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Saúde e Sociedade

Print version ISSN 0104-1290On-line version ISSN 1984-0470

Saude soc. vol.28 no.1 São Paulo Jan./Mar. 2019

http://dx.doi.org/10.1590/s0104-12902019000001 

Dossier

Presentation - Concepts, trajectories, and approaches to “agitation” and “non-conforming children”: social and cultural experiences in Brazil1, Chile2 and France3

aUniversidad de Chile. Laboratorio Transdisciplinar de Prácticas Sociales y Subjetividad. Santiago, Chile. E-mail: pcottet@yahoo.com

bUniversidad Academia de Humanismo Cristiano. Estudios Transdisciplinares Latinoamericanos. Santiago, Chile.

cUniversité Paris Descartes. Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société. Paris, França. E-mail: aude.beliard@parisdescartes.fr

dUniversidade Federal de São Paulo. Laboratório Interdisciplinar Ciências Humanas, Sociais e Saúde. Santos, SP, Brasil. E-mail: eunice_nakamura@hotmail.com

Agitation” and “non-conforming children” is the subject of reflection and discussion of a group of researchers interested in situations where children and/or their behaviors identified as problematic and disturbing.4

Children and their behaviors have received significant attention in various disciplines, including psychiatry, psychology, psychoanalysis, education and pedagogy, where special emphasis has been put on children’s development, their socialization and social integration. Scholars in these disciplines have illustrated how some scientific theories seem to legitimate the need for adapting both children and their behaviors to social and cultural expectations, that is, to the patterns of normality underpinned by the moral values of the society in which they live.

These subjects are however not studied only by the sciences that deal with normal and pathological human behavior. Children’s behaviors constitute an important theme for the social sciences to the extent that they involve a circulation of concepts, meanings, actions, practices, policies, social actors and institutions, pointing us to the need for an in-depth understanding of children and their behaviors: who identifies them as problematic? How are they thought of and described? What are the answers given to them?

Therefore, classifying children’s behaviors is part of a very complex process not restricted to biological signs or symptoms. It involves social and cultural aspects regarding the ways in which these behaviors are classified into categories and concepts from the point of view of social actors (adults) and institutions (responsible for child care), also revealing a political dimension depending on by whom and why these behaviors are considered problematic or the children are seen as non-conforming. In this sense, reflecting on “agitation” and “non-conforming children” constitutes a sociological issue about the relationship between the social and the biological dimensions of human behaviors (Mauss, 1968) and its consequences, especially in contemporary societies.

Studies of these qualification processes allow us to critically examine the association of problematic and disturbing behaviors in children, with the social norms in relation to which children are considered “non-conforming”, specifically in contemporary societies and with regard to attention, autonomy, self-control, performance and the school context. These “non-conforming” behaviors are often difficult to describe and to reflect on, because they are an intricate combination of medical, psychological, school and social problems. In this way they reveal how each society qualifies what the problems are and how the appropriate social responses are thought of, with a separation or articulation between social and medical problems.

These situations can be approached from different theoretical perspectives. Three main perspectives can be identified, which are reflected and articulated in the articles presented in this dossier.

Many studies are based on a perspective that highlights processes of medicalization or pathologization of children’s behaviors, thus evidencing the central role of the school in the social construction of different forms of child deviance (Pinell; Zafiropoulos, 1978). A series of studies have examined the transformations of psychiatric diagnoses and the development of different medical designations given to these problematic behaviors (oppositional defiant disorder, childhood hyperactivity, learning disabilities, conduct disorders, etc.), depending on the historical, social and cultural context. For example, several authors have analyzed how the construction of the Attention-deficit/hyperactivity disorder (ADHD) entity is linked to various interests (of the pharmaceutical industry seeking to sell drugs; of the educational institution seeking to exclude the most disruptive children; of medical specialties seeking to establish their scientific legitimacy) (Conrad, 1992; Conrad; Bergey, 2014; Malacrida, 2004; Rafalovitch, 2004). These analyses can be complemented by studies of the trend towards the “trivialization” of diagnostic categories, i.e. their diffusion in the vernacular (Nakamura, 2017), as in the case of hyperactivity in contemporary societies.

