Latest / Dr Justin Coulson's Happy Families / The Hidden Cost of Labels and What Kids Really Need Instead [with Sami Timimi]
Transcript
- 0:05Speaker 1: My book of the Year this year is called Searching
- 0:08Speaker 1: for Normal. It's by Sammy to Mimy. He works in
- 0:11Speaker 1: the UK as a child and adolescent psychiatrist and psychotherapist,
- 0:17Speaker 1: and it's taken me a couple of months to get
- 0:19Speaker 1: through this one. There's some pretty heavy concepts. At times,
- 0:22Speaker 1: it feels like you're reading more of an academic book
- 0:23Speaker 1: than a a popular trade book that you buy on
- 0:27Speaker 1: the shelves, and yet the conversation about mental health, the
- 0:30Speaker 1: conversation about diagnoses, about neurodiversity, trauma, and so much more.
- 0:35Speaker 1: It may be one of the most important books that
- 0:38Speaker 1: is on bookshelves at the moment. So today a conversation
- 0:41Speaker 1: with an author that I have been so excited to
- 0:43Speaker 1: talk with, Sammy to Mimy. That's coming up in just
- 0:46Speaker 1: a sec on the Happy Families podcast. Stay with us, gooday,
- 0:51Speaker 1: Welcome for the Happy Families podcast. Real Parenting Solutions every
- 0:55Speaker 1: single day on Australia's most downloaded parenting podcast, Dr Sammy
- 0:59Speaker 1: to Mimmy's new book is called Searching for Normal. It's
- 1:01Speaker 1: a new approach to understanding mental health, distress and neurodiversity,
- 1:05Speaker 1: and it asks a question that every parent is quietly
- 1:08Speaker 1: wondering have we started treating normal childhood struggles as medical problems?
- 1:15Speaker 1: Has psychology become too medicalized? After thirty five years in
- 1:18Speaker 1: child and adolescent psychiatry, Doctor to Mimmy has seen how
- 1:22Speaker 1: quick diagnoses like ADHD in autism and anxiety can sometimes
- 1:25Speaker 1: overshadow what kids really need, which is understanding and connection
- 1:29Speaker 1: and support. He helps parents to tell the difference between
- 1:32Speaker 1: genuine mental illness and the very real pressures of growing
- 1:36Speaker 1: up in today's world. In the book, he says, your
- 1:39Speaker 1: child isn't broken or abnormal. Psychiatric labels are cultural inventions,
- 1:45Speaker 1: not biological destiny. When distress is medicalized, it steals our hope.
- 1:51Speaker 1: But if we can find another story, we can break
- 1:52Speaker 1: the cycle that has trapped too many for too long.
- 1:55Speaker 1: Doctor to Mimy, so good of you to join me
- 1:58Speaker 1: on the Happy Family's podcasts.
- 2:00Speaker 2: Thank you so much for inviting me. I'm delighted to
- 2:02Speaker 2: be here.
- 2:03Speaker 1: So as I said in the intro, I was reading
- 2:04Speaker 1: your book, I had a few pages to go, and
- 2:07Speaker 1: then your publicist got in touch and said, would you
- 2:09Speaker 1: like to interview this man on your podcast? And I
- 2:12Speaker 1: just thought, oh my goodness, what a great opportunity. How
- 2:14Speaker 1: can I say no, I've loved the book. In the book,
- 2:17Speaker 1: you argue that much of what we label as a
- 2:18Speaker 1: disorder may actually be an understandable human response to difficult circumstances,
- 2:24Speaker 1: and immediately, in the context of ADHD and depression and anxiety,
- 2:29Speaker 1: I thought, this is the kind of thing that is provocative,
- 2:32Speaker 1: it's volatile, It's the kind of thing that a lot
- 2:33Speaker 1: of parents are going to take potentially offense at, because well,
- 2:38Speaker 1: we love our labels, and in the current psychological state
- 2:44Speaker 1: that we're in, there seem to be more and more
- 2:47Speaker 1: people who are saying, my child is definitely not right.
