1 For the sake of readability, the presenting symptoms and signs of today’s post-industrial Dundee are presented in the main text, while insights into similar ‘patients’ elsewhere and into the wider context are largely restricted to these notes. Thus the notes should be seen as evidence of contextual validity and external generalizability.
2 Though also a psychologist, Ingham proposed that the rationalistic assumptions underlying much research on young people’s sexual behaviour left no space for important social and structural influences on that behaviour. (Ingham 1994)
3 A well-known example is the difficulty health promoters have had in trying to get mothers to reduce the family’s consumption of high-fat and/or high sugar foods when the food in question has powerful social symbolic meanings (Douglas & Gross 1981); (Van Otterloo & Van Ogtrop 1989).
4 Young single mothers setting up home on a very restricted budget have to prioritise among essentials. According to (Speak 1995) a phone comes fairly far down the list.
5 Continuingly high teenage pregnancy rates were not so much seen as a public health problem in themselves. Concern arose from the lack of impact on the rates from the interventions currently espoused and funded by health services, as evident both in Dundee (still the case today – see (Director of Public Health 2000): Section 4.6.1 and Figure 39, pp.44—5) and in the UK more generally (NHS Centre for Reviews and Dissemination 1997). Such resistant figures suggested the generating mechanisms had not been adequately understood by the health service scientific community – no aetiology was emerging from the epidemiology.
While this research would wish ‘asocial conceptions’ to be identified as the proper problem for concern, the principal aetiological factors for early ‘teenage pregnancies’ in our population would seem to be: a) girls’ absent fathers, b) dyseducational schools, and c) excessive alcohol intake around social occasions which became sexual encounters.
6 According to recent work by John Ermisch, this would be expected from Dundee’s labour market situation: ‘…poorer local employment opportunities encourage pre-marital childbearing and discourage the formation of cohabiting unions, which delays marriage…[because] first marriage rates are much higher among cohabiting women than those without a live-in partner.’ (Ermisch 2000) http://www.irc.essex.ac.uk/pubs/workpaps/wp2000-26.php
7 ‘Scottish men and women continue to experience rates of lung cancer which are amongst the highest in the world….Incidence in the most deprived areas of Scotland is twice that in the least deprived areas.’ (Sharp & Brewster 1999)
8 ‘Epidemiology, the study of the health of human populations, is by definition a social science.’ (Terris 1985): 15. In his chapter on the social determinants of disease in the 13th edition of the definitive textbook of public health, Leonard Syme argues that conflicts and contradictions in the evidence on social determinants of disease might be eliminated if social epidemiology were to adopt a more appropriate disease classification scheme. (Syme 1992: 695)
9 Robert Oppenheimer claimed that ‘analogy is indeed an indispensable and inevitable tool for scientific progress’. By analogy he meant ‘relation and interconnection’, ‘a special kind of similarity which is the similarity of structure, the similarity of form, a similarity of constellation between two sets of structures, two sets of particulars, that are manifestly very different but have structural parallels’. (Oppenheimer 1965: 129)
10 ‘Physical and chemical knowledge can form part of biology only in its bearing on previously established biological shapes and functions: a complete physical and chemical topography of a frog would tell us nothing about it as a frog, unless we knew it previously as a frog.’ M. Polanyi, quoted (Matson 1964: 165)
11 Eric J. Cassell and Mark Siegler, the editors of a book of conference papers on ‘Changing values in medicine’ (Cassell & Siegler 1985), preface it with the following dedication: ‘ ‘This book is dedicated to Otto Guttentag. Virtually alone he explored the philosophical basis of medical practice and the role of the physician for decades before others began to follow, We honor his work, we honor his understanding, and we honor his example.’ p.iv
12 ‘Now, the proper frame of mind for discovering the meaning of a typical human situation is not the “objectivity” of the naturalist, but the intelligent sympathy of the exegetist, the interpreter. It is the frame of mind itself that has…to be changed.’ (Eliade 1965: 12). Also ‘…basic psychiatric concepts should take into account the hermeneutic nature of the diagnostic process.’ (Spitzer 1994: 177)
13 ‘Every morbid phenomenon, according to constitutional pathology, is the result of an injurious morbific factor in conjunction with a susceptibility of the organism….the ultimate phenomenon is so complex that in each case of disease it can only be understood by an analytical study of all the factors involved. Not only must the morbific cause be investigated, but also the inherited as well as the acquired constitution of the patient…’ (Faber 1930: 205-6)
14 Or the three English housing estates studied by David Page in his recent research for the Joseph Rowntree Foundation, with a very similar overall picture emerging. (Page 2000) www.jrf.org.uk/knowledge/findings/housing/n120.htm . To give him due credit, Page is concerned to locate these social bodies on their survival time-line: ‘The researcher concludes that these estate communities are “in the balance”: If conditions fail to improve, households who mind most – and have the choice – will leave, making renewal more difficult.’
