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Mental Health and Behaviour Problems - Chaired by Professor Eric Taylor
Bonnie’s story - read by Laura Clarke. This is not my story … but it could have been. It is an example of a young person not receiving help. This is Bonnie’s story and the book “The Child that Rocks the Cradle” is dedicated to her. Bonnie’s Story .... “I think Mum must have sent you ...” Danielle looked so uncannily like her mother that it was difficult at times to make the mental adjustment ... Bonnie had her problems at school. ... She never really liked it and missed as much as she could, often slipping back home in tears. She was a sensitive but troubled girl, bullied by the stronger pupils and easily led into situations she could not control. Throughout her life she felt she had to ‘fight for herself’ but was often too ‘straight’ about her feelings and actions - she could not be devious - was too ‘up front’ and so when manipulated and led into trouble by others - it was often Bonnie that took the blame. She was branded at school as a trouble maker even though it was usually other people’s trouble that she fell into. Like the time when she was ten years old and bullies stole her gold cross and chain - ripped it off her neck in the playground - and later stole her best leather coat - the one her mother had saved up for months to buy. They threw it in a bin. When this was reported to the headmaster the other girls denied it and Bonnie was blamed with making up the story. The head actually had her stand up in assembly , before the whole school , and told the children “I do not want any of you children playing with Bonnie - she is a thief and a liar!” Hardly a helpful strategy to support a troubled girl. And there were troubles at home ... Mum stuck up for Bonnie and did what she could for her but she had problems of her own which preoccupied her and took up most of her time. Like raising her four children and another she ‘took in’ .... without the support of a man around the place. She wanted to help Bonnie, but was left lost not knowing what to do for the best. Ivy is a very genuine, warm and caring woman - very down to earth and a staunch supporter of her family. If anything she is a ‘bit soft’ with them - always ready to jump in and help out - the sort of woman who has always been surrounded by children and those who need her readily supplied love and affection. Bonnie took after her in many ways - she too was a bit soft and cared too much for others - often not thinking of the consequences for herself. Danielle is very much like that too ... During part of Bonnie’s early life her Dad had been ‘away’. He left when she was three and was not released until her thirteenth birthday. Then he came home for the last time .. but in total he had spent thirty five years of his life in Jail. Bonnie took her father’s absence particularly hard and missed him deeply ... while Mum took some comfort and support by being active in the ‘Circle Trust’ - the prisoners’ wives organisation. Sadly, once a child becomes ‘type cast’ as a trouble maker, that reputation follows them in school reports and documents going from one school to another. So Bonnie’s ‘reputation’ proceeded her from her primary to her secondary school. She was misjudged in secondary school with serious consequences. In secondary school bullies are bigger and stronger and their actions can be more violent and extreme. Bonnie had begun to try to fight back by this stage. An incident arose when she was attacked by another girl and a fight ensued. Both grabbed hair and some strands came away in their hands. The strands of the other girl’s hair which were found in Bonnie’s hand, were put in the school safe ‘for evidence in case Bonnie is taken to court’. Never any mention of the part the other girl played. Another incident at the age of twelve had more sinister repercussions. Bonnie felt unwell and fainted on the school steps. She was told off for play acting and told to stop it and get up. She tried to pull herself together but could hardly stand, she was feverish and had severe stomach pains. ‘Oh the trouble maker again .. there’s nothing wrong with her ..’ After many protestations she was taken home and eventually to hospital. Again her reputation proceeded her and it was some time before anyone would take her seriously. Nurses, junior doctors and more senior doctors pronounced her as having ‘a stomach bug’ ‘gastro-enteritis’ ... ‘Take her home’ Ivy was told. Thankfully she did not but insisted on the consultant being called. ... In the operating theatre some hours later Bonnie’s appendix was found to have burst and she had raging peritonitis. This infection laid the ground for the abdominal pains and adhesions which Bonnie would suffer from in later years. The school rang Ivy the following day saying that Bonnie would be disciplined for defying the teacher and pretending to faint on the stairs. Ivy put her straight! Bonnie never learned to read and write properly and certainly missed any sex education lessons that there might have been in her school. In later years she was quite saddened by the lack of support and education which she received and felt left out by her lack of reading skills. Other girls might be able to read leaflets and contraceptive advice ... she could not. Bonnie’s life reached a dramatic climax when she became pregnant. At the time she realised this, she had been going out with by an older mentally disturbed man. Bonnie never really understood why she went with him in the first place ... it was just one of those acts of rebellious bravado which you recognise as a huge mistake right from the word ‘go’. ... but he discovered that she was pregnant and abducted her so that she could not have an abortion, and would be forced to give birth to the child who he claimed was his. For eight long terrified weeks Bonnie was held captive in a squat in Margate, a seaside town, empty and windswept cold out of season. The police had been alerted and family and friends were searching for her .. He did not give up without a fight and finally it took a police raid to rescue her from hell. ... Some years later this highly troubled and intensely violent man