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Copyright © 2024 by Abigail Shrier
版权所有 © 2024 Abigail Shrier

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Library of Congress Cataloging-in-Publication Data Names: Shrier, Abigail, author.

Title: Bad therapy : why the kids aren’t growing up / Abigail Shrier.

Description: [New York] : Sentinel, 2024. | Includes bibliographical references and index.
描述: [纽约] : Sentinel, 2024.|包括参考书目和索引。

Identifiers: LCCN 2023046210 (print) | LCCN 2023046211 (ebook)
标识符:LCCN 2023046210(印刷品)、LCCN 2023046211(电子书)

ISBN 9780593542927 (hardcover) | ISBN 9780593542934 (ebook)
ISBN 9780593542927 (精装) ISBN 9780593542934 (电子书)

Subjects: LCSH: Child psychotherapy—Social aspects—United States. | Child mental health—United States. | Child rearing—United States.

Classification: LCC RJ504 .S538 2024 (print) | LCC RJ504 (ebook)
中图分类号: LCC RJ504 .S538 2024(打印)LCC RJ504(电子书)

DDC 618.92/8914—dc23/eng/20231107

LC record available at https://lccn.loc.gov/2023046210 LC ebook record available at https://lccn.loc.gov/2023046211
LC 记录可在 https://lccn.loc.gov/2023046210 LC 电子书记录在 https://lccn.loc.gov/2023046211 上获得

Cover design: Pablo Delcan Cover photo illustration: Justin Metz
封面设计:Pablo Delcan 封面照片插图:Justin Metz

克里斯·韦尔奇(CHRIS WELCH)的书籍设计

Some names and identifying characteristics have been changed to protect the privacy of the individuals involved.



To my mother and father and

Zach. Always Zach. OceanofPDF.com

Sometimes love is not enough and the road gets tough

I don’t know why

—Lana Del Rey
——拉娜·德尔·雷伊(Lana Del Rey)



Author’s Note

Introduction: We Just Wanted Happy Kids

Part I

Healers Can Harm

Chapter 1 Iatrogenesis
第1章 医源性

Chapter 2 A Crisis in the Era of Therapy
第2章 治疗时代的危机

Chapter 3 Bad Therapy
第 3 章 糟糕的治疗

Part II

Therapy Goes Airborne

Chapter 4 Social-Emotional Meddling
第4章 社会情感干预

Chapter 5 The Schools Are Filled with Shadows
第5章 学校布满了阴影

Chapter 6 Trauma Kings
第6章 创伤之王

Chapter 7 Hunting, Fishing, Mining: Mental Health Survey Mischief
第 7 章狩猎、捕鱼、采矿:心理健康调查恶作剧

Chapter 8 Full of Empathy and Mean as Hell
第8章 充满同理心和卑鄙

Chapter 9 The Road Paved by Gentle Parents
第九章 温柔的父母铺就的路

Chapter 10 Spare the Rod, Drug the Child
第10章 饶了杖子,给孩子下药

Part III

Maybe There’s Nothing Wrong with Our Kids

Chapter 11 This Will Be Our Final Session
第11章 这将是我们的最后一节课

Chapter 12 Spoons Out
第12章 勺子出来

Acknowledgments Notes
致谢 注释

Select Bibliography


Author’s Note

Talk of a “youth mental health crisis” often conflates two distinct groups of young people. One suffers from profound mental illness. Disorders that, at their untreated worst, preclude productive work or stable relationships and exile the afflicted from the locus of normal life. Theirs is a crisis of neglect and undertreatment. These precious kids require medication and the care of psychiatrists. They are not the subject of this book.

This book is about a second, far larger cohort: the worriers; the fearful; the lonely, lost, and sad. College coeds who can’t apply for a job without three or ten calls to Mom. We tend not to call their problem “mental illness,” but nor would we say they are thriving. They go looking for diagnoses to explain the way they feel. They think they’ve found “it,” but the “it” is always shifting.

We shower these kids with meds, therapy, mental health and “wellness” resources, even prophylactically. We rush to remedy a misdiagnosed condition with the wrong sort of cure.


Introduction: We Just Wanted Happy Kids


y son returned home from sleepaway camp this summer with a stomachache. When it didn’t quickly abate, I took him to a pediatric urgent care clinic, where a doctor ruled out
今年夏天,Y 儿子因胃痛从露宿营地回到家中。当它没有迅速消退时,我带他去了儿科紧急护理诊所,医生排除了这种可能性

appendicitis. “Probably just dehydration,” came the verdict. But before the doctor cleared us to go home, he asked us to wait for the nurse, who had a few questions.

In bustled a large man in black scrubs wielding a clipboard. “Would you mind giving us some privacy so that I can do our mental health screening?” he said. After a beat, I realized that the privacy the man wanted with my son was from me.

I asked to see his questionnaire, which turned out to be issued by the National Institute of Mental Health, a federal government agency. Here is the complete, unedited list of questions the nurse had planned to put to my twelve-year-old in private:
我要求看他的问卷,结果发现是由联邦政府机构国家心理健康研究所(National Institute of Mental Health)签发的。以下是护士计划私下向我十二岁的孩子提出的完整、未经编辑的问题清单:

In the past few weeks, have you wished you were dead?

In the past few weeks, have you felt that you or your family would be better off if you were dead?

In the past week, have you been having thoughts about killing yourself?

Have you ever tried to kill yourself? If yes, how? When?

Are you having thoughts of killing yourself right now? If yes, please describe.[1]

When the nurse asked me to leave the room, he wasn’t going off script. He was following a literal one. The “Script for Nursing Staff” directs nurses to inform parents: “We ask these questions in private, so I am going to ask you to step out of the room for a few minutes. If we have any concerns about your child’s safety, we will let you know.”[2]

Driving my son home from the clinic, I was haunted by the following possibility: What if I had been just a little more trusting? Children often try to please adults by producing whatever answers the grown-ups seem to want. What if my son, alone in the room with that large man, had given him the “yes” the questions appeared to prompt? Would the staff have prevented me from taking my son home?

And a child who was entertaining dark thoughts? Was this really the best way to help him? Separate him from his parents and present him with a series of escalating questions about killing himself?

I hadn’t signed my son up for therapy. I hadn’t taken him for a neuropsychological evaluation. I had taken him to the pediatrician for a stomachache. There was no indication, no reason to even suspect, that my son had any mental illness. And the nurse didn’t wait for one. He knew he didn’t have to.

We parents have become so frantic, hypervigilant, and borderline obsessive about our kids’ mental health that we routinely allow all manner of mental health expert to evict us from the room. (“We will let you know.) We’ve been relying on them for decades to tell us how to raise well- adjusted kids. Maybe we were overcompensating for the fact that our own parents had assumed the opposite: that psychologists were the last people you should consult on how to raise normal kids.

When we were little, my brother and I were spanked. Our feelings were

seldom consulted when consequential decisions about our lives were made

—where we would attend school, whether we would show up at synagogue for major holidays, what sort of clothes fit the place and occasion. If we didn’t particularly relish the food set out for dinner, no alternate menu was forthcoming. If we lacked some critical right of self-expression—some essential exploration of a repressed identity—it never occurred to either of us. It would be years before anyone in my generation would regard these perfectly average markers of an eighties childhood as vectors of emotional injury.

But as millions of women and men my age entered adulthood, we commenced therapy.[3] We explored our childhoods and learned to see our parents as emotionally stunted.[4] Emotionally stunted parents expected too much, listened too little, and failed to discover their kids’ hidden pain. Emotionally stunted parents inflicted emotional injury.
但是,随着数以百万计与我同龄的女性和男性进入成年期,我们开始接受治疗[3],我们探索了我们的童年,并学会了将我们的父母视为情感发育迟缓的人。[4] 情感发育迟缓的父母期望太多,倾听得太少,未能发现孩子隐藏的痛苦。情感发育迟缓的父母造成了情感伤害。

We never doubted that we wanted kids of our own. We vowed that our child-rearing would reflect a greater psychological awareness. We resolved to listen better, inquire more, monitor our kids’ moods, accommodate their opinions when making a family decision, and, whenever possible, anticipate our kids’ distress. We would cherish our relationship with our kids. Tear down the barrier of authority past generations had erected between parent and child and instead see our children as teammates, mentees, buddies.

More than anything, we wanted to raise “happy kids.” We looked to the wellness experts for help. We devoured their bestselling parenting books, which established the methods by which we would educate, correct, and even speak to our own children.

Guided by these experts, we adopted a therapeutic approach to parenting. We learned to offer our kids the reasons behind every rule and request. We never, ever spanked. We perfected the “time-out” and provided thorough explanation for any punishment (which we then rebranded as a “consequence” to remove any associated shame and make us feel less

authoritarian). Successful parenting became a function with a single coefficient: our kids’ happiness at any given instant. An ideal childhood meant no pain, no discomfort, no fights, no failure—and absolutely no hint of “trauma.”

But the more closely we tracked our kids’ feelings, the more difficult it became for us to ride out their momentary displeasure. The more closely we examined our kids, the more glaring their deviations from an endless array of benchmarks—academic, speech, social and emotional. Each now felt like catastrophe.

We rushed our kids back to the mental health professionals who had guided our parenting, this time for testing, diagnosis, counseling, and medication. We needed our kids and everyone around them to know: our kids weren’t shy, they had “social anxiety disorder” or “social phobia.” They weren’t poorly behaved, they had “oppositional defiant disorder.” They weren’t disruptive students, they had “ADHD.” It wasn’t our fault, and it wasn’t theirs. We would attack and finally eliminate the stigma surrounding these diagnoses. Rates at which our children received them soared.

In the course of writing my last book, Irreversible Damage, and for years after its publication, I spoke to hundreds of American parents. And during that time, I became acutely aware of just how much therapy kids were getting from actual therapists and their proxies in schools. How completely parents were relying on therapists and therapeutic methods to fix their kids. And how expert diagnoses often altered kids’ perceptions of themselves.

Schools, especially, jumped at the opportunity to adopt a therapeutic approach to education and announced themselves our “partners” in childrearing. School mental health staffs expanded: more psychologists, more counselors, more social workers. The new regime would diagnose and accommodate, not punish or reward. It directed kids in routinized habits of monitoring and sharing their bad feelings. It trained teachers to understand “trauma” as the root of student misbehavior and academic underperformance.

These efforts didn’t aim to produce the highest-achieving young people. But millions of us bought in, believing they would cultivate the happiest, most well-adjusted kids. Instead, with unprecedented help from mental health experts, we have raised the loneliest, most anxious, depressed, pessimistic, helpless, and fearful generation on record. Why?

How did the first generation to raise kids without spanking produce the first generation to declare they never wanted kids of their own?[5] How did kids raised so gently come to believe that they had experienced debilitating childhood trauma? How did kids who received far more psychotherapy than any previous generation plunge into a bottomless well of despair?[6]
第一代在不打屁股的情况下抚养孩子的人是如何让第一代人宣布他们从不想要自己的孩子?[5] 如此温柔地长大的孩子是如何相信他们经历过使人衰弱的童年创伤的?接受心理治疗的孩子比以往任何一代人都多得多,他们是如何陷入绝望的无底井的?[6]

The source of their problem is not reducible to Instagram or Snapchat. Bosses and teachers report—and young people agree—that members of the rising generation are utterly underprepared to accomplish basic tasks we expect all adults to dispatch: ask for a raise; show up for work during a period of national political strife; show up for work at all;[7] fulfill obligations they undertake without requiring extensive breaks to attend to their “mental health.”
他们问题的根源不能归结为Instagram或Snapchat。老板和老师报告说——年轻人也同意——新生代的成员完全没有准备好完成我们希望所有成年人都派遣的基本任务:要求加薪;在国家政治纷争时期上班;完全不上班;[7] 履行他们所承担的义务,而不需要大量的休息来照顾他们的“心理健康”。

It’s not unheard of for boys of sixteen or seventeen to put off getting a driver’s license on the grounds that driving is “scary.”[8] Or for college juniors to invite Mom along to their twenty-first birthday celebrations. They are leery of the risks and freedoms that are all but synonymous with growing up.

These kids are lonely. They settle into emotional pain for reasons that seem, even to their parents, a little mysterious. Parents seek answers from mental health experts, and when our kids inevitably receive a diagnosis, they grasp it with pride and relief: a whole life, reduced to a single point.

No industry refuses the prospect of exponential growth, and mental health experts are no exception. By feeding normal kids with normal problems into an unending pipeline, the mental health industry is minting patients faster than it can cure them.

These mental health interventions on behalf of our kids have largely backfired. Recasting personality variation as a chiaroscuro of dysfunction, the mental health experts trained kids to regard themselves as disordered.

The experts operate from the assumption that everyone requires therapy and that everyone is at least a little “broken.”

They speak of “resilience” but what they mean is “accepting your trauma.” They dream of “destigmatizing mental illness” and sprinkle diagnostic labels like so much pixie dust. They talk of “wellness” while presiding over the downward spiral of the most unwell generation in recent history.

With the charisma of cult leaders, therapeutic experts convinced millions of parents to see their children as challenged. They infused parenting with self-consciousness and fevered insecurity. They conscripted teachers into a therapeutic order of education, which meant treating every child as emotionally damaged. They pushed pediatricians to ask kids as young as eight—who had presented with nothing more than a stomachache—whether they felt their parents might be better off without them.[9] In the face of experts’ implacable self-assurance, schools were eager; pediatricians, willing; and parents, unresisting.
凭借邪教领袖的魅力,治疗专家说服了数百万父母将他们的孩子视为挑战。他们为养育子女注入了自我意识和狂热的不安全感。他们征召教师接受治疗性教育,这意味着将每个孩子都视为情感受损的孩子。他们敦促儿科医生询问年仅八岁的孩子 - 他们只表现出胃痛 - 他们是否觉得没有他们的父母可能会更好。[9]面对专家们无情的自信,学校急切地求助;儿科医生,愿意;和父母,不抗拒。

Maybe it’s time we offered a little resistance.


Part I

Healers Can Harm

The best of doctors are destined for hell.

—The Mishnah


Chapter 1
第 1 章

• 医源性


n 2006, I packed up everything I owned and moved from Washington, DC, to Los Angeles to be closer to my then boyfriend. I had only ever visited California once, a few months earlier, when I had flown out to meet his parents. Outside of my boyfriend and his family, every single person who could identify my body in the event of an untimely demise

lived on the East Coast.

Then twenty-eight and having recently graduated from law school, I faced the unpleasantness of having become a lawyer. I was restless. My boyfriend had a business in Los Angeles. If I wanted things to work out with him, I needed to move.

But I also knew it was entirely possible that in this new life—his life—I would go crazy. My best friend, Vanessa, lived in DC. We’d both been hired by law firms, which meant long hours and an impossible time difference, as far as calls were concerned. I needed someone to listen to my worries and misgivings on my schedule. I needed a stand-in Vanessa, available every Thursday at six p.m. And for the first time in my life, I could afford one. I hired a therapist.

Every week, for a “fifty-minute hour,” my therapist lent me her full attention. If I bored her with my repetition, she never complained. She was a pro. She never made me feel self-absorbed, even when I was. She let me vent. She let me cry. I often left her office feeling that some festering splinter of interpersonal interaction had been eased to the surface and plucked.

She helped me realize that I wasn’t so bad. Most things were someone else’s fault. Actually, many of the people around me were worse than I’d realized! Together, we diagnosed them freely. Who knew so many of my close relatives had narcissistic personality disorder? I found this solar plexus–level comforting. In quick order, my therapist became a really expensive friend, one who agreed with me about almost everything and liked to talk smack about people we (sort of) knew in common.