15 Cf. ‘…in the area of urban health…European populations are becoming increasingly concentrated in cities (over 80% of populations are already urbanized), crammed together in living conditions that pour lifestyle and health concerns, environmental problems, poverty, alienation and the breakdown of social support networks into one great melting pot of problems. Solutions to the health problems this creates can only be found through policies and programmes carefully designed to deal with all these complex components – a high priority for the future.’ (World Health Organization 1999) Looking at the social determinants of health in a European context, the parallels between Scottish housing schemes and post-1990 Central and Eastern Europe/Former Soviet Union are striking. Reasonably enough – are they not both post-industrial areas of advanced marginality? See (Bobak et al. 1999) http://www.who.dk./hp/ihd/verona/publications/bobak1.htm
16 For a succinct review of temporary jobs in theory and practice see (Booth et al. 2000) http://www.irc.essex.ac.uk/pubs/workpaps/wp2000- 13.php
17 For discussion of why falls in unemployment seem to stop short of providing work for the long-term unemployed, see (Meager & Metcalf 1987).
18 Similar policies were being followed in the UK. ‘…local employment decline in the [English] Nort[h]-West region has been intensified by this process of corporate internationalization and switching of production overseas. Around one-third of the manufacturing shop-floor labour force in the Nort[h]-West in employed by just 31 British companies. Between 1975 and 1982 these companies reduced their combined workforce in the UK by 422 000, and in the North-West region alone by 87 000. Over the same period these firms expanded their overseas workforce by around 163 000….The basic point is that, both directly and indirectly, the Thatcher government’s policies have promoted and accelerated the ‘internationalization’ of Britain’s ailing industrial regions. Both the recent wave of rationalization, and its specific regional impact, must be interpreted in a global context, against a background of transnational capital restructuring.’ (Martin 1986: 267-8)
19 The numbers introducing quoted excerpts are the identifying numbers for each interviewee.
20 Housing authorities have little choice in this matter, since they are obliged to house people on the basis of need, and having young children makes a family a priority. Some fine-grained research from a University of Newcastle team (Clark et al. 1999) found that even small numbers of needy children could ‘de-stabilize’ a housing estate primary school, in four respects:
• young children entering the school were less prepared by their experiences in the home for the demands of schooling;
• the attainments of pupils in the school were depressed and more children had difficulties with literacy;
• increasing numbers of pupils displayed disruptive behaviour;
• it became increasingly difficult to involve parents in the life of the school or to count on support from parents for the schools’ values and expectations’. http://www.jrf.org.uk/knowledge/findings/socialpolicy/n39.htm
21Forrest and Kearns’s review of work on English disadvantaged neighbourhoods would suggest that the situation there is not yet irrecoverable (Forrest & Kearns 1999) http://www.jrf.org.uk/knowledge/findings/foundations/4109.htm
22 The residents of ‘Willowdene’ in north-eastern England marked the arrival of the hard drugs economy in the mid-1990s as the time of a serious drop in the liveability of the estate. (Johnston et al. 2000) http://www.jrf.org.uk/knowledge/findings/socialpolicy/o30.htm
23 No secondary school in Dundee made it into the Sunday Times (6 November 1999) top fifty (by exam passes) secondary schools in Scotland, which was achieved by four schools in towns within commuting distance: Kinross, Kirriemuir, Monifieth and St. Andrews.
24 The extreme example of health inequality is the desperate health status of the African American population, as presented by Nobel prize-winning economist Amartya Sen: ‘It is quite remarkable that the extent of deprivation for particular groups in very rich countries can be comparable to that in the so-called “third world”. For example, in the USA, African Americans as a group have no higher – indeed, have a lower – chance of reaching advanced ages than do people born in the immensely poorer economies of China or the Indian State of Kerala (or in Sri Lanka, Jamaica or Costa Rica for that matter). The African Americans as a group [i.e. not just the inner city residents] are overtaken in terms of the proportion of survival by some of the poorest people in the world.’ (Sen 1999: 20) See also (Wilkinson 1996)
25 ‘Good adaptability in the individual is one of the expressions of health….Whether they be expressed by a good or poor physique or a high or low immunity to infection or stable or unstable emotions, health-liability and disease-liability must always be due to the combined effects of genetic and environmental opportunity. Good adaptability in the social organism is again a sign of its health. This brings us a reminder that when we speak of local or general “fitness” or “adaptability” as expressions of normality or health, we should ask ourselves not only how the state has been come by, but also in what situations it is to be maintained. “Fitness or adaptability for what?” is a query which must be included in all our health assessments.’ (Ryle 1948a: 72-3) Emphasis added.
