174 Chapter 21
Box 21.3Psychologically sensitive handling trains the children and
adolescents or adolescent in psychological mindednessChild complains of
somatic symptomsPsychological
stress
for example, bullyingSymptoms persist
despite ordinary
remediesParents
look deeperChild
discloses
bullyingDisclosure leads
to steps that
end bullyingPromotes
disclosure of
psychological
distress in futureHealth and illness can each be self-perpetuating
The great majority of ill children and adolescents want to get better again
in order to get back to their friends and resume normal activities. However,
illness has its attractions too, including extra parental attention, sympathy,
gifts and relief from ordinary demands. Although health is usually more
attractive than illness, the balance may shift when the child or adolescent
is exposed to acute or chronic life stresses, particularly if the individual
has no obvious escape other than into illness. Intolerable but apparently
inescapable situations can range from undisclosed sexual abuse to being
trapped as a high achiever who is doing well at school but cannot sustain
the pace or tolerate being overtaken by others. The relative attractiveness
of health and illness can also shift after any period of illness, whether
purely physical or not. Once someone has been ill for a while, there
may be fewer reasons to get better again: former friends may have found
other people to play with, there is a daunting backlog of schoolwork, and
the individual may have lost interest or competence in former leisure
activities. In addition, prolonged illness may have instilled a liking for
the social world of the patient, whether at home or in hospital. Once
the attractions of illness exceed those of health, any move to make the
individual better may provoke an intensification of symptoms.
An accusatory stance is counterproductive
When children and adolescents first complain of a symptom, their parents
may be able to jolly them out of it or use a ‘come off it’ approach with