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This episode is the second installment of Happiness week on the plain English podcast on Tuesday.
I spoke with the directors of the Harvard study on adult development about what makes a good life based on their 80 year, longitudinal study.
And if you miss that episode, I would very strongly.
Encourage you to go back and listen to it.
Today’s episode is about the phenomenon of rising and rising and Rising teenage unhappiness.
American teens, especially girls and especially kids, who identify as lesbian, gay bisexual, or questioning are in golfed in historic rates of anxiety and depression.
And everybody seems to think they know why some people say it’s the phones.
Others say, it’s cool pressure.
Some people say it’s the parents fault.
Some people say, the world is just terrible and young people are merely paying attention.
I’m gonna get two theories in a second and we’re going to talk about theories, a lot in this episode.
But first, let’s just review the raw numbers.
The youth risk behavior, survey which is published by the Centers for Disease Control and prevention.
The CDC is the gold standard for measuring the state of teen behavior, and mental health, and between 2011 and 2012.
He won this survey found the share of teens who say they experience persistent feelings of Sadness or hopelessness has done nothing but go up every year for a decade for girls in particular.
The number has increased from 36% to 57% with the highest jump coming during the pandemic six out of 10 girls.
Now, say they are persistently, sad or hopeless.
I think it’s important to say that life appears to be worse for lgbtq teenagers in About every respect measured by this survey, they are less likely to feel close to people at school twice, as likely to be bullied, three times more likely to have considered suicide, that alone is a really important phenomenon.
And I think I’m going to go deeper into it in a future episode, but on the nature of this General phenomenon of teen sadness, what makes it so interesting.
So surprising to me is that this surge has coincided with other behavioral trends that Aren’t obviously bad reports of smoking or down, drug use and drinking have declined among teenagers.
Bullying, has not increased among boys and for girls it’s actually declined slightly according to the CDC and while a handful of people seem very eager to hang this phenomenon on the fact that well the world just sucks.
It being Doom and Gloom is just being rational.
Well, let’s take this argument seriously climate change is awful.
School shootings have become a bit more common inflation sucks.
The world is a mess but let’s take a deep breath here.
The world is always a mess.
Tins sadness has gotten worse.
Every year for a decade, has the world really gotten worse every single year in the last decade.
The truth is that in the period when Teenage xiety has increased joblessness poverty, child hunger, these things have actually all gone down.
Real disposable income is grown for the vast, vast majority of families.
Meanwhile in the Last decade a lot of the law, the worst long tail scenarios for climate change.
Have actually become less likely, I do not think the idea that ever-increasing teen anxiety is a rational response to the state of reality.
I don’t think that’s a tenable claim.
In fact, it leads to one of the most untenable conclusions possible, which is that over time over a long enough period.
Everybody should be permanently in hopelessly depressed.
That is to be frank.
One of the worst, most maladaptive ideas I can possibly imagine.
So what is going on?
Today’s guest is Matt deal a leading, adolescent psychiatrist in Washington DC and look, he’s fantastic.
I like episodes that are a little bit contentious, a little bit of a debate.
I can’t say that’s what you’re about to listen to.
This guy is just spot-on, across the board, not just his ideas, but also in the beautifully nuanced and balanced ways in which he expresses them.
I think this is a pretty special pod.
I’m Derek Thompson.
This is plain English.
Matthew Beal is the chief of Child and Adolescent Psychiatry at Georgetown University Medical Center and chief medical officer at Fort Health.
Matt welcome to the podcast.
Thanks so much Derek, great to be here.
So this is a topic that I’ve written a lot about that.
I’ve talked about on this show with a few different people.
I’ve talked to John height, the social psychologist.
Touch a Raiders and economists and sociologists on Tuesday of this week.
We talk to the directors of the Harvard study of human development.
You are the first psychiatrist I’ve spoken to on this show.
Not to mention the first adolescent psychiatrist, not even a mention.
The first Chief of adolescent Psychiatry at a major University Medical Center.
So it seems to me that the only reasonable place to start here is to acknowledge our profound expertise Gap, and give you the floor for a second.
I know you’ve read.
Add some of my pieces.
You generally know where I stand on this issue?
What are you singing on the ground in your work?
What is the state of teenage mental health?
From your point of view.
Thanks, Derek, really got to be here.
I’m equally humbled by being in that in the presence of a writer whose synthesis around these issues.
I really admired.
So I think the work you’ve been doing has been really important.
I’ve learned a lot from it, so I’m glad to be here in dialogue with you today.
I mean, I think there’s a couple of things That I’d outline, you know, many of us have been really shocked and dismayed at the data that came out from the CDC last week around adolescent mental health.
And I think I’d start by saying that someone who sees young people and their families in my office every week that this crisis is very real.
There are huge number of kids that are in terrible distress.
Our Healthcare System is not able to respond as effectively and as quickly as needed.
