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Sentinel
哨兵

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

Penguin Random House supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin Random House to continue to publish books for every reader.
企鹅兰登书屋支持版权。版权激发了创造力，鼓励了不同的声音，促进了言论自由，并创造了一种充满活力的文化。感谢您购买本书的授权版本，并遵守版权法，未经许可不得以任何形式复制、扫描或分发本书的任何部分。您正在支持作家，并允许企鹅兰登书屋继续为每位读者出版书籍。

SENTINEL and colophon are registered trademarks of Penguin Random House LLC.
SENTINEL 和 colophon 是 Penguin Random House LLC 的注册商标。

Library of Congress Cataloging-in-Publication Data Names: Shrier, Abigail, author.
美国国会图书馆出版编目数据名称：Shrier、Abigail、作者。

Title: Bad therapy : why the kids aren’t growing up / Abigail Shrier.
标题：糟糕的疗法为什么孩子们没有长大/阿比盖尔·施里尔。

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.
主题：LCSH：儿童心理治疗——社会方面——美国。|儿童心理健康——美国。|育儿——美国。

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

BOOK DESIGN BY CHRIS WELCH
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.
一些名称和识别特征已被更改，以保护相关个人的隐私。

pid_prh_6.3_146236080_c0_r0

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To my mother and father and
对我的父母和

Zach. Always Zach. OceanofPDF.com
扎克。总是扎克。OceanofPDF.com

Sometimes love is not enough and the road gets tough
有时爱是不够的，道路变得艰难

I don’t know why
我不知道为什么

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

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Contents
内容

Author’s Note
作者注

Introduction: We Just Wanted Happy Kids
简介：我们只是想要快乐的孩子

Part I
第一部分

Healers Can Harm
治疗师会伤害

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
第二部分

Therapy Goes Airborne
治疗通过空气传播

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
第三部分

Maybe There’s Nothing Wrong with Our Kids
也许我们的孩子没有错

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
选择参考书目

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Author’s Note
作者注

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.
谈论“青年心理健康危机”往往将两个截然不同的年轻人群体混为一谈。一个人患有严重的精神疾病。这种疾病在最坏的情况下，会妨碍生产性工作或稳定的人际关系，并将患者从正常生活的角度流放。他们的危机是被忽视和治疗不足的危机。这些宝贵的孩子需要药物治疗和精神科医生的护理。它们不是本书的主题。

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.
这本书是关于第二个更大的群体：忧虑者;可怕的;寂寞、迷茫、悲伤。大学男女同校，如果没有给妈妈打三到十个电话就无法申请工作。我们倾向于不称他们的问题为“精神疾病”，但我们也不会说他们正在蓬勃发展。他们去寻找诊断来解释他们的感受。他们认为他们已经找到了“它”，但“它”总是在变化。

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.
我们给这些孩子提供药物、治疗、心理健康和“健康”资源，甚至是预防性的。我们急于用错误的治疗方法来补救误诊的疾病。

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Introduction: We Just Wanted Happy Kids
简介：我们只是想要快乐的孩子

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.
阑尾炎。“可能只是脱水，”判决来了。但是在医生允许我们回家之前，他让我们等护士，护士有几个问题。

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.
熙熙攘攘的人群中，一个身穿黑衣的大个子男人挥舞着写字板。“你介意给我们一些隐私，这样我就可以做我们的心理健康检查吗？”他说。过了一会儿，我意识到那个男人想要和我儿子的隐私来自我。

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?
在过去的几周里，你是否希望自己已经死了？

In the past few weeks, have you felt that you or your family would be better off if you were dead?
在过去的几周里，你有没有觉得如果你死了，你或你的家人会过得更好？

In the past week, have you been having thoughts about killing yourself?
在过去的一周里，你有没有想过自杀？

Have you ever tried to kill yourself? If yes, how? When?
你有没有试过自杀？如果是，如何？什么时候？

Are you having thoughts of killing yourself right now? If yes, please describe.[1]
你现在有自杀的念头吗？如果是，请说明。[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]
当护士让我离开房间时，他并没有脱稿。他遵循的是字面意思。“护理人员脚本”指示护士通知父母：“我们私下问这些问题，所以我要请你走出房间几分钟。如果我们对您孩子的安全有任何担忧，我们会通知您。[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?
在开车送儿子从诊所回家的路上，我被以下可能性所困扰：如果我再信任一点会怎样？孩子们经常试图通过提供成年人似乎想要的任何答案来取悦成年人。如果我的儿子和那个大个子单独在房间里，给了他“是”的问题似乎提示了他怎么办？工作人员会阻止我带儿子回家吗？

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?
还有一个孩子在娱乐黑暗的想法？这真的是帮助他的最好方法吗？将他与父母分开，并向他提出一系列关于自杀的不断升级的问题？

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.
我没有给我的儿子报名接受治疗。我没有带他去做神经心理学评估。我带他去看儿科医生，因为肚子痛。没有任何迹象表明，甚至没有理由怀疑我儿子患有任何精神疾病。护士没有等到。他知道他不必这样做。

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.
我们父母对孩子的心理健康变得如此疯狂、高度警惕和近乎痴迷，以至于我们经常允许各种心理健康专家将我们赶出房间。（“我们会让你知道的”）几十年来，我们一直依靠他们来告诉我们如何培养适应良好的孩子。也许我们过度补偿了我们自己的父母假设相反的事实：心理学家是你最不应该咨询如何抚养正常孩子的人。

—

When we were little, my brother and I were spanked. Our feelings were
小时候，我和哥哥被打屁股。我们的感受是

seldom consulted when consequential decisions about our lives were made
在做出有关我们生活的重要决定时，很少征求意见

—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.
——我们在哪里上学，我们是否会在重大节日出现在犹太教堂，什么样的衣服适合这个地方和场合。如果我们不是特别喜欢晚餐的食物，就没有替代菜单了。如果我们缺乏某种批判性的自我表达权利——对被压抑的身份进行一些必要的探索——我们俩都从未想过。在我这一代人中，要想把这些八十年代童年的完全平均的标志看作是情感伤害的载体，还需要很多年。

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.
我们从不怀疑我们想要自己的孩子。我们发誓，我们的育儿将反映出更大的心理意识。我们决心更好地倾听，多询问，监控孩子的情绪，在做出家庭决定时适应他们的意见，并尽可能预测孩子的痛苦。我们会珍惜与孩子的关系。拆除过去几代人在父母和孩子之间建立的权威障碍，而是将我们的孩子视为队友、学员、伙伴。

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.
最重要的是，我们想培养“快乐的孩子”。我们向健康专家寻求帮助。我们吞噬了他们最畅销的育儿书籍，这些书籍确立了我们教育、纠正甚至与自己的孩子交谈的方法。

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
在这些专家的指导下，我们采用了一种治疗方法来养育子女。我们学会了向孩子提供每个规则和要求背后的原因。我们从来没有打过屁股。我们完善了“暂停”，并为任何惩罚提供了彻底的解释（然后我们将其重新命名为“后果”，以消除任何相关的羞耻感并让我们感觉不那么好

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.”
威权主义）。成功的育儿变成了一个具有单一系数的函数：我们孩子在任何特定时刻的幸福。理想的童年意味着没有痛苦，没有不适，没有争吵，没有失败，绝对没有“创伤”的迹象。

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.
但是，我们越是密切地跟踪孩子的感受，我们就越难以摆脱他们一时的不满。我们越仔细地检查我们的孩子，他们就越明显地偏离了无穷无尽的基准——学业、言语、社交和情感。现在每个人都感觉像是一场灾难。

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.
我们赶紧把孩子送回指导我们育儿的心理健康专家那里，这次是为了测试、诊断、咨询和药物治疗。我们需要我们的孩子和他们周围的每个人都知道：我们的孩子并不害羞，他们有“社交焦虑症”或“社交恐惧症”。他们不是行为不端，而是有“对立违抗性障碍”。他们不是破坏性的学生，他们有“多动症”。这不是我们的错，也不是他们的错。我们将攻击并最终消除围绕这些诊断的耻辱感。我们的孩子接受它们的比率飙升。

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.
在写我的最后一本书《不可逆转的损害》的过程中，在这本书出版多年后，我与数百名美国父母进行了交谈。在那段时间里，我敏锐地意识到孩子们从真正的治疗师和他们在学校的代理人那里得到了多少治疗。父母完全依靠治疗师和治疗方法来修复他们的孩子。以及专家诊断如何经常改变孩子对自己的看法。