26 Another condition a vulnerability to which is potentially genetically transmissible, and which therefore qualifies as having a diathesis to it, is schizophrenia. ‘Schizophrenia runs in families largely for genetic reasons. On this basis Rosenthal…proposed that the etiology of schizophrenia should be conceptualized in the context of the diathesis-stress model. In this model, the environmental factors are not specific to schizophrenia, whereas the genetic (diathesis) factors are. That is, genetic factors predict a specific risk of schizophrenia. Environmental stress, in contrast, is common to many disorders and is not specific to schizophrenia – i.e. the environmental component is not “schizophrenogenic.”‘ (Fowles 1992: 305)
27 These performance deficits at the aggregate level get mistakenly categorized as ‘social exclusion’, mistakenly in that such groups are not excluded from society so much as relegated to the inferior level of a dual system. For some useful references on social exclusion, see (Lee & Murie 1999)
28 This description may be relevant to one of the public health findings prompting this research, the high levels of hospital admissions in Dundee compared with other areas. Rather than being a true indicator of higher levels of ill-health, these could be e.g. a proxy indicator of high levels of poverty among social groups who, unable to access income-raising opportunities in the local economy, are therefore prompted to extract a rent from their illness.
29 Some very thorough research in England supports this concern with the lack of flexibility of the benefits system, in this case focusing on its inability to support the informal child care arrangements most lone mothers are forced to make because of the marginal nature of the work they undertake (short-term, low paid, with varying shifts and unsocial hours). (Noble et al. 1998) http://www.jrf.org.uk/knowledge/findings/socialpolicy/spr458.htm
Earlier (also very thorough) research on young single mothers’ difficulties in setting up home in Newcastle-upon-Tyne concluded that ‘Social policy does not distinguish between the different sub-groups of lone parents and does not recognize the additional needs and difficulties of [the youngest] group, especially in trying to establish an independent home.’ Particularly curious is how Income Support is assessed; ‘The vast majority of young single mothers were dependent on Income Support. Having a higher percentage of children under school age than other lone mothers they have a greater need of child care. Their young age means they have little in the way of work experience to help gain them employment. They are also less likely to receive maintenance, so the combination of part-time earnings, Family Credit and maintenance is a less viable option. Income Support is age-related with the youngest and most vulnerable women receiving the least financial assistance.’ (Speak 1995) http://www.jrf.org.uk/knowledge/findings/socialpolicy/sp72.htm A propos, a recent survey of policy in the area of youth and parenting found considerable incoherence. (Jones & Bell 2000) http://www.jrf.org.uk/knowledge/findings/socialpolicy/590.htm
30 Not mixing with those in work makes individuals more likely to suffer psychological distress and lowers an individual’s chance of moving out of unemployment, Carmel Hannan found. ‘…policies which isolate the unemployed into ghettos (for example, council housing schemes) do much harm and may play a large part in keeping the unemployed, unemployed’ (Hannan 1999). Lydia Morris also found concentrations of unemployment in particular kinship and friendship networks in Hartlepool (Morris 1992). The manner in which social disadvantages accumulate can be seen if to these analyses of isolated unemployed men’s lower chances of finding work is added Sarah Holloway’s finding that poorer mothers in Sheffield were more isolated through their almost exclusive dependence on family networks and therefore were less well informed about the educational opportunities for their pre-school age children. (Holloway 1998)
31 The intensity of these women’s dislike for school and the extreme avoidance behaviour it led to bears out Andy Biggart’s finding (with Scottish 1996 school leavers) that the consequences of low attainment in school were worse for young women than for young men. ‘Amongst young women, the differences between low-attainers and those with better qualifications were clearer. They appeared to form a more distinct group compared to the better qualified young women, and had the most deprived social backgrounds; they received less parental encouragement and were much more likely to truant and hold negative attitudes towards school and the teachers.’ (Biggart 2000: 4)
32 One possible response to this problem is to mobilize social workers to act in a mediating role between parents and schools. As a policy option it would seem not have a serious future (Vernon & Sinclair 1998), for two reasons : a) the statutory priority of child-protection work is currently leaving social services departments with very limited resources for preventive work with families; b) ‘Such was the stigma attached to involvement with these services that [Vernon’s and Sinclair’s] respondents doubted parents’ willingness to accept social work support when problems arose.’ http://www.jrf.org.uk/knowledge/findings/socialpolicy/SPRO28.htm
33 Some time spent battling with an uninterested labour market stimulated regrets about their school behaviour among young men surveyed about their attitudes concerning gender and work. ‘One of the most common themes emerging from the interviews was the regrets that the young men felt about school. They felt that they had played rather than worked, had had a laugh and had not thought about the future. They now saw school as a missed opportunity. Many of the young men gave the impression that school, exams and what teachers said were of little importance, and the school curriculum of little relevance to their lives.’ (Lloyd 1999) http://www.jrf.org.uk/knowledge/findings/socialpolicy/559.htm
34 Witness such combat manuals, targeted at the league-table watching classes, as John Rae’s Letters to Parents: how to get the best available education for your child (Rae 1999).
35 More than thirty years after Colin Lacey (Lacey 1970) identified working class masculinity values as a major factor in the self-selection out of education by Hightown Grammar schoolboys from working class backgrounds, ‘Notions of masculinity appeared to play a significant part in the majority of these young men’s poor use of school. Having a laugh, resisting teachers’ influence, acting tough and the displacement of emotions away from appearing weak and vulnerable were recurrent themes’. (Lloyd 1999) http://www.jrf.org.uk/knowledge/findings/socialpolicy/559.htm
36 A biological parallel would be infected cows interacting with poor dairy hygiene and malnourished children to make milk a similar multi-pathway pathogen for ‘a disparate galaxy’ of organic diseases (Hill 1965: 297).
