How therapy culture creates victims

Description

Could it be possible that the boom in therapy for young people is harming, not helping, the next generation? UnHerd’s Florence Read spoke to the author of new book ‘Bad Therapy’, Abigail Shrier, about mental health myths, gentle parenting and the medicalisation of American kids. Watch the full interview above or read the transcript below.

Transcript:

Florence Read:
I’ve got to start with the obvious question, I suppose the critique that someone else might come into this conversation with, which is: are we surely not just seeing the result of discovering all of the people who historically over the last few hundred years, where therapy was not so widely available, would have just been left to suffer in silence? Is that not a good reason for having this kind of boom in therapised young people?

Abigail Shrier:
So that’s a really good question. We always need to ask when we see a correlation, you know, the rise of treatment, the rise in prevalence, a rise in accessibility of treatment, and the complained malady—the disorder—going up, we need to ask, is that just a coincidence? Are those two trends just coinciding? They happen to go together? But it’s not that the treatment is ineffective or, as I argue, counterproductive? I don’t think so. And here’s why I don’t think it’s an accident. There are a few reasons. First of all, whenever there’s greater treatment in a population, greater accessibility for anything from breast cancer to maternal sepsis with more antibiotics, you want to see the point prevalence rates of any disease, any disorder, going down. We want to see the incidence of depression or anxiety in teenagers going down because we know these kids are getting flooded with treatment. Instead, it’s skyrocketing. So we know at the very least, it doesn’t seem to be helping. And I’m not the only one to have noticed that a team of researchers looked into this and they called it the treatment prevalence paradox about depression. Across the West, as people have gotten more treatment for depression, as it becomes more accessible and available, rates of depression, especially in our young, have gone way up. I mapped what the young generation, the most treated generation, was going through, and I held it up against the known harms of psychotherapy because researchers have looked into: what are the common side effects of psychotherapy? We know that any intervention with the potential to help also has the capacity to harm. And that’s true from everything from tylenol to X-rays. If it has the potential to do anything at all, by definition, it can also harm and that’s true of psychotherapy, too. The known harms of psychotherapy include things like making anxiety worse, making depression worse, a feeling of inefficacy, like I can’t do for myself, a feeling of demoralisation; ‘Gosh, I’m limited by this diagnosis, I can’t possibly lead the life I want to live,’ and alienation from family members, all things that typify this generation, which is also the most treated generation. So that’s the beginning of why I started to think this isn’t an accident.

Florence Read:
Is there an increase in severe what we might consider severe mental health issues schizophrenia, bipolar, or is it actually that there is a new crop of illnesses that have come up in recent years?

Abigail Shrier:
I start the book by separating between two groups of people: the severely mentally ill—those with a real mental disorder—who are under-treated and under-served, certainly in America, by a large margin. These people are not getting the help they need. Then we have what has been called “the worried well”, these people don’t suffer in a profound way. They are sort of the bummed out teens of the West. They’re fearful, they’re worried, they’re sad, but they don’t have major depressive disorder, and we’re reluctant to diagnose them with that. There is an expansion in diagnosis, there’s no question way more people, young people, are being diagnosed with things like ADHD, depression, anxiety, and whatnot. But mostly those aren’t people who are profoundly hampered by mental illness. Mostly, it’s people who are a little, you know, extra worried or a little extra fearful or a little extra bummed out.

Florence Read:
While being sensitive to these people’s feelings, you might consider this a high functioning versus a kind of extreme or low functioning version of a mental illness, is that fair distinction?

Abigail Shrier:
I don’t think so, because I don’t think they have mental illness. I think they’re being treated as if they have mental illness, they’re encouraged to think of themselves as having mental illness. They’re sort of working themselves into mental illness, but they don’t have mental illness.

Florence Read:
Okay so there wouldn’t be any markers in the blood of serotonin level or anything like that that would be measurable, biologically measurable about these patients, that would mean that they could get a firm diagnosis of what you might consider scientific mental illness?

Abigail Shrier:
It’s a good question, I will say that for all people, all sorts of people who get things like antidepressants, there’s a real question of the objective markers, even for the severely depressed. But let’s take the severely depressed for a moment, these are people whose lives are so profoundly affected, that they can’t get out of bed, that they are truly suffering in a way that they can’t function otherwise, that is not the population I’m talking about. Those people need all the resources we can give them. But mostly, I’m talking about people who just feel like they need a mental health day off work. They don’t even usually say they have mental illness, although these young people are quick to state their disorder, but they’ll just say I need it for my mental health, not that I have mental illness, but that this would be good to boost me and that’s what we’re doing. We’re assigning preventive care, so called preventive care, which has never worked successfully in mental health, preventive care to a population that is well, and that’s why we’re running into so many problems.

Florence Read:
I have noticed recently that there’s an urge towards encouraging people to think about their mental health as something that everybody has and is very much on a spectrum, that at any given time, you have this thing called your mental health. And it could be on a point of the spectrum, which doesn’t quite align with the very mentally ill if you’ve ever interacted with someone with extreme mental illness, it doesn’t feel at all like a spectrum. It feels that in fact, they have an illness in the same way that you either have cancer or you don’t have cancer, you don’t have a little bit of cancer.

Abigail Shrier:
Exactly and I love how you began when you said; “Isn’t it nicer just to call them high functioning?” No, I think it’s a huge error and here’s why. They’re not high functioning depressives, they don’t have major depressive disorder, which is a profound condition. I’m not minimising the actual conditions which people do have. What I’m saying is I’m disputing the idea that we’re all a little mentally ill. Now it is true that the rising generation describes themselves that way, they seem to believe we’re all on this big continuum of mental illness, where the serious schizophrenic is on one side, and I’m just a little to the right of that, that’s actually not true. Schizophrenia is a profound, profound illness that that is very difficult to deal with and the bummed out teenager doesn’t have a little bit of it.