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.
尤其是学校，抓住了这个机会，对教育采取治疗性方法，并宣布自己是我们在育儿方面的“合作伙伴”。学校心理健康人员扩大了：更多的心理学家，更多的辅导员，更多的社会工作者。新制度将诊断和适应，而不是惩罚或奖励。它引导孩子们养成监控和分享不良情绪的习惯。它培训教师将“创伤”理解为学生行为不端和学业成绩不佳的根源。

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?
这些努力的目的不是培养成就最高的年轻人。但是我们数以百万计的人接受了，相信他们会培养出最快乐、最适应的孩子。相反，在心理健康专家前所未有的帮助下，我们培养了有史以来最孤独、最焦虑、最沮丧、最悲观、最无助和最恐惧的一代。为什么？

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.
对于十六七岁的男孩来说，以驾驶“可怕”为由推迟考驾照的情况并非闻所未闻。[8]或者让大三学生邀请妈妈一起参加他们的二十一岁生日庆祝活动。他们对风险和自由持怀疑态度，而这些风险和自由几乎是成长的代名词。

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.
这些孩子很孤独。他们陷入情感痛苦的原因，甚至对他们的父母来说，似乎有点神秘。父母向心理健康专家寻求答案，当我们的孩子不可避免地得到诊断时，他们会自豪而宽慰地抓住它：整个生命，减少到一个点。

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.
没有哪个行业会拒绝指数级增长的前景，心理健康专家也不例外。通过将有正常问题的正常孩子喂入无休止的管道，心理健康行业正在以比治愈患者更快的速度来培养患者。

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.
这些代表我们孩子的心理健康干预在很大程度上适得其反。心理健康专家将人格变异重新塑造为功能障碍的明暗对比，训练孩子们将自己视为功能障碍。

The experts operate from the assumption that everyone requires therapy and that everyone is at least a little “broken.”
专家们的假设是，每个人都需要治疗，每个人都至少有点“破碎”。

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.
他们说“韧性”，但他们的意思是“接受你的创伤”。他们梦想着“消除精神疾病的污名化”，并像撒上那么多小精灵灰尘一样的诊断标签。他们一边谈论“健康”，一边主持着近代史上最不健康的一代的螺旋式下降。

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.
也许是时候我们提供一点抵抗了。

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Part I
第一部分

Healers Can Harm
治疗师会伤害

The best of doctors are destined for hell.
最好的医生注定要下地狱。

—The Mishnah
——密西拿

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Chapter 1
第 1 章

• Iatrogenesis
• 医源性

lived on the East Coast.
住在东海岸。

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.
那时我二十八岁，刚从法学院毕业，面临着成为一名律师的不愉快。我坐立不安。我男朋友在洛杉矶做生意。如果我想和他一起解决问题，我需要搬家。

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.
但我也知道，在这个新生命中——他的生活——我完全有可能发疯。我最好的朋友凡妮莎住在华盛顿特区。我们俩都受雇于律师事务所，就电话而言，这意味着工作时间长，时差不可能。我需要有人来倾听程表上的担忧和疑虑。我需要一个替身Vanessa，每周四下午六点有空。我有生以来第一次买得起。我聘请了一位治疗师。

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.
每周，在“五十分钟”的时间里，我的治疗师都会全神贯注地关注我。如果我的重复让她感到厌烦，她从不抱怨。她是专业人士。她从不让我感到自我陶醉，即使我是这样。她让我发泄。她让我哭了。我经常离开她的办公室，感觉人际交往中一些溃烂的碎片已经浮出水面并被拔掉了。

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.
她帮助我意识到我并没有那么糟糕。大多数事情都是别人的错。事实上，我周围的许多人比我意识到的还要糟糕！我们一起自由地诊断它们。谁知道我的许多近亲患有自恋型人格障碍？我发现这个太阳神经丛水平令人欣慰。很快，我的治疗师就变成了一个非常昂贵的朋友，他几乎在所有事情上都同意我的观点，并且喜欢谈论我们（某种程度上）共同认识的人。

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.”
我度过了美好的一年。我男朋友求婚了。我接受了。然后，在我们结婚前一个月，我的治疗师投下了一颗炸弹：“我不确定你们俩是否准备好结婚了。我们可能需要做更多的工作。

I felt the demoralizing shock of having walked into a plate-glass door.
我感受到了走进一扇平板玻璃门的令人沮丧的震惊。

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.
我的治疗师是一位令人敬畏的女人。她和我在一起至少十五年，拥有心理学博士学位，还有一段显然很牢固的婚姻。她放弃了从不错过普拉提的随意提及。有一次，在我们开会之前，我发现她在她一尘不染的办公桌前，吃着她小心翼翼地打开的蛋白质棒，并惊叹于她明显的自我控制能力，以及她设法为我们愚蠢的消费方式带来的尊严。也许我应该被她的声明抛入危机，但无论出于何种原因，我都没有。尽管她受过所有的训练，但她仍然是人，容易犯错。我已经独自搬到了全国各地，开始了新的生活，那时我知道：我不同意她的评价，我也不需要她的许可。我给她留了一封语音信箱，表达了我对她的帮助的感激之情。但是，我说，我会休息一段时间。

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
几年后，我幸福地结婚了，我恢复了对她的治疗。然后我尝试了精神分析师的治疗一年左右。我所经历的每一次治疗经历都沿着从启蒙到

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.
令人不安。偶尔，它会上升到“有趣”的水平。更多地了解我自己思想的运作方式有时是有帮助的，而且常常是令人满意的。

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.”
当我同意我的治疗师时，我告诉了她。当我不这样做时，我们谈论了这一点。当我觉得我需要继续前进时，我做到了。也就是说：我是一个接受治疗的成年人。我在生活中波涛汹涌的水域中游了足够长的时间，获得了一些自我认识，一些自尊，以及对自己感知的准确性的感觉。我可以说：“我想我给了你错误的印象。“或者，”也许我们把太多的责任归咎于我妈妈了？甚至，“我决定终止治疗。

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.
儿童和青少年通常没有能力说这些话。孩子和治疗师之间的权力不平衡太大了。儿童和青少年的自我意识仍在发展中。他们无法纠正治疗师的解释或建议。他们不能因为没有阿基米德观点而推翻治疗师对家人或自己的看法;他们脚下聚集的生命太少了。

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.”
尽管如此，我这个年纪的父母一直在为他们的孩子和青少年报名接受治疗，数量惊人，甚至是预防性的。我和一些妈妈们谈过，她们聘请了治疗师来帮助他们的孩子适应学前班，或者处理一只心爱的猫的死亡。一位妈妈告诉我，她的两个女儿一上中学，她就让治疗师“保留”了。“所以他们会找人谈谈我从来不想和我妈妈谈论的所有事情。

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.
一些妈妈用迂回的措辞告诉我，她们已经聘请了一位治疗师来监视他们乖巧的青少年的想法和感受。治疗师没有告诉我女儿到底说了什么，妈妈们向我保证，但她让我知道一切都很好。偶尔，我收集，治疗师向妈妈转达从小战俘那里收集到的具体信息。

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.
什么是“时钟”？一种用于测量时间的装置。什么是“时间”？用时钟测量的东西。治疗师与患者的任何对话都算作“治疗”。但你明白了：关于感情和个人问题的对话就像医学一样。

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.
父母通常认为，由善意的专业人士进行治疗只能帮助儿童或青少年的情绪发展。大错。与任何可能提供帮助的干预措施一样，治疗也会造成伤害。

Iatrogenesis: When the Healer Makes Things Worse
医源性：当治疗师使事情变得更糟时

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.
或者他“划伤”了一个器官。或者手术顺利进行，但患者在手术部位发生机会性感染。或对麻醉的过敏反应。或者褥疮，因为躺着恢复太久。或者一切都按计划进行，但整个治疗都是基于对问题的误解。

“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.
“医源性”是所有这一切的代名词。来自希腊语，医源性的字面意思是“起源于治疗师”，指的是治疗师在治疗过程中伤害患者的现象。大多数情况下，这不是渎职行为，尽管它可能是。许多医源性发生的不是因为医生恶意或无能，而是因为治疗使患者面临外源性风险。

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.
医源性无处不在，因为所有干预措施都有风险。当病人接受治疗时，风险通常是值得的。当一个健康的病人这样做时，风险往往超过进一步改善的潜力。

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.
在这里，我所说的“干预”是你通常只给有缺陷或无行为能力的人的任何类型的建议或纠正。因此，告诉孩子“吃蔬菜”或“充足睡眠”或“与朋友共度时光”可能是建议，但这不是干预。我们都需要做这些事情。

