The Ezra Klein Show: The Teen Mental Health Crisis, Part 2

Last week, we released an episode with a researcher psychologist Jean Twangie diving deep into

the data on the teen mental health crisis. You should listen to that one first, I think, if you

haven't. But I wanted to follow it up with an episode that operated more at the individual and

clinical level. What does it mean to be a teenager right now? What does it mean to be a teenager

in general? What is happening to your mind at that time of life? And why then are these two

things interacting in the present in such a dangerous way for people's mental health?

Lisa D'Amore is a clinical psychologist. She's the author of the emotional lives of teenagers

in the book Under Pressure. So she's done a lot of work on teenagers in general, on teen girls

in particular. She's also the co-host of the podcast Ask Lisa. And one thing she points out

across her work is that our culture has come to have a kind of pathological view of negative

emotions. We treat stress and anxiety and sadness as enemies to be eliminated from our lives and

the lives of our kids at all costs. But the cost of that, in turn, can become losing the

ability to have a normal relationship with these emotions and treating them as emergencies and

then being in a constant state of emergency. So here we tackle mental health on both an individual

and cultural level. And I think this is one of those episodes that while it's primarily about

teenagers, it's actually got quite a bit of relevance to adults. As always, my email

is reclinedshowatnytimes.com. Lisa D'Amore, welcome to the show. Thank you so much for having me.

So there's this tension right now between all this data showing there's something going quite

wrong for teenagers right now. And then the knowledge that it's kind of always been

hard to be a teenager. And you wrote a book about the emotional lives of teenagers.

So I want to start in that broader story. What has always been difficult about being a teenager?

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, say, 17 or 18-year-olds, 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, right? 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, right? 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 in the stress on

the teenager and it's stressful for the people around the teenager. Then there's, you know,

a whole bunch of nuance that you can bring into that, you know, the ways in which kids are trying

to figure out where they fit in their pure world and how to handle really powerful emotions that

come back on the scene and what they want to do with themselves over time in terms of, you know,

planning for the future and then becoming a romantic person, right? That also happens in this phase

of time and figuring out how to take really good care of yourself as that work gets handed over

from adults to you. So, I mean, the jobs of being a teenager are so many. The change that is

compressed into a very short period of time is tremendous. It's not easy.

And when you say change, do you mean social change? Do you mean biological change? What's

happening in the brain during this period? So I think about in terms of, like, the change of who

this person is, right? Who this person is as an 11-year-old versus who this person becomes at

18, 19, 20, right? I mean, that's just, these are just so much development happens. Neurologically,

we mark the beginning of adolescence when puberty is sort of underway and puberty is often underway

before the outward signs are visible. So I always do want to emphasize that 10 or 11 kids are

underway with being teenagers. And I think it's important to say that because I think

people notice this, that they're, you know, 10 and 11-year-old becomes more private, more reactive.

I don't like hearing this. I thought I had more time before my four-year-old became a teenager.

You don't. But teenagers are the greatest. So you can look forward to it.

That is not what I've heard. We're going to fact check that, and I'm not sure that's going to hold

up in fact checking. But I think it's important to know, because I think often people notice

their 10 or 11-year-old shifting and think, whoa, whoa, whoa. Like, I thought I had more time,

right? Just like you said, like I thought I had till 13 at least. But what we know is that the brain

is starting to remodel, that it actually becomes faster and more powerful and more efficient over

the course of adolescence, but that it also, that it remodels in the order in which it developed

initially, which is from the lower order regions where the emotions are housed to the higher order

regions where perspective maintaining lives. And so one of the hardest things about being a teenager

and raising a teenager is that adolescents, especially around ages 12, 13, 14, they're in

a juncture where they have what we could call a gawky brain, that their emotion centers are

upgraded and extremely powerful, and their ability to maintain perspective when they're stirred up

is comparatively weak. And it's hard when you're in that moment. And what we know when we look at

the data is actually emotionality tends to peak at around age 13, 14, and it's often driven by when

the child entered puberty. And that actually at ages 15, 16, 17, 18, teenagers level out a bit.

Parents of older teenagers will tell you that their 17-year-old is a lot less reactive than that same

teenager was at 14. One thing I've never understood about the development path here,

at least stereotypically, is, you know, you have a little kid, you have a four-year-old, as I do,

or a five-year-old. And, you know, we know that the emotionality is very high, executive function is

very low. And there's a sense that seven, eight, nine, 10-year-olds are sweeter, that they're very

fun, they're very playful, they're more in control themselves. And then 13, 14, 15-year-olds are, as

you say, kind of at an emotional peak. They're more difficult, again, in sort of the cultural

narrative of this. And that seems a little weird, right? If you would kind of expect that there'd

be a linear increase in executive function, and kids would just get easier, easier, easier every

year. So what is the explanation for this shift from tough at four, easier at eight, harder, again,

at 12? Like, what is different between the eight-year-old and the 12-year-old?

Well, so the way we understand this developmentally is that we actually talk about these phases of

development. So we call early childhood, which is basically five and under. And you can basically

say, like, it's intense, right? Like, there's a lot going on, they are a handful. And then we have

always described, ages six to 10, we call it latency, which is when all of that intense

emotionality goes quiet, you know, that they still have feelings that are important and sometimes

powerful. But the relative balance of their ability to regulate their emotions versus the strength of

the emotions is more favorable from six to 10. And then, as a result of these neurological changes,

latency ends around 11, adolescence begins, and all of that emotional power comes back to the four.