- 2:52Speaker 1: So I'd love for you to talk a bit about
- 2:53Speaker 1: how parents can tell the difference between ordinary distress or
- 2:57Speaker 1: ordinary hyperactivity and impulsivity, the typical ways that you want
- 3:02Speaker 1: and behave, versus a real clinical concern that needs extra help.
- 3:06Speaker 2: One of the things that I was trying to get
- 3:08Speaker 2: across in my recent book Searching for Normal, is one
- 3:14Speaker 2: of the difficulties of trying to figure this stuff out
- 3:18Speaker 2: is that we don't really have an understanding of what
- 3:24Speaker 2: we mean by things like normal. So I know the
- 3:27Speaker 2: title of the book is searching for Normal, but the
- 3:31Speaker 2: idea of normal assumes that we have an understanding of
- 3:35Speaker 2: what we mean by normal?
- 3:37Speaker 1: Is there a problem with that definition normal? Like from
- 3:40Speaker 1: a clinical or mental health sense? What can be problematic
- 3:45Speaker 1: with definitions like normal?
- 3:47Speaker 2: The problem is all the definitions that we use in
- 3:51Speaker 2: mental health are subjective and therefore their concepts that are
- 4:00Speaker 2: and be expanded in all sorts of different directions, because
- 4:04Speaker 2: we don't have what you would call empirical anchors, something
- 4:09Speaker 2: definite in the physical world that can make you differentiate
- 4:16Speaker 2: between something that's a problem in the hardwiring, if you like,
- 4:19Speaker 2: of the brain or the body, from things that aren't.
- 4:24Speaker 1: Can you got a little deeper on that?
- 4:26Speaker 2: The problem then becomes because our definitions are all subjective,
- 4:31Speaker 2: we literally don't know what we're talking about when it
- 4:34Speaker 2: comes to mental health, and it becomes in the eye
- 4:38Speaker 2: of the beholder. And the thing that we all have
- 4:42Speaker 2: in common is that when we have various issues, various
- 4:46Speaker 2: problems that we're trying to understand, is that we are
- 4:49Speaker 2: meaning making creatures. And the frameworks that we use to
- 4:53Speaker 2: make sense of these presentations of things that worry us,
- 4:59Speaker 2: of things that can us are very powerful in terms
- 5:04Speaker 2: of how we then understand and how we then react,
- 5:08Speaker 2: and how we then imagine what the type of problem
- 5:14Speaker 2: that the person is experiencing is all about. The thing is,
- 5:19Speaker 2: you can't see a thought under the microscope. So one
- 5:23Speaker 2: of the difficulties for all parents, and one of the
- 5:28Speaker 2: things that I say to parents when I meet with
- 5:30Speaker 2: them is that one of the things that I can't
- 5:33Speaker 2: do for you is deal with guilt, because all good
- 5:36Speaker 2: parents feel guilty most of the time. That's just something
- 5:40Speaker 2: that we have to accept because we love our children
- 5:45Speaker 2: and we're surrounded by these narratives that are in our
- 5:50Speaker 2: society at the moment that make us imagine that there
- 5:54Speaker 2: are all these disorders and problems and that you should
- 6:00Speaker 2: should identify them early and that you should intervene early.
- 6:04Speaker 2: So you can't blame parents who are wanting to go
- 6:07Speaker 2: down these pathways.
- 6:09Speaker 1: Ah, totally right. But what are some of the problems
- 6:12Speaker 1: or issues that can arise if parents do choose to
- 6:14Speaker 1: go down the pathway of early identification and intervention.
- 6:19Speaker 2: The problem is, if you go down these pathways, there
- 6:23Speaker 2: is a danger that your children are going to be
- 6:26Speaker 2: exposed to the issues of labeling. And sociologists have known
- 6:30Speaker 2: about the problems with labeling and the power of labeling,
- 6:36Speaker 2: and then you're exposing your child to the potential harms
- 6:41Speaker 2: that can come from them internalizing an idea, and you,
- 6:46Speaker 2: as a parent, and the teachers and all the other
- 6:48Speaker 2: people who they're going to come into contact with internalizing
- 6:52Speaker 2: this idea that there's something wrong, that there's something broken,
- 6:57Speaker 2: that there's something about them that means that they're unable
- 7:00Speaker 2: to function in society as it's made at the moment.