System doesn’t have the bandwidth or the infrastructure to deliver effective treatments to young people who need them.
And as a result emerging problems become entrenched problems and manageable clinical issues become very difficult clinical issues because we’re not getting care to kids fast enough, the rates of depression and suicidal thinking and behavior.
And teen girls reported by the SEC are extremely alarming as are the rate of exposure to bullying and Community violence, and sexual violence and these data.
Exactly what my colleagues and I are seeing in our clinical practices.
I think we’ll have a chance to talk later today about some of the potential cause of this crisis, in our conversation, about social media or to time with friends, and some of the other things that you’ve written about, secondly, think they want to point out.
As I see the distress and Adolescence is revealing a broader level of distress in our society.
And in particular, based on my clinical experience, I interpret this data about teens in the context of a larger state of Crisis and families.
Parents and families are struggling terribly.
And of all ages are struggling to feel connected, to feel hopeful to feel purposeful parents, are feeling overwhelmed or one, but fears about the future for themselves.
And for their kids in particular by economic uncertainty, by the cumulative, burdens of work, and child care, and elder care, as well as, by less support from the communities around them.
And makes sense, the teenagers, we know that teenagers in any era, all vulnerable to mental health challenges, due to the developmental obstacles, they face and they’re struggling particularly in our current ERA.
Words don’t exist in a vacuum.
They live in families and Flame families right now are not flourishing.
So I think it’s important to address this crisis from the standpoint of asking how we can support entire families to feel less overwhelmed, better connected that are able to cope effectively.
And then finally, you know, Derek you’ve written about how in the last ten years we have learned.
Or maybe we’ve been conditioned to take in information and to respond information on the internet in a very specific way, social media and all digital media, really emphasize anger and despair and hopelessness and despair.
This is the material that gets the most attention, the most clicks.
And I think this is really cheap and the way that we talk about our emotions and this cheapening, this kind of coarsening is affecting the way that all of us, including teenagers, who spend so much time online experience Our Lives, it makes it much more likely that we identify intense emotional states.
Particularly intense negative emotional states, like sadness or anxiety, or loneliness, as Central to our experience.
And so the story He’s you know, the stories we tell ourselves about our lives and about our world shape, our internal emotional landscape and when the stories that we hear, and that we’re engaged with online are all about rage and misunderstanding and Trauma, there’s a considerable and cumulative emotional toll.
Well, there is a lot there and we’re going to get a little bit deeper into, just about every single part of that menu that you wrote up for us.
I have one more question about these CDC numbers.
You know you I’m sure read about how this is affecting just about every single category of teenagers.
This is not just something that affects, you know, one ethnicity group or another, this is something that’s happening for every race for straight teens and gay, teens for students in every year of high school.
For teens in all 50 states and DC, even though there are several groups like American girls and lgbtq teenagers for whom it’s happening.
The most, that’s the general picture here.
And I just wonder before we get into the possible causes whether there’s anything in this report that rang false or really surprising to you.
Anything that like, diverged from your experience with a testimony of psychiatrists, where you and your friends looked at the See result and said, huh?
I didn’t even realize that was the case, and he surprised like that.
It’s a great question.
I wish there were more surprises.
I wish that we had gotten some unexpected.
Good news particular on mental health and risk of suicide.
I think there were some Silver.
Linings that maybe we can talk about more one of those was with regard to substance use and alcohol, use which continues on a trend.
Going down among young people, which actually is a complicated finding, I think that We’ll talk about more, I think that the degree to which kids feeling connected to their school’s, was a protective factor is something that got lost in the headlines.
But something that this data found very strongly, feeling connected to your school means that you feel like your school is safe.
You feel like there are people there that both peers and adults that you have relationships with and they care about you.
And then it’s a place that you feel good being when that was present, that was clearly a protective factor for young people.
So I think that’s a really important finding and then getting back to the family.
I think that I hope that in future iterations of this survey that they start to ask more interesting, questions about families.
The question they asked in this survey was basically do your parents know where you are and who you’re hanging out with and both most kids said, yes, of course most kids feel like their parents are hanging over their shoulder all the time and probably overestimate how much their parents are actually aware of what they’re doing, who they’re hanging out with.
And I don’t think that was probably the best measure.
Understanding the protective factors that families can play.
So I think that’s something that needs more attention and more thinking going forward.
So I think the best way to structure the rest of conversation is to talk about causes and then talk about Solutions.
And the first cause, obviously, everybody listening knows that this is coming.
Let’s talk about social media and the smartphone, what is your take on the connection between social media and smart phone, use and Rising teen anxiety?
So you talked about on your show with John Hayden, another folks about what the data shows and many of your listeners, probably know that there is a difficulty that has been described in making a causal connection between social media use and effect on mental health.
Prickly - recommend Hall that that evidence Gap is closing.
I think there’s a stronger and stronger evidence and they’ll even the last two or three years as a professor, I pointed out and some of his writing that shows that we’re making stronger and stronger cases about that causal Connection in particular for girls.