From another perspective (which could be called the analysis of the production of social pathologies), some authors have proposed another interpretation of the increasing prevalence of pathological entities built around behavioral disorders. They argue that the increase of these disorders can be analyzed as a consequence of transformations in dominant norms and values in various societies. From this analytical framework, we can understand how social and normative transformations constitute subjects, shape individual subjectivities, produce forms of discomfort, and make available grammars or registers to express suffering. Alain Ehrenberg (2014) thus hypothesizes that the transformations of the concept of an individual are based on the dissemination of behavioral adjustments in contemporary societies, especially those related to the idea of autonomy and individuals’ capacity for self-motivation and self-control. The increasing need for these adjustments can produce new disorders, which are increasingly numerous and visible, as the phenomena of social withdrawal and agitation attest. In dialogue with this type of approach, more emphasis can also be placed - as several authors in this dossier proposed - on how social inequalities and social relationships, in a given historical and political context, create forms of vulnerability and guide the expression of individual suffering (Radiszcz, 2016).

The articles in this special dossier draw on these two perspectives and also focus on a third one revealing a set of reflections and research paths, which could be summarized by an analysis of the social uses of the disorders in qualification processes (how children’s behaviors are qualified; how the children directly affected live; how they deal with the different diagnoses available; what meaning they give to them) and in practices, interventions, and care production (how the different actors deal with situations considered problematic, respond to disruptive behaviors, and manage crises?). This third perspective emphasizes the multiplicity of points of view and negotiations between all the actors concerned (the child, his/her parents and siblings, the school and care professionals, etc.) (Béliard et al., 2018; Nakamura; Planche; Ehrenberg, 2018; Singh, 2004, 2012).

The concepts of “agitation” and “non-conforming children” seem to imply discursive and epistemological dimensions of profound political significance. The relationships between common knowledge in general use (problematic child, school problems, hyperactivity, etc.) and specialized knowledge (diagnostics, clinical treatments, medications, regulations and protocols, etc.) produce a set of typical or regular situations that include adults’, institutions’ and children’s actions. Thus, the regimes of truth referred to the situations associated with “agitation” and “non-conforming children” seem to reveal conflicts in different levels of analysis, from which we highlight at least two main levels in the five articles of this dossier.

The first level of analysis, that could be called socio-epistemic, points to the conflict between common-sense and specialized knowledge, between scientific perspectives (psychodynamic, neurobiological, psycho-social, etc.), between institutional perspectives (pedagogical, school, mental health, family, etc.) and between generational perspectives (point of view of children and adults).

The article “Problematic, disturbing and non-conforming children’s behaviours: the concepts and care demands related to agitation in children in Santos and Campinas, Brazil” highlights some of these conflicts. The authors, Eunice Nakamura and Tatiana Barbarini, investigate the social consequences of the impossibility of defining specifically the boundaries of the concept of mental disorder that seems to be a “vague” term with no satisfactory definition, especially with regard to children’s behaviors. In this sense, they argue that to think about children’s problematic, disturbing or non-conforming behaviors requires one to understand the concepts underpinning the classificatory categories of children’s behaviors, presented as care demands, whether in common sense or in biomedical discourses. Based on what seems to be a relation between biological-psychological dysfunction and social-cultural expectation or response, they take as a starting point the idea that agitation is a multidimensional and vague category that can indicate different sorts of problems associated with children’s behaviors. A description and theoretical reflection is presented about the flow of discourses, knowledge and concepts regarding agitation that compose the networks for healthcare demands, considering the various social actors and institutions involved. The analysis focuses on: the different uses of the “agitationcategory and the normal, abnormal, problematic or pathological behavior that underlie them; the social actors and institutions involved in care demands and how they are interdependently connected; and finally, from a sociocultural perspective, the implications of classifying and defining children’s behavior from this vague category.

