm than good to some of our children, creating poor health where it claims merely to identify it, shutting the lights on creativity and talent in an effort to make the outliers more average. Under the aegis of “concern,” schools commonly hold a number of mental health “outreach” assemblies throughout the school year at any typical school above the sixth grade level.
What happens next: campus panic in the guise of concern
In the wake of high profile cases of violence on university campuses in North America, colleges and universities across the continent have implemented various “first aid” programs designed to identify potential mental health crises before they happen. My campus “Blue Folder” contains basic instructions for monitoring our students, and advises a three-step process for managing students who exhibit “unusual behaviour”: first, identify signs of mental health problems; second, provide initial help; third, direct the student toward mental health intervention as a requirement for continued registration.
The very first step, identification, assumes that “healthy” behavior means “fitting in” or being “like everyone else” — which at our school means adhering to the norms of a campus known for endless parties throughout football season, the largest regional St. Patrick’s Day street party in the province, and a month of drinking for all of October while the town celebrates the largest Oktoberfest this side of Bavaria. There has been no pause in the development of our mental health policies and guidelines to ask whether we have built a campus culture that would qualify as the kind of “sick society” that Robert Edgerton identified.4 Although not manifest in the language, my campus experience over the years has shown that the second and third steps form a trajectory toward removal of students who do not “fit in.” This very same school, however, has been criticized by the criminal court system for failing to protect students from their assailants on campus. In other words, in a world where sexual assault is normal but “Asperger” is not, a rapist is not subject to the whims of the blue folder, but a student with ASD is.
These sorts of on-the-fly policies at every level have poor records of accurately identifying actual threatening illness, have demonstrated no successful prevention of violence, and have successfully ejected students who display “unusual behaviours,” preventing them from registering for classes, and, in some cases, creating emotional/mental distress where there had previously been only somewhat unusual behavior.
In such an environment, the most vulnerable students are often the most talented because intellectual giftedness often corresponds with learning disabilities that include delays in processing speed and moderate Asperger/autism spectrum behaviors. Such students can easily find themselves placed on “compassionate leave” — required to submit to psychological assessments that are not easily available, and offered no health support. All because they appear unusual in the face of a party culture that lacks the manifest rules that those on the spectrum need in order to “pass” in neurotypical environments. For those on the spectrum it’s very hard to know how to navigate the landscape of “normal” bad behavior, and the ASD student is, therefore, at risk of ejection because they miss the mark when they try to cope. Conversely, it is well-known on campuses where sports rule the day across North America that star athletes can engage in actually atrocious, dangerous, and assaultive behavior without significant consequences or interruptions to their attendance. We are damaging one kind of health in the name of a perniciously normative health, then, at all stages of what was meant to be a public good.
Mary Louise Adams, The Trouble with Normal: Postwar Youth and the Making of Heterosexuality (Toronto: U. Toronto Press, 1997).
Andrew Lakoff, “Adaptive Will: The Evolution of Attention Deficit Disorder,” Journal of the History of the Behavioral Sciences 36.2 (2000): 149–169.
Jeanette Miller, “A Tale of Two Diseases: ADHD and Neurasthenia,” Nursing Clio, January 22, 2014.
Rachel Pike, Supporting students with Asperger Syndrome in Higher Education (London: National Autistic Society, 2005).
- Paul Axelrod, The Promise of Schooling: Education in Canada 1800-1914 (Toronto: U. Toronto Press, 2003): 25-25. Return to text.
- Malacrida, Claudia. Cold Comfort: Mothers, Professionals, and Attention Deficit (Hyperactivity) Disorder. (Toronto: University of Toronto Press, 2003). Return to text.
- Margaret Lock, “Accounting for Disease and Distress: Morals of the Normal and Abnormal,” in Gary Albrecht et al., The Sage Handbook of Social Studies in Health and Medicine (London: Sage. 2000), 259-276. Return to text.
- Robert Edgerton, Sick Societies: Challenging the Myth of Primitive Harmony (Don Mills: Macmillan Canada, 1992). Return to text.
“Sociologist Claudia Malacrida proposes, for example, that AD(H)D is a symptom of poor educational structures and resources, not a personal sickness.”
Easy to say. R.D.Laing insisted that schizophrenia was caused by relationships within families. I hope we would now avoid sociological reductionism, just as we try to avoid other kinds of monocausal theories. In the case of “mental illness,” we now know a little too much about the interaction between neurological disorders and other influences.
If this refers to the extensive diagnosis of ADHD among schoolchidren, I might agree, provisionally. Many of the diagnoses are initially “made” by teachers, who find some children hard to handle. They are handed over to doctors who have inadequate training in such matters, and who have a vested interest in finding new consumers of psychoactive drugs. The children are rarely given psychological tests, let alone brain scans. I think it likely that the drugs are given to too many children, which would in itself cause problems.
However, this is not to say that ADHD is not a real condition, often seen to be passed on in families. After all, adult diagnoses have little or nothing to do with school systems. The only question that arises is whether the observed remission as the majority of diagnosed children become adults is a matter of brain development or mistaken diagnosis.
We don’t have to reduce ADHD, or Asperger’s for that matter, to mere fashion, in the manner of Edward Shorter or Elaine Showalter.
As for ADHD and Asperger’s being the same or co-morbid, it is true that Americans used to have difficulty recognizing Asperger’s and UK psychiatrists had difficulty recognizing ADHD, because the syndromes were identified within separate medical cultures. However, that problem is beginning to fade. But to say that they are the same is simply to ignore the symptoms. Only an online pop quiz would get the two confused. There are other ailments that one might identify as co-morbid.
As for school systems attempting to turn out students who are conformist and unquestioning, except within narrow limits, this is surely something which all educational systems have always tried to do. Working against that expectation was the crime of Socrates. There are always questions that must remain unthinkable, if the student is to be accepted as “normal.”
The sociologist Jules Henry pointed this out back in the 1960s, in his Culture Against Man.
The identification of co-morbidity of AD(h)D with ASD refers to school systems asserting that they travel together. It is not the assertion of the author that the two are the same, nor even that they are, objectively speaking, properly apprehended together.
The article is specifically about how a particular form of McDonalized educational system largely from K-12, but now into post-secondary as well is imposing diagnoses in precisely the manner that you outline here, David. And the open question of remission or recovery as adults absolutely raises the issue of inappropriate diagnosis earlier, and also the possibility that removed from a poisonous system, the symptoms will abate, or become “positive traits”. There are some distinct “positives” to being able to place one’s attention in many places at the same time, and there are distinct positives to being highly logical, introverted and focussed.