37 Balmullo would put her within range of one of Scotland’s top fifty secondary schools by exam results, Madras College in St. Andrews.
38 ‘The vital importance of parenting: In tomorrow’s information economy, the quality of parenting will assume greater importance.’ (Scase 1999: 21)
39 For how long a family intends to endure is socially highly variable, ranging from a few years to many generations. Informative discussion of these variations can be found in Netting et a. (1984), where also can be found valuable criticisms of this commonsense practice of ascribing intentions to entities other than individual human beings!
40 The historical evidence would suggest that how far the parental generation maintained control over their children’s sexual activity (thus, implicitly, how strategic they were being about the development of the family) was a complex matter, with significant variations between regions and times. The economic situation was key: ‘Sexual morality in Scotland…was in practice largely a function of the authority relationship between parents and children, and the economic circumstances of both.’ (Smout 1976: 80). American teenagers recently surveyed about drugs abuse distinguished between ‘hands-on’, ‘half-hearted’ and ‘hands-off’ parents in terms of their day-to-day practices in controlling their children http://www.msnbc.com/news/533982.asp?cp1=1 .
41 The most authoritative findings on ‘teenage pregnancy’ as a problem are presented in the June 1999 Report by the Social Exclusion Unit (The Social Exclusion Unit 1999). The data refer to England, but the analysis was ‘shared by’ the Scottish Office. For a well informed response, see (Joseph Rowntree Foundation 1999). Kiernan (Kiernan 1995) investigated the social, economic and educational backgrounds of young parents and their post-birth experiences; while strongly based on a large sample, she pointed out that the fact that the subjects were all born in 1958 meant that their experience of being teenage parents had been in the mid- 1970s, a different world to that of the 1990s.
42 Pitching for more attention to be paid to the accounts of how they live which are produced by young mothers themselves, Ann Phoenix ‘argues that a negative focus on mothers under 20 is common because little attention is paid to the circumstances in which most mothers under 20 live. As a consequence any problems they experience are attributed to age rather than to structural factors such as their employment histories and prospects. The attribution of the ‘problem of young motherhood’ to youthfulness serves to individualize it, and as a result any difficulties seem to be young women’s own fault.’ (Phoenix 1991)
43 This case confirms the finding (in a survey of changes in the initiation of adolescent sexual and contraceptive behaviour in the USA between 1978 and 1988) that having a more highly educated mother was the only condition where a girl would be likely both to delay first intercourse and yet be protected for it (Cooksey et al. 1996).
44 ‘Membership in a minority, usually an economically and socially deprived group, is also a major risk factor [for sexuality-related risks in female adolescents]. It does lead to the tendency to achieve a sense of identity and worth through early sexual activity and motherhood, which provides the adolescent with social assistance and affiliation with a peer group sharing the same lifestyle.’ (Haka-Ikse 1997:468). On the tendency of girls from troubled family backgrounds to choose a risky/deviant male as a partner, to take sexual risks with him and to invest disproportionately in the relationship, see (Pawlby et al. 1997).
45 Recent Home Office research on England and Wales supports her observations a) that frequent underage drinking is associated with other forms of social deviance, and b) that parental influences are important: ‘Overall, a fairly small proportion of those aged 12-15 drank frequently, but these young teenagers were much more likely to engage in other types of delinquent behaviour. Those who took drugs, smoked regularly, had problems with school attendance or disliked school were more likely to be frequent drinkers. Offenders were also more likely than nonoffenders to be frequent drinkers….The findings suggest that parental drinking may have a strong influence over their children’s drinking. Children whose parents drank frequently were more likely to be frequent drinkers themselves.’ (Harrington 2000) http://www.homeoffice.gov.uk/rds/pdfs/r125.pdf
46 ‘In a survey of nearly 700 adults who had not had children, more women than men thought it important to be financially secure and established in their careers before starting a family. The number of women choosing not to have children has risen from 15 per cent to 18 per cent in the past two years, reflecting profound social changes and the increasing number of women reluctant to step off the career ladder…’ ‘Maternal instinct “is extinct for one woman in five”‘ Independent 27 October 1999
47 Cf. an English study from the mid-1980s: ‘Two-fifths of respondents’ own mothers had first given birth before they were 20 and it was usual for them to know siblings, friends and peers who had also had children in their teenage years.’ (Phoenix 1991: 93)
48 Research recently undertaken in Doncaster, a town with high levels of teenage pregnancy in a context of social deprivation, also found neighbourhoods in which a decision to have the baby was made easier by the local prevalence and visibility of teenage motherhood. (Tabberer et al. 2000) http://www.jrf.org.uk/knowledge/findings/socialpolicy/n50.htm Cf. (Smith 1993)
49 As was found with the mothers of young mothers in Doncaster by Sharon Tabberer and her team. (Tabberer et al. 2000) http://www.jrf.org.uk/knowledge/findings/socialpolicy/n50.htm
50 See (Wood 1984) for an illuminating discussion of boys’ sexual talk as evidence both of their attempt to remote-control girls’ bodies and of an alienated view of those bodies, citing Paul Willis’s view that it originated from the culture of the shop-floor but is now widespread throughout working-class culture. Compare (Halson 1991) and, for a more neighbourhood view as to the origins of sexual values, (Thomson 2001): ‘Through an exploration of sexual values we have shown how the values of the middle class commuter belt (equality, authenticity, educational achievement and androgyny) are consistent with socially mobile futures in which sexual experience and risk taking are deferred. In contrast, young people living in an isolated public housing estate are tied more directly into values of embodied capital (hardness, good looks, risk taking, experience) that are valued in the present, but which may thwart mobility and support early parenthood.’.
