By Harold S. Koplewicz, M.D., Anita Gurian PH.D., and Kimberly Williams, PSY.D.
The country music star Wynonna Judd amassed a fortune and squandered much of it, throwing money at her children out of guilt for missing hockey practices and buying more cars than she could ever drive. Having grown up poor in Appalachia, Ms. Judd said she found herself with everything and nothing at all.
Ms. Judd s remark epitomizes the no-win situation in which many American families have found themselves victims of the all-consuming affliction, a condition known as affluenza. Affluenza is an apt metaphorical term suggesting an illness that occurs when people view the acquisition of material goods as a measure of their worth. Affluenza is considered a serious, chronic, societal problem, akin to an epidemic. Affluence is a relative term. Typically, society reserves the terms affluence or privileged for the top 1% of the population, earning a total net worth exceeding 1 million dollars.
However, it is rapidly becoming apparent that middle to upper income households, with high-achieving, hard working, and or two-income families are also experiencing the pains of affluenza, even without the seven-figure salaries. Providing for ones family is part of the American dream, and indisputably, money represents opportunity and choice. Many affluent parents raise their children to benefit from these privileges, thus enabling them to grow up with a sense of confidence and to gain satisfaction from their relationships and accomplishments. However, when money and its pursuit become paramount, parental debt and overwork can result. Children's motivation to learn and explore diminishes because of easy access to material things, overindulgence, and a sense of entitlement. Within some families, day-to-day problem solving becomes difficult, and psychological distress emerges.
Given the social benefits of affluence, it is not surprising that many resources have been directed toward prevention and treatment services for disadvantaged youth. In fact, the research overwhelmingly supports the environmental, social, and behavioral challenges linked to underprivileged individuals and communities. However, the research is scarce regarding a newly identified high-risk group. As pointed out by Dr. Suniya Luthar, a professor of clinical and developmental psychology at Columbia University, children living in affluent families have shown an increase in problems such as substance abuse, anxiety, and depression. Luthar attributes these difficulties to two primary causes: the isolation from parents, both physical and emotional; and excessive pressure to achieve at academic and extracurricular pursuits. The obvious advantages of privilege obscure the fact that there is a possible threat to the psychological well-being of pressured but neglected children and adolescents.
A CHILD'S RESPONSE TO ISOLATION AND PRESSURE
Undoubtedly, parents of all socioeconomic status work hard to provide for their families. However, parents who are driven to excel professionally are home less often. Findings indicate that the higher the social economic standing, the less time parents spend with their children because of working early and later hours, weekends, and excessive travel. When families are together, communication tends to be superficial because each member remains focused on work; tuned in to their own computers, personal data assistants, iPods, and other personal technology; and unprepared to participate in meaningful dialogue. Successful parents also expect certain levels of success and achievement from their children. Parental pressure on children to succeed by making excellent grades, excelling in extracurricular activities, and gaining admission to stellar colleges can contribute to youth distress. Children become valued by what they do, not by who they are. This excessive struggle to achieve is linked to low mood, stress, and worry, which can eventually result in learning issues, depression, or anxiety.
It is well understood that in all communities, children with less available parents, school pressures, and psychological distress are unlikely to seek adult help. More commonly, they turn to peers for support. Unfortunately, youth in distress are at high risk for self-medicating their problems. It is striking that in the wealthy suburban communities studied by Luthar, girls are experiencing depression at a rate of 22% versus the 7% experienced by their urban less affluent counterparts. A quarter of suburban girls and boys experience anxiety, and illicit drug use among boys peaks at 59% compared with the 39% of their urban peers. Self-medication with cigarettes, alcohol, marijuana, and prescription drugs is on the rise in suburban communities.
AFFLUENZA AND THE RECESSION - A RUDE AWAKENING
In recent years, the affluenza epidemic and the clinical implications for parents and children have been of concern. Now, this condition of the privileged life has taken a startling and negative turn. The stock market has fallen to a historic low, and unemployment is at an all-time high. As our economic future seems uncertain, the unfolding crisis takes a toll on parents and children. The crisis has been thrust on a number of formerly affluent families who, at best, experience frustrating decreases in some indulgences and, at worst, undergo complete lifestyle changes. In the wake of the economy decline, many who previously lived in financial comfort are now experiencing catastrophic emotions. As their moods fluctuate and their anxieties are heightened, requests for clinical care are increasing. A recent American Psychological Association poll finds that three of four Americans are distressed because of money worries. Operators of crisis telephone helplines say the financial services crisis is sending everyday people to mental health services at levels not seen since the 9/11 attacks.
