School Phobia - a special kind of folie a deux?

Shakespeare wrote in the Sixteenth Century of, "The whining schoolboy with his satchel and shining morning face, creeping like snail, unwillingly to school." Even four hundred years ago, the reluctance of children to attend school was all too familiar and generally seen as a matter for amusement, rather than anxiety. It is such an enduring image; the child feigning illness to avoid school, the boy like William in the Richmal Crompton stories, the cheeky urchins playing truant. It is only in recent years that this desire to skip school has somehow become a medical condition.


Many psychologists are uneasy about the very idea of "School Phobia", preferring the more neutral expression, "School Refusal". Never the less, some psychologists do become involved in cases of "School Phobia" and it has grown to be a more or less accepted condition. What is certain is that a few years ago, many of those children who have now been deregistered from school and educated at home due to this problem would have simply stuck at it and remained. So what has changed?

For one thing of course, there is now a widespread realisation that not going to school is a realistic option. Whereas at one time LEAs would have chivvied parents into sending their kids back to school, a lot of people simply won't wear this any more and refuse to co-operate. The result is thousands of children who are not at school because, basically, they don't want to go. This is a curious state of affairs. As a number of sceptical researchers have pointed out, most of us have to get up in the mornings and do things we would rather not and indeed go to places, when we would prefer to stay at home. Is there such a disorder as "Getting Up in the Morning Phobia"? "Going to Work Phobia"? "Tackling the Housework Phobia"? What is it that makes "School Phobia" a genuine syndrome and not just a description of a child's disinclination to do something?

In order to make sense of this whole business of school phobia, it will be necessary to look at two very different concepts, the first of which is separation anxiety. Separation anxiety, when an adult or child becomes anxious about becoming separated from a person or thing, is a natural part of growing up. All babies display separation anxiety to a greater or lesser degree, although it normally withers away shortly after children start school. A few children though remain anxious about being separated from their mother. There are scenes at the school gates, tantrums and tears, sometimes the child can be physically sick or have an attack of something approaching hysteria. Of course, mothers too can suffer from separation anxiety of this kind. We are all familiar with cartoons showing the mother and not the child in tears after the moment of separation on the first day of school! For some mothers, this can be a serious problem. The one person in their lives who truly loves them absolutely and unconditionally is moving away from them. Worse still, if this process continues, then the object of their affection will gradually be moving further and further away; making new friends, acquiring new interests. It can be a very sad affair, this starting school.

Of course for most mothers, as indeed for most children, this is a passing phase. A few tears, a little sadness and then it is over. For others though, this can turn into something a little more serious. It can, in effect, become a folie a deux.

Folie a deux is a pathological condition in which two people share a delusion or mental illness. We see it sometimes in crimes, where two people encourage each other in their peculiar behaviours until the result is murder or occasionally a series of murders. Think Ian Brady and Myra Hindley. Each member of the folie a deux has an inclination in a certain, dysfunctional direction. Alone, this would probably go no further. The trouble begins when two people who share a particular strange tendency somehow get together. Then they can encourage each other and perhaps put into action what each by themselves would only daydream about. And this looks very much like what is sometimes happening in cases of "School Phobia".

Picture the scene. A child is suffering from the normal jitters and anxieties which accompany the beginning of school life. He looks for reassurance to his mother. Is she calm and collected about this business? Are his fears wholly unjustified? In most cases, the answer is yes. If there is any unhappiness on the mother's part, she takes good care to conceal it, at least until she is out of sight! What happens though if she is feeling bereft and inconsolable herself and allows her child to see this? Her child picks up on the mothers upset and becomes more distressed. This in turn makes his mother increasingly anxious. Before long, the two of them are playing a double handed game of "Separation Anxiety", winding each other up to ever greater pitches of misery. Sometimes, they persuade themselves that the only solution is to drop school entirely!

It is probably no coincidence that the peak times for withdrawing children from school in order to educate them at home are the first year of infants school and also the first year or so after starting secondary. These are of course also the peak years for "School Phobia" to manifest itself. I would be very curious to know if the scenario which I have outlined above is a common one. I know that it does happen, but have no idea how frequently. Those who have worked with very young children will perhaps recognise some of what I have talked about here. For some years, I helped run a support group for parents and children under five, many of whom suffered from separation anxiety. There was a psychologist, Community Psychiatric Nurse, social worker and me. It was a matter of common discussion among us that the mothers themselves were involved in the game and a large part of the work in tackling the problem was with the parents rather than the children. Some of these children did go on to suffer from "School Phobia". Because home education was not seen then as a viable option, this was over twenty years ago, none were deregistered. This was probably a good thing.