Chapter 2: Bad Therapy: Why the Kids Aren't Growing Up

A Crisis in the Era of Therapy

At sixteen, Nora[1] sits at the giggly edge of womanhood. Her hair, a cascade of dense brown curls. Her smile, all gums and braces, enlivens whenever she mentions her friends. She is always, always connected to them, she tells me—on Snapchat, all day long, even during class. At her large private high school in Southern California, she sings in the school choir, is a cast member of every play, and is a top student.

On a mild April afternoon, we sit on Adirondack chairs in her mother and stepfather’s backyard patio. Nora tosses her hair and recrosses her legs, bare in a flouncy skirt, testing the air with the notion that we are two adults—she, the cuter, more up-to-date model.

“I always have a friend who’s going through something super serious,” she tells me. “I don’t know why it’s always that way.”

That sounds normal enough for high school girls, so I ask: What are they going through? Anxiety, depression, she ticks off. Trouble with parents. Lots of self-harm.

Like what?

Scratching, cutting, anorexia, she rattles off. “Taking away basic needs. Like, one of my friends will be in the shower and turn it up too hot or too cold.”

Okay. What else?

“Trichotillomania.”

“Excuse me?”

“Pulling out your hair. That’s a big one.”

Also known as “hair-pulling disorder,” this is the urge to pull out hair from the scalp, eyelashes, and eyebrows, emanating from an uncontrollable need to self-soothe. Dissociative identity disorder, gender dysphoria, autism spectrum disorder, and Tourette’s belong on her list of once-rare disorders that are, among this rising generation, suddenly not so rare at all.

Nora is casually au fait with dozens of mental disorders, almost as if she keeps the Diagnostic and Statistical Manual of Mental Disorders by her bedside. (She doesn’t.)

Given how poorly so many seem to be faring, one might be inclined to suggest that these teens could really use some therapy. Actually, “a large majority” of Nora’s friends are already in therapy—many have been for years, she tells me. Several are on psychiatric medication.

Does it seem to be helping?

“I’d say for some, yes. Others?” Nora shrugs. “My friend, I’m not going to say her name—since COVID-19 started, she just got a lot of anxiety. She’s been on medication for a few years now. She sees a therapist, and I have to say, she just seems to be getting worse.” Nora thinks it over. “She honestly seemed better before medication.”

I ask Nora what seems to be troubling her friends. Nora reiterates that they’re going through “really hard things,” but when I ask her what, she is vague: strained relationships with peers, breakups, disagreements with parents.

By the time I meet Nora, I’ve interviewed enough adolescents to know that she isn’t avoiding the question. Teenage communication today is more constant, largely digital, and, even among teen girls, far more superficial than it was a generation ago. Less baring of souls, more trading of memes. Even to their best friends, they communicate only this: that they are going through something bad and serious, something that will require their friends’ sympathy and indulgence.

Some of her friends complain their parents are “emotionally abusive,” but when I ask Nora why their therapists haven’t called Child Services, she seems unperturbed. Yes, she assumes they’re sort of exaggerating. To preserve the friendship, you suspend disbelief.

There’s something else. Nora drops her chin, embarrassed by what she’s about to confess: “I’ve noticed with a lot of people who’ll use their mental issues—it’s almost like a conversation piece. It’s almost like a trend.”

I reassure her that she’s at least the twelfth adolescent to tell me this. She exhales.

What’s it like to have so many friends suffering with anxiety disorders and depression? Actually, she tells me, those who don’t have a diagnosis feel left out. “You’re expected to have these mental issues. And these things that are being normalized—these things are not normal,” she says. “I’m surrounded by it, so I think that in some ways, it has become our new normal. How is it possible, with all that around me, for it not also to be inflicted on me—for me not to be depressed about it?”

I ask her why it’s depressing to have friends who are struggling. “I know three people who were committed to mental facilities long-term—one who committed suicide,” she says. All of them, high school students.

Nora is faring a lot better than most of her peers and many of the young people I interviewed: she has a group of friends, a steady boyfriend, excels at school, and is planning for her future. She is on no psychiatric medication, and is not in therapy.

But she also casually bundles two sets of friends, as if they are one: those whose mental illness is so profound that it requires psychiatric commitment, and those who are seeking explanations for their unhappiness and discovering diagnoses. Like so many young people I talked to, she regards high school friends with “exam anxiety” or “social phobia” as existing on merely one end of a psychological continuum that terminates with the woman who shows up naked to Target.

They Need Therapy, You Say?

