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(1989) Adolescent Mental Health
(1989) Adolescent Mental Health
I I
ABSTRACT." Definitions and descriptions of adolescent is that a healthy adolescent should appear to have a mild
mental health are beginning to be grounded in psychol- case of mental illness. In other words, many of the symp-
ogists" empirical studies of a wide variety of patterns of toms or serious diff culfies that would signal mental illness
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
adaptation to adolescence. Three major themes guiding in adulthood or childhood are understood to be a normal
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current research relevant to mental health in adolescence part of adolescence. Adolescents may be expected to be
are discussed in this article." (a) a focus on analysis of extremely moody and depressed one day and excitedly
interindividual differences to describe variety in adapta- "high" the next. Explosive conflict with family, friends,
tion; (b) the integration of biological, psychological, social, and authorities is thought of as commonplace. This pop-
and cultural variables in models of adolescence; and (c) ular view is, to a great extent, based on the theoretical
an emphasis on the developmental aspects of adolescent work of the psychiatric clinical community in the 1950s
mental health. Empirical investigations of adolescent and early 1960s (Blos, 1962; Erikson, 1959, 1966, 1968;
mental health and development within the social context Freud, 1946, 1958). Largely on the basis of their expe-
of the family are reviewed. rience with adolescent psychiatric patients, these clini-
cians and theorists described adolescence as necessarily
a time of extreme psychic and interpersonal stress. Emo-
Adolescent psychology is in the midst of writing a new tional crisis and upheaval were viewed as appropriate re-
definition of adolescent mental health--a definition based sponses by the adolescent to major psychological and so-
on the description of a wide variety of patterns of adap- cietal tasks required during this phase of life: dramatically
tation to the biological, psychological, and social chal- reducing psychological dependency on parents, separating
lenges of adolescence. Psychologists' current understand- from the family, and forming an adult identity. Adolescent
ing of the range and variety of these developmental paths, turmoil was not only inevitable but necessary for sub-
strengths, and profiles of adaptation is central to this ar- sequent normal personality integration.
ticle. Toward a New Understanding of Adolescent
An earlier, and still popular, understanding of ado- Mental Health
lescent mental health viewed adolescence as a time of
profound inner turmoil and outward conflictua time of The storm and stress theory of adolescent mental health
"storm and stress." We briefly discuss this previous un- brought attention to the considerable number of physical,
derstanding of adolescent mental health in an effort to social, and psychological changes experienced by adoles-
place psychologists' present understanding in context. We cents in this culture. The theory emphasized the stress-
then review three major themes guiding current research fulness of managing these concurrent changes, and the
relevant to mental health in adolescence: (a) a focus on adolescent's attempts to cope with these changes were
analysis of interindividual differences to describe variety accorded dignity. In addition, the storm and stress per-
in adaptation; (b) the integration of biological, psycho- spective of adolescent mental health invigorated the
logical, social, and cultural variables in models of ado- scholarly community in the mid-1960s and prompted
lescence; and (c) an emphasis on the developmental as- important new research. This research was stimulated by
pects of adolescent mental health. Research examining the idea that adolescence is necessarily and typically a
reciprocal effects between adolescent development and time of emotional disequilibrium and unpredictable be-
family relationships is then reviewed. havior (Bandura, 1964; Douvan & Adelson, 1966; Offer,
1969; Offer & Offer, 1975). Data from study after study
Prior Definition: Adolescent Mental Health were analyzed to determine whether the majority of ad-
as Turmoil olescents exhibited serious psychological turmoil. These
empirical analyses led to a radical revision in the psy-
To be normal during the adolescentperiod is by itselfabnormal.
--A. Freud, 1958, p. 275 chological community's understanding of adolescent de-
velopment and mental health.