In particular, for early adolescent, girls for girls for 12 13, 14, 15 years old, in particular for kids who use social media in a passive way.
So, social media that’s used for lots of hours in a way that scrolling and looking and scrolling and looking and basically engaging in - social comparison, as opposed to kids users use social media in a briefer way.
That’s more active.
That’s connecting with posting writing to friends making plans.
Those are very different ways of using social media.
So they’re as the research has progressed.
I think we’re getting a finer and finer and clearer and clearer picture of the fact that there’s no doubt that social media is having a really dearly tears effect on mental health.
For young people, particularly some of these vulnerable groups.
I’ll say my clinical practice Derek.
I see that there are really specific vulnerable groups.
That seem most disposed toward experiencing the harmful effects of social media.
I definitely see the effect with girls.
I see the effect for girls who had pre-existing mental.
Condition skills, who struggle perhaps already with anxiety or depression, or with OCD, who tend to use social media, most much more obsessively and much more passively.
And in a much more self-destructive way, I see it with kids who have ADHD, who tend to struggle with reward processing in their brain and the ways that they respond to to immediately enjoyable activities.
And their ability to postpone immediate gratification for larger goals.
That may be pursuing for all of those reasons kid with ADHD, often times are quite vulnerable to the negative impacts the social media.
I think there are other groups as well.
I think the the you reference the impacts on lgbtq youth.
I think there are that’s a nuanced picture.
On the one hand, sometimes it allows kids to connect when they don’t have kids in their local community with whom they’re connecting around identity, on the other hand, And I think that it could, they can really be drawn into deep passive.
Destructive engagement, social media.
I see that my clinical practice all the time as well.
So I think it’s a nuanced picture, but I think we have to move past saying, well, gee, we don’t really know.
I think we say, we know that it’s bad and we’re finding out just how bad it is and for whom Why girls, why does he affect seem to be so much stronger for young teenage girls?
It’s a good question.
I think that’s a question that needs more research and that’s my, that’s my, my scientific answer.
I think my clinical intuition tells me that girls are much more oriented towards social comparison in general than boys and social media is this very available and Insidious tool for social comparison, particularly for upwards of comparison.
And for sort of a fear of not being where you want to be.
And so I suspect that that’s a big part of it.
I can absolutely identify with that particular statement.
I mean, it’s almost Beyond obvious, the internet in many ways is a machine for displaying to you where you fit in any social, hierarchy in which you want to be situated.
Like if I want to know how popular this podcast is, well, there’s a Spotify ranking, there’s an apple podcast ranking and guess what?
I’m not number one, there’s a lot of podcasts.
I had to me if I want to know how my tweets are doing.
I log into Twitter and right there at the top, are a bunch of treats are doing better than mine.
It’s the same for Or Tick-Tock, there will always be people that are funnier and taller, stronger more successful richer more.
Beautiful, always the internet is, as you said a beautiful tool for finding groups that you belong to.
But almost by that very same token.
It’s an unusually and berserk least, successful tool for situating you inside of hierarchies that can be devastating to people that are sensitive to social comparison.
I think that’s exactly right.
And for all the reasons we talked about earlier as well, we are mines gravitate toward extremes.
And so, the input that were most attentive to on social media, is the input that is terrifying.
That is off for sizing that is that the drawers are threats systems because we’re acutely attuned to threat on a very basic, biological level for the sake of survival.
And so, We’re looking we’re part of survival for being a human being for being a primate is finding your place in the social Fabric and surviving there and so we’re so attuned to these social signals and the social signals that we get on social media and on digital media in general are fundamentally distorted.
It’s I really important to say and this is sort of my grand theory about what social media and smartphones are doing to us.
It’s not just about the five hours of daily.
It’s about what those five hours are displacing.
So Lauren Steinberg.
Who is an adolescent’s researcher.
I talk to a lot about these topics told me once if Instagram is displacing TV, I’m not that worried about it for the most part.
If it’s displayed, if it’s displacing sleep, I’m worried.
And the truth is, it is the share of teens who got a two more hours of sleep declined, 30 percent between 2007 and 2019.
As you mentioned, today’s teens are less likely to drink, you know, less like to go to parties less likely to do drugs.
Less likely to smoke less life to do a list of drugs.
But they’re also less likely to just be out with their friends.
To get a driver’s license to play youth sports.
They spend much more time alone and they suffer for it.
One in five, Millennials say they have no friends, these are people in their 20s and 30s but I can only imagine what the effect is for four generations e.
So you know to borrow watch word from our episode earlier.
This week, I’m worried about the social Fitness of America’s teenagers.
That social media provides an inferior, good for sociality.
And as a result, true Social Fitness atrophies as people enter their 20s and 30s.
And life really starts to come at them and they need this Bank of social support.