Florence Read:
What I want to do now is kind of get into a programme that an American teenager might enter into that you describe in your book, and exactly what the steps of that might be. What is the general age of onset for these conditions that you don’t want to call mental health problems or mental illness, but just for the sake of clarity, I will do that now: What age do children in America start to feel mentally ill?

Abigail Shrier:
I know that, I can give you a few statistics; So in 2016, so this is a few years ago now, already one in six American children between the ages of two and eight had a mental health or behavioural diagnosis. That’s a report by the CDC. These are not kids who were on social media, it’s back in 2016. And it’s between the ages of two and eight. Okay, these little kids are being so diagnosed. So we know that there are surveys in which young people less than half of young people, the rising generation, you know, so called Gen Z, less than half of them say their mental health is good when surveyed. They are a generation by so many markers that believes itself unwell, they’re demanding mental health days off of work, they do not feel up to the challenges of life.

Florence Read:
So it’s not quite fair for us to say this is just a normal teenage or adolescent moment, a difficult moment between the age of 12 and 15, where we might have in previous generations just said, “Look, everyone goes through this little period where everything feels very confusing, and you have all of these strange emotions.” It’s not quite that that’s not the answer here.

Abigail Shrier:
If we treated it that way, maybe it would be the answer, but we’re not treating it that way. We’re diagnosing, we’re telling them they have a mental problem, and they are encouraging themselves to see themselves as disabled. Ill give you an example. I interviewed a world expert named Arthur Barsky on something called hypochondriasis or being a hypochondriac. We don’t call it that anymore. We now call it illness anxiety disorder, or somatic symptom disorder, but it’s basically the same thing. And I asked him, what is it? What does it mean to be a hypochondriac? Are these people who are faking it, faking their illness? And what I learned is no, they’re not faking it. These are people who apply hyper-focus to the normal pains we all feel. And through that hyper-focus they magnify their pain because our minds are actually able to do that. And that’s effectively what I believe young people are doing with their emotional life, I call them emotional hypochondriacs. They are applying so much hyper focus to every bad feeling, every feeling of worry, every feeling of sadness, that they are turning these minor incidents into a kind of trauma. They are absolutely magnifying their emotional injuries and talking themselves into a state of almost mental illness.

Florence Read:
So if a young person in America, because this book mainly focuses on the American system, has that feeling of hyper focus on trauma or pain, whether that’s normal or abnormal, what are the steps then? They get referred to a therapist? Is that through school? Is that a private clinic? What are the options here for a parent who thinks that their child is struggling or a child themselves? Who decides to take it into their own hands?

Abigail Shrier:
I’ll answer this a little roundabout, so when I started this book I had a totally different hypothesis, which often happens when I start writing something. I had a totally different hypothesis, I knew that the rising generation was struggling, that more of them were claiming to be anxious, depressed, and have anxiety and mental disorder, or depression, or PTSD, and all sorts of things than we had ever seen before. But, I thought perhaps it had something to do with the way they had grown up, they had been so gently raised, maybe it had to do with their parenting, maybe it had to do with the lack of depression, world war or major trauma to the generation that they had to rise to…

Florence Read:
They’ve never had like the school of hard knocks. So they’re not prepared for the real world.

Abigail Shrier:
Exactly. That’s what I assumed and I actually sold the book to publishers with that hypothesis. But as I was researching, I learned something. Not only were nearly 40% of the rising generation had been in some form of mental health treatment. But actually, when I looked at what was going on in schools, mental health staffs had expanded, they were all doing social emotional learning and coping mechanisms and emotions focus at schools. They were constantly the the mandate of schools with what they call trauma informed care, meaning we’re going to assume every child has been traumatised, they had been parented by parents who had read therapists books on how to raise children with therapeutic techniques. And then many of them had been seeing actual therapists. So the whole combination led to a life that was deluged in therapy.

Florence Read:
How did this happen? Was there a bill or a law that was encouraging or enforcing this therapising of schooling? Is that something we can point to that concretely actually changed the course of how we interact with therapy?

Abigail Shrier:
Some people trace this back to after the Second World War when some of the soldiers came back they were really struggling with what they had lived through and seen, and Congress passed a bill to refocus our mental health services and allocate services for the well. Suddenly, the watchword was preventive mental health care; our mental health experts were no longer going to treat the ill; they were going to treat the well also. That was called preventive mental health care. But as far as kids in schools go—by the way, preventive mental health care has never worked; it’s never been something we’re good at. It doesn’t have a good track record. But there’s something else that happened in schools in 2014, in 2014 President Obama looked at the rates at which minority students were being suspended and expelled from schools for bad behaviour and he wrote something called a ‘Dear Colleague Letter’ in which he effectively threatened schools with loss of funding if they continued to suspend or expel a disproportionate number of minority students. So then the schools wondered, what do we do with bad behaviour? And the answer came within that same 2014 letter: restorative practices, restorative justice. This is a system of understanding all bad behaviour as an outgrowth of emotional pain. And the solution became, we need to attend to kids’ emotional pain because they presumed that the only reason kids ever exhibited bad behaviour or acted out was because they had been traumatised.

Florence Read:
So I mean, in theory, that sounds like quite a good idea that if someone’s had a traumatic upbringing, whether that’s in poverty or with a lot of violence, that you should give them support at school so that they can live a high functioning life and they can escape that kind of world and enter into a different civil society. That feels like in its essence, there is something good there or good intention. How did it go so wrong?

