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Les enfants peuvent-ils s'exprimer

Can the Children Speak?

Voice, Children and an Adhd Diagnosis in an Ethnographic Research
Les enfants peuvent-ils parler ? Voix, enfants et diagnostic de TDAH dans une recherche ethnographique
Anna Witeska-Młynarczyk
p. 46-57

Résumés

Dans cette contribution, je poserai les questions « les enfants peuvent-ils parler ? » et « qui parle ? » à partir d’un terrain ethnographique auprès d’enfants vulnérables. Dans le cadre d’une recherche sur les expériences d’enfants diagnostiqués d’un trouble de l’attention et de l’hyperactivité (TDAH), menée dans la Pologne contemporaine, je proposerai une interprétation de la voix des enfants comme « émergente » et conditionnée par la réalité sociale quotidienne des enfants qui participent à l’étude, par les circonstances du projet ethnographique, par un débat politique plus large et par les infrastructures matérielles et sociales. Je présenterai également mon propre combat, les tensions relevant de la responsabilité éthique, mes biais et mes attentes, ainsi que la manière dont ils ont évolué au cours de l’échange ethnographique et intersubjectif. Une différenciation entre voix politisée et voix quotidienne des enfants sera notamment opérée.

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Texte intégral

Voice guarantees humanness at the same time as it calls it into question, delineates the human as it challenges it. Voice it seems, may reveal us, but it is easily, all too easily, also manipulated by us and mistaken by others for things it is not (“real” truths, for instance, parahuman sounds, or physical disabilities)—which indeed is why voice requires new talk about it. Martha Feldman (2015: 658)

  • 1 When anthropologists “speak for children” or show “the native’s point of view”, it is worth underli (...)
  • 2 I would like to thank the anonymous reviewers for their invaluable comments.

1The title Can the children speak? is a reference to an article published by Gayatri Spivak under the title Can the subaltern speak? (1988). With this text, Spivak began a discussion about the ethical problems of western scholars researching a different culture with universalizing tools. She argued that a research situation always takes the form of a colonial relationship. It is a process during which the academics represent “the other” to their audiences, and bring the voices of participants in their studies into their academic context. Ethnographic research has its circumstantiality and it is characterized by a double ventriloquism1 (Appadurai 1988). As Spivak convincingly argued, knowledge, including the ethnographic type, is never innocent, but represents the interests of its producers, who are embedded in particular discourses and imaginaries (1988). This text tells my own story—that of an anthropologist involved in an ethnographic study focused on children’s entanglements with psychiatrization, and using the methodology and the imaginarium of childhood studies. It is a story about the tensions and the attempts to overcome the impasses faced, while at the same time following the imperative of “giving voice” in this particular research project. It is a story about hesitation, multiplicity, and a search for an escape from a loophole of “the child problem” (Spyrou, Rosen, Cook 2019)2.

  • 3 This research was financed by the National Science Centre (Narodowe Centrum Nauki, NCN) in the FUGA (...)
  • 4 ADHD stands for Attention Deficit Hyperactivity Disorder. It is a psychiatric diagnostic category d (...)

2Between 2015-2018, I worked on an ethnographic project3 informed by the new childhood studies approach, in which I aimed to learn about the experiences of Polish children diagnosed with ADHD4. The project was meant as a sensitive ethnography documenting contemporary engagements of children with mental health services, psychiatric discourses and therapeutic practices. I was interested in the ways in which normalization of the psychiatric vernacular (Behrouzan 2016) has engendered new ways of knowing, interpreting and perceiving oneself and others in this particular local context—a middle-size Polish town, to which I gave the invented name Malden (Witeska-Młynarczyk 2019). This paper is an attempt to think honestly and reflexively about this ethnographic experience. It deals with children’s voices in ethnographic research, and with the poetics of their representation, in particular. It also presents my own efforts to listen to and to represent the voices of children concerned by ADHD, and to come to terms with the notion of “giving voice to children”.

3The “giving voice” project came as a post-positivist effort to highlight the power and authenticity of the voice of those who are excluded from the public space, or not represented. I believed that children with a psychiatric diagnosis, who are often understood as doubly incompetent, firstly due to their age, and secondly, due to their diagnosable non-normative behaviour (Liegghio 2016), and who are therefore silenced in adult society, constituted a group that was well suited for a “giving voice” project. Yet while in the field, I came to realize the inevitable tensions between what was expected (I wanted to reach out for critical and well—articulated voices) and what I actually experienced. Indeed, the voices I recorded were inconclusive, entangled and interdependent, and sometimes voice meant silence and withdrawal. In this text, I will focus on these and other strains that are involved in this type of study.

  • 5 I have written more about relational ethics in my work with children in an article Etyka dnia codzi (...)

4At the beginning of my research, I understood “the child’s voice as a matter of need, right and skill” (Komulainen 2007: 11). This implied that my research ethics focused on developing an attitude to get children to freely and openly express themselves (Dell Clark 2011), and to reduce adult authority in the research setting (Mandell 1988, Corsaro, Streek 1986, Mayall 2000). Yet, while in the field, I was constantly confronted with the social nature of human voice, its multi-vocality, ambiguity and situatedness (Komulainen 2007). This was particularly visible in the context of children’s words uttered in everyday situations—so diverse, interdependent and contextual. I observed the entanglement of voices in the complex network of relations, played out through social interactions embedded in often conflicting discourses (like medicalizing and de-medicalizing narratives) and conditioned by the material world of educational and health-related infrastructures, or by the new psychiatric and therapeutic technologies. This brought about change in my methodological and ethical orientation, characterized by a move towards the relational, the interconnected and the circumstantial (Ellis 2007; Joshi 2008; Meloni, Vanthuyne, Rousseau 2015; Witeska-Młynarczyk 2018)5, and moving towards an ethics in practice (Guillemin, Gilliam 2004). I will describe this change by referring to the ethnographic materials I gathered, and by engaging in discussions with other humanistic texts dealing with vulnerable children and voice.

