Bullying in school is a process that arises out of toxic group dynamics, not a problem originating with a single troubled person. It may not feel that way when you've just been jeered at by one of the stars of the school's athletic program or the meanest girl in your grade just posted a nasty comment on your Facebook wall, but that is how the American Psychiatric Assn.'s first foray into the subject describes bullying, and it shapes how the nation's psychiatrists propose to help stamp out the practice.
Dr. Stuart W. Twemlow, a teacher-turned-surgeon-turned-psychoanalyst who has exhaustively researched anti-bullying programs, is the coauthor of "Preventing Bullying and School Violence," released this week by the American Psychiatric Assn.'s publishing arm. Twemlow gamely admits that virtually none of the hundreds of anti-bullying programs marketed briskly across the world has a record of consistent, well-documented success. And he thinks he knows why: because they are devised outside of the school system in which they're implemented and because they're imposed, usually from the top down, by well-meaning school committees or administrators without a wellspring of community support.
"Schools are mirrors of the communities in which they exist: if families and communities are not involved, it doesn't matter what you do," said Twemlow, a professor of psychiatry at Baylor College of Medicine's Menninger Clinic in Houston. If a school is to rehabilitate an environment in which bullying flourishes, Twemlow added in an interview, "the individual school needs to set up its own program, to buy into that program and to make it its own."
To that end, Twemlow and his coauthor, Frank C. Sacco, offer a "toolkit" for communities, school administrators and, yes, psychiatrists and other mental health professionals, to structure an anti-bullying program that defangs the school bully by reshaping the school around him (or her). The role of the mental health professional, says Twemlow, is to do what he or she was taught to do: "Shut up and listen ... to ask questions and put a different slant on the problem."
Twemlow pays particular attention to empowering the "bystanders" -- an unmobilized army of kids or teachers who routinely witness bullying behavior but may not feel they can intervene. The book offers ways to identify which kids may be exceptionally vulnerable to bullying's toxic effects and how to draw them out of isolation and protect them from psychological harm. And he cites examples of schools in which bullies rule, even as desperate parents look to those who are thought to be in charge for help.
Calling bully-victim behavior a "public health crisis," Columbia University psychologist Jonathan Cohen praised the book as a guide for mental health professionals who want to become "essential change agents" in the lives of kids and their schools.
This may be a new role for psychiatrists, acknowledges Twemlow: While psychiatrists have long worked with schools to identify individual kids with problems, they will likely be greeted with hostility if they try to diagnose a whole community as needing therapy. But psychiatrists "know that kids don't function well unless they're in an environment that encourages it" and will step up to the task.
"I think they're ready for it," says Twemlow.