These are strange times indeed. Perhaps you, like me are stuck at home, working on your computer. I’m home because I’m on annual leave that I’d booked months ago to crack on with writing my next book. My husband is in the next room working from home indefinitely as London shuts down. Next week, I’ll be back in my NHS job. Being a child psychiatrist, I’m not on the front line, but doing my part ‘Keeping calm, washing hands and carrying on’. For now, we are continuing our usual service save that all our appointments will be conducted via phone or video conferencing. If there is one thing about the NHS it is that the staff are dedicated and we will do all we can to support our patients, either on the front line with corona-virus or trying to maintain as many normal services as we are able.
Children handle uncertainty and change differently. Big Sis has been dancing about with glee that school is cancelled, not at all downcast about a cancelled school trip to France, and outrightly refusing returning to school even if a place becomes available due to her mother being an NHS employee. Lil Bro has been subdued and downcast at the prospect of change, the cancellation of a class assembly and not being able to see his friends in person. All this, meanwhile grandma is self-isolating with a temperature >38 degrees C for the past 5 days.
Is it possible to stay sane? Here are a few tips:
Stay sociable. Social distancing doesn’t mean cutting all contact with friends and family. The telephone, texting, FaceTime and all manner of ways to remain connected still exist. Perhaps Big Sis’s nonchalant reaction to self-isolation is because she has her own smartphone and is part of generation digital who see no difference between personal and digital contact. We older generation can perhaps learn from our kids that we are lucky that we have tech and I’ve had more contact with my university gal pals this week than any other via WhatsApp. To be honest, we all lead such busy lives that we only saw each other once every 6 months anyway even before enforced isolation. It is also perhaps our social duty to stay connected digitally with our friends and family so that others know that we are doing OK, and we are not contributing to other people’s anxiety. You may find that they need a virtual shoulder to cry on or that their jokes still make you laugh however geographically far apart you are.
Stay active. Whether it be yoga, weights or a run in the park (keeping 2m away from others), staying active is as good for the mind as it is for the body. Plenty of home exercise videos and internet workouts are available.
Practice managing uncertainty. These are uncertain times, and for many of us that are used to being in control, managing uncertainty can be difficult and a source of anxiety. Start with a deep breath. We will all require to manage uncertainty at times in our lives and practising to manage it is a good thing. Most people that struggle to manage uncertainty do so because they fear that they are responsible for outcomes and will not be able to cope. They constantly worry whether they have enough loo roll, whether they should or shouldn’t use ibuprofen, whether their elderly parents have strayed outside. Rather than to go around in circles of panic worry, it may help to think through the worries and problem solve each scenario. Would it be the end of the world if you ran out of loo roll? In many countries loo roll doesn’t even exist and the good old hand suffices (I should know). Since we are all trapped in our homes and hopefully have access to running water, the world won’t cave in if we run out of loo roll. Take each day at a time and try to evaluate the facts rationally. The risk of serious ill health to most people, even in the older age group are still low. In the worst case scenario, if we or our relatives are severely affected (it will of course inevitably happen to some of us), there is nothing that we could reasonably have done to alter the course of events and worrying excessively adds to not relieves problems. If worries are financial and imminent, research government and business websites and see what support there is available for you.
Re-set your priorities. It’s not often that we get a break from our hectic lives. Being stuck at home for a while can be seen as a positive enforced break from the tread-mill. Use this time productively to think about your life’s journey and where you are going. In times of crisis, what really matters to you (health, family and friends) become sharpened – remember this feeling and perhaps take this opportunity to re-set priorities.
Spend quality time with your family. OK, we are all going to be forced to spend more time with our families. Social media is rife with despair about having to spend time with spouses and families, and indeed divorce rates have increased in some areas with enforced working from home policies. But taking time to reconnect with family members is positive. Although I was initially annoyed that the other half had eaten all my working from home snacks on day one, it is nice to have a coffee and lunch break with my husband rather than colleagues, and next week when the kids will join us, I have promised breaks for board games, indoor picnics and for Lil Bro and I to finish building the hydraulic robot arm project that we started at Christmas.
Help out those around you. We were posted a leaflet through the door from the local volunteer corps. It’s heartwarming that in any crisis, there are amazing people in the world that step forward to help others. People are rallying around to support those in the community around them, whether by donating time, resources or money there is so much do-gooding that can be observed. Lil Bro and I packed a care package that his school was collecting for the local Age Concern care home. Taking part in helping the community and those more vulnerable has benefits for mental health and can take your mind off the uncertainty that we all face. Not all of us are able to offer everything, but we can all offer something, even if it is just to make sure that you order take-out from a local restaurant business that may go under without your support.
Look for silver linings. When all this is over, for this too shall pass, there will be some silver linings. Pollution levels will have dropped and the air will be cleaner. We as a population will see that it is possible to change our life-styles and priorities: reduce air-travel, work from home for better work-life balance, and invest in the NHS to name a few changes, which may have long term benefits.
Self-Help. Prof Roz Shafran a lovely colleague at UCL is currently doing research on the quality of mental health advice on social media platforms such as Mumsnet. The initial data is pretty good, so good self-help is out there, both for a virtual hug and for decent information.
An excellent book for helping children with anxiety is this one:
Overcoming Your Child’s Fears and Worries, by Cathy Cresswell.
Other internet resources include:
Podcast to help explain Coronavirus to children with Autism by my excellent colleague Marianna Murin
I’m so sorry that I’ve neglected this blog for most of this year. Finding time to write has been really tricky which is a real shame as it’s what I really enjoy. I have so many more stories to tell about Molly and D over the last few years but as every working mum or dad knows carving out time for oneself in amongst children transitioning to secondary school, contemplating mobile phones, Year 4 friendship crises, packed lunches, class assemblies, forgotten violins, bake sales, endless clubs and classes, permission slips, nits, verrucas, molluscum, stitches and so on, there is hardly any time for anything. Just as you think one problem is sorted, another crops up.