The mental health establishment has successfully sold a generation on the idea that vast numbers of them are sick. Less than half of Gen Zers believes their mental health is “good.”[2] They do not believe mental health is something that arises typically, in the normal course of a balanced life, but like a boxwood tree, requires constant tending by the gardener you hire to prune it.

The rising generation has received more therapy than any prior generation. Nearly 40 percent of the rising generation has received treatment from a mental health professional—compared with 26 percent of Gen Xers.[3]

Forty-two percent of the rising generation currently has a mental health diagnosis, rendering “normal” increasingly abnormal.[4] One in six US children aged two to eight years old has a diagnosed mental, behavioral, or developmental disorder.[5] More than 10 percent of American kids have an ADHD diagnosis[6]—double the expected prevalence rate based on population surveys in other countries.[7] Nearly 10 percent of kids now have a diagnosed anxiety disorder.[8] Teens today so profoundly identify with these diagnoses, they display them in social media profiles, alongside a picture and family name.

And if you ask mental health experts if young people, in aggregate, have undiagnosed mental health problems, they invariably answer in the affirmative. Meaning, according to experts, not having a mental health problem is increasingly anomalous.

We have plied members of the rising generation with more antianxiety and antidepressant medication than any prior. We’ve afforded them more mental health accommodations in school[9] and in sports.[10] They face less stigma[11] for receiving mental health treatments, and so much more emotional sensitivity[12] from adults in their lives.

From the time they first lurched across the living room rug on unsteady legs, parents treated them to therapeutic parenting. (“I see you’re having some big feelings. How would you like to express that, Adam? Would you like to stomp your feet? Or grit your teeth?”) Their teachers employed therapeutic methods of pedagogy (“Tell me about your drawing, Madison. What does it represent to you?”) and read them books about how to process their feelings.

A decade ago, a writer for Slate noted that instead of using moral language to describe misbehavior, educated parents had begun employing therapeutic language.[13] A-list adolescent heroes from Huck Finn to Dylan McKay suddenly struck us as undiagnosed sufferers of “oppositional defiant disorder” or “conduct disorder.” Agency slunk out the back door.

Suddenly, every shy kid had “social anxiety,” or “generalized anxiety disorder.” Every weird or awkward teen was “on the spectrum” or, at least, “spectrumy.” Loners had “depression.” Clumsy kids had “dyspraxia.”

Parents ceased to chide “picky eaters” and instead diagnosed and accommodated the “food avoidant.” (Formal diagnosis: “avoidant restrictive food intake disorder,” or ARFID.) If a kid whined about an itchy tag at the back of his shirt or complained that hallway noise kept him from getting restful sleep, his parents didn’t tell him to ignore it; they bought tag-free clothing of soft Pima cotton and appointed his room with a soft-sound machine to address his “sensory processing issues.” No chiding kids for messy handwriting (that was “dysgraphia”). No telling kids with the blues that it takes time to adjust to a new town or new school (they have “relocation depression”[14]). No reassuring them that it’s normal to miss their friends over the summer (“summer anxiety”[15]).

We’ve all been swimming in therapeutic concepts so long we no longer note the presence of the water. It seems perfectly reasonable to talk about a child’s “trauma” from the death of a pet or the routine humiliation of being picked last for a sports team.

In the course of a single month, three zeitgeist-epitomizing stories hit the news: The American Academy of Pediatrics, in 2022, reversed perhaps a century of standard protocol and declared that kids with active headlice should no longer be sent home from school; better to scatter bloodthirsty vermin across the entire student body than that anyone bear the emotional stigma of having been sent home.[16] The Washington Post’s “mental health professional” informed readers that having your name mispronounced is damaging to the psyche.[17] And New York University fired a storied organic chemistry professor, author of the field’s premier textbook, because holding premed students to the same standards (and grading scale) he’d employed for decades suddenly failed to make student well-being a priority.[18]

“Student Wellness Centers” have sprouted at our most prestigious universities. Our best athletes withdraw from competition to attend to their mental health; and young Hollywood starlets, Prince Harry, and a slew of Grammy winners proclaim the “work” they are doing in therapy against a continuous struggle with anxiety and depression. “Wellness” and “trauma” form the contrapuntal soundtrack against which the rising generation came of age.

Seventy-five years of rapid expansion in mental health treatment and services has landed us here, marveling at the unprecedented psychological frailty of American youth.

The Treatment-Prevalence Paradox

It began with the soldiers returning home from the Second World War.[19] On a scale previously unimagined, GIs had seen—and meted out—death and suffering. Many returned home shaky—some, shattered.

