How and with what consequences do young people push up against standardized views of “normal” and “healthy” development? To what extent can young people’s attempts to disrupt developmental norms be understood as political acts? I became intrigued by these questions while conducting long-term ethnographic research with a subset of young participants in the 1982 birth cohort study in Pelotas, Southern Brazil (Victora and Barros 2006).[i] In the 1990s, when I was invited to collaborate in the study, the idea that “adolescence” was a distinct psycho-developmental phase was starting to gain momentum in global health and schools of psychiatry, psychology, and public health in various countries, including Brazil. Childhood has been the object of widespread and institutionalized scientific and clinical attention for well over a century (Morss 1990, Stephens 1995). However, only in the past two or three decades has “adolescence” coalesced as a demographic and conceptual site for the institutionalization of clinical interventions and knowledge production (Fabrega Jr and Miller 1995, Lesko 2001).
As I began my research, I noticed that skepticism about adolescence took shape almost as quickly as the category itself. While tracing the circulation and rapid scale-up of adolescence in publications and policy documents, I met psychiatrists and public health experts who drew from Brazil’s schools of psychoanalysis and social medicine to argue that adolescent-specific programming was an exaggeration, a classic case of unnecessary medicalization and individualism. Parents and young people alike explained that adolescence – a time of exploration, self-discovery, and extended schooling – was a luxury only the wealthy could afford. They challenged the idea that teens, wealthy or not, should not work or do household chores; and they disagreed with the motto so often repeated by teachers and school psychologists : “schooling should be the child’s only job.” Still others argued that the idea that adolescence is an inherently turbulent phase requiring behavioral and psychological intervention was infantilizing and classist, an excuse to dole out unjust reprimand.
To fully grasp what was at stake in my interlocutors’ critique of “adolescence,” it is worth briefly reviewing the historical creation of sciences of development. Much has been written about how twinned models of individual and societal development-as-progress, as conceived by 19th-century evolutionary theorists, have been built into the structures and epistemic culture of core institutions: education, medicine, labor, and law (Jones 1999). Evolutionists enchanted by the promises of Enlightenment science laid the groundwork for the naturalization of the linear stages that individuals needed to follow in order to be healthy, sane, and intelligent. “Good development,” these theorists argued, would contribute to society’s own evolution to higher stages of civilization (Bowler 2003). Evolutionary theory thus provided the epistemic frame through which whole segments of the population – from so-called “delinquents” and the “feeble-minded,” to children, women, and black and brown people — have been classified as second-class citizens, disciplined, excluded, and often institutionalized (Gould 1996 [1981]). To challenge the power of such an entrenched system is overwhelming, even paralyzing. Yet time and again, young people from the cohort showed me how the rise of adolescence as an object of governance became an occasion for them to undo normative models of development and fashion new ways of living.
Cohort studies can both constrain and facilitate an exploration of non-normative ways of life. They constrain because built into the design and method of most longitudinal studies is a specific definition of “development,” quantified and operationalized through prediction, individualization, and teleology. While epidemiologists have linked in-utero environments and early childhood experiences to a range of health outcomes in adolescence and adulthood, social scientists have called for less reductionist approaches to development and more nuanced considerations of the social contexts in which malleable “biopsychosocial” developmental trajectories unfold (Meloni 2019). Social epidemiologists call for ecological-level research and for measures of the “social and economic determinants of health” that include not just “poverty” but factors such as chronic discrimination (Krieger 1999). These calls not only reflect technical concerns with quantitative approaches; they are moral positions. Indeed, measures of social and economic “context” are most often treated as confounders of biological, psychological, behavioral, and familial characteristics, which are deemed more “modifiable” points of intervention, leading to what Beck and Niewöhner have termed “pragmatic reductionism” (Beck and Niewöhner 2006). Longitudinal research thus has a tendency to reproduce gendered and racialized knowledge of development alongside an interventionist emphasis on mothers’ parenting practices and expectant mothers (Mansfield and Guthman 2015, Pentecost and Meloni 2020l).
Sometimes, however, cohorts can provide a space for interrogating developmental science and for nurturing what I have come to think of as a politics of “developmental disruption.” As Lloyd, Filipe and Larivée write in this series, the cohort, possibly unlike other research environments, offers “space for ‘if’ in the models of … people’s lives” (Lloyd, Filipe et al. 2020). To explore this claim, I draw on social scientists’ commitment to unsettling assumptions of biological universality (Niewöhner and Lock 2018) through modes of interdisciplinary collaboration that move beyond social constructionist critique (Rose 2013). As the editors of this series argue (Gibbon and Pentecost 2019), to engage critically with developmental science while also opening possibilities for new ethical and political ways of living (Lappé, Hein et al. 2019) entails bringing together two ways of interacting with the cohort: first, from a science studies perspective that views the cohort as an authoritative and situated social, moral, political and technological phenomenon, and second, as a researcher looking for a stretchable epistemic space in which to be curious with researchers from other disciplines as well as with study participants.