The article “Against the tide: psychodynamic approaches to agitated childhood in France, between crisis and resistance” analyses the tensions that exist in specialized discourse in the French context, which is marked by major controversies. The authors (Céline Borelle, Jean-Sébastien Eideliman, Maïa Fansten, Maëlle Planche, Amélie Turlais) take as their starting point the questions surrounding a “crisis” in psychoanalysis. These questions are recurrent in the comments of professionals working with a psychoanalytical orientation whom they met during a collective survey on the trajectories of children in France considered as agitated. During this research, they held interviews with children and their families, and with professionals working in care centers, schools and public administrations. They also conducted observations and collected data in care centers. In these places, the authors observed a diversity of practices, but a clear majority of them were claimed to be more or less strictly psychoanalytical or more broadly psychodynamic approaches. After presenting some principles unpinning the psychodynamic approach to agitation, the article discusses the feeling of crisis expressed by the professionals met, and the reasons that may have caused it. A detour through a reflective analysis of the investigative relationships helps to shed more light on the consequences of this climate on daily work in general and on relations with institutional partners in particular.

A second political and sociocultural level of analysis, stemming from the debates associated with what feminist theories have called “intersectionality” (Crenshaw, 1989), presents other dimensions that add complexity to the level of socio-epistemic conflicts mentioned above. The dimensions of gender, ethnicity, generation, class and socioeconomic level, sexual orientation, and differing capacities, constitute important keys to understand the phenomena of subordination and domination, which must also be considered in the studies on “agitation” and “non-conforming children”. The intersectionality between these different dimensions can influence children’s trajectories, as well as those of the adults responsible for caring for them.

The notion of “trajectory” has also generated dialogues between our different researches, with the underlying idea that the history of the person is built in the interactions between the different points of view and the interventions of all the actors concerned. Some of the articles address these trajectories by exploring the particular experience of the person whose behaviors, or those of their loved ones, are considered problematic, sometimes compounded by the intersection of sociocultural aspects.

In the article “Rethinking medicalization: discursive positions of children and their caregivers on the diagnosis and treatment of ADHD in Chile”, Pablo Reyes, Pablo Cottet, Alvaro Jimenez and Gabriela Jauregui analyze the discourse of minors diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). In Chile, the prevalence of ADHD is three times higher than the global estimate, which raises the question of the experience of subjects under this diagnosis. Using a structuralist approach in qualitative research, the discourses of seven children and their respective caregivers from two public schools in the country were analyzed. For this purpose, 14 in-depth interviews were conducted, which were analyzed based on the strategy of structural analysis of the discourse. The results are organized according to the “ADHD-Situation”, with a discursive structure that configures four emerging realities representing the subjective experience of minors: (1) the myth of origin, which locates its origin in diffuse alterations of behavior and learning; (2) ambivalence in/of medicalization, which refers to adults’ (mostly teachers’) suspicion and the initial effects; (3) identity (de)stabilization, when the possibility of recovering or not the autonomy in the diagnosis is at stake; and (4) subversion of medicalization, which appears impossible in the subjective trajectory of minors. The results open interesting perspectives showing that the subjective experience of children with ADHD diagnosis in Chile is not homogeneous. ADHD can be a source of discomfort, the treatment of which will have different results, in some cases attenuating its incidence, but in others intensifying it.

The article “The multiple meanings of ADHD: between deficit, disruption and hidden potential” (Aude Béliard, Javiera Diaz-Valdes, Alvaro Jimenez, Alice Le Goff, Sarra Mougel, Hugo Sir) examines the subjective experience of the diagnosis of ADHD and the cultural meanings that shape this experience. It is based on two studies, in Chile and France, consisting of interviews and observations with the people diagnosed and their families. These data show that the diagnosis of ADHD can have very different meanings. From a thematic analysis, the authors identified three registers or ways of living and thinking about ADHD. In the deficit register, the disorder is experienced primarily as a failure of certain abilities. In the disruption register, the disorder is experienced as disrupting the person’s life, personality, and interactions, which must then be normalized. In the register of hidden potential, on which this article focuses in particular, ADHD is thought of as a different state, both difficult and valuable, a source of exceptional, extraordinary capacities that are often hidden in the ordinary functioning of social life. On the basis of case studies, the authors invite to a reflection that identifies the factors explaining the mobilization or non-mobilization of the hidden potential register, with particular emphasis on relational configurations, on socio-economic variables, on the gender variable but also on the institutional and political context in each country.

