Teenagers

Nick Gillespie | 4.10.2024 10:45 AM

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Abigail Shrier is author of the best-selling new book Bad Therapy: Why the Kids Aren't Growing Up. She argues that the mental health of Gen Z—people born between 1997 and 2012—is a mess because an infantilizing therapeutic culture pervades every aspect of their lives.

Shrier stresses that she's not against psychological counseling and help per se, but she believes too many unqualified and misguided people are causing far more problems than they solve.

Her previous book was the controversial Irreversible Damage, which looked at the rapid rise of girls identifying as transgender. We talk about the roots of today's therapeutic culture, the extent of the problems it causes, and how parents, teachers, and young people themselves might find a better way forward.

Previous appearance:

Abigail Shrier: Trans Activists, Cancel Culture, and the Future of Free Expression, July 7, 2021

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This interview has been condensed edited for style and clarity.

Nick Gillespie: The new book is Bad Therapy: Why the Kids Aren't Growing Up. Can you give us the elevator pitch for Bad Therapy?

Abigail Shrier: So I always start a book with a question, and my question was, why are the kids who've gotten the most mental health resources, had the most therapy, the most diagnoses, the most psych meds, the most wellness tips, the most coping tips, etc. They should be the picture of mental health. Instead, they're the picture of despair. And I wanted to know why.

And I also wanted to know why they have no interest in growing up. Why weren't they looking to move out of their parents' house? A larger percentage of them are living at home more than ever before, even with our low unemployment. Why are they putting off getting a driver's license or claiming that driving is scary? Boys over 17 are saying this. So, those were my two questions, and I found that they were related.

Gillespie: A couple of the big points that you make, which I think are really good and interesting and important, is that all medical interventions or any kind of interaction with a doctor of any stripe, they have the potential for negatives. Explain how that kind of intersects with the topic here.

Shrier: So there's this concept called iatrogenesis, which is a Greek word meaning when the healer introduces harms. What I want people to know is that any intervention, no matter how good, if it is efficacious, if it has the power to help, also necessarily has the power to harm. If it can do anything at all, then of course it can harm. So Tylenol, which is wonderful, can damage your liver if you take too much of it. X-rays. But what people might not know is that therapy, which also has the power to help, can harm as well.

Gillespie: For the context of the book, you're talking about Gen Z, but also kids who are in school now and are dealing with a much more therapeutic culture generally than you or I grew up with. Kids are different from adults. How does that factor into your book?

Shrier: A number of ways. When an adult goes to therapy, an adult first of all makes the decision, I want to work on this or I need the support. I know myself and I need this. You have their buy-in, the therapist has their buy-in, and they show up ready to work. Number two, they've lived enough life that if the therapist is a little off track, or maybe the therapist got the wrong impression, an adult can say, "You know what? I really think I gave you the wrong impression of my mom." Or "Look, my parents were difficult in that regard, but I wouldn't call them toxic. And I don't think breaking off with them is the right move."

It's very hard for a teenager or a child to say those things, especially if they're angry with mom. They don't know what constitutes emotional abuse, especially if an adult is leading them to think that they were emotionally abused, or that they had experienced trauma. And with a child, you don't have their buy-in. So a therapist is naturally going to want to pander to a child to get them on board. Now, if a child has a severe problem that they're coming to a therapist with, that sort of focuses the mind. You've got a kid who's anorexic or who has severe [obsessive compulsive disorder], you know what they're going to be talking about. But if you drop off a kid who's got some anxiety for general psychodynamic psychotherapy, the therapist could lead in any direction. And I think that's what we're seeing.

Gillespie: How many kids are on psychoactive drugs and in active therapy?

Shrier: We only stopped talking about ADHD not because it was being diagnosed any less—there are more diagnoses—but because so many young kids are on selective serotonin reuptake inhibitors (SSRIs) today, the antidepressant. The Food and Drug Administration (FDA) just cleared Lexapro, which is a very strong antidepressant, for 7-year-olds. In fact, we've been going in one direction, putting kids on more and more and more psychotropic drugs, anti-anxiety medications, and various forms of speed for ADHD.

So in 2016, one in six kids between the ages of 2 and 8, according to the Centers for Disease Control and Prevention (CDC), already had a mental health or behavioral diagnosis. Those kids weren't on social media. They didn't have smartphones, certainly not in 2016. They don't have them today. So we know that this diagnosis has been exploding. And also mental health treatment has gone in one direction. So, nearly 40 percent of the rising generation has been to see a therapist already. And I'm not the only one to have noticed this—a team of researchers did a year ago and called this the treatment prevalence paradox.

What they were noticing is that with treatment of illness, the more treatment there is, the more the point prevalence rate of a disorder should go down. We saw this with breast cancer treatment and other things. The incidence of death from breast cancer went down with more pervasive treatment. Here, there's been vast expansion of treatment and the rates of depression and anxiety have only gone up.

Gillespie: Supporters of that trend would say, "Well, that's because it's an epidemic. It's a pandemic of anxiety, of depression, of isolation, of whatever." But you're effectively saying that it's probably more caused by the intervention itself. Let's also talk about how the therapy culture has gone into schools. Because it used to be, certainly 30-40 years ago, teachers were not trained in therapy. They were not expected to be counselors. Most schools probably didn't even have school counselors or psychologists or anything like that on staff. But now, everywhere you look, that is considered part and parcel of K-12 teacher education, right?

Shrier: And that's why we're seeing so much increase in anxiety, depression, and the known harms of therapy, because we are treating a vast population, and mostly they are well. And here's the thing with iatrogenesis or when a healer introduces harm: If you have a problem, if you have a serious cut and you need stitches, it's worth the trip to the emergency room. But if you have a minor scratch, then you only stand to face risk, right? Because you don't stand to benefit, really.

So all the exposure to MRSA and other bacteria at the E.R., now you're just facing risk. And that's what we're doing with this generation. We're taking healthy kids who are a little bummed out, a little anxious, and we're loading them with intervention, as you say, much of it through school, through social-emotional learning and all the therapeutic techniques now going on in school. And so all these kids face is risk.

Gillespie: Why don't teachers push back on this ask of them, to be teaching history, or reading, or math, or whatever, and to also be scanning the classroom for problematic behavior?

They seem to have embraced this role as being therapists or being on the lookout for stuff, which I think you both stress and document very well. Whatever else you think about therapy and counseling, these teachers just aren't equipped to do that. So it's really wrong to ask them or to expect them to be any good at it. But why aren't they saying, "If you want kids to be put in therapy, come and do it yourself."

Shrier: So teachers broke down into a number of categories. Some of them absolutely objected. They're desperate to get through their lessons. That's why they got involved, and many of them told me they can't deal with even the behavioral outbursts. The kids have become so dysregulated. They're being asked to do things that aren't their job. They want to get out of teaching.

Then there are the teachers who don't really want to teach, or they find it really challenging, and it's much easier to play "Let's talk about your trauma" or to play a sort of amateur therapist. And of course, the third answer I have is that a lot of this is coming from school counselors who march in. And what I want people to know is that when a school counseling staff expands in your high school, it operates a........

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