I had a great year. My boyfriend proposed marriage. I accepted. And then, a month before we were due to get married, my therapist dropped a bomb: “I’m not sure you two are ready to get married. We may need to do a little more work.”

I felt the demoralizing shock of having walked into a plate-glass door.

My therapist was a formidable woman. She had at least fifteen years on me, a doctorate in psychology, and an apparently strong marriage of long duration. She dropped casual references to never missing Pilates. I once caught her at her spotless desk before our session, eating a protein bar she had carefully unwrapped, and marveled at her obvious self-mastery, the dignity she managed to bring to our silly modes of consumption. Maybe I should have been thrown into crisis by her pronouncement, but for whatever reason, I wasn’t. For all her training, she was still human and fallible. I had already moved across the country by myself, set up a new life, and by then I knew: I didn’t agree with her assessment, and I didn’t need her permission, either. I left her a voicemail expressing my gratitude for her help. But, I said, I would be taking some time off.

A few years later, happily married, I resumed therapy with her. Then I tried therapy with a psychoanalyst for a year or so. Every experience I’ve had with therapy has fallen along a continuum from enlightening to

unsettling. Occasionally, it rose to the level of “fun.” Learning a little more about the workings of my own mind was at times helpful and often gratifying.

When I agreed with my therapist, I told her so. When I didn’t, we talked about that. And when I felt I needed to move on, I did. Which is to say: I was an adult in therapy. I had swum life’s choppy waters long enough to have gained some self-knowledge, some self-regard, and a sense of the accuracy of my own perceptions. I could pipe up with: “I think I gave you the wrong impression.” Or, “Maybe we’re placing a little too much blame on my mom?” Or even, “I’ve decided to terminate therapy.”

Children and adolescents are not typically equipped to say these things. The power imbalance between child and therapist is too great. Children’s and adolescents’ sense of self is still developing. They cannot correct the interpretations or recommendations of a therapist. They cannot push back on a therapist’s view of their families or of themselves because they have no Archimedean point; too little of life has gathered under their feet.

Nevertheless, parents my age have been signing up their kids and teens for therapy in astonishing numbers, even prophylactically. I talked to moms who hired therapists to help their kids adjust to preschool or to process the death of a beloved cat. One mom told me she put a therapist “on retainer” as soon as her two daughters reached middle school. “So they would have someone to talk to about all the things I never wanted to talk about with my mom.”

A few moms told me, in roundabout verbiage, that they had hired a therapist to surveil their surly teen’s thoughts and feelings. The therapist doesn’t tell me what my daughter says exactly, the moms assured me, but she sort of lets me know everything’s okay. And occasionally, I gathered, the therapist relayed to Mom specific information gleaned from the little prisoner of war.

If the notion of “therapy” here seems vague, that’s largely to do with the experts. The American Academy of Child and Adolescent Psychiatry offers a tautology in place of a definition. What is “psychotherapy”? “A form of psychiatric treatment that involves therapeutic conversations and
如果这里的“治疗”概念看起来很模糊,那很大程度上与专家有关。美国儿童和青少年精神病学学会(American Academy of Child and Adolescent Psychiatry)提供了重言式来代替定义。什么是“心理治疗”?“一种涉及治疗性对话和

interactions between a therapist and a child or family.”[1] The American Psychological Association offers a similarly circular definition of psychotherapy: “any psychological service provided by a trained professional.”[2]
治疗师与孩子或家庭之间的互动。[1] 美国心理学会(American Psychological Association)对心理治疗给出了类似的循环定义:“由训练有素的专业人员提供的任何心理服务。[2]

What’s a “clock”? A device for measuring time. What’s “time”? Something measured by a clock. Any conversation a therapist has with a patient counts as “therapy.” But you get the idea: conversations about feelings and personal problems styled as medicine.

Parents often assume that therapy with a well-meaning professional can only help a child or adolescent’s emotional development. Big mistake. Like any intervention with the potential to help, therapy can harm.

Iatrogenesis: When the Healer Makes Things Worse

Any time a patient arrives at a doctor’s office, she exposes herself to risk.[3] Some risks arise through physician incompetence. A patient goes in to have a kidney removed, and the doctor extracts the wrong one. (“Wrong-site surgery” happens more often than you might think.[4]) Or negligence: the surgeon loses track of a stray clamp or sponge in the patient’s abdomen, then sews her up.
每当病人到达医生办公室时,她都会将自己暴露在风险之中。[3] 一些风险是由于医生的无能而产生的。一个病人进去切除肾脏,医生取错了肾脏。(“错位手术”的发生频率比您想象的要高。[4]) 或疏忽:外科医生在患者腹部丢失了杂散的夹子或海绵,然后将她缝合起来。

Or he “nicks” an organ. Or the operation proceeds swimmingly, but the patient develops an opportunistic infection at the surgical site. Or an allergic reaction to the anesthesia. Or bedsores, from lying in recovery too long. Or everything goes according to plan, but the entire treatment was based on a misapprehension of the problem.

“Iatrogenesis” is the word for all of it. From the Greek, iatrogenesis literally means “originating with the healer” and refers to the phenomenon of a healer harming a patient in the course of treatment. Most often, it is not malpractice, though it can be. Much of iatrogenesis occurs not because a doctor is malicious or incompetent but because treatment exposes a patient to exogenous risks.

Iatrogenesis is everywhere—because all interventions carry risk. When a sick patient submits to treatment, the risks are typically worth it. When a well patient does, the risks often outweigh the potential for further improvement.

And here, what I’m calling an “intervention” is any sort of advice or corrective you would typically give only to someone with a deficiency or incapacity. So, telling kids to “eat vegetables” or “get plenty of sleep” or “spend time with friends” may be advice, but it isn’t an intervention. We all need to do those things.

With interventions, a good rule of thumb is: Don’t go in for an X-ray if you don’t need one. Don’t expose yourself to the germs of an ER just to say hello to your doctor friend. And—just maybe—don’t send your kid off to therapy unless she absolutely requires it. Everyone knows the first two; it’s the last one that may surprise you.

Psychotherapy Needs a Warning Label

For decades, the standard therapy proffered to victims of disaster—terrorist attack, combat,[5] severe burn injury—was the “psychological debriefing.”[6] A therapist would invite victims of a tragedy into a group session in which participants were encouraged to “process” their negative emotions, learned to recognize the symptoms of post-traumatic stress disorder (PTSD), and discouraged from discontinuing therapy. Study after study has shown that this bare-bones process is sufficient to make PTSD symptoms worse.[7]
几十年来,为灾难受害者提供的标准疗法——恐怖袭击、战斗、[5]严重烧伤——是“心理汇报”。[6] 治疗师会邀请悲剧的受害者参加小组会议,鼓励参与者“处理”他们的负面情绪,学会识别创伤后应激障碍 (PTSD) 的症状,并劝阻他们停止治疗。一项又一项的研究表明,这种基本过程足以使创伤后应激障碍症状恶化[7]

Well-meaning therapists often act as though talking through your problems with a professional is good for everyone. That isn’t so.[8] Nor is it the case that as long as the therapist is following protocols, and has good intentions, the patient is bound to get better.
善意的治疗师经常表现得好像与专业人士讨论您的问题对每个人都有好处。事实并非如此。[8] 也不是说,只要治疗师遵循协议,并且有良好的意图,患者就一定会好转。

Any intervention potent enough to cure is also powerful enough to hurt. Therapy is no benign folk remedy. It can provide relief. It can also deliver unintended harm and does so in up to 20 percent of patients.[9]

Therapy can lead a client to understand herself as sick and rearrange her self-understanding around a diagnosis.[10] Therapy can encourage family estrangement—coming to realize that it’s all Mom’s fault and you never want to see her again. Therapy can exacerbate marital stress, compromise a patient’s resilience, render a patient more traumatized, more depressed, and undermine her self-efficacy so she’s less able to turn her life around.[11] Therapy may lead a patient by degrees—sunk into a leather sofa, well- placed tissue box close at hand—to become overly dependent on her therapist.[12]
治疗可以使来访者了解自己生病了,并围绕诊断重新安排她的自我理解。[10] 治疗可以鼓励家庭疏远——意识到这都是妈妈的错,你再也不想见到她了。治疗会加剧婚姻压力,损害患者的复原力,使患者受到更多创伤,更加抑郁,并破坏她的自我效能感,从而使她无法改变自己的生活。[11] 治疗可能会在一定程度上导致患者——沉入真皮沙发,近在咫尺的纸巾盒中——变得过度依赖她的治疗师。[12]

This is true even for adults, who in general are much less easily led by other adults. These iatrogenic effects pose at least as great a risk, and likely much more, to children.

Police officers who responded to a plane crash and then underwent debriefing sessions exhibited more disaster-related hyperarousal symptoms eighteen months later than those who did not receive the treatment.[13] Burn victims exhibited more anxiety after therapy than those left untreated.[14] Breast cancer patients have left peer support groups feeling worse about their condition than those who opted out.[15] And counseling sessions for normal bereavement often make it harder, not easier, for mourners to recover from loss.[16] Some people who say they “just don’t want to talk about it” know better than the experts what will help them: spending time with family; exercising; putting one foot in front of the other; gradually adjusting to the loss.[17]
对飞机失事做出反应然后接受汇报会议的警察在18个月后表现出比未接受治疗的警察更多的与灾难有关的过度觉醒症状。[13] 烧伤患者在治疗后比未接受治疗的患者表现出更多的焦虑。[14] 乳腺癌患者离开同伴支持小组时对自己的病情感觉比选择退出的患者更糟。[15]而对正常丧亲之痛的咨询往往使哀悼者更难,而不是更容易从失去中恢复过来。[16] 有些人说他们“只是不想谈论它”,他们比专家更清楚什么会帮助他们:与家人共度时光;行使;将一只脚放在另一只脚前面;逐渐适应损失。[17]

When it comes to our psyches, we’re a lot more bespoke than mental health professionals often acknowledge or allow. And Tuesdays at four p.m. may not be when we’re ready to confront our woes with a hired expert. Reminiscing with a friend, cracking a joke with your spouse you wouldn’t dare make with anyone else, helping your cousin box up her apartment— without talking about your problems—often aids recovery far more than sitting around in a room full of sad people. Therapy can hijack our normal processes of resilience, interrupting our psyche’s ability to heal itself, in its own way, at its own time.

Think of it this way: group therapy for those who experienced loss or disaster forces the coping to hang out with the sad. This may make the relatively resilient sadder and prompt the sad to stew. The most dejected steer the ship to Planet Misery, with everyone else trapped inside.

Individual therapy can intensify bad feelings, too. Psychiatrist Samantha Boardman wrote candidly about a patient who quit therapy after a few weeks of treatment. “All we do is talk about the bad stuff in my life,” the patient told Boardman. “I sit in your office and complain for 45 minutes straight. Even if I am having a good day, coming here makes me think about all the negative things.”[18] Reading that, I remembered saving up emotional injuries to report to my therapist so that we would have something to talk about at our session—injuries I might have just let go.
个体治疗也会加剧不良情绪。精神科医生萨曼莎·博德曼(Samantha Boardman)坦率地写了一篇关于一名患者在治疗几周后退出治疗的文章。“我们所做的只是谈论我生活中的坏事,”病人告诉博德曼。“我坐在你的办公室里,连续抱怨了45分钟。即使我今天过得很愉快,来到这里也会让我想到所有消极的事情。[18] 读到这里,我想起了把情感上的伤害存起来,向我的治疗师报告,这样我们就可以在会议中谈论一些事情——我可能已经放下了。

Interestingly, even when patients’ symptoms are made objectively worse by therapy, they tend to assume the therapy has helped.[19] We rely largely on how “purged” we feel when we leave a therapist’s office to justify our sense that the therapy is working. We rarely track objective markers, for example, the state of our career or relationships, before reaching a conclusion. Sometimes when our lives do improve, it’s not because the therapy worked but because the motivation that led us to start therapy also led us to make other positive changes: spend more time with friends and family, reconnect with people we haven’t heard from in a while, volunteer, eat better, exercise.
有趣的是,即使患者的症状客观上因治疗而恶化,他们也倾向于认为治疗有所帮助。[19] 我们很大程度上依赖于当我们离开治疗师的办公室时我们感到的“被清除”,以证明我们对治疗有效的感觉是合理的。在得出结论之前,我们很少跟踪客观标记,例如我们的职业或人际关系状态。有时,当我们的生活确实有所改善时,并不是因为治疗有效,而是因为促使我们开始治疗的动机也促使我们做出其他积极的改变:花更多的时间与朋友和家人在一起,与我们有一段时间没有消息的人重新联系,做志愿者,吃得更好,锻炼。

An embarrassing number of psychological interventions have little proven efficacy.[20] They have nonetheless been applied with great élan to children and adolescents.

D.A.R.E. to Say “Yes” to Drugs
D.A.R.E. 对毒品说“是”

Picture it: 1992. Blue eyeliner, Doc Martens, and acid-washed jeans shot out at the knees. Into your high school assembly room tromps a uniformed officer in clodhoppers, keys jangling at the edge of a stiff black belt, armed with a jeremiad about the dangers of drugs.
想象一下:1992年。蓝色眼线笔、Doc Martens和酸洗牛仔裤在膝盖处射出。走进你的高中礼堂,一个身穿制服的军官穿着长袍,钥匙在僵硬的黑带边缘叮叮当当,手里拿着一本关于毒品危害的杰里米。

This was the decades-long D.A.R.E. campaign, designed to raise awareness that drugs could ruin your life.[21] Utilizing therapeutic techniques designed by Carl Rogers, one of the most influential psychotherapists of the twentieth century, D.A.R.E. counselors led students in a kind of group therapy. They entered schools and prompted kids to talk about their personal problems, confess their drug use, and role-play refusing drugs from each other.[22]
这是长达数十年的D.A.R.E.运动,旨在提高人们对毒品可能毁掉你的生活的认识。[21] 利用二十世纪最有影响力的心理治疗师之一卡尔·罗杰斯(Carl Rogers)设计的治疗技术,D.A.R.E.辅导员带领学生进行一种团体治疗。他们进入学校,促使孩子们谈论他们的个人问题,承认他们的吸毒,并扮演拒绝对方吸毒的角色[22]

Turns out, you can lead a teen to D.A.R.E., but it might make him wink. The program flopped like Vanilla Ice in his parachute pants, humiliating everyone involved. Not only was the campaign entirely ineffective, but follow-up studies revealed that D.A.R.E. may have actually increased substance and alcohol use among teens.[23] Kewpie-faced Kirk Cameron pleaded, “You don’t have to try ’em to be cool,” but we sniffed a traitor, shilling for the Man. Kirk promised there were other avenues to cool, but teens who heard this message apparently figured drugs were quicker and more straightforward than most.[24] Participating in group therapy to discuss a problem you didn’t already have? That may be sufficient to introduce it.
事实证明,你可以把一个青少年带到D.A.R.E.,但这可能会让他眨眼。这个程序像降落伞裤里的香草冰一样失败了,羞辱了所有相关人员。这项运动不仅完全无效,而且后续研究表明,D.A.R.E.实际上可能增加了青少年的物质和酒精使用。[23]柯克·卡梅伦(Kirk Cameron)恳求说,“你不必尝试他们变得很酷,”但我们嗅到了一个叛徒,为这个人先令。 柯克承诺还有其他途径可以冷静下来,但听到这个消息的青少年显然认为毒品比大多数人更快、更直接。[24] 参加团体治疗来讨论您还没有的问题?这可能足以介绍它。

Wanting to Help Is Not the Same as Helping

Therapists almost always want to help, but sometimes they simply don’t. And while some therapies have shown success in circumscribed areas—like cognitive behavioral therapy has in treating phobias—those who study the efficacy of therapies often point out that the results across treatment types are not terribly impressive.[25]

Mental health experts have a long, florid track record of plying patients with ghastly treatments, introducing novel problems into the patient pool they claim to heal. Fortunately, they’ve abandoned many of the grisliest purported treatments: insulin-induced comas, deliberate infliction of malaria, and of course frontal lobotomies—all employed, not in the Medieval Period, but in the last century.[26] Therapists induced an epidemic of the phony ailment neurasthenia at the start of the twentieth century. A

century later, they were still ginning up ailments: recovered memory syndrome and multiple personality disorder.[27] Therapists fell for the fraud of widespread satanic ritual abuse, too.[28]

In the last decade, therapists promoted the gender dysphoria craze, which led to a 4,000 percent increase in diagnoses for teen girls.[29] A growing army of young women who regret their medical transitions, “detransitioners,” tell strikingly similar stories. Very often, when they trace their lives back to the junction where things sped dramatically off course, there stood a shrink playing railway signalman, flipping the switch.[30]

This shouldn’t surprise us. The human brain is perhaps the world’s most complex and least understood organic structure. Fixing the problems of the human mind is incomparably more difficult than setting a broken bone. We can’t expect therapists to fail less often than medical doctors. But we can expect more transparency and humility than practitioners typically bring to discussions of therapy’s limitations.

