Day Two - Friday 23^rd October 1998

Keynote Address - Chaired by Richard MacKenzie

Richard MacKenzie Good morning. I hope most of you are refreshed after checking-in yesterday’s challenges and new knowledge and review of old knowledge. I think coming from Los Angeles I am always refreshed to spend time with Diana and her group here in London because I am often reminded of the basic concept that we as individuals working with young people have to always to remind ourselves of. First of all yesterday we were reminded that problems are really potential for change: when a system is in balance it is very difficult to change that system. It’s very difficult for a lot of us to make changes in our life because we are set in our ways so to speak. And adolescents go through this whole series of so-called problems, what we call problems, but they provide us a potential for change and this was repeated again and again yesterday in the various presentations.

We are also reminded that what we often see as a resistance in working with young people maybe part of their resilience, the ability to carry on under very adverse conditions. The ability to survive under conditions that perhaps you and I would succumb. We are also reminded that in what we think of adolescents from the disease model, you know it’s very much a position that other medical practitioners think of adolescents, that we must modify that disease model, put a hyphen between the “s” and the “e”, it’s not really a disease, it’s really a dis – ease. And I am confident in that feeling, that they are feeling as they go through the changes of their transition from children to young adults.

We were reminded by Bob later in the day that you know we’ve got to look at adolescents, the youth from the point of view of their strengths and not their deficiencies. It’s like the more you pay attention to the more it’s going to grow. The more you pay attention to their deficiencies, and they seem to exaggerate their deficiencies before your very eyes. If you look at their strengths – that’s what seems to grow within them. And if you don’t believe that just try it on the next young person you see, pick up on something that is strong within them, something that you recognising as helping them to deal with their lives and you’ll see how they will grow, they will stand proud, they’ll try and exaggerate that for you so they become a better person.

We are also reminded that youth within themselves are a resource. We saw several examples of that with Daniel Hardoff and John Rees’s group and we forget that because we tend to see youth as being needy, being somebody that we have to give to something rather than seeing how much they can give back to their own youth and to the adult culture itself.

One of the thing I keep reminding myself and as Bob yesterday says, you know,  there is nothing more practical than a good theory. And one of the concepts that I have about youth and when I was up here two years ago providing a keynote I reiterated that concept and I’d just like to re-offer it to you as a way to sort from a lot of the information that you’ll hearing today and that you’ve heard yesterday. You know, Jean Jacques Rousseau once said, that we are born twice over: we are born once into existence and once into life. And that birth into existence is that existence that we all know. You know that baby being born from the mother, the baby was not there, the baby is now there, the world is there for the baby. But then there is a birth into life. And that’s adolescence. You exist and then you are born into life, you move beyond the boundaries that were protective of you and now you are exploring life itself and the social toxicities, and psychological challenges become the things that come to affect your very being not unlike the drug that maybe a mother may take when the baby is in the womb may affect that being. What we have around us begins to affect the being of the adolescent.

So as we move into our keynote address with looking at youth conserving our resource for the future it’s really appropriate to challenge this second day with that concept. And to keep that sort of framework in the back of your mind as how I am being the obstetrician to the youth of the future, what role am I playing in facilitating that birth and making sure that the product of that birth is the best that I know how to help with.

Our speaker of course, our keynote speaker Diana Birch is not a stranger to anyone in this room. Diana’s been instrumental in introducing the whole field of adolescent health to the UK, she has brought it down to the practical level by developing the Youth Support House in Beckenham. She has provided a colloquia for people like you and I to get together by having these conferences, she has provided literature for us to take away and she shares her experience of working with youth and she has generally just been a spark for all us who come from both sides of the pond so to speak, those of us in the US to hear of what’s going on in the UK and for those in the UK to constellate their energies for 2 days or sometimes to spend time with her in some of her programmes. I couldn’t think of a better keynote speaker to start off this second day than Diana who has organised this conference, who has probably spoken with most of you in this room, who has interacted with probably some of the more difficult youth that I have seen in her programme, and who has thought a lot about where youth are going, so I will turn the podium over to Diana to address the issue of youth conserving our resource for the future.

Youth - Conserving our Resource For the Future    Diana Birch

Adolescence is traditionally regarded as a time of turbulence, a cocktail of mixed emotions, anxiety, excitement, pain, fear and joy  - though as often as not the joy part is experienced as a retrospective emotion something not experienced until looking back and having gone through several adolescence’s or life changes.            