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.
对于干预措施，一个好的经验法则是：如果你不需要X光检查，就不要去做X光检查。不要仅仅为了向你的医生朋友打招呼而让自己暴露在急诊室的细菌中。而且——也许——除非你的孩子绝对需要，否则不要送你的孩子去接受治疗。每个人都知道前两个;这是最后一个可能会让你感到惊讶的。

Psychotherapy Needs a Warning Label
心理治疗需要一个警告标签

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]
任何足以治愈的干预措施也足以造成伤害。治疗不是良性的民间疗法。它可以提供缓解。它还可能造成意想不到的伤害，并且对多达20%的患者造成伤害。[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.
即使对于成年人来说也是如此，他们通常不太容易被其他成年人领导。这些医源性影响对儿童构成的风险至少同样大，甚至可能更大。

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.
当谈到我们的心理时，我们比心理健康专家通常承认或允许的要定制得多。周二下午四点可能不是我们准备好与聘请专家一起面对困境的时候。和朋友一起回忆，和你的配偶开一个你不敢和别人开的玩笑，帮你的表妹收拾她的公寓——不谈论你的问题——往往比坐在一个满是悲伤的人的房间里更有助于康复。治疗可以劫持我们正常的复原力过程，打断我们心灵在自己的时间以自己的方式自愈的能力。

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.
可以这样想：对那些经历过损失或灾难的人进行团体治疗，迫使他们与悲伤的人一起出去玩。这可能会使相对有弹性的人更难过，并促使悲伤的人炖。最沮丧的人将飞船驶向苦难星球，其他人都被困在里面。

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.
令人尴尬的是，许多心理干预几乎没有被证实的有效性[20]尽管如此，它们仍被很好地应用于儿童和青少年。

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
想要帮助并不等同于帮助

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]
治疗师几乎总是想提供帮助，但有时他们根本不想。虽然一些疗法在有限的领域取得了成功——比如认知行为疗法在治疗恐惧症方面的成功——但那些研究疗法疗效的人经常指出，各种治疗类型的结果并不是非常令人印象深刻。[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
心理健康专家在为患者提供可怕的治疗方面有着悠久而辉煌的记录，将新问题引入他们声称可以治愈的患者群体中。幸运的是，他们已经放弃了许多最可怕的治疗方法：胰岛素引起的昏迷，故意造成疟疾，当然还有额叶切除术——所有这些都不是在中世纪时期，而是在上个世纪[26]治疗师在二十世纪初诱发了一种虚假疾病神经衰弱的流行。一个

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]
一个世纪后，他们仍在为疾病而烦恼：恢复记忆综合症和多重人格障碍[27]治疗师也因撒旦仪式滥用的欺诈而堕落。[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]
在过去的十年中，治疗师推动了性别焦虑的热潮，这导致少女的诊断增加了4000%。[29]越来越多的年轻女性对自己的医疗转型感到遗憾，即“变性者”，讲述了惊人相似的故事。很多时候，当他们把自己的生活追溯到事情急剧偏离轨道的路口时，有一个收缩的铁路信号员站着，拨动开关。[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.
这不应该让我们感到惊讶。人脑也许是世界上最复杂、最不为人所知的有机结构。解决人类心灵的问题比固定骨折要困难得多。我们不能指望治疗师比医生失败的次数少。但是，我们可以期待比从业者通常在讨论治疗局限性时带来的更多的透明度和谦逊性。

“In psychotherapy, psychologists help people of all ages live happier, healthier, and more productive lives,” declares the American Psychological Association.[31]
“在心理治疗中，心理学家帮助所有年龄段的人过上更快乐、更健康、更有成效的生活，”美国心理学会宣称。[31]

There is, alas, no proof that they accomplish any of that in aggregate.
唉，没有证据表明他们总体上完成了任何这些。

Wanting to help is just not the same as helping.
想要帮助并不等同于帮助。

Therapists Are a Little Touchy about Iatrogenesis
治疗师对医源性有点敏感

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?
为什么治疗师通常不承认他们的方法会造成医源性伤害？

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.
——因为她是药。入场有点个人化。

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.
在医源性方面，收缩受到不良激励。医生可能会决定患者不再从甲状腺药物中受益，停用甲状腺药物并保留患者。治疗师按剂量获得报酬。一旦她决定你不需要治疗，她就会失去一个客户。

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.
实际上，情况比这更糟糕：在最长的时间内治疗病情最轻的人符合治疗师的利益。询问任何治疗师治疗双相情感障碍或精神分裂症患者是什么感觉。答：非常困难。（出于这个原因，许多人拒绝治疗这些患者。但是每周和有社交焦虑症的青少年坐在一起吗？家人按时付款，青少年的问题很小，在您的会议期间没有人变得暴力。难怪为什么在获得这样的病人后，治疗师可能不愿意放弃她。

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.
大多数治疗师不知道谁因他们的治疗而变得更糟，因为他们没有努力跟踪副作用。该行业不需要它。曾经主导治疗实践的医生（精神科医生）在近几十年来普遍停止提供心理治疗。[36]他们借给治疗的医疗权威落在了那些没有接受过医学培训的人身上。

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]
由于心理学领域缺乏明确的指导方针，什么才算是治疗性的“伤害”，[37]因此，即使治疗师愿意，也不清楚治疗师将如何跟踪治疗造成的损害。正如一组研究人员所说：“离婚既可以是积极的，也可以是消极的，在治疗中哭泣可以反映痛苦的经历和治疗事件。[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.
当医源性风险没有得到统计时，危害就会堆积起来，对健康的威胁远远超过对病人的威胁。原因不难看出：遭受枪伤，您在手术室中感染机会性感染的风险超过了您需要的挽救生命的治疗。

Suffer a scratch, and you have nothing to gain from surgery—nothing but risk.
遭受划伤，你从手术中没有任何好处——除了风险之外什么都没有。

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.
如果我们让一个普遍健康的人群沉浸在不必要的心理健康治疗中，我们会发现什么？史无前例的医源性作用。考虑到这一点，请认识一下正在崛起的一代。

OceanofPDF.com

Chapter 2
第 2 章

•

A Crisis in the Era of Therapy
治疗时代的危机

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.
她告诉我，她总是和他们保持联系——在Snapchat上，一整天，甚至在上课的时候。在她位于南加州的大型私立高中，她在学校合唱团唱歌，是每部戏剧的演员，并且是一名尖子生。

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
在四月一个温和的下午，我们坐在她母亲和继父后院露台的阿迪朗达克椅子上。诺拉甩了甩头发，重新交叉双腿，裸露在飘逸的裙子里，试探着空气，以为我们是两个成年人

—she, the cuter, more up-to-date model.
——她，更可爱、更现代的模特。

“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.”
“我总是有一个朋友正在经历一些非常严重的事情，”她告诉我。“我不知道为什么总是这样。”

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.
对于高中女生来说，这听起来很正常，所以我问：她们正在经历什么？焦虑，抑郁，她勾选了。与父母的麻烦。很多自残。

Like what?
比如？

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?”
好。还有什么？“拔毛癖。”“对不起？”

“Pulling out your hair. That’s a big one.”
“拔掉你的头发。这是一个很大的问题。

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.
也称为“拔毛症”，这是从头皮、睫毛和眉毛上拔出头发的冲动，源于无法控制的自我舒缓需求。分离性身份障碍、性别焦虑症、自闭症谱系障碍和妥瑞氏症都属于她曾经罕见的疾病清单，在这新兴的一代中，这些疾病突然变得不那么罕见了。

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.)
诺拉随便便就对几十种精神障碍了如指掌，就好像她把《精神障碍诊断和统计手册》放在床边一样。（她没有。

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.
鉴于许多人似乎过得很糟糕，人们可能倾向于建议这些青少年真的可以使用一些疗法。事实上，诺拉的“绝大多数”朋友已经在接受治疗——她告诉我，许多人已经接受治疗多年了。一些人正在服用精神科药物。

Does it seem to be helping?
它似乎有帮助吗？

“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.
我问诺拉，她的朋友们似乎有什么烦恼。诺拉重申他们正在经历“非常艰难的事情”，但当我问她什么时，她含糊其辞：与同龄人的关系紧张、分手、与父母的分歧。

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.
当我见到诺拉时，我已经采访了足够多的青少年，知道她并没有回避这个问题。今天的青少年交流更加稳定，主要是数字化的，甚至在十几岁的女孩中，也比上一代人更加肤浅。少一些灵魂的裸露，更多的模因交易。