51 Confirmed by a journalist interviewing teenage boys on North Tyneside in 1998 (Marks 1998).
52 A perception confirmed by contemporary research from the West of Scotland Twenty-07 Study (Sweeting & West 1996) which found that ‘Young people who reported more conflict with parents (regardless of family structure) were more likely to have health problems and lower selfesteem. They were also more likely to smoke, to have done less well at school, and were less likely to be students.’ http://www.jrf.org.uk/knowledge/findings/socialpolicy/SP95.htm
53 Sociological research in the last ten years has become more emphatic that children themselves are active agents in their own development (for bibliography http://www.keele.ac.uk/depts/crp/pages/biblio/biblio.htm ), most visibly in the ESRC Childhood 5-16 Research Programme, under the coordination of Alan Prout (currently of Stirling University, though for the Programme’s web page see http://www.hull.ac.uk/children5to16programme/index.htm ). This reflects a parallel process under way in British social policy and family law (Smart 2000)
54 Research has shown ‘that drinking is linked with the need for social acceptance and imitation of the peer group. Similarity seems to mean reinforcement of their masculinity and toughness for boys and a reduction of social anxiety for the girls. This implies that for both sexes drinking is closely associated with the influences of friends and with anxiety.’ (Hamblin 1980: 120)
55 See (Bell et al. 1999)
56 A statistical study of young people in the West of Scotland (i.e. the Greater Glasgow conurbation) with respect to structure, time and conflict in their families found the ‘most consistent relationships occurred in respect of “family time”. Young people who spent more time with the rest of their family were less likely to smoke or to have tried illicit drugs. They were more likely to have left school later, to have some qualifications, and to be students, with women less likely to have been pregnant by age 18.’ (Sweeting & West 1996) http://www.jrf.org.uk/knowledge/findings/socialpolicy/SP95.htm
57 A recent study of the relationship between smoking and self-esteem in Scottish 13-14 year olds found that self-esteem and [a good] self-concept were indeed associated with group membership, with ‘isolated’ and ‘disaffected’ youth reporting lower self-esteem. (Glendinning & Inglis 1999)
58 It is officially accepted (e.g. by the Office for National Statistics, as reported in The Guardian 9 December 2000) that, apart from in London, ‘Young women who became pregnant in areas with a high level of under- 18 conceptions were more likely to have the baby than an abortion. But in parts of the country where teenage pregnancies were uncommon, up to two thirds ended with an abortion.’ Researchers on young mothers in Doncaster (Tabberer et al. 2000) also found reports of hostility to abortion in their population.
59 Similar research (Pavis et al. 2000) on social exclusion of young people in rural Scotland found that graduates ‘mainly looked for jobs in the national, rather than local, labour markets. These young people reported an increasing social distance between themselves and those who had not attended university. This reflected a combination of emotional and psychological separation prior to attending university and exposure to different ideas and ways of life once there.’ http://www.jrf.org.uk/knowledge/findings/socialpolicy/210.htm
60 A similar dynamic of local networks in a disadvantaged neighbourhood reinforcing that neighbourhood’s social exclusion in relation to the wider area was found (Johnston et al. 2000) in ‘Willowdene’, a local authority housing scheme on Teesside where ‘since the 1970s the dramatic economic restructuring of local manufacturing industry has stripped away the economic security which underpinned social cohesion’. http://www.jrf.org.uk/knowledge/findings/socialpolicy/o30.htm
61 The recent evolution of social policy in Scandinavia (Moss et al. 1999) raises the interesting possibility that the apparent ‘pathology’ of British disadvantaged families being unable to maintain a monopoly of parenting functions may in fact be more a consequence of the slowness of the British state in responding to an obvious deficiency in social justice – the inequalities in life chances caused by women’s acceptance of child-care responsibilities (see Dex et al. (1996)) – than of the limitations in the parenting capacities of poor families so minutely detailed by the professionals who work with them. Accepting this would be to extend the reach of the social model of disability to social practices such as parenting, to acknowledge that in family life too there are discriminatory barriers functioning to produce a disabled minority in our society: ‘The social model of disability argues that people with sensory and physical impairments, people with learning difficulties, people who experience mental/emotional distress, older people are all disabled by the economic, social and environmental barriers and the discriminatory attitudes which are a feature of our society’. (Morris 1994) http://www.jrf.org.uk/knowledge/findings/socialcare/SC2.htm.