Do we as unfulfilled adults look back through rose-tinted glasses thinking ‘it must have been good’?  When I as a teen heard the old chestnut ‘school days are the best days of your life’, I thought that held little promise for the future. For some, the disadvantaged and abused, this carries no joy and this is a sadness for all of us, marking a sense of failure for us adults / professionals that we have not done more to bring happiness and joy into the lives of young people.  - A wasted resource.

Adolescence is a relatively new concept, in many ways self indulgent, a luxury of the developed world that youth has a period of respite before entering the adult world, a period to adjust, to reflect, to learn, to study or perhaps a period in limbo, no-mans lands -  not child or adult. As Judy Garland sang “I’m just an in-between”. Does this period really exist or is a mythical creation of modern society? (Perhaps of those practising adolescent medicine specifically ).

In many societies individuals move from the child to the adult world with no in-between stage, child to mother, daughter to wife, dependent child to worker.  The same was true in the western world not long ago, girls changed their short socks to stockings and started work the day after they finished school at age 15.  The cult of the teenagers began in the fifties with the  advent of pop music, teen fashion, teen culture which was encouraged by commerce who revelled in the new young market.

So society began to exploit the teenager at first in a subtle, relatively innocuous way and then in more pernicious ways. A market for drugs, for sex, for all that’s wrong with society. However, in truth adolescence has a dual concept -  it is both a phase and a transition, but the phase as we have said is a time to learn - the luxury once afforded perhaps only to university students. But are we also creating an opportunity for risk taking, delinquency, teen pregnancy etc? There is a high morbidity and a mortality associated with this period in limbo, this phase of adolescence. The activities of  fashions and cultures associated with higher and higher risks start creeping in to fill this void. 

For example, recently one of the children attending our pet shop refuge ‘P.J’, was to indulge in one of these American import activities after our doors had closed one evening. He went tagging on a railway line and was electrocuted - another life cut short by senseless filling in of spare time. Let me tell you a little more about PJ - he was street wise - a mercurial kid - the little loveable rogue - either on the street or in the shop. He rode the trains - grabbing the back of a train and riding to the next station - he crossed the tracks for excitement - classic risk taking - his friend John did not speak for a week after it happened and then he poured it all out in a group session I held for the children after the funeral - ‘I told him not to go - but he would never listen - I told him that when you hear a click the electricity is coming on strong and you have to run  - he was walking behind Perry and we heard him say ‘ouch’ then we turned round and his body was jumping - then it stated to burn and his mobile phone went off - I was scared to answer it because of the current - but I could see the face said ‘mum’.”  We could not bring ourselves to tell his mother that as she rang her son was dying on the track.  

This sad event - rather than stop the kids tagging on the railway lines – has encouraged them to  put up memorial tags - ORA RIP. – At the funeral, they could not tear themselves away and physically held the coffin - I’ll never feel the same about Eric Clapton’s ‘Tears in Heaven’ which was played over and over again  .... Our late night refuge / youth club is going to be called PJs  - we have an appeal for that at the moment -

As a transition adolescence achieves more of a level of legitimacy, this is an adjustment and we need to look at the needs of anybody adjusting. There are no other periods of our life when we change so much, at no other times do we change more physically, physiologically, emotionally, mentally and within our roles. In many ways modern life has diminished the other changes, the other adolescence’s in our lives. For instance, maybe the menopause male or female does not hold the fears that it once did, it is not linked with reproduction and with new understanding of hormone replacement therapy it is not linked with sexual activity either.  Retirement is no longer the threshold phase it used to be, it is now a more of a prolonged phase. Marriage, divorce do not have the significance they had in the past, there are often many marriages and divorces so there are not so many big watersheds in life and for some the role changes in adolescence can all coincide. Who are we?  - The  pregnant school girl is an example par excellence where all transitions coincide, adulthood, motherhood etc. Interfering with the establishment of identity.