Abigail Shrier:
Well, because they’ve ignored all the research. So for instance, what you just said; Do kids need support?” All kids needs support of course, including kids who’ve been through something very traumatic. They may need special kinds of support, there’s no question, depending on what they’ve lived through. But two things: one, should we presume that most kids will be traumatised by a tough upbringing? No, actually, we should presume the reverse. Most kids are remarkably resilient in the face of adversity. Two, is there proof that kids who have been severely physically abused are more likely to abuse their own children? Actually, no. In prospective studies, meaning forward facing studies, which are the only rigorous ones where you start with the kids were their children, Kathy Widom did this a wonderful researcher, she started with the kids who were actually children, she documented their abuse, so we have proof of it. And then she caught up with them 15 and 20 and 30 years later, and it turned out, they were no more likely to abuse their own children. And then the last thing is, well, let’s assume some of these kids do need extra support. Is it best given to them in schools? And is what we’re doing helpful? No, it’s counterproductive and here’s why. There are wonderful studies now, after I wrote the book, I literally had finished the book and two sets of researchers were thinking the same thing in Europe that I was thinking. One was this woman Foulkes out of Oxford, and another was a set of researchers out of Australia. They were looking at the techniques being used in schools, wellness techniques, coping mechanisms for dysregulation, anti bullying, awareness, they had a control group, so it was actually rigorous of kids who didn’t go through those programmes. And what they found was the kids that sat around, dwelling on their pain, focusing on their emotions, learning coping techniques for dealing with it, which of course forces you to think about bad emotions, those kids ended up sadder, more anxious, and more alienated from their families.

Florence Read:
Do you think that there is a step-by-step journey here that kids are going on, where they enter into a more soft therapeutic atmosphere like a counsellor’s office, where really, they’re just in there to talk, and then they end up snowballing down towards something much more extreme, whether that’s therapeutic interventions through medication or even, inevitably, surgery in some cases, if you’re talking about gender dysphoria, which is what your first book is about? Guide me through that I want to kind of understand how a parent might allow their child to go to a school counsellor, and then find out weeks or months later that they have been put on quite a strong medication?

Abigail Shrier:
There’s a lot of different categories of medication, there’s the speed, there’s the antidepressant, the SSRIs, the anti anxiety medication, and all of them come with serious side effects. And there’s a reason to really think about whether your child needs them before starting them on them. But let me just talk about therapy for a second, I wrote an entire book, obviously, about the irreversible damage about the transgender epidemic about teenage girls. What I want people to know is, in almost every case, the girl who was sent to a therapist by her parents, not for gender dysphoria, but for anxiety or depression. In almost every case, the therapist participated and encouraged the young teens revelation that she was transgender. Because what they were doing in psychodynamic psychotherapy while they were exploring the young girls alleged trauma, when they were done talking about mom, they would move on to gender. So how are you feeling about gender? And together, they would come upon this diagnosis. So before we even get to medication, there are very real ways in which therapy can make your problems worse, or introduce new problems. That’s what bad therapy is. It’s therapy that exacerbates current problems or introduces new ones.

Florence Read:
Is that a problem with a kind of affirmative practice? That’s how it’s often referred to.

Abigail Shrier:
Absolutely, we have affirmative care in the US and I’ll say something else, when you’re an adult in therapy it’s entirely different. Remember, therapy is set up in many instances to affirm the patient in some sense. Now, therapy at its best often challenges a patient, there’s no question, but things are different with a child. Why? Because they haven’t been the one to decide they wanted to go to therapy in the first case, right? Adults make that decision for themselves, but a teenager who shows up in the therapists office, it’s because her parents made her. So the therapist has to work to get her buy-in, in a way that the therapist doesn’t need to with an adult, but there’s something else too: a child doesn’t have the life experience of an adult. It’s very hard for a child to say to an adult, “Listen, I’m not sure we should be calling my parents toxic, I know that they said something insensitive, but I think that’s a little over the line.”

Florence Read:
A therapist is also to some degree an authority figure in the life of a child. I mean, any adult is a kind of authority figure. Theres a reason we teach children to try and be sceptical when someone says, Hey, you know, why don’t you come over here and get in the back of my van? It’s because children are naturally open minded and trusting to a fault. And in a therapeutic office, that’s even more a position of obvious institutionalised authority.

Abigail Shrier:
Precisely. That’s exactly right. I’m not against therapy; I’ve been in therapy, I write about it in the book. But any adult who goes to therapy has the resources to push back and say, “you know, I think we’re getting a little off track here. I don’t really blame my wife that much. I mean, it wasn’t totally her fault.” But it’s very hard for a child to do those things. And no one is watching. There’s no oversight when you drop your child off. Now, I am not saying a child who has a severe problem shouldn’t be put in therapy. Of course they should, an anorexic child, I mean, there’s so many conditions in which you take your child for treatment the moment that it becomes necessary absolutely. But the question is, are parents dropping their kids off without any sense that there could be negative side effects? And unfortunately, I think they are.

Florence Read:
How does patient therapist confidentiality work in the context of having a child patient? I’ve always kind of wanted to know…

Abigail Shrier:
Im not sure I totally understand it, because there’s a lot of wiggle room here. I know that the that the confidentiality seems to be between the therapist and the child, but a lot of the information gets leaked to parents. Parents often use the therapist, and they told me this, to kind of surveil the child like can you make sure nothing bad is going on?

Florence Read:
So kind of helicopter parenting?