“In psychotherapy, psychologists help people of all ages live happier, healthier, and more productive lives,” declares the American Psychological Association.[31]

There is, alas, no proof that they accomplish any of that in aggregate.

Wanting to help is just not the same as helping.

Therapists Are a Little Touchy about Iatrogenesis

Iatrogenesis isn’t news to medical doctors who are professionally obligated[32] to admit their treatments may produce adverse effects.[33] But when I asked therapists point blank whether therapy carried risks, most minimized and many outright denied this.[34] They wanted both to promote therapy as an effective remedy for mental illness and to deny that it carries significant risks.
医源性对于有专业义务[32]承认他们的治疗可能产生不良反应的医生来说并不是什么新闻。[33] 但是,当我直截了当地问治疗师治疗是否具有风险时,大多数人都将其降到最低,许多人直接否认了这一点。[34]他们既希望将治疗推广为治疗精神疾病的有效疗法,又否认它具有重大风险。

Why don’t therapists typically admit that their methods can cause iatrogenic harm?

A group of researchers considered the question and concluded that, unlike the doctor, the “psychotherapist is the ‘producer’ of treatment,” and is “therefore responsible, if not liable, for all negative effects.”[35] The therapist often doesn’t want to acknowledge that the medicine isn’t working
一组研究人员考虑了这个问题,并得出结论,与医生不同,“心理治疗师是治疗的'生产者'”,并且“因此对所有负面影响负责,如果不是负责任的话。[35] 治疗师通常不想承认药物不起作用

—because she is the medicine. The admission is a little personal.

Shrinks are badly incentivized where iatrogenesis is concerned. A doctor may decide that a patient would no longer benefit from thyroid medication, discontinue it, and keep the patient. A therapist gets paid by the dose. Once she decides you don’t need therapy, she loses a customer.

Actually, it’s worse than that: it’s in therapists’ interest to treat the least sick for the longest period of time. Ask any therapist what it’s like to treat a bipolar or schizophrenic patient. Answer: extraordinarily difficult. (Many refuse to treat such patients for this reason.) But sit with a teenager once a week who has social anxiety? The family pays on time, the teen’s problems are small, nobody’s getting violent during your session. It’s little wonder why, having acquired such a patient, a therapist may be reluctant to surrender her.

Most therapists have no idea who has been made worse by their therapy because they make no effort to track side effects. The profession does not require it. Medical doctors (psychiatrists), who once dominated therapeutic practice, generally stopped offering psychotherapy in recent decades.[36] The medical authority they lent to therapy fell to those without medical training.

And since the field of psychology lacks clear guidelines on what qualifies as a therapeutic “harm,”[37] it’s unclear how therapists would track damage done by therapy, even if they wanted to. As one group of researchers put it: “a divorce can be both positive and negative, and crying in therapy can reflect a painful experience and therapeutic event.”[38]

When iatrogenic risks go untallied, the harms pile up, threatening the well far more than the sick. It isn’t hard to see why: Suffer a gunshot wound, and your risk of picking up an opportunistic infection in the operating room is outweighed by the lifesaving treatment you require.

Suffer a scratch, and you have nothing to gain from surgery—nothing but risk.

What would we expect to find if we steeped a generally healthy population in a tea of unnecessary mental health treatments? Unprecedented iatrogenic effects. With that in mind, please meet the rising generation.


Chapter 2
第 2 章

A Crisis in the Era of Therapy


t 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.”
抓挠、切割、厌食症,她嘎嘎作响。 “带走基本需求。比如,我的一个朋友在洗澡时会把它调得太热或太冷。

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.”
“我想对一些人说,是的。其他人?诺拉耸耸肩。“我的朋友,我不会说她的名字——自从 COVID-19 开始以来,她就非常焦虑。她已经服药几年了。她去看了治疗师,我不得不说,她似乎越来越糟了。诺拉想了想。“老实说,她在服药前似乎好多了。”

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.
精神卫生机构已经成功地向一代人推销了他们中的许多人生病的想法。不到一半的Z世代认为他们的心理健康“良好”。[2] 他们不相信心理健康是在平衡生活的正常过程中通常会出现的,但就像一棵黄杨树一样,需要你雇用的园丁不断照料来修剪它。

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.
目前,42%的新生代有心理健康诊断,这使得“正常”越来越不正常。[4] 六分之一的 2 至 8 岁美国儿童被诊断出患有精神、行为或发育障碍[5] 超过 10% 的美国儿童被诊断为 ADHD[6]——是其他国家人口调查预期患病率的两倍。[7] 现在有近 10% 的孩子被诊断出患有焦虑症[8] 今天的青少年非常认同这些诊断,他们会在社交媒体资料中显示它们,并附上图片和姓氏。

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.
我们为新生代的成员提供了比以往任何时候都多的抗焦虑和抗抑郁药物。我们在学校[9]和体育运动中为他们提供了更多的心理健康住宿。[10] 他们因接受心理健康治疗而面临的耻辱感较少[11],而成年人在生活中的情感敏感性要高得多[12]。

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.
十年前,《Slate》的一位撰稿人指出,受过教育的父母不再使用道德语言来描述不当行为,而是开始使用治疗性语言。[13]从哈克·芬恩(Huck Finn)到迪伦·麦凯(Dylan McKay)的一线青少年英雄突然让我们感到震惊,他们是未确诊的“对立违抗性障碍”或“品行障碍”患者。机构从后门溜了出去。

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
在短短一个月的时间里,三个具有时代精神缩影的故事登上了新闻:美国儿科学会在 2022 年推翻了大约一个世纪的标准协议,宣布患有活动性头虱的孩子不应再从学校送回家;最好将嗜血的害虫散布在整个学生群体中,而不是让任何人承受被送回家的情感耻辱。[16] 《华盛顿邮报》的“心理健康

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.


“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]
国会批准了预防性治疗服务的急剧扩张。[20] 治疗师不再满足于治疗病人,他们决心支持健康人[21] 1946 年至 1960 年间,美国心理学会的成员人数翻了两番。[22] 然后,从 1970 年到 1995 年,心理健康专业人员的数量再次翻了两番[23] 自 1986 年以来,在美国,几乎每十年在心理健康方面的支出就会比以前翻一番。[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.
我不是唯一一个发现一些可疑之处的人,因为更多的治疗并没有减少抑郁症。一组学术研究人员最近也注意到了这一点。他们发表了一篇同行评议的论文,题为“更多的治疗,但更少的抑郁症:治疗 - 患病率悖论”[25]作者指出,自1980年代以来,重度抑郁症的治疗在世界范围内变得更加广泛(并且在他们看来,有所改善)。然而,在西方国家,没有一个西方国家通过这种治疗方法降低了重度抑郁症的发病率。许多国家都出现了增长。

“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]
我咨询了这篇论文的几位作者。两人证实,焦虑症也可以这样说。随着治疗的普及和分散,点流行率应该会下降。[27] 他们没有。虽然作者承认过去的抑郁症可能比我们意识到的要多,但他们认为现在的抑郁症至少同样多,甚至可能更多[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.
相反,自1950年代以来,青少年的心理健康状况一直在稳步下降[30],在1990年至2007年间(在青少年拥有智能手机之前),患有精神病的儿童人数增加了35倍。[31]虽然过度诊断或精神疾病定义的扩大可能部分解释了这种快速变化,但很难忽视或消除青少年自杀的惊人上升:“在1950年至1988年间,15至19岁的青少年自杀的比例翻了两番,”《纽约客》报道。[32] 精神疾病成为儿童残疾的主要原因。

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).
纽约州立大学新帕尔茨分校(State University of New York at New Paltz)的心理学副教授卡拉·韦尔梅伦(Karla Vermeulen)在采访中明确地告诉我。她在她的书中是这样说的,她写道:“过去的美国一代人没有面临过今天新兴成年人成长过程中同时存在的多个压力源的累积负荷”[33](重点是她的)。

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]
他们坚持认为,治疗师正在帮助年轻人。今天的年轻人面临着比他们的前辈更艰巨的挑战。治疗师通常指出三个:智能手机、COVID-19 封锁和气候变化。[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.
自从特温格和海特[36](以及你的真正[37])首次警告公众社交媒体和智能手机对青少年的危险以来,已经过去了八年。[38] 这应该为我们热心的心理健康专家提供一个明显的任务:像对待香烟一样对待社交媒体。呼吁限制初中和高中校园的智能手机。敦促公司在社交媒体上放置黑匣子警告,如果他们真的感到生气。

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,
事实上,当涉及到孩子和智能手机时,整个社会都已经放弃了。为什么父母继续向越来越年幼的孩子提供越来越多的这些设备?翻盖手机在紧急情况下很有用;GPS设备和数码相机比以往任何时候都更高质量,更便宜。为什么父母继续向孩子赠送 1,000 美元的手机,因为他们完全知道他们与抑郁、焦虑、

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!
相反,心理健康专家冲向相反的方向,拥抱智能手机的使用,认为智能手机对青少年抑郁症的影响被夸大了;[41] 为青少年及其父母提供关于“负责任的社交媒体使用”的研讨会,这有点像药物顾问讲授摇头丸的适当用途。心理健康专家来到学校,警告父母和青少年社交媒体的“风险”,总是小心翼翼地权衡这些与许多美妙的好处,然后得出结论:尽情享受吧!

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.
毕竟,在过去的五六十年里,青少年的心理健康状况一直在下降。[43] 然后是父母非常不愿意拿走我们孩子的智能手机。是什么导致了这种无能为力,面对他们构成的明显威胁?我们长期以来一直意识到它们的危险,却完全没有采取任何措施来减少它们在青少年手中的普遍存在,这一事实需要有自己的解释。我们坚持将这些设备交给青少年和青少年,这本身就是一个更大问题的征兆。

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]
COVID-19 封锁使无数孩子陷入惩罚性的隔离状态。如果我们的心理健康专家预料到迫使孩子陷入社交孤独一年多的可预测的心理健康灾难,他们在很大程度上将洞察力留给了自己。在2020年秋季,没有一个主要的国家专业组织甚至反对将封锁持续到连续第二个学年,届时可能会避免孩子们的孤立进一步加深。[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]
心理健康组织并不羞于涉足公共政策讨论:美国心理学会(American Psychological Association)抨击了美国的系统性种族主义历史。“我们的国家正处于种族主义大流行之中,”APA首席执行官在2020年6月的国会证词中说,他主张改变警察的策略。[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.
家长抗议;他们在很大程度上被忽视了。心理健康专家综合体及其所有机构影响力都拒绝向政策制定者提供关于对儿童影响的公开警告。[48] 也许他们不知道封锁会对他们唯一负责帮助的年轻人造成毁灭性打击。无论这一巨大失败的原因是什么,他们随后试图利用大流行的封锁来消除治疗流行悖论,或者更糟糕的是,主张他们在公共政策制定和美国儿童的生活中发挥更大的作用,这是不正当的。

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
事实上,在2019年新型冠状病毒逃离中国边境之前,近三分之一的18至35岁的美国人表示他们患有精神疾病。[49] 在过去十年中,非致命性自残的住院人数增加了 62%,[50]

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.
Karla Vermeulen 将她的头发剪成酷炫的小精灵剪裁,紧贴头皮。她的方形塑料眼镜的镜片有两张便利贴那么大,形状也差不多。在她的脖子根部,一串的陶器完成了一位严肃的研究人员的形象。事实上,Vermeulen几乎比任何美国人都更有资格成为青少年心理健康方面的专家。

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.
医学杂志《柳叶刀》(The Lancet)和美国国家公共广播电台(NPR)都同意:抑郁症只是对温室气体令人窒息的一种理性反应。

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]
《大西洋月刊》编辑富兰克林·福尔(Franklin Foer)在一篇关于他患有焦虑症的十四岁女儿的文章中也暗示了这一点。“我渴望建造一条海堤,保护她免受恐惧,”福尔写道,他决定让女儿逃学参加受活动家格蕾塔·桑伯格(Greta Thunberg)启发的气候变化抗议活动。“但她的榜样,以及桑伯格的末日预言,让我意识到,我父母对平静的渴望是幼稚的幻想;焦虑是成熟的反应。为了保护我们的孩子,我们需要拥抱他们的绝望。[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.”
“在上个世纪,自然灾害造成的死亡人数下降了95%以上。在过去的二十年里,实际的灾难本身已经减少了。灾害严格按照极端天气事件造成的死亡和损失来衡量,“长期环保活动家、几本环境书籍的作者迈克尔·谢伦伯格(Michael Shellenberger)说。“我们比以往任何时候都更有弹性。”

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]
他向我指出,去年全球死于与天气或气候有关的灾害的人数为6000人。从这个角度来看,仅在美国,今年(2023 年)就有 106,000 人死于药物过量和中毒。至于碳排放量,在过去十年中,全球碳排放量略有下降。[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.
根据 Foer 和 Vermeulen 的说法,父母的工作不是通过正确看待女儿的恐惧来阻止女儿的恐惧。[54]不要用舒缓的pablum来安慰她——显然,只有愚蠢的孩子才会爱上这种东西——就像地球将存在很长时间的想法一样。不要提醒她,多年来,人类已经迎接并掌握了之前的每一个挑战,包括残酷的气候变迁。不要向她保证,有才华横溢、敬业的人非常努力地工作,以应对气候变暖带来的变化。抵制占上风的冲动,让她知道有一天,在她完成学业后,她可以选择成为那些科学家中的一员。在那之前,她还有其他顾虑。就像通过九年级数学一样。

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.
Vermeulen 和 Foer 无意中帮助解开了最近的一个谜题。虽然十几岁的女孩的心理健康状况严重下降,但那些认同自由主义和左倾政治的人遭受的痛苦最严重。[55] 自由派的十几岁男孩比保守派的十几岁女孩表现出更严重的抑郁症。这应该表明,我们看到的大多数情况都不是精神疾病危机。它与我们赋予孩子的价值观和世界观、他们抚养他们的方式以及他们周围的影响密切相关。

