Be Well and Prosper
Aitken College
Lockdown was tough on kids, but don’t burden them with ‘mental health disorders’
Psychiatry is a funny thing. Unlike the rest of medicine, for most conditions, we don’t yet have scans or investigations to confirm a diagnosis. As a psychiatrist, I can’t take a blood test that confirms you have depression, or a brain scan that confirms you have anxiety. We rely on a constellation of symptoms that then constitutes a disorder or illness. Your history is our assessment. But there is a lot of overlap between conditions and making an accurate diagnosis is as much an art as it is a science.
There are many benefits of an accurate diagnosis. It can bring relief, validation and clarity. It can help guide treatment, increase awareness, and allow access to resources. If you presented to me with low mood, tearfulness, poor sleep, and hopelessness about the future, I may well diagnose you with depression. But what if you then told me your partner had left you or your beloved dog had died. Perhaps I would then say that what you’re feeling is a normal reaction to a stressful event. Maybe you are depressed, but perhaps you do not have depression.
Perhaps you do not require a tablet for your woes and time will bring resolution. Or maybe it won’t, in which case things will need to be revisited.
So when I read articles that flow from surveys of psychologists that cite mental health disorders increasing among pre-schoolers and teens since the pandemic, I’m concerned. A rise in mental health disorders among 18-month to five-year-olds, an increase in separation anxiety in children aged under five, an increase in depression and anxiety among teenagers aged 13 to 18.
COVID-19 and its lockdowns had a huge impact around the world, including in Australia. We heard politicians tout that “we are living in unprecedented times”, but are we? I guess we are. Our current generations, from Baby Boomers to Gen Alpha, had not lived through significant world events, such as the Great Depression, Spanish influenza or a world war. Until now, some of us had known adversity in the form of bushfires, droughts and floods, but nothing as catastrophic, widespread and long-lasting as COVID-19.
Our places of work closed down. Our schools, tertiary institutions, playgrounds and regular cafes shut. We couldn’t leave our suburbs, let alone our country. Many adults lost our jobs, our homes, our health, our sense of safety and predictability of the world around us. So after almost three years of disruption, when our children return to society and attempt to navigate the world around them, why are we so quick to label their struggles as an illness or a disorder?
Of course, infants born into COVID-19 lockdowns would be wary, as toddlers, of leaving their parents. They knew nothing else, but why does this need to be diagnosed as separation anxiety? Perhaps they remain fearful to go out into a world they are not familiar with, a world they had not had the right and privilege to navigate in the secure presence of their caregiver.
A teen isolated from friends at a crucial developmental stage for the better part of two years may have felt anxious about returning to school or attending social functions. Why does this need to be diagnosed as social anxiety or school refusal?
A child who has spent long periods in a home environment is likely to feel overstimulated, disorganised and distracted in settings where they may have been quite comfortable before the pandemic. Why does this need to be diagnosed as autism or ADHD?
I’m not saying these conditions don’t exist in children. They do, and they cause much distress and suffering. I do not discount that on any level. But stress and trauma can have a profound effect on children, and sometimes this may be best conceptualised as a normal reaction to abnormal events.
COVID-19 was a very abnormal and prolonged event. Instead of giving our children a diagnosis, a box to tick or a label that sticks, could we look to understand why these symptoms and struggles have come about, and what can be done to assist and overcome the difficulties they are facing.
Not easy if we, too, are struggling with our own challenges, but some of it will come down to the adults – the parents, the educators, the extended family and friends. Our children need to know they can cry and we will catch their tears.
But that doesn’t mean children should be viewed as passive beings deprived of agency. They are active participants in society, able to develop their own ways of thriving. Children are resilient. Making a mental health diagnosis in this transitional period for them may define how our children view themselves long-term, a box they cannot climb out of.
We do not know what the long-term impact of COVID-19 will be. Given the nebulous nature of mental health diagnoses, they may provide nothing more than false comfort for adults who are understandably seeking a semblance of control and security in the aftermath of the pandemic, in what remains a stressful and unprecedented time.
Samari Jayarajah is a psychiatrist and mother of two.
Mr Ben Lawless
Researcher