Abigail Shrier:
Yes exactly, so often that seems to be how it’s working in practice. Now remember, when you drop your child off to a therapist, the therapist’s job is to be non judgmental, that’s something we want as adults. We don’t want a therapist judging our life decisions; we want help with the things we need help with. But with a child, dropping your child off for a non-judgmental adult’s assessment of her life, who might say, you know, “Oh, you’re having sex at 12. That doesn’t seem to be a good idea.” You don’t want non-judgmental with a child, unless you absolutely need it again. That’s where we’re seeing so much mischief being made.

Florence Read:
There’s also a question here about do children have the right to privacy from their parents? This is obviously very tricky it’s like age of consent, it’s got a lot of grey area around it because of the way in which different people mature at different speeds. But you would think a child who is vulnerable in some way has said that they are feeling bad, whether that’s a genuine mental health problem, or just a sense of malaise that’s quite normal for an adolescent. Those are the wrong people to be allowing kind of complete privacy and ownership over their own future, given they’ve admitted freely by entering into therapy that they don’t feel good about themselves?

Abigail Shrier:
Thats a great point that I’d never considered before. But that’s true, that does create a vulnerability and here’s the problem; There are great studies showing that exercise does more to lift mood, any kind of regular exercise than antidepressants, or therapy. For mild to moderate depression that will do more. And it doesn’t have all the iatrogenic side effects, iatrogenesis being when the healer introduces the harm. Exercise doesn’t have those, in fact, doing things for others getting involved in community, spending time with friends, all these are incredibly good for mood. Dropping kids off at therapy, a lot of parents who I wrote the last book about, who thought they were dropping off a very anxious or nervous or sad teenager with a trusted adult, they thought the adult could just be trusted to sort things out for her. I don’t think in almost any case—and I talked to almost 1000 parents by the end—I don’t think in any case, I heard “the therapist told my daughter, ‘Nope, you’re not transgender, you’re just 12.'”

Florence Read:
If the parents worry is that their child, if they read a book like yours, their child might enter therapy and come out with a diagnosis that seems overly extreme or completely false if your book is to be believed; isn’t there a risk that there might be these kind of conservative therapists who crop up knowing that they could leech off these anxious parents and make good money off telling the kids that they are absolutely fine when in fact, some of those kids might actually not be fine at all?

Abigail Shrier:
So there’s always a danger of course of under treatment, right? We are not seeing that, we are so far from that, that it is not a realistic worry right now. If you’re telling me that after my book its going to have such a dramatic impact that people who need therapy won’t avail themselves. Wow, that would be a sea change!

Florence Read:
I’m ambitious for your for your prospects Abigail.

Abigail Shrier:
I don’t foresee that, and of course, I don’t advocate that. And I’ll tell you something else: if a child’s already on antidepressants, and we can talk about all the medications if you’d like, but if a child’s on them, wow, you need a mental health expert to help them taper. You need some kind of psychiatrist or some medical provider to help them taper if you believe they were prescribed it and they don’t need it, they can’t just go off it on their own, that’s dangerous. Because the symptoms of withdrawal are very serious.

Florence Read:
Let’s talk about those medications then because this seems like a good time. The US is kind of famously infamously over medicalised. Us in the UK see you Americans as people who are constantly kind of going therapy and popping pills. What are the most commonly prescribed medications at the moment for young people?

Abigail Shrier:
Stimulants are extremely heavily prescribed. So Strattera, Concerta, Adderall, Ritalin for ADHD supposedly, SSRIs; the FDA, our Food and Drug Administration just approved Lexapro, which is a very serious SSRI for seven year olds in our country.

Florence Read:
What would the effect of a seven year old who does not have the condition that would make that necessary taking that drug actually do? Would there be any harmful consequences of that? Or would it just have no effect?

Abigail Shrier:
There’s everything from weight gain, to being in an emotional snowsuit, where you never feel the lows, but you also never feels the highs of life. Never learning to cope with normal distress, because you’ve only ever done it on a chemical, with a chemical chaperone, Deletion of your sex drive, and of course suicidality is a side effect of SSRIs in adolescents for reasons we don’t totally understand.

Florence Read:
It’s a really interesting question about medication because of course, as soon as you get someone onto medication, it becomes naturally harder to function without that medication. That is, of course, the nature of being medicalised or feeling that psychologically you rely upon a chemical rebalancing your brain chemistry to succeed or to just function in everyday life. Is there a kind of reverse placebo effect where, in fact, coming off these medications becomes terrifying and daunting? Because actually, even if they are not helping you with the condition you think you have, you feel like you’re not gonna be able to cope without them?

Abigail Shrier:
Absolutely, first of all you’ll have to face withdrawal. Many people say – I haven’t been on them – but many people report that the withdrawal, the period when they were off them created the worst depression they ever felt, or the worst anxiety they ever felt. Absolutely, there becomes this fear of going off them. I’ll say something else, if you don’t mind. I want to respond to one more thing, to something you said earlier, which I thought was such an interesting question about the idea of “What if there’s a conservative therapist who tells you you don’t need anything, go ahead, is there money to be made?” No, there isn’t money to be made there because they lose the patient. See, the person who tells you you’re fine, keep playing or things will get better, you’re going through a rough patch, they might be wrong, it might turn out that you need more help than they gave you, but they’ve lost the patient. They don’t have an incentive to say that, right? But there’s something else too; it’s a really good way of triaging the people who really do need it. Because if you say to a kid, “You’re fine, here, let’s change some things in your life,” and the child is still suffering, and there’s nothing you can do to stabilise the child, now you know you have a child who really needs an intervention. But if you never make changes to her environment, if you never try to get her on a healthier course, and you just start with the medication, you don’t know what you could have done without it.