CHILDREN OF AFFLUENZA: THE NEW HIGH-RISK GROUP IN ECONOMIC CRISIS
Unfortunately, high parental education and/or material resources do not protect family relationships when the economy fails. A faltering economy lends to a decrease in personal resources and ultimately less control over one_s environment. In many instances, affluent parents, now with less disposable income, have decreased control over their own lives. Their children, used to the privileged lifestyles, experience difficulty in a different way. Having had little or no experience with living in hard economic times, they have difficulty processing experiences of disappointment. When anticipated rewards do not come to fruition, the emotionally healthy child recovers quickly, whereas others become increasingly frustrated, hold blame, or eventually experience great sadness resulting in depression. The new high-risk group of affluent children missed the opportunity to develop strategies of resilience. Resilience may be explained by the presence of protective factors, those qualities or situations that help children exercise patience, understand cause and effect, implement problem-solving strategies, and independently follow through on tasks.
When children lack the resiliency to effectively adapt to a changing environment, clinical symptoms may emerge. Young people begin to show signs of depression and anxiety such as sadness, worry, insecurity, or sleeplessness at home. In school, they may lack concentration and motivation or complain of poor memory and retention. Behavioral issues and social conflicts arise. Yet, this high risk group of youths, often considered well protected because of parental influence and wealth, are less often referred for clinical services. Parents may believe that their child_s problems are just temporary or attempt to troubleshoot and handle symptoms themselves. Unfortunately, the affluent child experiencing clinical symptoms often does not receive clinical services until physical symptoms present, there is school failure, or legal action is imminent.
To avoid missing the clinical needs of these high-risk children and families, intervention needs to be systemic; thus, a broad range of action is now required. Child and adolescent psychiatrists can be a strong voice in restoring confidence and balance in this era of financial uncertainty. They can help to raise consciousness about the false association between wealth and the perception of well being in our culture as well as urge systemic change, as voiced by Dr. Robert L. Hendren, president of American Academy of Child and Adolescent Psychiatry when urging then-President-elect Obama Ito provide funding to develop community based programs based on the Federal Child and Adolescent Service System Program (CASSP). Guided by CASSP principles, it is crucial to implement a Fsafety net_ of resources in primary care, school, community, faith-based and juvenile justice programs permeated by the knowledge and research of child and adolescent psychiatry.
Thus, intervention must begin earlier. Rather than waiting to resolve problems in the traditional clinical settings, help should start in the suburban community. Proactively, casting a wider net to identify high-risk children brings youngsters and their families to the appropriate clinical services sooner. In affluent districts from elementary to high schools, youth leaders, coaches, teachers, and tutors should be trained to recognize the signs of distress in children and be available to talk without fear of criticism, judgment, or stigma. Affluent school districts can implement similar mentoring, drug prevention, mental health awareness, and media outreach programs usually limited to the urban school districts.
When therapeutic intervention is warranted, families who have focused on the pursuit of affluence may not have developed strategies to increase resilience in their children. Therefore, treatment may take the form of family therapy to identify the patterns and interactions that perpetuate problems. Family therapy takes into consideration multiple influences, including socioeconomic class, culture, ethnicity, and religion. When individual psychotherapy is the effective treatment option, the constructs of cognitive behavior therapy can help children and adults to reframe their thinking and to problem-solve so as to rebound from disappointments.
In summary, the focus of this discussion is to acknowledge an increased health risk to some of the formerly affluent during the economic downfall and to stress the critical demand for clinical and community action plans to help families adjust to the new reality. Child and adolescent psychiatrists and other mental health professionals, educators, spiritual advisors, and community leaders must now establish more proactive and systemic roles by acknowledging the emergent risks in our children and families; by establishing dialogue, minimizing stigma attached to requesting help; and by guiding youth and families to obtain the help they need.