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.
即使是对他们最好的朋友，他们也只传达这一点：他们正在经历一些糟糕而严重的事情，需要他们朋友的同情和宽容。

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.
她的一些朋友抱怨他们的父母“在情感上虐待”，但当我问诺拉为什么他们的治疗师没有打电话给儿童服务时，她似乎并不为所动。是的，她认为他们有点夸大其词。为了保持友谊，你暂停了怀疑。

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.”
还有别的东西。诺拉垂下下巴，对她即将坦白的事情感到尴尬：“我注意到很多人会利用他们的精神问题——这几乎就像一个谈话片段。这几乎就像一种趋势。

I reassure her that she’s at least the twelfth adolescent to tell me this. She exhales.
我向她保证，她至少是第十二个告诉我这些的青少年。她呼出一口气。

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?”
有这么多朋友患有焦虑症和抑郁症是什么感觉？实际上，她告诉我，那些没有被诊断出来的人会感到被排除在外。“你应该有这些精神问题。而这些正在正常化的事情——这些事情是不正常的，“她说。“我被它包围着，所以我认为在某些方面，它已经成为我们的新常态。在我周遭的这一切中，怎么可能不让它也加在我身上——我不为此感到沮丧呢？

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.
我问她，为什么有朋友在挣扎会很沮丧。“我认识三个长期被送进精神病院的人——一个自杀了，”她说。他们都是高中生。

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.
诺拉比她的大多数同龄人和我采访的许多年轻人要好得多：她有一群朋友，一个稳定的男朋友，在学校表现出色，并且正在规划自己的未来。她没有服用精神科药物，也没有接受治疗。

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.
但她也随便把两组朋友捆绑在一起，就好像他们是一体的：那些精神疾病严重到需要精神科承诺的人，以及那些正在为他们的不快乐寻求解释并发现诊断的人。像我交谈过的许多年轻人一样，她认为患有“考试焦虑症”或“社交恐惧症”的高中朋友只是存在于心理连续体的一端，这种心理连续体以裸体出现在塔吉特的女人身上结束。

They Need Therapy, You Say?
他们需要治疗，你说？

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]
新生代接受的治疗比以往任何一代人都多。近40%的新生代接受过心理健康专家的治疗，而X世代的这一比例为26%。[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.
如果你问心理健康专家，年轻人是否总体上有未确诊的心理健康问题，他们总是回答是肯定的。这意味着，根据专家的说法，没有心理健康问题越来越不正常。

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
从他们第一次双腿不稳地蹒跚在客厅地毯上时起，父母就对他们进行了治疗性养育。（“我看到你有一些很大的感觉。亚当，你想怎么表达呢？你会

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.
喜欢跺脚吗？还是咬紧牙关？他们的老师采用了治疗性的教学方法（“告诉我你的画，麦迪逊。它对你来说代表什么？并给他们读关于如何处理他们的感受的书。

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.”
突然之间，每个害羞的孩子都患上了“社交焦虑症”或“广泛性焦虑症”。每个奇怪或笨拙的青少年都是“在光谱上”，或者至少是“光谱”。孤独的人有“抑郁症”。笨拙的孩子有“运动障碍”。

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]).
父母不再责备“挑食者”，而是诊断并适应“食物回避者”。（正式诊断：“回避型限制性食物摄入障碍”或ARFID。如果一个孩子抱怨衬衫后面有个发痒的标签，或者抱怨走廊的噪音让他无法安然入睡，他的父母并没有告诉他不要理会它;他们买了柔软的皮马棉的无标签衣服，并为他的房间配备了一台柔和的声音机器，以解决他的“感官处理问题”。不要因为乱七八糟的笔迹而责备孩子（那是“书写障碍”）。不要告诉忧郁症的孩子需要时间来适应新城镇或新学校（他们有“搬迁抑郁症”[14]）。不能让他们放心，在夏天想念他们的朋友是正常的（“夏天焦虑”[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.
我们都在治疗概念中游泳，以至于我们不再注意到水的存在。谈论孩子因宠物死亡而遭受的“创伤”或被选为运动队最后一名的例行羞辱似乎是完全合理的。

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.
专业“告诉读者，你的名字读错是对心灵的伤害。[17]纽约大学解雇了一位著名的有机化学教授，他是该领域首屈一指的教科书的作者，因为让医学预科生达到他几十年来一直采用的相同标准（和评分标准）突然未能将学生的福祉放在首位。

[18]

“Student Wellness Centers” have sprouted at our most prestigious universities. Our best athletes withdraw from competition to attend to their mental health; and young Hollywood starlets, Prince Harry, and a slew of Grammy winners proclaim the “work” they are doing in therapy against a continuous struggle with anxiety and depression. “Wellness” and “trauma” form the contrapuntal soundtrack against which the rising generation came of age.
“学生健康中心”在我们最负盛名的大学中如雨后春笋般涌现。我们最优秀的运动员退出比赛以关注他们的心理健康;年轻的好莱坞明星哈里王子和一大批格莱美奖得主宣布了他们在治疗中所做的“工作”，以应对与焦虑和抑郁的持续斗争。“健康”和“创伤”构成了新生代成长的对立配乐。

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.
75年来，精神卫生治疗和服务的快速扩张使我们来到这里，惊叹于美国年轻人前所未有的心理脆弱。

The Treatment-Prevalence Paradox
治疗-流行悖论

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.
它始于从第二次世界大战中返回家园的士兵[19]，在以前无法想象的规模上，美国大兵已经看到并遭受了死亡和苦难。许多人摇摇晃晃地回到家中，有些人摇摇晃晃。

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.
这个指数级扩张的故事中蕴含着一个悖论。更广泛可用的治疗方法应该可以降低疾病的发生率（和严重程度）。

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.
以乳腺癌为例，它每年无情地杀死超过四万名美国女性。自1989年以来，随着乳腺癌早期发现和治疗的改善，乳腺癌的死亡率直线下降。或孕产妇死亡率：随着抗生素的普及，分娩时的孕产妇死亡率急剧下降。更好、更广泛地获得牙科护理意味着更少的无牙美国人。随着我们开发了针对儿童疾病的免疫接种和治疗方法，儿童死亡率急剧下降。

And yet as treatments for anxiety and depression have become more sophisticated and more readily available, adolescent anxiety and depression have ballooned
然而，随着焦虑症和抑郁症的治疗方法变得越来越复杂，更容易获得，青少年的焦虑和抑郁已经激增.

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]
“有效治疗的增加应该会缩短抑郁发作，减少复发，并减少复发。综合起来，这些治疗的进步无疑应该导致抑郁症的患病率估计值降低，“他们写道。“这些减少是否发生了？经验答案显然是否定的。[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
经过几代人的干预，情况不应该是这样。更多的抗生素使用应该意味着更少的感染死亡。和

more generally available therapy should spell less depression.[29]
更普遍的治疗方法应该可以减少抑郁症。[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.
是的，这两种趋势的巧合——在一个对心理障碍的认识、检测、诊断和治疗大大扩展的时代，心理健康状况的恶化——可能就是巧合。它没有揭开因果箭头。但它很奇特。至少，它可能提供了一个线索，即许多治疗方法和许多助手实际上并没有帮助。

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.
治疗师会坚持认为我做错了事情。他们是救生员，而不是鲨鱼;只是新生代一直在鲨鱼出没的水中游泳，比上一代人都面临着更艰巨的挑战。

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?
是智能手机，假人吗？

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]
抽动障碍、性别焦虑症、厌食症、分离性身份障碍、拔毛癖、切割：智能手机引发的可怕游行可以填满自己的精神病学手册。如果智能手机是一个想见你女儿的男孩，一代人以前，父母会看他一眼，然后说：我不可能让那个孩子进门。智能手机和社交媒体的兴起为青少年心理健康状况不佳的环境原因提供了一个令人信服的候选者。[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.
他们没有。没有一个心理学组织——美国精神病学协会、美国心理学会、全国学校心理学家协会或美国学校辅导员协会——发出任何这样的号召。在过去的十年中，随着孩子获得第一部智能手机的平均年龄下降到十岁，[39]这些组织对此几乎没有什么可说的。

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.
他们一直专注于自己的风格和干预方法。因为任何父母都可以拿走手机，但只有心理学家才能诊断孩子或转诊药物。他们本可以做的最重要的事情来帮助改善孩子的心理健康，但这些事情不需要他们的专业知识。