Florence Read:
Do you think this is just an issue that affects the upper or upper middle class? Because we have an image of kind of California stay at home mothers who have ultra rich finance husbands and they just spend all day worrying about the wellness of their children, that kind of cotton wool parent, that feels like the preserve of this sort of incredibly expensive therapy, the kind of person who might also have you know, a horse whisperer or a dog Reiki masseuse, whatever it is. It feels like a luxury product, is that the case here? Are we just talking about the elite or does this actually trickle down?

Abigail Shrier:
It absolutely trickles down, that’s something I really thought about when I was writing because I don’t believe in writing books that are about fancy people’s problems that they create for themselves. I just have a limit to how much sympathy I have for that situation. I have some sympathy but you know, at a certain point if you created your own problem, that’s not something that terribly interests me.

Florence Read:
Yeah, you can pay your way into it, you can pay your way back out of it.

Abigail Shrier:
Right, exactly, exactly. That’s just not something that captivates me as a Journalist. But here’s why I don’t think this falls into it. First of all, these things like the social emotional skills that are being taught, the counselling staffs that have expanded in every public school, this is across our country, it’s every public school. And here’s the thing, these things that start out as fads of the rich, and of the upper middle class, the middle class, they always hit the lower income families the hardest, and those are the families that can’t remediate. So if you have a child showing up to school, and he is poor, and he has had larger adversity, having a counselling staff telling them that they’ve been traumatised, that they are marked by this trauma, and that we have to adjust our expectations of what you can achieve down. That’s devastating. Because no one in that child’s life is saying to him, “You can do it. Do you know how many kids show up at school every year who are just in your circumstance, and they’ve gone on and achieved things? Let’s talk in history about people who are even poorer than you and did great things.” You know, “You can do it. Just because you came from a poor background, that doesn’t mean you can’t achieve anything. There’s nothing we should limit you by.” That’s what they need to be told. That’s what they’re not going to hear. And these are the kids who are going to be most vulnerable to the message that they’ve been traumatised in a permanent way.

Florence Read:
I’m thinking of kind of The Sopranos, where Tony Soprano sits in the the therapist’s office and he’s so affronted, at least at the start of the series, by the feminine nature of therapy, because it’s so flies against his hyper macho Italian mobster identity that he rejects it as an idea. There are many patriarchal figures are a la early Tony Soprano, so isn’t there an argument there that we really need support for those people to allow them to release their emotional lives? They might actually just not get that at home, whereas the trends of gentle parenting and kind of feminised parenting that we have in the elites means that children who suffer a few hard knocks at school can come home to their cushy house and their mother will kiss it better? Is there not an argument there that actually it is those who are in the highly patriarchal lower end of the socio economic spectrum, who require a softer approach somewhere like school where they can get it?

Abigail Shrier:
What you started with, the question started with a sort of characterisation of the idea that all therapy is kind of feminine and talking about your problems is always foolish, and self-indulgent…

Florence Read:
Or considered so by a certain group in society, which I think is still an issue, even now.

Abigail Shrier:
I hear that all the time, I hear that on the right in America. That’s not the argument I’m making. It’s not the argument I’m making, because I don’t consider it a terribly serious argument to just say all therapy is dumb. It’s feminine, no one needs it. I don’t think that’s backed up. But also, I just don’t think that’s right. There are people who feel that they need it and benefit from it. And there are there are kinds of therapies that have been very effective. But I also am just someone who believes that if you’re an adult and wants to go to therapy, good for you, that’s your business. I just wouldn’t write a book about that. You know, I talk about my own experiences in therapy, I’m fine with therapy. The question is a traumatised child, a child who’s lived through absolutely traumatic experiences at home; is it helpful to have counsellors casually inquire about their trauma at school? So, unless there’s a reason that they have indicated they are struggling, I don’t think necessarily that should be our presumption. Why? Because actually, the research doesn’t show that. So a few things. Let’s get clear, sorry, I’m not being clear. There are kids who are profoundly traumatised by various things who have suffered horrible neglect and abuse. Those kids may need help. The question is, is a school counsellor the best person to give it to them? I would think in general No. Now why? Because they’re off all summer. They take holidays off, a child who needs profound support needs to get it and school is often not the best place to provide it. Okay. But there’s something else too, you don’t want to dabble in a child’s profound abuse in the middle of her school day. She may cry, she may be brought low by the memories, she may be re traumatised, you don’t want to break her down in the middle of her school day. Unless there’s an absolute reason to address it.

Florence Read:
Does the proliferation of these kinds of less severe diagnoses actually encourage school counsellors to act more casually around the idea of trauma? Are they using the word trauma in a more throw away manner than they might have done 50 years ago?

Abigail Shrier:
We know they are in America, there are now therapists making money calling themselves climate therapists. They help you with your climate anxiety. They talk about summer anxiety, that’s the anxiety a child might have missing his friends or her friends over the summer, because he doesn’t get to see the school friends over the summer. There’s relocation depression, that’s the depression you go through when your parents move. These are things that used to be considered normal parts of life, that we are psycho pathologising. So yes, school counsellors are absolutely doing that. And young people, if you see they talk about their PTSD at being teased in middle school, they don’t have PTSD, but they believe they do.

Florence Read:
Even if you never see a school counsellor, or even go to to a therapists office, you are not safe from the therapised culture you claim in your book. So, tell me more about that, what is this kind of water we swim in that means that everyone has absorbed a certain degree of therapy using language into their lexicon and into their being?

