Raising Responsible Children
Graydon G. Goss, MD
Common Misconceptions About Children
It takes a lot of training to become a child psychologist or psychiatrist. In my case, after four years of college at Brown University, I endured Medical School at Dartmouth, Internship and Residency in General Psychiatry, ( four more years ), followed by two years of training in Child and Adolescent Psychiatry.
Although I believed myself to be armed to the teeth with the latest and best in medical and psychiatric education, I nevertheless found myself feeling bewildered and helpless when confronted with my first real job as a Ward Chief on the Adolescent Crisis Unit at Los Angeles County General Hospital.
The first thing I noticed was that most kids in Psychiatric Hospitals didn't look or act sick. The younger the kids were, the more this observation seemed to be the case. While their behavior may have been awful, or their ways of expressing emotions primitive and unpleasant, I could not, usually, find any accountable sickness.
For years, you see, I'd been treating patients with illnesses of all types. Whether the problem was diabetes, liver failure or a broken arm all my prior patients had several things in common:
While it was true that some of the children on the Psychiatric Wards looked really depressed or had some obvious mental impairment, most of the kids looked like they were having a great time, running around the unit and getting into as much trouble as possible!
When I interviewed such a kid, the conversation often went like this:
Me: "Do you have any problems?"
The kid: "No"
Me: "Do you want any help?"
The kid: "No"
As you can see, this made them quite different from my previous patients. In order to really find out why these kids were in the hospital I'd go read their charts. What I found in the medical record was this:
This difference between patients on the child psychiatric wards and all other patients I'd treated was not a trivial one. How, I thought, was I going to treat patients who had no complaints of their own? It's the parents and teachers who have the complaints here! The kids didn't want treatment at all. I didn't know where to start. This was real different from regular medicine.
Then I recalled the words of a medical school professor I'd met years before. He was one of those old and wise physicians who'd been around the block a couple of times. We'd been discussing the art and science of diagnosis ---- how to figure out what's wrong with a patient.
"Because we are doctors," he had said, "we are trained to find illness. We are biased and may therefore fail to recognize health when we see it."
The remark meant little to me at the time I'd heard it, but it seemed to make sense in terms of the kids I was now seeing. I had been trained as a physician. Physicians treat disorders, ( medical conditions that cause symptoms and signs of disease). In the field of Psychiatry we treat psychiatric disorders. There's a big thick book that lists and discusses them all called the "Diagnostic and Statistical Manual". Included in the Manual are such things as Oppositional Defiant Disorders, Conduct Disorders ( all sorts of these), Attention Deficit Disorders and Depressive Disorders that are believed to cause undesirable behavior in children and adolescents.
I found myself struggling to pigeon-hole kids into these "Diagnostic categories", but had a hard time doing so. Parents would tell me that the kids were stubborn, or fought with other kids, or stole things. Which disorder was that? Furthermore, the diagnostic criteria were themselves vague. For example, one such criterion, needed to substantiate a medical diagnosis of Attention Deficit Hyperactivity Disorder is "the patient ) has difficulty sustaining attention in tasks or play activities". I found myself wondering whether a child so diagnosed was " having difficulty " or merely chose not to pay attention, ( especially if the task in question wasn't much fun ).
The more I thought about it, the less I liked the concept of all these disorders. Maybe my professor had been not only wise, but right! Perhaps there were no such disorders, or maybe only some of them were real. I found myself thinking "how can I tell a kid with Oppositional defiant disorder from one that's just spoiled rotten or who's parents let him get away with murder". When I voiced these thoughts to my colleagues, many of them got upset with me. Such notions weren't "medical" enough.
The medical / psychiatric profession seems convinced that kids misbehave because they've got various disorders.
I've become convinced that most of the time kids misbehave because they want to.
If you ask kids why they skip school, cheat on tests, lie, torment their peers, or ignore what their parents tell them, they'll usually tell you the truth. They simply want to. Period.
But wait a minute! Doing what you want to is not a disease! To the contrary, it is the most important thing there is when you are a kid! Kids don't care about the future, or what's good for them, or what's socially acceptable. If it feels good kids do it.
The reason kids misbehave is that they want to.
If you're five years old and you're angry with another kid it feels good to throw a slush ball at him. If you're fourteen it feels good to go joy-riding in dad's car and guzzle beer. At any age from four to twenty it feels great to win the approval of your peers by doing something that your parents hate.
So where's the illness? How can you tell if there is one?
I have a suggestion. Let's assume that an illness exists and is truly responsible for undesirable behavior if and only if the kid complains that it interferes with having fun, and, if observation bears out that complaint.
