Maureen Fitzpatrick – Module SSC230: Early Lifecourse Approaches
A Tsunami of Adolescence Anxiety: An impact of today’s modern world
By Maureen Fitzpatrick
I decided to do the course because I would like to eventually work training people with special needs and or to take up an advocacy role in partnership with people who are experiencing social exclusion.
This is an example of my course work that I have submitted for SSC230: Early Lifecourse Approaches
A Tsunami of Adolescence Anxiety: An impact of today’s modern world
This assignment will critically examine research evidence that investigated a rise in the prevalence of mental health disorders amongst adolescents and in particular the rise of anxiety disorders among young girls in Western capitalist countries such as Europe and North America (Dooley at al., 2019; Kessler,2007; WHO, 2000). Biopsychosocial factors that affect the development of a cohort of adolescents will be explored using a life course approach (Jacob, Baird, Barker, Cooper & Hanson, 2015; Mazza, 2017). Longitudinal studies will be analysed to demonstrate the relationship between poverty and the development of mental health disorders through pathway and cumulative risk models, in which structural inequalities predict outcomes that impact later life health outcomes. Hall’s (1908) Theory of ‘Storm and Stress’ will be compared to the research findings conducted by Margaret Mead (1928) suggesting that psychological disorders in the teenage years mainly manifest in Western individualistic societies. Arnett’s (1999) adapted translation of ‘storm and stress ‘states that young people can make more choices and act out of agency due to modern individualistic societies. Marcia (1966) concluded that increased individualism has given an increased choice which makes commitment more difficult to identify. Through Meta-analytic studies this assignment will confirm that anxiety is higher in individualistic societies than in collectivist societies. Psychological perspectives such as attachment theory, learning theories, and Bronfenbrenner’s bioecological system theory will explain the findings of the increase of anxiety and mental health issues in adolescents. It will be argued that there is over medicalizing of anxiety in young people and this obscures that the roots of ‘the epidemic’ stem from economic inequalities, and the epistemological fallacy that young people living in a modern individualistic world have more personal agency than they actually have (Beck,1992). Interventions to support mental health should be in line with sustainable development goals which address the causes of the causes of psychological distress which are structural inequalities in the distribution of power within societies.
A life-course approach to health explains how crucial stages for an individual’s life are relevant for health and it can explain illnesses in later life which can lead to an increased risk of mental health and a risk of early mortality. It investigates the social perspective of cultural, social, and economic circumstances experienced by an individual, and their cohort (Jacob, Baird, Barker, Cooper & Hanson, 2015). The Life-course perspective explains three models that are interconnected. Hertzman ( as cited in Maggie, 2005) describes how bios-psychosocial factors interact influence outcomes for later life. The critical period model is where an environmental exposure to an individual in a limited time window affects the body’s organs and structures at that specific time of development with a result of permanent damage. This exposure will influence the health of an individual in later life. This model includes risks from biological and social exposures. No other exposure in later life will alter that effect on the individual. An example of this is the Dutch Hunger Winter study which showed that members of the cohort who were exposed to poor nutrition following conception had higher risks of developing schizophrenia and obesity in later life (Roseboom et al., 2011).
The cumulative effect model refers to the series of risks and poor social determinants of health an individual is exposed to which build-up to affect the individual during their life course. Structural inequalities shape the individual at risk, and the ability to deal psychologically with risks. Bronfenbrenner’s (1993) Ecological systems model explores how risks such as maltreatment, neglect, poverty, discrimination in an individual’s microsystem, and macrosystem influence their mental health outcomes. Exposure to toxic stress hinders the development of an individual to self-regulate. Trauma impacts negatively on brain development which impacts behavior, learning, and health throughout the lifespan (Harvard.edu, 2020). Recent studies in epigenetics suggest that environmental hardships and risk in the first five years of childhood produce risky behaviors and increase the risk of unpredictability in adolescence and later years (Machluf & Bjorklund, 2015). The Adverse Childhood Experience study (Anda & et al., 2010) has concluded that children living with abuse, neglect, and poor family circumstances are at risk of poor health outcomes. Patalay and Fitzsimons (2018) described how poor socioeconomic status is associated with poor mental health in girls aged 11-14 but not in males of the same age. This emphasizes how the sex-specific vulnerability of deprivation is linked with poor mental health in female adolescents. Economic and social policy should focus on interventions to reduce the inequalities limited by the social determinants of health due to an unfair resource distribution through society (Marmot et al, 2008). Governments need to set targets that are in line with the Sustainable Development Goals which will address the inequalities in society (United Nations, 2020). Multi-level interventions aimed at reducing social determinants of health such as poor education, unemployment, and substandard housing. Interventions need to focus on improving the self-esteem and well-being of an individual by improving family and working life. Housing policies need to address the causes of homelessness. Various countries have recognized that accessibility to primary health care is essential to reduce mental health inequalities. There needs to be increased awareness of suicidal tendencies through prevention programs, and media coverage which may lower suicidal ideation (Wahlbeck et al., 2017).