And so we've never, on the academic and clinical side, articulated a linear path. We've always

sort of thought, like, zero to five is intense, six to 10 is often, like you said, peaceful,

easygoing, quite a lovely, enjoyable time of family life in that latency age kids, they're

fun to be with, they think we're funny, they want to go to the grocery store with us, you know,

they don't react too strongly. And then along comes adolescence, and the emotions are put on steroids

again. One of the striking things I learned from your book is that during this teenage cognitive

upgrade, you get this big rise in dopamine in the teenage brain. Tell me a bit about what that's

doing. Well, what it means is that teenagers feel things more intensely than younger kids do,

and then adults do, that the charge of an emotion is more pronounced and amplified for them.

And this, of course, is true for all of their emotions. So it means that when they're low,

and I think all of us can plug into memories of, you know, having really hard moments as a teenager,

like the bad times feel so bad, so intense, and that they'll last forever and go in a million

miles in all directions. It also means, and we don't talk about this enough, teenagers feel joys

and pleasures more potently than little kids or adults do, you know, that I have memories of

growing up. I grew up in Colorado, and I worked as a bus girl until I could buy myself a car,

and I had my own car at 16. And I have memories of driving that car with the windows down and music

on in the beauty of Colorado. And like the level of delight in that is not a feeling I can regain

at 52 in my car. So it's just a powerful time that there's just a huge charge to their experiences.

So this has been fairly stable. Our brains haven't changed, I think, that much in recent years.

And yet there's really big shifts, as best I can tell, on what it is like to be a teenager,

sort of what world those brains are interacting with. So a couple 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 adolescents 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?

My thinking on it can probably best be headlined with sort of like too much input, too much output.

The teenagers are taking in so much more data than we ever were, you know, and obviously a large

part of this is delivered to them by digital technology. But they are, you know, 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 like so much input and the expectation of

so much output, there's no way that's not going to be stressful for kids.

And a certain amount of that stress is turning truly toxic. So I've been

really bowled over, I think is the right term for it, by this stat from the CDC's Youth Risk

Behavioral Survey. This survey, as you know, of kids in the 9th to 12th grade, and it found that,

quote, in 2021, almost 60% of female students experience persistent feelings of sadness or

hopelessness during the past year, 25%, 25% made a suicide plan. When you heard that,

what did you think? Did it track with what you see? Like, how did that fit into your

sense of what it is like to be a teenager now?

It certainly tracked with what I was seeing clinically at the time those data were collected.

So those were fall of 2021. And when that report came out, of course, I was as alarmed as everybody

else was by it, I actually had to pull my notes on writing I was doing at that time about what

was going on for teenagers in the fall of 2021, because in that way that the whole pandemic

sometimes can feel like a blur. I was like, okay, where were we then? And what I found in my notes

is that teenagers were miserable. They were entering their third school year disrupted by

the pandemic. And they were under a lot of different configurations. Some kids were going back

masked, and many of them were very anxious about what the social realities would be of being masked

at school. Some were going back to schools that weren't requiring masks, and a good chunk of

those kids were very worried about their own safety. And some were still in hybrid situations,

which they were very unhappy about. And even the teenagers where things started to feel like they

were normalizing or felt better, what they were telling me clinically was that they didn't trust

it. They were like, we're going to get back into our lives, and it's all going to be ripped away from

us again. So I think it's important to locate those data in time. That was a very, very hard time

to be a teenager. They're alarming no matter what. I'm very interested to see new data as it keeps

coming out, because what I can tell you from being on the ground, working with adolescents,

is that we're seeing a very mixed picture now. There are a lot of teenagers who are doing

not just fine, but actually thriving and have the pandemic very far in their rear view mirror.

There are a lot of kids who are suffering tremendously, either as a result of the pandemic

or as a result of new things. There's also a story that isn't getting as much discussion

as it should, which is we're seeing a huge percentage of kids who don't go to school,

like they used to, who just don't physically show up at school. And those data, I think,

are still going to come out. But I'm hearing it anecdotally across all SES groups and all

kinds of schools that there's a huge amount more school avoidance or truancy or absenteeism,

like whatever you want to call it. So the current picture is pretty mixed, and we're going to have

to make sense of it. I take your point on locating that 2021 survey in time. But when 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?

You know, I mean, 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, 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, like 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 like, okay, for any given teenager, what's keeping them up at night, right? 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 childcare 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. We spoke with Jean Twenge for an earlier episode

here, who I didn't realize until you told me it, but that you all went to school together way back

when. And her very strong view is that that data is explained by smartphones and social media,

that that's what is displacing sleep, that that is also what is displacing time spent with friends.

And that explains why you're seeing such a sharp rise right around 2012 when, you know,

more social media becomes algorithmic and smartphones become kind of everywhere and

everybody's on social media. Do you buy that? I definitely agree with the displacement argument.