- 7:04Speaker 2: So rather than being able to help parents tell the
- 7:08Speaker 2: difference between a clinical problem and a non clinical problem,
- 7:13Speaker 2: which I think is, you know, that depends on each
- 7:16Speaker 2: person's situation and what's going on in that family, in
- 7:22Speaker 2: that young person, in their peer group, in their school,
- 7:25Speaker 2: and so on. What I would give some pointers to
- 7:30Speaker 2: are a few things that I think would be helpful
- 7:35Speaker 2: for parents to keep in mind in helping them negotiate
- 7:39Speaker 2: this difficult area because we're so surrounded by this narrative
- 7:43Speaker 2: that there's all these vulnerabilities and potential disorders lurking in
- 7:47Speaker 2: the background. So my first tip would be, don't try
- 7:52Speaker 2: too hard, because we live in a society that puts
- 7:56Speaker 2: pressure on us and our children to perform, and the
- 8:00Speaker 2: problem is we can then see our children and or
- 8:03Speaker 2: ourselves as primarily vulnerable, and then we get drawn into
- 8:07Speaker 2: noticing all sorts of ways in which their mental or
- 8:11Speaker 2: behavioral health could go wrong, and we could then be
- 8:14Speaker 2: launched into as seeming never ending search for the right
- 8:18Speaker 2: diagnosis or the right treatment, and in doing that we
- 8:22Speaker 2: risk collecting labels and the various accompanying interventions. So that's
- 8:27Speaker 2: one thing I would say, Please don't try too hard.
- 8:30Speaker 2: I think when we're very worried about our children, when
- 8:33Speaker 2: we're driven to guilt, there is the temptation to intervene unnecessarily.
- 8:39Speaker 1: What's the second one.
- 8:40Speaker 2: The second thing I would suggest to parents is don't
- 8:44Speaker 2: fear emotions. When we put emotions in the class of
- 8:47Speaker 2: problems that can only be solved by special expertise, like
- 8:51Speaker 2: a specific therapy or worse, as I said, psychiatric medication,
- 8:56Speaker 2: what we risk in doing that is losing agency and
- 9:00Speaker 2: alienating ourselves from parts of ourselves that are to be
- 9:05Speaker 2: experienced rather than feared. Our job as parents, if we're
- 9:09Speaker 2: going to allow our children to grow and develop psychologically,
- 9:14Speaker 2: is to understand that we can't prevent all suffering disappointments,
- 9:21Speaker 2: and our job instead is to be there when our
- 9:24Speaker 2: children have these difficulties in their life, when they're going
- 9:28Speaker 2: through emotional upheaval and emotional distress, is to be there,
- 9:34Speaker 2: to be patient, allow this to happen, and help them
- 9:38Speaker 2: on their way.
- 9:39Speaker 1: You've mentioned the first two things, don't try too hard
- 9:42Speaker 1: and don't fear emotions. Tell us the third idea.
- 9:45Speaker 2: The third thing that I would say is see nurturing
- 9:49Speaker 2: relationships as a greater priority than controlling behavior, because when
- 9:55Speaker 2: we're distressed by behavior of our children, we often have
- 10:00Speaker 2: we can get through to them so that they change
- 10:03Speaker 2: in a way that would stop them doing the sorts
- 10:05Speaker 2: of behaviors that we're considering, things that we're worried or
- 10:10Speaker 2: frustrated about or irritated by. Unfortunately, when our attempts to
- 10:16Speaker 2: kind of control behavior can accidentally damage a relationship. So
- 10:20Speaker 2: for me, one of the things that I've put as
- 10:23Speaker 2: a priority in my work with young people and families
- 10:26Speaker 2: where there's a lot of worry or where there's a
- 10:29Speaker 2: lot of worry about behavior and behavior that is causing
- 10:34Speaker 2: distress or frustration or irritation to the parents, is to
- 10:39Speaker 2: focus on emotional flow, So on the emotional dynamic between
- 10:46Speaker 2: the young person and their parents or their family more widely.