Darek’s voice

5From the fieldnotes:

I started to attend the regular meetings of a therapeutic group for children with ADHD at one of the public psychological centres here in Malden. We meet once a week in the afternoon for 3 hours. There are eight boys aged nine to twelve who have been signed in by their parents. The psychologist and the pedagogue working in the centre prepare a scenario for each meeting. I am allowed to participate, and I am introduced to the boys as of one of the leaders, but in fact I did not design the program and my role is clearly auxiliary. […]
The boys could not wait for the meeting to be over. Darek, a very spirited and intelligent ten-year-old boy, who kept repeating throughout the session: “Why do I need to sit here? I do not want to be here”, runs to the door first, when the psychologist announces the end of the first meeting. The hallway is crowded with parents who, as it turns out from the small talk I have exchanged with the carers, felt anxious and curious about whether the group would function or not. Darek approached his mother
[his dad was standing next to her, but the words were directed to the mother—AWM] saying loudly and in an irritated tone: “It took us forty minutes to drive here! I could have spent this time with my dad playing football. It would be of more use to me. Why do you have to psychologize me all the time? I do not want to come here! Why do you think I need all those psychologists and psychiatrists?”

6My attention immediately focused on Darek. His ability to theorize about his lifeworld was remarkable from the point of view of an anthropologist who leans towards critical literature that advances the politicised notion of psychiatrization (Coppock, LeFrançois 2014). He was commenting on the unnecessary and oppressive type of care mistakenly phrased as being “in the best interest of the child” (Mills 2018a). I recognized a very vocal, critical and thoughtful voice of a boy, an expression of resistance to the bad forms of care organized by the adults.

The topic, the context, the research

  • 6 This americanization proceeds mainly through the dissemination of the Diagnostic Statistical Manual (...)
  • 7 The relative delay with which the discourse on ADHD became popular in Poland (1990s) points to its (...)

7ADHD is a psychiatric diagnostic category used worldwide in paedo-psychiatry. In the Polish context, the abbreviation ADHD started to permeate everyday language in the 1990s as a consequence of the growing awareness of this diagnostic label, in the context of expanding diagnostic opportunities that emerged in the Polish post-socialist landscape of mental healthcare, and with the globalization of expert systems. The country’s transition towards the neoliberal state model was characterized by rapid privatization, increased plurality, and the subsequent fragmentation and dispersion of state-financed and private services and entities available on the market and their transmission to the patient-client. The increased usage of the ADHD label by Polish professionals was interpreted in sociological literature as an Americanization of Polish psychiatry (Wróblewski 2018)6. Since the 1990s7, various actors, including pharmaceutical companies, patients’ organizations, psychiatrists, and the Polish ministries of health and education, have been engaged in promoting both the new psychiatric technologies and the ADHD-related knowledge on a lay level. Polish experts claim that 3-5% of Polish children suffer from ADHD (Kołakowski et al. 2015:30).

8Even though such universalistic estimates have been questioned in the literature (Mills 2018b; Timimi, Taylor 2004), the increase in the diagnoses and the usage of health-care services in Poland by children under the auspices of this diagnostic category remains unquestionable (Witeska-Młynarczyk 2019: 25).

9My research was designed as a multi-sited ethnography (Marcus 1995) in which I followed an object (i.e. ADHD understood as an object of knowledge and social practices) and also aimed to seize the opinion of children, because they were not represented publicly. In particular, I focused on the diagnostic paths and experiences of children who attended public schools. As Valerie Harwood and Julie Allan argued, “the current climate in education is one of acceptance and promotion of psychopathology as the default explanation of problems” (2014: 18-20; cf. Bendix, Millei 2016). During my research I observed how the discourse of special education was being permeated by the psychiatric vernacular (Witeska-Młynarczyk 2019). Hence, the study naturally attended to the growing involvement of non-medical personnel in diagnostic processes (families and schools) and the increasing significance of lay people (including children) in accomplishing, maintaining or obstructing the routine work of medicalization (Conrad, Bergey 2014; Malacrida 2004; Witeska-Młynarczyk 2020). This situatedness, added to the dispersion of medical knowledge and authority, the growing multiplicity of approaches to ADHD-like behaviors present in the field, and the frequent acts of contestation of the diagnosis, had consequences for the ways in which children’s voices were staged and understood in this research study.

  • 8 In this locality, the children were diagnosed mainly in the school context. The preliminary diagnos (...)

10During the fieldwork, I gathered the bulk of my material around a few focal boys who received ADHD diagnoses or were involved in diagnostic processes8. I worked more or less intensely with eleven children, aged six to thirteen. I conducted ethnographic work in the family environment and in educational, medical and counselling spaces. I relied on a mixed methodology depending on what was possible in each case, and ensuring that I gave priority to in-depth work based on these cases. Frequently, my work involved interviewing the carers (family members, teachers, school directors, psychologists, psychiatrists), spending time with the families, walking the kids to schools, conducting participant observation within the spaces of importance for the children, preparing various research tasks, or just talking to them. With four of the children and their families I worked closely in their homes. In six of the cases, I conducted participant observation in schools. With two groups of school children aged eight to nine, I ran my research in focus groups using participatory methods. I took part in a therapeutic group for children diagnosed with ADHD run by a public psychological centre, and visited educational meetings organized for parents and teachers by the same institution. I implemented childhood studies methods to work with both diagnosed and non-diagnosed children, using drawing, vignettes, small photo-projects and other tasks (Witeska-Młynarczyk 2019). In other words, apart from the work focused on eliciting the voices of children concerned with an experience of ADHD, I conducted extensive observational work focused on everyday interactions, and reached for other perspectives than those of the children with the diagnosis. This method of collecting ethnographic material gave me access to the multiple and often contradictory perspectives of the various actors involved, as well as allowing me to observe the processual form of psychiatric labelling embedded in both medical and non-medical contexts.