I'm such a fan and proponent of sleep that if a phone or digital technology in any form is getting

in the way of sleep, I'm on the side of sleep and not on the side of that technology. So I think

that's a huge piece and I don't know that I can say with such confidence that displacing in time,

in person time, is as powerful as the loss of sleep. I'm kind of agnostic on that,

but I do know sleep really matters. I think, again, we have to be very careful when we get

into the conversation about social media because I don't think there's a kid on the planet for

whom it's not simultaneously a positive and negative experience. And if we're not engaging that,

either directly with teens or as parents thinking about it in that form,

I think it's very, very hard to have meaningful conversations with teenagers about how to take

good care of themselves in the landscape of a lot of digital technology and a lot of social media.

So to get more granular here, what uses of smartphones and social media do you think are

healthy for teens or good for them? What does a research show there versus which ones are unhealthy?

So we have some, I would call it preliminary data that helped us to make a distinction about

how kids actually use this stuff. And what those data show us is that if kids are engaging,

if they're commenting, if they're interacting with peers, that seems to be associated with

actually psychological benefits and certainly less psychological harm than if kids are just

scrolling and scrolling and scrolling and scrolling. And so I think there's a lot that gets

collapsed in the discourse. Social media gets collapsed. There's a whole lot of different

things going on in social media, some that I think is clearly bad for kids, other stuff that is

either benign or neutral or good, and even screens. That's something that gets collapsed.

There's a lot of different stuff that happens on screens. Some of it great for kids, some of it

you wouldn't want your kids anywhere near. So I think what's hard is that the conversation

that is the most accurate is probably also going to be the most detailed and nuanced and

hard to pin down at times. There's an argument that you'll hear pretty often now, which is

I would frame it as parents have become insufficiently paternalistic about this. So

I could reframe that argument to be provocative about it to say, you know, there's not a smoker

who doesn't have both a positive and a negative experience of smoking

because it's enjoyable when you're doing it, and of course there are terrible health consequences.

And so our kind of answer to that was it's not legal before you're 18. And there are a bunch of

people, Senator Josh Hawley has put out a bill like this, who just say, this is ridiculous. We

just, you shouldn't be able to have this before 16, even if you like it, because we don't think

it's good for you. We think the data is clear enough at this point and that this sort of thing

everybody's in of an individual negotiation. It's just a lose, lose situation that it needs

to be a collective decision. How do you think about that? Well, I of course operate at the level

of the individual kid and the individual family. So the way I think about things like that is that

I don't disagree that social media can be incredibly hard on kids and their mental health.

Social isolation is also incredibly hard on kids and their mental health. And so as long as kids

feel, and I think this cannot be unpacked a bit, feel that they need to have some digital technology

to stay connected to their peers, that's really important and I think needs to be honored. And

what that technology is and what the platforms are involved, that is in the details of it.

But the way I think we could walk into it while we wait for legislation or figure out what the

communal response is going to be is that I encourage parents to think about looking for an

inflection point. How much digital technology does your kid need to stay meaningfully connected to

the kids they know? And what's I think not discussed enough is often texting will get kids very far

for a long time and you can give a kid, if you want to give them an iPhone, you can give them

an iPhone with no browser and no social media apps. It's a texting machine and then watch and see

how long can they stay connected. And I do completely agree that we should push the introduction of

social media as deep into development as we can. It's a very different thing for 12,

13, 14 year olds to be using TikTok and Snap and all the ones they love versus the 17, 18, 19 year

old. But I think it's critical that we don't make it so simple as you either give kids social

media or you don't. I think that we can say they need connections, they need to be part of their

friendship groups and increasingly those things do get mediated through online environments.

And so can you go so, so slowly to make sure they're still connected but they're not in over their heads?

That's a place where I think the question of displacement again here collectively becomes

profound. So I've been really struck by this finding that by early 2020, so pre-pandemic,

eighth and tenth graders were going out with friends about a full weekday less often

in person than they had been in the 1990s when Gen Xers were teens. And I think back on my own

teenage experience and just when I remember being a teenager and I didn't love it for a bunch of reasons,

but the real thing I remember now and the thing that more than anything still shapes my life now

because I mean, they're still my best friends today, it is sitting around playing Tony Hawk

on the PlayStation after school. And you know, when you look at the numbers on how much less

in person socializing there is now, it's pretty big. I'm curious both what you think about that

as a trend and also if you buy or believe that it might be a behind or a contributor

to some of the worsening mental health outcomes. On the worsening mental health outcomes,

I'm just gonna say, I don't know. I don't know. I haven't heard that from kids, you know, that

longing to be more in person is part of what's getting in the way of their mental health. And I

take seriously in teenagers assessment of their own experience, but I also do know what you mean

about that kind of big open unstructured time of hanging out with the people that were your people

in high school. And I had that too. And what I think now about what displaces that, I mean,

some of it may be social media for a lot of kids, but I think there could be other things, right?

We have kids much more protected than we used to. We don't let them roam like we used to.

In some sectors, kids are just busier. You know, they just have so much more going on in terms of

the demands on them after school and the expectations. And so I think it's important and

interesting that kids don't spend as much in time, in person time with the people that they

are close with. But I'm not quite ready to lay that all of the feet of social media and then

say that that's what's causing all this distress.

One thing you see very clearly in the data is that teenage girls are suffering much more

in terms of anxiety, in terms of depression, in terms of suicidal ideation than teenage boys.

