Protection not pressure. Interview with Professor Michael Schulte-Markwort

March 2018

Professor Michael Schulte-Markwort is a child and adolescent psychiatrist at the Hamburg Eppendorf University Medical Centre and doctor in charge of the department for child and adolescent psychosomatic medicine of Altona Paediatric Hospital. He is well-known for his work on mental illness in children and adolescents, particularly stress-induced depression.

Photo: © Berthold Fabricius

Erziehungskunst: What do children suffer from most today?

Michael Schulte-Markwort: That is a difficult question since it is a question about epidemiology. Depression and anxiety disorders are the most frequent.

EK: What are the reasons for children suffering in this way?

MSM: There are many different reasons because there are children who are born with particular constellations of their personality and who are disposed towards anxiety disorders. The same also applies with regard to depression. The converse also applies: children who grow up in a good family atmosphere have a 50 percent lower risk of developing depression.

EK: Is mental illness thus one the one hand related to psychogenetic and on the other to environmental causes?

MSM: No, not necessarily just psychogenetic, there are also biological factors. That is what I meant with innate. The most important factor which functions as a protective factor against the development of depression is a positive family atmosphere; that means conversely that a negative family atmosphere increases the risk of children developing depression.

EK: What do children tell you in the consultation: is it more about family or school matters?

MSM: That can vary a great deal. A high percentage of marriages in Germany end in divorce. One particular feature of divorce is that it contains the high risk of children suffering mental distress. Divorce as a rule brings with it conflicts and arguments between the parents. On the other hand: 30 percent of all class 9 pupils in Hamburg say, “I am stressed at school”.

EK: What puts the most stress on children in school?

MSM: Teachers who the children feel do not understand them, who are not good at explaining things, who have no respect for them, and a workload the children can barely manage. For kindergarten children it is true that the many social contacts with twenty and more other children can also be very exhausting.

EK: What has to change?

MSM: The first thing I tell parents is to ensure that there is minimal conflict in the family. That is easy to say, of course, but I do believe that we can make a bit of an effort here to get on with one another and also to remain attractive to one another. The other thing is that we must ensure that schools are better cared for, that the classes are smaller, that the teachers have a fundamental and thorough attitude of respect, and that all the actors in school feel responsible for creating an atmosphere in the school in which children feel comfortable. There is also the need for a different kind of education. Education in Germany is deficit-led. We don’t tell a child, you spelled thirty of fifty words correctly, but we say, you got twenty of fifty wrong.

EK: You refer to an “education of making things work”. What do you mean by that?

MSM: It does not occur to any teacher, for example, to apologise to a child who has performed badly by saying that they did not explain the material well enough. That requires a rethink. Teachers might be led to understand this if we measured pupil satisfaction on an ongoing basis and fed that back to teachers in an anonymised form. If a teacher learns that twenty out of twenty-five children like them, then that gives them a quite different incentive to do something or also to change something compared to a teacher who only receives positive feedback from five pupils. Here in the medical faculty it is quite normal for students to evaluate their lecturers once every semester.

EK: Is there not the concern, then, that pupils, particularly at a certain age, will bully a teacher out?

MSM: There is a fundamental distrust among adults of children that they would exploit something like this. There are no grounds for such a view. If we take children seriously and offer them respect, then they also always respond with respect. Children are not sadistic or aggressive of their own accord. That tends to be a problem among us adults.

EK: Parents get involved on behalf of their children to a much greater extent today than previously. Does that also have negative effects – early intervention, “helicopter parents”, to name but two buzzwords? Is it not the adults here, too, who are the actual problem?

MSM: The adults, yes, but not necessarily the parents alone. Rather, the adults who are around the child. I also reject the term helicopter parents. There are undoubtedly parents who are overprotective. But I always advise parents when they are in doubt as to whether protection or pressure is appropriate: “Be protective”. If there is any doubt as to whether to be supportive or demanding, then supportive is always better.

I think it is a good thing that parents are involved in this way today and I also think it is a good thing that parents come to see me much earlier than twenty years ago. I am happy when I can often say: “It is good that you came, but don’t worry, you have a fantastic child.” I want parents to be attentive. And I prefer them to err on the side of being a little bit too attentive. I always say that we cannot give enough love – that is impossible. We tend rather to have the problem that there is too little love.

EK: There is no healthy measure in the middle?

MSM: An interesting question what healthy means in this context. I believe the notion that in earlier times there once existed some kind of instinct as to how to bring up children is a romantic idea. This same instinct inflicted corporal punishment and let children starve. I could go on. To this extent I’m glad that we have left those things behind us.