“The voice project” and psychiatrized children

  • 9 Dominique Béhague and Samuel Lézé argued that child-centric approaches have led to a reification of (...)
  • 10 I am a member of the Childhood Studies Interdisciplinary Research Team at the University of Warsaw (...)

11One of the real accomplishments of the new sociology of childhood has been to advance an understanding of children as active participants in the construction of their social worlds (c.f. Alanen 1988; James, Prout 1990). With the emergence of new childhood studies in the 1980s and 1990s, social researchers began to treat children as capable of representing themselves and their experiences, and started to focus on empowering young people as active research participants and eventually as researchers, treating the research situation as a possibility to engage children in a public debate on the themes that concern them. A project of “giving voice to children” pursued by academics and activists was inspired, among others, by the UN Convention on the Rights to the Child (1989), and it was shaped by the language of rights. It meant to promote the values of self-determination, freedom, democracy and care (James 2007: 261). Although there is criticism on projects that centre on children’s voices (Béhague, Lézé 2015)9, childhood studies scholars propose to consider that they do more than simply letting children speak—“it is about exploring the unique contribution to our understanding of and theorizing about the social world that children’s perspectives can provide” (James 2007: 262), and they urge that critical reflection should further advance this type of research. Overall, the increasing popularity of projects foregrounding children’s voices implied a willingness on the part of the researchers to take political action and to represent repressed and silenced voices in order to make the world more democratic and just, and to broadcast the authentic voices of those systematically unheard, who have suffered injustice or who were treated as immature and unable to speak for themselves until now (cf. James 1993, Alanen 1992). This applies to the group of academics I became a member of, who have been involved in projects that set discovering “children’s perspectives” and influencing the public debate as their priorities10.

  • 11 The authors propose the term “psychiatrized children” to signal that something has been done to the (...)
  • 12 A solid discussion on the topic of psychiatrization and children is provided in a paper “Psychiatri (...)

12This child-centred agenda has resulted in a large amount of empirical research in which we hear children from various cultural backgrounds speak about their lives and the things that matter to them (cf. Abbott 2013; Field 1995; Lee 2001; Mayall 1996; Krawczak, Maciejewska-Mroczek, Radkowska-Walkowicz 2018). However, some children continue to inhabit zones of cultural invisibility (Rosaldo 1988) and their voices remain hardly audible. Among these, psychiatrized childhoods11 constitute one such insufficiently researched area of social reality (LeFrançois, Coppock 2014)12. When I embarked upon my own research project on the experiences of children with ADHD in Poland, inspired by various participatory research conducted with children in other geographical locations (Coppock 2002; Harwood 2006; LeFrançois 2006; Liegghio 2016; Singh 2011), I felt an urge to advocate and to highlight the voices of children who were recognized as the beneficiaries of psychiatric care. I aimed to insist on their right to proper care as well as their right to being listened to when they do not want to be psychiatrized. I intended to see how these children engage in sense-making activities when having psychiatric vernacular as a resource. I also wanted to describe their position of being “silenced,” and provide them with the opportunity of a critical commentary. I imagined their voices would provide a sound critique of the present state of affairs.

13Yet, as argued by Webb Keane, “to speak in a singular or monologic voice appears to be the highly marked outcome of political effort rather than a natural or neutral condition” (1999:271). Similarly, Audre Lorde pointed out that the process during which silence might be transformed into language and action requires “the decision to define ourselves, name ourselves, and speak for ourselves, instead of being defined and spoken for by others” (Lorde 41). Such a voice is a politicized voice. In his seminal text, Albert Hirschman (1970) noted, in the context of organisational or institutional decline, that the members have the option either of an exit (a withdrawal) or of a voice (openly sharing their concerns with the aim of influencing reality). If the institution listens to the issues raised, there is a chance of avoiding failure. Both anthropology and childhood studies can serve as a technology of voice, bringing children’s voices forward into the public sphere. Research and its representations can turn into a political effort of speaking out, defining children’s position, thus providing an alternative to the exit strategy. The condition of Polish mental healthcare required the voice, and not the exit. My challenge was to truthfully construct the politicized voice of children. Yet their everyday voices turned out to be difficult to use as political voices.

The borderlands between academia and the public

  • 13 Here are a few examples of the articles that appeared in weekly magazines: “There is no day without (...)

14The public debate about the dramatic state of child and youth psychiatry in Poland commenced almost at the same time as my research activity, as the problems of access to healthcare and the social understanding of the importance of child and youth mental health began to be openly discussed in the media, taking up much coverage13. These representations foregrounded the voices of professionals—highlighting the problems caused by lack of funding, poor infrastructure, and overall structural deficiencies. They also included a particular depiction of contemporary young people (as fragile, non-resilient, unable to feel any appreciation for life, living fake relationships on the Internet), and of the state of their mental health (an epidemic of suicidal tendencies, a rise in diagnoses of child and adolescent depression, an increase in acts of self-harming) which all pointed to a deeper cultural crisis that younger generations are participating in. This portrayal made me even more focused on enabling the children to speak about their experiences, imagining that their voices could provide me with useful arguments and counter-points.

15The world I decided to research was in crisis. The children I met lived at the intersections of an unstable educational system (Sadura 2017), transforming family patterns (Sikorska 2019), in a sanist and ableist society in which the stigmatization of mental health problems was common place, and where the collapse of the institutionalized child and youth psychiatry was soon to become a fact (Witeska-Młynarczyk 2019). These were the “intermediary power formations”, also called “para-infrastructures” by João Biehl and Ramah McKay (Biehl, McKay 2012)—the precarious and unreliable therapeutic policies and the institutionalized solutions within which children experience themselves. These not only constituted a challenge for “the ambiguous political subjectivities that crystalize” but they also formed “new ethnographic quandaries” in the research situation (Biehl, McKay 2012:1210).