And you've written an all book about the particular pressures on teenage girls. So what

has changed about being a teenage girl? Well, there's two issues there. One is the kind of

questions we ask, and then what are the particular stresses on girls? So just to

pull back the lens a little bit, we have always in psychology had another rule, which is girls

tend to internalize, boys tend to externalize, which is that when girls are in distress,

they tend to collapse in on themselves, report and experience more depression and anxiety,

whereas boys are more likely when under distress to act out to get themselves in trouble,

to be hard on the people around them. So we do get this pattern in the data where the girls look

really quite a bit worse than the boys, which isn't to say they're not. But we're asking about the

kinds of things from which girls tend to suffer and from which girls tend to report suffering,

whereas we're not as good at detecting how boys may be suffering, because often we're asking

self report questions. And so then saying, have you been kind of a jerk lately? And are you looking

at stuff online that is harsh and misogynistic? We're not asking those questions, and yet I think

that's a lot of how boys are going to let us know they're suffering.

But isn't this data somewhat validated by things like who's ending up in the emergency room for

cutting for a suicide attempt, for an OD attempt, that kind of thing?

Certainly, we do see girls who are attempting suicide more than boys. We also know when we

look at the data over time, actually, boys are more likely to complete a suicide. So

we want to be careful about leaving boys out of the distressed conversation, and not that you are,

but I just always want to acknowledge that. Okay, so then for the girls who are reporting

rising rates, I think some of it is the pandemic. I'm not going to count it out. I think there is

a truth to the ways in which digital technology for girls, especially young girls, can

foment a lot of comparison, a lot of questions about their appearance. I think there's both very

obviously toxic versions of this, time spent on the side of TikTok, which is how kids describe

like what their algorithm is serving up, a side of TikTok that is very focused on ultra thinness,

ultra fitness. I mean, that's hugely concerning, and I worry a lot about that and eating disorders.

There's also, I think, something subtler that happens for girls online, and I think there

is a boy version of this, but I hear a lot about it with girls. It's sort of called the

that girl phenomenon, where there are posts and videos that are highly aspirational about

this incredibly put together young woman, and she may have a body that looks normal and healthy,

and she may be eating fabulous foods, but she's got a journal that is perfectly detailed and

beautiful pastel colors and a to-do list that she is crushing, and it's meant to be

inspirational. It's meant to show a young woman who's really got it together and is living a

healthy life, and I look at that, and I think, and I talk with teenagers, there's really not a

way to look at that without feeling like you haven't made good use of your day. I think there's

both obviously concerning harms that girls especially may be vulnerable to, and then I

think there's subtler stuff that goes on online that actually doesn't get enough attention.

You sort of predicted a minute ago where I was about to go with boys, which is there's something

strange and revealing maybe in the data, which is that if you look at report on suffering,

right, am I anxious? Am I depressed? Am I making a suicide plan? Am I hopeless?

You see much, much worse numbers among young women, and if you look at outcomes, boys look

terrible right now compared to the Richard Reeves of who wrote the book of Boys and Men on the

show a couple months back, and he was talking about how badly men are doing compared to women

in terms of academic achievement, in terms of whether or not they actually complete high school,

complete college, how they end up doing in many ways in the labor market, probably in the bottom

half of the income distribution, and then as you mentioned, in terms of actual things like

suicide, I mean it's such a horrible phrase, suicide completion, death by suicide,

but also death through violence. Boys on a lot of levels when you sort of look at the mental health

data are looking better, and then you look at the outcomes data and they're looking worse. Why do you

think that is? The lens that I've brought to it in my most recent book, The Emotional Lives of

Teenagers, I have a section, I don't actually remember what I called it, but you could have called

it, it's very hard to be a sixth grade boy, and what I unpack in that section are the data on the

neurological differences that are pretty much in place by sixth grade that really put girls in an

extraordinary advantage, and there's also physical advantage too, that because they come to puberty

earlier, sixth grade girls as a group are more sophisticated in their thinking, their brains

have been upgraded in a way that allows them to be more powerful in their cognition. They've been

better students since the day they walked in school, and so this combined with an increasing

kind of neurological firepower gives them a lot of strength in the classroom, and then also in sixth

grade, and for part of seventh grade, girls are also taller, stronger, faster than boys. That shifts

as eighth grade comes along, but as I was working on this book I was thinking, oh my gosh, imagine

being a sixth grade boy that you're sitting in class and the girls are just running laps around

you as a group, and then you go outside, and like they are physically running laps around you,

like that's got to feel horrible to have that all happening at a moment when you're trying,

you know, as some boys are, to consolidate a sense of masculinity, and one of the boys I

interviewed for my book just, he just hit it on the nose, he said, you know, at that time, like

there's nothing worse in the world than being beat by a girl, you know, when you're trying to figure

out what you're all about is coming into a masculinity boy, and so I think there's something

really powerful happening, and what I lined that up with in my book were the data showing that

that's when sexual harassment begins, and I think people often think it occurs a lot later in

development, sixth grade is usually when it starts to kick up, and I thought, oh, I can imagine that

there may be some boys who are like, you know what, I got to take these girls down a few pegs,

and this is a way I can do it. I can imagine two responses to that story,

and I think one of them is, well, we really need to teach a masculinity that doesn't feel

there's nothing worse than being beaten by a girl, and then there's another response, maybe not

mutually exclusive with the first, and this is more of a policy response, this is one of Richard

Reeves' big arguments, is that we are actually making a mistake here, and we should redshirt

boys and hold them back a year, and have them start school a year later because they're just

going to do better. They're going to be more ready and more capable, and putting girls and

boys on the exact same track when they are on developmentally different tracks is not good

for anyone, so I'm curious how you'd answer both of those responses. I think the first one

feels very challenging to me, and what I mean by that is so much of how boys who are trying to

sort out a sense of masculinity do that by 5th, 6th, 7th grade, it's actually at recess that

they are policing one another in a very deliberate and often very aggressive way, and so I'm interested

in the idea that we could try to teach 10, 11, 12-year-old boys a more expansive view of masculinity.