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.
我问贝丝,在她治疗的数千名学生中,有多少人提到气候变化或系统性种族主义是他们痛苦的原因。她斩钉截铁地告诉我——没有。没有一个。“我不认为有人。就像他们可能会随便开个玩笑一样?贝丝的回答与我的工作不谋而合。在我对年轻人的数十次关于他们心理健康的采访中,没有人将气候变化作为他们或他们朋友情绪挣扎的原因。除了一位(TikTok 影响者)外,所有人都明确否认气候变化是年轻人痛苦的重要来源。

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]
研究人员经常根据自己的政治偏见,将他们认为最合理的任何解释嫁接到年轻人身上。对于保守派研究人员来说,无父之人的增加、婚姻的减少或宗教信仰的减少——所有这些都与精神疾病发病率的攀升相吻合——似乎是合理的解释。对于自由派研究人员来说,气候变化、校园枪击案、系统性种族主义、经济不平等和 MAGA 的政治提供了青睐的候选人。[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.
所以,是的,今天的年轻人比前几代人更担心气候变化,就像 1962 年的学童比今天的学童更担心与俄罗斯的核战争一样。但是,没有现存的记录表明,六十年代的孩子对核灾难感到恐惧,没有上学。[60] 就此而言,1941 年 12 月 8 日,美国学童是如何游行上学的?然而他们做到了。


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.
根据学术心理学家和几本关于Z世代的书籍的作者Jean Twenge的说法,新兴的一代与之前的一代截然不同。不仅仅是被诊断出精神疾病的比率使它们如此独特。他们更服从权威,和蔼可亲,并与妈妈联系在一起。与千禧一代相比,他们在政治上更激进(更有可能支持极左立场),并且更不倾向于自我膨胀。实际上,在1995年至2012年之间出生的Z世代中,很大一部分人似乎不是希望、乐观或对自己的信念,而是恐惧。他们可以说是有记录以来最可怕的一代。

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.
2021 年 4 月,我在特温格位于圣地亚哥的家中见到了她,为《华尔街日报》介绍了她。我想更多地了解这一代人,他们已经开始陷入困境。我们坐在潮湿的塑料椅子上,相距十英尺,在她郁郁葱葱的后院里,大流行病在我们周围肆虐。

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)
年龄相仿。2016 年,高中生每天花在彼此身上的时间比 1980 年代少一个小时。他们也从事最少的性行为(但可以说是最容易获得的)

[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.
[62] 并报告恋爱关系或恋爱邂逅最少。[63]他们不愿意跨越前几代人急切地启动自己的里程碑。正如一位年轻人对我说的那样,表达了我听到其他人附和的情绪,“我非常害怕开始上大学。但我想每个人都在我这个年纪的时候?实际上,我在那里。不,我们不是。

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. ThesocialcriticChristopherLaschonceobservedthattherapy “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 themselvesdisqualified,ineffect,fromtheperformanceofadult responsibilitiesandbecomedependentonsomeformofmedical
不,它们是实际友谊的红利流。那么多时间记录在阳光下,堆积在汽车里进行公路旅行,勉强避免事故,在糟糕的社区迷路——他们是投资的资本。治疗师以实践的方式关心你,并精确地照顾你,就像任何专业人士对客户一样——在“五十分钟小时”的时间里,只要她接受你的保险,或者你保持现金流为正。社会评论家克里斯托弗·拉什(Christopher Lasch)曾经观察到,治疗“同时宣布患者不适合管理自己的生活,并将他交给专家。[64]当我从拉什那里读到这句话时,我不禁想起了贝卡的困境:“随着治疗观点和实践获得普遍接受,越来越多的人发现自己实际上失去了履行成人责任的资格,并变得依赖某种形式的医疗


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
其中一些应用程序有助于与真人一起进行治疗。有些人将青少年与通过文本进行治疗的治疗师联系起来,以避免用实际的面对面对话(Charlie Health)或将 Zoom 的无数治疗师来打扰他们。有些应用程序可以将无舵者与各种生活方式的教练(BetterUp)相匹配。允许小孩(“0-14 岁”)及其父母跟踪情绪的应用程序(小水獭)。许多健康应用程序已经取消了人类治疗师的模式,使任何可以使用iPad的孩子都可以免费进行“治疗”。“没有治疗师的治疗”是大型科技公司进行治疗的解决方案

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]
可扩展 - 能够满足痴迷于治疗的社会的无底线需求。集成人工智能可能很快就会将人类治疗师完全排除在循环之外。几乎所有这些应用程序的目标也是心理健康初创公司Talkspace的座右铭和使命:“人人享有治疗”。每一个孩子。[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-
在 COVID 爆发后的短短 15 个月内,超过 30 亿美元的资本投资涌入心理健康科技初创公司[67]-

19. Therapy and its iatrogenic effects are being crop-dusted across the entire population.
19. 治疗及其医源性作用正在整个人群中播撒农作物。

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.


Chapter 3
第 3 章

Bad Therapy


hen he was two years old, Camilo Ortiz and his parents entered the United States illegally from Colombia. Unable to speak English, ineligible even for public assistance, they moved into

a one-room basement apartment in Queens. Ortiz’s father devised a series of schemes to support the family—many of them illegal.

When Ortiz was eleven, his parents divorced. When Ortiz was seventeen, his father was caught ferrying $300,000 cash in the trunk of his car. His father was arrested, convicted, and imprisoned for money laundering.
奥尔蒂斯十一岁时,他的父母离婚了。奥尔蒂斯十七岁时,他的父亲被发现在他的汽车后备箱里运送了 300,000 美元的现金。他的父亲因洗钱被捕、定罪和监禁。

But Camilo Ortiz does not enter our story as a patient. He enters as a tenured professor and leading child and adolescent psychologist. And he has a divergent perspective on how psychotherapists ought to be treating troubled, anxious, and stressed-out kids.
但卡米洛·奥尔蒂斯(Camilo Ortiz)并没有以患者的身份进入我们的故事。他以终身教授和领先的儿童和青少年心理学家的身份进入。他对心理治疗师应该如何治疗陷入困境、焦虑和压力过大的孩子有不同的看法。

For one, Ortiz worries that a lot of therapy directed at kids is useless. “It’s just a pretty easy job to play with kids in your office, so the incentives are all wrong,” Ortiz told me. “I could make a great living if I just said, ‘Sure, bring your kid in, and I’ll play blocks with her and we’ll do play therapy.’ And that would not do a thing of good for them. And I could have a full caseload as long as I want.”

Although he gets several calls a week from parents pleading with him to see their young children in individual therapy, he turns them all down. For most problems, Ortiz says, individual therapy has almost no proven benefit for kids. “The evidence is pretty clear that parent-based approaches are more effective.” Meaning, a therapist should treat a kid’s anxiety by treating the kid’s parents. Parents often unwittingly transmit their own anxiety to their kids. And parents are in the best position to help a child deal with her worries on an ongoing basis.

And yet numberless psychotherapists not only offer individual therapy to young kids, they practice techniques like “play therapy” that have shown scant evidence of benefiting kids. In fact, there’s very little evidence that individual (one-on-one) psychotherapy helps young kids at all.[1]

But why doesn’t individual therapy work for young kids? If it’s good for the goose—why not for the goslings? “Well, let’s take an anxious five-year- old,” Ortiz says. “Let’s say I’m the best therapist in the world and I teach her some amazing techniques for dealing with anxiety, on a Monday at four

p.m. So we’re supposed to believe that on a Friday, when she’s dysregulated, and anxious, at age five, she’s going to remember what we talked about, and then be able to institute difficult techniques in a moment of dysregulation?” he asks rhetorically. “I can’t get adults to do that. It just doesn’t work with children.” It’s far more effective, Ortiz says, to teach the parents who spend many hours a day with their kids the best techniques for, say, getting a child over her fear of sleeping alone.

Also, the power imbalance between therapist and child in the intense context of individual therapy is simply too great, he tells me. Children are easily convinced of things. Think recovered-memory therapy, a dark episode in the history of psychiatry in which therapists inadvertently implanted false memories in child patients.

I met Ortiz at his Tudor revival in Forest Hills, Queens, where he lives

with his son, elegant wife, and yappy dog, Pesto. (His daughter was already away at college.) Ortiz looks a little like he just stepped out of a Brooks
与他的儿子、优雅的妻子和雅皮狗 Pesto。(他的女儿已经上大学了。奥尔蒂斯看起来有点像他刚从布鲁克斯走出来

Brothers catalog. Tweedy and trim, he wears tortoiseshell glasses, slacks, and a half-zip mock neck sweater. His appearance suggests a boyhood poring over Latin declensions, boarding at Exeter, summers in Montauk. Not one mired in privation until a test score in elementary school won him a spot at the prestigious Hunter College High School. There, for the first time, he found himself surrounded “by only very smart kids who had high aspirations for educational attainment.” Their ambition was infectious, or at least instructive. He realized he had high ambitions for himself, too.
兄弟目录。他身材修身,戴着玳瑁色眼镜,穿着休闲裤和半拉链仿领毛衣。他的外表表明他童年时正在研究拉丁语变格,在埃克塞特寄宿,在蒙托克度过夏天。直到小学的考试成绩为他赢得了著名的亨特学院高中(Hunter College High School)的一席之地,他才陷入贫困。在那里,他第一次发现自己周围“只有非常聪明的孩子,他们对教育成就有很高的期望”。他们的雄心壮志是有感染力的,或者至少是有启发性的。他意识到自己也对自己有很高的抱负。

Today, Ortiz is a professor of clinical psychology at Long Island University, where he trains psychologists and conducts research into treatments for child and adolescent anxiety and depression. So what makes someone a good therapist for adolescents? For one thing, he said, a good therapist doesn’t treat therapy with a teen as an annuity. “If your therapist doesn’t talk to you about termination [of psychotherapy] during your first session, it’s probably not a good therapist.”

Ortiz absolutely believes in the ameliorative power of specific kinds of therapies, especially cognitive-behavioral and dialectical behavior therapies (known as CBT and DBT) for remediating specific ailments like tic disorders, affective disorders, and obsessive-compulsive disorder. Ortiz is a cognitive behavioral therapist, and he uses its methods to help families of kids who suffer with conditions like chronic bed-wetting. He has seen it improve the lives of his patients. But he has enough respect for the power of therapy to reject the idea that everyone should be in therapy, a notion Ortiz likens to a surgeon who ventures: Well, he looks healthy, but let’s open him up and see what we find.

Therapy, when it works for adults, gets its power from the patient’s buy- in. But a child or adolescent who enters therapy invariably does so because she was strong-armed by an adult. Sometimes, there is no buy-in at all. A therapist must then flatter or entertain the adolescent, avoiding the unpleasant toil that represents therapy at its best. And if the adolescent still isn’t convinced, matters may be made more explicit: Mom thinks whatever is wrong with you is serious enough to lay out $250 an hour.

However hard we work to “destigmatize” therapy, the message to any child patient is twofold: Your mother thinks there is something wrong with you and Your problem is above her pay grade. Almost necessarily, the presence of the intermediary will alter a parent’s relationship with her child, whether the parent realizes this or not.

For those tallying iatrogenic risks of one-on-one psychotherapy with children, that’s: demoralization (convincing a young person there’s something wrong with her) and undermining parental authority (Mom can’t handle your problems, so she’s hired someone who can—someone who has better judgment about you than she does). All for a process with doubtful chance of working.

Ortiz discloses the risk of iatrogenesis in a waiver to his therapy clients because he wants them to be on the lookout for iatrogenic effects; he wants them to avoid harm. “I talk to my clients about the fact that in some percentage of cases, people get worse in therapy. It’s not a big percentage, but it can happen,” he said.

This struck me as not only sensible but wise. After I interviewed Ortiz, any psychologist, psychiatrist, or therapist I came to trust needed first to take seriously the possibility that therapy can harm. Fortunately, I found my way to forty-five academic psychologists and fifteen psychiatrists, many with international reputations for excellence, all of whom freely acknowledged the possibility of iatrogenesis. (Several had authored books and papers on the subject.)

What does bad therapy look like, I wondered. If a sadist wanted to induce anxiety, depression, a feeling of incapacity, or family estrangement, what sort of methods would she employ? How would a malevolent mastermind induct a generation into a tyranny of feelings?[2] Like this.
我想知道糟糕的治疗是什么样子的。如果一个虐待狂想引起焦虑、抑郁、无能感或家庭疏远,她会采用什么样的方法?一个恶毒的策划者将如何让一代人陷入感情的暴政?[2] 像这样。

Bad Therapy Step One: Teach Kids to Pay Close Attention to their Feelings

Yulia Chentsova Dutton heads the Culture and Emotions Lab at Georgetown University. I traveled to DC to meet her in the hopes that she might shed light on why American kids, in particular, seemed to be struggling so mightily with emotional regulation.
尤利娅·钦佐娃·达顿(Yulia Chentsova Dutton)是乔治城大学文化与情感实验室的负责人。我前往华盛顿特区与她会面,希望她能阐明为什么美国孩子似乎在情绪调节方面如此挣扎。

“I am an emotions researcher,” the pixieish Soviet émigré said as we toured her lab. “Emotions are highly reactive to our attention to them. Certain kinds of attention to emotions, focus on emotions, can increase emotional distress. And I’m worried that when we try to help our young adults, help our children, what we do is throw oil into the fire.”

In our three hours together, Chentsova Dutton reviewed with me her cross-cultural research comparing young people’s emotional responses to stressors in countries like Japan, Russia, and China. She also showed me the room in her lab where she fixes electrodes to subjects and observes them through a one-way window, while they watch a video designed to deliver psychological provocation. Not at all hard to imagine why she likes her job. A rich emotional vocabulary can help children describe their feelings.
在我们在一起的三个小时里,Chentsova Dutton 和我一起回顾了她的跨文化研究,比较了日本、俄罗斯和中国等国家年轻人对压力源的情绪反应。她还向我展示了她实验室的房间,在那里她将电极固定在受试者身上,并通过单向窗观察他们,同时他们观看旨在传递心理挑衅的视频。不难想象她为什么喜欢她的工作。丰富的情感词汇可以帮助孩子描述他们的感受。

But many of our therapeutic interventions with children, she says, go far beyond supplying one. “We are basically telling them that this deeply imperfect signal”—that is, what they are feeling—“is always valid, is always important to track, pay attention, and then use to guide your behavior, use it to guide how you act in a situation.”

Placing undue importance on your emotions is a little like stepping onto a swivel chair to reach something on a high shelf. Emotions are likely to skitter out from under you, casters and all. Worse, attending to our feelings often causes them to intensify. Leading kids to focus on their emotions can encourage them to be more emotional.

It troubles Chentsova Dutton that so much therapeutic intervention with kids proceeds from the conceit that children should attribute great import to their feelings. Emotions are not only unstable, they’re also highly
让Chentsova Dutton感到困扰的是,对孩子们的如此多的治疗干预都源于一种自负,即孩子们应该把他们的感受归因于极大的重要性。情绪不仅不稳定,而且高度

manipulable, she said, hinting that she could make me feel all kinds of things if she really wanted to. Asking someone a series of leading questions, or making certain statements to them, can reliably provoke certain emotional responses. (“It’s just so easy,” she said.)

In an individualistic society like ours, we incline toward the erroneous belief that feelings accurately signal who we are in the moment. But in fact, “feelings are responsive to so many cues, and because of that, so often are off.”

The anger you feel does not necessarily indicate that you are in the right or that someone treated you unfairly. You may feel envious of a friend, even though you would not actually want what he has. You may feel loved by someone who mistreats you or resent someone who’s only treated you kindly. Feelings fool us all the time.

