[Text: Observer Network columnist Zuo Wei].
Is the homework done? "How's it going this year?" ”
After the final exams, although the students have entered the winter vacation, the soul questions of relatives have also made many children "tremble" about the upcoming Spring Festival.
Relatives may just be kind to ask questions, but the children's "grade anxiety" cannot be ignored. According to the author's survey, the child psychiatric departments of major hospitals are often overcrowded, and this phenomenon has lasted for many years. At the same time, a large number of children and parents are caught in self-doubt and anxiety.
On the one hand, the number of psychological problems among minors has increased, and the screening rate of depression has increased. On the other hand, depression has been generalized, and people have paid more attention to emotional problems, which has led to a surge in the number of patients. "At present, there are far from enough pediatric psychiatrists who can help problem families achieve crisis intervention, and at the same time, a large number of confused children and their parents cannot distinguish between depression and depression, and cannot effectively counsel or actively help themselves.
At the annual meeting of the Asian Education Forum on November 12 last year, Mr. Zhang, a director of a municipal psychological counseling industry association, said to me: "I am very moved. This time, everyone is a 'parent', hoping that the environment around the child will be better. To protect children's mental health, we need responsible advocacy. ”
01 "Distorted Care" and "Grass and Trees".
The child has old scars on his wrist caused by years and multiple self-injuries. At the urging of the school, the child protection center and the social service center, the child's mother came to see us with great reluctance. She said she was very busy at work and asked us to hurry up. "The staff of a city psychological service center are very helpless. They inform parents that their child is currently at high risk of psychological crisis. The child's mother replied: "She is hypocritical, and she will be fine after puberty." ”
But what if the child can't make it over puberty? "Director Zhang told me that in the past, the depression screening rate of adolescents was concentrated in the age of 14-20, especially in the third year of junior high school and the third year of high school. However, in recent years, studies have found that the adolescent population has shown a trend of one high and one low, with an increase in suicide rates and a younger age for self-harm and self-harm. "The age distribution of suicide has become a high incidence in junior high school, and the age of 12 has become a hurdle for some children to continue their lives. ”
Across the country, psychiatrists and social workers for the protection of minors have seen too many tragedies of twisted saplings.
The love and concern of some families for their children is extremely distorted. They don't care much about their children's physical and mental health and moral character, and don't pay attention to their children's repeated emotional breakdowns and self-harm, but they pay too much attention to their children's academic performance and strengths. "Even when such families begin to realize the problem and seek help from a psychiatric hospital, it is usually because the child has difficulty going to school or is staying at home. Initially, the purpose of "seeing a doctor" was also very clear: I hoped that the doctor would help the child "return to school as soon as possible".
In this case, the concern is that the child's social function has been impaired, and the lack of social function affects the person's life. "In the case of psychological clinics in big cities, there are many families with "wrong concerns". These families usually have a good economic situation, and many parents have achieved a leap in social status by relying on the accumulation of young people. Most of them can't accept that their children are inferior to themselves, and they use their experience to "carve a boat for a sword" to ask their children, and they are also incomprehensible to their children's grades or emotional "feedback" - "He is in much better condition now than I was then, what is he not satisfied with?" ”
There are also reasonable and gentle parents who say that they don't want anything from their children, and at the same time internalize their children with hidden expectations. "What is internalization? How parents perceive their children becomes how children perceive themselves. Parents feel very innocent, the current educational environment is like this, don't follow the crowd, what should children do if they complain about themselves in the future? Even many children show that "the more parents say they understand themselves, the more children push themselves". Therefore, in recent years, it has been found that more and more "top students" are depressed, and the psychological disorders of de facto orphans (parents who are alive but no one to seriously raise children) are more violent behavior.
At the same time, in stark contrast to the "indifference" or "ostrich mentality" of appeals, the psychiatric department and the children's emotional department of the hospital are also full of a large number of families who are "all soldiers and trees" and "snakes and snakes".
I watched the online self-evaluation, and I felt that the child was full of problems, so I quickly took the child to check for psychological problems. The parents of the 8-year-old child Xiao Na said, "Hang up to the expert number of West China Hospital." The expert and the child chatted alone for a short while, and the expert let the child play, and I was 'scolded' by the expert for nearly half an hour when I went in alone. The expert said that the child did not have any problems at all, and it was me who had the problems. ”
Cortana's parents' experience of "seeking medical treatment" is laughable. In fact, she should not only be glad for a "false alarm", but also because her city has the country's top mental health resources, and the people she receives are also real psychologists.