I think that obviously would be a great way to go. I don't think you can do that in the classroom

without accounting for what's happening at recess and finding a way to address it.

As for the red-shirting boys, I think it's a pretty interesting idea. I know it's not without

downsides, but I care about boys because I care about kids, but I also feel like, well, even if

you really feel like you're interested largely in the girls, don't we want the girls to have male

classmates who feel that they enjoy the same behavioral controls and intellectual strength

that the girls do? I think there's value in that too, and so I think interventions like that,

if they benefit boys, they probably also benefit girls.

Tell me a bit in your practice in terms of seeing kids, what are the differences in what you hear

between the modal girl who comes in for help and the modal boy? How are they experiencing this

era differently? It's hard to do modal girl in a private practice because you're just looking

at one kid in depth, and what I'll say is the kids who are coming now mostly are coming because

of what's happening now in their lives. It's very specific to them. It's very individual to their

concerns or needs, but when I think over time about girls I've cared for, boys I've cared for,

and of course we're working with a pretty strict gender binary here, but I think what I see is

girls suffer, but they also, as a function of how we socialize them, they tend to enjoy a lot more

conversation around them, about emotion, a lot more latitude to express their suffering in language,

a lot more support that actually comes their way as a result of being able to talk about how

bad they feel. This can go down a road that turns into rumination where they're talking and talking

and talking, and their friends are talking and talking and talking about negative emotions in

a way that isn't helping, but until it takes that turn, being able to express emotions in words is

an extraordinary asset to anyone who can do it, whereas the boys I've cared for have largely

not been encouraged or felt that they were allowed to talk about their internal worlds

publicly or to even come up with a language for them, and I talk about a boy in my book who,

when his mom would ask him like, what's going on, how do you feel, he told me the only word I

can think of is static, so he was aware of an agitation but didn't have a label for it, and

there's nothing that means that girls should be better at labeling emotions than boys in terms

of their biological endowment, but it is how we socialize and it is what we allow, and so I find

for boys, it's like they've got one hand tied behind their back when they come up against

something that's emotionally painful because they don't have the permission or the practice in our

culture to put that experience into words, and as soon as you get it into words, it comes down to

size, it is shareable, it can be observed, and it can often be modified. 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 it

self has become part of the problem, so tell me a bit about that argument you're making.

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, right? 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? Let's take anxiety here as the example because it's one of the two I'm more

personally familiar with, and one thing that was interesting to me in reading your book was thinking

on my own experience of one, at a certain point in my life, coming to a label, right? I'm an anxious

person, and two, as that became an easier label, an easier concept for me to apply to my own

internal experience, I noticed that I was classifying more things as anxiety, and not just

becoming averse then to the experience of it, but in many ways averse to the things, right?

I think that spaces where I might have understood it at another point as anticipation, excitement,

a kind of edginess, it all began to feel like, well, I don't want to feel that, and so I shouldn't

do that, and I wonder how much in your experience there is some relationship, like the shadow side

of becoming much more open and accepting and even eliciting of the negative emotional experiences

of kids, but also of adults, also creates an overreliance on them, and for that matter,

because we then treat them as bad experiences, creates a kind of aversion to things that people,

at another point, might have just understood to be part of life.

I think that's a worry, right? I think that if we consciously or not operate with this idea that

you're supposed to feel good, and then if you come up against something that doesn't feel good,

you should be very wary of it. I think it can have unintended consequences, 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 their informational, right? If you notice that you've got a particularly uncomfortable feeling

every time you're in somebody's presence, like 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, as I've practiced a long time, and I've cared for kids who've come up against

horrible tragedies, you know, and it's very painful work to be with them as they work through

intense grief and 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 were surprisingly agnostic about emotions, we don't really prefer positive ones

over negative ones, to us, they're all data, they're 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, you know, data coming across the transom that can be put to good use.

Our negative emotions, and for that matter, are positive emotions on a societal level contagious,

and when I ask that, one thing in my mind is we know that if kids are hearing more about suicide,

they're more likely to commit suicide, we know there are concerns around school shootings,

and whether or not you report the names of the shooters, because we know there's copycat tendencies,

and we know there are also generational and cohort effects on how people deal with emotions. I mean,

famously, you know, you go back a couple generations, and you have much more stoic responses to

emotions, I mean, I think many of us have had grandparents who grew up in the World War II era,

or in a Great Depression era, or a more difficult era, and they seem pretty

hardy given what they've gone through, pretty, you know, if not upbeat, at least unwilling to

wallow, then obviously there's a much more both open and I would say to some degree wallowy approach

to emotions currently. Is there something here where when you look at these lines going up and

lines going down, that something is causing the line to start, but it can develop its own momentum

up or down, because these things are contagious, they're learned social behaviors?