The article “ADHD and gender: subjective experiences of children in Chile”, presented by Pía Uribe, Gabriel Abarca Brown, Esteban Radiszcz y Eleonora López Contreras, explores how the children’s subjective experience diagnosed with ADHD is crossed by a gender dimension. Based on open interviews conducted with children between the ages of 7 and 13, the authors show general trends that articulate gender and characteristics associated with the ADHD diagnosis, with children’s experiences that dismantle such trends. Although research on ADHD has tended to ignore gender differentials, recent contributions produced mainly from epidemiology have revealed that this diagnostic category seems to be strongly related to gender. However, these contributions seem to limit their scope to the study of the symptoms as well as the cognitive, affective and social functioning of children, neglecting subjective aspects associated with ADHD diagnosis and treatment practices. The findings were grouped according to four emerging axes: (1) locations, (2) abilities, (3) approaches, (4) interactions. Thus, they show how the experiences of boys and girls are multiple in relation to the diagnosis and it is not possible to be reduced to a binary gender perspective.

Some food for thought emerges when reading the articles in the dossier. The respective places of the different professional approaches are very different in the three countries, and take place in different articulations between the public health system and the private sector. The relationships between families, schools, healthcare professionals and administrative possibilities for recognizing a health problem are articulated in different ways, giving different meanings to diagnoses. All these data invite a more systematic analysis of the relationships between the point of view of children and families, the point of view of school professionals, the production of care (the practices and representations of professionals, which shape people’s experiences and guide their trajectories), the bureaucratic and technical issues, and the socio-political contexts particular to each country.

The analyses presented in the articles show both the centrality of the phenomenon of child unrest in the diversity of contemporary societies and the interest in continuing this common work of comparing singular national contexts.

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11 The results presented in this dossier by the Brazilian authors are part of three different research projects: “Social and cultural meanings of childhood mental health problems in Santos, Brazil, and Paris, France: contemporary representations of children”, a post-doctoral study with a fellowship from the National Council of Technological and Scientific Development (CNPq-Brazil); “The condition of the hyperactive and inattentive child: a study on psychiatric intervention in contemporary forms of child social inclusion” and “The network of demand and care in child mental health - Social, family, school and health relations around the problems of child learning and conduct”. The latter two are carried out in Campinas with fellowships from São Paulo Research Foundation (FAPESP-Brazil) and the National Council of Technological and Scientific Development (CNPq-Brazil), respectively.

2All the Chilean authors of this dossier participated in the research project “Discomfort trajectories in children diagnosed with Attention Deficit and Hyperactivity Disorder (ADHD): Subjective and social experience of multiform suffering”, developed by LaPSoS. The research received funding from Contest for Strengthening Productivity and Continuity in Research (FPCI) of the Faculty of Social Sciences of the University of Chile, as well as from CONICYT through its International Cooperation Program/Support for the Formation of International Networks between Research Centers (Contest 2017), Folio REDES170095.

3The French authors of this dossier participated in the research project “The meanings of agitation in childhood: individual paths, family dynamics, professional practices”, which received funding from the Institute of Public Health Research (IRESP) and the Pfizer Foundation.

4This research network has been developed from the exchanges between researches conducted in Brazil at the LICHSS (Federal University of Sao Paulo), in Chile at the LaPSoS (University of Chile), and in France at CERMES3 (University of Paris Descartes). More information is available on the network’s website: <https://en.nonconformes.org/>

Received: November 30, 2018; Accepted: December 10, 2018

Correspondence Pablo Cottet Universidad de Chile, Facultad de Ciencias Sociales. Av. Capitán Ignacio Carrera Pinto, 1.045, Ñuñoa. Santiago, Chile. CP 685 033.

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