I’ve had a lot of lives, one of the advantages of not dying. In addition to being a disk jockey, an improv actor/director, school principal and drunk, I’ve also been a special-education director. Going through some files the other day, I came upon the following essay, written during that period, on the challenges of diagnosing students with emotional and behavioral disorders, what used to be called emotional handicaps by special educators and out-of-control pains in the ass by many teachers. I share it now, not because I think it has great insight, but because I don’t think things have changed much since I wrote it.

“Terror is the given of the place.”  So Joan Didion began Salvador, but it might also serve as an introduction to the world of the chronically mentally ill.  Although our culture has glamorized mental illness over the years, in such books and films as One Flew Over the Cuckoo’s Nest, King of Hearts, A Beautiful Mind and Harold and Maude, the reality is much grayer, starker and more frightening.

Likewise, such psychologists as R.D. Laing and Thomas Szasz theorized mental illness out of existence, declaring what we call “insanity” a sane reaction to an insane world.  Unfortunately, this panglossian view does not match reality.  Instead, we must look to the harsh day-to-day existence of Susan Sheehan’s Sylvia Frumpkin (in the non-fiction masterpiece Is There No Place on Earth for Me?), with her repeated suicide attempts, her ever-unsuccessful stays in group homes and her complete lack of social skills, nay, her mastery of anti-social skills.  Sylvia’s life in and out of various psychiatric institutions is a far cry from Ken Kesey’s fictional McMurphy and the other lovable lunatics of Cuckoo’s Nest.  Likewise, Mark Vonnegut’s classic memoir, The Eden Express, presents a realistic and unflinching report of his experience with schizophrenia.  Although Vonnegut’s acute psychosis has passed, and he became a successful pediatrician, the reality of his struggle with reality lingers and horrifies.

While we glorify a type of mental illness in the abstract and on celluloid, we demonize those who suffer from the real thing in the here and now.  The deinstitutionalization movement, despite its theoretical and philosophical moral strength, unleashed thousands of folks with mental illness literally onto the streets, so that many Americans’ most vivid experience of serious mental illness is the vacant-eyed stare of the crone digging through a dumpster.

Certainly not all children identified as emotionally disturbed or behavior disordered are mentally ill; still, children and young adults with mental illness, whether schizophrenia, bipolar disorder or other major illnesses are so identified.  Because of this, clinicians and educators must take great care in recommending this label for students with emotional problems which interfere with learning.  One could, in fact, make a case that the label “emotionally disturbed/behavior disordered” is the most stigmatizing educationally handicapping condition.  Even mental retardation seems to have shed its once-prevalent connection with sexual deviancy and potential violence and has been, quite rightly, sanitized through the use of less judgmental labels such as “developmentally disabled” and “cognitively impaired” and through the example, for instance of Sean Penn’s character in I am Sam.  Realistic and chronic mental illness, contrariwise, has no such poster boy.  Because of the potentially negative power of this label, then, it should be applied only as a last resort, after all possible attempts have been made to provide academic and extra-academic support.  While this process should, of course, be used in the identification of all disabilities, it may be nowhere so important as with the emotionally disturbed/behavior disordered population.

One of the major difficulties with this label is its very broadness, including five separate characteristics.  Because of the scope of this disability, it encompasses the socially isolated child, the depressed child, the school-phobic child and the actively psychotic child.  While it is true, for instance, that the category “cognitively impaired” includes both the child who is identified as moderately intellectually and developmentally disabled, with an IQ of 60, and the profoundly intellectually-disabled child whose IQ is for all practical purposes unmeasurable, the continuum in that disability seems, at least in most teacher’s perception, more clearly demarcated.  That is, teachers may be reassured by the apparent objectivity of the IQ scores used as signposts in identifying the degree of intellectual disability; the apparent subjectivity of clinical interviews and projective testing done by psychologists may not offer the same clarity and confidence to a teacher.

Along with the caveat that the emotionally disturbed/behaviorally disordered label is potentially stigmatizing comes the dictum that the net not be set too widely in searching for such students.  That is, too often in education the belief and practice is that diagnosis must precede remediation, that diagnosis is in fact transcendent over the immanence of remediation.  This view, drawn from the clinic, does not always serve the child well, particularly in cases where remediation can conceivably be offered sans diagnosis (e.g., a student can regularly see a school psychologist or outside therapist without being formally identified as emotionally disturbed/behaviorally disordered) or, more chillingly, if no known remediation exists (e.g., the child whose psychosis does not respond to medications).

Likewise, the special education team must ensure that its judgements are culturally and racially as value-free as possible:  oddness does not equal illness.  Whether examining the inner-city African-American child, whose experience with justice and violence may make his world-view strikingly different from the examiner’s and other team members, or working with a child of members of an exotic snake-handling Christian sect, special education teams and psychologists must try to distance themselves from their own values and determine rationally the best interests of the child and whether these interests are served by coding the student or whether the necessary remediation can be offered without a formal diagnosis.

In summary, in looking at the theoretical, psychological and social issues involved in the detection of children with emotional disturbances/behavioral disorders, one must always be aware of the potential stigma attached to this label and its effects both in and out of the classroom on a child’s growth toward adulthood.  Along with this, one must consider the possibility, even the likelihood, of a self-fulfilling prophecy; teachers told that a student is emotionally disturbed may, consciously or unconsciously, expect inappropriate or even bizarre behavior and through their very expectation, help to bring about the behavior and attitudes they fear.