They need this roster of friends that they haven’t been able to build in the physical world because they have been submerging their face and this virtual world of inferior friendships, I think I think you’re so on it there and that concept is facial Fitness that y’all Your previous guest book about is so important, the breadth and depth and frequency of friendships is so profound and and of course, as kids and teenagers, a primary developmental goal is practice.
You need reps to build to build, Social Fitness, just like physical fitness.
It has to come with reps and and I’ve got a preteen in a teenager at home.
And when I watch my kids, interact with a group of friends, What it does to their Vitality when their interact with a group of friends, in person playing pickup sports or going out to the mall or going on, run to walk around town or just interacting outside of school and they get into the car after interacting with a group of friends.
Their Vitality, what their what their biological signals are about how they feel as opposed to the singles you get from kids.
And I know they’re probably many parents listening the signal, what you see when your kid is on their phone for 30, or 60 or 90 minutes and the signal that they send out what their body language tells you, what their eye contact tells you.
It’s a it’s a totally different physiological experience and is building a very different kind of rep.
Yeah, I to dumb it down a bit.
I think people’s need to hang out more.
I think we need a Renaissance of hangs in America to be quite honest.
That’s the first bucket I want to make sure that we get to all of these and give us some time for Solutions.
The first bucket was social media and smartphones second bucket is a little Hard to describe.
It’s the way we talk about mental distress.
I’ve become utterly fascinated.
By the way, young people and really many people online, have absorbed the language, the vocabulary of therapy.
You see so many more references to trauma, and harm and emotional capacity at triggers self-care, but I’m so interested in the fact that you see this ubiquity of therapy speak coinciding with the it’s of a culture that is not therapeutic at all.
There’s you’ve mentioned this just minutes ago, lots of research from including A Wharton University of Penn that finds that these intense and negative emotions are the most likely to go viral online, anger and outrage, an instinct to catastrophize, everything to be Doom and Gloom about everything.
That’s what gets shares.
That’s what gets retweets.
But modern, like cognitive behavioral therapy will tell you that the emotions you want to avoid in structuring your emotional response.
The world are Anger, outrage and instinct to catastrophize, everything and doom and gloom approach to everything.
I wonder what you make of this, like in the Atlantic.
I said it’s kind of like the internet has become the therapy version of a hospital where the fake doctor’s know the words for every disease but half of the surgery is result in sepsis and the patients are dying.
Like we’re all talking like therapists but online, not practicing anything like with CBT would encourage, what do you make of that juxtaposition?
I I love that analysis because I find it to be so accurate and I think that there’s a there’s several converging Trends here.
One trend is a very good one which is that stigma around talking about mental health and talk about our emotional, how our emotional experiences is on the rapid Decline and I genuinely think that that is a path towards less human suffering.
I think the when people are not suffering in silence and people have language to describe their emotional experiences.
Have The Bravery to talk about it with their peers, or with other adults and to get support that is, that is a good thing.
At the same time, what you’re talking about, which I think is equally true.
And important is that we have sort of hollowed out some of the meaning of terms, like trauma.
I mean, trauma is Tommy, is a really important and profound Concept in human thriving and human health.
When people experience trauma, especially during childhood, it has really meaningful Effects on your long-term, physical and mental health, particularly that goes on addressed and and and Trauma is real and all too common.
I mean, in this CDC data, 14, percent of teenage girls say that they’ve been sexually assaulted and their lives.
I mean, II just, I can’t say that without feeling nauseated, it’s the ubiquity of terrible trauma, and kids lives is so profound.
And as such to do so much to do with this crisis, and at the same time, the word trauma is so overused.
Used that it is being leached of meaning.
It is being is being diluted as a useful construct, because we’re talking about trauma in so many everyday occurrences that, I think it’s very, very confusing to young.
People have been traumatized, was this a traumatic experience that I had and we’re missing the opportunities because of the way language taking place to engage in again, where I think you talked about, in a previous show about post-traumatic growth.
And although we know about resilience and about the ways that things that people don’t deserve to have happen to them, they can survive and with support and with personal growth they can move past things and we’re leaving that on the sidelines.
And we’re focusing sort of inexorably on harm what is the right way to talk to a teenager or really anybody about how to balance these two really important?
Fax number one that the D stigmatization of mental distress, anxiety, and depression is good for us.
But number two, that at the same time, we’ve been destigmatize in the terminology around anxiety, we’ve taken to over use terms like trauma that risk bankrupting.
The very thing.
We’re trying to save.
Like how do you walk that fine.
I’m fine line.
Yeah, but I love the question and and it’s not it’s not something that can happen in one conversation with the young person I think.
And so this is, these are the kind of topics that require lots of conversations repeated conversations as well as a lot of listening to teenagers own perspectives about this because, because that’s where I do, most of my learning is hearing how young people occurred in this together, as well.
I think a couple things one is, I think that we used to think about mental illness As this as like a lightning strike, this terrible thing that happens to a few people and God forbid, it happens to me or anybody that I loved and let’s not talk about it.