Abigail Shrier:
Adults, teachers, everyone throws around casual diagnoses of your children; they may even throw it around to the children themselves and tell them, “Oh, you have a learning disability. Oh, you have ADHD. Oh, you have a little PTSD.” And they refer to their own. I remember before my my kids, they have these routine tests that kids school kids in America have been given every year in elementary school. But before the test, the teachers announced, you may have some testing anxiety so we’re going to have your parents write a little letter of encouragement to you before the test to help soothe you as you go into your test. Telling an entire population that they may have testing anxiety is the way to create testing anxiety in a population, it’s completely irresponsible. That is the mental health staff’s at schools advice? Certainly the one that my didn’t mind did. But I’ve also heard this across the country, introducing the idea to kids that you may have depression, you may have suicidal thoughts, you may have anxiety, is a great way to introduce it and that’s what they’re doing,

Florence Read:
What sort of evidence we have for that confirmation bias? Because I think there is a gut feeling amongst many that that is true. But I’ve never quite heard a kind of robust defence of why actually, you would not want to bring up an idea to a child for fear that they might latch on to it apart from a kind of anecdotal sense that children love to latch on to things.

Abigail Shrier:
Oh gosh, there’s so much great research on this that I’m almost overwhelmed. But let me give you the Vienna subway study, the Vienna suicide subway study of the 1990s. So in Vienna, Austria, there was a spate of subway suicides, people throwing themselves on the subway. And the researchers had found three things that seemed to spread a suicide contagion: One, valorising the subject; two, repetitive mention of suicide; and three, casually presenting suicide as a means of coping with sadness or disappointment. Those things were increasing it, so they they made the newspapers stop doing that, they no longer reported suicide in those ways. They were able to drop the suicide rate by 75% in Vienna, and keep it down for five years, just by avoiding those things. Repetitive mention, valorising the subject of a suicide, presenting it as a means of coping, “you might feel suicidal”, all those things, encourage it in people’s minds. And there’s lots of studies on this. If you introduce anxiety, for instance, take anxiety. We know that treating parents of young children with anxiety who seemed to manifest anxiety disorder, treating the parents is often the best way way to cure the children. Why? Because it’s the parents that are communicating their anxiety to the children. We know that it’s communicable. When you say to a child, “You should be worried, this is worrisome. Oh my gosh a dog just barked at you. Oh my goodness, that is scary. Isn’t it scary? It must have been terribly scary.” You’re increasing the child’s anxiety.

Florence Read:
This feels like very basic parenting 101. You write in the book about this new trend of gentle parenting or permissive parenting as you refer to it, which is this idea that you need to challenge your child less, discipline them less, and ask them more open questions, effectively treat them like a little adult who can kind of make up their mind about their own decisions. Tell me more about how that parenting style has gone in tandem with the therapised culture and what the effects of those two together might be?

Abigail Shrier:
So gentle parenting is really therapeutic parenting. It’s parents pretending that they’re therapists. They are non-judgmental, they put themselves on the level of the child, they never punish, they avoid the word “no,” and every time a child acts out, they ask the child, “Oh, you’re experiencing big feelings, let’s talk about your feelings, I empathise with your feelings.” They’re always affirming the child’s feelings exactly as a therapist would, or as therapy often works out, and they never punish. They try to avoid all punishment and the so-called “stigmatisation of bad behaviour.” It’s a disaster, it’s a disaster to put a child in charge, it’s a disaster to never punish a child and never be an authority with your own children. Now, that doesn’t mean being unloving, or unemotional, or even unaffectionate, of course. But telling a child who’s just clocked his sister, “Oh, I see you’re feeling some big feelings. Let’s talk about that”. That little sister should expect to be hit again, and that’s that’s what’s happening.

Florence Read:
Do you think it’s any coincidence that it’s Gen X’s who are the kind of parents of now who are doing this over therapies thing, that were the latchkey kids, or the kids whose parents use a kind of self soothing technique and let them cry for hours and hours, which was the trend of the time then? Is there any coincidence that we’ve seen a kind of overcorrection in this generation?

Abigail Shrier:
Right, so I talked about this in the book that I don’t think it’s a coincidence. I think that we really believed in therapy (Gen X). Im at the very tail end so I’m the youngest of the Gen X, but then Millennials went further with it. But I think that we grew up with the idea, you know, the movie Good Will Hunting, you mentioned The Sopranos, all of this reinforced the idea that the only way to cure bad feelings is to talk it out. Now, in fact, there’s not very good research for that, or at the very least, there’s conflicting research. Some people, even people who experienced terrible trauma are better served by not talking it through, because that would only re traumatise them. But unfortunately, therapy is a profession – and I quote, a wonderful, wonderful mental health physician Richard Byng from England, he works with convicts in Plymouth, England, he talked to me about this, that very often the profession assumes wrongly that everyone needs to talk about their problems, and only by talking to the to them about their problems can get get past those problems. That’s not true. It’s never been true. And some people will be much better served. by actually getting out in the world, doing exercise, being with others, being involved in a in a project that is meaningful, or serves the community. All these things have have wonderful impacts on mental health way beyond sitting around, and rehashing it every week.

Florence Read:
Well this brings us on to the kind of reasons for this mass mental health event or whatever is happening to these kids, however, we want to refer to it. Because I think in previous conversations, people might have said to you, you know, “I throw my hands up in the air because these these are the most privileged kids who have ever lived. They are these western, hyper wealthy, incredibly free, liberated young people. They have nothing to worry about”. But actually, I think that’s not quite fair. I don’t think it is so much of a paradox, I think, probably being told all the time that you are the luckiest kids to have ever lived might actually cause you to feel quite a lot of anxiety, depression, whatever it is about the state of reality, which is obviously never as good as it seems or is sold to be. Do you think that we’ve actually kind of traumatised the generation by trying to promote the idea that they haven’t so good?