Of course the physical and physiological transition is of very great importance but I will mainly limit myself in this discussion to the emotional and physiological parts of the transition and change. I should not want to sound too depressing or have you going away with a negative image, but we have to look at the problems in order to find solutions.  Denial is one of our biggest enemies, so is the very natural mutual patting on the back which can happen at big congresses like this one, but we have to bite the bullet and look the problems full in the face and if we are being honest we will see that the main problems for youths is adults, we create society, we run it, we perpetuate problems because it suits us because we earn money from them and we turn away and don’t want to see them, 

We talk in a blasé fashion that the universal panacea the “resilience” of youths, but basically you develop resilience by being knocked, resilience is in relation to the assaults and problems in life. 

Roger Tonkin  writes on his email, “lets create opportunity out of challenge”, this is good and I find it uplifting to see this on his messages - but perhaps we could try to remove some of the challenges. Of course, just as our bodies develops somatic strength from physical challenge, training, weight lifting etc. so our psyche develops emotional strength from learning to survive hurt and pain.

What we need to ask is:-

1. Is it desirable to be “emotionally strong” implying a certain coldness, distancing, blocking perhaps.

2.  Is the learning process maladaptive. Each concept, the physical and emotional, can be taken to extremes. 

Emotional development encompasses a basic necessity to learn tolerance of frustration, we can’t have everything we want.  Mother can’t supply the milk to her infant instantaneously and satisfy the baby’s every whim, thus object relations are born.  The good breast, the good mother fulfils the child’s needs, thus the good object.  The bad breast, the bad mother frustrates the child and does not supply immediately, hence the bad object, an essential part of emotional physiological development.

However, in order to develop emotionally one does not need to take this to extremes, the child does not need to be abused, neglected or abandoned.  It is when this happens that the response to abuse, the survival mechanism, coping strategy, the resilience if you like,  can be maladapted - like Ellen speaking of her uncle’s abuse of her “I can take it, he can punch me as hard as he likes, I don’t feel it”.  On her sexual abuse “I didn’t think it hurt me until I stopped to think about it, I thought it was normal,  she called it just a game, it didn’t hurt me because I blanked it off”.

So looking again at preserving this valuable resource for the future, perhaps we could break it down into looking at early patterns,  prevention of abuse, the early childhood with the long term consequences that it carries through into the adolescent phase and then into adulthood. And then at the additional assaults and stresses  that we place upon these young people as they go through their adolescence.

Abuse of whatever type naturally produces harm in the present,  hinders the development and carries a maladaptive pattern into adulthood. The child who grows up secure in the relationship with a parent is not so vulnerable to subsequent abuse, the child learns how to deal with emotions by using this relationship with mother or a parent as a prototype for future relationships. 

More primitive feelings, profound love, deep hate can not be held by the infant without the moderating effect of mothers reactions, the child projects his feelings onto the parent who mirrors them back in tolerable form. A child learns to love himself from the way he is loved by others, however, the child will also learn to hate him or herself by the way he is hated / abused by others.  The child will feel bad about himself, will feel guilty that he cannot make mother happy and be ready to meet the reinforcement of other abusing situations.  He may be unable to show his real feelings, may substitute one permitted feeling for another taboo feeling and will learn coping mechanisms and maladapted forms of behaviour.

The main hurdles we need to confront in helping to heal these wounds are the damaged self esteem, self concept,  value system of the young person entering the turmoil of adolescence.  So here we do have some advantages in that albeit adolescence is a period of turmoil, and also a period of vulnerability to further assaults with other harmful messages, it is also a window of opportunity for the establishment of positive change.  The young abused person enters this scenario of adolescence with a value system which is warped by his or her previous experiences affecting the way he or she feels about themselves,  self worth,  the way he or she judges others who is safe who is good,  the way the young person judges the world around him, a code of behaviour and a code of relationships.

Such a young person is also a needy child, an empty vessel who has never had enough of mother, who can be jealous of others, attention seeking, insensitive, develops shallow relationships and be unable to give - hence the difficulty of being seen as someone who is unable to place others needs above their own. This comes up frequently in the context of early parenting, a mother who can not put her child’s needs above her own, certainly she can not until she is also re-parented and given love, affection and being able to fulfil some of her own needs in the safety and security of  a therapeutic relationship or therapeutic environment.  This young person will also be entering adulthood with no concept of security or of knowing that someone cares about you enough to show you what’s right or wrong.  If no one care’s about the consequences of your actions then your actions are worthless and perhaps you are worthless too, no one care’s about you. An experience of misplaced trust, attempting to trust people who then abuse them, mean they enter the scenario of adolescence unable to trust.  They are also unable to communicate and often do so in indirect and more harmful ways acting out self harming, delinquency, suicide attempts, always of attempting to break the silence.   ..... Can we learn how to listen.