murdered his wife and then , afraid to face the consequences, committed suicide. “Every day he scared me half to death ... he said he wanted to make sure I was all right and that the baby was growing OK but I don’t know how I survived it. He never let me out of the flat ... I thought I was going to die. He said he would kill me if I didn’t have his baby and that he would blind me so that I would never be able to see the baby after it was born. When they got me out of there I was a wreck ... I never thought I would get over it and I was so worried in case the baby would be affected. Anyway .. my family helped me a lot after that and then I had a boyfriend who was good to me ... he was a good Dad to Danielle and we had everything we needed for a while ....” The golden haired little girl was doted on by the family who fell over themselves to do everything they could for her. Bonnie was besotted with her daughter and never once regretted having a baby when she was so young. Sadly, for Bonnie relationships were not so easy .. Bonnie married and divorced .. . and married again ... and separated ... she never really found the support that she looked for or deserved in a man. Her father cared deeply for her and has been her staunch supporter since he returned home .... but Bonnie never really filled that gap caused by his absence while she was growing up. Bonnie’s real problems began when the stresses and anxieties of her life caused her childhood asthma to return with a vengeance. She spent weeks and months in and out of hospital, placed on stronger and stronger drugs. She had not had a comfortable relationship with the medical profession. It was yet another case of a false reputation having been built around her. Even when I had first seen her in her teens I was warned about this ‘awkward, disruptive girl’ involved in dramatic situations of her own design. - I found someone quite different - a sensitive, vulnerable girl who sometimes did seem to attract problems like a magnet, but who was not a natural trouble maker. “Sometimes I think they don’t take me seriously. I have been ill so may times ... and often I get a lot of pain. Nobody really explains things to me properly ....” This was her plea when, beset with gynaecological complaints and stomach pains, she begged for a full medical investigation. Again she was thought to be exaggerating her symptoms and perhaps partly making them up. Again she was vindicated by a last minute operation which found adhesions from her past appendix problems had caused internal complications. Perhaps it was true that Bonnie’s problems were partly psychological - but in that case did she not deserve help for her emotional problems .. for her anxiety .. for the depression into which she slid from time to time? ... perhaps a lost, frightened, young girl needed to be listened to and reassured. Certainly her symptoms were probably exacerbated by her anxiety ... but however you look at it ... Bonnie was in genuine pain. Sadly Bonnie’s health went from bad to worse. A defective heart valve sent small blood clots through her body making her suffer a series of mini strokes .. almost un noticeable at first .. causing a period of deafness, loss of balance .... some transient symptoms which were regarded as malingering before their significance was realised. She was placed on stronger and stronger drugs. .... These had side effects which made matters worse. Steroids ballooned out the once pretty face.... her body became distorted and bloated. Eventually infections weakened her to the state where her frail body could fight no more. Bonnie died on 10th October 1995. She was twenty nine years old. When we made contact again with her daughter Danielle, she was angry and bitter. Acting out angrily at school and at home. A young girl very much in danger of slipping into the pitfalls that beset her mother ... so alike ... so bereaved. Bonnie had collapsed and died at home just after Danielle returned from school. The young girl had given her mother mouth to mouth resuscitation in a desperate attempt to save her and was left sitting in a chair ‘talking to Bonnie’ and clutching her night-dress. When an aunt tried to get her to move she shouted at her to go away. - “I was so angry. Why should she still be there and my Mum gone?. They told me she died in the ambulance .. but I knew it wasn’t true. I knew she was dead at home .. I could feel it. ... I said to them ‘Why are you taking my Mum?’ I wanted them to leave her with me. But now that’s Mum’s gone I often think - ‘How am I going to do it on my own, without my Mum?’ .... but it’s OK now ...” “Do you think it really is OK?” “No. ... It isn’t. .... It isn’t OK” Danielle lives with her maternal grandmother and grandfather in a small but happy household where she is able to keep her pet rabbit and lumbering Rottweiler dog. .. But living with grandparents is not the same as being raised by parents ... a pension does not go far towards buying teenage fashions and sometimes the generation gap is just that much too wide ... Life has been hard ... thus the remark .. “I think Mum must have sent you..” Perhaps she really did .... Danielle has responded to some attention, to being remembered, and to remembering us ... to seeing her mother talking on a video clip of a television news programme ... one of those perennial programmes when people are asking “....what can be done to stem the flood of teenage mothers?” When really the question should be “What can be done to help teenage mothers?” She cared to the end ... even to planning her funeral service .. she knew she was dying and wanted her family to suffer as little as possible. The songs she chose for the service were “I will always love you” ; “You’ll never walk alone” ; and “One day at a time, sweet Lord”. She then asked that the congregation leave the church to the strains of “Always look on the bright side of life” . Very ‘Marty Pythonesque’ and very Bonnie! Danielle is a credit to her Mum and I am proud and privileged to have been able to share their lives a little . .. I wish I could have done more. Bonnie’s story is the only story in this book that is unchanged - names are original and facts are as they happened. I asked the family if they wanted it changed to be anonymous or to keep things confidential and they said - ‘No, Bonnie would have wanted it told straight - how it is!’ Which is what I have done. * * * * * Peter Wilson - What is Mental Health in Adolescence? I want to talk very briefly about what is mental health in adolescence, that is my simple question to you and in fifteen minutes I hope to make it clear. Basically mental health is not mental illness, surprise, surprise! I am going to talk about it in relationship to young people, to adolescents, and just think about the kinds of problems they have. The title of my talk is extremely important in terms of the title of this conference. Youth being a resource for tomorrow. The essence of mental health, is about emotional well-being, it is about the capacity to learn, the capacity to relate, the capacity to enjoy relationships, it is about the capacity to be surprised, the capacity to be imaginative, I could give you a long list of capacities. But if you add them up, if you listen to every one carefully, it is really what I think you would hope you had or your children had and your teenagers had. These capacities that the human being has to learn, to live, to relate, to grow, to find out, to contribute, to give, and so forth. That sounds like a rather idealistic set of terms, and of course nothing is as easy as it seems. If we had further time, for discussion, and got down to the nitty-gritty of what you think a mentally healthy adolescent looks like or is, we would have a lot of discussion, and it would clearly vary a great deal according to where you come from, what your culture is, what your background is, what you value, how you think people should live with each other in a society, what you think the relationship is of this life to another life. All kinds of things come into the way of how we consider what is good for people to live and to live with each other. The worry about talking about mental health in that rather idyllic way is that we can become rather moralistic and holier than thou and think that all mentally healthy people are like me and all mentally unhealthy people are like you. There is a danger of becoming very narrow. Mental health is more than the absence of mental illness, mental health is about health. I want to try and broaden the concept out, so that is isn’t just the province of psychiatrists, shrinks, people down the road that we can forget about. Mental health is about the soundness, the well functioning-ness and the robustness of the mind. That is all it is, and the mind is how we feel, think, anticipate, remember, and so forth. So, I want to try and capture the sense of a healthy mind. A mind that is actually functioning on all cylinders, using all the capacities that are there. Now, in the same way that we talk about physical health, none of us have wonderful physical health all the time. We’ve all got our dimples, we’ve all got our pains, we’ve all got our worries about our bodies. None of us feels absolutely marvellous all the time - we might be today, but not tomorrow and so forth, and similarly I think it is the case with mental health. We must not be looking for perfection all the time, but just for that kind of capacity, that readiness, that sort of strength to make the most of a given day, a given circumstance. So, I think it is very much about the capacity of a person, of an adolescent, to cope with the pressures and the anxieties that he or she might have. That is what it is about, mental health is measured according to these coping capacities. Now, let us just think about young people. You know them as well as I do, you know them in your families, in your work load, and you know them in yourselves. You all sit there, looking very adult, but in fact there are all kinds of young bits, childish bits and adolescent bits there, so don’t pretend that we are talking about people out side. Let’s think about yourself and what you remember. And think about the pressures and anxieties. I think there are two ways of thinking about it. I think there are a lot of very strong, powerful internal pressures, which all young people of all kinds of shape, size and whatever go through. They have to come to terms with their bodies. And I am going to give a sort of elemental, sort of mini-lecture on adolescents for a minute, the body, puberty, the changes, the impact on the mind, secondary characteristics, menstruation, emissions, the capacity to impregnate, to be impregnated, all of those things, first time, big, big for a young person, body growing at great rate. That is the fundamental task of adolescence, to come to terms with all that, and all of the sensations, all of the fantasies, and whatever else, which are aroused by that, and get to some sort of adult state, - (we will not discuss in 15 minutes what is an adult) - when you get to a state really where there is a capacity to relate comfortably with ones self, with ones body and relationship with others. The other task is to establish a sense of identity. To be able to get a sense of oneself as a distinct human being, separate from ones parents, able to stand on ones own two feet, and take some kind of responsibility for oneself. That is a big, big task. I have said it very quickly but I think that they are the two key tasks, and some how coming to terms with the limits of what one is able to do as an individual. These are things that all young people are struggling with internally, and I think it is taking them longer to do these days than it was in say, certainly 100 years ago. Puberty arrives much earlier, which is, I think the onset of adolescence, and in these days where there is so much more economic uncertainty, so much more unemployment, so much more difficulty for young people to get their niche in society, I think that adolescence is prolonged. I think there is now about 15 years where people are going through this adolescence, where they are going through a period of youth, before they can be something more than that. So, I think it is a combination of these internal pressures, and living in today’s complicated society. It is very difficult really to figure out how you are supposed to be these days. The