The clinical psychologist Lisa Damour offers an on-the-ground look at the mental health crisis teenagers are facing.
“[New York Times’ Ezra Klein] [..] What has always been difficult about being a teenager?
[Clinical psychologist and author of “The Emotional Lives of Teenagers” and “Under Pressure” Lisa Damour] Well, we have a few cardinal rules in psychology, and one is that change equals stress. And if you look at an 11-year-old, which is typically when we mark the beginning of adolescence, and you look at a, say, 17 or 18-year-old, so someone who’s pretty far down the line of being a teenager, you’re looking at six or seven years, and you’re looking at so much change. I mean, an 11-year-old next to an 18-year-old — they’re hardly from the same species anymore.
If you pack that much change into a short period of time, it’s an inherently stressful thing. So I think that’s the baseline of all baselines, just that they’re changing so much and so fast that they experience it as stressful, and everyone around them is impacted by those changes and the stress on the teenager, and it’s stressful for the people around the teenager. [..]
[Klein] [..] a couple of years back, you wrote this book “Under Pressure.” And I want to read a quote from it. You write, “A recent report from the American Psychological Association found that adolescence can no longer be characterized as an exuberant time of life, full of carefree experimentation, except for during the summer months. Today’s teens now, for the first time, feel more stressed than their parents do.” Why do you think that is?
[Damour] My thinking on it can probably best be headlined with, like, too much input, too much output. The teenagers are taking in so much more data than we ever were. And, obviously, a large part of this is delivered to them by digital technology. But they are awash in information about the world around them, about the news, about what their friends did yesterday, about what’s happening right this minute with everybody they know. So I think it’s a huge amount to try to integrate all of that. And I think it’s very stressful.
And then we ask far more of teenagers than we used to, that not just for affluent kids, there’s tremendous achievement pressures for kids in many socioeconomic areas. I look at what we ask kids who are applying to college to deliver today versus what I was asked when I was going through that process. So I think a lot about the combined effect of so much input and the expectation of so much output. There’s no way that’s not going to be stressful for kids. [..]
[Klein] [..] what I look at the data here, what I see is really not a huge pandemic spike, but a spike that begins — it depends on how you look at it and what you’re specifically looking at, but 2011, 2012, 2013, something begins happening really sharply. And depression is going up, anxiety is going up, suicide is going way up.
And the pandemic, compared to whatever begins in that kind of 2012-ish era, looks a lot smaller. So something begins happening that continues — and I don’t want to take anything away from how hard the pandemic was for teens or for anybody else — but something is going on before it that is spiking suicide, for instance, in a way that it’s pretty unnerving. What do you think it is?
[Damour] [..] the honest answer is we don’t really know. We have a lot of things that we point to and that we worry about. I think one thing that we don’t talk nearly enough about are the data on worsening sleep in teenagers because, certainly, starting right in that same time frame — 2011, 2012, 2013 — you see this incredibly steep climb in the data on the proportion of teenagers who sleep fewer than seven hours a night. And it maps, actually, very cleanly onto the data about worsening mental health problems. And we also know that sleep disruption and suicide are closely connected.
And so I’m always interested in sleep, partly because there’s no controversy about its role in our overall health and mental health. Everybody’s in agreement that sleep is the glue that holds us together. But I also think it gives us a way to tease apart questions of, OK, for any given teenager, what’s keeping them up at night? Is it their social media is it outrageous academic program? Is it that they’re working two jobs and trying to do school or doing child care for their family and aren’t getting enough sleep?
So I think if we thread through that path of sleep, I feel like we’re always on sturdy ground, and I think we can tell very specific stories, or parents can interrogate it very specifically about their own kid in terms of what the disruption might be. [..]
[Klein] One of the core threads of your book, “The Emotional Lives of Teenagers,” is I would call it a critique of how our culture now treats negative emotions. When we talk about anxiety, when we talk about sadness, when we talk about depression, it isn’t that those can’t be pathological, but I think it’d be fair to say that you’re arguing we are treating them almost as too pathological in a way that itself has become part of the problem. So tell me a bit about that argument you’re making.
[Damour] That is actually one of the main reasons I wrote the book was a worry about where the discourse had moved. And one of the ways I can describe it is that as I’ve watched the headlines come out in the pandemic and after the pandemic about teenagers, so often, psychological distress is rolled up with mental health concern as though they are one and the same. And we have never, as academic or clinical psychologists, seen it that way.
And, in fact, what I hope we can maybe move toward is an understanding that it’s actually often the inverse, that much of the time, the presence of distress, the experience of distress, is evidence of mental health. And what I mean by that is there are lots of circumstances in daily life where we fully expect to see distress. If a kid’s best friend moves away, we expect to see sadness. We are more concerned about its absence. If a kid has a huge test and they have not started studying and that test is tomorrow, we expect to see anxiety. That is actually what we would rather see than a kid who is indifferent.
And I think what I feel I’m working against, what my field is working against, is this strange equation that has evolved in the discourse where being mentally healthy is equated with feeling good or calm or relaxed. And those are all lovely things, but those are not how we, as psychologists, assess mental health.
We’re looking for two things — do the feelings fit the situation, even if they are negative, unwanted, unpleasant? And then, second, and perhaps more important, are they managed effectively? Are they managed in a way that brings relief and does no harm, or are they managed in a way that does bring relief but is going to come at a cost? [..]