One understanding of adolescent mental health, of- The majority of this research of the past 20 years
ten perpetuated by the media and assumed by the public, clearly refutes the notion that most adolescents undergo
tories or profiles of adolescent ego and moral development opment), and sociocultural variables (e.g., the transmis-
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throughout the high school years. Within a sample of sion of skills, proper social behavior and values necessary
adolescents with no known psychiatric diagnoses, a va- for adulthood, and initiation rites) in seven cultures. These
riety of types of developmental trajectories are found. studies emphasize that the social structuring of the ad-
Each trajectory type identifies the base levels of ego and olescent experience partly determines the consequences
moral development for subjects in early adolescence and and meaning of changes in adolescence.
characterizes their rate of progression, regression, or sta- Worthman (1986) examines the psychological costs
bility in development throughout high school. We are to adolescents of particular cultural environments and
currently investigating how these varieties of develop- social expectations regarding puberty. Whether or not
mental patterns are related to adolescent adaptive func- physiological changes in the pubertal process are cultur-
tioning and family interactions. ally recognized depends on the society. She notes that
unlike Western societies, the Kikuyu in Kenya mark onset
Interaction of Biological, Psychological, Social, and of puberty with circumcision rites for females. According
Cultural Aspects of Adolescence to Worthman, the Kikuyu structuring of meaningful
Investigators of adolescence are increasingly turning to a maturational experiences, such as an initiation rite, helps
multivariate and systemic approach to understand ado- to deflect anxiety in adolescence. Pubertal changes are
lescent development, adaptation, and mental health thereby normalized and integrated with broader social
(Brooks-Gunn & Petersen, 1983; Hill, 1987; Petersen, processes.
1988). This approach integrates biological, psychological, More research with an explicit focus on the social
social, and cultural variables into the examination of var- context of adolescent mental health and development is
ious patterns of adolescent psychological growth and the needed, even within our own society. The majority of
processes influencing the formation of these patterns. empirical studies of adolescent mental health in the
Analysis of the reciprocal effects of these additional factors United States recognize the potential of contextual vari-
with psychological development is especially critical for ables for influencing the course of adolescent growth and
the study of adolescence because of the significant and adaptation. Contextual variables in these studies are sta-
rapid changes that occur in each of these arenas during tistically or methodologically controlled so that they do
this life phase. This approach demands a greater collab- not obscure the effect of psychological variables of interest.
oration and communication between psychologists and As a result, the vast majority of empirical research on
investigators of adolescence from the disciplines of soci- adolescent mental health is based on purposefully re-
ology, biology, medicine, psychiatry, and anthropology. stricted, homogeneous samples (e.g., White, middle-class
One example of an extensive research program that adolescents from nuclear families). Our knowledge of the
exemplifies this integrative approach is the work of so- variety of patterns of adaptation in adolescents from lower
ciologists Simmons, Blyth, and their colleagues (Blyth, socioeconomic statuses, of different ethnic backgrounds,
Simmons, & Carlton-Ford, 1983; Simmons, 1987; Sim- or from alternate family structures is, therefore, severely
mons & Blyth, 1987) investigating the influence of social limited. An important task for future research will be to
variables (e.g., school structure) and biological variables study the context of adolescents' lives in greater depth
(e.g., rate of pubertal development) on self-esteem. Their and diversity.
inclusion of these dimensions in studies describing ado- Developmental Features of Adolescent Mental Health
lescent adaptation has allowed them to highlight the in-
The study of adolescence is fundamentally the study of
change. Depending on the variable of interest, change or
3Though this definition supportsthe discoveryof a varietyof pat-
terns of mental health, werecognizethat, as withany definitionof mental development in adolescence is usually conceptualized ei-
health, cultural values strongly influence our descriptions of what is ther as a series of qualitative reorganizations of capacities
healthy and what is pathological. (e.g., stages of cognitive and moral development) and be-
adolescent is "on time," late, or precocious in specific growing agreement on the significance of family ties, pa-
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areas of development. Brooks-Gunn and Ruble (1983) rental models, and reciprocal influences between adoles-
and Klein and Litt (1983) have shown that the sociocul- cents and their families. Not only do families affect ad-
rural meaning attributed to being "on time" or not with olescent development, but aspects of adolescent devel-
regard to aspects of pubertal development can have a sig- opment (e.g., puberty and cognitive changes) affect the
nificant impact on adolescents' self-images. In addition, life of the family.