Abigail Shrier:
I agree with that. I will tell you something, I have never called them snowflakes. I do not believe their distress is to be minimised. These kids are in real distress. And I don’t think we’ve given them the best life. I think their life is often very unhealthy and there’s a reason they feel so bad, and it is disturbing. I started the book by taking their distress seriously, because I believe it deserves to be I don’t believe they’re not entitled to feel bad. Here are some reasons why; their parents were afraid to exert authority with them, so very often they didn’t feel like anyone was really in charge, that’s a terrifying thought to a child. They had way too much tech, which makes kids awfully lonely. Social media in place of in-person interaction is terrible for a child and we know that.

Florence Read:
They’re told as well via social media, they can have more friends than any generation ever has before, but then they realise probably quite quickly that those friendships bear no resemblance to the friendships of 100 years ago or even 25 years ago, when you had to have meaningful in person connection with someone to actually consider them a friend.

Abigail Shrier:
That’s right, there was a beautiful, by a young British woman Emily Towner I think her name was , a wonderful piece of research called ‘Welcome to my Zoom party’, all about how zoom parties it turns out don’t fill you up. It’s almost like having no part. So you think, oh, they’re having so much fun, they’re always connected their friends, but it’s not filling them up. It’s not true. And you know what else? We didn’t give them chores or jobs or responsibility, the things that make them feel they have capability in this world, we denied them. We denied them extended family, we denied them more siblings, all this stuff is so good for you. And there’s great research on all of it. People who love you, and you love back over time, over a lifetime, like siblings, extended family, grandma, grandpa, these people are necessary, they’re good for you and we deprive them of that.

Florence Read:
There’s just been a bill today released that may potentially ban Tiktok in the US, I’m sure you’ve been reading all about it. Would you support something like that? Do you actually think the answer here is to start intervening in the lives of young people and the kind of content they’re seeing the the ways they’re interacting with each other? Is there an argument for a kind of emergency intervention here?

Abigail Shrier:
There are very, very many reasons not to like TikTok and be worried about it, of course, its relationship to the CCP and everything. But do I believe in playing a shell game of chasing after which social media app is worst for kids now? No, I think we’re gonna lose that badly. Because the reason is, it’s all pretty bad for kids. And it’s all only one part of why they’re so sad today. So if parents give kids a healthier life, if they take away the phone, certainly during the school hours, and maybe completely depending on their age, if they exert authority in their home, if they give the kids a sense of purpose, if they have them doing chores, and contributing to the household, if they have high expectations for those children, if they give them a moral sense of treating other people kindly if they if they punish bad behaviour, and tell kids we expect better next time, if they have faith, when they get minor scratches that they will be resilient. Wow, now you’ve got a healthy child out in the world. You don’t have to do this frantic worry over which app, which social media app we need to ban next.

Florence Read:
Do you think there’s a chance that some families will go kind of full elite luddite and start removing phones, removing screens from their children’s lives, and then the ultra rich can actually start to create this elite retreat movement where they step away from modern society and allow their kids to grow up in the way that they might have 50 years ago.

Abigail Shrier:
So the truth is, I think we’re already seeing it. Whenever I meet a an impressive young person, I asked them about their life. And their life looks a lot more like a kid’s life in the 1980s. And they usually don’t have a phone, or it’s extremely restricted use, and they do spend a lot of time reading and they don’t have a lot of screens, and they do spend a lot of time with family. So I think it’s already happening. I think those families don’t call attention to to themselves. But I think there’s going to be a huge bifurcation, with between the kids who have absolutely no attention span and have terrible feelings of loneliness and incapacity, these kids who have been over-treated and the group that was left to have a healthy childhood, and whose parents said, “nope, we’re not doing that here”.

Florence Read:
It might become a kind of status symbol. It used to be that your kid had a Blackberry that was the big thing at school. Now, it might be if your kid has no phone at all.

Abigail Shrier:
I could imagine that. I mean, absolutely. I know in the UK, you’re already banning them, the phones during the school day. This is so obviously the right move. I think it’s so important. I don’t think it could be more important. This is, you know, one of the one of the most important things we can be doing right away to help kids. And Jonathan Haidt talks about it a lot. He has been spearheading this. And I think, you know, it’s wonderful. And it’s an absolute no brainer that we have to get behind that. I want to invite those people who think that to talk to someone who’s raising a child who’s really struggling with a disorder. These people, what they have to do with a child with severe autism, or OCD, or anorexia, or all sorts of mental conditions that you can have. These people often and one woman in particular talk to her at length, I always think about her, she’s so angry about all the parents who talk about their ‘spectrum kids’, kids who are a little on the spectrum of autism. And she says you don’t know what autism is, my son has autism, it’s so hard. And he doesn’t belong in a normal, in a regular classroom, because he can’t do it, it doesn’t serve him, let alone the other children, he needs more intervention than that. So having all these other kids prevent pretending that they are sort of depressed, is not helping the kids who are actually struggling with major depressive disorder, and it’s not helping the kids who are talking themselves into a kind of depression. So I believe that does a disservice to everybody to pretend that the average middle school kid has a little bit of PTSD, that doesn’t help our combat vets who actually have PTSD.

Florence Read:
It’s a bit of a catch-22 for parents at the moment, though, isn’t it? Because there’s a politicisation of this, which is that, and correct me if you think I’m wrong, there is a progressive alignment with caring for the mentally ill it’s like caring for another minority, whether that’s an ethnic minority, religious minority or whatever. And so it’s aligned with the progressive movement, social and political movement. And so for a parent to say, look, I don’t agree with this hyper normalisation of the therapeutic model. I don’t agree that you my child is mentally ill. The child could turn around quite easily and say, Look, Mom, you’re on the wrong side of history. It is good to care about the mentally ill and I as a self assigned mentally ill person is now a kind of minority who needs to be cared for in this progressive manner. Is that something you saw when you were looking into this?