It’s therefore such a joy that my lovely agents at Watson Little occasionally send me an email to tell me that the rights of my parenting book ‘Inside Out Parenting’ have been sold abroad. And yesterday, hiding in the secret cupboard where the postie leaves things that cannot get through my letterbox was a parcel containing 3 copies of a lovely little book.
I’m so chuffed to report that my book ‘Inside Out Parenting’ is now available in Thailand. I can’t read a word of it but the pictures are super cute! I particularly like that the cartoon me is missing a few tyres around the waist and bags under the eyes. If you know anyone in Thailand in search of a parenting book, please let them know!
So, if you have been following my blogs then you will perhaps have followed my daughter’s 11+ journey. Unfortunately she didn’t manage to get into the local grammar school which is the one that I myself attended (see posts about overcoming failure and how 11+ was in the 80s), but luckily for us, we were financially able to consider independent school options. We have sent our children to state schools so far and have never employed a tutor and so this would be our first departure into ‘paid privilege’. An unequal education system is not something that I am altogether comfortable with, but having the knowledge that within the state primary system my children have been relatively unchallenged and indeed have been teaching other children in their classes, I did feel that it would be important for them to go to a secondary school that would be more academically challenging in order for them to fulfil their potential. Whilst I was happy to teach my children the content of the 11+ exam papers, I really am not up to teaching GCSE French or Geography and quite frankly am looking forward to resigning from the teaching role altogether!
Choose the right range of schools
Many London independent schools are among the best independent schools in the country and we made the decision to sit Molly for 5 schools within reasonable commute. As our main reason for choosing the independent sector was for the teaching and academic environment, we only looked at schools which were well-known for good academic record and/ or pastoral care. For me the grounds, the school uniform and the politics trips to Washington and netball trips to Barbados were actually a turn-off (promoting privilege) although I recognise that there is nothing wrong with being interested in these aspects of schools. We ended up choosing 5 schools including one which is usually consistently in the league table top 5 schools in the country and one which was slightly less academic which we knew Molly would have a very good chance of getting in to bar disaster. I think that if you are putting children through 11+ exams, you should absolutely set them up to succeed by choosing at least one school that is a definite shoe in. Even if this school is not your first choice, make no differentiation between it and the other more challenging schools. In my mind, 5 schools is a sufficient number of schools to choose. I know children that sat 8,9,10 different schools and really? What is the point – you are aiming to narrow down to 1 school at the end of the day, so increasing a child’s exam burden is really a big price to pay for your own indecision. Try and get a realistic idea of your child’s ability as if your child has very little chance of success (say less than 50:50), remember that your ‘let’s have a punt’ is potentially at the expense of your child’s self-esteem.
Avoid setting your heart on a school
Unless a school is an absolute shoe in for your child, it is worth not setting your heart on a competitive school. The reason being that however hard you try to hide it, your child will be able to tell that you have a preference for a school and if they do not get in, they will feel that they have let you down and suffer disappointment in themselves. For children at this age never underestimate how much that they want to make you proud – it’s probably their top priority. If you can protect them from feeling like they have disappointed you, I would recommend it. My mantra throughout the whole 11+ process was ‘We don’t choose a school, a school chooses us’ and when pushed to choose a favourite ‘My favourite school is the school that chooses us.’ This was not a disingenuous act, but the truth. I’ll tell you why.
League tables are not all that they seem
If you look carefully at independent school league tables, you’ll see that the majority of schools in the top 50 have children who achieve remarkably good grades and regularly send children into Oxbridge and other really good Unis. Their position in the league tables is largely determined by the proportion of children who for one reason or another do not do as well. Rather than fixating on the number of A* children, we should consider why some children are not doing so well. It is easy for a school which sets a gruelling entrance exam to select intelligent children; and when you put intelligent children in, you’ll likely get intelligent children out. Simples. It does not necessarily mean that the quality of teaching at these schools is better. More impressive are schools with an easy entrance procedure that achieves good results – like many in the state sector. What the league tables hide is that in the majority of highly competitive schools a tranche of children are ‘managed out’ between acceptance and GCSEs. I know this because as a child psychiatrist, we often see children whose parents have been at best ‘asked to look at other schools’ and at worst ‘told/ threatened’ that their child will have to leave their school, because their child is not cutting the academic mustard at the prestigious school and their results will affect the school’s league table position. Are the top schools in the league tables then, just the schools that are best at smuggling ‘unsuccessful’ children out? It would be useful for league tables also to publish the number of children that left each school before GCSEs. One would imagine that people needing to move out of area would be fairly evenly distributed and so schools with higher than average student turnover would be interesting. Worse still are schools that kick children out between GCSE and A-levels or dictate which A-levels a child is and is not allowed to pursue for the sake of league table standing. This is not acceptable in the state sector and should not be acceptable in the independent sector either. In my mind, a school as a safe supportive environment for the formative years of children’s lives should commit to trying to fulfil the potential of its students and not be actively contributing to their potentially life-long neurosis that they ‘are not good enough’. To this end, much to the chagrin of my own Tiger mother (now tiger grandmother), I was happy to give Molly the choice of which school she went to amongst the 5 that I had chosen that she sit, irrespective of league table standing.
Good mental health promotes academic success
My strategy in getting Molly through the 11+ exams incorporated thinking about mental health, because as I frequently want to say to my patients ‘If your child commits suicide, it won’t really matter whether or not he/she got a place at Oxbridge will it?’. Extra-curricular activities continued throughout Year 5 and 6, as did play dates and holidays. Work hard, play hard was the mantra. We had started working towards 11+ early, so there was no panic and the increase in work was gradual. I was fortunate in that after Molly did not get into the grammar school, the majority of the motivation to work harder came from herself, and it was amazing to see how determined that she could be when she wanted to do something herself. From the start, the 11+ process was something that we did together and I was clear that whether we succeeded or failed, we would shoulder the joy or defeat together. In this way, if she failed, she could have someone else to blame as well as herself. After the exams and interviews, but before the results came out, I asked Molly to rate on a scale of 0-10 how stressful the experience had been. She said 4.5. I’ll take that! (Although it did cross my mind that damn – I could have got her to work harder!).
