The Side Effects of School: A Crisis in Mental Health Can’t Be Solved Through Therapy, by Dr Naomi Fisher

We’re facing a crisis in young people’s mental health.  Every day I get emails from several parents, asking if I can help their children.  They tell me how distressed their children are, how they are harming themselves and how they don’t know how to help.  There are so many that I can’t see most of them.

They come for many reasons. The pandemic has been hard, and many of them have family difficulties or have experienced trauma.  And for some of them, school itself is causing the distress.  I hear stories of feeling controlled, of being given detentions because their hair style was wrong or their blazer not on.  I hear stories of chronic anxiety about ‘being behind’, of nightly terrors about spelling tests.  I hear stories of children who totally refuse to go anywhere near a book, despite having started school full of enthusiasm and with a love of stories. 

I hear the stories of those who have given up, who think at age 14 that there is no future for them, because they’ve been told that if they don’t get nine GCSEs at 16 they will never get a good job.  They’re burnt out already, after years of trying to do what they were told.  They tell me that they do not enjoy anything anymore and they don’t get out of bed. 

Then I’m asked to fix the children.  Do some therapy, or maybe some mindfulness, and help them keep going. Build their resilience.  See if they can get back to education to keep going for a few more years, just until GCSEs. 

But no matter how many of them I help, the referrals keep coming. It’s like a tidal wave.  I’ll never be able to meet the need, because what I am offering – therapy – is a way to patch up each individual.  It can’t look at the system which is creating this distress, and ask what is going so wrong for our young people. 

Improving mental health is about so much more than treating problems when they arise. That’s like treating lung cancer without encouraging people to quit smoking.  No matter how good we get at treating lung cancer, to really improve health we need to stop people getting ill. 

Targets and Tests

There’s a new government Schools White Paper out.  It says that by 2030, 90% of primary school children must reach the ‘expected level’ in English and Maths, something which only 65% of them did in 2019.  To that end, children will be going to school for more hours every week, and Ofsted will be visiting schools more often.  Oh, and they’re also going to have access to funded training for a senior mental health lead ‘to deliver a whole school approach to health and wellbeing’.

I can imagine what that will involve.  Mindfulness in assembly, or a friendship bench. Maybe a school counsellor to talk to the most distressed young people.  Perhaps some training on ‘trauma-informed classrooms’ or a nurture zone in an upstairs corridor somewhere.

What I’m sure it won’t include is any examination of the contradiction at the heart of how we educate our children.  It’s unlikely that these trained mental health leads will be encouraged to ask whether perhaps the way we are schooling our children has some serious weaknesses – and in fact could be causing intense distress for many.

For the priority of the school system as it currently works is not to help young people flourish, but to get through a curriculum.  Delivering content, rather than nurturing developing children.  And because this is the priority, we test the effectiveness of our education system through exam results.  We don’t see human thriving or psychological wellness as an outcome of the system – but they are, just as much as GCSE results.  They are the outcome which can make a life worth living.

Unwanted Effects

In medicine, unwanted effects of drugs are often called side effects.  A drug you are taking for your high blood pressure may also give you insomnia, or a dry mouth, or a tickly cough.  Some of these side effects only come to light when people who are taking the drugs start to report unusual symptoms.  Sometimes these unwanted effects are deeply damaging, and then there is a medical scandal.  Some argue that we shouldn’t call any effect of treatment a ‘side effect’ because it leads us to behave as if they are insignificant when in fact they can be life altering.  Some effects are wanted, and some are not, but we need to know about all of them. 

We rarely talk about the side effects of education.  When looking at ‘evidence-based education’  I have seen no research which looks at the unwanted effects of interventions such as the Year 1 Phonics Screen, or zero-tolerance behaviour policies.  I have never read a study which looks at unwanted effects of extremely controlling school environments, of the distress caused by silent corridors, Saturday detentions and rules about facing forwards and making eye contact.  I’ve seen few studies which link the increased pressure in schools with the growing numbers of children who are struggling to attend. Instead, most research focuses on exam results, and usually on Maths and English. The assumption is that we don’t need to consider the unwanted effects of policies designed to raise test scores; because this is seen an unequivocally positive thing to do. 

