188 Chapter 23
Rules and autonomy
During adolescence there is a shift from accepting rules and boundaries
imposed by others to setting them oneself, substituting self-imposed
control for externally imposed control. Young people face a demanding
task as they try to exercise their growing capacity and desire for self-
determination within limits acceptable to their parents and society as a
whole. Not surprisingly, surveys confirm that the commonest causes of
arguments with parents in this period are issues relating to rules and
autonomy. At the more disturbed end of the spectrum, ‘out of control’
teenagers pursue their own desires while paying little or no heed to
society’s rules and other people’s needs. It is the simultaneous absence of
externally imposed and self-imposed control that makes these adolescents
particularly difficult to manage for all those involved, including parents,
teachers, social workers and psychiatrists. When parents can no longer
cope, simply taking these youngsters into care into a foster home may
not improve matters, unless the foster carers have better disciplinary skills
that the birth parents (which they may do, especially if they have had
specific training). Placing them in a children’s home may only aggravate
the problem, since the lack of containment in many children’s homes is
reflected in high rates of various ‘out of control’ activities. These activities
can include precocious and unprotected sexual activity, overdoses and
wrist cutting, drug taking, running away for days at a time and theft. There
is often a frustrating gap in services where all a clinician or parent can do
is watch an adolescent decline: out of control but not harming themselves
enough to be detained under legislation, or offending sufficiently seriously
to be incarcerated in a young offenders’ institution (which may not do
them much good anyway).
Biological and social influences interact
Biological factors contribute to the pubertal upsurge in sexual and ag-
gressive behaviours in humans as in other animals; the consequences of
delayed puberty bear this out. However, different cultures channel these
biological predispositions in different ways, amplifying some features and
suppressing others. Commonsense notions to the contrary, there is no
convincing evidence that hormone levels are abnormally high among
extremely aggressive delinquents or multiple sex-offenders, and the effi-
cacy (let alone desirability) of ‘chemical castration’ in these circumstances
remains very dubious. Pathological variations in post-pubertal sexual and
aggressive ‘drives’ seem more related to social and psychological variables
than to biological variables.
The interplay of biological and social factors in adolescent development
is well illustrated by the findings of a Swedish study of the consequences
of early puberty for girls. Roughly 10% of a large and representative