I really can’t give you much advice about interviews as Molly did all the hard work. Luckily, social ability is actually Molly’s strength and I knew that as long as I could help deliver her to the interview stage she’d more likely than not shine. Unfortunately, little did I know that at some schools the parents are also interviewed. Having been on-call and therefore unable to take annual leave to take Molly to the exams, I was responsible for taking her to interviews so could not back out now and make my husband take leave again. After a morning fretting about getting ready for the interview, words of wisdom from someone much wiser than me saved the day: ‘Don’t worry mum. Just be yourself.’ How lovely.
The Final Say
We were lucky enough in the end for Molly to be offered places at all 5 schools that she sat. We gave the final school decision to Molly and she is looking forward to starting in September. As mentioned, my mother was horrified at the lack of regard to league table standing in the decision making, but all my friends and colleagues in child psychology and psychiatry were in agreement. I liked what one of them said: there was a survey about how much people liked their furniture and IKEA flat-pack came out really well as people appreciate things more when they feel that they have contributed to making it. I hope this means that Molly will really enjoy the school that she has chosen. I am also grateful that if it all goes tits up – she can’t blame me!
And finally – it’s not just in Hollywood
Just as a sordid aside, I want to mention that I really wasn’t shocked about the stories from Hollywood about the rich buying their children’s places at elite universities. It is really a sad state of affairs if people think that only a few schools or universities can ‘make’ our children’s futures, and sadder too that the rich and influential feel that they can take these opportunities from other people. But just so it is out there, it happens here in England too, and it already starts at 11+. I know several children who have managed to get a place at academically selective schools for which they had not been on the waiting list for after interview, or had never been invited to interview or had never even sat the entrance exam for! These are not the super rich and famous but everyday upper middle class folk enacting their (white in the cases I know) privilege. Unfortunately, I’m not party to how these amazing feats were accomplished by parents so cannot share the tips with you here – that would probably have been a more interesting blog post! Sorry!
Last year I had a lively debate with my literary agent about children’s screen time. She had mentioned that there was a gap in the market for a book about the toxic effects of screen time for children and did I want to write a book about this? Many parents worry about the negative effects of screen time and really want to know about safe levels of screen time.
Being an evidence-based science nerd, I mentioned to her that I had not seen any good evidence for there being any negative impact on children of screen-time (based on length of time, not content). I admit, that I am not doing research in this area and so have not been ploughing journals and databases for evidence on this area, but in general, I go to conferences and child psychiatry meetings and get to hear about important research that is brewing (if there is any) before results are released to the press and general public and I had seen nothing on screen-time ‘being toxic’ that was definitive or evidenced based and that would warrant a book. I myself love the telly and happily watch anything from Newsnight to Love Island. On my days off, I’m quite happy to watch Flog it! and Cash in the Attic too. I’m good at putting boundaries on my phone, but admit to watching videos of pug dogs and dancing cats first thing in the morning or late at night. I am not ashamed to say I love screen time, it’s how I relax and I certainly don’t feel that my life is being ruined by screens.
There are many confusions in the screen-time debate that deserve clarification:
- Different people mean different things when they talk about ‘screen time’. Screen time could mean any TV, smart phones, internet, gaming, social media or any time doing anything on a computer. Most adults who spend their day working on a computer are in effect spending most of the day on ‘screen-time’. Is this detrimental? Excel can certainly drive me crazy at times, but I’m not sure this is what is meant when most people say that ‘screen time is bad for your health’. What about cooking with a YouTube video – is this screen time? What about my children’s favourite (not)…playing piano to ABRSM practice partner? Does this count? As screens are used for a myriad of activities which are getting more and more interactive, these days defining ‘screen time’ is rather more tricky than it sounds and we should be specific when we (particularly ‘experts’) talk about ‘the ills of screen-time’ and what it is exactly that we mean.
- Most of the weariness about screen time seems to be a judgement call on content rather than the fact that entertainment is brought by a screen itself. I think that we can all agree on children staying away from pornography and having age-appropriate certificates for internet content because beyond a doubt exposure to inappropriate content is harmful to children (violence, sex, aggression, extremist content, websites on how to build bombs and slit wrists etc.) – I don’t think anyone finds this contentious. But beyond this judgements on screen time being detrimental seem to be related to our own personal sense of ‘good’ and ‘bad’ content. I’m sure most parents would not complain about their children watching the news or Blue Planet. What about YouTube? Does it make a difference if your children are using YouTube videos to make loom bands or bake cakes or if they are watching YouTube videos of YouTubers watching other YouTubers play video games? Does it make a difference if your children are playing chess on the computer as opposed to MarioKart? If so, what we are really saying here is not that screen time is bad, but we should raise the standard of programming or that there should be parental control over access to content. How children use social media is a separate debate to absolute screen time usage and relates again to content rather than screen time-limit discussions. The best way to be aware of and happy about the content of what your children are accessing is to have an open, respectful and trusting relationship with your children. This takes time and energy to build but will make everything in your life easier, not just reduce screen time arguments.
- Association does not mean causation. Type in negative effects of screen time into Google and I am sure you will get a whole list of science-sounding information about the ills of screen time. But the same can be said if you type in vaccination and autism, deodorant and cancer and any number of absurdities. There are association studies between screen-time and health factors for sure e.g. obese children watch more TV and depressed children use more social media, but these do not mean that the screen-time is CAUSING negative effects on health. Is it because children that don’t like exercise like to watch TV, or did the TV ‘make’ children stop exercising? Does social media ‘make’ children depressed or do depressed children get drawn to social media due to their existing insecurity? Does TV make children behave badly or do parents of badly behaved children struggle more to get children off TV? Does gaming stop children doing their homework or do children that don’t want to do their homework play computer games? It is difficult to untangle and at present, the jury is still out, but my wager would be that simply removing screens from households of obese children would not miraculously lead to the child suddenly taking up sports, nor would removing the screen from the gamer lead to more homework being done.