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.
和自残？最尽职尽责的父母充其量只是要求他们的孩子在厨房里停靠，并在睡前停止滚动。这就是限制与注意力缩短、失眠、严重焦虑和抑郁令人信服地联系在一起的设备。

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]
当我问父母为什么他们会给孩子一个让孩子面临各种精神障碍风险的设备时，他们总是给出一个答案：这就是他们与朋友制定计划的方式。我不希望他们是唯一一个没有的人。治疗师通常不鼓励父母拿走青少年的智能手机，理由是这样做只会破坏亲子关系。[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?
当我们提出问题时，为什么公立初中和高中集体放弃了所有努力来监督它们的使用，即使在上课时间也是如此？

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?
我与一所私立高中的一位校长交谈过，那里的学生整天随身携带手机，甚至在课堂上（现在是大多数高中的标准协议）。我说，这会在他们努力学习时吸引他们的注意力。这使他们无法相互了解。他们不会像没有手机那样说话或交朋友。然后是社交媒体破坏他们情绪健康的所有方式。你为什么允许这样做？

He nodded amiably until it was his turn to speak. “It keeps them calm,” he said.
他和蔼可亲地点了点头，直到轮到他说话。“这让他们保持冷静，”他说。

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.
没有人认真努力阻止青少年使用智能手机——不是父母，不是老师，绝对不是心理健康专家——因为智能手机已经成为我们向年轻人支付的另一种心理健康设施。我们知道这对他们不利。我们知道长期后果从黑暗到可怕。我们知道这些设备会上瘾、剥夺睡眠和诱发病理。但就目前而言，他们提供无与伦比的姑息治疗——像任何毯子一样舒缓。

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
如果心理健康专家想为青少年做最好的事情，建议父母不要给青少年使用智能手机将是一件轻而易举的事。他们会像医生一样说：如果你要让你的孩子继续吸烟，那么把他带到这里是没有意义的。他们坚持自己

out as guardians of youth mental health; they ought to offer the most radical
作为青少年心理健康的守护者;他们应该提供最激进的

advice when it comes to smartphones and our young.
关于智能手机和我们的年轻人的建议。

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.
对于已经在面对面互动中苦苦挣扎的一代人来说，心理健康专家现在提供了终极吗啡滴注：嵌入智能手机的疗法。有些人已经取消了语音和视频互动，通过短信提供治疗。

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]
如果你想改善孩子的心理健康，锁定她的智能手机可能是一个开始。至少，智能手机会让青少年远离面对面的朋友和活动的世界，这可能会增强她的幸福感。毫无疑问，它们加剧了各种社会传染，从抽动障碍到性别焦虑。但是放逐智能手机并修复一代人？我不太确定。[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?
不喜欢你的单独监禁？

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.
本着这种精神，APA吹捧了平权行动对心理健康的益处，[46]并在一份引人注目的新闻稿中宣布准备“帮助社会应对气候变化”。[47]但是，面对强迫社会孤立的紧迫和普遍的威胁？蟋蟀。

How could the experts have missed a mental health calamity so obvious and foreseeable?
专家们怎么会错过如此明显和可预见的心理健康灾难？

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]
近20%的12至17岁女孩报告说，她们在前一年有过严重的抑郁发作。在过去十年中，儿童自杀率上升了150%。[51]

“Climate Anxiety”
“气候焦虑”

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.
Vermeulen培训治疗师并撰写书籍，以指导他们为新兴一代提供咨询。她的专长是“灾难心理健康”——也就是说，处于危机中的人们。有人可能会说：这是她的时刻。

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
当我得知她写了一本书《灾难一代：9/11后的成年》时，我立即联系了她。我以为是志同道合的人

—one who’d studied the same cohort that so completely fascinates me.
——一个研究过让我如此着迷的同一批人的人。

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.
她向我保证，年轻人是有韧性和坚强的。他们只是在迎接比他们之前任何一代人都更艰巨的挑战。“他们正在处理所有这些其他压力源，但这一切都漂浮在气候变化的不稳定表面上，”她说。

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.
事实证明，《一代灾难》可能是印刷文字史上最具误导性的标题。Vermeulen所说的“一代灾难”实际上意味着：这一代人不是一场灾难——不是一场灾难。如果说有什么不同的话，那就是其他人都是一场灾难，因为他们对这些伟大的、有社会意识的年轻人过于挑剔。

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
像Vermeulen一样，许多治疗师都相信“气候焦虑”是心理健康障碍的一个真实而重要的类别。一种家庭手工业已经兴起来治疗它：“气候意识疗法”。随着极地冰盖融化，热带疾病肆虐，飓风和洪水计划登陆诺阿海德复仇，年轻人当然很沮丧！性质

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?
但是，我敢问，气候焦虑是理性的吗？我们能为孩子们提供对他们恐惧的肯定吗？

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.
实际上，虽然地球正在变暖，但有很多理由对环境持乐观态度。许多环境趋势正朝着正确的方向发展。

“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
然而，人们告诉调查人员，当大多数趋势朝着正确的方向发展时，他们今天对环境的焦虑比过去任何时候都要多得多。当我们几乎完全燃烧煤炭发电或用氟氯化碳在臭氧层上炸开一个洞时，环境焦虑的爆发在哪里？或者当一层棕黄色的烟雾挡住了洛杉矶安吉利诺斯对附近圣盖博山脉的视线时？所有这些都是已知的问题，但精神问题

health diagnosis was nonexistent. That alone may have contained the spread of worry.
不存在健康诊断。仅此一项就可能遏制了担忧的蔓延。

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.
换句话说，即使对于深切关注气候变化的成年人来说，验证和加强孩子对人类因气候变化而灭绝的恐惧也不是理性的当务之急。相反，这是一个成年人出于自己的原因做出的非常具体的选择。

“Embrace Their Despair”
“拥抱他们的绝望”

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.
如此多的进步父母似乎认为，当涉及到气候变化时，他们的工作就是吓唬孩子们。睡前使用“人类灭绝”一词。尽可能多的就寝时间。

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
我问Vermeulen，对一个孩子说，听着，你现在真的夸大了气候变化的威胁是否合适。让我们开始吧

through the week.
整整一周。

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]
Vermeulen明显受到打击。“我永远不会告诉别人他们在夸大其词。这是非常无效的，没有帮助。这将提高防御能力，让他们感到被忽视。[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.
但是孩子们会把很多担忧抛给他们的父母，有时只是为了看看哪些会反弹。听从治疗师的指示并拥抱孩子绝望的父母为床下的怪物注入了生命。在少数家庭中，父母自己也被世界末日的恐惧所困扰，这种恐惧也威胁着孩子，这让我们感到惊讶。

Beth, the Psych Nurse: Stop Trying to Make Climate Anxiety Happen
心理护士贝丝：停止试图让气候焦虑发生

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.
贝丝现在已经三十多岁了，她在一家医疗诊所担任了十多年的心理护士，为波士顿地区三所大学的学生提供服务。贝丝告诉我，尽管每个人似乎都对年轻人的心理健康感到震惊，但情况比我们所知道的还要糟糕。她经常看到无法给自己办公室打电话的大学生。他们要求大学辅导员——甚至是家长——代表他们安排约会。[57]他们声称他们的“社交焦虑”禁止了这项基本任务。但是为他们开处方的贝丝告诉我，事实并非如此。他们从来没有被要求自己做任何事情。

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.
举个例子，贝丝回忆说，一位大学男女同校的学生带着她的妈妈一起去赴约。这位妈妈用手机上的应用程序跟踪女儿的月经期。

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.
我问女儿是否在某种程度上有精神障碍。不，贝丝说。她只是，很好，管理得很好。从不被允许跌倒或失败，站在两条摇摇晃晃的腿上，几乎没有试过地面。然后，从家庭遮阳篷下推出大学，大学生活像冰雹一样袭击了这些孩子。

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.
贝丝说，许多大学年龄的年轻女性每天吸食大麻几次，只是为了减轻她们的痛苦。她告诉我这是新的。大麻的使用不是社交的;它是强迫性的和药用的。

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.
那么，他们为他们所感受到的痛苦提供了什么理由呢？考试压力。被堆积如山的工作压得喘不过气来。完全无法达到教授设定的期望，与他们以前的公立学校教师不同，如果他们的成绩允许的话，他们实际上可能会让他们失望。

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.
贝丝说，他们的很多痛苦都属于社交互动变得非常糟糕的类别——他们在网上说过或发布过的事情，后来他们后悔了，似乎无法停止重温。抛弃他们或让他们的文本“阅读”的男孩。他们想克服它。他们认为他们做不到。