16While following discussions in the media and progressing with the fieldwork, I was observing the beginning of the transformation of Polish psychiatry, which, through the actions of the people gathered around the Mental Health Congress (Kongres Zdrowia Psychicznego)14 among others things, was moving towards the deinstitutionalization of care, a trend that has recently arrived from Western Europe. However, the steps that were being taken were not yet felt by the boys whom I met. The new community-based mental health centres for children and youths were in an experimental phase and these experiments were not taking place at the peripheral Malden where I was conducting my research. In the emergent debates there was no discourse on children’s rights, nor any readiness to listen to what children had to say.

  • 15 The examples of awareness campaigns are: ADHD—the world is not enough (ADHD świat to za mało), Face (...)
  • 16 See for example Illina Singh’s work on ADHD and Ritalin in which children’s voices are used to advo (...)

17With this research, I therefore found myself at a particular historical moment, in which distrust towards the institution of psychiatry and psychiatric labelling within Polish society was very high, while at the same time sanism and ableism were an everyday experience for the people struggling with the stigmatization of various manifestations of psychological distress. The political voice that demanded proper reform was in fact coming from within psychiatry itself, from patients’ groups, even though many took the exit path. The people who engaged in the struggle for deinstitutionalization and for more humane forms of mental health care did not use the anti-psychiatric narrative. They focused on dialoguing and cooperating with the professionals. Their discussion evolved around adult experiences. By a joint effort of patients and professionals, a few public awareness campaigns15 were also launched with the aim of destigmatizing mental illness, but also with the intention to raise awareness. In such circumstances, I began to ask myself whose interest would be served by the ethnographic act of presenting the anti-psychiatric voices of children. I started to think that the “giving voice project” was moving in the direction of an anti-psychiatric narrative, which might strengthen the distrust towards the professionals involved in the reform of mental health care. I also felt that it may increase the parental state of anxiety which came as a response to a number of contradictory voices already present in the media and on the market, while it would not influence rigid educational and social settings. On the other hand, the voice advocating psychiatric interventions16 would leave issues like over-medicalization, or the unreasonable usage of psychiatric drugs as the first line therapy in children with ADHD, or the child’s position in a diagnostic process and in a medical consultation without any critical commentary.

18As recognized by Rachel Rosen and Catherine Twamley, on a journey through “the borderland between academia and ‘publics’” (Rosen, Twamley 2018: 4) a researcher is faced with questions—“For whom and what for am I generating knowledge?”, and, eventually, “How to create ‘a world-changing knowledge’?” (c.f. Burawoy 2005). I hoped to produce such knowledge, yet the world I was participating in and observing was very tangled and ambiguous. The tensions resulting from my situatedness, i.e. the anti-psychiatric and critical academic literature that was my starting point, as well as the childhood studies calling for realizing children’s rights through research were becoming uncomfortable. I also felt strained by the three year funding this grant had obtained. Coming to terms with all the challenges this work implied, both in terms of recognizing my own stance, but also realizing what was ethical and truthful to the field, required an amount of time which I did not have.

Ethnography and childhood studies as a technology of voice

19Allison James notices that anthropology is “uniquely positioned to contribute” to the project of giving voice to children (James 2007: 262), partially as the science of “the other” and because of its commitment to the underprivileged, but also as a discipline within which the discussion about representation and voice has already taken place in the 1980s (Clifford and Marcus 1986). Inviting “the giving voice” agenda of childhood studies to ethnographic research meant brining tension along with a certain technology of voice and an approach to voice. The methodology of extracting children’s voices can be recognized as a historically situated and politically conditioned genre that mediates children’s utterances and delineates the process of turning sound into meaning (Kunreuther 2006: 327) and, eventually, into publically available representations. However, the ethnographic technology of voice is not itself unitary, and it is certainly not identical to the equally multiple technologies of voice that emerge from within childhood studies—ranging from participatory/applied and more observational/descriptive works. As James, Hockey and Dawson argued—“different styles of representation reflect or help constitute particular theoretical stances towards the problem of representation itself” (1997: 3). With a legacy of a reflexive turn on my anthropological shoulders, I kept asking myself, how would I represent children’s voices in this research? How could I take Darek’s “Why do you have to psychologize me all the time?” as a straightforward expression of a liberal and critical subject? How would such an approach be useful for the ongoing debate concerning the crisis of paedopsychiatry, and in fact, a much broader crisis of para-infrastructures responsible for providing care to children in Poland?

  • 17 This unresponsiveness shall also be read as an active strategy, a voice.

20Gradually, while conducting the research, I also started to feel uncomfortable with the moral imperative that made me expect the children to be vocal. I felt a need to counterbalance, in an ethnographic practice, a liberal discourse of ‘voice’ associating it with political participation, consciousness, and agency (Schäfers 2017: 10). It has recently been argued in childhood studies literature that “the thrust of approach and conception continues to favour singular—if socially, culturally, and historically embedded—subjects who display, or must be allowed to display, creativity and active engagement of the world in the here-and-now” (Spyrou, Rosen, Cook 2019: 3). Yet, while in the field, I encountered many children who were passive and not interested in the possibility of speaking for themselves within the framework of this research project. The children often felt unresponsive, bored, impatient or uncertain (Witeska-Młynarczyk 2019)17. At the beginning I thought that, as a novice to childhood studies’ methodology, these attitudes were a sign of my lack of expertise. However, with time I realized that these vaguely political everyday voices were telling me stories not so much about my competence but about their social positions. The attitudes I faced showed me that the project of “giving voice to children” is not of interest to every child we meet in the field. It has become our expectation of childrento have things to say, to be vocal, to take their chances, to stand up for their rights and to act accordingly. However, it also became clear that the more lucid the children’s voices became in my representation, the less my ethnographic work would reflect the children’s reality, since children were apparently not very prone to utter their politicized, independent voices other than in the politics of their everyday lives.