Congress greenlit a dramatic expansion in preventive therapeutic services.[20] No longer content to treat the ill, therapists became determined to support the healthy.[21] Between 1946 and 1960, membership in the American Psychological Association quadrupled.[22] Then, from 1970 to 1995, the number of mental health professionals quadrupled again.[23] In the United States since 1986, nearly every decade has seen a doubling of expenditure on mental health over the one before.[24]

There’s a paradox embedded in this tale of exponential expansion. More widely available treatment ought to abate the rate (and severity) of disease.

Take breast cancer, pitiless killer of over forty thousand American women each year. As early detection and treatment for breast cancer improved since 1989, rates of death from breast cancer plummeted. Or maternal mortality: as antibiotics became more readily available, rates of maternal death in childbirth collapsed. Better and more widely available dental care has meant fewer toothless Americans. And as we developed immunizations and cures for childhood illness, child mortality rates nose-dived.

And yet as treatments for anxiety and depression have become more sophisticated and more readily available, adolescent anxiety and depression have ballooned.

I’m not the only one to have found something fishy in the fact that more treatment has not resulted in less depression. A group of academic researchers recently noticed the same. They published a peer-reviewed paper titled “More Treatment but No Less Depression: The Treatment-Prevalence Paradox.”[25] The authors note that treatment for major depression has become much more widely available (and, in their view, improved) since the 1980s worldwide. And yet in not a single Western country has this treatment made a dent in the incidence of major depressive disorder. Many countries saw an increase.

“The increased availability of effective treatments should shorten depressive episodes, reduce relapses, and curtail recurrences. Combined, these treatment advances unequivocally should result in lower point-prevalence estimates of depression,” they write. “Have these reductions occurred? The empirical answer clearly is NO.”[26]

I checked with several of the paper’s authors. Two confirmed that the same might be said for anxiety. As treatment has become more widely available and dispersed, point-prevalence rates should go down.[27] They have not. And while the authors admit that there was likely more depression in the past than we realized, they argue that there is at least as much, and probably more, depression now.[28]

After generations of increased intervention, that shouldn’t be the case. More access to antibiotics should spell fewer deaths from infection. And more generally available therapy should spell less depression.[29]

Instead, adolescent mental health has been in steady decline since the 1950s.[30] Between 1990 and 2007 (before any teens had smartphones), the number of mentally ill children rose thirty-five-fold.[31] And while overdiagnosis or the expansion of definitions of mental illness may partially account for this rapid change, it is hard to dismiss or contextualize away the startling rise in teen suicide: “Between 1950 and 1988, the proportion of adolescents aged between fifteen and nineteen who killed themselves quadrupled,” The New Yorker reported.[32] Mental illness became the leading cause of disability in children.

Yes, the coincidence of these two trends—deteriorating mental health in an era of vastly expanded awareness, detection, diagnosis, and treatment of psychological disorders—may be just that: coincidence. It does not unveil a causal arrow. But it is peculiar. At the very least, it may provide a clue that many of the treatments and many of the helpers aren’t actually helping.

Therapists will insist that I’ve got things wrong end up. They are the lifeguards, not the sharks; it’s simply that the rising generation has been swimming in shark-infested water, meeting more formidable challenges than any prior generation.

Karla Vermeulen, an associate professor of psychology at the State University of New York at New Paltz, told me that explicitly in our interview. And she says so in her book, where she writes: “No past American generation has faced the cumulative load of multiple simultaneous stressors today’s emerging adults grew up with”[33] (emphasis is hers).

Therapists are helping young people, they insist. Young people today simply face more formidable challenges than did their predecessors. Therapists typically point to three: smartphones, COVID-19 lockdowns, and climate change.[34]

Is It the Smartphone, Dummy?

Tic disorders, gender dysphoria, anorexia, dissociative identity disorder, trichotillomania, cutting: the parade of horribles induced by smartphones could fill a psychiatric manual of its own. If smartphones were a boy who wanted to see your daughter, a generation ago, parents would have taken one look at him and said: No way am I letting that kid in the door. The smartphone and the rise of social media offer a compelling candidate for an environmental cause of poor adolescent mental health.[35]

Eight years have slipped by since Twenge and Haidt[36] (and four years since yours truly[37]) first warned the public of the dangers of social media and smartphones to teens.[38] That ought to have provided our eager mental health experts with an obvious mandate: treat social media like cigarettes. Call to restrict smartphones from middle school and high school campuses. Urge companies to place a black-box warning on social media, if they were really feeling feisty.