62 For this see (Long et al. 1996: 23-28))
63 For a similar observation in the field of child care and protection work see (Daniel & Taylor 1999)
64 The perception that pressure on resources and a redrafting of their role towards care management rather than care giving has been pulling social workers away from direct work with clients is confirmed by a study looking at young people in care who go missing. The research found that when planning and coordination became their principal task the reduction in direct contact with the young people being looked after made it more difficult for social workers to achieve a holistic understanding of their needs (Wade et al. 1999).
A commissioned review of provision for looked-after children found to be widely prevalent the view that children’s human rights were of secondary importance to business efficiency for social work departments: ‘Many of the young people consulted said that social workers did not have enough time for them, and that when they did see their social worker, they felt they weren’t being listened to. Social workers expressed the same concerns. They felt their caseloads were too high to give children the attention they needed; that there was barely enough time to fulfil their statutory duties to carry out reviews, fill in Looked After Children forms, and arrange alternative when placements break down.’ (Morris 2000) www.jrf.org.uk/knowledge/findings/socialcare/380.htm
65 In 1971, nearly half of British teenagers who conceived outside marriage then had a ‘shot-gun wedding’. In 1991 only 1 in 20 did so. (Burghes 1995) http://www.jrf.org.uk/knowledge/findings/socialpolicy/sp84.htm
66 The children of the superseded male(s) could find themselves in an insecure position with their replacements. ‘In depth interviews with families living on local authority housing estates in Staffordshire found that:
• Almost all agreed that a 16-year old boy who was in conflict with his mother’s new partner should be the one to leave home, rather than the partner….
• Young people whose families had been disrupted by parents separating and forming new relationships were most likely to have become homeless because of conflict between themselves and their parent’s new partner or because their parent wanted “to make a new life”. (Smith, Gifford et al. 1998) http://www.jrf.org.uk/pressroom/releases/160398.htm
67 A model, it should be remembered, explicitly associated with the explosively mobile populations of post-war America, with nuclear families setting up home often thousands of miles from grans and aunties.
68’When asked to identify the most important attributes and roles that defined a man, the young men were…traditional in their thinking. Having a job, defending their family and being a good father were seen as central. (Lloyd 1999) http://www.jrf.org.uk/knowledge/findings/socialpolicy/559.htm ‘Most families preserved a “traditional” approach to male and female roles in which mothers’ and fathers’ activities were complementary….Many fathers…seemed comfortable in a position “on the sidelines” of family life, “earning their place” through their role as provider – a role which appeared to afford a certain status and the respect of other family members.’ (Warin, Solomon et al. 1999) http://www.jrf.org.uk/knowledge/findings/socialpolicy/659.htm
69 It was the 1930s South African anthropologist Isaac Schapera who realized that, in the politically dependent situation in which local tribes found themselves, the missionary and the colonial administrator had become as fully part of the tribe as the chief and the witch doctor. ‘Distributed parenting’ builds on this insight, seeing local servants of the UK state with power over the destiny of poor families as effectively part of the family: the ‘social father’.
70 ‘Symptoms…express a disturbance of function. Although they are often caused by organic disease they do not express the disease but the disturbance of function which the organic change produces. The same symptoms may thus be produced by functional error or structural flaw. While not specific for diseases, symptoms are, nevertheless, specific for functional errors, and these errors, for the most part, depend upon an exaggeration, a depression, or an inhibition of normal reflex phenomena. The dyspnoea of great effort in health is physiologically similar to the dyspnoea of small effort in heart disease. The angina of anxiety or tobacco excess or anaemia has the same physiological basis as the angina of coronary sclerosis, although none of its gravity….It is by the character and behaviour of the symptom and by its associations that we differentiate. Giddiness may be due to cerebellar disease, to slight organic changes in the labyrinth, or to transient circulatory effects. Again, it is not on the symptom itself so much as its severity, duration, and associations that we base our diagnosis. The conception of symptoms as the signals of functional disturbance may seem a very elementary one, but it is none the less important. It is as such rather than as the listed characteristics of disease that we should wish to view them. We should constantly be asking ourselves ‘What does this symptom mean?’, not ‘What is it a symptom of?’ (Ryle 1948b: 72-3
71 One plausible argument has been put forward linking these healthrisking behaviours with the need to achieve an autonomous adult identity and emancipation from the parental world, but one achievable within the restricted sphere of control available to young people in conditions of economic hardship. Their significant feature is that they use young people’s own bodies as the vehicle of pleasure, access to which is relatively cheap. (Pini 1997)