That’s a shame, because when curriculum is the main priority, strategies are used which make no psychological sense at all.  Strategies which don’t just cause distress, but which make learning more difficult.  An educational approach may  appear  to ‘work’ in the short term but have long term consequences which schools may not see at all – because the children who experience them either stop going to school, or keep very quiet about it until after school hours. 

Remove autonomy  => decrease motivation.

From the moment a child steps through the doors of a school, the process starts of taking away their autonomy.  Autonomy means the ability to make your own decisions, to manage and govern yourself.  There is a certain irony that the peak time for autonomy in the education system is age 3.  Nursery children are generally allowed to make choices about whether they spend their time in the sand pit or at the drawing easel, the home corner or the messy play area.  In a well-functioning nursery, the children are managing themselves in the space, moving from activity to activity as they choose and navigating the social environment. 

It’s not allowed to be like that for long.  From reception upwards, the gradual process begins of removing those opportunities for self-management.  It starts with little phonics groups, and talks about how the things children choose to do are less important than doing what adults tell them to do. This is done because adults think they must prioritise the curriculum, so the children ‘keep up’.

Children learn that the things they love should be ‘kept for playtime’ whilst they spend their time learning about adult preoccupations such as fractions and subordinate clauses.  Each year they have less chance to manage themselves, until they get to the highly restrictive secondary school, where frequently their only real choice is to conform or rebel.

This is despite extensive research which shows that autonomy is important for high quality motivation.  Research by Edward Deci and Richard Ryan show that in order for a person to be intrinsically motivated, they need autonomy, a sense of mastery and good quality relationships.  When we are intrinsically motivated, learning is of a higher quality – and we enjoy what we do more. 

You can see this in practice in young children.  They learn through play because they love to play.  For them, learning is highly enjoyable.  They get deeply interested in particular topics, and learn huge amounts about dinosaurs, or diggers, or train timetables – all because they are interested.  No one has to make them learn. 

By the time they are a few years into school, the sparky preschoolers have turned into teens who don’t know what they want to do, and who aren’t interested in anything.  They can no longer be trusted to manage themselves in the way they did when they were 3, because they may well create havoc or refuse to do anything at all.  This behaviour is then used as a reason to control them further.  No one ever asks if it could be a reaction to how they have been treated.

We know it doesn’t have to be like this, because teenagers who have never been to school don’t have this problem.  They stay motivated to learn.  They choose to learn complicated and challenging subjects.  It’s not surprising that when we tell children their interests aren’t important, they become teens who believe their interests don’t matter.  We see the unwanted effects of removing autonomy from our children in our teens.

Use anxiety to motivate =>  watch it spiral.

Children with low autonomy are not motivated which leaves schools with a problem.  How can we persuade children to learn the curriculum? They aren’t interested!

One of the answers is to use anxiety.  Anxiety can indeed be a motivator.  If you make someone scared enough, they will often work hard to get away from that fear.  So schools tell children that if they don’t study, they’ll never get a job.  Or, in the more immediate future, if they don’t do as they are told they’ll have to stay after school for a detention, or they’ll get their name written on the wall for all to see.   

Anxiety isn’t easy to titrate.  If you create a system where anxiety is being deliberately used as a motivator, for some children that anxiety is going to become uncontrollable.  They will start to worry all the time, or to chew their sleeves to shreds.  They will stop being able to sleep for worry about tomorrow’s test or next years’ exams.  I know this happens, because I see it in my clinical practice.