For example, if a kid tells me that he's upset because he cannot sit still on the little league bench no matter how hard he tries and that as a result his friends make fun of him, I'll consider the presence of disease. If, furthermore, his parents substantiate the complaint, I take the possibility very seriously.
Conversely, if a teacher tells me that she's upset because a kid is throwing spitballs and looking out the window instead of obediently studying math, and the kid tells me he hates math and prefers to throw spitballs, I seriously doubt that an illness is responsible for the problem.
It's not just the doctors who fall for the disorder theory. Most parents who arrive at my office with their kids in tow believe on some level that a psychiatric disorder is responsible for whatever behavior has them worried. They must! After all, I'm a doctor. You go see a doctor if someone is sick!
The first thing I tell such parents is that although their concerns are valid, their children are probably normal. I ask a few questions about the troublesome behavior and, within a few minutes, can be quite straightforward in reassuring them that there is no need for prolonged therapy for their child.
The most wonderful thing a physician can do is to NOT find a disease.
The next thing I do is to get some details about whatever behaviors have alarmed the parents and to figure out what motivators maintain them. If a normal kid misbehaves, there's got to be a payoff; a reward for doing it. The reward has to be important to the kid and is often invisible or incomprehensible to the parent. Given a choice, a kid will decide what to do based on his or her own analysis of what will feel best at the time.
Having explored the lives of thousands of children and adolescents, I've managed to sum things up like this: Kids will decide how to behave in any situation according to Goss's Law of Child Psychiatry Number One:
LAW NUMBER ONE
Kids want to have as much FUN, FREEDOM and CONTROL as possible.
This Law has profound implications for parents, especially when compared with Goss's Law of Child Psychiatry Number Two:
LAW NUMBER TWO
Parents want kids to behave responsibly and work hard.
It doesnt take a rocket scientist to notice that kids and their parents have opposite ideas about behavior. This fundamental difference leads me to the horrifying conclusion stated in Goss's Law of Child Psychiatry Number Three:
LAW NUMBER THREE
Conflict between parents and children is INEVITABLE and must be anticipated
and effectively dealt with.
Law Number Three is an upsetting one. It seems to imply that families are doomed to arguments, battles and screaming matches. NOTHING COULD BE FURTHER FROM THE TRUTH. ( Just read on....)
Law Number Three also raises some interesting questions about human development. If parents and children are so fundamentally different in their goals and objectives, how do kids ever turn into adults? At what point do kids change their agenda and start being hard-working and responsible? What triggers the change? By what process does the transformation occur? When I ask parents these questions I usually get answers like, " beats me".
Most adults honestly don't understand their own transformation across the "responsibility gap". They remember trying to get away with murder as kids, being sneaky and manipulative and untrustworthy. Then, they just "grew up".
This lack of understanding represents an understandable combination of faulty memory and a lack of objectivity. But we don't like to admit to either, and we hate to admit ignorance, so we tend to just make up answers. We tell ourselves that our kids will "grow out of" their misbehaving ways, that they'll "mature" at some point, or that the change will just "happen".
When I lecture to parents, I ask them the questions, get the "beats me" answers and then suggest the following:
Parents pretend that there are "Responsibility Genes"
Just as we know that there are genes that make our kids grow up physically, change their bodies during puberty and turn kids into adults, we have a tendency to believe that similar genes will transform the little monsters into caring, considerate, responsible adults.
As attractive as the Theory of Responsibility Genes is, there is no evidence, genetic or otherwise, that such genes exist and plenty to suggest that they do not. I like to summarize this point as Goss's Law of Child Psychiatry Number Four:
LAW NUMBER FOUR
There are no responsibility genes.
If you look at Laws Number Three and Four together some interesting conclusions result. If there are no responsibility genes, and conflict between parents and kids is inevitable, it's hard not to make the leap to Goss's Law of Child Psychiatry Number Five:
LAW NUMBER FIVE
Kids learn to behave if, and only if, parents win the conflict and make them behave responsibly.
Conversely, if children, rather than their parents, prevail in the conflict of agenda and succeed in their steadfast pursuit of Fun, Freedom, and Control, they will not learn to behave. I call such children, "Kids who run the show". You can recognize such children by their credos:
" I can do anything I want!!"
"You can't make me"!!