72 Similar factors (drug abuse, poverty, unemployment and poor housing) have been identified as linked to higher reconviction rates for offenders. (May 1999) http://www.homeoffice.gov.uk/rds/pdfs/r97.pdf 73 For an overview of mental health issues in distressed communities see (Buss and Redburn 1988)
74 From the 400 stories gathered from people with experience of the mental health services in Tayside, it emerged that ‘People wanted….to be listened to, to have personal attention and active, interesting and full days.’ (Director of Public Health 2000: 41) www.show.scot.nhs.uk/thb/publications/arep9899/phar9899.pdf
75 In a recent survey of Scottish young people’s perceptions of mental health, boredom was given as the most common reason for feeling mentally unhealthy, ‘particularly by young people from the most deprived area’. (Armstrong, Hill et al. 2000)
76 Writing at the same time and about the same population as Talcott Parsons, Erik Erikson claimed that ‘to a considerable extent adolescent love is an attempt to arrive at a definition of one’s identity by projecting one’s diffused ego-image on another and by seeing it thus reflected and gradually clarified. This is why so much of young love is conversation.’ (Erikson 1965: 253-4)
77 However, a nationally representative analysis (Buchanan & Ten Brinke 1997) of data from the National Child Development Study (all children born in the first week in March 1958) found that for women an experience of severe social disadvantage as a child was associated with mental health problems at age 33. http://www.jrf.org.uk/knowledge/findings/socialpolicy/sp125.htm
78 Of potential concern in this regard should be a recent WHO Europe finding that the highest figures of young people who reported eating potato crisps every day were recorded in England, Ireland, Northern Ireland, Scotland and Wales, ranging from 45% to 78%. (WHO Press Release 2000) http://www.who.dk/cpa/pr00/pr0001e.htm Less stringent legislation results in UK potato crisps being more highly flavoured with additives than e.g. their Italian equivalent. They are also highly associated with non-meal-related drinking of alcohol, a less prevalent phenomenon in southern Europe.
79 A WHO international survey of adolescent health found that ‘Students who watched more television were more likely to consume so-called junk food.’ (WHO Press Release 2000) http://www.who.dk/cpa/pr00/pr0001e.htm Understanding this kind of situational interlocking between a healthindifferent and a health-harming behaviour (as here, TV watching and bad diet – cf. above, succeeding (sc. non-failing) schools and early teenage conceptions, and below, hospitality and excessive alcohol intake) is not possible from analysis of routine medical statistics in a biomedical interventionist framework. The key fact to be associated remains outside the frame. If social behaviours make for illness, health-oriented medicine needs to become (once again? – Virchow in 1849 thought it then was) a social science.
80 Of all registered cancers in Tayside 1985-1994, lung cancers for the City of Dundee district were 28 per cent for men (colorectal cancer 13 per cent), 15 per cent for women (breast cancer 21 per cent). In both cases these Dundee rates were three or more percentage points higher than the other Tayside districts.(Director of Public Health 2000: 37) http://www.show.scot.nhs.uk/thb/publications/arep9899/phar9899.pdf
81 Confirmed by (Brynin 1997), who emphasises the power of the example given by older siblings.
82 In a recent study of teenage smoking in Scotland, regular smoking was associated with respondents’ perceptions of their friends’ levels of smoking. Over two thirds of regular smokers disclosed that the majority of their friends smoked, compared with only one fifth of non/ex/occasional smokers. (Bell, Pavis et al. 1999)
83 See Joyce Canaan’s essay on this topic in (Mac an Ghaill 1996)
84 Obviously enough, conflict at this level of intensity would with difficulty be containable within the home, thus requiring one of the parties to leave, usually the child – weaker, poorer, usually unqualified, and thus likely to end up homeless. ‘…interviews with young people who had become homeless – and with some of their parents – confirmed that friction within families played a major part in their being evicted or deciding to leave home….Eviction of young men from the family home had sometimes been precipitated by being caught stealing from their parents or by physical confrontation with their fathers.’ (Smith, Gifford et al. 1998) http://www.jrf.org.uk/pressroom/releases/160398.htm In her Scotland-wide research in the early 1990s, Gill Jones found that ‘younger people [setting up home] were both more vulnerable and in need of support, and the least likely to receive it from their parents’. (Jones 1995) http://www.jrf.org.uk/knowledge/findings/socialpolicy/sp70.htm
85 (Pavis, Platt et al. 2000)
86 ‘While involvement in a peer group seems to improve communication skills in the youngest group, it is associated with increased risk behaviour among older groups. For 15-year olds the amount of time spent with friends is a decisive predictor for smoking and the experience of drunkenness.’ (WHO Press Release 2000) http://www.who.dk/cpa/pr00/pr0001e.htm
87 Cf. Deborah Orr’s article ‘The culture consuming us all’ [i.e. consumerism] The Independent 22/8/2000: ‘Can it be that we are largely unhappy, broadly dysfunctional and all attempting to have lives that are not possible for us?’