In recent years, the rising number of minors' psychological problems and the cases amplified by the Internet have aroused anxiety and thinking in society, especially among students and parents. Excessive focus on depression, especially the excessive defensiveness of schools and the sensitive fears of parents, makes adolescents more likely to fall into trouble. More and more children who do not conform to the pathology of depression "put a label" on themselves, causing ridicule and misunderstanding of depression on the Internet, and a large number of parents are at a loss and rushing to the doctor like Xiao Na's mother.
02 What happened to the kids?
At the psychology session of the 2023 Education Forum for Asia Annual Conference, a number of education experts, psychology experts, and clinicians announced cutting-edge data, many of which were shocking. Xu Kaiwen, chairman of the Social Psychological Service Working Committee of the China Life Care Association and founder of Daru Psychology, said: "The screening rate of depression among adolescents has reached 246%, and the prevalence of psychological disorders in children and adolescents was 175%, and the suicide rate among adolescents aged 15-20 is 334 100,000. His team also conducted suicide risk assessments (2020-2022) on 23,409 primary and secondary school students, who were much more at risk than college students, reaching 19 overall3%。
The parent is sick and the child has a fever. "Countless facts have proved that the pathology is manifested by the child, but it is actually the parent who has the problem. But psychologists say we can't just put the blame on parents. Many parents are also struggling with pain, confusion, fear, and regret. They had never heard of "depression" when they were teenagers, and in today's mixed environment, they don't know what to do when their child has a suspicious condition. In fact, in the face of the changes in family structure and social transformation brought about by material development, not only the family, but also the education system, the psychosocial service system and the public perception, we and the world are not prepared.
So why are the symptoms and crises concentrated in children?
Because minors are the most vulnerable part of society, but the pressure passed on at all levels ultimately falls on them. At the same time, the psychological strength of minors to support themselves is too small, and this "one big and one small" tears at the disordered body and mind, and then shows many unprecedented situations.
For example, in recent years, more and more families and schools have abandoned the character education of cultivating morality, and the success or failure of students is based on grades, resulting in a very single standard for minors to evaluate their self-worth. Another example is that the increasing academic pressure has greatly squeezed the play and sleep time that teenagers need most, and the child's whole world is highly tense, leaving him with no room and time for trial and error for spiritual growth.
Zheng Yi, chief child psychiatrist at Beijing Anding Hospital, calls this phenomenon "social isolation." He emphasized that in fact, the process of group play is very conducive to the cultivation of children's mental health literacy. For example, many children realize that 99% of people can't get the first place through games, and find that their personal abilities are not outstanding but they are good at communication and cooperation, which is conducive to self-affirmation and future career planning.
Why do adults find children vulnerable nowadays? Looking only at the group performance, the ability of adolescents to resist pressure and frustration is indeed unprecedentedly weak. But if one person or ten people are like this, it may be an individual reason. If the group is like this, then the problem is the children's environment. "Director Zhang told me that now that children have become a single individual, many of the truths and behavioral norms that should have been explored in group play and even friction have disappeared. "So everyone only sees themselves, and they focus too much on their own inner world and less on the healthy connection with others. ”
The social isolation of "only seeing oneself", coupled with the single evaluation system of meritocracy, has led some children and families to a situation not seen in China for many years: self-harm and extreme mutual injury among student groups have increased, and the friendship between classmates has become a life-and-death competition. Some students can't reconcile with themselves if they can't be the first, and they can't even be the first in the physical sense.
03 Dilemma and prospects.
Crisis crisis, crisis organic. The problems that have arisen today will be an opportunity for the family and society to grow. Experts have repeatedly stressed that the publication of cutting-edge relevant data and survey reports to show that the form is grim, not to create anxiety and panic, but to "get up and do it" - to protect children's mental health, not to be indifferent, and not to over-interpret. At the same time, the psychological crisis of adolescents in China has received the attention of all levels of the state and society, and it is precisely the best moment for intervention.
But at the moment, we still face many dilemmas.
The first is the unconscious or ostrich mentality of the really sick family.
Psychological service centers across the country, when carrying out mental health group activities for various schools, have encountered children asking for help: My parents are more seriously ill than me, but they don't admit it.
CPS clinical experts told me, "The key to whether a family can intervene or successfully save themselves depends on whether the parents are willing to change." When you meet parents who are resistant, it is difficult for everything to unfold. They can't accept that their children have mental disorders, let alone that they have. ”
Because of the deep stigma, the parents were reluctant to step through that door. In this way, some top hospitals in big cities have begun to try to reduce parents' resistance by using "children's academic ability evaluation" and "children's attention test" instead of psychological problems as the starting point. To put it simply, the Children's Neuropsychology Clinic, which is composed of experts in child neurology and psychology, diagnoses and ** children's disordered behaviors (such as ADHD) and family psychological problems through clinical assessment.