The pathway model refers to linked exposures or events where stress inducing exposures or experiences lead to another risk and the links are continuous. It can combine both social and biological risks. It suggests that risks can send an individual on a definite trajectory. Negative events and stressors in the life course can be a cause of social anxiety disorder. Events such as family conflict as in the case of parents’ marital breakup, sexual and physical abuse have a long-lasting effect on an individual (Kessler, Davis & Kendler, 1997). Brumariu (2010) applied the pathway model for the development of anxiety. The study found that temperament and poor early attachment predicted early anxiety. This study also suggested that experiences with peers and emotion regulation are accountable for explaining interactions between some attachment patterns or temperament and anxiety in later life. Bowlby’s Attachment Theory maintains that a baby’s first connection with an adult is the most important as this is how it connects to others (Hart, 2008). A meta-Analysis by Lawrence and colleagues (2019) concluded that anxiety disorders are 7 times higher in children of parents with anxiety disorders contrasted to parents that have negligible mental health symptoms . Studies such as the MWS-1(2012) to MWS-2(2019) have shown a marked increase of young people in the moderate, severe, or very severe range for depression and anxiety (Dooley et al., 2019).
There are no identifiable genes that create a susceptibility to Anxiety disorders, but children of socially anxious parents are more likely to be diagnosed with a mental health disorder and this suggests familial links. Recent studies suggest a complex link and interaction between cognition, emotional, and biological responses. Research, where identical twins were studied, showed a rate of 21.5% for both twins having anxiety, compared to a 13.5% rate for dizygotic twins having anxiety. These findings indicate a genetic predisposition but because the rate is very low it indicates that psychosocial and environmental factors also play an important part in the development of anxiety disorders (Andrews et al., 1990). The child’s temperament style of social inhibition of the child has been linked to the development of an anxiety disorder (Clauss & Blackford, 2012: Hudson & Dodd, 2012). Banduras (1977) Observational Learning Theory can explain how a child can learn and mimic a parent’s anxiety behaviour (Doherty & Hughes, 2009).
Every individual has a certain amount of choice to take care of their mental health. Rational Choice Theory gives that responsibility to an individual, but some adolescents make choices to take risks. Individual agency is inhibited by structural forces such as environment, classism, racism, and ableism while at the same time structural dynamics generate the identities of individuals and their culture proposing they are interrelated. (Giddens, 1984). The modern life course introduces a more structural opportunity for individuals to change in socio-economic standings. This pathway is influenced by structural advantage and psychological development (Hitlin & Kirkpatrick Johnson, 2015). Structural inequalities create an important role in affecting who is at risk, and the capability to cope with such risk (Merchant, 2013). Individuals with better socioeconomic status have more agency. Individuals are progressively accountable for their life courses within western societies, partly because of disappearing class networks (Honneth, 2004). The importance of agency versus structure has been disputed with many academics suggesting agency is an illusion while others maintain that western concepts of agency emphases positive ideas of an individual, thus observing noticeably anti-social self-determining actions. Beck (1992) argues that modern life is indicated by individualists and there is a move from structural agency. He suggests that identity is based on the individual rather than the community.
The life course incorporates that individuals born throughout time are born into different worlds, with different constraints and choices (Johnston et al., 2011). The era in which someone was born into shapes their development and outcomes. Valsiner & Lawrence (1997) suggests that the life stage known as adolescence is predominantly an invention of the 18th to 20th Western culture. Literature throughout time has depicted young people and the idea of adolescence is not new (Shute & Slee, 2015). To have adult status in preindustrial times, biological maturity was the main benchmark. Girls were expected to marry once they reached menarche. The post-industrial revolution brought technologies with a demand for education increasing. Recognition of adult status was delayed, and the transition of adolescence began. In traditional cultures that celebrate age grades with distinct ceremonies such as the Jewish Bar Mitzvah, the process of psychosexual development appears easier to deal with as they have less to learn since the pace is slower.