The language I use to think about what you're describing is a language of norms,

and, you know, one of the things that you can say about teenagers is that they are very vulnerable

to norms, more than children are more than adults are, and they can be shaped by the norms around

them pretty readily, and I think there is a norm, and I think a lot of this actually does get

transmitted through digital technology that matches what you describe, you know, where there's a very

heavy focus on feelings, which as a psychologist, of course, I'm all for, but there can also be,

I think, at times a too heavy focus on a sense of having a feeling and that being a bit paralyzing,

whereas as a psychologist, I think, yeah, no, you're going to have a huge range of feelings,

now the question comes down to what's the coping, right? How do you cope with that distress?

Are you, you know, able to talk to someone to feel better? Does going for a run help you feel

better? Does, you know, watching a TV show you love help you feel better? Like, that's what

we want to see people think about is what their coping strategy is going to be,

and also we want people to steer clear of coping that's going to, you know, come at a price

down the line, whether it's, you know, abusing substances or being hard on people or taking

it out on themselves, and so I think part of why I've done the work I've done is to try to

help advance a conversation where I want people to think about negative emotions more the way

that psychologists do, of like, yeah, anxiety, it happens, it can play a valuable part in your life,

here's the limit of when it's helpful to you, here's what you do when that happens,

but psychologists don't feel as paralyzed in the face of negative emotions as I think sometimes

I can hear in the discourse. For us, they are to be worked with, they are to be

soothed, they are to be learned from, but they don't actually have to stop you in your tracks,

and if they are stopping you in your tracks, we then get very serious about treating that

so that people can live rich and full lives. Well, tell me a bit about that distinction,

you know, for a parent with a teen or just a person looking at themselves, what separates

sadness that is appropriate, healthy, growth giving, as you put it, and sadness that is

depression, that is pathological anxiety, that is appropriate,

growth giving, difficult, but worth going through with, oh, I have an anxiety disorder now,

I'm an anxious person, I have a real problem here. How do people know what the line is?

So, for sadness versus depression, there's a few things that are easy to point to. So one is,

when you're sad, you're usually sad about something, right? My dog died, my best friend moved away,

whereas in depression, there's sort of a cloud that has covered your son, you know,

everything feels sad or low or blank, or in teenagers irritable is important to acknowledge

that often depression in adolescence looks like a very prickly porcupine who is annoyed by everybody.

Another distinction between sadness and depression that I find especially useful is often in sadness

where sad because the world has somehow become impoverished, that, you know, the dog has died,

the friend has moved away, there's a loss in the world, there's less of the world.

In depression alone, that sense of impoverishment also extends to the self, that in depression alone,

we hear people saying, I am no good, I am a burden on my family, it would be better for people if I

weren't here, you know, taking up all their time and energy, you don't hear that in sadness, that's

depression. You can also look up the diagnostic criteria for major depressive disorder, they can

be helpful, but they're distinct enough and then there are easy ways to make the call on that.

As for anxiety versus the anxiety disorder, I think part of what's so frustrating is that we

use the same term both to describe probably adaptive and healthy everyday nerves and also

something that we diagnose. So if we talk about anxiety in the day to day, the way I like to

think about it is anxiety is a gift handed down by evolution to alert us when something's not right,

you know, so if you're late for some unimportant appointment, getting anxious is going to get

you out the door, you know, hopefully it will activate you and motivate you to get going.

So anxiety is not pathological, so long as it actually matches a real threat,

either in the outside world such as being late or, you know, a terrible driver right around you,

I also try to pay attention to anxiety when I'm having it, like, you know, that sense of, like,

you're about to say something and then you're not sure if you just say it, you feel a little anxious

and then you say it and then you wish you hadn't, right? Like, that's functional, useful.

No, I have no idea what you're talking about there. I've never, never had that experience

as a public figure. Exactly. And then you're like, why didn't I listen to my anxiety, right?

So that's all healthy. So healthy anxiety is, it matches a threat, whether you're the threat or,

you know, somebody else's a threat. And it's proportional to the event. And that's what's

really important, right? If a kid hasn't studied for a test that matters, they should feel some

anxiety. Feeling a panic attack is not going to help them. So we would consider the anxiety

appropriate, the scale, not so much. Pathological anxiety then can be defined in that way. It shows

up when everything's okay. And, or it's way too big for whatever the problem is. And what I want

to make sure to get across is we're great at treating anxiety disorders. We have had a really

good handle as clinicians on the treatment of anxiety disorders for decades. There's very little

controversy in the field about this. We know what to do. Medication could be an option,

but it's not always necessary. There's lots of other options. And so again, I walk up to this

landscape of talking about emotion, talking about distress and talking about pathology quite a bit

more than we used to. I think with a lot more hope and a sense of like sleeves rolled up than I

often hear around me, I think that there can be a kind of unhelpful and I think at times unnecessary

sense of like, there's nothing to be done or here's where we are. And that's just not how we see

this as psychologists. So is your view that a societal unwillingness to tolerate and be open to

negative emotion has led to more people experiencing pathological versions of those emotions? Is that

for you part of what explains this sort of last 10, 15 year run up in pretty tough emotional

states, both for teens and for adults? I don't know that I would go so far as to say

this explains or helps to explain why we're seeing rising rates of clinical disorders.