And one of the arguments that threads through my book is actually about the value of psychological distress. And this is something that seems strange to say at this moment in time, that there’s value in psychological distress because we are so set against it as a culture, but I can tell you from the side of psychology and certainly the side of development, this has not really been something that is controversial or that we’ve questioned.
And what I mean by that is emotions — there’s a lot of value in the negative ones across a lot of different domains, like one is they’re informational. If you notice that you’ve got a particularly uncomfortable feeling every time you’re in somebody’s presence, there’s value in figuring out what that’s about. It helps us make decisions. It helps us guide our thinking. They’re also growth-giving. You know, Ezra, I’ve practiced a long time, and I’ve cared for kids who’ve come up against horrible tragedies.
And it’s very painful work to be with them as they work through intense grief, intense distress. And yet there’s something kind of extraordinary about how much maturation arrives as a function of them actually grappling with a very painful feeling. They become more broad-minded. They become more philosophical. And there’s actually, for me, almost a universal marker of when this is happening, which is that they become actually very annoyed with their age mates for having concerns that feel, to them, very petty or minor.
And they only arrive at that point by having gone through something very, very painful. And so psychologists — we’re surprisingly agnostic about emotions. We don’t really prefer positive ones over negative ones. To us, they’re all data, they are all growth-giving in their own way, and occasionally, the situation derails, and a person has a feeling that does not make any sense and we need to figure out why. Or they have a feeling that is getting in the way of their ability to live a rich and full life, and we need to take care of that. A huge percentage of the time, we just sort of see it as data coming across the transom that can be put to good use. [..]
[Klein] [..] if Congress came to you and said, we want to make things better for teenagers across the country, we look at these numbers and the high suicide rate and the high depression/anxiety rates, and we think there’s something really wrong here, and we want to do something, what would you tell them to do?
[Damour] [..] the strongest force for adolescent mental health are caring relationships with loving adults, that teenagers need adults who get them and back them and are connected to them. Ideally, this would be adults at home, but it doesn’t always work out that way, and it doesn’t have to. So I think a big piece of it actually is shoring up the adults. I think it’s important that adults are in good shape if we want teenagers to be in good shape, so thinking about what’s impacting adult well-being and adult mental health is key.
I also think about these devastating numbers from the pandemic about teen mental health. And one of the dots that doesn’t get connected enough, I think, is that not only were kids not in school, they also weren’t doing their after school programs with, sometimes, phenomenal coaches who really help kids grow or extracurriculars with incredible adults who really are interested in teenagers and like them and make that clear.
And I think about it from the standpoint of what does it mean if we make education such a difficult career to go into and make it so unappealing to adults. I worry that we’ll end up with warm bodies around teenagers when what we need are adults who are incredibly devoted to them and interested in them. And so I think about it the policy level, which is not my strength, how do we take care of adults? How do we make sure that the adults who are around teenagers are the best possible options because that’s how we head off so much distress in adolescence. And that’s how we cultivate thriving in teenagers. [..]
[Klein] And then when we talk about the healthy and unhealthy coping with negative emotions, something that that brings up for me is, certainly, some of that is modeled — that is modeled by adults, too. It isn’t just how they react to their kids, but how their kids see them reacting to themselves.
So when you think about what is healthy for people to do when they are feeling a lot of anxiety, when they’re feeling a lot of sadness, what are, to you, the kind of healthy coping mechanisms — for things that are nonpathological. You don’t have generalized anxiety disorder or something — versus what are the things that maybe your modeling that you’re modeling not the most healthy strategy in the world?
[Damour] So when psychologists think about coping and healthy coping, we actually divide the world into two categories. There’s coping by expressing what we’re feeling, and there’s coping by taming or bringing back under control our emotions. So on the menu of healthy coping, if we start on the expressing category, there’s talking about what we’re feeling and seeking social support.
There’s also finding other healthy ways to get feelings out. Teenagers will often listen to music as a way to catalyze the expression of emotion. They’ll put on a sad playlist and cry alongside it. I think, often, teenagers enjoy a much broader and, frankly, more creative repertoire for finding emotional expression. They’ll make things. They’ll do art. They’ll create music. But I think adults do those too. So there’s the expression category of just discharging the emotion in a way that brings relief and does no harm.
And then there’s the taming category. And, as psychologists, we hold these on equal footing. So we also do things to help ourselves feel better, whether it’s going for a walk or taking a bath or finding a food that we love and enjoying it or getting with a TV show that we know we’re going to leave the end of the episode feeling better than we did when we started.
And I think, if we can bring coping forward as the thing to focus on — the distress, that is a done deal. We’re going to feel it. Our kids are going to feel it. It’s the question of how it gets coped with that really sets people down a path towards growth and health, or it can set them down a path where things don’t go well and they end up digging themselves into something that becomes harder to get out of.
So coping is what it’s about, but what you said about modeling, I think the best parenting advice I ever got, actually, was on the inside of a chocolate wrapper. It said, don’t talk about it. Be about it — that kids watch us, and they’re going to do what we’re going to do far more than they’re going to do what we tell them to do.”
Full interview transcript, E Klein, New York Times, 2023.5.23