  • 18 It may be of relevance here that the children I worked with grew up in lower middle-class and worki (...)

21As noticed in contemporary literature on the topic, the efforts of ‘raising their voices’, and the imperative of ‘having voice’ concerning issues that involve you, or to be ‘vocal’ in expressing one’s opinions—these are idioms that stem from Western language ideology that associates voice with individuality, agency, and authority (Schäfers 2017). These notions became an element in the circumstantiality of my research, an imperative with which I commenced the project, yet, apart from Darek’s performative utterance, I saw very few utterances of unequivocal children’s voices18. In my ethnographic experience, I encountered messiness and interconnectedness, as opposed to a critical and monologic perspective of psychiatrized children. Hence, I started to look more carefully into questions already posed by others: How and from where were children’s voices and experiences emerging (Gallacher, Gallagher 2008), and is it always productive to position children’s voices in a framework of choice, creativity, freedom, and transparency? The questions “What kind of child do we chose to bring into light? What kinds of inclusions and what kinds of exclusions result from our choices?” (Spyrou, Rosen, Cook 2019: 6) and “Does it, in the specific context and debate, serve the interests of children to present them as having a distinct perspective?” (Spyrou 2011: 161) can also be raised, and we can also question the routine practices which constitute a child as an agent, and the significance of the kinds of frames for interactions that are prevalent in the everyday life of children (Komulainen 2007: 18). I therefore gradually reshaped my focus and turned my attention to the contradictions, tensions, “para-infrastructures”, multiplicities of voices and their instability, and the processes of becoming a child with a diagnosis, rather than on enabling a strong critical voice of children who resist the “oppressive” adult carers, or who are being “rescued by the new psychiatric technologies”.

22Martha Feldman notices that “voice is at its most characteristic when it sounds” (2015: 658). This position directs our attention towards the materiality of voice, which can be recorded, extracted and exploited for (academic) purposes and for bigger political aims, as well as play a role in the politics of everyday life. When voice is being observed in social practice, as opposed to being extracted and quoted in texts, there are particular features that come to the forefront—its relationality, its situatedness at the boundaries, or the escape from the unitary (Feldman 2015). These features of voice may result from the fact that voices emerge from within the everyday forms of sociality (Ochs, Capps 2001). Voices exist within the actual multiplicity of voices (Appadurai 1988), and are characterized by heteroglossia (Bakhtin 1994/1935), since they emerge from within specific institutional and historical contexts (Spyrou 2011: 155). Moreover, following Webb Keane’s discussion on voice, my position coheres with his argument that “speakers are not unified entities, and their words are not transparent expressions of subjective experience” (Keane 1999: 271). As subjectivity does not

[…] merely speak as resistance nor it is simply spoken (or silenced) by POWER. It continually FORMS and RETURNS in the complex play of BODILY, LINGUISTIC, POLITICAL and PSYCHOLOGICAL dimensions of human experience, WITHIN and AGAINST new infrastructures and the AFFLICTIONS and INJUSTICES OF THE PRESENT (Biehl, Moran-Thomas 2009: 270).

23Hence, in this paper, I aim to question the possibility of children’s voice understood as a pure representation of truth and intent (Jackson, Mazzei 2009). Yet, instead of abandoning voice as a working category, I propose a reflection on its nature and on what makes it a troublesome but also resource-rich research material. I do not offer children’s voices for the sake of public debate, but instead, I attend to the micro-politics of everyday life and the ways in which children act (also through silences) co-creating the world of psychiatric practices from an underprivileged position. I also suggest that ethnographers may find themselves in a situation of choice. Guided by my ethnographic experience, and instead of recording and representing a unitary and politically loaded voice, I chose to entangle myself in the doing, “in the layers of voices” including my own epistemological assumptions that have shaped my methodological and ethical choices (Jackson, Mazzei 2009: 19). Hence, what I have been presenting here is a story of an ethnographer who gave up on a craving for a politically loaded voice of children and a method of militant anthropology, and instead adopted an approach towards describing the knots and the conditionings, thus realizing what Patti Lather has called a “less comfortable social science” that “stays close to the complexities and contradictions of existence” (Lather 2007: 152).

Not the “super-agents”

24As Jean Hunleth (2019) puts it:

We have a mantra in childhood studies: children have agency. We repeat this mantra because children’s agency has been ignored for so long in ethnographic research. […] An overemphasis on children’s agencyunderstood as the active roles children take in the worldinvites us to overstate children’s power, understate their vulnerability, insufficiently problematize the constraints placed on children […]. Children are, in fact, agents, but not the “super agents” […].

25There, at the hallway of the psychological centre, to me Darek seemed like he possessed the characteristics of a super-agent. He was clear about his opinions, and he stated them openly. His utterances had an effect on reality. They puzzled his parents and drew the attention of other people too. They immediately drew my attention and made me think of him as an ideal candidate for a closer ethnographic study in which I could enable him, relying on the participatory research methods, to give me a coherent story, a critical perspective which I could then represent in my book. Yet, the sound of irritated voice was articulated in a specific social situation. There were other people present, overhearing the exchange between the boy and his parents, and there was a history of previous encountersthe psychologist and the pedagogue diagnosed the boy in a long diagnostic process and repeatedly consulted his parents. These professionals were now looking at the exchange between the boy and the parents and they probably felt some discontent (later during the day they explained to me how they disapproved the amount of authority this boy held in the family). There were Darek’s parents who had an influence upon the interlocutory power of his words and their eventual extraction and translation. There were other boys present, there was the story of their recent encounter with each other, and there were many other elements that determined the way in which Darek’s words were uttered and how they acted upon reality.