- 10:52Speaker 1: Okay, so we've got don't try too hard, don't fear emotions,
- 10:55Speaker 1: prioritize nurturing the relationship versus controlling the behavior. I love
- 10:58Speaker 1: this one. It's something that I still struggle with with
- 11:01Speaker 1: my own kids, So I love this one. Tell us
- 11:04Speaker 1: your fourth and final one.
- 11:05Speaker 2: The final one that I would put in there is
- 11:09Speaker 2: beware of what I call concept creep. So concept creep
- 11:13Speaker 2: is something that's been happening quite a lot in our
- 11:17Speaker 2: culture recently, where concepts that were originally developed in clinical world,
- 11:24Speaker 2: whether it's in psychiatry or psychotherapy, have sort of leaked
- 11:27Speaker 2: out into our culture. My kids, when they were growing
- 11:32Speaker 2: up they're now adults, started talking about some years ago
- 11:38Speaker 2: feeling depressed, not feeling miserable, not feeling frustrated, but feeling
- 11:44Speaker 2: So that was I think one of the first examples
- 11:48Speaker 2: of words that came from a clinical world and crept
- 11:51Speaker 2: into the everyday life. But we've got all sorts of
- 11:56Speaker 2: concepts that have now crept in from emotional regulation, emotional intelligence, meltdown,
- 12:04Speaker 2: so children now have meltdowns, they don't have tantrums. So
- 12:08Speaker 2: these kind of more ordinary bits of language and the
- 12:12Speaker 2: reason why I think you should be careful of starting
- 12:15Speaker 2: to think in those terms is that they draw you
- 12:18Speaker 2: towards an idea that what your kid is experiencing is
- 12:23Speaker 2: outside of the realm of the ordinary, side, of the
- 12:26Speaker 2: realm of what we consider to be the social world
- 12:32Speaker 2: of expectations, and in the realm of a potential problem.
- 12:38Speaker 1: Today and the Happy Families Podcast, we're talking to doctor
- 12:40Speaker 1: Sammy Timimi, who has over three decades experience working with
- 12:43Speaker 1: children and families as a psychiatrist and psychotherapist, and it's
- 12:47Speaker 1: the author of the new book Searching for Normal. After
- 12:50Speaker 1: the break, we'll talk neurodiversity and the increase in ADHD
- 12:54Speaker 1: and autism diagnoses. Stay with us. This is the Happy
- 13:06Speaker 1: Families Podcast Today talking with doctor Sammy to Mimi, author
- 13:09Speaker 1: of Searching for Normal, which I reckon is one of
- 13:11Speaker 1: the most important books at the moment that covers issues
- 13:13Speaker 1: such as mental health, trauma and neurodiversity, ADHD and autism diagnoses,
- 13:19Speaker 1: and just the idea of neudiversity. There's been an extraordinary
- 13:24Speaker 1: increase in exposure to a conversation about that. I would
- 13:27Speaker 1: say probably over the last let's say ten to twelve years.
- 13:32Speaker 1: What do you think is driving the surge and what
- 13:35Speaker 1: should parents do about it?
- 13:37Speaker 2: There are many factors that would be driving this, and
- 13:44Speaker 2: it is quite an extraordinary expansion. What has happened over
- 13:48Speaker 2: the years is what I call a mutation of constructs.
- 13:52Speaker 2: And this comes back to what I was saying earlier
- 13:55Speaker 2: that because the definitions are subject because they refer to
- 14:02Speaker 2: behaviors rather than you know, you don't get a blood
- 14:06Speaker 2: test for ADHD and get a brain scan. What you
- 14:10Speaker 2: do is you have a questionnaire. Or in terms of
- 14:14Speaker 2: autism diagnosis, there's also some observational tools, and I've done
- 14:18Speaker 2: all the training in all of these, and I'll be
- 14:21Speaker 2: quite honest with you, they're no better than pop psychology
- 14:26Speaker 2: quizes that you might find on even the ones that
- 14:33Speaker 2: appear to be more sophisticated, they're just more sophisticated versions
- 14:36Speaker 2: of the same thing. They don't have any empirical anchors.
- 14:41Speaker 2: And what that means is that they can be expanded.