- It’s not what children are doing, it’s what they’re not doing. The only evidence for the ills of the screen is that it takes up time that children could be doing something more worthwhile. But in this regard, the screen is no different for instance than an intense sedentary hobby like stamp-collecting or knitting. Both of these hobbies have some merits (as does watching TV), but done for hours at a time can lead to inactivity and lack of social interaction. The solution is not to ban screens but to encourage other interests.
The reality is that it is difficult to do any proper ‘gold standard’ research in this area, as this would require an ‘experiment’ where large cohorts are required to reduce or stop screen time altogether and measures of before and after are taken and confounders are taken into account (e.g. socio-economic status, parental educational level, child’s innate personality). These experiments are generally expensive and unpopular (most people will not react well to being randomly told to stop screen-time and if they volunteer to do this, they are de-facto a biased sample) and very hard to enforce (it’s difficult to check study participants are not having sneaky peeks at their TVs and phones), but I am sure that some researchers may try and do this kind of study in the future.
In the meantime I was very pleased to see that earlier this month the Royal College of Paediatrics and Child Health Guidelines on screen-time took heed of available research (or lack of it) and stated that there is no evidence for a ‘safe’ screen time limit because screen-time has not been proven to be ‘unsafe’. Please read the report, but in summary the guidance was:
- Children should not use screens before bedtime ( this is as blue light can affect sleep)
- Children should not snack while using screens (to prevent obesity)
- Children should have other opportunities for exercise (to prevent obesity)
- Screen time should be under the control of parents, at a level that they feel appropriate
And so, this is the uncomfortable truth about screen-time. Instead of asking: ‘is screen-time toxic?’, we should spend more time asking ‘How can I support my child’s social skills?’, ‘How can I improve my child’s diet and exercise?’, ‘How can I support my child to read/ write/ draw?’, ‘How can I improve my relationship with my child so that they want to spend time with me?’, ‘How can I improve respect in my relationship with my child so that they will comply with my instructions?’.
It may be convenient to blame ‘screens’ for all the ills of our children, but ultimately, it is parental responsibility to control screen-time in younger children and ensure that they are accessing appropriate content and doing other activities that are enhancing their development (physical activity, creative activity, social activity) instead of/ or as well as screens. It is also parental responsibility to teach children to control their own screen-time so that as adolescents they can make their own appropriate life choices. All the above is really tough and not necessarily what we thought we were signing up for when we had kids, but the reality is that if we don’t do it, who will?
If you are having trouble starting on rules around screen-time in your primary aged children, here are my family’s house rules on screen-time (but of course you should develop your own that work for you):
- Encourage other activities (play dates, reading, street dance, baking, swimming etc) from a young age BEFORE allowing access to lots of screen-time. This way, your child has formed good friendships and outside interests which they will want to continue and are willing to give up screen time for. Starting friendships and new activities can be daunting for some children and screen-time is a good excuse not to do things that are daunting, therefore: establish other strong interests first.
- Be good with boundaries. Parents that are good at setting boundaries in general (e.g. for bed time, eating greens, homework) generally don’t have problems establishing boundaries for screen time. The issue for parents is usually about being able to set and stick to boundaries in general not anything specific to screen time. If you have difficulties with boundary setting, get help to improve this. The Incredible Years is a very good behavioural management book for parents.
- Demonstrate your own ability to control screen-time. If you are always on your screen, then most children will do as you do rather than as you say.
- No TV between 9am-5pm (enforced about 90% of the time in term time, less so in the holidays). Within this (as there are plenty of hours before 9am if your children are early risers like mine and after 5pm), my children regularly have access to between 2-4 hours screen-time a day (aged 9 and 11) and I do not feel it has made them morally corrupt/ aggressive/ obese/ brain dead/ socially inept children. I have however had to endure a rather tiresome programme called Nicky, Ricky, Dicky and Dawn – episodes of which could lead me to stick pins in my eyes. Unsanctioned TV use leads to no TV for any children for a week – once you’ve enforced this once or twice, they tend to learn not to break the rule .
- No screen time until homework/ music practice/ chores are completed (enforced with 70% success). This rule both limits screen use and also ensures that there are no arguments hauling children off devices to do homework, the homework has to be done first.
- iPad which can be used between 9am-5pm is locked by password under parental control so that I am largely in charge of when and where this is accessed and for what purpose.
- No screens at the dinner table for any one including adults (enforced with 90% success rate by me and 50% by father), although as a family we do like a regular TV dinner all together watching Bake-Off or something similar. I work part time and generally have already gassed enough to the kids about their day and my day, but if this hasn’t happened and dinner is the only time to engage your children in chat, then I would recommend dinner table chat over a TV dinner.
- Try and avoid giving a child a phone until secondary school. Believe me, if your children are losing friends solely because they don’t have a phone, these are not the best friends for your child to keep anyway. If they are struggling with friendships, the solution is to support this, not to buy them a phone/ trainers/ designer clothes to keep these so-called friends.
- Keep going. Like with any family, there are occasional rows in my household about getting children off the TV/ iPad , but these are once in a while and part of life and no reason to abandon all control or feel like a failure. Remember, tomorrow is a new day to try again.
I’m told that the whole screens issue becomes worse as children become teenagers so I’m sure that the house rules will need revising, but for the time being this has worked so far. And as an avid viewer of reality shows like ‘Faking it’ and ‘The Real World’ as a teen, I’m now a psychiatrist: the ultimate real-world people watcher. My agent’s husband is also an advocate of avid film and telly watching as a child and he is now a film director – so go figure.
It’s not all bad…
Jo Malone CBE
(lots more amazing and smart women)
I can’t believe that I am going to be part of this amazing line-up at Red Magazine’s ‘Smart Women Week’ September 18th-22nd. I have been a great fan of Red Magazine the last 10 years and so I was absolutely chuffed to be asked to speak at their London event about all thing’s child mental health. If you would like to come along, please see the link below for tickets!
