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Authority, Responsibility & Diagnosis

Problems, symptoms, and dynamics appear in batches and recently I have encountered a challenging dynamic working with young people. The issue relates to the question of diagnosis and not infrequently a demand for medication to ‘solve the problem’. Attempting to make sense of this I have noticed that all but one of these young people come from privileged homes with parents who are guilty or anxious about their capacity to effectively parent their child. This may be fuelled by separation and dispute between the parents or fractures within the family. Presenting symptoms include abuse and violence to other family members, refusal to cooperate with ordinary requests by parents and unwillingness to accept ordinary limits or constraints to their activities. In exploring the situation with the young person, they often speak about consulting both their peers and the Internet and being convinced that they are suffering from a mental illness over which they have no control. By extension they believe they also have no control over the troublesome behaviour which has brought them to therapy because it is viewed as unassailable evidence that they are unwell and not poorly behaved. This impotence is reflected in parents who are clear that they do not wish the young person to be medicated but are at a loss as to know how to respond to their child’s behaviour. The fear that they may be suffering a ‘mental illness’ further undermines their capacity to take firm action.

This is a problem of authority and responsibility where the young person is unwilling to take responsibility for or exercise authority over their behaviour, attributing it to the illness which effectively is given responsibility. Medication of the illness becomes the solution with all authority and responsibility located in drugs. Medication or not, it is the young person who can choose to exercise their authority and effect change. This requires a challenge to the construction carried by the client and their family. Instead of collapsing illness and poor behaviour it is important to remove the belief that those with a diagnosis cannot manage violent or abusive behaviour. While acknowledging the young person may be anxious or depressed and this may make living more difficult, they are also challenged to take responsibility for behaviour that hurts themselves and others. Everyone has something either in their body or relational world that makes life challenging yet not everyone is abusive.

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