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]
那么，为什么这么多治疗师、研究人员和知识分子坚持认为气候变化是他们痛苦的主要原因呢？为什么年轻人告诉研究人员气候变化是他们焦虑的原因？事实证明，当年轻人没有陷入严重痛苦的阵痛时，他们会提供对周围成年人来说似乎合理的理由，并获得他们想要或需要的同情和关注。[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。

[61]

But for therapists who continue to see “climate change” as rational grounds for serious mental disturbance, optimism is not an option. There is no bright side, and it does no good to point out to a young person claiming “climate anxiety” that she may be suffering an emotional parallax. With some notable exceptions, placing an adolescent’s worries into perspective is not what therapy does—nor even what it seeks to do. That wouldn’t be affirming the patient.
但对于那些继续将“气候变化”视为严重精神障碍的理性理由的治疗师来说，乐观不是一种选择。没有光明的一面，向一个声称“气候焦虑”的年轻人指出她可能正在遭受情绪视差是没有好处的。除了一些值得注意的例外，正确看待青少年的担忧并不是治疗的目的，甚至不是它想要做的事情。那不是对病人的肯定。

No. We. Can’t.
不。我们。不能。

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
特温格告诉我，与千禧一代相比，Z世代约会、获得驾照、保住工作或与朋友见面的可能性要小得多

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.
他们也比前几代人更加悲观，尤其是比千禧一代更加悲观。今天的年轻人为什么如此悲观？我问特温格。

“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.”
“一切，”她说。“在他们自己的前景，世界的前景。你要问，是什么原因造成的？是因为这个世界太糟糕了，所以他们才会抑郁吗？还是他们认为世界很糟糕，因为他们抑郁了？它可能是其中之一。

But there’s something else, too. In numbers never before seen, young people doubt they have the power to improve their circumstances.
但还有别的东西。在前所未有的数字中，年轻人怀疑他们是否有能力改善自己的处境。

“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.
“控制点”是心理学家用来指代一个人的代理感的术语。如果你有一个内部控制点，你相信你有能力改善你的环境。如果你有一个外部控制点，你就没有。相反，你倾向于将事件归咎于你无法控制的事情，比如其他人或运气不好。

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.
Twenge说，正在崛起的一代已经走向了外部控制点。站在人生旅程最起点的一代人也认为他们无法做任何事情来改善自己的命运。

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.
这些深深的无助感、无能感和依赖感可能是这一代人抑郁的症状。或者所有这些都可能是第三种原因的症状，治疗无法治愈，但可能会恶化。但是，今天的心理健康专家很少考虑当今年轻人面临的任何问题，而他们并不是不变的解决方案。所以，更多的治疗，那么。还有多少？负荷。

Becca: My Therapist Is Helping Me Prepare to Make Friends—in College
Becca：我的治疗师正在帮助我准备在大学里结交朋友

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.
当我们说话时，贝卡刚刚从加利福尼亚州圣克拉丽塔的一所大型公立高中毕业。她没有工作，也没有找工作的计划。目前，她只是想在秋天上大学之前进入正确的心态。她希望学习——你猜对了——心理学。她的治疗师正在帮助她准备结交朋友。

“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.”
“这对我来说是一个终生的问题。我认为这更像是把自己放在那里，“贝卡告诉我。“我的治疗师特别说，我应该是第一个伸出援手的人。所以我一直在努力，尤其是现在我要上大学了。我还不知道我的室友情况，但我肯定会尝试与他们交谈并变得更亲近。这有点像一个新的开始。

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.
几代人以来，这种平凡的生活事实——需要在新的地方结交新朋友——是年轻人下定决心自己做的事情。但自从她六岁时父母离婚以来，贝卡一直在接受治疗。你无法说服她，她不需要治疗师来帮助她计划、排练和重新审视她结交朋友的尝试。

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.”
对于与她的治疗师如此亲近的人来说，贝卡并不了解她现在的“最好的朋友”，这也许并不奇怪。贝卡无法告诉我她的大多数朋友都信什么宗教，或者他们的父母以什么为生。他们对她也不太了解。“和我的朋友一起，我们谈论男孩之类的东西。但是和我的治疗师一起，我谈论更深层次的问题，比如我的焦虑。她给了我一些方法来帮助我，比如冥想，坐下来思考是否真的值得强调。

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.
专业治疗师给出的建议可能比另一位青少年的建议更成熟、更有分寸。无论如何，买单的父母当然希望如此。但这并不是一个明显的胜利。因为在接下来的三十年里，你的治疗师不会在你每年的生日那天给你打电话。

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.
她不会强迫你在二十一岁生日那天在卡拉OK酒吧羞辱自己，因为她那么爱你。她不会把你介绍给同事，也不会因为她无法忍受单独见到你而劝说她的男朋友为你安排一个布置。你的治疗师不会跳上火车去参加你的单身女郎，只是为了让她可以为你的不幸事件干杯，或者在你的婚礼上站在你身边，泪流满面地捧着一捧牡丹花。她可能会答应理解你，但让我们面对现实吧：你的治疗师不会因为你们中的一个人生了孩子而从她的小时账单中珍视来庆祝你孩子的出生。

No, they are the dividend stream of actual friendship. And so many hours logged bearing souls, piling into cars for road trips, narrowly avoiding accidents, and getting lost in bad neighborhoods—they are the invested capital. Therapists care about you in the practiced manner and to the precise extent any professional does a client—for the duration of a “fifty-minute hour,” so long as she takes your insurance or you remain cash-flow positive. The social  critic Christopher  Lasch once  observed that  therapy “simultaneously pronounces the patient unfit to manage his own life and delivers him into the hands of a specialist.”[64] And I couldn’t help thinking of Becca’s predicament when I read this from Lasch: “As therapeutic points of view and practice gain general acceptance, more and more people find themselves disqualified, in effect, from  the performance  of adult responsibilities and  become  dependent on  some form of  medical
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

authority.”[65]
权威。[65]

Therapy for Every Single Child?
每个孩子的治疗？

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
新生代已经接受了很多治疗。多亏了人工智能，阵雨可能很快就会变成山洪暴发。这就是四位不同的风险投资家告诉我的：大型科技公司已经在彻底改变心理健康，他们开发的应用程序很快就会有能力为每个孩子提供治疗.

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.
我渴望见到我孩子未来的治疗师，我注册了myala，这是一款健康追踪应用程序，“任何16岁以上的学生都可以使用”，根据其网站。我的会议从“签到”开始，以评估我目前的精神状态。

Here are six of the first ten questions my therapist-bot asked me:
以下是我的治疗师机器人问我的前十个问题中的六个：

“How lonely do you feel?” “How supported do you feel?”
“你觉得有多孤独？”“你觉得支持程度如何？”

“How worried do you feel right now?”
“你现在有多担心？”

“How down do you feel right now?” “How often do you feel left out?” “How sad do you feel right now?”
“你现在情绪有多低落？”“你多久感到被冷落？”“你现在有多难过？”

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.
你可能像我一样想知道：你被问到有多难过，以六种不同的方式，一串代码无法关心你是否在街上被鞭打？这一系列的问题似乎足以让几乎任何人的馅料变平。我试图放弃调查。它没有让我。

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.
事实证明，如果你不愿意向人工智能承认你感到多么孤独，你会收到一条通知，提醒你你也失败了。

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]
心理健康初创企业的宣传材料表明，潜在投资者是坚定不移的：新生代的心理健康状况不佳，意味着难以想象的商机。他们声称，美国六分之一的儿童“患有损害心理健康障碍”。没有尴尬或道歉，一个内部投资者的推销将16至26岁的儿童和年轻人称为“滩头阵地人口”。[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.
在我们把每个孩子脆弱的心灵交给他们全面和不分青红皂白的心理健康干预之前，值得仔细检查已经在进行的努力。充其量，他们未能缓解他们声称要治疗的疾病。但更有可能的是：心理健康专家倡导和分配的方法和治疗方法已经使年轻人病得更重、更悲伤、更害怕长大。

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Chapter 3
第 3 章

•

Bad Therapy
糟糕的治疗

a one-room basement apartment in Queens. Ortiz’s father devised a series of schemes to support the family—many of them illegal.
皇后区的一居室地下室公寓。奥尔蒂斯的父亲设计了一系列计划来养家糊口，其中许多都是非法的。