And if it happens goodness, what we know what a terrible thing and I think everything that we know from epidemiological data over the last 30 years, in both kids, and adults is that mental?
Health challenges are a ubiquitous part of the human condition.
There are longitudinal studies various laws, very high.
Quite a longitudinal studies that did.
Didn’t study from New Zealand and the Great Smoky Mountain study, the ran out of Duke that show, you know, by the time, you’re 40 years, old, 60, or 70, or 80 percent of us are going to haven’t had an episode of mental illness up here.
We were depressed.
A time we were overwhelmed by anxiety appeared found.
We were eating drinking too much or misusing drugs.
It’s a part of the human condition.
And so I think the way that we talk to kids about it is this is something that could happen to you.
It has happened in our family because it’s like, show me a family where it hasn’t Aunt.
And the key is to understand it to recognize it to talk about it, to get help when you need it.
And also the story doesn’t stop there.
This is something that people can live with.
Can recover from can make a part of how you become stronger can make you a better friend, a better parent, and a better student, and a better word.
There’s all these things that these very common human experiences of getting depressed or getting terribly anxious.
And then getting help can be part of a long-term story, and narrative towards strength.
So that’s how I did that.
That sort of, sort of a, an amalgam of the different, kind of conversations that I have with kids.
No, I think it’s definitely deserving of a longer conversation but that’s really fantastic.
Answer and such An important thing, I think, for people to remember to keep us humble about the preciousness of Happiness to keep us from judging those that are dealing with mental health crises and to encourage us to be soft on ourselves when we’re having problems to remember that.
This is a very common part of the human experience and there’s not something wrong with us.
This is proof of our Humanity, not an exception to our Humanity.
Just at flourishing is not the absence of mental health challenges.
If the, it’s the persistence in the return to Health in the setting of these things happening, that happened to a lot of people, a lot of the time, well said, I feel that for listeners that were expecting a bit more of a debate considering that where I my head is nodding off of its off of my spine, every single time you talk, but we’ll move right along to the third bucket.
And see if maybe we disagree a bit here, the third bucket is the parenting piece and I know that this is a little bit more controversial, there is a theory.
And that was the subject of a 20/20 Atlantic feature.
Called what happened to American Childhood by K Julian.
The talks about this phenomenon of accommodate of parenting that especially among college educated higher income parents that are spending a lot more time with their kids, especially a lot more time with their teens getting them ready to go to college that anxious parents in attempting to insulate, their kids from ever experiencing risk and danger and disappointment are unintentionally transferring.
Xiety to their kids and making them ill-equipped to deal with the inevitable distresses of life that you’ve just described.
How do you feel about this, third bucket?
The role of accommodated parenting?
Well, I think this is one of those situations in which we have to give proper.
Respect to the wickedness of this problem of this mental health problem and it’s, it’s really complex.
So, I think that piece was interesting and I think it was fairly specific around Socioeconomic status and cultural groups that it was referring to.
When you go back to the CDC data, as you point out the introduction, this is across all groups, all cultural groups, ethnic groups, linguistic groups socioeconomic status.
And so, I don’t think we can, we can’t defer to a to an explanation that is specific just to one slice of SES.
So I think there’s no question that there is a lot of accommodative Tang.
And I think of it, in terms of there’s a mentality, I think that a lot of parents have particularly parents who have achieved or were born into middle class or upper middle class status, and there’s a degree to, which they want to future-proof their children.
They want to make sure that their children have lives that are as good as or better than their lives.
They experience the world.
As a world of scarcity, there are shrinking opportunities.
It’s harder to get into the college’s.
And there are fewer great jobs and so I need to do everything I can to make sure that my kid has every opportunity that I had.
And that made that means sat tutors and fancy summer experiences and a resume for college applications that look like somebody who’s been in the workforce for 20 years.
I’ll do anything that I have to do to help my kid be successful.
And I think that that that does connote a lot of anxiety on the part of parents.
And I think again that’s specific to certain groups.
There are other groups of cultural groups.
And an ethnic groups that are dealing with a difficult other.
Kind of anxiety anxiety by economic precarity.
Anxiety about a racist and violent World in which they live.
And they wish they were worried about the safety of their kids.
When they go out into the, under this, to into the community each day, when they walk to school, when they get behind the wheel of a car.
And so, that’s a different kind of anxiety that parents are coping with, and that probably drives a whole other kind of parenting.
A viewer that may impact kids as well.
I think the common denominator is we have parents who are in a state of hyper vigilance overwhelm of not knowing exactly what to do or how to take care of their kids in a way that’s allowing the other kids to have the kind of future that they imagine for them.
And so, I think that’s sort of a convergent point in a very complicated Terrain.
The fourth bucket that I want to ask you about and I am writing an article about this right now.
So my understanding of this particular zone is a little bit underdeveloped, but I just read this study.