Adults should be telling kids how imperfect and unreliable their emotions can be, Chentsova Dutton says. Very often, kids should be skeptical that their feelings reflect an accurate picture of the world and even ignore their feelings entirely. (Gasp!) You read that right: a healthy emotional life involves a certain amount of daily repression
大人应该告诉孩子们他们的情绪是多么不完美和不可靠,Chentsova Dutton说。很多时候,孩子们应该怀疑他们的感受是否反映了世界的准确画面,甚至完全忽略了他们的感受。(倒吸一口凉气!你没看错:健康的情感生活需要一定程度的日常压抑

How is a child supposed to get through a day of school if she’s never learned to put aside her hurt feelings and concentrate on the lessons in front of her? How will she ever be a good friend if her own feelings are always, at every instant, front and center? How will she ever hope to function at work?

She can’t. She won’t. They aren’t.

But isn’t it a good idea to inquire regularly about kids’ feelings? Therapists, teachers, and parents in America all seem to proceed under the belief that checking in is a little like sticking a thermometer outside your front door: harmless and occasionally helpful.

Michael Linden, a professor of psychiatry at the Charité University Hospital in Berlin, thinks this is a terrible practice. “Asking somebody ‘how are you feeling?’ is inducing negative feelings. You shouldn’t do that.”
柏林夏里特大学医院的精神病学教授迈克尔·林登(Michael Linden)认为这是一种可怕的做法。“问别人'你感觉如何?'会引起负面情绪。你不应该那样做。

Why? I asked. If all you’re doing is asking, each morning, How are we feeling today, Brayden?, isn’t the child as free to provide a positive answer

as a negative one?

That isn’t true, Linden shot back. “Nobody feels great,” he said. “Never, never ever. Sit in the bus and look at the people opposite from you. They don’t look happy. Happiness is not the emotion of the day.”

Linden is a world-renowned expert in the iatrogenic effects of therapy.

After I had read one of his papers on psychotherapy’s more reckless adventures, we arranged to meet over Zoom. Handsome and cheery, he apparently loves poking fun at Americans—which, I’ve learned, is something German and Northern European academics find almost irresistible. Linden has a full head of neat gray hair, a broad smile, and a sporting air of disagreeableness.

If you track a person’s emotions over the course of a day or even a week, Linden told me, happiness is actually a very rare emotion, statistically speaking. Of our sixty-thousand wakeful seconds each day, only a tiny percentage are spent in a state we would call “happy.” Most of the time we are simply “okay” or “fine,” trying to ignore some minor discomfort: feeling a little tired, run down, upset, stressed out, irritated, allergic, or in pain. Regularly prompting someone to reflect on their current state will—if they are being honest—elicit a raft of negative responses.

Linden saw my surprise, so he asked me to consider how I was feeling right then, during our interview. I was inclined to say “good,” but he jumped in: “You don’t feel happy in this moment. You are concentrating on the interview.”

He was right. It was five a.m. in California when we spoke, and I am, to put it mildly, not a morning person. I was acutely aware that the three sleeping children one floor above me might, at any moment, wake and interrupt the interview. I disliked how tired I looked on my webcam. Having allotted every spare minute to sleep, I had run out of time to apply makeup. I hadn’t downed my morning coffee.

Linden looked relaxed in his merino wool sweater, but I was pale and exhausted, straining to seem sharper than I felt, struggling to catch his

meaning through the sharp pickets of his accent. So not “happy,” exactly, no. Linden was spot-on. Being more aware of, and precise about, my current feelings elicited primarily negative introspection.

I thought back to Nora’s friends and wondered which of them would be helped by paying closer attention to their feelings. Not those who were struggling with profound mental illness. Certainly not those who, according to Nora, were leaning into their diagnoses, exaggerating their symptoms.

But there’s an even bigger problem with asking kids, over and over, to reflect on their feelings, Linden told me. It has to do with psychological orientation.

Psychologists have studied the states of mind that tend to make us more successful, whatever the challenge. There are at least two we can adopt: “action orientation” and “state orientation.”[3] Adopting an action orientation means focusing on the task ahead with no thought to your current emotional or physical state. A state orientation means you’re thinking principally about yourself: how prepared you feel in that moment, the worry you feel over a text left unanswered, the light prickling at the back of your throat, that crick blossoming in your neck. Adopting an action orientation, it turns out, makes it much more likely that you accomplish the task.
心理学家研究了无论面临什么挑战,都能使我们更成功的心理状态。我们至少可以采用两种方法:“行动导向”和“状态导向”。[3] 采取行动导向意味着专注于未来的任务,而不考虑你目前的情绪或身体状态。状态取向意味着你主要考虑的是你自己:你在那一刻的准备程度,你对未得到答复的文本感到担忧,喉咙后部的刺痛,脖子上绽放的蟋蟀声。事实证明,采用行动导向可以使您更有可能完成任务。

Our best coaches know this instinctively. Consider the way they motivate a team before the game: We can do this! they say. Wiggins, you’re gonna cover number eleven like you’re his shadow. Tyler, watch the penalties. Defense—you’re gonna put relentless pressure on their QB, I want to see hurries and sacks. Offense, head up, stay composed, nice clean blocks. Focus, focus, focus on the task ahead!

They do not say: Let’s take a moment to hear how each of you is feeling. Tyler, we’ll start with you. Still bummed about your parents’ divorce? If you want to win—if you want to accomplish anything—among the worst things you can do is attend to your disappointments, discomforts, and painful relationships right now. No winning head coach asks his players to consider their feelings at halftime because thinking about yourself shatters your ability to get things done.

“State orientation keeps you from being successful in anything,” Linden said.

I asked Linden what he would expect to see in a society where kids were constantly encouraged to heed their feelings.

“If you start your day by asking yourself whether you are happy, the result can only be that you’re not happy. And then you think you need help to become happy. And then you go to a psychotherapist and he’ll make you really unhappy in the end.”

But why can’t the answer always be “I’m happy”?

Because it will never be true, Linden says. And time spent answering this question only pushes us further from any tangible goal and the satisfaction of having completed one.

Bad Therapy Step Two: Induce Rumination

We all have a friend who has spent way, way too much time obsessing over her ex. That’s rumination, a style of thinking characterized by brooding on past injuries and personal problems. Venting may produce relief, but rehashing the same hurt can become pathological.[4] It is also one of the most significant iatrogenic risks of therapy.
我们都有一个朋友,她花了太多时间痴迷于她的前任。这就是反刍,一种思维方式,其特点是沉思过去的伤病和个人问题。发泄可能会产生缓解,但重复同样的伤害可能会变得病态。[4] 它也是治疗中最重要的医源性风险之一。

Leif Kennair, a world-renowned expert in the treatment of anxiety, depression, and obsessive-compulsive disorder, studies disorders of rumination. A professor of personality psychology at the Norwegian University of Science and Technology, Kennair has also written a book (sadly, in Norwegian) rigorously detailing the ways therapy can become counterproductive.
莱夫·肯奈尔 (Leif Kennair) 是治疗焦虑症、抑郁症和强迫症的世界知名专家,研究反刍障碍。作为挪威科技大学(Norwegian University of Science and Technology)的人格心理学教授,肯奈尔还写了一本书(可悲的是,是用挪威语写的),详细描述了治疗可能适得其反的方式。

“Trying to get the patient to consider their past and how it went wrong, and what could have gone better and how should it be different, what can happen, what’s the most likely outcome and so on—a lot of these different interventions are actually worry- and rumination-increasing interventions,” he told me over Zoom. Instead, when patients present with depression or generalized anxiety disorder, therapists “should be doing worry and

rumination discontinuing interventions.”[5] Meaning, a good therapist should do what cognitive behavioral therapists do: prove to a patient that rumination is an unproductive mode of thought and train them to stop.
反刍停止干预。[5] 意思是,一个好的治疗师应该做认知行为治疗师所做的事情:向患者证明反刍是一种无益的思维模式,并训练他们停止。

By the time I spoke to Kennair, several therapists had assured me that there was no proof that young people today were more depressed than were prior generations. I asked Kennair how we could be sure that young people weren’t simply more “open” about their poor mental health?

Kennair’s response was elegant and astonishing: being overly prone to talking about your emotional pain is itself a symptom of depression. “If you do this”—habitually give voice to your negative thoughts or personal problems—“you’re co-ruminating at least. But I believe they are ruminating more. And rumination is the major predictor for depression.”

Bad Therapy Step Three: Make “Happiness” a Goal but Reward Emotional Suffering

Hang around families with young children for an afternoon, and you’ll hear parents check that their kids are enjoying their ice cream, excited about school the next day, that they had fun at the park. In so many ways, we signal to kids: your happiness is the ultimate goal; it’s what we’re all livin’ for.[6]

According to the best research, we have it all backward. If we wanted our kids to be happy, the last thing we would do is to communicate that happiness is the goal. The more vigorously you hunt happiness, the more likely you are to be disappointed.[7] This is true irrespective of the objective conditions of your life.
根据最好的研究,我们完全落后了。如果我们想让孩子快乐,我们要做的最后一件事就是传达幸福是目标。你越是积极地追求幸福,你就越有可能失望。[7] 不管你生活的客观条件如何,这都是事实。

“We know that chasing positivity for yourself is actually associated with low psychological function—that it’s associated with more depressive symptoms,” Chentsova Dutton told me. “We know that people who are really strongly desiring to be happy are not particularly happy and that the desire to be happy serves as a vulnerability factor.”
“我们知道,为自己追求积极性实际上与低下心理功能有关——它与更多的抑郁症状有关,”Chentsova Dutton告诉我。“我们知道,那些真正强烈渴望快乐的人并不是特别快乐,而快乐的渴望是一个脆弱的因素。

Consider your grandparents. My grandmother, who grew up poor, took genuine delight in life’s peculiar deliverances: a scoop of chocolate ice cream; a simple family birthday party with an unsightly homemade cake; tchotchkes with Hebrew lettering turning up in a remote country antique shop. Each produced in her the spasmodic glee of someone who never expected that her own life would be filled with happiness.
想想你的祖父母。我的祖母出身贫寒,她对生活中奇特的解脱感到由衷的喜悦:一勺巧克力冰淇淋;一个简单的家庭生日派对,有一个难看的自制蛋糕;带有希伯来字母的 tchotchkes 出现在一家偏远的乡村古董店。每一种都使她产生了一种痉挛的喜悦,她从未想过自己的生活会充满幸福。

By insisting that happiness be their goal, we place kids in a crucible. On the one hand, “chasing positivity” tends to make them more depressed. Then feeling depressed gets socially rewarded, Chentsova Dutton said. So, kids are naturally “amplifying their signal of how much they suffer.”
通过坚持幸福是他们的目标,我们把孩子们放在一个坩埚里。一方面,“追逐积极性”往往会让他们更加沮丧。然后感到沮丧会得到社会回报,Chentsova Dutton说。因此,孩子们自然而然地“放大了他们遭受多少痛苦的信号”。

Cody, a senior at a public high school in Brooklyn, told me the same. A generation ago, kids might have identified with what Cody calls their “strengths”: the jock, the popular kid, the math team member, the beauty queen. But today, that’s verboten. “Identifying with your strengths now isn’t seen as too cool because some people may manipulate you into thinking that you’re privileged because of it.”
布鲁克林一所公立高中的大四学生科迪也对我说了同样的话。一代人以前,孩子们可能已经认同科迪所说的他们的“优势”:运动员、受欢迎的孩子、数学团队成员、选美皇后。但今天,这就是 verboten。“现在认同自己的优势并不被视为太酷,因为有些人可能会操纵你,让你认为你因此而享有特权。

What’s wrong with identifying with your struggles? “Well, I see that they don’t try to solve it.”

Cody took pains to explain that he wasn’t talking about the severely depressed—just the average kid. Once they get the validation from other students for their mental health crises, “they don’t break out of that rut,” he said.

Bad Therapy Step Four: Affirm and Accommodate Kids’ Worries

All Mason will eat is buttered noodles. Harper is afraid of dogs. Would you mind crating your dog during our visit? Or, from the therapist: Sounds like your kiddo has testing anxiety. I’ll write her a note, so that the school gives her untimed tests. Sound familiar?

Therapists aren’t the only ones who affirm and accommodate children’s anxiety. Parents do this all the time. But therapists do so while purporting to

treat it. “Therapists can inadvertently project the message that clients need to be very worried about anxiety-producing stimuli,” Ortiz told me. “We have found that therapists who are themselves anxious people tend to be over-protective in their interventions with clients.”

It may bring a child short-term relief for a therapist to agree that dogs can be scary and brainstorm strategies for avoiding the chocolate lab next door. But this may also reify the worry, intimating that coming across a dog is like encountering a mountain lion: an emergency worthy of full-blown evasive action. So, yes, therapists can reinforce a child’s or adolescent’s outsized fears. Therapists can make kids’ anxiety worse.

A core tenet of therapies like CBT is that a kid’s extreme aversion to, say, dirt may be based on the false belief that dirt is harmful. The best way to demolish this maladaptive belief is for your kid to have direct and repeated contact with precisely the thing she is afraid of.[8] If your kid is afraid of dogs, you prompt her to pet a dog.[9] For a germophobic patient with obsessive-compulsive disorder who is washing his hands a hundred times a day, the therapist might insist the patient touch a toilet and, eventually, stick his hand into a messy toilet bowl. Ortiz once led a patient to do this and then wipe his hand on a pillow and sleep on it.
像CBT这样的疗法的一个核心原则是,孩子对污垢的极度厌恶可能是基于污垢有害的错误信念。消除这种适应不良信念的最好方法是让您的孩子与她害怕的事物进行直接和反复的接触。[8] 如果你的孩子害怕狗,你提示她抚摸一只狗。[9] 对于每天洗手一百次的强迫症恐惧症患者,治疗师可能会坚持让患者触摸马桶,并最终将手伸入凌乱的马桶中。奥尔蒂斯曾经带领一个病人这样做,然后在枕头上擦手,然后睡在上面。

“Once they can do these pretty outrageous kinds of exposures, then the regular fears that they typically worry about don’t seem so big. Touching your own door handle once you’ve stuck your hand into a toilet bowl pales by comparison.”

“Exposure therapy” is CBT’s escalating method of encouraging patients to confront things that make them uncomfortable. It is among the few therapies with an evidentiary track record of benefits. Although a great many therapists claim to use CBT methods, a fraction of them are trained in its rigors or practicing its evidence-based methods.[10]

School psychologists and counselors so often do the opposite: solidify a child’s worry through affirmation and accommodation.[11] They intervene with the teacher, ostensibly on a child’s behalf, to lighten the homework load or to provide tailored assignments if the standard curriculum seems to cause too much stress. None of this encourages the development of a child’s

natural resources for coping with her worries or overcoming stressful situations.

Accommodation deprives children of the opportunity to vault a challenge and renders them “actually less capable,” Ortiz said. Force a kid to sleep in a house beset by the normal sounds of snoring siblings, whistling of winds, or creaking of joists, and eventually she will sleep. She’ll realize, more importantly, that she can.

We all need practice sitting with discomfort, Ortiz emphasized— emotional as well as physical. If we get the necessary practice, we become better at tolerating it. If we don’t, we may become worse at it. And yet so many adults are intent on deleting all irritation and inconvenience from children’s lives as if they were toxins.

I asked neuropsychologist and author Rita Eichenstein why we’re seeing so many phobias and so much anxiety among kids today. “There’s sensory deprivation. The minute the kid goes home from the hospital, they’re in a car seat, facing backwards,” she said. “The pristine nursery. That’s all quiet now. They’re all using sound machines. They’re not getting dirty. They’re not outside in the dirt. They’re not getting that normal chaos.”
我问神经心理学家和作家丽塔·艾兴斯坦(Rita Eichenstein),为什么我们今天在孩子们中看到如此多的恐惧症和焦虑症。“有感官剥夺。孩子从医院回家的那一刻,他们坐在汽车座椅上,面朝后,“她说。“原始的托儿所。现在一切都很安静。他们都在使用发声机。他们没有变脏。他们不在外面的泥土里。他们没有得到那种正常的混乱。

Banishing normal chaos from a child’s world is precisely the opposite of what you would do if you wanted to produce an adult capable of enjoying life’s intrinsic bittersweetness, the small pleasures you might never notice if your life were a theme park, all cotton-candy jingles and frictionless rides.