Even for those for whom it isn’t overwhelming, anxiety isn’t something which makes learning fun.  It isn’t really about motivation to learn, but about a motivation to get away from the feared outcome.  This leads to cheating, or to ingenious strategies to avoid punishment.  One girl I met had managed to order the teacher’s answer book for Biology from the internet, guaranteeing her full marks for her homework without the need to learn any Biology at all.  Makes perfect sense, if your aim is to get the right answers and avoid detention.  Makes no sense at all, if your aim is to learn biology.

Anxiety makes learning more difficult. When a person is worrying, they can’t concentrate on learning.   Their brain is too busy trying to keep them safe.  The unwanted effect of using anxiety to motivate is that learning becomes harder – which then makes adults and children even more anxious.

Make constant comparisons =>some will start to think that they are inferior.

A basic premise of school is that children move through it in age groups, and what they learn is determined by age.  They are compared against others of their age group, and judged to be ‘behind’ if they aren’t at the same level.  This starts right from the beginning, when children are ‘behind’ if they aren’t yet interested in letters, or if they don’t want to sit still on the carpet.  There’s an assumption that this is fair, and that those who do less well could catch up if they worked hard, but the neuroscience doesn’t bear this out.

Over the last 20 years our knowledge about brain development has mushroomed.  We can now scan the heads of living people, which means we can gain insight into how brains actually work.  What we find is that brain development continues for far longer than we thought. In brain terms, adolescence continues until at least age 25.  And not every brain develops at the same rate.  At the ages when young people take standardised exams, their level of brain development is hugely variable. 

This means that we are comparing children against each other when their brains are at very different developmental stages.  Not just that, we are comparing them against each other and then using those comparisons to make decisions which will affect them for the rest of their lives.  We know that differences in maturity matter even within a school year.  Research shows that the children who are the youngest in their school year do less well at GCSE, and are more likely to be diagnosed with SEND. 

Some young people, on finding themselves on the hard end of these comparisons, will give up on learning and education.  They’ll decide that they are stupid and it’s all pointless.   Judging children as ‘behind’ has serious side effects.  It may be meant to motivate but in practice, many retain this view of themselves into adulthood and never ‘catch up’. 

What’s the alternative?

So that’s the context for all the emails I get from parents  – but I’m not being asked to look at context.  I’m being asked to fix the children.  And here’s the paradox.

There’s nothing wrong with the children. They are put in a system which prioritises curriculum and test results over flourishing.  The system uses anxiety, comparisons and removes their autonomy.  These aren’t healthy conditions for young people to grow up in.  They cause distress. No amount of psychology or mental health training will solve that.  We don’t do magic.

We know this when we take time to reflect. Most adults know that their psychological wellbeing is improved when they can make meaningful choices in their life, when they are not afraid or shamed and when they are not constantly comparing themselves against others.  We seem to forget that the same principles apply to young people.

A serious mental health intervention needs to look at the school system and how it creates problems.  We need to ask whether it would really matter if young people took different exams at different times.  We need to ask why we hurry children on from play, and whether that might be doing damage which we only see years later.  We need to allow for much more variety in educational outcome, and much more developmental variation in young people.  Young people should be enabled to succeed in so many different ways.

The best way we know to do that is to allow young people choice and autonomy in their education. This would mean there was no need to use anxiety or comparisons to motivate, because we would accept that young people learn different things at different times. The best way is to develop systems and structures which allow for empowerment and individual differences.  This would mean stopping the focus on curriculum and instead focusing on helping young people learn the things which interest them. Even if this means they will all choose to learn different things.  

This means allowing young people the time and space to manage themselves and their learning again, just like they did when they were 3.  Then they can start to rebuild their trust in themselves and their ability to direct their own learning and life.  

This is frightening for adults, because most of us grew up being  told that we couldn’t be trusted.  We learnt that we’d amount to nothing without the pressure and comparisons of school.  Many of us carry that with us for life. We’re passing it onto the next generation.

We can do better for our children.  Let’s start today.

Dr Naomi Fisher is a clinical psychologist and author of Changing Our Minds: How Children Can Take Control of their Own Learning.  She is the mother of two self-directed learners. 

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