Watching Molly do cartwheels the other day, I discovered a new psychiatric syndrome: somatopsychosis. It’s a very rare condition and she may be the only sufferer largely due to her terrible parent: me.
Most of us are aware of the miraculous power of our minds over our bodies and the inextricable links between psychological problems and physical problems. At the most basic, feeling physically unwell can make us feel sad about not being able to do things we wanted to do, or anxious that we may have a serious or life-threatening illness. Being a medical student was the worst. Reading lists of symptoms of rare neurological diseases was bound to bring on symptoms of blurred vision, pins and needles and lethargy such that a self-diagnosed brain tumour became a convincing reality. Conversely, when we experience bereavement, adversity or tragedy, we often feel it physically as “heartache” or “headache” or “tiredness” and “sleeplessness”. The term “psychosomatic” is basically a fancy way of saying bodily (somatic) symptoms for which there is a psychological (psycho) basis.
Children are no different and due to their immature abilities to identify and express emotions, their propensity to cite psychological problems as physical ones are more frequent. For children, who may have less understanding that psychological problems stem from the head, the gut is the most frequent organ assigned to physical problems. Children who are worried at school may experience genuine stomach aches or constipation which miraculously remit at the weekends and on holidays. For teenagers and adults, the neurological often (but not always) begins to preside with headaches and migraines becoming more prevalent presentations of psychosomatic symptoms.
Psychosomatic symptoms more commonly arise in children who are less able to understand, identify and report their feelings and emotions. Therefore younger children, and children with learning difficulties and or autistic spectrum disorders are more vulnerable. It may also occur in children where reporting feelings and emotions is not possible, discouraged or seen as a sign of weakness or failure. Often children may have experienced past or current physical problems and therefore have a good understanding of how to solicit help or get their needs met for physical problems. Often parents can contribute to symptoms by their own fears and anxieties about their child’s physical health. This is particularly so if the child has a long standing medical condition or has been unwell in the past. Doctors and health professionals can add their own anxieties “of missing a rare disorder” into the mix with repeated investigations and suggested treatments to help uncover and treat an underlying biological basis to problems, and neglect to consider that the underlying problems may be psychological.
If that is the long established thinking on psychosomatic symptoms, what then is my new disorder of “somatopsychosis”? Well, exactly the reverse: psychological symptoms caused by physical ones. This sounds highly unusual, and indeed, Molly is the only recognised case report of this pathological condition that I have just made up. Here is how it works:
Some doctors, like myself (I hope this is the case and I am not an unusually hard-hearted anomaly), have a skewed sense of pain severity due to our dealings with pain at the very severe end. At times it can border on the down-right unsympathetic: when my husband complains of woozy head and sniffles, it’s most definitely man-flu of no significance and he should take Lemsip, go to bed and quit complaining. When an adult patient complains of pain from a blood test, I sometimes mentally think “Come on – it’s a skin prick – I’ve just sewn someone’s entire arm back on!” and don’t let me get started on people that wince in extreme agony from having a blood pressure taken. I am of course professional, kind and sympathetic to my patients, but I am also human, so I hope you will forgive the occasional internal eye-roll at such “wimpish” behaviour.
Unfortunately for my children, professionalism doesn’t wholly apply at home and although broken legs, cuts that are likely to leave scars and high temperatures are met with the usual heightened maternal anxiety (including vivid nightmares of misaligned bones or fractures that disturb the bone growth plates that only people of medical training contemplate) I admit to a general propensity to a lack of sympathy to minor physical pain. As such poor Molly and D have learnt that a grazed knee will earn a dusting off, a quick wound wash, a hug and a wipe of the tears, but then an expectation that the episode is now over and they are to carry on playing. A bumped knee will unlikely earn more than an “Oh dear, you’ll get a nasty bruise” or sometimes, I admit to even worse: “Well, that’s what you get for charging around without looking where you are going.”
As a child psychiatrist on the other hand, identifying and expressing feelings and emotions are a different kettle of fish. From a young age, both children have been encouraged to talk to me about their internal lives, what has worried them at school and all angles are thoroughly investigated and talked through with utmost attention.
It appears that this table-turning of the usual scenario where parents pay immense attention to physical pain and tend to access less of their children’s internal worlds can have its own unhealthy consequences. Here’s what happened:
Molly: Whee! look at me! I can do really good cartwheels now!
Me: You’d better watch out, doing cartwheels on a slippy rug is not the best idea…
Molly: Ouch! [Blubber, blubber]
Me: I told you so.
Molly: You don’t know what a terrible day I had. Girls were being mean to me at school.
Me: [???? What the hell? Where did that come from?]
I had to suppress a smile as I realised what was happening. Molly subconsciously knew that I wasn’t going to give her sympathy for a bumped bottom, but a potential peer interaction problem would give her the comfort and attention she needed at that time of physical pain.
AAARGHH! I have generated somatopsychosis! At least my early recognition of this oddity has reminded me to be more sympathetic to my children and change my ways. I absolutely don’t want her to subconsciously fabricate mental health problems to gain attention. It does go to show though, the frightening power of our day to day words and actions on our children, and the critical importance of what we DO and DON’T give attention and kindness for.
My dad told me he sent a copy of my parenting book to his old university friend who is in his 70s. After reading the book, his friend’s comments were these: “It’s not a book on how to raise your children, it’s a book on ‘How to Train Your Husband!'”
I had to laugh. I thought that it was only in the last chapter of my book “Inside Out Parenting” that I broke forth into a feminist rant on equality in childcare and domestic chores (promise), but it has to be said that since the book’s release several men have commented to me that they feel sorry for my husband. Also I do know that for some time now several of Banker’s friends no longer allow me unsupervised contact with their wives lest I contaminate them with my views on equality in domesticity and the value of fathers in the lives of children, so it is possible that this flavour pervades more of the book than I realise.