The silences and the complexities

  • 19 Though it was only partially true in Darek’s case.
  • 20 The adult bias implies that, as a political strategy, the adults maintain limited knowledge about c (...)

26One of the social conditions influencing what the children whom I met in the research were saying was adultism, sanism and shame19. The parents of children with diagnoses whom I met in the field hardly ever communicated with their children about ADHD in a straightforward way. They did not try to build children’s competences by expanding their knowledge and by generating a positive understanding of the diagnosis. They did not attend to the idea of children’s rights to learn about their diagnosis and to express their opinion. In such families, an adult bias20 (Waksler 2012) as well as half-truths resulting from a fear of stigma were visibly present (Witeska-Młynarczyk 2017). The adult-bias and inattentiveness to children’s rights to information and participation in the decision-making process was also manifested by some of the medical professionals and teachers. Such an attitude could imply: lowering the voice, when speaking about ADHD or about a child in his presence, treating a child as if they were not there, making direct commentaries while the child was present and not reacting to his/her questions, wanting to decide for the child, asking the researcher not to talk about ADHD with children, not telling children explicitly that the therapeutic group they were attending was for the children with such a diagnosis, not realizing the need to talk to the parents about the ways in which they could explain the diagnosis and its consequences to their children.

27The more I spent time with children who were not as vocal as Darek, the more I thought about the division between voice and silence as being “[…] perhaps more elusive than it seems—not all voices are heard, and perhaps the most intrusive and compelling are the unheard voices, and the most deafening thing can be silence” (Dolar 2006:4). Looking more carefully at what was less vocal, I felt that “the overwhelming preoccupation with children’s agency guides researchers to focus on the creative, innovative and productive capacities of children (as evidenced through their voices) at the expense of investigating social and cultural reproduction” (Spyrou 2011:159). I also reflected upon Nick Watson’s complaint about how infrequently researchers attend to the emergence of children’s experience from within social settings (2012), as well as Hayley Davies’ (2008) and David Abbott’s (2013) observations that researchers often ignore the fact that disabled children, as well as healthy children, are a part of families (and other social settings), while participatory research presents children as independent and separate beings.

28One of the obstacles in my research were the difference in the auspices of “giving voice to children” that I was using in my work when compared to those under which children were speaking out in their everyday lives (Gubrium, Holstein 1998: 164), as they emerged from within a conflictual field permeated by sanism and adultism, in which various discourses and values clashed, producing tensions which remained unresolved and which produced difficult emotions blocking children’s motivation to speak.

The multiplicity of voices

29Still, the other reason why my ethnographic story did not become coherent was the multiplicity of voices I encountered. In fact, the children’s voices recorded and observed during this research were very diverse. Sometimes resistance was not stated as openly as in Darek’s case, but came about in small narrative passages about past diagnostic events, like this one–a story of the EEG examination, being a part of an ADHD patchwork diagnosis (see Gardner et al. 2011) of a 10-years-old boy:

Golden Wolf: There was something like, some very strange suckers. At first they poured some acetum on my head, just onto some spots and later those strange suckers. And I was afraid that they were singling out what I was thinking. I was thinking not to think and I was thinking about everything.

30Or a commentary that is less direct but more heavily loaded affectively, co-authored by two boys attending group therapy for children with ADHD diagnosis in a local public psychological centre:

Myself: So you both have ADHD? How do you know it?
Daniel (10 years old): [laughing]
Miron (10 years old): My mum told me [in a sad voice].
Myself: Did your mother tell you? Do you remember this conversation?
Miron: I do not.
Daniel: I was in the car with my mum recently. She wanted to sign me in [for this group], so she told me.
Miron: Sonny, you have ADHD [in a howling voice meant to imitate the mother], so, stop working, cause I do not want you!

31However, there were also less critical voices, like when in a one-to-one conversation with me about the “finish the sentence” exercise, eight-year-old Kamil with ADHD diagnosis positively commented on pharmacotherapy:

Myself: The ADHD drugs are
Kamil:
Good, they help.
Myself:
When I take them, I feel
Kamil:
Very well.

  • 21 These conversations took place with two or three children pointed out by the teacher as friends or (...)

32My impression of the multiplicity of children’s voices was strengthened when I talked with children who were attending a class together with a boy who had an ADHD diagnosis21. The fragment of the conversation cited below was recorded when the children were completing a task of explaining or writing down some free associations of ailments that were printed out on a piece of paper. ADHD was listed among diabetes, allergy and dyslexia. When children read “ADHD” they started a vivid exchange:

Bob: John has it!
Martha:
It is someone, simply sick and –
Bob:
Coocoo.
Martha:
He behaves like a loony and he takes medication.
Bob:
He is sick in his brain.
Maria:
Moreover, he fools around.
Martha:
And he hits people.
Maria:
He hits people.
Bob:
Someone is sick in his brain from birth and it cannot be cured.

33This clearly discriminatory exchange is an example of the deep entanglement of children with adultist and sanist society. After hearing these voices, I was forced to turn to the social conditions from which they had emerged. I turned the question around in order to ask “who was speaking”? The project of “giving voice to children” had been stood on its head and I felt more confident about turning to nuanced anthropological ways of conceptualizing children’s voices and representing them in a form of ethnography. Such words felt inconvenient for me, because they stood in a sharp contrast to my own values—that of inclusiveness, tolerance and empathy. They did not sit comfortably in the “giving voice” project.