In this outpatient unit, specialized doctors will perform a series of assessments, examinations and diagnoses: some of them will address the problem of simple attention through non-pharmacological interventions, pharmacological interventions and behavioural modifications. Some families with psychological problems are referred to psychiatrists and psychologists**. Not only minors, but also some middle-aged and elderly people with mental illness, their children are advised to go through the 'neurology' examination, and then transfer to the psychiatric department if psychological problems are found. ”
Second, it is the excessive interpretation of depression in society, especially on the Internet, which is reflected in "distinguishing depression, signs of depression and depression" and "cognitive contradiction between two generations".
Taking the "2022 Adolescent Mental Health Survey Report" as an example, the results of a nationwide survey of more than 30,000 adolescents found that 14 of the adolescents who participated in the survey8% were at risk of depression to varying degrees. "Many people do not have the ability or time to read carefully, and only interpret the information through a few minutes or even tens of seconds, and it is easy to pessimistically equate the depression risk detection rate with the diagnosis of depression, and even stamp the short-term depression as depression. The interviewed experts pointed out that, first of all, depression is not the same as depression, and the risk of depression in children is not a diagnosis of depression. In fact, depression is one of the seven emotions and six desires of people, and most people have experienced varying degrees of depression. You can't take some self-assessment forms on the Internet and put them on yourself and your children. ”
2022 National Blue Book on Depression (People's ** Health Client, Health Times United Good Mood, Lundbeck China).
Secondly, depression is not to mention the extreme consequence of some people's discoloration - suicide without taking medicine. "Many parents don't know much about their children's depression or depression in the early stage, and their children are at a loss and panic when they are depressed in the short term, and even refer to Xiaohongshu and other places to buy their own medicines. ”。With the ease of information** and dissemination, many people associate suicide cases with depression. It is true that the WHO report that depression is the second leading cause of death among people aged 15-29 years, but in reality, the overall suicide death rate in China is still a small probability, with a suicide death rate of about 7.1 million per year. According to the latest data from a number of experts at the 2023 Annual Conference of the Asian Education Forum, the suicide rate among adolescents aged 15-20 in China is 334.1 million, if the age is extended to primary and secondary school students, on the whole, it will not exceed 5.1 million, which is much lower than that of developed countries.
Of course, a small probability does not mean that the situation is not serious. The loss of every precious life is sad and regrettable, but suicide should not be magnified and continue to have a negative impact on society. Social attention to mental health is undoubtedly a progress, but the focus should be on solving the problem rather than amplifying the negative emotions themselves, and even deliberately empathizing with the "reason for suicide" on ** and triggering imitation.
This is especially evident when extreme events occur in society (such as "continuous jumping"): whether the department can stop the extreme emotional exaggeration and the spread of extreme behaviors on the Internet, which will immediately affect the positive or negative behavior of adolescents in the future.
As for the "cognitive contradiction between the two generations", there are opposing views on the Internet from time to time. Some remarks think that today's children are too squeamish and fragile and inconsiderate of their parents, while others believe that children's extreme behavior is the "sin" of the original family or even "both parents are a scourge".
In this regard, Professor Gou Ping, a professor of psychology at the Teachers College of Chengdu University and director of the Sichuan Provincial Youth Sex Education Popularization Base, told me: "This kind of 'blame' interpretation of mutual blame magnifies individual cases and catharsis emotions, but it is not conducive to the 'attribution' of events, is not conducive to family repair and problem solving, and pushes parents and children further and further." In fact, a child's extreme behavior is never the result of a single factor or event, and should not be simply interpreted or defined. In some reports, parents "forced" their children to death or children were exterminated, which was amplified by the Internet because of "scarcity".
2022 National Blue Book on Depression
Therefore, we have to mention the loss of the Internet position of teenagers. Prosecutor Wang of the Juvenile Protection Studio told me: "At a time when our network has not really achieved classification, I hope that when we encounter controversial incidents, we will not only pursue traffic, but sometimes please raise the camera a little bit." "The negative energy and negative values of the Internet greatly pollute the immature minds of children.
Third, it is the current situation of "too many monks and too little porridge" and the dilemma that is difficult to change in the short term.
Whether it is a difficult family who really needs it, or an ordinary family who wants to get rid of self-doubt, they often feel that there is no way to seek medical treatment.