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.”
首先，奥尔蒂斯担心很多针对孩子的治疗是无用的。“在办公室里和孩子们一起玩是一件很容易的事，所以激励措施都是错误的，”奥尔蒂斯告诉我。“如果我说，'当然，把你的孩子带进来，我会和她一起玩积木，我们会做游戏治疗，我就可以过上好日子。这对他们没有好处。只要我愿意，我就可以处理满满的案件。

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.
尽管他每周都会接到几起父母的电话，恳求他去看他们的孩子接受个人治疗，但他都拒绝了。奥尔蒂斯说，对于大多数问题，个体治疗对孩子几乎没有任何好处。“证据很清楚，基于父母的方法更有效。意思是，治疗师应该通过治疗孩子的父母来治疗孩子的焦虑。父母经常在不知不觉中将自己的焦虑传递给孩子。父母最有能力帮助孩子持续处理她的担忧。

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]
然而，不计其数的心理治疗师不仅为年幼的孩子提供个人治疗，他们还练习“游戏疗法”等技术，这些技术几乎没有证据表明对孩子有益。事實上，很少有證據表明個人（對一對一）心理治療對年幼的孩子有幫助。[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
但是，为什么个体治疗对年幼的孩子不起作用呢？如果它对鹅有好处，为什么不对小鹅有好处呢？“好吧，让我们带一个焦虑的五岁孩子，”奥尔蒂斯说。“假设我是世界上最好的治疗师，我在周一四点教她一些处理焦虑的惊人技巧

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.
下午。所以我们应该相信，在星期五，当她五岁时失调和焦虑时，她会记住我们谈论的内容，然后能够在失调的时刻制定困难的技术？“他反问道。“我不能让成年人这样做。它只是不适用于儿童。奥尔蒂斯说，教那些每天花很多时间陪伴孩子的父母最好的技巧要有效得多，比如说，让孩子克服对独自睡觉的恐惧。

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.
此外，他告诉我，在个体治疗的激烈背景下，治疗师和孩子之间的权力不平衡实在是太大了。孩子们很容易相信事情。想想恢复记忆疗法，这是精神病学史上的一个黑暗插曲，治疗师无意中在儿童患者身上植入了错误的记忆。

—

I met Ortiz at his Tudor revival in Forest Hills, Queens, where he lives
我在奥尔蒂斯的都铎王朝复兴中遇见了他，他住在皇后区森林山

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.”
如今，奥尔蒂斯是长岛大学的临床心理学教授，在那里他培训心理学家并研究儿童和青少年焦虑和抑郁的治疗方法。那么，是什么让一个人成为青少年的好治疗师呢？他说，首先，一个好的治疗师不会把青少年的治疗当作年金。“如果你的治疗师在你第一次治疗期间没有和你谈论终止[心理治疗]，那么它可能不是一个好的治疗师。

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.
奥尔蒂斯绝对相信特定种类的疗法的改善能力，尤其是认知行为和辩证行为疗法（称为CBT和DBT），用于治疗抽动障碍、情感障碍和强迫症等特定疾病。奥尔蒂斯是一名认知行为治疗师，他使用其方法来帮助患有慢性尿床等疾病的孩子的家庭。他已经看到它改善了患者的生活。但他对治疗的力量有足够的尊重，拒绝每个人都应该接受治疗的想法，奥尔蒂斯将这种想法比作冒险的外科医生：好吧，他看起来很健康，但让我们打开他，看看我们发现了什么。

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.
当治疗对成年人有效时，它的力量来自患者的支持。但是，进入治疗的儿童或青少年总是这样做，因为她被成年人强力武装。有时，根本没有买进。然后，治疗师必须奉承或娱乐青少年，避免代表治疗最佳状态的不愉快的辛劳。如果青少年仍然不相信，事情可能会更明确：妈妈认为你有什么问题，足以每小时支付250美元。

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.
无论我们多么努力地“消除”治疗的污名化，给任何儿童患者的信息都是双重的：你的母亲认为你有问题，你的问题超出了她的工资等级。几乎必然地，中间人的存在会改变父母与孩子的关系，无论父母是否意识到这一点。

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.
对于那些计算与孩子进行一对一心理治疗的医源性风险的人来说，那就是：士气低落（让年轻人相信她有问题）和破坏父母的权威（妈妈无法处理你的问题，所以她雇用了一个可以处理的人——一个对你有更好判断力的人）。所有这些都是为了一个工作机会可疑的过程。

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.
奥尔蒂斯在向他的治疗客户的豁免中披露了医源性发生的风险，因为他希望他们注意医源性影响;他希望他们避免受到伤害。“我和我的客户谈论这样一个事实，即在某些百分比的情况下，人们在治疗中变得更糟。这不是一个很大的比例，但它可能会发生，“他说。

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.)
这让我感到不仅明智而且明智。在我采访了奥尔蒂斯之后，任何我信任的心理学家、精神病学家或治疗师都需要首先认真对待治疗可能造成伤害的可能性。幸运的是，我找到了四十五位学术心理学家和十五位精神病学家，其中许多人在国际上享有卓越的声誉，他们都坦率地承认医源性的可能性。（一些人撰写了有关该主题的书籍和论文。

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
不良治疗第一步：教孩子密切关注自己的感受

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.”
“我是一名情绪研究者，”当我们参观她的实验室时，这位小精灵般的苏联移民说。“情绪对我们的注意力有高度的反应。某些对情绪的关注，对情绪的关注，会增加情绪困扰。我担心，当我们试图帮助我们的年轻人，帮助我们的孩子时，我们所做的就是把油扔进火里。

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.”
但她说，我们对儿童的许多治疗干预措施远远超出了提供一种治疗。“我们基本上是在告诉他们，这个非常不完美的信号”——也就是他们的感受——“总是有效的，总是很重要的，可以跟踪、注意，然后用它来指导你的行为，用它来指导你在这种情况下的行为。

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.
过分重视自己的情绪有点像踩到转椅去拿高架子上的东西。情绪很可能会从你、施法者和所有人的身下掠过。更糟糕的是，关注我们的感受往往会导致它们加剧。引导孩子专注于自己的情绪可以鼓励他们更加情绪化。

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.)
可操纵，她说，暗示如果她真的愿意，她可以让我感受到各种各样的东西。向某人提出一系列引导性问题，或对他们做出某些陈述，可以可靠地引起某些情绪反应。（“这太容易了，”她说。

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.”
在像我们这样的个人主义社会中，我们倾向于错误地认为感觉准确地表明了我们当下的身份。但事实上，“感觉对如此多的线索有反应，正因为如此，所以经常是关闭的。

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.
你感到愤怒并不一定表明你是对的，或者有人不公平地对待你。你可能会嫉妒一个朋友，即使你实际上并不想要他所拥有的。你可能会被一个虐待你的人所爱，或者怨恨一个只善待你的人。感情无时无刻不在欺骗着我们。

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?
如果一个孩子从来没有学会放下受伤的感觉，专注于眼前的课程，她应该如何度过一天的学校？如果她自己的感情总是每时每刻都处于前沿和中心位置，她怎么会成为好朋友呢？她将如何希望在工作中发挥作用？

She can’t. She won’t. They aren’t.
她不能。她不会。但事实并非如此。

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.
但是，定期询问孩子的感受不是一个好主意吗？美国的治疗师、老师和家长似乎都认为，签到有点像把温度计贴在前门外：无害，偶尔有帮助。

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
为什么？我问。如果你所做的只是每天早上问，我们今天感觉如何，布雷登？，孩子难道不能自由地提供肯定的答案吗？

as a negative one?
作为负面的？

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.”
那不是真的，林登回击了。“没有人感觉很好，”他说。“永远，永远。坐在公共汽车上，看着对面的人。他们看起来并不开心。幸福不是一天的情绪。

—

Linden is a world-renowned expert in the iatrogenic effects of therapy.
Linden是世界知名的医源性治疗效果专家。

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.
在我读完他的一篇关于心理治疗更鲁莽的冒险的论文后，我们安排通过Zoom见面。他英俊开朗，显然喜欢取笑美国人——据我所知，这是德国和北欧学者几乎无法抗拒的事情。林登有一头整齐的白发，灿烂的笑容，以及一种令人不快的运动气息。

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.
林登告诉我，如果你在一天甚至一周内跟踪一个人的情绪，从统计学上讲，幸福实际上是一种非常罕见的情绪。在我们每天六万秒的清醒时间中，只有一小部分是在我们称之为“快乐”的状态中度过的。大多数时候，我们只是“没事”或“没事”，试图忽略一些轻微的不适：感觉有点累、疲惫、心烦意乱、压力过大、烦躁、过敏或疼痛。定期促使某人反思他们当前的状态——如果他们是诚实的——会引起大量负面反应。