Mental illness throughout history has been chronicled from the earliest record in the old testament of the Ancient Hebrews right up to the works of Foucault. The work of Foucault suggests that psychiatrists construct society through ideas and conceptualizations of mental health discourses. Medicalisation describes the process by which non-medical problems are discovered, recognized and treated as a medical disorder (Conrad, 2007). Several experts have suggested that the development of medical control is one of the most potent changes in the West in the last fifty years (Clarke et al.,2003). Beck (1992) argues that increased anxiety is due to living in a risk society. However, the biomedical approach to understanding and treating anxiety has led to labelling and medicalizing of anxiety even though the risk has been associated with social structures.
Due to the extended transition into adulthood, some groups of adolescents are restricted in their life choices due to structural constraints, young people are continuing in education longer and marrying in their thirties which leads to delayed adulthood, living with parents, and relying on them financially (Johnson et., 2011). The youth are now living under the false assumption of epistemology fallacy that essentially raises their obligation to transition and make the right decisions or live with self-blame as a failure (Furlong & Carmel as cited in Merchant, 2013), this itself is giving rise to high mental disorders amongst disadvantaged youth. Changes associated with the economy and consumerism have generated greater levels of risk. Modern youth now have an increasing sense of autonomy, self-control due to the high demand for a multidimensional set of interdependencies. With the ability to make choices comes an increase of different risks in their life course. A European study of two German-speaking countries concluded that there is a higher quantity of anxiety and neuroticism which was predicted by age of marriage and unemployment (Schurmann & Margraf, 2018). Meta-analyses in America of children and college students show increased rates of anxiety and neuroticism (Twenge, 2000). The National Institute of America concluded that one in three 13 to 18-year olds will experience an anxiety disorder (Mc Carthy, 2019). These findings show that the differences in anxiety and neuroticism rates between Europe and North America are connected to social factors such as the economy and very high divorce rates. Studies in Japan have concluded that adolescents have a moderate level of anxiety in comparison to western countries. This is explained due to culture and strict education demands (Shin-Ichi et al., 2008). In Western capitalist societies, government policies should be established in line with the sustainable development goals to focus on the lack of agency and to decrease the risk to lower socio-economic groups in society. For example, Goal 10. 2 by 2030, includes empowerment and promotion of social, economic, and political equality for all (United Nations, 2020).
The categorization of Stanley Hall’s Storm and Stress Psychological theory remains an open discussion. Repeated negative effects during this period have been assumed to explain the increased rates of affective disorders, suicide, and accidental death during this time of life. Reports that the onset of many mental health symptoms rise significantly from infancy to puberty (Kessler et al., 2005). However, some teenagers emerge from adolescence with minimal chaos. The theory suggests when a Universal child reaches puberty there is a stage of Storm and Stress which involves mood disruption, conflicts with parents, and taking part in risky anti-social behaviours (Hall, 1904). Storm and stress suggest that there is a discontinuity, a sudden change in adolescent development due to biological causes in the brain, and hormones. He believed that the youth are very receptive to stimuli causing increased stress (Arnett, 1999). In Western societies there is evidence there is a gap in the life course but there is also continuity due to gradual cumulative change. Evidence is not as consistent for non-western societies (Johnson et al.,2011).
Modern research has explored brain development and evidence suggests that biological factors as suggested by Hall (1904) in ‘Storm and Stress’ can increase emotions and sensitivity. Increase hormones such as testosterone can lead to increased aggression. Adolescence involves a period of the lengthy structural brain development of grey and white matter tracts (Dumontheil, 2016). This development change in white enables higher cognitive functions such as cognitive control and social cognition. The difference in white matter development implicates emotion processing and regulation in individuals diagnosed with an affective disorder. (Ladouceur et al., 2012). Grey matter development in individuals with a high IQ have a greater window of sensitivity to the environment (Dumontheil, 2016: Ladouceur et al., 2012). The difference in the growth between pubertal maturation and subcortical regions support processes concerning rewards and emotions. Parietal frontal and temporal cortex development aids self-regulation and social understanding. Adolescents react specifically to emotion and rewards but also, they have reduced self-control which indicates an increase in taking risks and mortality compared to children. Adolescents become more sensitive to peer rejection and risky behaviors increase in the company of their peers (Dumontheil, 2016). The events individuals experience can mould neural pathways with synaptic pruning altering the brain itself into a more efficient neurological structure in adulthood. Studies have established that individuals with Social Anxiety Disorder have a greater cortisol response when performing in front of onlookers. Social Anxiety disorders are linked with hypersensitive postsynaptic 5HT receptors. People with general anxiety show a low dopamine activity (Beidel & Turner, 2007).