[12] And yet, consider how we proceed. We beg doctors to give our kids antianxiety medications, teachers to give them untimed tests. We purchase plastic visors so bathwater never runs over our toddlers’ eyes, and carefully remove sesame seeds from their hamburger buns.[13] We aren’t just driving ourselves insane. We’re making our kids more fearful and less tolerant of the world.
[12] 然而,请考虑我们如何进行。我们恳求医生给我们的孩子服用抗焦虑药物,老师给他们不定时的检查。我们购买塑料面罩,这样洗澡水就不会流过幼儿的眼睛,并小心翼翼地去除汉堡包上的芝麻。[13] 我们不只是把自己逼疯了。我们正在让我们的孩子更加恐惧,对世界的容忍度降低。

Bad Therapy Step Five: Monitor, Monitor, Monitor

In decades past, parents primarily fretted over physical dangers to kids: stranger danger, crossing the street, and the like. But as parenting took a therapeutic turn, and we began to worry about emotional damage, we realized we could never look away. After all, a kid who breaks an arm lets out a scream. But a child who’s been traumatized by teasing makes no sound. We required much more intel, round the clock. We needed adult eyes on our kids: therapists, school psychologists, and counselors ready to conduct infrared thermal imaging of our kids’ emotional lives. We expected them to monitor and report back to us.

“Kids today are always under the situation of an observer,” said Peter Gray, a professor of psychology at Boston College and author of the classic introductory textbook on psychology. “At home, the parents are watching them. At school, they’re being observed by teachers. Out of school, they’re in adult-directed activities. They have almost no privacy.”
“今天的孩子们总是处于观察者的境地,”波士顿学院(Boston College)心理学教授、经典心理学入门教科书的作者彼得·格雷(Peter Gray)说。“在家里,父母在看着他们。在学校里,他们被老师观察。在校外,他们参加成人指导的活动。他们几乎没有隐私。

It took only a moment’s reflection to realize this was true and a dramatic departure from the experience of previous generations. At school, my kids have “recess monitors,” teachers who involve themselves in every disagreement at playtime and warn kids whenever the monkey bars might be slick with rain. On the bus, “bus monitors.” After school, so many kids I know head to scheduled activities—bouldering or ukulele or jiujitsu— presided over by an adult.

One might be inclined to think this an improvement over letting kids tromp around the world unsupervised. Adults generally model better behavior than kids do. Parents give better advice than friends. Teachers are likely to insist on fair rules and curb bullying. And all of them will ensure that no kids experiment sexually or with drugs. More monitoring is better, isn’t it?

Actually, Gray said, adding monitoring to a child’s life is functionally equivalent to adding anxiety. “When psychologists do research where they

want to add an element of stress, and they want to compare people doing something under stress versus no stress, how do they add stress? They simply add an observer,” Gray said. “If you’re watched by somebody who seems to be assessing your performance, that’s a stress condition.”

In the last generation, we came to think of unsupervised time as dangerous—a host site for childhood trauma, bullying, and abuse. Better that a recess monitor establish clear rules for schoolyard kickball and insist that everyone play fairly than a kid ever feel left out. Better to hire bus monitors than risk some kid taking another’s lunch money. Better that parents track their teens’ whereabouts with an app than ever wonder where they are—or trust them to get home safely. But this incessant monitoring has infested childhood with stress.

True, teens can’t engage in sexual activity if they’re being watched. But they can’t engage in intimacy, either, Gray pointed out. Put another way, a supervised “playdate” is no play at all—not if you’re referring to the evolutionary activity that confers vast psychosocial benefits and teaches us to get along with other humans.

Real play, of the developmentally beneficial sort, involves risk, negotiation, and privacy from adults:[14] the fort or treehouse built to block adults’ view. Instead, Gray warns, we are living through a “play deprivation experiment” in which teachers and parents and therapists endlessly instruct children on feelings and emotions—but rarely afford them the space or privacy to develop the capacities that are the subject of their endless preaching. “We have removed the things that are joyful to children, and we have substituted things that are anxiety-provoking, and they would be anxiety-provoking for you and me too,” he said.

Things that are joyful to children: danger, discovery, dirt. Games whose rules they invented with that ridiculous cast of characters they call friends. Their hearts aren’t fooled by Mom’s carefully arranged simulacra: the hypoallergenic, nontoxic “slime” she begs all the kids to make with her from a kit that arrived from Amazon. Isn’t this fun? It’s so gross! Right, girls?! Harmless enough, but it doesn’t help a kid blow off steam or test her limits or negotiate relationships with peers. It doesn’t help her learn about

herself and, in the process, discover what sorts of activities or people she might one day come to love.

Bad Therapy Step Six: Dispense Diagnoses Liberally

Your five-year-old son wanders around his kindergarten classroom distracting other kids. The teacher complains: he can’t sit through her scintillating lessons on the two sounds made by the letter e. When the teacher invites all the kids to sit with her on the rug for a song, he stares out the window, watching a squirrel dance along a branch. She’d like you to take him to be evaluated.

And so you do. It’s a good school, and you want the teacher and the administration to like you. You take him to a pediatrician, who tells you it sounds like ADHD. You feel relief. At least you finally know what’s wrong. Commence the interventions, which will transform your son into the attentive student the teacher wants him to be.

But obtaining a diagnosis for your kid is not a neutral act. It’s not nothing for a kid to grow up believing there’s something wrong with his brain. Even mental health professionals are more likely to interpret ordinary patient behavior as pathological if they are briefed on the patient’s diagnosis.[15]

“A diagnosis is saying that a person does not only have a problem, but is sick,” Dr. Linden said. “One of the side effects that we see is that people learn how difficult their situation is. They didn’t think that before. It’s demoralization.”

Nor does our noble societal quest to destigmatize mental illness inoculate an adolescent against the determinism that befalls him—the awareness of a limitation—once the diagnosis is made. Even if Mom has dressed it in happy talk, he gets the gist. He’s been pronounced learning disabled by an occupational therapist and neurodivergent by a neuropsychologist. He no longer has the option to stop being lazy. His sense

of efficacy, diminished. A doctor’s official pronouncement means he cannot improve his circumstances on his own. Only science can fix him.[16]

Identifying a significant problem is often the right thing to do. Friends who suffered with dyslexia for years have told me that discovering the name for their problem (and the corollary: that no, they weren’t stupid) delivered cascading relief. But I’ve also talked to parents who went diagnosis shopping—in one case, for a perfectly normal preschooler who wouldn’t listen to his mother. Sometimes, the boy would lash out or hit her. It took him forever to put on his shoes. Several neuropsychologists conducted evaluations and decided he was “within normal range.” But the parents kept searching, believing there must be some name for the child’s recalcitrance. They never suspected that, by purchasing a diagnosis, they might also be saddling their son with a new, negative understanding of himself.

Bad Therapy Step Seven: Drug ’Em

First comes diagnose, then comes medicate. But if Lexapro, Ritalin, and Adderall were the solution, the decline in youth mental health would have ended decades ago.[17]

Altering your child’s brain chemistry is about as profound a decision as you’ll ever make as a parent. But for many child psychiatrists and far too many pediatricians, it involves little more than a pro forma signature and tearing off a sheet gummed to a prescription pad.[18]

Steven Hollon holds a named professorship in psychology at Vanderbilt University, where he studies the etiology and treatment of depression. “You want to be very careful starting children and adolescents on antidepressants,” he told me. He’s even more adamant about antianxiety medicines like Xanax and Klonopin. “Anything that makes you feel better within thirty minutes is going to be at least psychologically and physiologically addictive, and it probably is going to be both.”
史蒂文·霍隆(Steven Hollon)在范德比尔特大学(Vanderbilt University)担任心理学教授,在那里他研究抑郁症的病因和治疗。“你要非常小心地让儿童和青少年开始服用抗抑郁药,”他告诉我。他甚至更加坚持使用Xanax和Klonopin等抗焦虑药物。“任何让你在三十分钟内感觉好些的东西至少在心理上和生理上都会上瘾,而且很可能是两者兼而有之。

I asked Hollon if, absent a severe psychological crisis, we should be interrupting adolescent development by introducing antidepressants. “Evolutionary biologists would say no. An evolutionary biologist would say it’s part of life. You learn to deal with grief, you learn to deal with loss,” he said. We need to develop those capacities for our own survival. “The things you can learn to do—sometimes they hurt a little bit, it’s scary at times. But the things you can learn to do, you’re better off learning to do those things than relying on a chemical substance.”

With children and adolescents, there’s far less proof of antidepressants’ efficacy than for adult patients.[19] The evidence base is far smaller than it is for adults.[20] And kids are, by definition, a moving target, undergoing changes so rapidly that doctors run the risk of medicating for circumstances soon to be in the rearview mirror.
对于儿童和青少年,抗抑郁药疗效的证据远少于成人患者。[19] 证据基础远小于成人。[20]根据定义,儿童是一个移动的目标,变化如此之快,以至于医生冒着为即将出现在后视镜中的情况进行药物治疗的风险。

There are the meds’ morbid side effects, imposed on a teen who is already struggling: weight gain, sleeplessness, diminished sex drive, nausea, fatigue, jitteriness, risk of addiction,[21] and, of course, a sometimes-brutal withdrawal.[22] Suicidality remains a side effect of antidepressants for reasons that are not well understood.[23]
这些药物的病态副作用强加给已经在苦苦挣扎的青少年:体重增加、失眠、减退、恶心、疲劳、紧张、成瘾风险,[21]当然,有时还有残酷的戒断。[22] 自杀仍然是抗抑郁药的副作用,原因尚不清楚。[23]

But possibly the grimmest risk of antidepressants, antianxiety meds, and stimulants is the primary effect of the drugs themselves: placing a young person in a medicated state while he’s still getting used to the feel and fit of his own skin. Making him feel less like himself, blocking him from ever feeling the thrill of unmediated cognitive sharpness, the sting of righteous fury, an animal urge to spot an opportunity—a romance, a position, a place on the team—and leap for it. Compelling him to play remote spectator in his own life.

Many adults, accustomed to popping a Xanax to get through a rough patch, are tempted to extend that same accommodation to their suffering teen. But the impact of starting a child on psychotropic medication is incomparably different. Every experience of a child’s life—so many “firsts”—will now be mediated by this chemical chaperone: every triumph, every pang of desire and remorse. When you start a child on meds, you risk numbing him to life at the very moment he’s learning to calibrate risks and
许多成年人习惯于弹出 Xanax 来度过艰难的时期,他们很想将同样的住宿扩展到他们受苦的青少年身上。但是,让孩子开始服用精神药物的影响是无与伦比的。孩子生命中的每一次经历——如此多的“第一次”——现在都将由这个化学伴侣来调解:每一次胜利,每一次渴望和悔恨的痛苦。当你让孩子开始服药时,你就有可能在他学习校准风险的那一刻让他麻木。

handle life’s ups and downs. When you anesthetize a child to the vicissitudes of success and failure and love and loss and disappointment when he’s meeting these for the first time, you’re depriving him of the emotional musculature he’ll need as an adult. Once on meds, he’s likely to believe that he can’t handle life at full strength—and thanks to an adolescence spent on them, he may even be right.

If you can relieve your child’s anxiety, depression, or hyperactivity without starting her on meds, it’s worth turning your life upside down to do so.

Bad Therapy Step Eight: Encourage Kids to Share Their “Trauma”

“Really good trauma-informed work does not mean that you get people to talk about it,” physician and mental health specialist Richard Byng told me. “Quite the opposite.”

Byng helps ex-convicts in Plymouth, England, habituate to life on the outside. Many of these former prisoners endured unspeakable abuse as children and young adults. And yet, Byng says, the solution for them often includes not talking about their traumas.

One of the most significant failings of psychotherapy, Byng says, is its refusal to acknowledge that not everyone is helped by talking about their problems. Many patients, he says, are harmed by it.

“If you know that someone’s been traumatized, what I tend to do is just acknowledge it very lightly,” Byng told me. “Very lightly just acknowledge that, yeah, part of why you’re like this is because some bad stuff’s happened. And we’ll put it aside. But I’m trying to talk about what’s going on in the present.”

Not every kid who’s experienced serious adversity will be helped by “sharing” their traumas? The act of talking about your past pain does not necessarily relieve it? Discussing a traumatic experience, even with a

trained therapist, can sometimes increase suffering? This is my shocked face.

Therapists would better serve patients if they adopted a humbler approach, Byng says—one that “acknowledges that some people don’t want to talk about things. That acknowledges that some people will just need to go off and be on their own, but also that some need support and that it’s hard to know what people need and what’s going to be helpful.”

But many teachers, counselors, and therapists today presume the opposite: Kids cannot possibly get on with their lives until they have thoroughly examined and disgorged their pain. In the Academy Award– winning film Good Will Hunting, the protagonist (played by Matt Damon) can escape his traumatic past and get the girl only after he has thoroughly explored his history of child abuse with his therapist (played by Robin Williams). In packed theaters across the country, hearts swelled, tears rained down, and the American mind renewed its faith in the curative miracle of talk therapy. Outside of Hollywood, rehashing sad memories often creates more problems than it solves.

There are therapies, like dialectical behavior therapy, that take a better approach than the model that insists that you can only be cured if you are compelled to “talk about it.” This better approach, in Byng’s view, involves “accepting you’ve been harmed and acknowledging that only you can make a difference,” without pressing people to talk about their pain. But he admits “that’s quite difficult to pull off.”

And yet it’s often what’s best for patients. A dose of repression again appears to be a fairly useful psychological tool for getting on with life— even for the significantly traumatized among us.

Rarely do we grant kids that allowance. Instead, we demand that they locate any dark feelings and share them. We may already be seeing the fruits: a generation of kids who can never ignore any pain, no matter how trivial.

Bad Therapy Step Nine: Encourage Young Adults to Break Contact with “Toxic” Family

Clinical psychologist and author Joshua Coleman has devoted his entire practice to a phenomenon known as “family estrangement”: adult children cutting off their parents, refusing to speak to them, even barring them from seeing the grandkids. A large-scale national survey confirms a recent increase in this phenomenon: almost 30 percent of Americans eighteen and older had cut off a family member.[24]
临床心理学家和作家约书亚·科尔曼(Joshua Coleman)将他的整个实践都致力于一种被称为“家庭疏远”的现象:成年子女切断父母的联系,拒绝与他们交谈,甚至禁止他们见孙子孙女。一项大规模的全国性调查证实了这种现象最近有所增加:近 30% 的 18 岁及以上的美国人与家庭成员断绝关系[24]

Are the ostracized parents typically abusive? No, Coleman said; in general, he doesn’t believe they are. From his own practice, Coleman has observed that adults who were abused as children very often blame themselves for the abuse. “Often, they’re more interested in salvaging whatever they can of parental love.”

So what gives? Why do so many young people today seem to have a hair-trigger for yeeting the ’rents? I don’t care how annoying she is, you don’t cancel Mom just because her needling gets under your skin. (You hang up on her, wait five minutes, call back, act as if nothing happened, and casually ask her to pick up your sons from soccer practice.)