media is enormously powerful, we don’t know the half of it - what it’s effects are on young lives. But enormously powerful images, knowledges, what ever else, come through the television, the tube, the super digital highway, a mass is coming in. We are living in a time when families are also changing so it is very difficult to get a sense of what a normal family life is. I have used the word normal for the first time, I thought I would try and not use it in my 15 minutes, but it is very difficult. What is normal? What is not normal? These kinds or pressures, issues about gender, changing notions about role and so on. So you have young people struggling to find an adult self, with these basic teenage anxieties, in the context of a society which has a lot of uncertainty and change built into it. I do not want to sound alarmist because I think the majority of young people, say three quarters of young people in this country get by pretty well. They live fairly lively, interested, good lives, they have a good laugh. I have been very moved recently, reading a piece of work done by some people in Scotland about health promotion, they did a fairly large survey of young people’s attitudes, they had about 4,000 people in the survey, and it was very moving to read about how young people essentially talk about they mental health status. They feel ready to take on the challenges, they get up and they want to go to school, they enjoy school, and they like their friends and they can’t wait to find out what is going to come the next day - there is that forward movement, there’s that readiness, there is that capacity to have a real good laugh, which is I think a very appealing feature. And they know what they value. School matters a lot to them, family matters a lot to them, i.e. schools that care, that respect, that stimulate, and similarly families who have been backing them up for years. Friends mean an awful lot, friends come up top of them all. The capacity to have a friend it a measure of mental health. There are a lot of young people who do not kind of positive kind of living, and find it difficult to have friendships because they are envious, or because they are so sensitive to feeling rejected and neglected, and they live in their adolescent isolation with a great deal of distress. I was very struck reading this survey, which had really taken my imagination, because what comes across is young people talking about themselves and their lives and what matters to them and so on. One of the key things that comes through so strongly is the diversity of feelings that young people feel. There was one young person who put it very clearly, it is a very ordinary statement, but it is very straight-forward:- ‘Some days I feel trapped. Homework sometimes gets on top of me, but I still find a way to do it. Some days I feel great. I play football, and if I am lucky I score a goal. And sometimes, some days I just can’t be bothered. Some days school is great and it goes in fast. Some days, it’s rubbish and very, very, very slow. Some days the teachers seem to be on your back. Some days they seem to help you a lot. Some days I am angry at my sisters, and some days I don’t want to annoy them at all.’ Simple ordinary statement. But what a mixture, what a buffeting about. Some days. You could sing a song, not ‘Yesterday’ but ‘Some days’. Another one said:- ‘Today I don’t know how I feel. I change every five minutes, my life is very weird.’ And another one says, and this is even more to the point:- ‘I feel quite depressed, but happy today’ So it is not surprising that another one said:- ‘I keep on asking myself questions and wondering if I am normal or not’ I think it is a big question, what is normal? Which parent thinks which kid is normal and so forth. It is the capacity really to tolerate that kind of perplexity, that contradiction of emotions, that kind of buffeting around from one day to some day to all the rest of it, the capacity to tolerate that, bare the anxiety of it and somehow create from it which I think constitutes the core of mental health. So the big question is, how do you cultivate it? Well I think we know how to cultivate mental health. It is very easy. You love your kids from the word go, and you care for them and you contain them and you protect them from abuse and so forth. And we could speak more about that. But the trouble is there are a lot of youth that don’t get that kind of background, and they feel very frighten and very angry, and tormented by their feelings, to the point where they really cannot function and either they withdraw into themselves and become very isolated, loose themselves into drugs, or they become very angry, defiant, or they become suicidal. There are all sorts of ways in which young people can tell us that they are not feeling healthy mentally. And I think that those young people, and there are many, many of them, I said that three quarters of them are ‘OK’, which means really that there are about 7 million kids that are ‘OK’ in this country, but maybe 2 million kids are not ‘OK’. The NSPCC this week said that 1 million kids are being abused. People say ‘really, one million?’, but that is only one in ten. There are an awful lot of young people, however, who are stuck, frightened, terrified of themselves and the people around them, and they cannot get to the mental health status that they wish. The majority of them are not mentally ill, they do not have a major disturbance in their reality testing, in their feelings about their bodies, their image and so forth, but they do have significant mental health problems in the sense that they don’t have the things which I think define mental health. Some of them tell us, some of us show us that they are in distress, in the way they behave and their symptomatology says to us ‘help’. Others are resistant, they are too ashamed, they are too frightened, they are too untrusting, and they just push people away. The great challenge to us all in this business is not to be pushed away by young people, who may want to conceal their distress, but to stay with them and to try to facilitate them to live mentally healthy lives.
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