However, Margaret Mead challenged Hall’s theory of Storm and Stress. Through her anthropological research Mead in 1925 contradicted the assertion that storms and stress in adolescence are worldwide. She maintained that culture could have an impact rather than biological influences that cause adolescents to suffer emotional and psychological stress. Through her studies of Samoan girls, she established that Samoan youth were relaxed and well balanced due to their cultural and societal norms (Delaney, 1995). Also, Jeffrey Arnett (1999) modified Hall’s theory of storm and stress where an amended version of the theory is more accurate in today’s modern world. It is predominantly linked to western individualistic, neoliberalist societies such as North America and Europe where there is individual variability, with agency the youth becoming more independent, and with the ever-changing environment which can lead to risky behaviour. But not all young people suffer from it as each person is individual and it is not cross global or cross cultures. He concluded in more traditional cultures adolescents do not expect to become independent from the family so there is less conflict. However, conflict can occur in traditional families where an adolescent is challenged due to economic changes and integration with the modern global society (Arnett, 1999).
Biological factors are embedded in an evolutionary approach where there are family conflicts, peer influence, and risk-taking. Conflict during socialization of the child should be viewed as a struggle concerning the biology of a child with the biology of the parents but also the biology of the child in conflict with the culture of the parent (Badcock, 2012). Bandura disagrees with the evolutionary approach suggesting that media contributes to portraying youth as stormy. He believes that parents that are in good relationships with their adolescents often wait for the stress and stormy phase to start which leads Bandura to suggests that this can become a self-fulfilling prophecy. He believes any problem in adolescence develops from early childhood struggles and hardships (Vilelli, 2013).
Marcia (1966) argued that the increase in anxiety is due to the large creation of choices young people have and these choices increase identity moratorium. Psychodynamic approaches suggest that identity matures because of inner conflict. This approach formed statuses: achievement (commitment after exploration), foreclosure (commitment with no exploration), moratorium (continuing exploration), and diffusion (no commitment and exploration). Marcia’s research has concluded that most adolescents are in identity achievement or identity foreclosure. That is, a high level of positive improvements and a secure identity is considered. Whereas people with a moratorium and an identity status are considered to have a high level of unsafe problematic behaviour and irregular identity crisis (Hatano, Sugima & Crocetti, 2015). As adolescents develop through their teenage years they think more about their identity and they may reassess values that they already accepted. This can lead to an identity crisis, but most can solve it before they reach adulthood. Our culture growing up also influences the way we perceive ideas such as self and identity. Living in an individualistic culture a person gains a sense of identity as an autonomous individual who has clear distinctive boundaries separating from other people. But if a person grew up in a traditional based culture the conception of self would be with the family members and friends.
To improve the wellbeing of young people interventions that remove the existence of stigma, manage mental health symptoms need to be established. Policymakers need to tackle problems in accessing services that can make it a difficult transition to adulthood. Universal healthcare should be made available to reduce mental health inequalities by increasing awareness of the risk of suicide through precaution programs that reduce suicidal ideation (Wahlbeck et al.,2017). There is a large amount of money invested in early years education to support the cognitive development of children from disadvantaged areas. Due to brain restructuring in the ages 9- 14, it is a good stage for prevention interventions.
The life course approach incorporates a bio-psycho-social understanding of health during a lifespan and it focuses on the adolescent period as important for health outcomes such as low educational attainment and disorder. The transition between adolescence and adult life is a central period that provides an opportunity to impact adult, physical wellbeing. An individual’s mental health can influence how a person navigates norms and social structures which can affect educational accomplishment and employment capability. Individuals that are uninvolved with education participate in risky lifestyles and are more likely to experience poor life experiences. It is at this life stage that due to poor social determinants of health they are more at risk to experience an abrupt than a gradual transition to adulthood (Sapiro & Ward, 2019). Psychological development is constrained by genetics and environmental influences. All an individual undergoes and understands is partly determined by nature (brain and genes) and partly by nurture (the environment as a child, poverty, risk of neglect, physical abuse, sexual abuse, food inequality). These factors are continuously interacting in a complex way. It is not our social situations that determine how we develop but our social circumstances impact how good we are at adjusting to the changes that take place during our life span. (Elder, 1998). Studies suggest Anxiety among youth is increasing, this due to the over medicalizing of young people and not considering the stress associated with the responsibility of self -failure in an individualistic society. The mixture of attachment styles, biological, negative life events, and stressors such as making risky choices with an increased abundance of life options and have a causal role in the development of social anxiety disorder for most affected individuals. Eastern cultures have less prevalence of Social anxiety disorder than Western cultures due to having a positive constructive attitude towards anxiety. The existence of stigma, management of mental health indicators, and problems in accessing services can make it difficult to transition to adulthood. Policymakers and health care professionals have a duty to provide adequate interventions and healthcare.
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