cross-cultural studies show that timing of pubertal de-
velopment may vary not only by individuals but by coun-
Changing Views of Adolescent-Family Conflict
try. For example, the age of menarche may vary both A pervasive belief, stemming from the storm and
within a society and between societies. In the United stress theory of adolescence discussed earlier, is that
States the median age ofmenarche is 12.8 years for White severe ongoing family conflict should be expected during
Americans and 12.5 for Black Americans, and the range the adolescent years. We now know, from a variety of
for 95% of girls is 9.8 to 15.8 years (Eveleth, 1986). The studies using such diverse methods as epidemiological
median age of menarche is 14.2 years in Czechoslovakia surveys (Rutter, Graham, Chadwick, & Yule, 1976),
(Whiting, Burbank, &Ratner, 1986), 15.9 years among phone interviews (Monetemayor, 1983), and time sam-
the Kikuyu of Kenya (Worthman, 1986) and 18.0 years piing with electronic beepers (Csikszentmihalyi & Larson,
among the Bindi of New Guinea (Eveleth, 1986). 1984), that for most families with adolescent members,
Thus, current approaches to the study of adolescent serious conflict and disorganization are not characteristic
mental health and development no longer try to describe states (Hill, 1987). Conflicts do occur during the various
a unitary picture. Empirical descriptions of adaptation phases of adolescence, and they arise over mundane
are now seen as a function of an adolescent's particular issues, such as the family chores, curfews, eating practices,
point in a trajectory of development. This developmental dating, and personal appearance. However, the current
"point" is less often designated exclusively by age (early, evidence, drawn from various kinds of self-reports offered
middle, or late adolescence) but more and more often is by nonpatient adolescents and their parents, provides no
precisely delineated by each adolescent's developmental support for a picture of dramatic increase in family con-
level and timing with respect to a variety of biological flict from childhood to adolescence. In general, despite
and psychological variables and institutional settings. The the past dire predictions, the family is not "at risk" for
importance of accurately describing an adolescent's turmoil or disorganization during the adolescent years.
placement on several interacting developmental trajec- Indeed, detailed accounts of daily family life temper the
tories underscores the critical nature of longitudinal data more dramatic view of adolescent and family turmoil.
in adolescent research. Archives of longitudinal social Yet it would be a mistake to conclude that conflicts
science data, such as the Henry A. Murray Research between adolescents and their parents are insignificant
Center of Radcliffe College and the Institute of Human and rare except when there is family or individual
Development at Berkeley, greatly facilitate the study of psychopathology.
adolescent mental health by providing for reanalysis of Although there may not be striking quantitative
data on a variety of aspects of growth and adaptation shifts in amount, the loci of the conflicts do change. And
collected over several decades. 4 these very loci illuminate significant aspects of family life
during adolescence. By more clearly identifying the
sources of conflicts and how they shape, and are shaped
4Reflectingthe importance of effortsto investigate the develop- by, individual and family functioning, we can enhance
mental courseof mental health, the National Instituteof MentalHealth our knowledge of adolescent development within the
has recently funded the establishment of a national archive for longi-
tudinal mental health data at the Murray ResearchCenter of Radcliffe family, especially the range of individual and family di-
College. versity. In addition, such investigations can lead us closer
Although there are theoretical and intuitive reasons to must shift from viewing multi-faceted and personal issues as
believe that aspects of adolescent development influence conventional and legitimately subject to their authority, to
granting the adolescent (or young adult) increasing personal ju-
family relationships, it is a biological aspect of adoles- risdiction over these issues. (Smetana, 1988a, p. 333)
cence, puberty, that has been most intensively investigated
from this perspective. Paralleling an increasing interest Through such cognitive changes, adolescent devel-
in biological determinants of social relations in adoles- opment may lead to transformations in family relation-
cence (e.g., Brooks-Gunn, Petersen, & Eichorn, 1985; ships. On the surface are mundane, often ubiquitous,
Brooks-Gunn & Warren, in press; Inhoff-Germain et al., conflicts over the use of the car, choice of friends, or eve-
1988), recent reports delineate impacts of pubertal mat- ning activities. But beneath these seemingly concrete dif-
uration on parent-adolescent relationships (Steinberg & ferences may be deeper ones: the adolescent's increasingly