Conclusion

34The literature devoted to children, youth and mental health actually forks out in two directions. On the one hand it records children’s voices to criticize the oppressive psychiatrization and to illustrate how children’s rights are being violated (Le François 2006, Liegghio 2016). On the other hand, it exposes children in a way that proves the positive effects of pharmacotherapy, the agentive power of children who have the diagnosis, and both the constructive and negative effects of psychiatric labelling, thus allowing a depiction of psychiatric practices as the implementation of children’s right to health (Singh 2011). Fewer works bring to the light the grey zones (Béhague 2018; Behrouzan 2016; Beeker et al. in print), the processes, the ways in which the new clinical-scientific projects are actually being co-constituted in the multi-directional relationships between the clinic, the science, and everyday life (Béhague 2018; Jasanoff 2012), and eventually, how children can take quite complex attitudes towards the practices of psychiatrization, and how this can strengthen and weaken them at the same time (Jenkins 2015; Beeker et al. in print).

35In the end, my research did not provide with the auspices under which Darek could tell his story. I did not provide him with the resources to build up a coherent narrative which could than serve me as a vehicle for criticizing the upscaling practices of biopsychiatry, and this was not entirely my choice either. Even though the family (including Darek) agreed that I would participate in the group therapy, making notes out of these meetings and using them in my ethnography, they did not proceed with separate meetings to allow me to work with their child separately. In fact, the boy left the therapeutic group after a few meetings.

36Martha Feldman argued that:

[…] voice is nothing if not relational, always situated at boundaries. […] voice swerves toward such nonrepresentable and fully relational domains as meaning, affect, value, and identity—domains that are always contingent and heavily dependent upon social relationships (Feldman 2015: 658).

37The interlocutory power of Darek’s utterances from the hallway, and the possibility of turning it into a politicized voice represented through ethnography, did depend upon many social relationships—Darek’s relationship with his parents, his mother and father’s relationship, the one between his parents with the professionals working in the psychological centre, and Darek’s relationship with the children and the professionals taking part in the group therapy. In a short conversation with his mother, I could see how she struggled between creating a space for her child to speak up and “setting the limits”—a language proposed by the psychologist who was there in the hallway, and whose presence meant the mother could have felt judged for the progress she was making in building her authority vis-à-vis Darek. As I understood later, this relationship between the parents (mainly the mother) and the specialists from the centre had a significant influence upon me not being able to develop a research relationship with this family. The specialists were strongly opposed to the parents’ idea of withdrawing Darek from his regular educational routine in order to apply for home education. The parents did not communicate their decision openly towards the professionals. They withdrew the boy from the group therapy and stopped the consultations. Did Darek partially mimic his parents’ stand when talking about “psychologizing”? The parents clearly lingered towards a more democratic upbringing and were ready to disconnect Darek from the psychological centre and the therapeutic interventions it offered. Was his voice partially articulating the parental hesitation and their socio-political position?

38Similarly to Sirkka Komulainen, I gradually “had to come to terms with the fact that I was not representing the voices of either children or adult actors in the settings; instead I ended up deconstructing the notion of ‘voice’ altogether” (2007: 21). I aligned with other works in the field of childhood studies that critically rethink concepts of voice and agency and which call for approaching childhood and children’s voices within wider contexts of interdependence (Meloni, Vanthuyne, Rousseau 2015; Spyrou, Rosen, Cook 2019). When we conceptualize children and their voices as relational and contextual, we come to understand ethics as a performative, intersubjective and reflexive dialogue, “relative to different modes of belonging” (Meloni, Vanthuyne, Rousseau 2015: 108). In this imaginary, our ethnographic research becomes an element of the complex social landscape in which children can become entangled. The way children’s voices will be approached and represented is an issue requiring careful consideration and deserving an honest discussion.

  • 22 At the beginning of 2019, I published an ethnography presenting my research titled “Children’s expe (...)

39An ethnographic story emerges from an intentional effort, and implies attentiveness and the purposeful action of interpreting and representing by using particular instruments (e.g. participant observation) and genres. “The risk of speaking up” in fact means “a risk that adheres to the radical contingency of action” (Kottman 2005: xxv). This risk belongs to the ethnographer, who is obliged to contemplate the larger framework and the consequences of representing children’s voices, especially when a researcher engages in projects that foreground children who speak up about such sensitive issues as publically debated mental health. Where the desire for societal change and the enhancement of psychiatrized children’s rights bristle, there follows a focus on the politically charged voice, and the research becomes a moral project. Yet, children’s needs and rights and their articulations are also social constructs (Komulainen 2017: 21). In this research project, I found it more ethnographically truthful to approach children’s voices as processes rather than locations, and as something that does not exist in isolation, and that should not be disembodied from its interactional contexts (Komulainen 2007: 23-24). If my ethnographic representation22 lost in clarity and political force, it nonetheless aspired to give an account of a reality that was filled with nuance and less obvious elements.

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Notes

1 When anthropologists “speak for children” or show “the native’s point of view”, it is worth underlining that, while creating ethnographic work it is most often the anthropologists who assume the final editorial position (James 2007). Additionally, we are not a transparent medium for children’s voices, because the way we hear these voices is already conditioned by our cultural backgrounds and expectations that come as a consequence of our positionality (Appadurai 1988).

2 I would like to thank the anonymous reviewers for their invaluable comments.

3 This research was financed by the National Science Centre (Narodowe Centrum Nauki, NCN) in the FUGA scheme (grant number: 2015/16/S/HS3/00150).

4 ADHD stands for Attention Deficit Hyperactivity Disorder. It is a psychiatric diagnostic category described in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and it is used by psychiatrists worldwide, mainly in paedopsychiatry, but also increasingly to diagnose adults. ADHD is a symptoms-based diagnosis focused on a triad of persistent behaviors including hyperactivity, inattention and impulsivity. The diagnostic category is also included in the International Classification of Diseases (ICD) under the name Hyperkinetic Disorder.