They didn’t. None of the psychological organizations—not the American Psychiatric Association, the American Psychological Association, the National Association for School Psychologists, or the American School Counselor Association—issued any such call to arms. In the last decade, as the average age of a child getting a first smartphone dropped to age ten,[39] these organizations had little to say about it.

They’ve been preoccupied with their own style and method of intervention. Because any parent can take away a phone, but only a psychologist can diagnose a child or refer for medication. The most important thing they could have done to help improve kids’ mental health was something that didn’t require their expertise.

In truth, the entire society has dropped the ball when it comes to kids and smartphones. Why have parents continued to supply these devices in ever greater numbers to younger and younger kids? Flip phones are useful in emergency; GPS devices and digital cameras are of higher quality and cheaper than ever before. Why do parents continue to gift $1,000 phones to kids knowing full well that they are linked to a rise in depression, anxiety, and self-harm? The most conscientious of parents at best require their kids to dock them in the kitchen and cease their scrolling at bedtime. That’s what counts as restricting a device that has been convincingly linked to shortened attention span, insomnia, severe anxiety, and depression.

When I asked parents why they would hand their children a device that puts kids at risk for a wide array of mental disorders, they invariably give one answer: That’s how they make plans with friends. I don’t want them to be the only one who doesn’t have one. Therapists typically discourage parents ever from taking away a teen’s smartphone, on the grounds that doing so will only sabotage the parent-child relationship.[40]

And while we’re asking questions, why did public middle and high schools, en masse, abandon all efforts to police their use even during class time?

I spoke to one head of a private high school where students keep their phones with them all day long, even in class (now standard protocol at most high schools). It siphons their attention while they’re trying to learn, I said. It keeps them from getting to know each other. They don’t talk or make friends in the same way as they might if there were no phones present. And then there’s all the ways that social media sabotages their emotional well-being. Why would you allow this?

He nodded amiably until it was his turn to speak. “It keeps them calm,” he said.

Nobody has made any serious effort to block teens’ smartphone use—not parents, not teachers, and definitely not mental health experts—because smartphones have become one more mental health accommodation we disburse to the young. We know it isn’t good for them. We know the long-term consequences run from dark to dire. We know the devices are addictive, sleep-depriving, and pathology-inducing. But for right now, they provide unbeatable palliative care—soothing as any blankie.

If mental health experts wanted to do what was best for adolescents, advising parents against giving young teens smartphones would be a no-brainer. They would say, as a doctor might: There’s no point in bringing your kid here if you’re going to let him keep smoking. They hold themselves out as guardians of youth mental health; they ought to offer the most radical advice when it comes to smartphones and our young.

Instead, mental health experts rush in the opposite direction, embracing smartphone use, dismissing smartphones’ impact on adolescent depression as exaggerated;[41] offering seminars to teens and their parents on “responsible social media use,” which is a little like drug counselors lecturing on the appropriate uses of ecstasy. Mental health experts arrive at schools to warn parents and teens of the “risks” of social media, always careful to weigh these against the many wonderful benefits, and then conclude: Have at it!

And for a generation that already struggles with in-person interaction, mental health experts now offer the ultimate morphine drip: therapy, embedded in the smartphone. Some have done away with both voice and video interactions, offering therapy by text message.

If you want to improve a kid’s mental health, locking up her smartphone might be a start. At a minimum, smartphones take a teen further from the world of in-person friends and activity likely to bolster her sense of well-being. They are undoubtedly responsible for exacerbating a variety of social contagions, from tic disorders to gender dysphoria. But banish the smartphone and fix a generation? I’m not so sure.[42]

Youth mental health has been in decline, after all, for the last five or six decades.[43] And then there’s parents’ powerful reluctance to take away our kids’ smartphones. What accounts for this fecklessness, in the face of the obvious threat they pose? The very fact that we’ve been so long aware of their dangers and done absolutely nothing to curtail their ubiquity in adolescent hands requires its own explanation. That we persist in handing these devices to young teens and tweens is itself a symptom of a larger problem.

Didn’t Enjoy Your Solitary Confinement?

COVID-19 lockdowns sent numberless kids into punishing isolation. If our mental health experts anticipated the predictable mental health catastrophe of forcing kids into social solitude for over a year, they largely kept the insight to themselves. Not a single one of their major national professional organizations even opposed the lockdowns’ continuing into a second consecutive school year in the fall of 2020, when a further deepening of kids’ isolation might have been averted.[44]

The mental health organizations are not shy about wading into public policy discussion: The American Psychological Association has railed against America’s history of systemic racism. “Our nation is in the midst of a racism pandemic,” said the APA’s CEO in his June 2020 congressional testimony, advocating changes to police tactics.[45]

In this vein, the APA has touted the mental health benefits of affirmative action,[46] and, in a splashy press release, announced its readiness “to help society respond to climate change.”[47] But against the pressing and pervasive threat of forced social isolation? Crickets.