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Hill, 1978; Steinberg, 1988; Hill, Holmbeck, Marlow, varied conceptions of roles, authority, expectations, and
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Green, & Lynch, 1985a, 1985b; Holmbeck & Hill, 1988). responsibilities. Basic realignments in family relationships
A number of general conclusions can be drawn. Pubertal and new views of parental authority and of family roles
maturation differentially influences parent-adolescent and rules may be necessary to permit continued growth
relationships, independent of effects that might be con- of the adolescent and family, rather than an impasse re-
nected with the adolescent's chronological age. In the early suiting from sustained opposition by the adolescent or
and middle phases of the pubertal cycle, there is tran- parents' reluctance or inability to appreciate new per-
siently increasing conflict, distance, and dissatisfaction in spectives from their changing son or daughter. There re-
parent-child relations, an effect particularly apparent with main important questions about how family relationships
mothers. Although many of these findings are based on specifically change during such realignments of perspec-
adolescents' reports of family relations (Steinberg, 1988), tives. These questions are being pursued in ongoing lon-
analyses of observed family interaction sequences provide gitudinal family studies based on direct observation of
similar findings (Holmbeck & Hill, 1988; Steinberg & families and using scoring systems sensitive to the extent
Hill, 1978). In addition, a recent short-term longitudinal of constraining and enabling (Hauser et al., 1984; Sme-
study offers the intriguing suggestion that girls' maturation tana, 1987) and cognitive and alfective support and con-
may be accelerated by conflict and distance with their flict (Powers et al., 1983; Powers, 1988) expressed by par-
parents, particularly with mothers (Steinberg, 1988). ents and adolescents toward one another.
Important cognitive changes are also occurring dur-
ing adolescence: Family Contributions to the Adolescent's Development
For the first time in their lives, some adolescents are able to of Autonomy and Intimacy
employ formal operational thought.., take the role of others A third group of studies delineates family influences on
• .think in terms of possibilities, alternatives, and principles,
.
aspects of adolescent development. Two aspects of ado-
and they may have the cognitiveequipment to think about family lescent psychosocial development are especially impor-
issues and situations independent of their own immersion in tant: autonomy and intimacy. Earlier formulations
them. (Hill & Holmbeck, 1986, p. 176)
equated autonomy with detachment from parents, with
Such cognitive and social-cognitive developments have freedom from parental attachments and influence (Hill
been studied extensively. Yet it is only recently that they & Holmbeck, 1986; Steinberg & Silverberg, 1986). But
have been linked to transformations in family relation- there is now strong theoretical and empirical support for
ships. In her studies of family conflicts, Smetana (1985, an alternative view, one that does not assume major psy-
1988a, 1988b) has shown that an increasing "gap" be- chological or behavioral disruption in family relations as
tween parent and child reasoning and social judgment underlying or reflecting adolescent autonomy. Instead,
emerges in adolescence. Children are more likely to reason current studies address the interplay between transfor-
about personal items (e.g., friendships, content of cor- mations in autonomy and transformations in family re-
respondence, and recreational activities) in terms of per- lationships. One direction of work considers how varied
sonal choice, but parents of children at these ages do not advances and deflections in autonomous development are
demonstrate parallel changes. Smetana's results suggest influenced by family relationships.
that Baumrind (1968, 1987) has pointed to potential
in studying adolescent-parent relationships it is important to connections between parenting style and adolescent au-
examine the coordination of adolescents' and parents' perspee- tonomy through her conceptualizations of prototypes of
fives. . . . Children viewthemselvesas increasinglyemancipated parental authority. Traditional parents "value a sense of
from their parents' conventionalperspectivesduring adolescence. continuity and order more than innovation and risk-tak-
Torn between the necessity of maintaining the family social sys- ing. They accept the pattern of understanding and value
tem and allowing the child increasing personal jurisdiction over judgements that has been worked out over time by pre-
willfulness (autonomy strivings). This last pattern is as- trast~ adolescents with minimal levels of identity forma-
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sociated with major deflections in autonomous develop- tion and perspective taking were found in families that
ment and problematic adolescent behaviors (Baumrind, blurred boundaries between members and avoided dis-
1987). agreements.