What a healthy measure is, is often determined from outside. We always have to take into account that when doctors are asked by society to provide a more detailed diagnosis we also see more. That is something I am often asked: do we, as child psychiatrists, not project things into children in our diagnosis that aren’t there? I always reply: no, we don’t do that. I try very hard not to treat a child that has no reason to see me. But I can also tell you that I see things today which I did not observe thirty years ago. And I am glad that I see them. In other words, overall I am not of the opinion that we exaggerate. For me neglect is still the more important concern. In that respect I am happy to put up with the barbs about early intervention.

EK: You say one of the problems is that adults often lack respect towards children and adolescents. How do over-protectiveness and lack of respect fit together?

MSM: I don’t see a contradiction here. If I keep crossing my child’s boundaries and say, you have to go to summer camp this year, whether you like it or not, because your English is not yet good enough, then this shows a lack of respect because I fail to include the child. If I say, I know that you have separation anxiety but you have to start going to kindergarten now since I absolutely need to return to work for my own personal fulfilment, then that would be something similar. There are, of course, situations in which the parents have no choice but to go to work. That is not what I am taking issue with. But if there is a choice, then the issue appears in a different light.

EK: You once mentioned in an interview that we had lost sight of the individuality of the child. What did you mean by that?

MSM: I believe that such a perspective has not been lost but has never really been there. I think we have to keep practising, sharpening our view of what individuality really means. That would also automatically mean that we don’t have such large classes. They make it impossible to teach individually.

EK: You also say that childhood has been organised to the nth degree with the “focus on optimisation”. Are human relationships left behind in the process and is this what children are really suffering from?

MSM: I believe that ultimately it is a bit more complicated than that. For me, the principle of pervasive economisation is what lies behind it. We all have a dogmatic view which says: to stand still is to regress. In my field, the economisation of medicine has an effect which we then, of course, complain about when surgeons only any longer consider the number of artificial hips they can implant. This principle is also transferred unfiltered to our children and they grow up from birth on the treadmill. This leads to certain symptoms or abnormal behaviours which cannot be prevented. We then complain about the breathlessness for which we are ourselves responsible.

EK: Have children also changed?

MSM: Yes. Children today are more sensible, they are used to being asked, they reflect on things and are disciplined, actually they are incredible.

EK: You link a change in how we think about education with new thinking about values. What is the connection?

MSM: We urgently need a debate about values. We have stopped any discussion about which values we consider to be important and want to pass on, which values our children should live. We have no discourse about this. The strongest values are, even if it might sound a bit trite, love, respect and human dignity.

EK: Do nursery care and early school enrolment foster fatigue in children?

MSM: Fatigue often fails to be recognised so that I cannot associated it with a school enrolment scenario. I don’t get the impression in the clinic that the phase is continuing in which parents said, I have such a clever child, let’s send them to school as early as possible. I think that some normality has returned here. It is fundamentally the case, after all, that children like to achieve things. Children love achievement. They like to show that they can do something. It simply has to take place at a level which is appropriate for their development and age.

EK: What, then, leads to burnout in children?

MSM: What leads to burnout in children is when a nine-year-old child, class 4, about to make the transition to secondary school, looks at me and says: if I don’t succeed in moving to secondary school my life is over. When the pressure has been internalised to such an extent that these children no longer know where to turn. Or also, for instance, when they reach the final school leaving exams and tell me that a mark lower than 1.5 is worth nothing and they have 36 to 38 hours of lessons per week and then in reality have to work 50 to 60 hours.

EK: From what age should children be cared for by someone else?

MSM: Sending children to nursery at a very early age gives me food for thought and makes me sad. Particularly when it isn’t really necessary. It might, of course, be necessary for psychological reasons. There are mothers who cannot cope with being with children all the time, who find it boring and need change, cognitive stimulus. Apart from this, I cannot see why we should send a child to someone else before the third year of life. What is the benefit? Other than that children learn, I have to exert myself and exertion becomes my life principle.

EK: What do you consider to be the best age to start school?

MSM: I continue to think that the seventh year of life, that is when they are six, is a good age for starting school. But I would wish for bit more of an individual approach in this question. There are children for whom it would be good to start school earlier and children who would benefit from going to school later.

EK: What tips can you give to parents whose children are entering school age.

MSM: My wish is for parents who have the confidence to disregard their own needs and see their child independently and then to draw up a profile of their child. To ask, what is our child actually like? What distinguishes this child, what difficulties do they have, what do they particularly like to do and, on this basis, what do we think is the best age for our child to start school?

EK: Your strengths include adopting a different perspective. You want to give the children and adolescents whose distress you experience daily in clinical practice a voice: what would be the three most important demands “out of the mouths of babes”?

MSM: Take me seriously, take in what I need, be guided by my needs, do me justice and trust me!

Mathias Maurer asked the questions.

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