5 I have written more about relational ethics in my work with children in an article Etyka dnia codziennego w badaniach etnograficznych z dziećmi z diagnozą ADHD. Opis warstwowy (2018).

6 This americanization proceeds mainly through the dissemination of the Diagnostic Statistical Manual (2013) and various psychiatric diagnositc tools based on this classification (Wróblewski 2018).

7 The relative delay with which the discourse on ADHD became popular in Poland (1990s) points to its peripheral position on the map of global mental health (Mills 2014, Witeska-Młynarczyk 2019). However, calling Poland the periphery of the global mental health seems not sufficiently nuanced. I prefer to use the term “global-middle” as understood by József Borocz (2016)—i.e. as the societies whose living standards are clustered around the world mean per capita income but which are often absent from global conversations.

8 In this locality, the children were diagnosed mainly in the school context. The preliminary diagnostic practices were undertaken by teachers, pedagogues, and psychologists working in schools. The families were then referred to the public psychological centre legally responsible for diagnosing the pupils of the same school. The specialists working there would refer the parents to the psychiatrist when necessary, and, in particular, when they saw a need to use medication. The schools were supposed to consider the diagnoses issued both by the psychiatrist and by the psychological centre. An ADHD diagnosis normally implied a recommendation written for school in which the specialists stated a behavioural plan for a particular child. No teaching or class support was possible for an ADHD child under the then obligatory legislation.

9 Dominique Béhague and Samuel Lézé argued that child-centric approaches have led to a reification of the child/adult distinction that mimics universalizing and developmentalist assumptions, and obscures the ontological variability of the very materiality of children’s developmental processes (Béhague, Lézé 2015: 250).

10 I am a member of the Childhood Studies Interdisciplinary Research Team at the University of Warsaw whose members have conducted research projects enabling children’s voices on such themes as in vitro, health, obesity, Turner syndrome or adoption.

11 The authors propose the term “psychiatrized children” to signal that something has been done to these children and that their distress is not simply a natural inner part of themselves. Moreover, LeFrançois and Coppock want to politicize the assumptions relating to children with psychiatric disorders, and undermine the binary of the healthy/ill child that is a part of biomedical psychiatry and a fundamental element of sanist discourse (2014). Compare the term “psychotropic childhoods” used by China Mills (2018b).

12 A solid discussion on the topic of psychiatrization and children is provided in a paper “Psychiatrization of, with and by children: drawing a complex picture” (Beeker, Witeska-Młynarczyk, Meerman, Mills 2020).

13 Here are a few examples of the articles that appeared in weekly magazines: “There is no day without a suicide attempt. Why do children not want to live?” (2019), “Is pediatric psychiatry about to take a turn? It has passed it. It has just fallen into the abyss” (2018), “The mental health of our youth has never been so bad. Our fragile children” (2018).

14 More details about Kongres Zdrowia Psychicznego are available on <https://kongreszp.org.pl/our-mission-story/>.

15 The examples of awareness campaigns are: ADHD—the world is not enough (ADHD świat to za mało), Faces of Depression (Twarze Depresji) or You Can Go Mad (Można Zwariować)—which was announced at the II Kongres Zdrowia Psychicznego and which will set off in the autumn of 2019.

16 See for example Illina Singh’s work on ADHD and Ritalin in which children’s voices are used to advocate the use of medication (2012).

17 This unresponsiveness shall also be read as an active strategy, a voice.

18 It may be of relevance here that the children I worked with grew up in lower middle-class and working-class families, and some in families who were living off social benefits. They lived in a middle-sized Polish town and they attended public schools.

19 Though it was only partially true in Darek’s case.

20 The adult bias implies that, as a political strategy, the adults maintain limited knowledge about children and they do not seek their opinions. This enables them to act as they routinely do towards children, carrying out adult plans and projects in which children are included, though not necessarily as willing participants (Waksler 2012: 217).

21 These conversations took place with two or three children pointed out by the teacher as friends or as children who get along.

22 At the beginning of 2019, I published an ethnography presenting my research titled “Children’s experiences of ADHD. An ethnography of a contested diagnostic category”. It consisted of two volumes. One was a thicker book meant for adults—mainly academics but also for the parents and the people professionally involved in supporting children. The second volume was thinner and I wrote it for children—in particular for those who took part in the research, but not only them. The book was conceived as a text that would be accessible to children, explaining my research and presenting my conclusions including diverse voices and perspectives and my attempts to explain what enabled them. The idea of publishing ethnographies and edited volumes presenting anthropological works concerned with children’s lives in a double format (for adults and for children), came up within the Childhood Studies Interdisciplinary Research Team (of which I am a part), when we considered bringing to life a new series of books titled “children/borders/ethnographies” (in Polish: dzieci/granice/etnografie). Apart from my book on ADHD (2019), thus far two books have appeared in this double format—Children and Health. Introduction to Childhood Studies (2018) and Turner syndrome. Voices and experiences (2019). For more information on the team, the ongoing research and the book series, please visit our website: <http://www.childhoods.uw.edu.pl>.

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Anna Witeska-Młynarczyk, « Can the Children Speak? »Revue des sciences sociales, 63 | 2020, 46-57.

Référence électronique

Anna Witeska-Młynarczyk, « Can the Children Speak? »Revue des sciences sociales [En ligne], 63 | 2020, mis en ligne le 15 juin 2020, consulté le 10 juillet 2020. URL : http://journals.openedition.org/revss/4902; DOI: https://doi.org/10.4000/revss.4902

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Auteur

Anna Witeska-Młynarczyk

Institute of Ethnology and Cultural Anthropology, University of Warsaw
Interdisciplinary Childhood Research Team
a.witeska-mlyn[at]uw.edu.pl

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Revue des sciences sociales

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