In contrast, authoritative parents, according to In our research (Hauser et al., 1984; Powers et al.,
Baumrind, do not regard their standards or themselves 1983), we also find strong ties between parents' affective
as divinely inspired or infallible. They are supportive, responsiveness (acceptance, empathy, and support) and
committed, and show differentiated responsiveness. Con- adolescent ego development. The meaning of these cross-
text and individual differences guide their support for au- sectional findings is illuminated by recent longitudinal
tonomous expression and emphasis on "disciplined con- analyses suggesting links between these family interactions
formity" (Baumrind, in press). They are affectively re- at age 14 and subsequent ego development trajectories
sponsive (loving, supportive, and committed) and (Hanser, Powers, et al., 1987). Both mothers and fathers
cognitively responsive (providing a stimulating and chal- were least enabling toward those adolescents who sub-
lenging environment; Baumrind, 1987). In short, "'the sequently showed arrested ego development. On the other
authoritative parent combines limit-setting with negoti- hand, parents expressed more cognitive and affective en-
ation, thus encouraging the child's contribution to the abling toward adolescents who later showed trajectories
discipline process" (Grotevant & Cooper, 1986, p. 84). of progressive development. Thus, family discussions oc-
Although Baumrind's published findings to date involve curling in middle adolescence already show indications
familial antecedents of competent early and middle regarding which adolescents will exhibit arrested or un-
childhood functioning, results from other studies support stable development in their subsequent years.
the conclusion that authoritative parenting also predicts These sets of observations highlight the significance
greater autonomy in adolescents (Hill, 1980, 1987). De- of specific kinds of family relationships in the unfolding
spite this clear association between a particular kind of of adolescent autonomous development (identity explo-
parenting and adolescent development, there is an im- ration, perspective taking, and ego development). We
portant qualification that must be kept in mind. In the cannot yet, however, draw holistic pictures of adolescent
absence of longitudinal studies that deal with parenting families, be they "individuated," "enabling" or "sup-
in the preadolescent years, we cannot know whether these portive" characterizations. Differentiated relationships
connections represent parental contributions to auton- between dyads of family members are characteristic of
o m y or parents' responsiveness to their more autonomous these findings. Each of these dyads contributes in different
adolescents. W h e n we have access to data from Baum- ways to the development of adolescent autonomy. This
rind's wave of adolescent observations, we will be in a caveat is not meant to rule out the eventual distinguishing
better position to understand the extent to which these of "family types" that may be most effective in promoting
parenting practices function as antecedents of autono- varying paths of autonomy development. However, right
mous development. now more is to be gained from understanding the fine
Other pertinent findings about possible parent con- texture of family relations than from "smoothing" this
tributions to development of autonomy describe the im- texture in order to arrive at a readily comprehensible
portance of parent ego development (Hauser et al., 1984; account of the role of this complex social system in shap-
Hauser, Houlihan, ctal., in press). Parents at higher levels ing these paths.
of ego development (with greater awareness of self and A second significant strand of adolescent develop-
increasing appreciation of individual differences among ment involves intimate and close relationships. Adoles-
people, Loevinger 1976) express more explaining, cu- cents experience distinctive dilemmas around maintain-
riosity, and problem solving in family discussions with ing meaningful family and peer attachments in the midst
their adolescents and spouses. This observation is of in- of rapid pubertal, cognitive, and environmental change
parent relationships. In M. Gunnar & C. Collins (Eds.), Development to menarche: Sequential analysis offamily interaction. Submitted for
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