Looking at international data comparing School intensity across countries to reports of adolescent distress.
And to make a very long story, short richer countries seem to have sadder teenagers in part because richer countries have higher education standards which means they have more Didn’t attend schools, which means they have more Scholastic competition, which means that they have more stressed out teenagers.
So I’m wondering and I’m as I’m reciting the finding of this study, I’m definitely Hearing in my recitation that there’s an SES element to it that not every school is going to have the exact same level of intensity and that a hetero G of intensity.
Might yield a her head orogeny of adolescent distress, but let me just pose the question you this way in your practice.
How true does this ring?
And college anxiety are a major driving factor of teenage anxiety.
I think it’s very, it’s a profound factor and again, it tends to track around what their perceived opportunities are for young people.
I think in in communities and settings and which kids are in very high achieving competitive schools, whether those are public schools or private schools and there’s the sense of G from this graduating class.
Only five kids are going to get into the ivy league.
How do I make sure my kid is one of those?
And I think there’s a, there’s a congruent but very different anxiety in different Communities In Schools that my team.
And I work with that are in communities that are historically divested and which there is a sense of far, fewer opportunities in post-secondary, education, and in the workforce and parents feel an anxiety about the basic safety of their kids, as well, as, what can what levers can they possibly pull, what can they do to open up opportunities for their kids in a world where it feels like opportunities.
So I think there is a Common Thread there.
I think the data that you cite around competitors in schools is quite interesting because I think kids do experience that very directly to experience it as Zero Sum and either I’m going to succeed or you’re going to succeed.
We can’t both succeed which is a really tough way for kids to operate.
There was an amazing study by the late Economist Alan Krueger about how where people applied to college was more Predictive of their adult income then where they actually went.
That is a student with a, you know, 1500 sat who goes to Penn State, but got rejected from Pain.
Learn just as much on average is a student with the same SAT score who got into the ivy league.
So for most students, the set of schools where you apply is more predictive than the school that actually accepts you.
And I find that so profound and It’s so compelling and when I go back to high schools and I talk to seniors, 17, 18 years old, I say, this is maybe the single most important factor that I could possibly impress upon you.
I did not get into my first choice of college.
I did not get the, my second choice.
I didn’t get into my third choice.
I didn’t get in my fourth choice.
I got to my fifth choice and it was a great school, and I had a great time, and I’m very happy with where I am in my life.
And if I could go back to 17, 18 year-old Eric and make like one, Edit to my psychology.
I would reduce my anxiety about college by a factor of literally 100 and I so wish that I could have that impression but I could have that effect on college students today.
Because one implication of this academic research, that is more important where you apply, then where you go, is that the habits that you develop when you’re 18 years old?
Our a better indicator of the person you’ll be at 38, then where you go to school for four years, habits are more important than the outcome of what school randomly accepts you.
And I just I wish I could have some way of making every 17 and 18 year old that I confront recognizes fact.
I’ve a few quick reaction to that story one.
I love it.
I’m going to use it to as much as teenagers need.
To hear it.
Parents need to hear it more.
So I hope you go around and share that story with the parents of those 17 year olds and three.
I think all of us who have young people in our lives, should take your example.
And think of the things that we worried about that, we wish we hadn’t spent so much time worrying about and share that with young people in our lives.
Because all of us made some of those attribution errors about what’s going to really matter, and it causes a lot of suffering.
So we’re able to reflect on that with our kids and young people, our lives.
I think, We help them.
Let’s talk about what to do about this.
And as we talk about solutions, they want to be attentive, to the fact that I’m sort of imagining our audience, breaking down into roughly three groups, we might have younger listeners dealing with exactly the kind of adolescent distress, they were discussing.
I have to imagine that we have parents of adolescence or maybe older children younger children who want guidance in this area.
And then finally, number three, I think there are people who are interested in the biggest Solutions here at the public or public policy.
So being attentive to those groups who are listening, where do you want to start with your Solutions?
Let’s-let’s-let’s, I’ll follow your rubric, exactly.
So you know, I for those young people and families that are listening, these are some things that I think are useful to think about and I’ll just try to be simple and direct first is please limit the time that you spent on social media.
Please limit the time that your kids spend on social media parents.
You can do that, you have that ability and please use it.
It will have a meaningful effect on your kids while being secondly.
Stay involved in your teens lives, ask questions, be curious, get to know their friends.
They’re going to push back on that because they’re trying to develop Independence and that’s that Dynamic is normal, but your active and persistent role is valuable and crucial and appreciated, even if you don’t feel the appreciation, parents talk to trusted peers.
When you’re concerned about your kids, talk to your relatives, talk to clergy, talk to your pediatrician, talk to your kids, teachers, See clinical support.
If your concerns persist many parents operate under the assumption that getting help somehow might intensify the problems talking about suicide, might plant the idea of suicide and kids heads.
That’s just not true.