Because at present, psychological counselors and family education instructors who have been certified by the state are really rare talents. Taking the national psychological counselor as an example, in the truly authoritative CPS clinical psychology registration system (Clinical Psychology Registration Committee of the Chinese Psychological Society), as of November 1, 2021, there are only 3,670 registered personnel in the registration system, and most of them are concentrated in first-tier and new first-tier cities. One counselor told me, "One month, I worked 28 days in a row and I felt like I was getting sick. At the same time, some patients complained that they had been listed as experts at Beijing Anding Hospital, but were told that they would wait for a year.
What is even more infuriating is that in the face of huge market demand, capital and corruption have been eyeing this new world, which has attracted great attention from hundreds of millions of families, and it is difficult to focus on supporting settings and regulatory mechanisms. In recent years, many "self-test diagnosis of depression", "medication sharing for depression patients" and "psychological counselor family education promoter**" are harming countless families.
In order to solve the problem of talent gap, the state has carried out a lot of work - such as setting up CPS supervision points in qualified cities to carry out talent training and practice; Another example is the pilot project in many cities, where the Women's Federation, the Civil Affairs Bureau, and the Social Work Office jointly provide free training on the "National Social Worker Professional Proficiency Examination", "Continuing Education for Professional and Technical Personnel and Advanced Seminar on Modern Service Industry", etc.; Uninsured centers in various localities have also hired professional psychological counselors and supervisors to provide services for civil affairs and the public in extreme poverty. Even in some areas, due to the lack of stable external talents, public prosecutors and social workers have to obtain relevant qualification certificates and wear multiple hats in addition to their own work.
However, in the exploration period of lack of relevant standards, psychological service personnel in many places are still using the outdated content of Western psychology, and even rudely reproduce the old way of Western psychological development of "diagnosis of depression when it is found, and prescription of medicine when depression is diagnosed". In order to facilitate management or under pressure from parents, some schools encourage students with depressive mood or students with depressive symptoms to suspend their studies and push the institution to prescribe medication**. Such effects are often not ideal, but rather damage students' mental health and exacerbate negative emotions among student groups.
At the meeting, Xu Kaiwen proposed that in fact, the research and application of Western psychology have been stagnant for many years, and China's mental health services should follow the Chinese path of localization - active management and intervention in potential crises. Just as smog leads to an increase in respiratory diseases, the key is to control pollution; Student mental health is a social and educational issue that cannot be addressed by the healthcare system.
04. It is better to sit and talk about the Tao than to get up and act.
In May 2023, the Ministry of Education, the National Health Commission and 17 other departments jointly issued the Special Action Plan for Comprehensively Strengthening and Improving Student Mental Health in the New Era (2023-2025), marking the elevation of strengthening student mental health to a national strategy.
The country's attention and measures for students' mental health will reach unprecedented intensity in the future. At the meeting, four major actions came into being ("Illuminator Rural Teacher Growth Plan", "Crisis Interventionist Registration Standards and Ethical Standards Formulation of China Life Care Association", "Peace of Mind Project to Build a Mental Health and Crisis Prevention System for Urban Students", and "Social Governance Group Empowerment"), aiming to further call on all sectors of society to join in and gather more strength.
A large number of practices have proved that the family is the first environment for children's mental health growth. Parents do not need to be pessimistic and anxious about the process of children's growth, and it is important to have a common sense: the life process itself is tortuous, and at the same time it is extremely resilient. At a time when the influence of family education on children is becoming more and more prominent, how parents can pass on a positive attitude and life resilience to their children is intuitively reflected in the fact that when there is a problem in the family, parents and children can self-mediate and repair and grow together. Just as an airplane encounters unstable air currents and a respirator pops out of the head, you have to put yourself on before you can assist your child.
The educational environment should return to the origin of traditional Chinese culture of "cultivating people with virtue", rather than repeating the "hollow disease" of over-exploitation, extreme utilitarianism and nihilism in Western education. The key to schools and families in the short term is to build a healthy living environment for children. As Xu Kaiwen said at the meeting, "I hope that courageous educators and courageous parents will dare to start from themselves and adjust themselves to influence this utilitarian education field." ”
For example, to build a psychological firewall for children on the Internet - one is to try to isolate the mental pollution caused by negative energy to children, and the second is that "the closer the child is connected to the real world, the more rooted his roots are in the land, and he will not easily give up his real self for the virtual world." At the same time, the sun is boutzer, and all things are bright. Children must not be deprived of physical activity, outdoor play time, and good sleep in order to increase the vitality and resilience of life. In the face of the great changes and challenges of adolescence, children with a healthy body and a sunny mindset feel that nothing is enough to fear, because life is truly self-sufficient.