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Since the 1990s, researchers and policy-makers in a host of countries and within global health organizations have turned their attention to adolescents, a neglected population group, and adolescence, a life phase defined by particular developmental characteristics. Adolescence has become coterminous with a litany of health risks, conditions and behaviors: smoking, drug & alcohol abuse, school truancy, learning disabilities and conduct disorder, violence, depression, anxiety, sexual risk-taking, and poor nutritional habits (WHO 2003). Risk factors such as “sex by fifteen” and “early childbirth” are now routinely measured alongside smoking, binge drinking, and reckless driving, and linked statistically to mental disorders such as depression and anxiety, a conglomerate that is sometimes referred to as “adolescent morbidity” (Erskine, Baxter et al. 2017). Through the logic of co-morbidity, attention to adolescence has brought together experts from disparate subfields and broadened the population reach of each of these subfields’ epistemic activities (Patel, Flisher et al. 2007).
Longitudinal research, in particular, has played an important role in framing adolescence as a key site for interventions to prevent ill-health in adulthood (Sawyer 2012). Researchers running the first major birth cohort studies with participants who entered adulthood in the 1980s and 1990s have calculated the potential gains of intervening in childhood and adolescence for the future health – and economic productivity — of the whole adult population (Frost, Reinherz et al. 1999, Noack and Puschner 1999). Using this body of research, authors of the 1999 World Health Report claimed that around 70 percent of premature deaths among adults are due largely to “behaviors, habits, and lifestyle choices” initiated during adolescence (WHO 1999). For example “lifestyle” behaviors “consolidated” in adolescence are said to predict future rates of chronic diseases, such as cancer (Fergusson, Lynskey et al. 1996), and learning disorders in childhood predict adolescent delinquency, which in turn has been linked to adult criminality and antisocial personality disorder (Moffitt 1993, Fombonne, Wostear et al. 2001).
Core to much of this research is the neuroscientific creation of the “adolescence brain,” premised on the idea that the young people’s emotions, decisions and behaviors can be attributed to inherent bio-developmental characteristics such as impulsivity and risk-taking (Bessant 2008). Social scientists and youth justice activists have avidly critiqued the biological essentialization of adolescent brain research (Males 2009, Koffman 2012). One particular contentious claim, depicted in Figure 1, asserts that adolescent neurodevelopmental characteristics predict adolescent pregnancy, which in turn leads to lasting major depression in adulthood (Chalem 2012).
Social scientists have avidly critiqued the classed, gendered and racialized assumptions that underpin the neuro-pathologization of teen pregnancy (Geronimus 2003, Macleod 2003). Social epidemiologists have produced considerable counter-evidence to show that conditions of poverty and social stigma, rather than age of pregnancy or developmental characteristics, account for mental illness in adulthood (Lawlor and Shaw 2001). Researchers from the 1982 Pelotas cohort, leaders in the critical epidemiological study of inequity, have pointed to the social and economic determinants of teen pregnancy; among cohort participants, teen pregnancy was found to be higher among young women with fewer years of completed education, from families with low income, and among those who self-identified as black or brown (Gigante, Barros et al. 2008). Cohort researchers have also countered the premise that teen pregnancy is a key cause of school abandonment, by showing that school-based difficulties (and alienation from education) tend to precede, and thus possibly contribute to, teen pregnancy itself (Gonçalves and Gigante 2006). As depicted in Figure 2, social epidemiology can contribute to challenging the presumed universality and directionality of developmental knowledge.
During the first phases of my fieldwork in the late 1990s, Figure 1 knowledge was actively disputed among Brazilian academics and public policymakers. However, in everyday practice in schools, clinics, small NGOs, and families, I found that people often expressed ideas that sounded very much like Figure 1 knowledge – even if they did not specifically refer to the neuro – to classify young people’s propensity towards school failure, early parenthood, and developmental stagnation. Figure 2 knowledge circulated informally as well, used by critical educators, social psychiatrists, teachers, parents, and young people as they sought to counter the pessimism, classism and racialization enmeshed within Figure 1 knowledge.
I became intrigued to know more about the epistemic and pragmatic frictions that typified everyday uses of Figure 2 and Figure 1 knowledge. Much has been written about the mobilization of social movements that counter normative knowledge and scientific assumptions (Frickel 2010). Because scientific constructs do not simply begin with the work of scientists but are reflections of long-standing and widely-held values and prototypes (Young 1982), the public can know, use, and informally challenge science before “facts” crystallize and gain momentum. As I was starting to learn in Pelotas, this can happen somewhat under the radar, in ways that sit outside of recognizable and emerging forms of biosociality and citizen science (Gibbon and Novas 2007). How, I wondered, were young people interacting with Figure 1 and Figure 2 knowledge, and with others also using this knowledge, and how did these interactions inform their own developmental politics?