- 14:44Speaker 2: And they've become expanded in two directions, So they can
- 14:48Speaker 2: become expanded horizontally by including lesser degrees of behavior presentations,
- 14:57Speaker 2: so lesser behaviors can be included, or lesser severe behaviors
- 15:02Speaker 2: can be included, and then they can be expanded vertically,
- 15:05Speaker 2: which means that new populations that previously didn't have the
- 15:09Speaker 2: likelihood of these diagnoses enter into the realm of diagnosis.
- 15:13Speaker 1: Sammie, can you give us some ideas, some examples in
- 15:16Speaker 1: terms of ADHD and autism.
- 15:19Speaker 2: With ADHD and you can see a very similar pattern
- 15:23Speaker 2: with autism that happened a few years later. It starts
- 15:27Speaker 2: out as in my clinical lifetime, I trained in child
- 15:33Speaker 2: psychiatry back in the mid nineties, and we didn't diagnose
- 15:36Speaker 2: anybody with ADHD. There was something called hyperkinetic disorder which
- 15:41Speaker 2: was focused on levels of behavior, so activity levels, and
- 15:48Speaker 2: this was a very rare disorder. So in my first
- 15:51Speaker 2: nine months of child Psychiasha, I didn't see anybody who
- 15:53Speaker 2: was diagnosed with this condition. And it was also at
- 15:57Speaker 2: that time considered that if you had signific learning difficulties,
- 16:01Speaker 2: that would automatically exclude you from such a diagnosis, because
- 16:05Speaker 2: it was considered that learning difficulties by itself would be
- 16:09Speaker 2: a reasonable explanation for why you might be struggling with
- 16:13Speaker 2: your behavior. Then the concept of ADHD got imported from
- 16:17Speaker 2: the US and it starts out with a prevalence rate
- 16:22Speaker 2: of about zero point five percent of children. Over the years,
- 16:25Speaker 2: this expands and eventually it becomes about three percent of children.
- 16:31Speaker 2: At this point it still thought of as what we
- 16:34Speaker 2: call a developmental disorder, which means that the expectation was
- 16:39Speaker 2: as children grow up, most of them would grow out
- 16:41Speaker 2: of it. However, by the early two thousands in this country,
- 16:46Speaker 2: the concept of adult ADHD was beginning to creep in.
- 16:49Speaker 2: So this is your example of beginning to vertically expand.
- 16:55Speaker 2: So the idea that it was a lifelong disorder and
- 16:59Speaker 2: something that was not likely to recover from was happening.
- 17:05Speaker 2: And now the concentration was also on ideas of attention,
- 17:09Speaker 2: so attention comes more into the picture levels of attention.
- 17:13Speaker 2: So this is a new behavior being brought in. And
- 17:16Speaker 2: then in the last five to ten years, but particularly
- 17:20Speaker 2: in the last five years, the concept of masking allows
- 17:24Speaker 2: it to go even further. So the concept of masking
- 17:28Speaker 2: is you actually have the symptoms, but you should don't
- 17:31Speaker 2: show them.
- 17:32Speaker 1: Because you're keeping them hidden and chilled them inside until
- 17:35Speaker 1: your home and it's safe to let alone exactly.
- 17:38Speaker 2: And so this allows a greater degree of women to
- 17:43Speaker 2: come into the diagnostic category women and girls. So by now,
- 17:48Speaker 2: the it's expanded to you know, five percent in some countries,
- 17:53Speaker 2: ten percent of the population and rising, and in doing
- 17:59Speaker 2: that it also starts to become incorporated into identity politics.
- 18:09Speaker 2: So as it expands, you also got a group of
- 18:14Speaker 2: people who understandably rejected some of the medicalization of this,
- 18:20Speaker 2: but instead still kept the whole idea that there's something
- 18:23Speaker 2: neurological going on. So that's where the neurodiversity comes in,
- 18:28Speaker 2: which I think is a Bonker's concept. I'll be perfectly
- 18:32Speaker 2: frank with you, because we're all neurodiverse, but this idea
- 18:35Speaker 2: that we can separate a group who are neurodiverse, who
- 18:38Speaker 2: are unable, if you like, who have a problem functioning
- 18:43Speaker 2: in society as it's made at the moment, and a
- 18:46Speaker 2: group who are neurotypical in which society is made for us. Well,
- 18:51Speaker 2: all of us are struggling with the way society is.