How could the experts have missed a mental health calamity so obvious and foreseeable?

Parents protested; they were largely ignored. The mental health–expert complex, with all its institutional heft, declined to offer so much as a public warning to policymakers about the impact on kids.[48] Perhaps they didn’t know the lockdowns would be devastating to the young people they were uniquely responsible to help. Whatever the reason for this colossal failure, there’s something perverse in their subsequent attempt to use the pandemic lockdowns to wave away the treatment-prevalence paradox, or—worse—to argue for their greater role in public policy development and the lives of American kids.

In truth, before the novel coronavirus had escaped China’s borders in 2019, nearly a third of Americans between the ages of eighteen and thirty-five said they were experiencing a mental illness.[49] Hospital admissions for nonfatal self-harm were up 62 percent over the previous decade,[50] with nearly 20 percent of girls ages twelve to seventeen reporting having had a major depressive episode in the previous year. Child suicide rates rose 150 percent over the previous decade.[51]

“Climate Anxiety”

Karla Vermeulen wears her hair in a cool pixie cut cropped close to the scalp. The lenses of her square plastic glasses are the size and shape of two Post-its. At the base of her neck, a string of beaded earthenware completes the picture of a no-nonsense researcher. Indeed, Vermeulen outranks almost any American as a credentialed expert in adolescent mental health.

Vermeulen trains therapists and writes books to guide them in the counseling of the rising generation. Her expertise is “disaster mental health”—which is to say, people in crisis. One might say: This is her moment.

When I learned she’d written a book, Generation Disaster: Coming of Age Post-9/11, I contacted her immediately. I had assumed a kindred spirit—one who’d studied the same cohort that so completely fascinates me.

Young people are resilient and strong, she assured me. They are simply meeting more formidable challenges than any generation before them. “They’re dealing with all of these other stressors, but it’s all floating on this unstable surface of climate change,” she said.

It turns out, Generation Disaster may be the most misleading title in the history of the printed word. By “generation disaster,” Vermeulen actually means: This generation is not a disaster—not by a longshot. If anything, everyone else is a disaster for being so overly critical of these magnificent, socially conscious young people.

Like Vermeulen, many therapists are convinced that “climate anxiety” is a real and important category of mental health disorder. A cottage industry has arisen to treat it: “climate-aware therapy.” What with the polar ice caps melting, tropical disease raging, hurricanes and floods scheduled to land with Noahide vengeance, of course young people are depressed! Nature, the medical journal The Lancet, and NPR all agree: depression is merely a rational response to the greenhouse gases’ smothering fug.

Atlantic editor Franklin Foer intimated the same in a piece about his fourteen-year-old daughter who suffers from anxiety. “I long to build a seawall that can protect her from her fears,” Foer writes of his decision to let his daughter skip school to attend a climate change protest inspired by activist Greta Thunberg. “But her example, and Thunberg’s doomsaying, have made me realize that my parental desire to calm is the stuff of childish fantasy; anxiety is the mature response. To protect our children, we need to embrace their despair.”[52]

But is climate anxiety—dare I ask—rational? And is the best we can offer kids affirmation of their fears?

Actually, while there is little doubt the earth is warming, there’s a great deal of reason for environmental optimism; many environmental trends are going in the right direction.

“Deaths from natural disaster have declined over 95 percent over the last century. Actual disasters themselves have gone down over the last twenty years. Disasters are measured strictly as deaths and damages from extreme weather events,” said Michael Shellenberger, a longtime environmental activist and author of several books on the environment. “We’re more resilient than ever.”

The number of people who died from weather-related or climate-related disasters last year was 6,000 globally, he pointed out to me. To place that in perspective, 106,000 people will die this year (2023) from drug overdose and poisoning in the United States alone. As for carbon emissions, they slightly declined globally over the last decade.[53]

And yet people are telling surveyors that they feel far more environmental anxiety today, when most trends are going in the right direction, than they ever did in eras past. Where was the outburst of environmental anxiety when we were almost exclusively burning coal to generate electricity or blasting a hole in the ozone layer with CFCs? Or when a blanket of brown-yellow smog blocked Los Angelinos’ view of the nearby San Gabriel Mountains? All were known problems, but the mental health diagnosis was nonexistent. That alone may have contained the spread of worry.