Help is the first step towards relieving their suffering and then and then the last part for parents particular is please take care of your own mental health.
Get your own clinical support.
If you’re feeling depressed, if you’re overly anxious, if you’re drinking too much, if you’re feeling constantly overwhelmed, Armed that is will impact your kids.
So, please take care of that, please limit your own social media.
Think about your own digital media, hygiene and invest time and effort.
In enhancing your own social network, build your Social Fitness, spend time with friends and family in particular, At the level of schools and health care.
I just want to come back to this thing about school connectedness.
It’s a crucial protective Factor when kids feel safe and valued and connected other students and adults at the school, their mental health improves.
So schools need to invest time and resources and building and sustaining relationships work.
Extra hard to reach the disconnected.
Kids just a brief anecdote with a school that we worked with in d.c. there there is a school that on the first professional day of the year, they put the name of every kid in the school.
School on a Post-It note and put it up on the wall in Auditorium and all the in every adult that work in the schools and it was in the room and they said to all the adults go over and pull off the name of every child that you got a relationship with that, you know, you know what they like to play a recess.
You know what’s your favorite subject?
And so all the adults did that and some had to post it notes and some had eight and then they looked at the 20 or 30 post it notes that were still on the wall and they said those are the kids that we need to be worried about.
Those are the kids that we need to make an extra effort to reach out to their not connected, and we can do something about that.
It’s just an example, kind of thinking that needs to be brought to bear.
And then we need to reduce barriers to Great.
Mental health care for all the kids who need it.
We need resources to expand Mental Health, Services in schools.
We need resources to allow pediatricians to address mental health, concerns and primary care.
So they need to be able to partner with psychiatrists and psychologists and therapists to identify and work on mental health concerns while kids are in the pediatricians office.
We need to intelligently deploy Telehealth, and digital Health tools to expand access to care.
Obviously, the Telehealth thing has been huge Since the pandemic I think mental health is best one of the best use cases for Telehealth and we deployed in a way that intelligently intersects with the system’s where kids spend time in schools and in their pediatrician offices.
In order to be most effective in reaching the most kids.
And then finally, for the, my colleagues mental health, we need to think about the mental health of the whole family.
Not just a young person, is identified with depression or anxiety.
But what’s going on with that family?
What’s keeping them?
What can we do to help them?
And then finally, the policy level I know you spend a lot of time thinking and writing what Derek, we need to explore strategies to reduce access to social media for young people and particularly for early adolescents.
That’s something that I know is being talked about a lot.
Now, we need to take steps to make families lives more manageable.
So things like paid parental leave and affordable, child care and the child tax credit.
These are policy decisions and choices that affect the mental health of families and kids.
And By, ignoring those neat, those screaming needs from families to make their lives more manageable.
There are Downstream effects on teens mental health.
And then finally, we need to really enforce mental health, parity laws.
So that mental health and addiction care.
Truly gets the same coverage in the same payment is other health conditions if this finally happens and isn’t force that will draw more practitioners and to mental health care and will incentivize the Health Care Systems at large to invest in mental health infrastructure with that if that doesn’t happen, we’re not going to move forward.
That’s a fantastic answer.
I feel like it’s it’s practically a congressional testimony.
I hope we have some people from some Congress people to office who are who are listening I have to follow up questions.
One, is you mentioned?
You said two things that I wonder how they fit together?
One is that When we deal with people virtually we get less data from them from their bodies.
We it’s not like being with them physically and that in some ways you know virtual Hangouts aren’t the same as real world Hangouts.
I also know that Telehealth therapy is becoming very popular.
Do we have evidence that Telehealth therapy which is obviously in many ways, more convenient than the real world, the physical world. - is worse.
That’s a good question.
So I when I reference earlier to some of those signals we get from kids is what I’m imagining, when you see kids who are in a row on Instagram or who on Snapchat and are scrolling and passively consuming digital information or input interaction by video on a FaceTime call or in a Telehealth appointment actually is quite rich.
And so, I think that they’re particularly for kids.
In the right age group.
So kids older than 8 or 9 years old who can really engage in a conversation by my video.
I think there’s a lot of anecdotal evidence and emerging, real strong clinical evidence, that Telehealth interventions for mental, health are effective.
And I think that we really should rely on them.
We should do more research and we should get a finer and finer picture of for which kids and adults and for which conditions to help Telehealth work best.
But I think most of us in the field feel confident based on our Experiences over the last three years that we can really reach kids, effectively, with conventions by Telehealth.
It’s the ants that I’m rooting for.
I just want to make sure that the answer that I’m rooting for is, in fact, the correct answer because, you know, sometimes, motivated reasoning can lead one astray.
The second question that I had the second follow-up question that occurred to me is that you mentioned that the system that currently exists, does not have the bandwidth to deal with the demand with the Adolescent, maybe even adult demand.
For for mental health services.
I know that the u.s. is unique in terms of how long and how expensive our medical education system as we have the longest medical education system in the world with eight years with the most expensive.