- 18:54Speaker 1: So if you look at the big picture, what are
- 18:56Speaker 1: the potential drivers of this expansion.
- 18:58Speaker 2: They are, to my mind, partly a crisis of economy,
- 19:05Speaker 2: So of people are feeling insecure, pessimistic about the future,
- 19:10Speaker 2: so there's a greater degree of distress. This level of
- 19:14Speaker 2: distress level of insecurity that people have becomes a potential
- 19:19Speaker 2: something to exploit for profit.
- 19:21Speaker 1: Yeah, it's a gold mind for big pharmaceuticals.
- 19:24Speaker 2: And it's been a gold mine. And this is why
- 19:27Speaker 2: I call what's happened the mental health industrial complex, because
- 19:31Speaker 2: in the last few years there's been a rapid expansion
- 19:37Speaker 2: of expensive assessments, of books, of podcasts, of magazines, of
- 19:45Speaker 2: self help manuals, of online programs. Not just the pharmaceuticals,
- 19:51Speaker 2: but there's a whole raft of things. I really feel
- 19:58Speaker 2: the current generation of young people growing up I have
- 20:02Speaker 2: been the most pathologized generation that there has been, and
- 20:08Speaker 2: that really worries me because I think we've been setting
- 20:12Speaker 2: young people up and there's so much evidence now to
- 20:14Speaker 2: suggest that that's what's happening. We're setting young people up
- 20:19Speaker 2: to be disempowered and sometimes to be unnecessarily disabled.
- 20:25Speaker 1: It's a solid take, it's a provocative take. It's the
- 20:27Speaker 1: kind of take that gets people to sit up and
- 20:29Speaker 1: pay attention, and I'm sure that there's going to be
- 20:31Speaker 1: a lot of people that have a lot to say
- 20:33Speaker 1: about it. Personally, I think the book is needed. I
- 20:35Speaker 1: think it's a vital insight into where we are from
- 20:39Speaker 1: a mental health perspective in the current climate, and a
- 20:42Speaker 1: great call to action in terms of how we can
- 20:45Speaker 1: make some changes. Sammy, I could talk to you all day,
- 20:47Speaker 1: I reckon if you and I could sit down over
- 20:50Speaker 1: a coffee table with a couple of nice drinks and
- 20:54Speaker 1: some snacks, you and I could probably talk for two
- 20:57Speaker 1: weeks and solve all the problems of the world. It
- 20:58Speaker 1: would be so much fun. But for now we're going
- 21:00Speaker 1: to have to leave it there, simply because time gets
- 21:02Speaker 1: the better of us. Thank you so much for being
- 21:04Speaker 1: generous with your time and having a chat with us
- 21:06Speaker 1: about your new books, Searching for Normal.
- 21:09Speaker 2: Thank you so much for inviting me.
- 21:11Speaker 1: The book Searching for Normal is available right now everywhere
- 21:14Speaker 1: that you buy your books. One of my favorite books
- 21:16Speaker 1: of the year. There's no way for me to say
- 21:18Speaker 1: it without being any more excited about it than that
- 21:21Speaker 1: I just loved the book. Doctor Sammy to Mimmy, practicing
- 21:24Speaker 1: consultant child an adolescent psychiatrist and psychotherapist, working previously with the
- 21:29Speaker 1: NHS in the UK. He's written forty book chapters, mainly
- 21:31Speaker 1: in academic books, although his most recent one, before Searching
- 21:34Speaker 1: for Normal, was called Insane Medicine. How the mental health
- 21:37Speaker 1: industry creates damaging treatment traps and how you can escape them.
- 21:40Speaker 1: Check out Searching for Normal and new approach to understanding
- 21:43Speaker 1: mental health, distress and neurodiversity wherever you buy your books.
- 21:47Speaker 1: The Happy Family's podcast is produced by Justin Ruland from
- 21:50Speaker 1: Bridge Media. Mimhammonds provides research admin and a whole lot
- 21:52Speaker 1: of other support and if you'd like morofo to make
- 21:54Speaker 1: your family happier, please visit us at happyfamilies dot com
- 21:57Speaker 1: dot a u