Everyone has phases, stages, and degrees of mental disease throughout their lives, especially children, adolescents, and young adults. It is a part of normal growth and development to go through phases of change. Sometimes, a young person gets stuck in a phase, and it becomes something more—a mental health disorder—and they may receive a diagnosis. Often, if the young person can receive the help and support they need, this phase shifts, and the phase of disorder returns to order. If they remain stuck, the goal of mental health treatment is to get them unstuck. Child psychiatrists hesitate to firmly diagnose a disorder in children and teens as we recognize brain, mind, and identity development as a moving target. Mental illness is not a disease. Mental illness is a disease. If you are not sure if your child is going through a phase or stuck in a phase, talk to your pediatrician or a psychiatrist like me.

In psychiatry, diagnoses were created to help other mental health professionals have a common language to describe certain patterns of thinking and symptoms in patients. For many patients and young people, these diagnoses have become a part of understanding themselves and identifying who they are.

I have found that parents as well will often identify their child by their diagnosis. Diagnoses have shifted from a framework of patterns to an identity of core beliefs. How we see our children shapes how they see themselves.

I choose to see children, teens, and young people with diagnoses differently.

Every child is born as a rosebud. Beautiful, elegant, tightly closed with the greatest of potential. Yes, there are leaves and there are thorns, but they are identifiable and often avoidable. With love and care, these rosebuds unfold to grace our lives with their chaotic perfection and long-lasting fragrance. We learn to live with their thorns and embrace their flowers throughout our lives.

This is my hope for all children. For every child to unfold their true potential to the world.

As a psychiatrist, for the children that I care for, there has often been a different path of development. Perhaps they were lacking in water. Perhaps their environment was arid and dry, with soil that was not so fertile. Perhaps the sun was too hot, and they incurred a sunburn here and there. We do not know exactly how or why, but something changed in these little buds, morphing them into an entirely different species.

For these roses, they evolved to become what I call “The Cactus Kid.”

Cactus kids are still sturdy, still strong, but they have grown burrs and spines all over that are rampant and sharp. They evolved them as a means of both protection and survival—coping strategies, if you will, that may have initially served them but are now maladaptive. These burrs are the signs and symptoms of mental disease: anxiety, depression, anger, apathy, opposition, self-harm, and even suicidal thinking.

Think of how painful it must be to be a cactus kid. To feel thirsty and undernourished all the time. To feel like no one wants to be near you. To feel like you hurt everyone around you without even trying. To feel like you are no longer yourself.

If you are the parent of a Cactus Kid, you know how hard it is.

Let’s face it. You feel their prickles on you even when they are in another room.

You try to show them love and affection, but if you hug a cactus, you are going to get hurt. And yet we must care for them. But how?

Therapy works from the inside out. Therapy, good feelings, good food, sleep, vitamins, and sometimes even medications. Inside Out.

We don’t exactly know what went on inside to grow a cactus kid. But we do know some of the factors on the outside that forced them to evolve.

So whatever those factors are, we have to work to change them. From the outside in.

We will help our cactus kids re-adapt. We will water them more frequently and liberally with our attention and time. We will create some shade for them from the bright rays of school and what they experience as unreasonable demands. We may even need to manage our own expectations. We will nourish them with wholesome food and affirmations. We will arm ourselves with garden gloves and extra padding to give them the care they need, and maybe even a hug or two. We will remind them that we know on the inside who they really and truly are.

A rose in cactus clothing.

For youth:

Over the past decade, mental health awareness has improved substantially. COVID has unmasked the mental struggles that we all manage daily. Mental health challenges have been somewhat normalized. Gen Z has made tremendous progress to reduce mental health stigma and brought awareness to help address mental health concerns. This is progress. Yet, I have found this openness has at times created a shift in identity formation.

I have heard more and more young people claim proudly:

“I have ADHD. I don’t think like other people.”

“I am bipolar, so people just have to deal with my ups and downs.”

“My anxiety gets in the way of me making friends.”

There is power in the awareness of your own patterns and how this can impact others. As a child psychiatrist and parent, I am a bit concerned about children so strongly identifying with a diagnosis and as being diseased. Adolescents, as an expected part of normal development, try on different identities and labels to understand who they truly are.

Who we think we are affects what we think we can and cannot do. I have seen in my own patients how their identification with a diagnosis has limited their potential to stretch their minds and try out life experiences. So for any young person reading this: For my Cactus Kids, here are my 2 cents. You are more than a disease. You are more than a diagnosis. You are YOU. You are evolving and will continue to evolve. Right now, you may have symptoms of a diagnosis. Do not let that diagnosis alone define you. Do not let that diagnosis design your life. Go deeper than the diagnosis. Get to know the true you.

The world has been waiting for someone exactly like you to arrive. Prickles and petals. Thorns and all.

Shivana Naidoo is a child psychiatrist.