Medical education system in the world in terms of average debt accumulated by the time someone has finished, do you think we need to make it easier to become a psychiatrist?
A A therapist there are trade-offs, of course, in making it easier, there’s less training, there’s less training, that’s just ipso facto.
But do you think that given this wave of demand, that we are clearly seeing from young people that it’s time for a national conversation around making it easier to become a therapist or counselor.
I think the workforce issues are critical the way I think about is not so much as make it easier.
It’s let’s open.
More doors and less incentivize people in a more effective way.
So open more doors, meaning I think that there is a lot of really interesting work around expanding the workforce to include para, clinical or preclinical folks who can address many of the concerns and kids, and adults, when they’re emergent, or when they’re mild and severity.
So the use of trained mentors and therapeutic mentors community health workers folks who have training.
But a more limited training to deal with milder problems and to do it in community-based settings, that will reduce many barriers to care.
And then I think that we need to train more social workers counselors psychologists and psychiatrists weird that we’re already drawing more people into these fields.
I know it, our medical school at Georgetown, the rate of people going into Psychiatry and into child.
Psychiatry are increasing because people are more interested in it.
Neuroscience is fascinating, the Therapeutics work beautifully.
There’s a lot of attention in the culture around It but we need to incentivize people further by the pay that people can earn.
Not so much that Psychiatry was particularly in social work and therapy and counseling and psychology people are under compensated.
And this is critically important work that gets treated as sort of the stepchild of the Health Care system and doesn’t get adequately compensated.
And so we’re not drawing enough people into into into these roles.
I think if we can adjust that one of the reasons I mentioned parody if we can adjust compensation from third.
Artie payers, then we can increase compensation draw more talented people into the field and broaden and deepen, the workforce.
I wonder sometimes whether CBT cognitive behavioral therapy and some of the basics of CBT and DBT, dialectical behavioral therapy should be taught in schools, more broadly in high schools and maybe even before, I mean, how many tens of millions of Americans had to read animal farm and The Great Gatsby even though they never became English, professors, or English Majors look, I love reading but how many I mean, tens of millions?
How many tens of The people learned Advanced algebra or precalc even though they never became computer scientists or Advanced mathematicians, tens of millions, but everyone has a brain 60, 70 % of adults.
You said deal with mental health distress or mental health issues, by the time, they’re what 40, 50 years old.
That’s much higher than the share that become English professors, or Advanced mathematicians, or computer scientist.
I’m not by the way, denigrating precalc and Animal Farm I’m saying to the degree to which our education system should be set up to prepare future adults for the challenges and opportunities of their adulthood.
It’s not clear to me that the education system is a perfect preparation that reflects those inevitable opportunities and challenges.
Should we do it?
Should we teach CBT in high school?
Still waiting for us to have a chance to disagree?
So it’s not it’s not going to happen here, 100%.
This, this stuff is very accessible and teachable.
Kids as young as five and six years old and become that, we teach that we introduce and teach again, and teach again and teach again, and come back to this.
This is part of building healthy citizens, it’s like, teaching Civics.
We teach civics or the people can participate in our democracy, and that’s more important than ever.
Now, we should be teaching emotional health skills.
So that people can maintain emotional equilibrium during the inevitable ups and downs of our lives and schools the right place to do it.
Let me just jump in there.
They’re we’re not going to do an entire 101 session on cognitive behavioral therapy and there a time left but I’ll pick up exactly where you left off.
Five and six years old.
What is a lesson from CBT that we could teach to someone in kindergarten or first grade because it can run?
Fourth grade can learn how to identify emotions.
This is what it feels like to be angry.
This is what it feels like to be frustrated is like what it feels like to be bored or disappointed or excited or enthusiastic and being able to label emotional experiences is very very bad.
Valuable for kids were just finding language to describe their experiences.
It helps them to resolve social conflict.
It helps them to identify their feeling, get help from adults, and it’s super teachable.
I totally agree and I especially feel like the value of being able to identify anger or jealousy.
Or distress isn’t just that by shining a flashlight on it.
You can sometimes watch the feeling dissipate go away but also, you begin to see how all the feelings.
Yes, jealousy, anger.
It all is just like, This River going under a bridge just swoosh.
It’s there and then it’s gone.
And so in identifying these emotions, you also get clarity on the bigger picture.
You don’t just see the individual ripples on the water.
The entire River, you see all of this is just moving through me and I don’t have to identify with any particular passing feeling.
I can see that by the nature of their being feelings, they’re not going to last forever.
I love your use of metaphor there, to Derek mean that kids respond to metaphor and thinking about emotions as moving, water, or clouds across the sky, or changing.
Whether it really helps kids to identify in a very deep visceral way with the fact that these, that no feeling lasts forever.
So very much.
This was really valuable to me.
I appreciate it, really enjoyed it.
Thank you, dear.
Thank you for listening.
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