Now take a look a Law Number Five taking into account our discussion of "disorders". If we assume that there are illnesses that make kids lie, skip school, or steal, then the Law makes no sense. If, on the other hand, we get gutsy and throw the disease theory out the window, we can go onto Goss's Law of Child Psychiatry Number six:
LAW NUMBER SIX
Kids misbehave because parents don't make them behave.
Complicated, isn't it?
Children are not genetically programmed to turn into nice adults. As parents, it is our responsibility to make our kids responsible. If we fail, they fail. We don't fail because we're terrible people. We fail because kids don't come with instructions and we don't get any parent education. We try to engage in a serious conflict with our kids without the tools to win. Our kids prevail and successfully pursue their quest for Fun, Freedom and Control. Our goal of raising responsible people is superseded. The kids are not made to behave. They succeed in avoiding responsibility.
Our psychiatric wards, juvenile halls, foster homes and prisons are full of examples of such parental failure.
If we choose to attribute irresponsible behavior to illness, we fail to accept our primary job as parents. If we believe that misbehavior is the result of some psychiatric abnormality in our children, we will tend to seek treatment for them rather than to correct their behavior ourselves.
Treatment is the job of therapists. If we believe in the illness, we will hand over our work to them. If you give your kid to a therapist to "cure" of his behavioral illness, you won't make your kid behave. Quite to the contrary, you'll feel sorry for your poor sick child and make excuses for his behavior. You'll feel guilty if you get angry at his irresponsibility. You'll sit around waiting for the therapist to do something, feeling increasingly helpless as time goes on. Your kid will continue to win the great conflict. He'll be experiencing a lot of Fun, Control and Freedom but will be driving you crazy in the process.
You need - Goss's Laws of Child Psychiatry Numbers Seven and Eight:
LAW NUMBER SEVEN
The whole concept of behavior disorders is misleading.
LAW NUMBER EIGHT
No therapist is ever going to get your kid to obey you!
It's hard work to raise our kids, but it's our work. If there is no illness, therapists have nothing to treat.
SO WHY ARE THERE SO MANY THERAPISTS?
When I flip through the Yellow Pages, I find page after page of therapists and child treatment services offering to "help" troubled children and "treat" bad behavior. I see increasingly aggressive advertisements featuring slogans and touching renderings of tearful children and adolescents bereft over their inability to succeed. The clear message is " If you even think there's something wrong with your kid - we can fix it."
In Los Angeles, where I practiced, the competition between hospital based programs and out-patient therapy centers for business has become fierce and it is business. Clearly there are more private sector services available than are needed, even if my assertions are incorrect and we are instead facing an inexplicable and unparalleled epidemic of behavioral illnesses of unknown origin.
It appears to me that in many cases, the concept of behavioral illness has arisen as the result of two major factors:
If you take a minute and think about it, everyone achieves immediate benefit from the concept of behavioral illness. If parents become convinced that some disorder is responsible for misconduct, they no longer have to assume the responsibility for correcting it. Instead of being angry at their kids for misbehaving, they can feel sorry for them. Since it is human nature to feel terrible if you blame someone for something they can't help doing, parents then stop blaming their kids. Kids so excused receive increased freedom and control and have more fun. Therapists are then called in who make money. Since there is actually nothing wrong with their patients ( the children ), treatment goes on and on. In the meantime the kids are free to and sometimes encouraged to misbehave. ( Some therapists believe that good therapy entails letting kids do anything they want to and observing the result ). Parents become more hesitant to make demands on their "sick" kids, so conduct deteriorates because kids are thus free to do increasingly more outrageous things in their relentless pursuit of a good time. When the therapists finally give up the kids get put into hospitals and other kinds of "inpatient" programs which then get to bill for their services.
Everybody wins in the short-term. Eventually, however, the money or the insurance run out. The kids return home. Their behavior is now really intolerable. Nobody likes them. City, County and State services become required. Police and juvenile officials get involved.
The kids eventually begin to suffer. And when they finally do they suffer the most.
They become known as " bad " kids by other parents, teachers and peers. They feel as though they are always " in trouble." School performance deteriorates until any efforts exerted academically seem to be a hopeless waste of time. The kids become depressed and despondent. They turn to drugs and peers and gangs in a desperate search for relief and understanding. Often, they wind up abandoned by parents, in juvenile hall or out on the streets. For many, crime or prostitution become essential forms of income. All too frequently they commit suicide.
This is every parent's nightmare.
It's becoming a national crisis.
The myth of behavioral illness is what, in the long run, turns the nightmare into reality.
Let's dismantle the myth. . . .
Let's find some real answers. . . .
( continued in Chapter Two )
e-mail Dr. Goss to request the full text