For many people the status quo is very satisfactory thank you very much and boats shouldn’t be rocked. But if like me you feel that “Equality starts at home” then here are my contributions on how to attempt to achieve this. I am by no means an expert on husbands or relationships but equality is something that I have thought about and tried to implement. Rather than feel ashamed or guilty about being a “mean wife” (which I am not impervious to feeling due to societal expectations of a “good wife”), I shall embrace the “How to Train a Husband” banner and offer you these gems:
- Choose your husband wisely. Simplistic advice perhaps but many of us get caught up in love and romance that we don’t think beyond to the potential 50+ years of life ever-after when desire abates, life goes on and chores are required to be done. Choosing a husband that respects and loves you is really important. My definition of “love” involves caring about your happiness. If being a “perfect housewife” is making you desperate or depressed, then husbands need to care about that and try to be more involved to allow you to fulfil yourself in the ways that you need.
- Start from a base of equality if you can. It is much easier to argue for equality in the home if your relationship started off on a basis of equality. Marrying your boss or someone incredibly wealthy unfortunately can put you an an unequal power footing from the outset. You may always feel weaker in your ability to assert your needs. But for many young couples these days, it is more commonly the case that going into parenthood both partners are working and earning an equivalent salary, the power dynamic only changes when one parent (usually, but not always the wife) steps back from her career due to childcare responsibilities. If this is the case, then you know what equality in a relationship feels like so you should seek to maintain it.
- Assert your needs. Some people love quitting their jobs to undertake the fantastic experience of parenthood. This is great. But some people don’t and they feel guilty about feeling this and/ or complaining about being unfulfilled by their caregiving role. I would say that if you don’t feel totally fulfilled, then it is imperative that you make this known to your partner. Harbouring guilt and unhappiness will gnaw at you from the inside and is the harbinger of depression. We all have to do things out of responsibility, but we need support and hope that there are alternatives or compromises to be made to work towards something more fulfilling. Hopelessness and feeling there is no way out is a very dark place. If you abided Rule number 1, then a partner that cared about your happiness would step in and do what they could to allow you to feel more fulfilled. Even if they could not actively help, their support and understanding of your feelings can sometimes be enough. Equally, if breadwinners feels trapped in a job they hate they should make their voice heard: adjustments need to be made for everyone’s happiness and an effective team and division of labour should work for all.
- Childcare is a 9-5 job. Of course this is blatantly untrue as children need looking after throughout the clock. But if it were a standard job, these would be the hours that you would be employed to work. As such, from this view point, any work that is required to be done outside of the 9-5 framework are a job for parents – of which there are usually two. Whilst I have undertaken to be the primary carer for my children between normal working hours (unfortunately in my case Banker works 7am-7pm), any child related problems outside these hours or at the weekends are equally shared. I know that this seems ridiculous to point out, but I have seen many of my friends continue to resume full responsibility for their children at weekends running themselves ragged while their husband relaxes after a hard week in the office. Really? If you are in possession of several young children I can honestly say that I think going to the office should be regarded as veritable downtime. If your husband poo poos this notion, book a week’s holiday away and get your husband to be sole charge of the children for a week (no grandparent support allowed). I promise that within a week, they will come around to the notion that going to the office is easier than childcare.
- Childcare and Maid are two different jobs. Just because you have given up your job to look after your children, this does not mean that you have also become the live-in maid. If your husband treats you like a maid, please stop and think whether this would have happened before you got married and gave up your job to look after children? If it did happen before you got married – why did you marry him…?? If it didn’t used to happen, what has changed, why have you become the maid? If he wants a maid, he should employ one. If the family are suffering because of reduced income due to your quitting your job to look after children, then this is a FAMILY problem, meaning that EVERYONE needs to pitch in to help with the cleaning and chores. You should both be maids. I know that this sounds petty, and I do more than 50% of the domestic chores in my household, but HELL if that is the “expectation”. If there is ever a whiff of discontent or insinuation that domestic chores are my “responsibility” – I go on full-on strike! Yes, ladies – I have purposefully picked out my husbands’ shirts and underpants from the dirty laundry and laundered my own and the children’s clothing only. If there are complaints about no clean shirts I point at the washing machine. Many of my friends find this despicable – but really? I never washed his clothes before we had children, why should having children together mean that I am now responsible for washing his clothes?
- Maintain a job and income. I know that this is not always possible, but if you can, in any way shape or form, I think this is beneficial for your self-esteem and sanity. The only way to maintain respect in a relationship is by knowing and believing that you WANT not NEED to remain in it. For me, knowing that I have maintained employment skills in a part-time job means that I have certainty that should my relationship fail, I could go full-time and be able to support myself and my family. It wouldn’t be ideal, but it wouldn’t be the end of the world. We would all wish for our marriages to last and relationships to succeed, but there is nothing successful in a marriage that lasted in misery and entrapment. Remaining in a marriage for fear of destitution is not really a great place to be in. Finances aside, a job allows you not only financial independence but to maintain social contact with other people and to meet new people such that should a relationship fail, you do not feel socially isolated and unable to meet new and interesting people. I don’t know if there are statistics to back this up, but anecdotally it feels like that when a couple divorce, the husband re-marries more readily than the wife. I don’t think that it is always because the wife typically gets custody of the children that this happens, but because many wives have been socially isolated or cosseted within female only social groups long before the divorce settlements are initiated.
- If “Training” your husband is not in your nature, encourage others to do it for you. I have found that often mothers are more readily blamed for anything that happens involving their children. When Big Sis broke her leg at the park with her father, my mother rebuked me with “What the hell were you doing letting your husband take her to the park!” This transfer of blame from fathers to mothers should be unacceptable but it happens all the time. Banker had a spate of being late to pick up Big Sis and Lil Bro on his nursery runs. Rather than rebuke him the nursery were congenial when he arrived late. However, the following day I would be given a telling off about the children being picked up late. I immediately countered that it was my husband who was late and not me. They acknowledged this and asked me to let my husband know that this was not on. Luckily, I had taken a good dose of assertiveness that morning and said, ‘You know, if I tell him it will be perceived as nagging. It will be much more effective if you ring him at work and tell him yourself.’ To my alarm, the nursery teacher became all bashful and said, ‘Am I allowed?’ This was the first time that I realized the unfairness of it all. Professionals are more than happy to criticize working women on their parenting but dare not criticize working men. I said to the teacher: ‘Not only are you allowed, but I would be delighted if you did!’. Mothers: encourage professionals to talk to your husband directly and refuse to be accountable for your husband’s actions. My additional advice, is this: if you are a professional who works with children, be it teacher, nursery worker, teaching assistant, doctor, nurse, dentist, or other, please be fair and call fathers to account as well as mothers.