But here's what I would say. I think it really corners all of us if we continue to equate

being mentally healthy with feeling good. Because the conditions it creates is that

a person wakes up and that person can be an adult or a teenager and they start their day and it's

a regular day and something goes wrong and they feel really lousy. And what I'm now encountering

clinically is caring for people who not only feel lousy about the thing that went wrong,

but who now have anxiety about what this means about their overall mental health.

And it's that second round of negative feelings that is not helping us and is not necessary,

I think, that people are allowed to be upset about their lousy day. They deserve support

around their lousy day and my job, their job is to find their way to good coping to manage that

lousy day for people to encounter the typical variety of human experience in all of its light

and dark and to come to the dark and then feel anxious that they should not be having those

feelings. That is not helping us, I think, right now.

I've heard you in your own podcast describe the way a lot of parents act like a linebacker

around teenagers, negative emotions, right? Like as if they're trying to protect the

quarterback from any negative emotion. One thing that I do think is reasonably well

understood is that there has been a shift in parenting more away from giving kids,

as you mentioned earlier, freedom to roam. But I think also towards being much more concerned

if your kid is unhappy. Often for good, right? I think it's good to be, I mean, I hope it's

good to be attentive to our kid's emotional states, but that there's some line where it's not just the

emotional state that can become pathological, but the parents' unwillingness to tolerate it too,

or at least destructive, that there's some amount of growth that you are refusing to allow your

child to experience. As a parent, how do you know where that line is between, you know,

you don't want your kid to suffer and also suffering is an important growth-oriented part of life?

So this is critical. And I think a very critical part of the moment we're in. And I think there's

a few things to say by way of groundwork. You know, one is, I think one of the most natural

things to being a parent is that we just hate to see our kids suffer, right? I mean, it's just such

an instinctive response. And, you know, like whenever one of my kids had a, you know, a crummy cold,

where they were like coughing and their nose was running, I've always thought to myself like,

I would rather have those symptoms myself than watch you have them, like I hate watching you

suffer. So I think I have so much allowance and empathy for the first reaction parents have when

their kid is in emotional pain, which is you just want to make it stop. And I get that. And I think

I want to layer into that the reality that this has been an extraordinarily difficult time to be

a parent, right? Parenting through the pandemic, asked of adults, extraordinary things, and often

beyond all imagination of the kinds of things we would have ever imagined were necessary for

maintaining family life. And so I think if you combine that, that parents are tired and raw

as a function of what they've been through, and then in walks their kid who's had a really lousy

day and their kid is suffering, that's a lot going on in a kitchen. And I have a lot of room for

parents who just want to shut it down or make it stop or figure out how to keep that feeling from

showing up again. But you get to the issue here, which is those feelings are happening,

whether we want them to or not, and they may have real value. And if we cannot tolerate our kids

distress, they will not be able to develop the capacity to tolerate their own distress. And so

the job here, and I think about this all the time, is how do we shore up parents, given all

they've been through, so what, that when their kid walks in the door after a really rough day,

the parent can serve in the role of a steady presence, even if they maybe don't feel that way

inside all the time, so that they can help that young person use the incident of distress

as a training ground for figuring out how to manage distress well and not be scared of it

and cope with it effectively. So it could be an example here. Let's say you got a teenager

there having a lot of trouble with friends at school, they feel nobody likes them,

nobody sees their worth or lonely. The kid comes in upset. What do you do?

Well, I promise you, you can never go wrong, I think, if your first reaction is just straight

up empathy, right? If the kid comes in and just lays it down and is just miserable and

describes it in vivid detail, that'll be painful for the parent. I think it's really valuable

as a first step always, just for the parent to say like, I am so sorry or like, that stinks,

right? Or anyone describing what you're describing would feel horrible right now.

And to give that an opening chance, right? To give that a chance to help, which it often does,

to see where the young person takes that, there's huge value in that often on its own, right?

Whatever the kid is feeling now, they're not having to feel it alone. We're not questioning them,

we're not challenging them. From there, parents can do things like talk about,

do you want my help with this or what would help you feel better or what have you tried?

I mean, I think there's a lot of conversation that can continue from there,

but in my experience, if you don't start with empathy, anything else you've got won't land

in the way you mean for it to. And often, if you start with empathy and you actually start

by offering it as though it may be enough for that young person in that moment to get through

this hard time, at least the day. To me, that actually sort of feels like the old-time steady

presence move, right? You're hugely present, you're engaged with what that young person is

describing, but you're not unsteady, you're not picking up the phone, you're not canceling plans,

you're not making this bigger than the young person has brought it home as being.

I think there's real value in that because teenagers are reading us for how upset they

should be. And a kid who comes in after a day like that and describes it, if the parent is

activated to full blast and becomes very, very upset or very, very anxious, that actually does

not usually help the young person get their hands around it. It may in fact make them feel like,

whoa, I thought this was like a 15-year-old situation. This appears to be like 52-year-old

scale bad. That can be more upsetting than just offering steady empathy and seeing

where the young person wants to go next. And I know that a lot of your work is with individual

families, but you've also thought a lot about the broader societal moment here. And we're seeing

something happen societally. So are there actually policies? I mean, if Congress came to you and said

we want to make things better for teenagers across the country, we look at these numbers and this

high suicide rate and the high depression and anxiety rates, and we think there's something

really wrong here and we want to do something, what would you tell them to do?

