Abstract
Rarely have adolescents received as much attention as in the past couple of decades. In part this is because young people spend a longer time as adolescents. Historical trends to earlier onset of puberty tied with postponement of the social transitions of marriage, parenthood and the economic independence that comes from full-time employment, are both responsible. Adolescence has emerged as an ever more distinct life phase for other reasons. More dominant and commercially driven youth cultures have emerged with profound influence on lifestyles, attitudes and eventually health. Youth are the consumers of tomorrow and for that reason adolescents have become the promotional targets for industries ranging from fashion and recreation, to illicit drugs and alcohol.
In medicine too, adolescent health has been one of the great growth areas over the past couple of decades. Adolescent and youth psychiatry have been a major part of that development, with Australian groups among the leaders in research and clinical service development. The case has been based on observations that so many mental and behavioural disorders emerge in these years, that early and preventive intervention targeted to this age group is warranted.
The prominence of adolescence is generally taken to be a good thing with young people having now greater educational, recreational and general life chances than any previous generation. This book takes the opposite view. Philip Graham argues that far from a golden age, the social and economic changes of the past few decades have left adolescents disempowered and ill-equipped for adult life and facing a growing tide of psychosocial problems.
The book has been supposedly written for parents of teenagers as well as teachers and other professionals working with young people. In fact, there is much in here that would be thought-provoking and challenging for psychiatrists and other health professionals. It covers a broad scope: the history and myths of adolescence, the emergence of diverse youth cultures and the common emotional, behavioural and health problems of adolescents.
Its principle argument is that from the age of around 14 years, an individual has the cognitive capacity to be viewed as a functional though inexperienced adult. The reasons for this not happening are that we have adopted a concept of adolescence as a transitional phase between childhood and adulthood and put in place disempowering social structures that reflect that view. Taking the example of secondary schools, the growing importance of education has meant that a great majority of adolescents remain in full-time education whereas in previous generations they would already have made a transition to employment and independence by the mid-teens. The result is what some sociologists have called a state of semidependence. Graham suggests a range of empowering remedies that we might adopt: introducing annual student feedback on teacher performance; involving students in teacher appointments; and involvement of students in the running of schools as part of their work experience. So, too, in family and local neighbourhoods, he suggests a range of novel empowering strategies.
The book ends with a plea for the end of adolescence as a concept to guide policies for this age group. Rather, we should view those from the age of 14 years as adults, inexperienced in many ways, but with close to the range of entitlements and responsibilities of other adults. This, in turn, would pave the way for better intergenerational relationships and an end to the ‘us and them’ mentality that has pervaded recent relationships between the teens and adults.
There is much that is thought-provoking in this book for those of us in the ‘adolescent health’ industry. Some of his suggestions are unlikely to get support quickly even if there is much sense in the argument. It would, for example, be a brave politician who would adopt an idea that the legal age for alcohol use should be reduced to 14 years as that would allow the adoption of more comprehensive harm minimization and early intervention approaches. This is an important book. It is one that we should be encouraging every trainee in child and adolescent psychiatry, paediatrics and adolescent medicine to read, to debate and to refer to.