- Share the Mental Load: What scientific explanation is there to say that organising childcare, making a packed lunch or reminding children to put on a coat and remember a PE kit require a pair of breasts? None-whatsoever. Yet generations of women have been conned into subsuming these activities as their responsibility. I myself spent much time and sleepless nights wracking my brains over solutions to tricky childcare logistics when I wanted to return to work. It only struck me when Big Sis was 7 that fathers could actually contribute to regular weekly childcare duties, rather than just at the weekend, Banker too was surprised to be asked. He had indeed sat through my endless rantings about how maybe we could pay ‘anyone-in-the-world’ to look after the children, without once suggesting that part of this responsibility was his. There ensued, of course, the typical grumbles: ‘important job’ . . . ‘impossible’ . . . ‘money’ . . . ‘promotion’ . . . ‘blah’ . . . ‘blah’ . . . ‘blah’. However, I happened to know that one of his colleagues had been able to wangle a late start to drop his children at school a few times a week. This colleague had just spent a tonne of money fighting for shared custody of his children, following a divorce. For him, it was a privilege to be able to do the school run. So I pointed out to my darling husband that I was offering him exactly this privilege, without the expense of a divorce and custody battle. Bargain! Seriously, though, surely childcare arrangements are a shared responsibility? Why does it so often fall to mothers? Even when fathers are doing childcare, it is often because the mothers have told them to do so and given them explicit instructions of where things are and what to do. The other day, having just cleaned the kitchen, I asked Banker to make Big Sis a packed lunch for her school trip. He replied, ‘OK. But what goes into a packed lunch?’ I did not dignify this question with an answer. A grown-up, well-educated man should be able to work this one out for himself. I, for one, would like some time off from all the thinking and planning of parenting, as well as all the doing. Make sure it is not just the load that is shared, but also the mental load.
I know I might sound like a right old dragon. But the good news is this: although implementing and fighting my corner with my husband has not always been plain sailing, I know this for a fact: my husband has been grateful for my honesty and has thanked me openly for allowing and fostering his relationship with his children. At a recent book publicity event, the male CEO of a major publishing company came up to me to say that he chimed with my view: the thing he is most grateful to his wife for was to insist that he participated in childcare. Although he grumbled at the time, he recognises now the difference it has made to his relationship with his children, now fully-grown. Because children are not blind, they see everything: who is doing what for whom. Providing the cheque for lavish birthday parties and expensive presents will never quite equate to the tear wiper, illness healer, sandwich maker, homework teacher, hug-giver, PE kit rememberer, confidence instiller; and I think that deep down, we all know this to be true.
For many parents it’s back to school this week, a time of mixed emotions. I’m sure that I am not alone in feeling a sense of relief (thank God I’m no longer responsible for them 24/7 or for organising who will be responsible for them 24/7), sadness (how the heck did they get this big? A minute ago I was wiping their bottom) and anxiety (how will they get on with their new teacher?).
The “Back to School” prep has all been done. This year, thanks to a last minute job application form that was due, the majority was delegated to Banker. For the first time, he braved John Lewis alone with the kids to battle over the last Size 3 Geox, AND he ironed on all the name labels on the new uniforms. This latter he did correctly this time as last year when he was assigned this task he spent an hour ironing on sticker name labels (used for books and pencil cases etc) rather than the iron-on name labels (used for clothing). They obviously didn’t stick and I had an absolute barney as I had to repeat the task. This year all was done to standard, which goes to show that these parenting tasks need not be the preserve of mums (if we are happy to tolerate a hiccup or two)! All I did was get Lil Bro his back-to-school haircut and then they were set.
As soon as my kids saw their friends they were off without a backward glance.
I toddled off to the shops. It was with sadness that on my return from the shops, a good hour after the school bell had tolled that I saw a mum and her son outside the school gates. I heard a snapshot of their conversation “Just go in and talk to the others. It’ll be fine.” It occurred to me that for some families, “back-to-school” is not just a logistic nightmare of name labels, new shoes and haircuts, but a return to a battle-ground and heartache.
As an autism specialist, it is not uncommon for my clients to loathe school and in extremis to refuse to go to school. Anxiety is the most common co-morbidity in children with autism, and it is also the most common mental health problem in primary school aged children. So here are a few pointers on school refusal:
Try to find the cause for anxiety
- Encourage your child to feel safe to talk to you about their problems. This requires a non-judgemental attitude and a guarantee of confidence and that they will not get into trouble. They will also need to know that they will be taken seriously, and that you will have the resources and strength to help them. Many children I see in clinic do not disclose bullying to parents as “it will worry them”, “they won’t believe me”, “they will only confront the situation and make it worse” or “they won’t be able to do anything”.
- Often it is not sufficient to ask your child why they will not/ do not want to go to school. Persistent badgering on this question may cause more harm than good if it is not forthcoming given encouragement. Sometimes your child may not fully understand their own emotions or the cause of their emotions and therefore cannot tell you even if they wanted to. In this instance, it is up to you to speak to teachers and friends and come up with your best guesses. Discuss these hunches with your child in a non-judgemental way: “If I were in your shoes, I’d be a little scared of your new teacher…” and see whether any of them chime with your child. This is a favourite child psychiatrist strategy of mine as usually one of your guesses will be correct and when you see a child’s face respond to you verbalising their darkest emotions, you can tell that you’ve got to the heart of it and work can begin.