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.”
林登看出了我的惊讶，所以他让我考虑一下我当时在采访中的感受。我本想说“好”，但他插话说：“你现在不觉得快乐。你正专心致志地进行面试。

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.
他是对的。我们交谈的时候是加利福尼亚的凌晨五点，委婉地说，我不是一个早起的人。我敏锐地意识到，在我上面一层的三个熟睡的孩子随时可能醒来并打断采访。我不喜欢我在网络摄像头上看起来很疲惫。我把每一分钟的空闲时间都用来睡觉，我已经没有时间化妆了。我早上的咖啡还没喝完。

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
林登穿着他的美利奴羊毛毛衣看起来很放松，但我脸色苍白，筋疲力尽，努力让自己看起来比我感觉的更敏锐，努力抓住他的

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.
意思是通过他口音的尖锐纠察队。所以不是“快乐”，确切地说，不是。林登说得很对。更加了解和精确地了解我目前的感受，主要引发了消极的内省。

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.
我回想起诺拉的朋友们，想知道他们中的哪些人会通过密切关注他们的感受而得到帮助。不是那些正在与严重的精神疾病作斗争的人。根据诺拉的说法，当然不是那些倾向于他们的诊断，夸大他们的症状的人。

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.
但是，一遍又一遍地要求孩子们反思他们的感受还有一个更大的问题，林登告诉我。这与心理取向有关。

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!
我们最好的教练本能地知道这一点。想想他们在比赛前激励球队的方式：我们能做到！他们说。威金斯，你要掩护11号位，就像你是他的影子一样。泰勒，看点球。防守——你会对他们的QB施加无情的压力，我想看到匆忙和麻袋。进攻，抬起头来，保持镇定，干净利落的盖帽。专注，专注，专注前方的任务！

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.
他们不会说：让我们花点时间听听你们每个人的感受。泰勒，我们从你开始。还在为父母的离婚而苦恼吗？如果你想赢——如果你想完成任何事情——你能做的最糟糕的事情之一就是现在关注你的失望、不适和痛苦的人际关系。没有一个获胜的主教练会要求他的球员在中场休息时考虑他们的感受，因为考虑自己会破坏你完成任务的能力。

“State orientation keeps you from being successful in anything,” Linden said.
“国家取向使你无法在任何事情上取得成功，”林登说。

I asked Linden what he would expect to see in a society where kids were constantly encouraged to heed their feelings.
我问林登，在一个不断鼓励孩子们注意自己感受的社会中，他希望看到什么。

“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.”
“如果你通过问自己是否快乐来开始新的一天，结果只能是你不快乐。然后你认为你需要帮助才能变得快乐。然后你去看心理治疗师，他最终会让你非常不开心。

But why can’t the answer always be “I’m happy”?
但为什么答案不能总是“我很高兴”呢？

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.
因为这永远不会是真的，林登说。花在回答这个问题上的时间只会让我们离任何有形的目标和完成目标的满足感更远。

Bad Therapy Step Two: Induce Rumination
不良疗法第二步：诱导反刍

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
“试图让患者考虑他们的过去，它是如何出错的，什么可以做得更好，应该如何不同，会发生什么，最有可能的结果是什么等等——很多这些不同的干预措施实际上是增加担忧和反刍的干预措施，”他在Zoom上告诉我。相反，当患者出现抑郁症或广泛性焦虑症时，治疗师“应该担心和

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?
当我与肯奈尔交谈时，几位治疗师向我保证，没有证据表明今天的年轻人比前几代人更抑郁。我问肯奈尔，我们如何才能确保年轻人不会对他们糟糕的心理健康状况更加“开放”？

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.”
肯奈尔的回答优雅而令人惊讶：过于倾向于谈论你的情绪痛苦本身就是抑郁症的症状。“如果你这样做”——习惯性地表达你的消极想法或个人问题——“你至少在共同反刍。但我相信他们正在思考更多。反刍是抑郁症的主要预测因素。

Bad Therapy Step Three: Make “Happiness” a Goal but Reward Emotional Suffering
糟糕的治疗第三步：把“幸福”作为目标，但奖励情感上的痛苦

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]
在有小孩的家庭周围闲逛一个下午，你会听到父母检查他们的孩子是否正在享用他们的冰淇淋，对第二天的学校感到兴奋，他们在公园里玩得很开心。在很多方面，我们向孩子们发出信号：你的幸福是最终目标;这就是我们赖以生存的目的[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.”
认同你的挣扎有什么错？“嗯，我看到他们没有试图解决这个问题。”

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.
科迪煞费苦心地解释说，他不是在谈论严重抑郁症的人，而只是在谈论普通的孩子。他说，一旦他们从其他学生那里得到心理健康危机的认可，“他们就不会摆脱这种陈规陋习。

Bad Therapy Step Four: Affirm and Accommodate Kids’ Worries
不良治疗第四步：肯定和适应孩子的担忧

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?
梅森吃的只是黄油面条。哈珀害怕狗。在我们访问期间，您介意将您的狗关在笼子里吗？或者，来自治疗师：听起来你的孩子有考试焦虑症。我会给她写一张纸条，这样学校就会给她不定时的考试。听起来很熟悉？

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
治疗师并不是唯一肯定和适应儿童焦虑的人。父母总是这样做。但治疗师在这样做的同时声称

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.”
对待它。“治疗师可能会无意中传达出这样的信息，即客户需要非常担心产生焦虑的刺激，”奥尔蒂斯告诉我。“我们发现，本身就是焦虑症患者的治疗师在对客户的干预中往往会过度保护。

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.
它可能会给孩子带来短期的解脱，让治疗师同意狗可能很可怕，并集思广益，避开隔壁的巧克力实验室。但这也可能加剧了这种担忧，暗示遇到狗就像遇到美洲狮一样：一种值得采取全面规避行动的紧急情况。所以，是的，治疗师可以强化儿童或青少年的过度恐惧。治疗师可以使孩子的焦虑变得更糟。

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.”
“一旦他们能够进行这些非常离谱的曝光，那么他们通常担心的常规恐惧似乎就不会那么大了。相比之下，一旦你把手伸进马桶里，触摸自己的门把手就显得苍白无力了。

“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]
“暴露疗法”是CBT鼓励患者面对让他们不舒服的事情的升级方法。它是为数不多的具有明显益处记录的疗法之一。尽管许多治疗师声称使用CBT方法，但其中一小部分人接受过严格的培训或实践其循证方法。[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
学校的心理学家和辅导员经常反其道而行之：通过肯定和迁就来巩固孩子的担忧。[11]他们表面上代表孩子与老师进行干预，以减轻家庭作业负担，或者在标准课程似乎造成太大压力时提供量身定制的作业。这些都不能促进孩子的发展

natural resources for coping with her worries or overcoming stressful situations.
应对她的担忧或克服压力情况的自然资源。

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.
奥尔蒂斯说，住宿剥夺了孩子们挑战的机会，使他们“实际上能力下降”。强迫一个孩子睡在被兄弟姐妹打鼾、风啸声或托梁吱吱作响的正常声音所困扰的房子里，最终她会睡着。更重要的是，她会意识到她可以。

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.
奥尔蒂斯强调，我们都需要练习坐着不舒服——无论是情感上的还是身体上的。如果我们得到必要的练习，我们就会更好地容忍它。如果我们不这样做，我们可能会变得更糟。然而，如此多的成年人一心想把所有烦恼和不便从儿童的生活中抹去，就好像它们是毒素一样。

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.
从孩子的世界里驱逐正常的混乱，与如果你想培养一个能够享受生活中内在苦乐参半的成年人，如果你的生活是一个主题公园，你可能永远不会注意到的小乐趣，所有的棉花糖叮当声和无摩擦的游乐设施，你所做的恰恰相反。

[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
不良治疗第五步：监测，监测，再监测

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.
在过去的几十年里，父母主要担心孩子的身体危险：陌生人的危险、过马路等等。但随着养育子女的治疗转向，我们开始担心情感上的伤害，我们意识到我们永远无法移开视线。毕竟，一个断了胳膊的孩子会发出尖叫声。但是，一个因戏弄而受到创伤的孩子不会发出声音。我们需要更多的情报，昼夜不停地。我们需要成年人的眼睛来观察我们的孩子：治疗师、学校心理学家和辅导员，随时准备对我们孩子的情感生活进行红外热成像。我们希望他们能够监控并向我们报告。

“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。