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Juliane, a 15-year-old participant in the ethnographic study of the cohort, did not shy away from voicing her opinions. What particularly troubled her was when her teachers, the school psychologist, and sometimes her mother used some variation of Figure 1 knowledge to warn her of the impulsivities of adolescence and the negative psychological impacts of “early dating.” According to Juliane, these warnings incorrectly presumed she was not a “conscious and conscientious” person. Marisa, another cohort participant, described the many difficulties she encountered while navigating romantic life as a school-going resident of the favela. She did not see herself as “immature” or “at risk” of teen pregnancy, and if she was doing poorly in school, it was because of the stresses of her parents’ meagre earnings and job insecurity.[ii] These young women’s positions validated the work of critical educators and social medicine practitioners who brought consciousness-raising campaigns (e.g. Figure 2 knowledge) to schools to reframe the “youth problem” in social rather than psychological or biological terms.
At the same time, Juliane and Marisa struggled against everyday references to “the social” of Figure 2 knowledge. They felt uneasy with the weighty discourses and the subtle social pathologization that some of their well-meaning, socially-attuned teachers used. Juliane was starting to fall in love and she looked forward to setting up a new home with her partner and becoming a mother. Marisa tried shifting the focus of her troubles from her “life in poverty” to the infantilizing and deficits-based model of adolescent development circulating in schools, which she argued was disproportionately used to target young women from the shantytown. Both Juliane and Marisa used social constructionist logics to question the suitability of the knowledge with which they were being characterized, whether it be neuro or social, and they explicitly associated Figure 1 and Figure 2 knowledge with middle-class values and power.
Over time, Marisa began to engage with the politics of knowledge somewhat differently from Juliane, and in ways that shed light on her own way of engaging developmental disruption. For Juliane, the struggle to understand her place in the world, which required constant negotiation with and defiance of Figure 1 and Figure 2 knowledge, made her want to recoil from all but her most intimate of social relations. In many ways, Juliane’s withdrawal protected her from chronic stress of social inequity. Marisa, in contrast, countered the potential paralyzing exhaustion of confronting epistemic misrepresentation by more emphatically pointing to the detailed emotional, bodily, and relational aspects of her existential pains. This was not a form of self-pathologization. Marisa drew activist energy from analyzing the material existential aspects of her life, and making these visible to family, friends, and teachers. Anger, sorrow, frustration, dizziness, and a sick stomach were not only private internal states; they provided a grounding for new relational and political ways of living and learning. We might consider that Marisa was productively using biosocial theory to critique universalizing scientific constructs, while also side-stepping some of the well-known pitfalls of social constructionism (Hacking 1999). As scholars have argued, social constructionism tends to black-box biology, either avoiding the material reality of suffering altogether or leaving the production of knowledge about the biological and psychological up to life scientists (Wilson 2015).
At the same time, Marisa also situated her life in ambiguous tension with biosocial theory. She was less interested in considering “how the social gets under the skin” than figuring out how to use her experiences, relationships, and “development” to disrupt the patterning of the social world itself. Marisa was not alone in this regard. She and other women butted up against the exhausting and sometimes de-mobilizing idea of an across-the-board biosocial entanglement of life (Roberts 2017). Some teachers’ commitment to non-causal language seemed to leave questions of action, change, and accountability unanswered. Young women avidly debated the notions of association, risk, causality, and likelihood they encountered in everyday life, and as participants of the cohort study itself. Rather than reclaim categories of clinical expertise (e.g. adolescence) as nodes for collectivized identity-making, they used their observations of the patterning of life – of how knowledge about the social patterns was being produced, who produced it, what this knowledge missed, distorted and got right – to begin experimenting with how life might otherwise be lived (Béhague 2019). They were, I conjecture, using insights into how “customary biologies” reflect patterns and regularities (Niewöhner 2011) that have long entrenched gendered, racialized, classed, and ableist norms, and restricted access to biosocial plasticity itself to those with power (Meloni 2019).[iii]
To give but one example: even when Marisa became pregnant as a 17-year-old, and even as she made plans to marry the father of her child, she remained in school and defied her parents’ wish that she put her education aside to settle into a domestic role as mother and wife. In school, Marisa went out of her way to counter assumptions that her teen pregnancy was somehow linked to common “risk-factors,” such as psychological immaturity, lack of knowledge about contraceptives or poverty. Over time, she theorized that her anxieties and depressions reflected a conscious decision to keep living in distinct spheres of life – home, school, family, parenting, friendship, employment, etc. – that often hold very different standards for what it means to be and become an adult in society.