If you find a cause then dealing with the cause will be your next step. Some common causes for school refusal in primary aged children are:
- bullying/ social ostracisation by peers
- bullying/ fear of a teacher/ fear of being told off
- anxiety about a particular subject: fear of failure in an academic subject, fear of being ridiculed in P.E.
- anxiety about leaving the parent (separation anxiety) for fear something may happen to the parent.
Sometimes, there is no one-single cause and anxiety may be generalised or the sum of minor anxieties that can overwhelm. Working through each one, however minor, can be important.
Dealing with the cause should always involve:
- Working together with the school. The natural parental instinct is to do your utmost to protect your child which can mean confronting the school staff or the parents of other children. Try to stay calm and keep an even head – whatever happens, getting other parents and teachers on side will lead to better outcomes for your child than making adversaries.
- Supporting your child. As well as in relation to the identified cause, increasing your child’s self-esteem, resilience and social skills will always help.
- Sometimes, parents will allow children to stay off school due to school refusal. It is important to remember that this can inadvertently encourage problems as you are in effect teaching your child that crying and fussing will lead to a day off school. Sometimes it is impossible to get a child into school, but if this is the case, then schoolwork should be done at home rather than a pleasurable day at home watching TV and playing computer games. An incredibly boring or taxing day of chores at home may lead some children to the conclusion that school is preferable!
- If at all possible, get children back into school as quickly as possible because the longer that they are off school, the harder it will be to get them back.
In September 2013, after a prolonged period of doubting, mental deliberation and build-up, I ventured on-line and bought myself a domain name: Shrinkgrowskids.com. It was meant to keep me busy while the children were in school because finding employment in school hours only is impossible. I psyched myself up. I was about to start writing when the following happened:
- my daughter broke her leg (she was 6 years old and too little to use crutches. We have a typical Victorian townhouse on 3 floors. She needed hoisting everywhere. I put my back out)
- my dad got diagnosed with cancer (thankfully now in remission)
- my son had terrible allergies to a list of over 20 food items
There were a lot of hospital appointments. The blog got put on the back-burner. Life’s never easy and there is always an excuse NOT to do something.
I’m glad that I persisted.
In January 2014, I finally got the chance to sit down and blog and this led on some 3 years later to the publication of my book last month. So I wanted to share the following with you:
Remember your dreams and make time to make them happen!
Here’s a little taster from the intro of my book:
Oh, for pity’s sake!’ I silently cursed.
I had timed the nursery run to a tee and for once we were actually on schedule – until my three-year-old daughter, Molly, realized that her new shoes did not have her name label in them. Disaster! I tried to persuade her that this would be fine for one day and promised to stick the labels in that night; I explained that I couldn’t do it there and then because we would be late for her nursery (and, more importantly, I would be late for a meeting I was due to chair). But Molly out and out refused to see reason.
So I tried cajoling, then bribing, then threatening her. All to no avail. Ultimately I gave in, impatiently got the name labels and grumpily stuck them in her shoes. But by then it was too late. Molly was digging her heels in and her anger wasn’t just about the shoes anymore, but had become an incoherent fury with the world in general. And she was still refusing to put on her shoes. There followed more shouting, this time from me, along the lines of, ‘Now I’m going to be late!’ Reciprocal shouting and foot stamping from Molly ensued, until I realized that physically picking her up, bundling her under my arm and forcibly depositing her in the car was the only way I was going to get anywhere that day.
This was no mean feat. Picture me shuffling sheepishly down the road to the car, praying not to encounter any of my neighbours, Molly tucked under my arm like a log, kicking and screaming, with no shoes on. Simultaneously, my eighteen-month- old son D (Chinese for little brother, which is what we’ve always called him), was clinging on to me like an oversized pendant, his arms wrapped tightly around my neck. Assorted nursery-required paraphernalia was haphazardly piled into two bags, which weighed down so heavily on my elbows that they were cutting off the circulation to my fingers, from which dangled the contentious shoes. I must have resembled a demented rag and bone woman with my assorted wares hanging all over me. Meanwhile, Molly’s ongoing high-pitched wails of, ‘You’re hurting me!’ advertised our approach to everyone in the neighbourhood.
It was on that day of model motherhood that I decided I should write a book about parenting. If this seems perverse, I haven’t even confessed the funniest part of the story yet. About an hour after that little episode, I finally took my seat at the meeting. There I sat, solemnly discussing the effects that ‘compromised parenting’ has on the mental health of children. Believe me, the irony was not lost on me.
You see, I am a child psychiatrist. Handling Molly’s meltdown should have been second nature to me, but it wasn’t. After this humiliating escapade, I started to write down the more ridiculous of my parenting moments, because on one level they intrigued me: ‘Surely a child psychiatrist should know better?’ I kept asking myself.
Before having children I probably considered myself some-thing of a ‘parenting expert’. I doled out parenting advice to parents like hot dinners and wore my, ‘I know about parenting; I’m a child psychiatrist y’know’ badge with pride. It was only when I actually became a parent that I woke up to the humbling reality that there is no such thing as a ‘parenting expert’. Parenting is, in essence, often a process of mainly well-intentioned trial and error. The well-intentioned part is important because in recent times parents have been taking their role in their children’s development much more seriously. We’ve come a long way from the days when children were seen and not heard; when it was fairly common for them to be farmed out to wet nurses, governesses or boarding school at one end of the social spectrum, or sent up a chimney at the other. We now know that leaving the administration of parenting to others means potentially leaving the outcomes
Indeed, sometimes it seems we have gone to the other extreme; there has been such a seismic shift in our attitudes towards parenting. Rather than abdicating responsibility for our children, or being ambivalent, we now have an almost obsessive preoccupation with them. I like to think that this is because my profession has done such a great job at promoting the importance of loving and understanding our children, though cynics might argue that it has more to do with the fact that most of us can no longer afford nannies, governesses or boarding schools. Whatever the reasons, there is no doubt that there is now a genuine interest in giving our children the best possible start in life.