The other side of the coin which unfortunately often goes hand in hand with the factors we have already described, is how are adolescents abused and exploited during their adolescence? We have seen how they can be damaged prior to adolescence and as the young person enters the scene of adolescence.  But this exploitation continues on a grand scale throughout adolescence.     Again wasted resources –

Her are some ‘wasted resources’  - Gary the son of a teenage mother who was brought up by his grandmother and when she died, became a street child and then attempted to use his meager personal resource to protect his sick mother and younger sisters from an abusive man. He lost his childhood.    

John who fled from an abusive mother into the hands of a needy damaged and abusive girlfriend and ended up in prison, taking the blame when she abused their child. Lee who was beaten by his father, led into crime and drug abuse by his brothers and ended up a very angry young man screaming out for someone to listen to him. We need to stop these kids from being trapped in the perpetuating system of abuse.

How else can we waste the resource?  By professional abuse. By the care system - in the pregnant schoolgirl survey (The child that rocks the cradle) girls in care had a worse history - higher incidence of abuse, crime, disruptive behaviour and in their pregnancies showed more harmful patterns of repeat pregnancy -  their children fare worse at 5 yrs - 10 yrs - 15 yrs follow up. By not allowing adequate funding to break the cycle of waste we are perpetuating the problem from one generation to the other.

Let us look again at exploitation - let me take you briefly through a progression of exploitation.  We had a very successful workshop on exploitation in Atlanta last year in which I concluded that it is very important to regard youth as a resource rather than a commodity, not a commodity we can use but a resource we can value and value together, in so doing we need to encourage youth and not exploit them. However exploited they are, on a number of different levels they are exploited because of their attributes which include youth, vitality, vibrance, sexual energy, a need to be independent, a need to get out there and work and earn a living and a need to experiment and explore their surrounding. 

All these attributes are exploited in the work force by being used as cheap labour or by unsafe situations, they are exploited in the fashion market, whether it’s in advertising or in purchasing goods ranging from CD’s, music, trainers and other more harmful  substances such as drugs, alcohol, alco pops, tobacco etc. and they are exploited sexually in pornography, paedophilia, they are exploited by their families, by friends, by other young people and by society and by society at any level.

So what can we do about this?  The first things is that we need to stand up and be counted, we need to discuss these issues out in the open and we need to confront the denial surrounding some of these activities.  Many of these activities are covert  and sometimes as professionals we can collude with the covert nature because we don’t want to face some of the wider issue’s, but the issue’s are wide and world-wide and we need to look at them together.  Many of the issue’s also involve danger, because in speaking out against pornography and prostitution, we are not only exposing activities but we are challenging and taking away the source of livelihood of those involved in the sex industry, the drugs industry etc.  The situation becomes and dangerous game of issues money, finance, power and politics are interwoven in a dangerous web, so we need to stand up and be counted not only in order to expose perpetrators and to expose exploitation of youth but also to allow youth to understand and see that we have a value system, that certain activities are acceptable, concern others and are not acceptable. 

As we have seen many of our young people from deprived backgrounds and from abusive backgrounds have grown up without a value system of their own.  We do not wish to impose ours, but we do need to show that we have one and they can sample our value system and then decide on their own set of values.  Perhaps if you have a value system they can respect themselves and value themselves enough not to allow others to exploit them.  So we need to work on two levels, we need to work on those who would harm and exploit youth, who would waste our resource for the future and we will also need to work on youths themselves to make sure that they value themselves, as an important resource for the future. 

And in order to value themselves for the future they need to have a sense of future and a sense of future which is worthwhile, we need to give them a future worth investing in. And perhaps we can do that -  here is Beverley - 15 years ago as a pregnant schoolgirl  and now a solicitor - We can be encouraged by this and by the positive work done in Jamaica - self esteem boosted - peer counselling;   And the Italian earthquake -   How many friends in London - and an apt catch phrase - ‘Rimarginiamo le ferite ‘ - ‘Lets heal the wounds’   Our youth have many wounds - let us help them to heal and conserve their strengths for all of our futures.