Bad, mad and sad: rethinking the human condition in childhood with special relevance to moral development

Identifying the territory, between what is subject to change and what is not in human functioning, is an extremely important strategy for limiting the range in which wisdom (discretion, judgment and the management of uncertainty) must be exercised. Over the last 30 years, child and adolescent psychiatry has seen an immense shift from the 'cannot change' category to the 'change category' and an even bigger shift to the territory between changeable and unchangeable. The question of the capacity for change in humans and the more traditional notion of 'the human condition' are in need of re-evaluation. The possibility that there might be elements of the human condition that are beyond good and evil is especially relevant to the psychiatric treatment of children and young people. The notion of the human condition in children and adolescents becomes problematic if an essential element of the human condition is the irreducibly unchangeable, as the essence of youth is change and the capacity to change. The notion of personality disorder, and the persistence of disturbed behaviour that the diagnosis implies, are completely out of place in childhood and adolescence. There is a telling discrepancy between the small number of mental health treatment facilities and the large number of juvenile detention facilities in Australia. The problem is that we can achieve change, and there is little political or community will to enable it to happen.