Sitting in these different spaces, Marisa shifted to activism, contributing to a long-standing tradition of grassroots mobilization that gained considerable legitimacy in the 2000s under President Lula’s government. Marisa eventually completed her secondary education and gained entry to university, like many young people of her generation who benefitted from the government’s significant investment in public education. Yet she refused any simple narrative of individual or societal progress. Instead of characterizing her life’s changes as successes or failures, or as indicators of “good adulthood” (or not), she explicitly created a non-stagist mode of living, being, and becoming (Biehl and Locke 2017). As she flowed through divorce, single motherhood, reading feminist texts, activism, university life, a good deal of emotional pain and physical illness, and a budding profession as a teacher, she actively broke with segregationist (normative) forms of adulthood, widening her social circles and altering social patterns in highly meaningful micro-steps. In jest and with some pride, as a 30-something, Marisa sometimes considers herself an “adolescent” still.
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What might it mean to bring Marisa’s way of knowing and being to the cohort? To render the cohort a milieu for exploring (and facilitating) developmental disruption requires explicit commitment to productive epistemic conflict, and to the frank recognition of the political economy of research environments (Béhague, Gonçalves et al. 2008). We might think of cohorts, when resituated in this way, as an avenue toward what Emily Yates-Doerr has termed “controlled equivocation” (Yates-Doerr 2019) or what Charles Briggs and Clara Mantini-Briggs describe as the epistemic border-crossings of “health/communicative justice” (Briggs and Mantini-Briggs 2016).
Marisa’s fluid border-crossings taught me that on-the-ground uses of biosocial theory, and specifically, her emphasis on how “the social gets under the skin,” may be enabling certain kinds of politics while precluding others. Her reflections directed us to explore a pattern in-the-making; we took seriously the possibility that teen pregnancy was in the process of being intimately interwoven with lasting emotional painfor some young women — not inherently so, in the way some developmental biologists and neuroscientists might claim, but with vital and material impacts nonetheless. Using ethnographic and epidemiological approaches (Béhague, Gonçalves et al. 2012), we explored how the emotional turmoil that some young mothers experienced ensued not first and foremost because of poverty or the difficulties of single motherhood, but rather because these women were engaging in an embodied and public form of politics (Béhague 2019). The social got under Marisa’s skin because she invited it in; because she observed social patterns, debated probabilities, and situated herself otherwise, even as this exposed her to heightened discrimination. The social got under her skin because gaining access to biosocial malleability became an integral part of her politics.
I have yet to ask Marisa what a possible “Figure 3” might look like. I’d hazard a guess that it could have arrows going in multiple directions and circular patterns. It might also figure nooks and crannies at the tails of the normal curve, where she and her daughter and her students and friends are fashioning new ways of being. In small but cumulative increments, these new ways of being have the potential to unsettle assumptions of developmental “progress” that have long underpinned scientific constructs of human evolution.[iv]
Dominique Béhague is Associate Professor at the Department of Medicine, Health and Society at Vanderbilt University and Reader at the Department of Global Health & Social Medicine at King’s College London. Béhague’s long-term research in Southern Brazil explores the intersection of psychiatry, politics, and the rise of adolescence as an epistemic object of expertise. She co-designed the longitudinal ethnographic sub-study the 1982 Pelotas Birth cohort, one of a handful of interdisciplinary cohort studies taking place in a country in the so-called Global South. Her research has been funded the US National Science Foundation, the Fulbright Foundation, the World Health Organization, the UK Economic and Social Research Council, and The Wellcome Trust.
Notes
[i] The 1982 Pelotas cohort is run by epidemiologists at the then Department of Social Medicine (now the Department of Epidemiology) at the Federal University of Pelotas in Southern Brazil. In 1997, colleagues and I initiated an anthropological sub-study with 96 of the cohort participants and visited them until 2007, from the time when they were 15 years of age up until their 25th birthdays. Throughout these years, I have conducted interviews with over 100 professionals working in schools, clinics, research, and the public health system, several of whom I have interviewed repeatedly. The epidemiological cohort has continued with several surveys throughout the years (Horta 2015), and starting in 2019, we began to re-visit some of the original participants from the ethnographic sample.
[ii] In addition to using pseudonyms, I have altered certain details of Marisa’s and Juliane’s lives to ensure their anonymity.
[iii] With regards to adolescence, the “transformative” Lamarckian vision of adolescence that psychologist Stanley Hall codified in the early 20th century was proposed by some scientists at the time as a solution to pessimist, immutable and racialized Mendelian eugenicist proposals of the time. Yet as authors have shown, this malleable biosocial vision of adolescence has consistently, throughout the 20th century, been made accessible primarily to wealthy and white young men (Lesko 2001).
[iv] Many thanks to Michelle Pentecost, Sahra Gibbon, Helen Gonçalves, Laura Stark, Junko Kitanaka, and Guntars Ermansons for their comments on the ideas presented in this reflection.
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