When parents confront the adult children who’ve cut them off, Coleman tells me, the most typical explanation they give is: “ ‘Well, my therapist said, you emotionally abused me or you’re emotionally incestuous. Or you have a narcissistic personality disorder.’ The parents, of course, respond defensively, and that just feels like proof positive to the adult child.”

Coleman added, “I’ve wanted to write an article for the longest time with a title something like, ‘Your Biggest Threat to Your Relationship with Your Child Isn’t Parenting. It’s the Therapist They’re Going to See at Some Point.’

One of the most damaging ideas to leach into the cultural bloodstream, according to Coleman, is that all unhappiness in adults is traceable to childhood trauma. Therapists have made endless mischief from this baseless and unfalsifiable assertion.

This is precisely how therapy often encourages young people to look at their lives. If your career isn’t going well, if you’re having trouble in relationships, if you’re dissatisfied with your life, commence the hunt for hidden childhood traumas. And since parents are ultimately responsible for your childhood, any unearthed “childhood trauma” inevitably reads as an indictment of parents.

Family estrangement is a major iatrogenic risk of therapy not only because it typically produces so much desperate, chronic distraught to the cut-off parents. It also strips the adult child of a major source of stability and support—and for generations after. Estrangement means grandchildren raised without the benefit of loving grandparents who pick them up from school or temper their parents’ foul moods. Worse, it leaves those grandkids with the impression that they descend from terrible people. People so twisted and irredeemable, Mom won’t let them in the house. Even the homeless guy outside Walgreens gets a wave and a dollar every once and a while. But the people I come from? They must have done something unforgivable.

Children learn that all relationships are expendable—even within the parent-child dyad. Mom cut off her own parents. There’s just no good reason to believe she wouldn’t do the same to me if I did something to upset her, too.

Bad Therapy Step Ten: Create Treatment Dependency

Therapists can do harm to someone’s agency and belief in themselves, Dr. Byng told me. Treatment dependency is a common iatrogenic risk of therapy. “I think that’s probably the simplest explanation of the problem: that we’re just teaching people that they’re not adequate humans.”

A patient inducted into the habit of consulting with the therapist may become convinced she cannot ever act without the express approval of an authority figure. A young person trained by adults to seek approval before

undertaking small risks won’t feel capable of meeting the challenges we consider intrinsic to adulthood—making a new friend, grappling with a breakup, choosing a college major

My friend Evelyn runs a major lab at one of America’s premier biomedical research institutions. Each year for the last fifteen, she reviews hundreds of applicants to hire a select few recent college graduates for a year of research. The candidates hail from the nation’s top universities, where they typically aced all of their premed requirements. Some have been published in academic journals. Suffice it to say, these kids are no slouches. Whatever the struggles of their generation, Evelyn’s hires represent the crème de la crème of having their shit together.
我的朋友伊芙琳(Evelyn)在美国首屈一指的生物医学研究机构之一经营着一个大型实验室。在过去的十五年里,她每年都会审查数百名申请者,以雇用少数应届大学毕业生进行为期一年的研究。候选人来自美国顶尖大学,他们通常在那里满足了所有医学预科要求。部分论文已发表在学术期刊上。我只想说,这些孩子不是懒惰的。无论他们这一代人的挣扎如何,Evelyn 的员工都代表了将他们的事情放在一起的精华。

Last year, when I called Evelyn for her birthday and mentioned the topic of my book, she grew suddenly animated. In the last decade, she’s observed a marked change in young adults.

“They are very afraid. They’re afraid to be wrong. They’re afraid to crystallize an idea in the lab and then test it. They’re afraid not to be ‘amazing.’ She sounded frustrated. “It’s almost like they’d rather not start than find out that they’re not amazing. The amount of fear—” She stopped for a moment to consider her own, younger children. “That’s what I don’t want to raise.”

I ask her how she knows it is fear that constrains them and not, say, inexperience or prudence. She knows it’s fear, she says—because they tell her. “A huge percent of my mentorship conversations with them are about their psychological state and their experience in the lab and how they’re doing emotionally.” They regularly update her on their mental health, expecting she’ll want to know. She does not know precisely how they came to this idea—that providing mental health updates is an important part of cellular research—but she’s learned to roll with it.

When Evelyn was in high school, she was running her own experiments at the National Institute for Health, under the supervision of a cell biologist. Now, she can’t get college grads with far better academic grounding to do the same. “They could do any research they wanted,” she says. “I would love it if they would run their own experiments.” Though they have the

foundational scientific knowledge to succeed in medicine, she says, they lack all traces of gumption. Compared with the young people she hired a decade ago, “they have no agency,” she says.

I can hear in her voice a surge of exasperation. “I said to one of them, ‘Are you here to hand me the syringe of saline when I ask for it? Is that really what you want to be here for? You can have resources: go do some science.’

She sounds harsh, but she really isn’t. She’s gentle and kind and nurturing. She absolutely loves to kindle scientific curiosity and is possessed of ample reserves of patience. She suggested to one intern that he design his own experiment and run it. His response? ‘I’m working up to it. First, I want to get my skills together.’ I mean, what’s ‘working up to it’?” she says. “Six months later, you’re going to do an experiment?”

“It sounds as if they’re childlike?” I venture.

“Yes!” she says. “They are ‘in training.’ They are ‘getting ready.’ They’re saying ‘I’m getting these skills. I’m going to launch—I promise,’ she says. “The level at which they are satisfied with what they are producing is very low.” Meaning, they hold themselves to the standard of a much younger, much less accomplished student.

What Evelyn describes is precisely what “treatment dependency” looks like. Leery of trusting herself, a patient will develop an “external locus of control” and be reluctant to attempt the sort of reckless chance from which romantic adventure and professional success might otherwise be born.

Emotional Hypochondriacs

Bad therapy encourages hyperfocus on one’s emotional states, which in turn makes symptoms worse. This reminded me of a few people I’ve encountered who seemed to suffer from hypochondriasis. The girl on the soccer team who almost never made it onto the field but was always nursing a mysterious sports injury, arriving at school with a soft cast or neck brace or crutches, tenderness no X-ray could explain. Or the young social justice

activist I interviewed who was on disability and kept rescheduling our conversations for “migraines” or Lyme disease or a litany of other, always- changing frailties.

Was it possible that mental health experts were turning young people into emotional hypochondriacs? For that matter, what is hypochondriasis?

According to Arthur Barsky, Harvard Medical School psychiatry professor and world expert in hypochondriasis (now known as somatic symptom disorder or illness anxiety disorder), hypochondriasis is an anxiety disorder. Hypochondriacs have anxiety about their health and physical symptoms.
根据哈佛医学院精神病学教授、疑病症(现称为躯体症状障碍或疾病焦虑症)世界专家亚瑟·巴尔斯基(Arthur Barsky)的说法,疑病症是一种焦虑症。疑病症患者对自己的健康和身体症状感到焦虑。

Hypochondriacs are not wimps, and they are not imagining their pain. But nor do they necessarily have more pain than other people. They are simply overly attentive to the normal pains we all feel.

“The hypochondriac interprets his normal bodily sensations unrealistically, believing they are a sign of disease,”[25] Barsky wrote in his book, Worried Sick. That hyperfocus—a kind of anxiety about the body—is enough to amplify physical symptoms.
“疑病症患者不切实际地解释他的正常身体感觉,认为它们是疾病的征兆,”[25]巴尔斯基在他的书中写道, 担心生病.这种过度聚焦——一种对身体的焦虑——足以放大身体症状。

“Women are terrified of breast cancer. They will examine their breast so frequently, that it starts to get tender. And they say, ‘Well, Jesus! It must be inflamed,’ ” Barsky told me. “What they’re doing is actually making it worse.” The most effective treatments for hypochondriasis, Dr. Barsky said, are behavioral modifications that force the sufferer to stop mentally and physically attending to her pain.

I asked Barsky which hypochondriacs are most resistant to treatment.

Those who have turned their distress into what he calls an “organizing principle.” They join online groups devoted to their mysterious illnesses, stop going to work and rearrange their social lives as a shrine to their symptoms. They require nothing short of a rescue mission: something to shift their focus from themselves and tear them from this self-destructive mental loop.

Bad therapy does precisely the opposite. It engenders intensive focus on feelings, amplifies emotional dysregulation, increases a sense of

hopelessness, of incapacity and a paralytic helplessness against a rising sea of feelings.

And far from confinement to the psychoanalyst’s couch, bad therapy is today practiced on almost every kid—by therapists and just as often by nontherapists. The epicenter of bad therapy in your children’s life is, most likely, their school.


Part II

Therapy Goes Airborne

I can’t think of a content area that needs more social-emotional learning than mathematics.

—Ricky Robertson, educational consultant
—Ricky Robertson,教育顾问


Chapter 4
第 4 章

Social-Emotional Meddling


he first time anyone suggested my then seven-year-old daughter had “a lot of anxiety,” I was not at the pediatrician, but at a parent- teacher conference. “She’s looking at the clock a lot at the end of

the day,” the assistant teacher piped up. “She seems to have a lot of anxiety about missing the bus. We thought you should know.”

It seems unlikely that any teacher a generation ago would have scrutinized a second grader’s clock-checking at the end of a nine-hour school day, much less have sprung this banal observation like a magician’s reveal, at parent-teacher conferences.

I knew that this was the first year my daughter was taking the bus without her older brothers, so there was no one to alert the driver if she failed to board on time. But also, her grandfather hates to be late; her father hates to be late; I hate to be late. Worrying over punctuality is very much within the norm of our family. And yet, a teacher who had met my daughter only a few months before informed me that this was grounds for concern, airily implying that I ought to get her tested.

Most American kids today are not in therapy. But the vast majority are in school, where therapists and non-therapists diagnose kids liberally.

According to a survey of physicians in the Washington, DC, area, teachers were most likely to be the first to suggest an ADHD diagnosis in children.[1] Probably for this reason, one of the premier nonprofits devoted to adolescent mental health, the Child Mind Institute, provides an online “symptom checker” specifically to help a parent or teacher inform herself about “possible diagnoses.”[2]
根据对华盛顿特区医生的调查,教师最有可能是第一个建议儿童诊断为多动症的人。[1] 可能出于这个原因,致力于青少年心理健康的主要非营利组织之一,儿童心理研究所,提供了一个在线“症状检查器”,专门帮助父母或老师了解“可能的诊断”。[2]

I began to wonder what else schools were doing in the name of improving kids’ “mental health.” I was in luck. Each year, the state of California sponsors a three-day public school teachers’ conference to showcase its vast array of emotional and behavioral services. Immediately, I registered.

That is how, in July of 2022, I came to join more than two thousand public school teachers at the Anaheim Convention Center, right next to Disneyland.[3] Ankle tattoos winked over fresh pedicures, Anne Taylor cardigans abounded, and the occasional mohawk sliced indoor air cool enough to crisp celery.
就这样,在 2022 年 7 月,我来到迪斯尼乐园旁边的阿纳海姆会议中心与两千多名公立学校教师一起。[3]脚踝纹身在新鲜的修脚上眨眼,安妮·泰勒(Anne Taylor)的开衫比比皆是,偶尔的莫霍克切片室内空气凉爽到足以酥脆的芹菜。

We talked “brain science” based on a YouTube video many of us had seen.[4] It explained that the brain is like a hand, with the thumb folded into the palm. “Our amygdala is really important in serious situations,” said the voiceover. This sounded right. We felt like neuroscientists.

We lamented the burdens placed upon school counselors, now part of an expanded psychology staff, which oversees every public school the way diversity officers dominate a university. We were leery of these new bosses, but we had to admit, they had a big job to do. Our kiddos were bonkers. (The word we were careful to use was “dysregulated.”) Counselors now routinely monitored the social-emotional quality of our teaching, sniffed out emotional disturbance in our students, and decided what assignments to nix or grades to adjust upward.

We talked about the need to give kids “brain breaks,” the salvific power of “Mindfulness Minutes,” and the importance of ending each day with an “optimistic closure.” Our purview was the “whole child,” meaning we were expected to evaluate and track kids’ “social and emotional” abilities in addition to academic ones. Our mandate: “trauma-informed education.” We

pledged to treat every kid as if she had experienced some debilitating trauma.

Subsequent interviews with dozens of teachers, school counselors, and parents across the country banished all doubt: Therapists weren’t the only ones practicing bad therapy on kids. Bad therapy had gone airborne. For more than a decade, teachers, counselors, and school psychologists have all been playing shrink, introducing the iatrogenic risks of therapy to schoolkids, a vast and captive population.[5]

“Emotions Check-Ins”: Constantly Taking Every Kid’s Emotional Temperature

Forget the Pledge of Allegiance. Today’s teachers are more likely to inaugurate the school day with an “emotions check-in.”

Ask kids: “How are you feeling today? Are you daisy bright, happy and friendly?” school counselor Natalie Sedano advised our assembled conference room of teachers. “Or am I a ladybug? Will I fly away if we get too close?”
问孩子:“你今天感觉怎么样?你是雏菊,聪明,快乐和友好吗?“学校辅导员娜塔莉·塞达诺(Natalie Sedano)建议我们聚集在一起的教师会议室。“还是我是瓢虫?如果我们靠得太近,我会飞走吗?

This prompted great excitement in the audience, and teachers jumped up to share their own “emotions check-ins.” One teacher shared a wellness check-in she learned from a teacher training. Every day, she asks her kids if they feel it’s a “bones” or “no bones” kind of a day, borrowing the verbiage from a viral TikTok video in which a pug owner shares the mood of his thirteen-year-old pug, Noodle. If Noodle sits upright, it’s a bones day! If he collapses, it’s a no-bones day.
这引起了观众的极大兴奋,老师们跳起来分享他们自己的“情绪签到”。一位老师分享了她从教师培训中学到的健康检查。每天,她都会问她的孩子们,他们是否觉得这是“有骨头”或“没有骨头”的一天,借用了一段病毒式传播的 TikTok 视频中的措辞,其中一位哈巴狗主人分享了他 13 岁的哈巴狗 Noodle 的心情。如果面条坐直了,那就是骨头日!如果他倒下了,那将是无骨的一天。

“That is so fun!” Sedano enthused. “Love it! Thank you!”

No one betrayed a worry that having kids peg their day as “no bones” at the very start might tend to lock a kid into feeling it was a “bad day” all day long. (I tried to goad a few of my table companions to consider that maybe all this feelings focus was a little much; no dice.)

But I couldn’t help remembering what I’d learned from Kennair and Linden. They would have said that this unceasing attention to feelings was

likely to undermine kids’ emotional stability.

If we wanted to help kids with emotional regulation, I asked Kennair, what would we communicate instead? “I think I’d say: worry less. Ruminate less,” Kennair said. “Try to verbalize everything you feel less. Try to self-monitor and be mindful of everything you do—less.

But there’s another problem posed by emotions check-ins: They tend to induce a state orientation in kids, potentially sabotaging kids’ abilities to complete the tasks in front of them at school.[6]

“If you want to, let’s say, climb a mountain, if you start asking yourself after two steps, ‘How do I feel?,’ you’ll stay at the bottom,” Linden said.

Many psychological studies back this up.[7] An individual is more likely to complete a difficult task if she adopts a task orientation—a focus on the job ahead. If she’s thinking about herself, she’s less likely to complete it.
许多心理学研究都支持这一点。[7] 如果一个人采用任务导向——专注于未来的工作,她更有可能完成一项艰巨的任务。如果她在考虑自己,她就不太可能完成它。

We were only at the very beginning of the school day, and already things were looking grim. But I resolved to give these mental health experts a chance. After all, they were only trying to help.