Florence Read:
To stick with this idea that caring for the mentally unwell is a kind of progressive value, and just take it to its kind of logical conclusion; is there -and maybe I’m being incredibly cynical here so apologies- a sense that in schools, there is now a reverse victim hierarchy, where you can gain social status or clout in a kind of progressive system by being someone who has one of these various disadvantages? Whether that’s you are a woman, or you’re an ethnic minority, or religious minority, and that allows you some social status within this new configuration, which puts patriarchal white men at the bottom and then elevates the victim status? If you are a white boy, and you’re being told that you are the aggressor, you are the baddie in society, does it make you more likely to hook on to falsely a medical diagnosis that no one can actually dispute, but does then put you in a category of a victim? Even though none of your immutable categories would put you there?

Abigail Shrier:
Absolutely, many of the young people I interviewed told me that explicitly, they said, it’s weird not to have a mental health disorder. And it’s weird not to have a diagnosis. That’s how they put it. You know, we all have a diagnosis. Here’s another thing that was so troubling, and by the way, it’s very similar to the last book I wrote about these girls who were looking for a way to explain their pain that people would respect, and a lot of these girls who identified as transgender were white girls, they were looking for sympathy.

Florence Read:
They were reading the culture and seeing where they might fit in.

Abigail Shrier:
Exactly, and here’s the disturbing part; these kids had convinced themselves, when I talked to this one young woman, Nora, who’s a high school student out here, she said, basically, the way she described her friends, both the ones who had been institutionalised for suicide attempts, and the ones who have social anxiety. She saw them as one and the same, all one continuum of mental illness. And that’s how kids are seeing themselves today. It’s all just one continuation from the serious schizophrenic who’s screaming on the street to, “Oh, I get nervous before a test. We’re all a little mentally ill”, it’s not true. And it’s doing them a terrible disservice.

Florence Read:
I have to ask you this, because I’ve got you here and I read your last book, you dealt with the issue of puberty blockers throughout that book. And in fact, it comes into this book as well ofcourse. In the UK, just last week, the NHS announced that it was no longer going to prescribe puberty blockers as a treatment for gender dysphoria for young people using it services. Is that something you’d support in the US? Is it something you think is a good thing? There have been many trans activists and also trans allies saying that it will cause a mental health crisis for those people who are on waiting lists already, and have been waiting for years to have this treatment that they feel is a kind of cure for their mental problems. What do you say to that?

Abigail Shrier:
I so admire Britain for the way it’s handled this. I think that the NHS making this decision is one of great integrity. And I’m so admiring of all the people all the wonderful doctors and journalists and people who worked to expose the risks and speak up at great personal cost to themselves about the terrible risks and lack of shown benefit of puberty blockers. I can’t say enough good things about the way the UK has handled this. I have to say in the US, it’s unlikely that we will have as easy a process to curtailing the way overuse of puberty blockers in our country. And the reason is we don’t have a centralised medical system, it’s much harder and unfortunately our medical organisations, accrediting organisations are all pushing affirmative care and have for years now for well over a decade. So I really admire what the UK has done. And I wish we could do something similar in the US, but I don’t see it happening, I think that they will try to come up with a legislative solution. So a ban, a political ban that turns what is a medical issue into a political issue, unfortunately, in America, and that has a whole bunch of other you know, externalities that that come to play.

Florence Read:
Very last question for you before I let you go. Tell me what do you think the long term downstream effects of this over therapised, perhaps over medicalised generation will be? What sort of social creatures will they be? What sort of political creatures? It’s hard to imagine a kind of artist or revolutionary being born out of a generation of people who have had their emotions dulled to some degree?

Abigail Shrier:
That’s right. We’re already seeing it. We’re seeing you know, I think the wonderful journalist Bryah India has pointed out that we’re seeing large numbers of young people believing they’re asexual. Maybe because they’ve had their sex drive deleted by this medication, we are already seeing political radicalisation, they want to be followers. We are seeing a lack of efficacy, that’s the side effect, feeling like they can’t do anything to improve their lives. Well, that tends to lead you to radical causes. If you feel helpless in this world, you tend to want to have someone to come along and save you and we’re seeing that. So I hope there was a big push back against the needless medicalisation of a generation that can do on its own if we would just delete a lot of this needless intervention.

Florence Read:
Ok, I told you that was the last one. But I’m going to ask you one more simply because I want to end on some note of optimism.

Abigail Shrier:
This is the easiest problem to solve. It’s the single easiest one. It doesn’t take money. It doesn’t take expertise. It just takes people going back to remembering what makes a healthy childhood and a healthy life. Parents need the authority to shove the experts out the door when they don’t believe they’re necessary. The kids need structure, the kids need chores, they need their families around, grandparents, cousins, neighbours, they need all the good things of a healthy childhood. And we need to stop medicalising normal, normal behaviours and they need to be told when they have a minor injury, you’re going to be just fine.

Florence Read:
Abigail Shrier, thanks so much for your time today.

Abigail Shrier:
Thank you. Take care.

Florence Read:
So that was Abigail Shrier, author of the new book ‘Bad Therapy’, which paints a gloomy picture of the case of youth mental health, or whatever you want to call it across America, which does seem to be declining, despite rapidly increasing numbers of people in therapy. It’s a strange conundrum, one that I don’t think has a simple answer. There’s obviously a lot of sociological factors at play. I suppose we might ask, what are we teaching our kids at home and in school that is making them so brittle-minded? Perhaps a return to Zen philosophy, or stoicism or even religion could be the answer? I don’t know. Let me know what you think in the comments and thanks for watching. This was UnHerd.

Discussion