Even for adults who are profoundly concerned about climate change, in other words, validating and reinforcing a child’s terror about human extinction via climate change is no rational imperative. It is, instead, a very specific choice that an adult makes for her own reasons.

“Embrace Their Despair”

According to Foer and Vermeulen, a parent’s job is not to arrest a daughter’s fears by placing them in perspective.[54] Not to ply her with soothing pablum—something only dumb kids fall for, apparently—like the idea that the earth is going to be around for a long time. Not to remind her that for gazillions of years the human species has met and mastered every prior challenge, including brutal vicissitudes in climate. Don’t reassure her that there are brilliant and dedicated people working very hard to meet the changes brought on by a warming climate. Resist the urge to take the upper hand and let her know that one day, after she finishes her education, she can choose to be one of those scientists. Until then, she has other concerns. Like passing ninth-grade math.

Vermeulen and Foer unwittingly help unlock a recent puzzle. While teen girls have seen a severe mental health decline, those who identify with liberal and left-leaning politics have suffered worst of all.[55] Liberal teen boys evince worse depression than conservative teen girls. That ought to suggest that most of what we’re seeing isn’t a mental illness crisis. It’s deeply connected to the values and worldview we’ve given our kids, the ways they’ve raised them, the influences around them.

So many progressive parents seem to believe their job is to scare the ever-living crap out of kids when it comes to climate change. Use the phrase “human extinction” at bedtime. As many bedtimes as you can.

I ask Vermeulen if it would ever be appropriate to say to a kid, Listen, you’re really exaggerating the threat of climate change right now. Let’s get through the week.

Vermeulen becomes visibly stricken. “I would never tell someone they were exaggerating. That’s very invalidating and not helpful. That’s going to raise defenses and make them feel unheard.”[56]

But kids toss a lot of worries at their parents, sometimes just to see which ones bounce back. Parents who follow the therapists’ direction and embrace their children’s despair breathe life into the monster under the bed. In the small number of homes where parents are themselves wracked with apocalyptic fears, it shouldn’t surprise us that such fears also menace the child.

Beth, the Psych Nurse: Stop Trying to Make Climate Anxiety Happen

Now in her late thirties, Beth has been a psych nurse for over a decade at a medical clinic serving the students of three Boston-area universities. As alarmed as everyone seems to be about young people’s mental health, Beth tells me, it’s worse than we know. She routinely sees college kids who can’t bring themselves to call her office. They ask a college counselor—or even a parent—to schedule an appointment on their behalf.[57] They claim their “social anxiety” forbids this basic task. But Beth, who writes their prescriptions, tells me that isn’t it. They’ve just never been made to do anything on their own.

As an example, Beth recalled that one college co-ed brought her mom along to the appointment. The mom kept track of her daughter’s menstrual periods with an app on her phone.

I asked if the daughter was mentally impaired in some way. No, Beth said. She was just, well, managed. Never allowed to fall or fail, standing on two wobbly legs that have barely tested the ground. Then, thrust out from under the family awning for college, university life hits these kids like a hailstorm.

Many college-age young women, Beth says, are smoking marijuana several times a day, by themselves, just to mute their pain. She tells me this is new. The marijuana use isn’t social; it’s compulsive and medicinal.

I asked Beth how many of the thousands of students she treats mention climate change or systemic racism as a reason for their distress. She told me flatly—none. Not a single one. “I don’t think anyone ever. Like they might make some an offhanded joke about it?” Beth’s answer dovetailed with my work. In my scores of interviews with young people about their mental health, none gave climate change as a reason for their or their friends’ emotional struggles. All except one (a TikTok influencer) explicitly denied that climate change was an important source of young people’s distress.

So what reasons do they give for the pain they feel? Exam stress. Being overwhelmed by the work piling up. Total inability to reach the expectations set by professors who—unlike the public school teachers they had before—may actually fail them if their grades warrant it.

A lot of their distress, Beth says, falls into the category of social interactions gone very bad—things they said or posted online that they later regret and can’t seem to stop reliving. The boy who dumps them or leaves their texts “on read.” They want to get over it. They believe they can’t.

