Opinion | The disordered thinking has to stop

The Netherlands is sick, Prime Minister Lubbers said in 1990. He was referring to the nearly nine hundred thousand people who are unfit for work. More than thirty years later, the Netherlands is sick again, but now much worse. According to the Trimbos Institute one in four Dutch people has a mental disorder. Nearly half are among young people and students. Would it?

Social workers in youth care see children and young people with concentration problems, anxiety complaints, rage, compulsive symptoms, long-term absence from school, eating problems, substance abuse, self-mutilation, gloom, confusion. Serious problems that not only they, but also their parents struggle with. When they come to the psychologist or psychiatrist with their children, their first question is often: What is wrong with my child? Does it have ADHD? autism? Something else? Young people who come independently also want to know one thing in particular: which disorder do I have?

That is the question that emergency responders are going to work with. They ask questions and pull out their thick ‘disorder book’: the DSM, the handbook for psychiatry that contains about 350 symptom descriptions (classifications) that all have a name (‘label’). These labels are lavishly thrown around and aid workers are not the only ones. Teachers, coaches, parents and young people are also quite adept at it. Disorder thinking has spread like an oil slick in our society, and that has to stop.

For the record: we are not saying that disorders do not exist, but we do say that (1) you should not immediately approach psychological problems from a disorder perspective and (2) you should not label every psychological problem with a disorder. We list our main objections below.

First and foremost: thinking in terms of disorders fails people and can even be harmful, especially for children and young people.

A disorder is about something that is not there, and should be there, such as good concentration. Or that something is there, but shouldn’t be there, such as angry outbursts. In short: something is wrong. By emphasizing that, we are – perhaps unwittingly – hammering home the message that someone with a “disorder” is imperfect and flawed.

This can be especially hard for children and young people. They are in full development, experimentation and change, and that goes hand in hand with trial and error. Basically there is nothing wrong with that. Good support may be needed if that process goes off the rails. If appropriate support is not forthcoming, the feeling of failure can negatively affect self-image and lead to feelings of powerlessness and victimization. That does not help to develop a solid and stable self.

Objection two: the disorders perspective compartmentalizes thinking and perception.

Looking through a disordered lens is very directive, because someone’s feelings and behavior do not exactly fall within the artificial DSM classifications. Real people are much more colorful. If psychological problems are nevertheless squeezed through a DSM mold, you no longer see what is really going on. And as a result, possible solutions are also lost sight of.

Objection three: the disorders perspective wrongly focuses on the person who would suffer from the ‘disorder’.

The person labeled as a disorder is the one who needs treatment. But problems always occur in a social context in which someone moves: family, school, group of friends, neighbourhood, in short, all environments in which we deal with others. Anyone who focuses on the child or young person as a problem maker loses sight of the possible contribution of others to the emergence and resolution of problems.

Read also: Even a ‘not very extreme’ event can lead to trauma

Better alternative

Can all of us, and counselors in particular, talk about mental health problems without (immediately) talking about disorders? Is there a better alternative? Yes.

Care providers should make an effort to fully understand why this child and these parents are asking for help at this time. What is the core problem? That starts with asking open questions, and letting children, parents and teacher(s) each tell their story. Be as concrete as possible, try to look broadly and without judgement, and don’t make what you see bigger than it is. Look at the whole context. This is the best way to see why these parents and this child are currently stuck, and what is involved. And pay attention to the developmental stage of the child.

Once all the information has been collected, a broad, explanatory analysis that gets to the root of the problem is necessary. It is then essential that those most directly involved (child, parents and possibly the teacher) endorse this analysis. Because only when it is clear what is involved and what everyone’s part is in it, you can come up with suitable, concrete solutions together. Not to ‘treat the disorder’, but to get on well. Those involved should also look at themselves.

For example, an introverted 13-year-old girl who finds it difficult to make eye contact does not immediately have autism; she may need time to feel safe. Then it helps if parents and school give her that time. A 15-year-old who eats very little for a period does not automatically have an eating disorder, but may be experimenting with her own (body) limits. It is understandable that parents react anxiously to this, but what helps this adolescent better is an open, curious attitude.

Calm and confidence

As a rule, children and young people benefit most from parents and care providers who exude calm and confidence, and who do not panic from temporary problem behaviour. That takes courage, because they have to endure feelings of powerlessness and unease, instead of looking for quick ‘solutions’. But there is no quick fix. The best way to support children and young people is not to make them patients, but to consider the concrete problems and tackle them together. This is how they learn that they can cope with life.

If people, from young to old, indicate that they suffer from psychological complaints, that is not something to be trivialized. It is certainly true that one in four Dutch people and almost half of young people are having a hard time. From school stress and performance pressure to debt, war nearby and a global climate crisis – it is understandable that quite a few people feel stressed, angry, gloomy, powerless, anxious or alone. But mental disorders are usually not all those uncomfortable feelings.