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Adolescence is not a medical condition

Michael L. Baizerman and Judith B. Erickson

It is increasingly common to read about adolescence and adolescents in the language of medical metaphors: "They are sick and must be cured". This is a constant theme of editorials written about them, letters to advice columnists from exhausted parents who live with them, and in the literature aimed at professionals who work with them. Adolescence as a period of life is a syndrome, within which are others, e.g. "adolescent borderline syndrome". This particular one is characterised by, among other "symptoms", "immature behaviour", "compulsiveness", and "mood swings". This depiction is pure G. Stanley Hall, who in 1904 gave the classic description of "the adolescent". In 5th Century B.C. Athens, adolescents and adolescence were described in similar terms. Western societies have a long history of focusing on differences in behaviour using current theological and medical language as metaphors to understand these differences.

Adolescence and adolescents are heard by adults as calling out to be understood. Adults seem driven to make sense of adolescents, for in that process lies control of the unusual and the difficult. To many adults, kids are exotic, not least because of their dress, hairstyles, language, and friendship rituals. They are strange in fascinating ways; they may be intimate strangers, noisy companions, silent partners, and affectionate buddies, ad seriatim, with dazzling rapidity. All that adolescence and adolescents mean to adults and, reciprocally, adults mean to adolescents, is found in the mutual dances of understanding and misunderstanding.

General medicine, like its own adolescent psychiatry, is a perspective on and a language of difference. Appropriately so with disease, but far less so with social behaviour, where its use is metaphoric. The social power of medical language lies in its ability to objectify and give legitimacy to adult efforts to control the often exotic forms of personal development that occur during adolescence. Medical metaphors confound the ordinary, typical and "normal", the different, the weird, and the odd, with the sick and the crazy. Biological metaphors confuse body illness with personal sickness, and distort development so that it suffocates life. Adolescence as a time of life and as a body of scholarly understanding is merely suggestive of how actual adolescents live their everyday lives. Agricultural metaphors of "raising", "rearing" and "growing" are joined to the biological and developmental in an adult language that is the professional's new rhetoric of adolescence. This promises existential understanding but can deliver at best only explanation and at worst, the distortions of ideology.

The adolescent ideology is a set of beliefs, facts, and interpretations that prevent the believer from seeing real young people in their uniqueness and possibility. It is a false truth - too often one built from weak correlations done in studies characterised by Neopositivist rigidity.

Instead, medical practitioners must speak in a different idiom using other metaphors. They must remember the call to their vocation and their witness to hurt and happiness. They must be reminded of the place of stories in their work, and of life as a story, a narrative. They must be asked literally to see the adolescent as a narrative in process and, in so doing, place the ailment and the pain in the context of everyday life and this moment, this paragraph.

It is the craft of medicine that suggests how to understand and be with adolescents. Medical sciences have little to offer on this. Medical language has only a limited place in the everyday lives of kids and most adults. This is how it should be. Yet, just as the early theological metaphors of sin and willfulness were given shape in the poor houses and asylums, these current medical metaphors have already taken form in the brick and mortar of a vast array of adolescent treatment facilities. The medical model of diagnosis, pathogenicity, and therapy used therein has become the lens used almost universally to view youth as behaviour and life as facts and living as troubles, problems, or illness.

Being a kid, with its orientation to exploration, adventure, and risk is seen as a "condition", as needing control and prevention. The moral panics provoked by such dilemmas as AIDS, "punk-hood", and chemical use have been extended to redefining the ordinary ups and downs of life as an epidemic of depression with enhanced risk for suicide. Yes, clearly, some adolescents are clinically depressed over a relatively long time and, yes, some of these and other youth do kill themselves. This is not at issue. What is at issue is the pervasive way of looking at a whole time of life as a period of morbidity or pathology, gaining legitimacy for this view, and becoming the experts who offer non-negotiable truths about cause and appropriate intervention.