Anette Wickström

At a time when recurring reports point to increasing levels of mental ill health among young people, it is important to understand what young people mean when they respond to surveys containing symptom checklists. Based on a performative understanding of questionnaires, the aim of this research project was to examine what the symptoms reported by young people in the WHO Health Behaviour in School-aged Children (HBSC) survey represented. The analysis showed that the reported symptoms reflected either transient everyday concerns or more serious problems. Some symptoms associated with everyday concerns were perceived by participants as positive, such as feeling nervous before a choir performance or a school presentation.

The findings demonstrated that the measurement of mental ill health, and reports in which all self-reported complaints are described as indicators of mental ill health, have consequences for young people. First, the public narrative that emerges creates an overly homogenized picture of young people’s mental health. On the one hand, ordinary human experiences risk being pathologized; on the other, serious problems may become obscured. Second, young people's mental health is not understood within its social and everyday context, which conceals structural problems and socioeconomic disadvantages that contribute to psychological strain. Third, when young people's emotional responses are measured and described as mental ill health, experiences arising from engagement in schoolwork or from challenging themselves are also included in the statistics. Taken together, these are far-reaching consequences that affect the lives of children and young people. As a counternarrative, young people's own perspectives can provide a more nuanced and contextualized understanding of mental health among youth.

The project was carried out in collaboration with Sofia Kvist Lindholm, Department of Behavioural Sciences and Learning, and Kristin Zeiler, Department of Thematic Studies, Linköping University.

Funding: The Swedish Research Council (Vetenskapsrådet) 2017-2022, and The Swedish Research Council for working life, health and welfare (FORTE) 2017-2020.

To explore children’s and young people’s experiences of undergoing orthodontic treatment, I combined several ethnographic methods. Six patients aged 13 to 17 were followed over the course of one year. The data consisted of self-produced video diaries combined with follow-up interviews. The findings showed that, after the initial phases of treatment at the clinic, responsibility for managing the orthodontic appliance was delegated to the home. For treatment to be successful, young patients, with the support of their guardians, needed to work diligently with their braces. Orthodontic treatment relieved children and adolescents of functional dental problems and of feelings of embarrassment about teeth that were not straight and aesthetically pleasing. At the same time, the medical technology created new constraints by shaping experiences of time and space in different ways. During the first six months of treatment, participants experienced, in a phenomenological sense, the body as alternately “disappearing” and “dysappearing” as pain recurred cyclically. Each time the braces were tightened, the pain returned. Patients became acutely aware of their bodies in the here and now, while their ordinary routines and projects faded into the background. Although the active cyclical phase of treatment lasted only about two years, treatment frequently extended over much longer periods, often throughout the patient’s lifetime, because retainers were required to prevent the teeth from shifting back. Orthodontic treatment is therefore a highly sought-after intervention that nevertheless has far-reaching effects on young people’s everyday lives.

Funding: Swedish Research Council (Vetenskapsrådet), 2013-2016.

Aesthetic considerations have become the dominant rationale for contemporary orthodontic treatment, and new technologies have made a wider range of dental corrections possible. To explore children’s and young people’s experiences of orthodontic practice, as well as norms and ideals concerning teeth and dental appearance, I conducted an ethnographic study at two orthodontic clinics. Drawing on a sociocultural perspective and using video observations, participant observations, and interviews, I examined how orthodontic treatment was carried out and how children and adolescents interpreted these processes. Visualizations of the current and future dentition established what was considered normal and what was regarded as deviant. The clinical assessment process and expectations regarding dental appearance could be understood through the concept of “the exceptionally normal”, that is, a rare dental occlusion in relation to what is commonly found in the population. Most participants were grateful for the opportunity to have their teeth corrected. However, the project also showed that it was difficult for those who wished to do so to decline a treatment that was primarily concerned with aesthetic correction of the teeth.

Funding: Swedish Research Council (Vetenskapsrådet) Postdoctoral Fellowship, 2011-2012.

The school's efforts to improve pupils’ well-being and relationships through manualized programs have enjoyed considerable appeal. Educational authorities have invested resources in staff training and the purchase of programs through a market that has opened to private providers. These manual-based methods originated in clinical settings and were initially designed for target groups identified as needing therapeutic intervention. To adapt them to the Swedish school context, treatment-oriented programs were revised into preventive interventions.

As part of an evaluation of health-promoting initiatives for children and young people, I conducted a study of the implementation of the DISA program. The acronym was translated as Depressive Symptoms in Swedish Adolescents in the group leader’s manual and as Your Inner Strength Activated (Din Inre Styrka Aktiveras) in the students’ manual. The course was aimed at 13-year-old girls and sought to teach techniques for transforming negative thoughts into positive ones.

The aim of the study was to examine the implementation of the course, with particular attention to the girls’ perspectives. I conducted observations and video-recorded 13 course sessions. The analysis showed that the girls shifted the focus of the course away from inner thoughts and towards communication and collaboration. Their responses constituted a critique of the idea that universal interventions can easily be implemented to address something as complex as well-being. The findings pointed to the need for a critical approach to the manualized programs marketed to Swedish schools, and for interventions that are more context-sensitive and grounded in the realities of specific situations. The minority knowledge expressed by pupils when they participate in shaping the activities in which they are involved constitutes an invaluable source of insight for developing strategies and practices aimed at improving the well-being of children and young people.

The study formed part of a larger research project led by Karin Zetterqvist Nelson and was conducted in collaboration with Katrineholm Municipality.

Funding: Swedish National Institute of Public Health 2009-2011.

When parents are informed that the sex of their newborn child is unclear, many experience this as frustrating or even almost incomprehensible. The situation can be particularly difficult to accept if they were previously unaware that some children are born with external and internal sex characteristics, sex chromosomes, and hormone levels that are not typical of only one sex. The aim of this study was to explore, from a phenomenological perspective, parents’ experiences of having a child with ambiguous sex characteristics, their experiences of the medical process of sex assignment, and their views on allowing their children to undergo genital surgery when such procedures were not necessary for the child’s physiological functioning. The study also contributes a critical perspective on the practice of genital surgery.

The study was conducted in collaboration with Kristin Zeiler, Department of Thematic Studies, Linköping University 2008.

In 2004, I conducted six months of ethnographic fieldwork for my doctoral dissertation in Nkolokotho, a rural area of KwaZulu-Natal in northeastern South Africa. The aim was to understand how people managed health and relationships in a community severely affected by hiv/aids. The findings revealed that participants sought improved access to medical professionals and biomedical care, while simultaneously regarding returning home as “the great medicine.” Health was understood primarily in relational terms, as contingent upon connections to family, ancestors, and place. The participants’ ongoing efforts to restore social relationships to address health problems were a consequence of their marginalized position in society, not part of any organized resistance movement, but rather a form of resistance manifested in everyday life. Conceptions of health also reflected a history of structural oppression and lived experiences of segregation.

The project was a collaboration among Department of Medical and Health Sciences at Linköping University, University of KwaZulu Natal and Africa Centre for Health and Population Studies, Wellcome Institute.