88 ‘Participation in consumer markets is important to one’s sense of self and social status as an adult. It is likely to be delayed by the increasing economic dependency that many young people now face. Research shows that young people rely more and more on their families for financial support and there are suggestions that families may try to cushion their young people from the worst effects of poverty…by supplementing their spending.’ (Morrow & Richards 1996) http://www.jrf.org.uk/knowledge/findings/socialpolicy/sp98.htm
89 Cf. ‘…researchers from the Open University have found that grant maintained schools were able to improve their examination results over the past decade principally because they managed to take in fewer pupils with social disadvantages.’ (Pyke 1999)
90 For a similar concept – ‘social-breakdown syndrome’ – functioning to organize findings for another category of people finding themselves pushed to the societal margins, see (Kuypers & Bengtson 1973). Briefly, ‘social-breakdown syndrome suggests that an individual’s sense of self, his ability to mediate between self and society, and his orientation to personal mastery are functions of the kinds of social labeling experienced in life…[T]he elderly in Western society are susceptible to, and dependent on, social labeling because of unique social reorganizations in late life, e.g., role loss, vague or inappropriate normative information, and lack of reference groups. Consequences to the dependence on external labeling – generally negative for the elderly – are the loss of coping abilities and the development of an internalized sense of incompetence.’ (p.181) The crucial similarity between the two syndromes is that they are peopleharming adaptations to noxious social organization.
91 For extended examination of the way in which the narrowness of hegemonic masculinity is now a social and mental health concern, see (Frosh, Phoenix et al. 2001)
92 The apparently widespread presumption in the British adolescent mind that there is an association between being drunk in public and being grown up may underlie the finding that ‘Perceived drunkenness is lowest in France, Greece, Israel, Portugal and Switzerland, while in England, Northern Ireland, Scotland and Wales it is consistently high’. (WHO Press Release 2000) http://www.who.dk/cpa/pr00/pr0001e.htm
93 ‘We cannot really separate an organism from its environment. It’s not merely the impossibility of defining a precise physical boundary, but all we perceive about an organism involves the world external to it.’ (Pantin 1965: 87)
94 ‘1 Marriage isn’t a part of peoples lives.’ ’40 Young folk don’t put any value on marriage. Having a baby – that’s important for a lot of them, but they don’t want to be married or thought of as married.’
95 ‘In our culture…youth….cannot just relax and wait for the passage of time to turn them into adults. Maturation is not a preprogrammed process that unfolds automatically; a young person has to learn habits of thought, action, and feeling that are often difficult and unnatural. This is a process which, not surprisingly, is cause for much tension and conflict.’ (Csikszentmihalyi & Larson 1984: 11-12)
96 ‘1 Slappers are girls who are out every weekend looking for a lad. You’re not allowed to be single, folk would think there was something wrong with you. If you have a baby, it’s okay to be on your own, because you have obviously been good enough for a shag.’
97 Parsons explicitly acknowledged that the ideal typical nuclear family he described was not universal, even in 1960s America. “It may…be reasonably supposed that a major factor in the vicious circle to which the lower class, white and Negro alike, is subject lies in the field of relations between the family and the solidarity and influence systems with which it articulates. My essential point is that this is a two-way and not a one-way relation. By nearly every criterion ‘family disorganization’ is particularly prevalent in the lower class. Not only is this one principal source of the other social problems in that group, but in another sense it is not an isolated phenomenon. It is in part a consequence of the low input to lower-class families of influence in the form of ‘social acceptance’: from the point of view of the higher social groups they are ‘the wrong kind of people.’ (Parsons 1965: 48)
98 This research did not enquire into the effects associated with bereavement suffered by women on the death of their mothers. However, from the emerging understanding of these families as psychosocial systems with a comparatively low internal boundary between mother and daughter, one could hypothesise that there might be greater than average distress and associated dysfunctions at that point in their lives.
99 However one defines it, Hutson and Jenkins may have been observing something of the same phenomenon in their study of the transition to adulthood among the unemployed in South Wales. While they found the transition ‘surprisingly unstructured by gender’, the difference lay ‘in the apparent ability of some males to put ‘full’ adulthood off or, and this is probably a better way of putting it, in their scope for irresponsibility. Whereas women’s adulthood is more heavily weighted towards socially defined responsibilities – in particular for children – men seem more likely to enjoy the rights attached to adult status. This situation is probably encouraged by unemployment, although such a conclusion must remain more of an impression than a defensible finding.'(Hutson & Jenkins 1989: 155). One party irresponsibly putting adulthood off and the other party taking it on early has to be a formula for difficulties in the union they may be trying to form.
100 42 ‘You look at a place like Kirkton, young people aren’t encouraged to be any different than their parents. Therefore, they don’t see themselves as doing anything different than them. What they see is what they become.’
101 I have presented an account of how this might be happening at the Annual Conference of the Society for Infant and Reproductive Psychology, Birmingham, September 2000. For abstract see Ryan (2000).
102 ‘The pattern is a global pattern of the whole organ, and, when it is altered, the effect is never quite localized. There is a sort of nearest neighbour situation.’ (Waddington 1969: 176)
