2.3 Towards a critical framework
Is it possible to construct an alternative framework for understanding young people's health, and if so, what resources might we need to draw on to do so?
A cultural perspective can help us to see constructions of adolescent mental health as interwoven with histories of ‘youth concern’. Recent debates about young people's wellbeing can be seen as an extension of more general anxieties about the state of contemporary childhood (James and Prout, 1997). A Foucauldian analysis would view current notions of what constitutes health as part of changing institutional practices, serving particular social and political purposes (Foucault, 1967, 1973). For example, adopting this approach in relation to young people might prompt us to ask why recent policy has begun to focus so much on mental health and to construe young people's needs in these terms rather than others. What kinds of interventions does it make possible, and what wider purposes are served by this change of emphasis? Along these lines, the Iraqi-born child psychiatrist Sami Timimi has argued that ‘the system of faith used in modernist child and adolescent psychiatry’ has ‘its cultural origins in Western history’, and he adds, perhaps somewhat reductively:
We must also accept that Western biomedical psychiatry represents the economic value system of capitalist, free market thinking and be happy to go along with the pharmaceutical industry's drive to open new markets (children's mental health is a growth area).
(Timimi, 2005, p. 38)
A comparative or cross-cultural perspective can throw light on how concepts of health and wellbeing have developed in different societies and cultures. Research shows that many cultures do not distinguish between physical, emotional and spiritual health in the way that contemporary Western societies do. Even in the UK, ideas about young people's wellbeing have changed radically in the last century, as ideas about youth have changed. For example, in the Victorian period there was a strong association of children's wellbeing with notions of moral purity.
A biographical perspective situates wellbeing within the life story of the whole person, rather than seeing it as a separate issue, and at the same time invites us to view it from the young person's perspective. Perhaps life becoming more difficult for young people? This has obvious implications for attempting to understand an apparent increase in mental health problems among young people. John Clarke's idea of the ‘magical recovery’ saw youth subcultures as trying to resolve the contradictions of the older generation (Clarke, 1976). Arguably, this idea can also be related to phenomena such as the increasing incidence of eating disorders and self harm. There are some parallels here with a psychoanalytic explanation, which would see the unconscious anxieties of the wider society as projected on to young people, who then symbolically (and in some cases literally) ‘embody’ them. For example, eating disorders such as anorexia and bulimia might be seen as ways of ‘acting out’ societal anxieties about consumption.
Together, the three theoretical perspectives offer a challenge to generalised understandings of young people's wellbeing and simplistic explanations of the apparent increase in health problems experienced by young people today. The cultural, comparative and biographical perspectives all lend support to a view that locates young people's wellbeing in particular social contexts, while also challenging and interrogating what is meant by wellbeing. They contribute to a critical framework for understanding young people's health, one which starts from the following key assumptions:
Definitions of wellbeing for young people can never be universal or absolute, but will depend on particular cultural and historical contexts.
Concerns about young people's health need to be seen as interwoven with wider and changing discourses about youth.
These concerns can be seen as, in part, projecting wider social concerns on to young people.
Young people have real experiences of physical and mental ill health, but these experiences need to be seen as shaped by the particular contexts in which they occur.