The School Psychologist Would Love to Talk to You

Few schools today believe that they can get by without a full psych staff, typically comprising a school psychologist, team of school counselors, and handful of social workers. Student outbursts that might once have earned a kid detention, suspension, or a trip to the principal now prompt a scheduled visit with a counselor or school psychologist.

In 2022, California announced a plan to hire an additional ten thousand counselors in order to address young people’s poor mental health.[8] A recent California bill, likely to pass, allocated $50 million for the hiring of additional squadrons of social workers and mental health professionals in public schools.[9] Meaning, however much in-school therapy kids have already received, they likely will soon be getting much more.
2022 年,加州宣布了一项计划,将额外雇用一万名辅导员,以解决年轻人心理健康状况不佳的问题。[8]加州最近的一项法案可能会通过,拨款5000万美元用于在公立学校雇用更多的社会工作者和心理健康专业人员。[9] 这意味着,无论孩子们已经接受了多少校内治疗,他们可能很快就会得到更多。

California school psychologist Michael Giambona provides individual therapy sessions to his middle school students during the school day. He also routinely runs interference with kids’ teachers on kids’ behalf.
加州学校心理学家迈克尔·詹博纳(Michael Giambona)在上学期间为他的中学生提供个人治疗课程。他还经常代表孩子干扰孩子的老师。

“My teachers have special training in working with individuals with behavior needs and mental health needs,” he told me. “So they know how to handle situations. And we meet weekly, and we talk about what’s going on with each student and how we can approach them and support them when they need it.”

That all sounded promising—adults trained to address kids’ specific disorders and prepared to tailor the classroom experience accordingly.

But there’s a problem with in-school therapy, an ethical compromise, which arguably corrupts its very heart. In a remarkably underregulated profession, therapists still have a few ethical bright lines. And among the clearest is—or was—the prohibition on “dual relationships.”

As psychologist and author Lori Gottlieb explains, “The relationship in the therapy room needs to be its own, distinct and apart,”[10] she writes. “To avoid an ethical breach known as a dual relationship, I can’t treat or receive treatment from any person in my orbit—not a parent of a kid in my son’s class, not the sister of coworkers, not a friend’s mom, not my neighbor.”
正如心理学家兼作家洛里·戈特利布(Lori Gottlieb)所解释的那样,“治疗室中的关系需要是独立的、独特的和独立的,”[10]她写道。“为了避免被称为双重关系的道德违规行为,我不能治疗或接受我轨道上的任何人的治疗——不是我儿子班上孩子的父母,不是同事的妹妹,不是朋友的妈妈,不是我的邻居。

This ethical guardrail exists to protect a patient from exploitation. A patient may reveal her deepest secrets and vulnerabilities to her therapist. Anyone possessing this much knowledge of a patient’s private life may be tempted to exert undue power. And so the profession makes “dual relationships” off limits.

Except that school counselors, school psychologists, and social workers enjoy a dual relationship with every kid who comes to see them. They know all a kid’s best friends; they may even treat a few of them with therapy. They know a kid’s parents and their friends’ parents. They know the boy a girl has a crush on, what romantically transpired between them, and how the relationship ended. They know a kid’s teammates and coaches and the teacher who’s giving him a hard time. And they report, not to a kid’s parents, but to the school administration. It’s a wonder we allow these in- school relationships at all.

The American Counseling Association appears to have noticed the obvious problem. In 2006, it revised the ACA Code of Ethics. While still prohibiting sexual relationships with current clients, it decided that “nonsexual” dual relationships were no longer prohibited—especially those that “could be beneficial to the client.”[11]
美国咨询协会(American Counseling Association)似乎已经注意到了这个明显的问题。2006年,它修订了ACA道德准则。虽然仍然禁止与现有客户发生性关系,但它决定不再禁止“非性”双重关系,尤其是那些“可能对客户有利”的关系。[11]

As school counselors and psychologists came to see themselves as students’ “advocates,” they slipped into a dual relationship with their students: part therapist; part academic intermediary; part parenting coach.

[12] Today, school counselors and psychologists commonly evaluate, diagnose, and treat students with individual therapy; meet with their friends; intervene with their teachers; and pass them in the lunchroom. A teen who has just spent a tear-soaked hour telling the school counselor her deepest secrets might reasonably be fearful of upsetting anyone with that much power over her life.
[12] 今天,学校辅导员和心理学家通常通过个体治疗来评估、诊断和治疗学生;与朋友见面;与老师进行干预;并在午餐室传递它们。一个刚刚花了一个小时泪流满面的青少年告诉学校辅导员她最深的秘密,她可能会有理由害怕惹恼任何对她的生活有如此大权力的人。

But are school counselors and social workers exerting undue influence over kids?

Over the past two years, so inundated have I been with parents’ stories of school counselors encouraging a child to try on a variant gender identity, even changing the child’s name without telling the parents, that I’ve almost wondered if there are any good school counselors. One parent I interviewed told me that her son’s high school counselor had given him the address of a local LGBTQ youth shelter where he might seek asylum and attempt to legally liberate himself from loving parents.

There are good school counselors; I interviewed several. But the power structure’s all wrong. Grant a leader the powers of a monarch, and he may gift his subjects freedom—but what’s to tether him to his promises? That’s placing a whole lot of trust in an individual counselor’s conscience.

You might respond at this point: Fortunately, my child has never been to see the school counselor. But more likely, you don’t know. In California, Illinois, Washington, Colorado, Florida, and Maryland, minors twelve or thirteen and up are statutorily entitled to access mental health care without parental permission. Schools are not only under no obligation to inform
在这一点上,你可能会回答:幸运的是,我的孩子从来没有去看过学校的辅导员。但更有可能的是,你不知道。在加利福尼亚州、伊利诺伊州、华盛顿州、科罗拉多州、佛罗里达州和马里兰州,12 岁或 13 岁及以上的未成年人依法有权在未经父母许可的情况下获得心理健康护理。学校不仅没有义务通知

parents that their kids are meeting regularly with a school counselor, they may even be barred from doing so.[13]

As long as a parent has not specifically forbidden it, a school counselor may be able to conduct a therapy session with a minor child without parental consent.[14] School counselors are encouraged to make “judgment calls” about what information, gleaned in sessions with minor children, they may keep secret from the children’s parents.[15]
只要父母没有明确禁止,学校辅导员就可以在未经父母同意的情况下对未成年子女进行治疗。[14] 鼓励学校辅导员对在与未成年子女的会议中收集到的信息进行“判断”,他们可以对孩子的父母保密。[15]

Even in states that require parents to be notified of their kids’ in-school therapy, school social workers remain free to meet informally with a child and inquire about her sexual orientation, gender identity, or parents’ divorce; such conversations often do not count as “therapy.”[16]

The Group Therapy Behemoth: Social- Emotional Learning

Ever since her school adopted social-emotional learning in 2021, Ms. Julie[17] routinely began the day by directing her Salt Lake City fifth graders to sit in one of the plastic chairs she’d arranged in a circle. How is each of you feeling this morning? she would ask, performing a more intensive version of the “emotions check-in.” One day, she cut to the chase: What is something that is making you really sad right now?
自从她的学校在 2021 年采用社交情感学习以来,朱莉女士[17] 例行公事地开始新的一天,指导她在盐湖城的五年级学生坐在她安排成一圈的塑料椅子上。你们每个人今天早上感觉如何?她会问,执行更密集的“情绪签到”版本。有一天,她切入正题:现在让你真正难过的事情是什么?

When it was his turn to speak, one boy began mumbling about his father’s new girlfriend. Then things fell apart. “All of a sudden, he just started bawling. And he was like, ‘I think that my dad hates me. And he yells at me all the time,’ ” said Laura, a mom of one of the other students.

Another girl announced her parents had divorced and burst into tears. Another said she was worried about the man her mother was dating.

Within minutes, half of the kids were sobbing. It was time for the math lesson; no one wanted to do it. It was just so sad, thinking that the boy’s dad hated him. What if their dads hated them, too?

“It just kind of set the tone for the rest of the day,” Laura said. “Everyone just was feeling really sad and down for a really long time. It was hard for

them to kind of come out of that.”

A second mom at the school confirmed to me that word spread throughout the school about the AA meeting–style breakdown. Except that this AA meeting featured elementary school kids who then ran to tell their friends what everyone else had shared.
学校的第二位妈妈向我证实,关于AA会议式崩溃的消息传遍了整个学校。除了这次 AA 会议的特色是小学生,然后他们跑去告诉他们的朋友其他人分享了什么。

Thanks to social-emotional learning, scenes of emotional melee have become increasingly common in American classrooms. In 2013, the New York Times reported on a near identical scene that took place after a California teacher conducted a similar social-emotional learning session with his kindergarteners.[18]

“With children especially, whatever you focus on is what will grow,” Laura said. “And I feel like with [social-emotional learning], they’re watering the weeds, instead of watering the flowers.”

Advocates of social-emotional learning claim that nearly all kids today have suffered serious traumatic experiences that leave them unable to learn. They also insist that having an educator host a class-wide trauma swap before lunch will help such kids heal. Neither claim is well-founded. But the predictable result is precisely what Ms. Julie saw: otherwise happy kids are brought low and a child seriously struggling has his private pain publicly exposed by someone in no position to remedy it.

When I first heard the term “social-emotional learning,” I assumed a

hokey but necessary call for kids to get a grip. Or maybe it was the new name for what they used to call “character education”: treat people kindly, disagree respectfully, don’t be a jackass. Proponents insist it arrives at those things, albeit through the somewhat circuitous route of mental health.

Sometimes described by enthusiasts as “a way of life,”[19] social- emotional learning is the curricular juggernaut that devours billions in education spending each year and upward of 8 percent of teacher time.[20] (Many teachers say they try to ensure that social-emotional learning happens all day long.)[21] Through prompts and exercises, social-emotional learning (SEL) pushes kids toward a series of personal reflections, aimed at
有时被爱好者描述为“一种生活方式”[19],社会情感学习是一门课程,每年吞噬数十亿美元的教育支出,占教师时间的8%以上。[20](许多教师说,他们试图确保社会情感学习整天都在进行。[21] 通过提示和练习,社会情感学习 (SEL) 推动孩子们进行一系列个人反思,旨在

teaching them “self-awareness,” “social awareness,” “relationship skills,” “self-management,” and “responsible decision-making.”[22] (At least one variant, “transformative SEL,” embeds kids’ soul-searching in straight-up Marxism, according to a bracingly honest admission by a California town’s department of education.[23])

Seventh-grade teacher Kendria Jones’s “deep commitment” to social- emotional learning means sharing her own upbringing at the hands of a drug-addicted mother.[24] She tells her eleven- and twelve-year-old students what it’s like to be a single mom after the death of her son’s father. “I’m very vulnerable with them,” she told Education Week.
七年级教师肯德里亚·琼斯(Kendria Jones)对社会情感学习的“深刻承诺”意味着分享她自己在吸毒成瘾的母亲手中的成长经历[24],她告诉她十一岁和十二岁的学生在儿子的父亲去世后成为单身母亲的感觉。“我和他们在一起非常脆弱,”她告诉《教育周刊》。

Interestingly, were Jones an actual therapist, such self-disclosure would be considered unethical. Anytime a therapist might be inclined to share her personal history in order to gratify her own need, she must abstain in order to prioritize the client’s needs.[25] And here’s where things get tricky: teachers aren’t actually trained in psychotherapy, and they aren’t bound by its ethical guidelines, either. Setting up an “emotional sharing” session may sound good, but typically, therapists perform this function under ethical guidelines so that they don’t inadvertently exploit or betray their patients.
有趣的是,如果琼斯是一名真正的治疗师,这种自我披露将被认为是不道德的。任何时候治疗师可能倾向于分享她的个人历史以满足她自己的需求,她必须弃权以优先考虑客户的需求。[25] 这就是事情变得棘手的地方:教师实际上没有接受过心理治疗的培训,他们也不受其道德准则的约束。设置“情感分享”会议可能听起来不错,但通常情况下,治疗师在道德准则下执行此功能,以免无意中利用或背叛患者。

Sometimes when a kid plunks himself down on the rug for morning circle, he is in no mood to exhibit a painful experience no matter how much it might expand the class’s emotional horizons to hear that Austin walked in on his parents having sex. This leaves teacher-therapists with a problem: How to get kids to dish about their emotional lives when they don’t want to?

One presenter at the conference, Amelia Azzam, a regional mental health coordinator for Orange County Public Schools, told a story that seemed to answer this quandary. She knew of a teaching assistant who trailed a seventh grader to lunch. She “goes out to lunch where this young student sits, and she always says ‘hi’ to him. And she has casual interactions with him.” And one day, he told her that his dad was getting out of jail. “Nobody else knew that,” Azzam said.
会议的一位演讲者,奥兰治县公立学校的区域心理健康协调员阿米莉亚·阿扎姆(Amelia Azzam)讲述了一个似乎回答了这个难题的故事。她认识一位助教,他跟着一个七年级学生去吃午饭。她“出去吃午饭,这个年轻的学生坐在那里,她总是和他打招呼。她和他有一些随意的互动。有一天,他告诉她,他爸爸要出狱了。“没有人知道这一点,”阿扎姆说。

Good therapists know that it may be counterproductive to push a kid to share his trauma at school. Good therapists are trained specifically to avoid

encouraging rumination. But school staff who play therapist rarely seem aware that they might be encouraging rumination as they stalk a kid at lunch, waiting to see if he’ll open up about his father’s incarceration minutes before a history test.

“Sometimes people who don’t talk, who don’t share—that’s not resilience,” educational consultant Ricky Robertson told the audience of teachers. “That’s emotional amputation.”
“有时候,那些不说话、不分享的人——这不是韧性,”教育顾问里奇·罗伯逊(Ricky Robertson)告诉老师们。“那是情感截肢。”

Sarah: School Staff That Play Therapist with My Kids Are Playing with Fire

Sarah is a teacher married to a doctor, raising three kids she and her wife adopted out of foster care. All three kids suffered sexual and physical abuse before the state removed them from the home of their biological mother. Each has a significant learning disability.

One of their daughter’s first memories is of eating kitty litter from the box. Describing what he saw when he removed the kids from their biological parents’ home, “the detective cried on the stand,” Sarah told me.

Sarah and her wife pay for qualified therapists to work with each kid on an ongoing basis. A source of constant heartache to Sarah is that she must send them to public school, where so many teachers and counselors are eager to play amateur therapist.

“My kids don’t need to be ashamed about their background. They didn’t do anything wrong,” she said, her voice like an overtightened guitar string. But teachers who engage kids in social-emotional lessons “don’t understand the ramifications of the words that they use that can make a child feel less than, in just a simple assignment, whether it’s social-emotional or not. By trying to do the right thing, they actually hurt my kid.”

“How do they hurt your kid?”

“Because they don’t understand the gravity of what her situation is.”

When teachers casually pry into Sarah’s kids’ past pain for the benefit of class “unity” and empathy development, it puts at risk all the work her

children have done in actual therapy to cope with the memories of their early childhood and cordon them off, for the length of a school day. “It’s not right,” Sarah said, referring to teachers’ constant invitations that kids share their traumatic experiences.

To justify the need for this “trauma-informed care”—and the full- court press to persuade kids to divulge their traumas—several educators offered me the example of a student whose father died that morning. Would that be a good day to insist that Hayley take her algebra test? No, it would not. The only way for a teacher to know whether to postpone the algebra test is by prompting an entire class of kids to take turns sharing their trauma.

One wonders how educators get away with a pretext so transparent. But succeed they do. For more than a decade, they have been quietly increasing and expanding their interventions, transforming every school into an outpatient mental health clinic, staffed largely by those with no real training in mental health.