Wednesday, 20 January 2010

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.

18 comments:

  1. So 'separation anxiety' and 'folie a deux' are recognised conditions, but 'school phobia' isn't? I see.

    As you say, many children get the jitters when encountering a new school environment, but for most this phase soon passes. But for some children it doesn't and develops into serious distrss. The most obvious reason why a child might not want to go to school is because they don't like it. Really, really don't like it. With good reason in many cases, I suspect. An adult, faced with a job they hated that much would change their job as soon as they were able. Children do not have this option. 'School phobia' is not, as far as I am aware, a term coined by parents, but by psychiatrists who see the child's aversion to school as irrational. As if the child must be wrong in their assessment of school as being somewhere they really don't want to be.

    You were concerned enough about your child's welfare and education not to send her to school at all. Presumably you see this as a reasonable course of action on your part. Why then, do you consider it unreasonable for another parent to follow suit?

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  2. I don't consider it at all unreasonable for any parent not to send a child to school. I think it a terrible mistake for a parent to say to a child, "Now we will do such and such" and then not to do it. It is a particularly bad move if the proposed action is one that the parent herself is dubious about. This simply teachs a child that any course of action suggested by the parent, from putting his shoes on to visiting the doctor, is actually the opportunity for a long debate. Not sending a child to school is one thing; sending her and then changing your mind when she cuts up rough and you get upset, is quite another.

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  3. So you are saying that sending a child to school, finding that the school is not offering a suitable education and that your child is being physically bullied and the school can't/won't stop it so because the child is in such state of distress you remove her from that environment is 'sending her and then changing your mind when she cuts up rough and you get upset'? Or are you referring to parents who allow the child to stay away from school whenever they 'cut up rough'?

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  4. Nothing that I said above had any reference to either bullying or education. If a child has been registered at a school which then proves not to be providing a suitable education, then I think this an unacceptable situation. If a child is subjected to bullying which the school is unable or unwilling to tackle, this too is unacceptable.

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  5. But those might be the reasons for the child 'cutting up rough'. It's not always easy to extract accurate information from a school, let alone a 5 year-old about what is happening when the parent is not there.

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  6. I must confess that I have yet to encounter a five year old child who has become anxious and distressed because she feels that her school is not providing her with a suitable and efficient full-time education. Your experience may however be more extensive and varied than my own.

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  7. "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?"

    I think it's the level of fear/stress that makes the difference between your average child that doesn't fancy school that day and someone with school phobia. I've had contact with two children who struggled with going to school. The first threw up frequently before school and refused to cooperate when there. Social workers collected her every day, dragging her to the car and from the car to school as necessary (it was a few years ago). She was eventually sent to a boarding school by the LEA, had a breakdown, and now aged 32 has never worked. Incidentally, there was an abuse scandal at the school whilst she was there but luckily she was not one of the abused in that sense.

    The other, more recent case, became so upset at her mother attempting to force her to school that she threatened her with a kitchen knife - this was an 8 year old who got on fine with her family in every other area of family life and discipline. Social workers also attempted to take her to school but were not allowed to touch her so just forced her mother to drag her to the car. The problem was she either refused to get out at the other end or left school as soon as the social worker had gone.

    BTW, neither of these children had any trouble separating from their mother in other situations, including days and weeks away with friends, going into town themselves, travelling on public transport to visit friends and family, attending various courses and activities, etc.

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  8. I've worked with very young children in playgroups and primary schools. I saw children who were frightened and withdrawn for whole days, whose parents had left them at the door without a backward glance. We were supposed to tell the parents that their children had stopped crying as soon as they left, and often this was just not true. Some of them cried for hours. There is a widespread perception among people who work with children that attachment is a bad thing, that children should be encouraged to be independent as soon as possible, and that it is the mother's fault if they find it difficult to separate.
    That's not how I see it. I attachment parented my children and didn't force any of them to spend time away from me until they were ready. They were all happy to spend time with relatives and close friends from babyhood, but none was ready for large groups of people they didn't know well without me or another person they were attached to until they were between 6 and 8. Then they were really up for it; they all asked to go to HE meetings and sleepovers with friends, and one of them went happily on an activity holiday for a week at the age of 7, with no-one he knew at all. In contrast with many of their friends who were left at playgroup whether they liked it or not, none of them has ever shown any signs of separation anxiety. My 11-year-old has friends who still can't cope with sleepovers.

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  9. Things seem to have gone backwards.

    My sister is in her late 30s.

    At about 13/14 she was school phobic.

    They didn't force her into school, she went to a special unit where they built up her resistance to the school-esque environment and the emotional responses she had to both that and being away from my mum.

    It took about a year to get her back into mainstream ed and there were tears along the way particularly at the start, but nobody got dragged and the lady who did the picking up and overseeing was firm but persuasive so S would go to the unit despite her absolute panic.

    She has a PHD now, works in a high powered position at a uni, so I think we can say it worked.

    If dragging had been involved I'm not so convinced the outcome would have been the same.


    Folle di deux...Egads, that has hit a nerve that I think I must have buried under a couple of decades of denial.

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  10. "They didn't force her into school, she went to a special unit where they built up her resistance to the school-esque environment and the emotional responses she had to both that and being away from my mum."

    It probably varies from area to area both in the past and now and not all of the social workers used force. The person I spoke about started having problems around 1990 so probably only a few years after your sister and they tried a special unit before the boarding school. Did your sister have trouble separating from your mum for any other activities, or was it just school?

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  11. "I must confess that I have yet to encounter a five year old child who has become anxious and distressed because she feels that her school is not providing her with a suitable and efficient full-time education. Your experience may however be more extensive and varied than my own."

    You know as well as I do that those are not the terms in which a five year old would express themselves. However, five year-olds can get distressed when they are shouted at, humiliated, not given a chance to explain themselves etc. My son's Y2 class suffered a significant increase in tummy aches on Thursdays and Fridays, which were the days covered by a particular supply teacher.

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  12. >>>>>>>>>>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.<<<<<<<<<<<

    I bet it was.

    Some professionals can be remarkably prejudiced when it comes to parents. Often, it's because they have no children of their own yet.

    The worst place of all for this sort of nonsense was school staffrooms, where bitching about parents, spreading gossip about them, making up silly theories about their parenting was rife. Usually these young women in the staff room were childfree.

    Guess what? I was one of them.

    Then I had children.

    Mrs Anon

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  13. "Did your sister have trouble separating from your mum for any other activities, or was it just school?"

    Just school. Although she wouldn't go and sleep at a friend's house for instance, she would go to the normal after school activities like dance and music lessons and go to play with her friends.

    School can be very intense (it's a very long day), quite unenjoyable and a very scary place when you are feeling off kilter so I suppose the feelings were harder to manage in that context, whereas other activities were fun and offered enough distraction from the internal chatter that she could get through any feelings of concern.

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