The first thought I have is that the finding that helps me sleep at night is the knowledge

that 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 at 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. You mentioned earlier in our conversation sleep. Something I've often heard

suggested is just that high school should start later. Anything where teenagers are going should

not start before 9.30 just given the way their body clocks work. Do you think we should do that?

I think it's a good thing to consider. I think often the reason that high school starts so early

is just because of the busing plans that the little kids who've been up for hours go last

and the high schoolers go first and it's often just because a single bus service

is getting everybody to school. So I think things like that are not good reasons to

have teenagers go very very early and it is true that when kids hit puberty it is harder for them to

fall asleep at a reasonable hour. Given how essential sleep is I'm open to anything that

improves adolescent sleep and as much as I exercise caution around technology and social media and

its connection to mental health concerns we have really good data showing that if it's keeping kids

up at night it will mess up their mental health it will get in the way and so you know I think

there's also rules that feel pretty straightforward but I don't know that we've done a good job of

encouraging adults to implement them like not having technology in kids bedrooms overnight

if that can be helped at all. Adjustments like that can make a big difference and adults shouldn't

have their tech in their rooms either when we look at what the data say. I think if we get really

serious about sleep and we look at all of the things that interfere with it I think a multi-pronged

approach would go very far. You have a more I think nuance take on social media than I do I'm a

little bit more alarmed and in the direction of a hammer at this point but if a parent comes to you

because as you say you know we don't have a huge collective answer anytime soon and say you know

what's on the index card here that I should be doing or advising to make sure my teenager is using

this stuff well so I know that if I know something is going wrong there I'm able to intervene you

know what do you tell them what is a good sort of two or three or four bullet point set of

guidelines or rules that you advise parents to deploy here. So number one is just go slow right

start them off with texting if they end up in the meanest text thread ever they're probably not ready

for social media right I mean really know your kid and go very slow. The next thing on the card

would be like these are teenagers and we need to remember that and for anything related to safety

Ezra you know when it comes to teenagers you do safety with teenagers not two teenagers like they

have to be in on it with you and so then what I would say is if a teenager is underway with social

media I think it's actually about a collaborative conversation where the parent says like what is

it that adults don't understand about social media I mean I think you really need to ask that

question I think it's not a great idea to just try to give teenagers advice about social media

because nobody teenagers included you know really wants advice from somebody who knows way way less

about the thing than the teenager does themselves right. So I think you ask like what is it that

adults don't understand and this is my favorite question to ask teenagers about anything because

you know they always provide an incredible education and then I think an adult should say

what do you like like what's the great stuff like what's the best stuff out there and find out why

kids spend time on it that gives them pleasure and gives them joy and then I think the adult can

say and I wouldn't advise asking all of these questions in a single conversation what don't

you like like what are the downsides what is the stuff you come up against that really

makes you uneasy or you think is a problem and then I think the adult can say what are you doing

about that or what have you done about that and then I think the adult can say how can I help or

should I be stepping in here right I think you know this is a conversation with probably an older

teenager but I think if you're trying to come in over the top and do safety to a teenager on anything

you're going to run smack dab into the fact that teenagers are organized around autonomy

and really don't like to be controlled and I think it sets up a dynamic that isn't going to

improve your relationship with that kid. 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 right 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 non pathological right you

don't have generalized anxiety disorder or something versus what are the things that

maybe if you're modeling bad you're modeling not the most healthy strategy in the world.

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 you know there's talking about what we're feeling and seeking

social support there's also finding other healthy ways to get feelings out you know 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 you know they'll make things they'll

do art they'll create music but I think adults you know 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 unequal footings so

we also do things to help ourselves feel better whether it's like you know going for a walk or

taking a bath or finding a food that we love and enjoying it or you know getting with a tv show that

we've been you know 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 you know

the distress that is a done deal like we're going to feel that 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 um I think the best parenting advice I ever got actually was on the inside

of a chocolate wrapper it said um don't talk about it be about it you know 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 then always our final question what are three books that have influenced you that you'd

recommend to the audience as a psychologist a book I go back to again and again was written by

another psychologist Nancy McWilliams it's called Psychoanalytic Diagnosis it's four clinicians

but it's written so thoughtfully and clearly that I actually think anyone who's interested in human

psychology would get a huge amount out of it personally I actually just finished a book called

Transcendent Kingdom by Yah Jesse a novel beautiful about a neuroscientist and also

adolescence and development and then um my favorite graduation gift so I'm giving it a

lot right now is A Swim and a Pond in the Rain by George Saunders which is kind of about Russian

literature but it's about much much more than that and it's just a really extraordinary book

so those are the three that I'm thinking of Lisa DeMore thank you very much thank you

this episode of the Israel Klein shows produced by Annie Galvin fact-checking by Mary Marge Locker

and Kate Sinclair mixing by Jeff Gelb our production team is Emma Vagau Annie Galvin Jeff

Gallagher Richard Kermit Kristen Lynn original music by Isaac Jones audience strategy by Shannon

Busta the executive producer of New York Times opinion audio is Andy Rose Strasser and special

thanks to Sonya Herrero and Christina Samilowsky

Machine-generated transcript that may contain inaccuracies.