So why, then, do so many therapists and researchers and intellectuals insist that climate change is a primary cause of their distress? And why do young people tell researchers that climate change is a reason for their anxiety? Turns out, when young people are not in the throes of severe distress, they offer reasons that will seem rational to the adults around them and garner the sympathy and attention they want or need.[58]

Researchers often graft onto the young whatever explanation seems most rational to them, based on their own political biases. For conservative researchers, the rise of fatherlessness, the decline of marriage, or decreased religious affiliation—all of which coincide with climbing rates of mental illness—might seem rational explanations. For liberal researchers, climate change, school shootings, systemic racism, economic inequality, and the politics of MAGA provide favored candidates.[59]

So, yes, young people today are more worried about climate change than were previous generations, just as schoolkids in 1962 were more worried about nuclear war with Russia than schoolkids today. But there is no extant record of a rash of sixties kids, terrified as they were of nuclear apocalypse, failing to show up for school.[60] For that matter, how did American schoolchildren march off to school on December 8, 1941? And yet they did.[61]

But for therapists who continue to see “climate change” as rational grounds for serious mental disturbance, optimism is not an option. There is no bright side, and it does no good to point out to a young person claiming “climate anxiety” that she may be suffering an emotional parallax. With some notable exceptions, placing an adolescent’s worries into perspective is not what therapy does—nor even what it seeks to do. That wouldn’t be affirming the patient.

No. We. Can’t.

The rising generation is strikingly different from those prior, according to academic psychologist and author of several books on Gen Z, Jean Twenge. It isn’t simply the rates of diagnosed mental illness that makes them so distinctive. They are far more obedient to authority, agreeable, and tied to Mom. More politically radical (more likely to favor far-left positions) and much less inclined to self-aggrandizement than, say, millennials. Actually, what seems to motivate a large portion of Gen Z, born between 1995 and 2012, is not hope or optimism or belief in themselves—it’s fear. They are arguably the most fearful generation on record.

In April 2021, I met Twenge at her San Diego home to profile her for The Wall Street Journal. I wanted to learn more about a generation that had already started to seem awfully troubled. We sat on damp plastic chairs, ten feet apart, in her lush backyard while the pandemic raged around us.

Gen Z, Twenge told me, is far less likely to date, obtain a driver’s license, hold down a job, or hang out with friends in person than millennials were at the same age. In 2016, high school seniors spent up to an hour less per day hanging out with each other than those of the 1980s. They also engage in the least amount of sex (while arguably having it most available)[62] and report having the fewest romantic relationships or romantic encounters.[63] They are reluctant to cross the milestones at which previous generations eagerly launched themselves. As one young person said to me, expressing a sentiment I heard echoed by others, “I was very scared to start college. But I guess everyone was when they were my age?” Actually, I was there. No, we weren’t.

They are also far more pessimistic than previous generations—much more pessimistic than millennials, especially. What are young people today so pessimistic about? I asked Twenge.

“Everything,” she said. “At their own prospects, the prospects of the world. And you have to ask, what causes what? Is it because the world is so bad, that’s why they’re depressed? Or do they see the world as bad because they’re depressed? It could be either one.”

But there’s something else, too. In numbers never before seen, young people doubt they have the power to improve their circumstances.

“Locus of control” is the term psychologists use to refer to a person’s sense of agency. If you have an internal locus of control, you believe you have ability to improve your circumstances. If you have an external locus of control, you do not. Instead, you tend to attribute events to things outside of your control, like other people or bum luck.

The rising generation has moved toward an external locus of control, Twenge said. The generation standing at the very beginning of life’s journey also believes it can’t do anything to improve its lot.

These profound feelings of helplessness, ineffectiveness, and dependency may be symptoms of the generation’s depression. Or all may be symptoms of a third cause, something therapy can’t cure but could worsen. But today’s mental health experts rarely consider that there is any problem facing today’s youth to which they are not the invariable solution. So, more therapy, then. How much more? Loads.

Becca: My Therapist Is Helping Me Prepare to Make Friends—in College

When we speak, Becca has just graduated from a large public high school in Santa Clarita, California. She doesn’t have a job or a plan to look for one. For now, she’s just trying to get into the right mindset before she heads off to university in the fall. She hopes to study—you guessed it—psychology. Her therapist is helping her prepare to make friends.

“It’s kind of been a lifelong issue for me. I think it’s more of just putting myself out there,” Becca tells me. “And my therapist says, specifically, that I should be the one to reach out first. So I’ve been trying that and especially now that I’m going off to college. I don’t know my roommate situation yet, but I’m definitely going to try to talk to them and become closer. It’s kind of like a fresh start.”

For generations, this mundane fact of life—needing to make new friends in a new place—was the sort of thing young adults simply resolved to do on their own. But Becca’s been in therapy since her parents divorced when she was six. You cannot convince her that she does not need a therapist to help her plan, rehearse, and revisit her attempts to make friends.

Perhaps unsurprisingly for someone so close to her therapist, Becca doesn’t know her current “best friends” all that well. Becca can’t tell me what religion most of her friends are or what their parents do for a living. Nor do they know very much about her. “With my friends, it’s mostly, we talk about boys and stuff like that. But with my therapist, I talk about deeper issues, like my anxiety. She gives me methods to help with it, like meditation and just sitting down and thinking about whether it’s really worth stressing over.”

Advice dispensed by a professional therapist is likely to be more mature and measured than that of another teenager. Parents who foot the bill certainly hope so, at any rate. But it’s hardly a clear win. Because your therapist won’t call you on your birthday every year for the next thirty.

She won’t coerce you into humiliating yourself at a karaoke bar on your twenty-first birthday just because she loves you that much. She isn’t going to introduce you to a coworker or harangue her boyfriend into arranging a setup for you, just because she can’t stand to see you alone. Your therapist won’t hop on a train to attend your bachelorette just so she can toast your misadventures or stand beside you at your wedding, tearily clutching a fistful of peonies. She may promise to understand you, but let’s face it: your therapist will not be prized from her hourly billing to celebrate the birth of your child just because it feels so monumental that one of you had a baby.

No, they are the dividend stream of actual friendship. And so many hours logged bearing souls, piling into cars for road trips, narrowly avoiding accidents, and getting lost in bad neighborhoods—they are the invested capital. Therapists care about you in the practiced manner and to the precise extent any professional does a client—for the duration of a “fifty-minute hour,” so long as she takes your insurance or you remain cash-flow positive.

The social critic Christopher Lasch once observed that therapy “simultaneously pronounces the patient unfit to manage his own life and delivers him into the hands of a specialist.”[64] And I couldn’t help thinking of Becca’s predicament when I read this from Lasch: “As therapeutic points of view and practice gain general acceptance, more and more people find themselves disqualified, in effect, from the performance of adult responsibilities and become dependent on some form of medical authority.”[65]

Therapy for Every Single Child?

The rising generation has already received a lot of therapy. Thanks to artificial intelligence, the rain shower may soon become a flash flood. That’s what four different venture capitalists informed me: Big Tech is already revolutionizing mental health, creating apps that will soon have the capacity to provide therapy to every single child.

Eager to meet my kids’ future therapist, I signed up for myala, a wellness tracker app “available to any student over the age of 16,” according to its website. My session began with a “check-in” to assess my current mental state.

Here are six of the first ten questions my therapist-bot asked me:

“How lonely do you feel?”

“How supported do you feel?”

“How worried do you feel right now?”

“How down do you feel right now?”

“How often do you feel left out?”

“How sad do you feel right now?”

You may be wondering, as I did: What fresh hell is being asked how sad you are, in six different ways, by a string of code incapable of caring if you were flogged in the street? This series of questions seemed enough to flatten the stuffing of just about anyone. I tried to abandon the survey. It didn’t let me.

Turns out, if you’re not up for confessing to AI how lonely you feel, you’ll get a notification reminding you that you’ve failed at that, too.

Some of these apps facilitate therapy with an actual person. Some connect teens to therapists who conduct therapy over text, to avoid hassling them with an actual face-to-face conversation (Charlie Health) or to the numberless therapists who will Zoom. There are apps that match up the rudderless with every manner of life coach (BetterUp). Apps that allow little kids (“ages 0–14”) and their parents to track their moods (Little Otter).

Many wellness apps have already dispensed with the human-therapist model, making the “therapy” free to any kid with access to an iPad. “Therapy without a therapist” is Big Tech’s solution for making therapy scalable—able to meet the bottomless demand of a society obsessed with therapy. Integrating AI may soon cut human therapists out of the loop entirely. And the goal of nearly all of these applications is also mental health startup Talkspace’s motto and mission: “Therapy for All.” Every single child.[66]

Over three billion dollars of capital investment poured into mental health tech startups[67] in just the fifteen months following the onset of COVID-19. Therapy and its iatrogenic effects are being crop-dusted across the entire population.

The decks of promotional materials mental health start-ups show potential investors are unflinching: the poor mental health of the rising generation spells unimaginable business opportunity. They claim that one out of six of children in the United States “has an impairing mental health disorder.” Without embarrassment or apology, one internal pitch to investors refers to kids and young adults between sixteen and twenty-six as its “beachhead population.”[68]

Before we hand over the delicate psyches of every single child to their totalizing and indiscriminate mental health interventions, it’s worth scrutinizing the efforts already underway. At best, they have failed to relieve the conditions they claim to treat. But far more likely: the methods and treatments mental health experts champion and dispense are already making young people sicker, sadder, and more afraid to grow up.