One of my four-year-old twins has a thing where he pretends he can’t do something he’s done many times before. “I can’t find my sweater,” he says of the sweater on the floor in front of him—the sweater he does not want to wear. “I have no sweater. I don’t know how to put it on. My arms don’t work. Ugh! Ugh! I can’t pick it up with my arms!”
The other twin is in a whiny era. He responds to minor setbacks—difficulty snapping his jeans, getting the wrong jam on his toast, inability to find his water bottle after approximately 1.25 seconds of looking—with loud, tearful cry-whines. His life is over, you understand. The bottle is gone forever.
There is nothing wrong with either twin, and I wouldn’t share these stories if I thought there were (or if there weren’t two of them, giving both plausible deniability). This phase they’re in is deeply annoying, but it’s not diagnosable. It’s nothing that won’t go away with a little discipline and time. They will mature. They will learn to like sweaters and find bottles. They will grow up.
But too many American children “aren’t growing up,” as journalist Abigail Shrier says in the subtitle of her new book. Bad Therapy argues that several factors have combined to ruin American childhood: overhasty diagnosis and medicalization of normal growing pains, the decline and abdication of parental authority, expert and institutional overreach, and—of course—smartphones.
As has become widely recognized in the last half decade or so, children, teenagers, and young adults are growing more anxious, unhappy, lonely, and afraid to pursue what were once commonplace marks of rising independence, like getting a job, learning to drive, or finding a romantic mate. That is, they are afraid to grow up.
Shrier’s version of the story is a mixed bag. She is undoubtedly onto a real problem—and you don’t need to share her politics or skepticism of the mental health care industry to admit it, as a recent Atlantic interview with a longtime psychiatrist indicates.
She offers some sound advice for families that need a bit of gumption. Her reporting on the state of in-school therapy will be valuable to parents who don’t yet realize how drastically the situation has changed since their own time in class.
But in several cases, I found Shrier using data in ways that were confused if not outright misleading, and in multiple spots her claims were contradictory or her arguments otherwise wanting.
Why the kids aren’t growing up
The problem Shrier tackles is, in one sense, a kind of buyer’s remorse. For several decades, American parents have been “buying in” to the notion that what our children need is more adult protection, organized activities, and therapy. This would “cultivate the happiest, most well-adjusted kids,” we thought. “Instead, with unprecedented help from mental health experts, we have raised the loneliest, most anxious, depressed, pessimistic, helpless, and fearful generation on record. Why?”
Shrier’s answer is that therapy for children—enabled by new parenting assumptions and changes to broader cultural norms and practices—is the problem posing as the solution.
In other fields of medicine, she writes, advancements and expansion of access to care have reduced rates of disease and improved patient outcomes. But “as treatments for anxiety and depression have become more sophisticated and more readily available, adolescent anxiety and depression have ballooned.”
Shrier’s recommendations get a lot right. We shouldn’t be overhasty to diagnose children with mental illness, and the decision to introduce our children to therapy—even (or especially) if it’s “just” the therapist at school—must not be undertaken casually. “Any intervention potent enough to cure is also powerful enough to hurt,” Shrier advises. “Therapy is no benign folk remedy. It can provide relief. It can also deliver unintended harm.”
I share much of her skepticism of psychiatric medications for kids, which seem to be inadequately researched (compared to use in adults) and too widely dispensed to dull elementary-aged boys’ high energy and high school girls’ high emotions. “If you can relieve your child’s anxiety, depression, or hyperactivity without starting her on meds, it’s worth turning your life upside down to do so,” Shrier says, and I find it hard to argue with that.
That said, Shrier’s opposition to therapy for children is more sweeping than even the book’s title suggests, and it likely goes beyond where most people, myself included, are willing to follow. She endorses cognitive behavioral therapy for adults and, in an introductory note, says she’s not opposed to psychiatric care for young people suffering from “profound mental illness.” But the rest of the book is so vehemently anti-therapy that I finished it unsure when, if ever, Shrier would deem therapy for a child worth the risk.
Public schools, increasingly rife with staff therapists and mental health assessments, are a major culprit in Shrier’s account. She contends that assessments are made too carelessly and that treatment is dispensed too freely, sometimes without parental knowledge and often in defiance of best therapeutic practice.
For instance, routine in-school assessments used in many states—Shrier shares excerpts of these surveys—discuss suicide at length and in detail, despite known contagion effects. And in-school therapists will almost unavoidably blur relational lines with their patients in a manner that would be deemed unethical in other contexts.
Shrier is at her best when she argues that parents must be more authoritative (not authoritarian) and more hands off. Chill out and read fewer parenting books. Let your kids go free-range. Dispense real punishments when they do real wrong, and don’t be a pushover on the rules that really matter. You will like your kids more if they are well-behaved, and so will everyone else. Be strict about smartphones and wary of rushing too quickly to get a diagnosis of mental ill health.
As my husband more succinctly puts it: Few rules, consistently enforced.
The devil in the details
Unfortunately, when read closely, Bad Therapy gets a bit sketchy. One issue is Shrier’s use of data, which is sometimes presented without important context.
For example, Shrier writes that “one in six US children aged two to eight years old has a diagnosed mental, behavioral, or developmental disorder.” Her footnote points to a page on children’s mental health from the Centers for Disease Control and Prevention. For this specific claim, that page in turn cites another report, also posted on the CDC site, on “Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders and Poverty Among Children Aged 2–8 Years.”
Unlike Shrier’s line, this report makes four things clear: One, this is an undifferentiated number that also includes many diagnoses quite distinct from Shrier’s subject, like intellectual disabilities or language delays. Two, these are parent-reported diagnoses from a Census question that asked if a “a doctor or other health care provider [has] ever told you that this child has [one of these conditions].” But a parent might misremember or may have mistaken a nurse’s passing speculation for a formal diagnosis.
Three, income data indicates in “line with previous research, [that] compared with children in higher-income households, those in lower-income households” receive these kinds of diagnoses more often. And four, these lower-income, more-diagnosed children are less likely than higher-income kids to have “seen a health care provider in the previous year.”
Shrier is writing about middle- and upper-class kids whose parents shop for diagnoses, seeing doctor after doctor until they find someone willing to hand out a script. But her source is focused on low-income children who go to the doctor less often and whose diagnoses are, in some unknown proportion of cases, outside the category of things like anxiety and depression that we generally associate with the language of “mental illness.” So how many US kids, aged two to eight years old, have a diagnosis in the sense Bad Therapy cares about? No idea.
One more example. In the course of arguing that smartphones alone cannot explain the decline in kids’ mental health, Shrier cites page 8 of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness by Robert Whitaker. “Between 1990 and 2007 (before any teens had smartphones), the number of mentally ill children rose thirty-five-fold,” Shrier writes.
But this is not precisely what Whitaker says. He reports that from 1987 to 2007, the number of children “who received an SSI [Supplemental Security Income] payment because they were disabled by a serious mental illness” increased “thirty-five fold.” This statistic does not actually tell us that the number of mentally ill children increased, let alone their percentage of the population, which is the most important measure. Instead, it tells us that the federal government started paying SSI to 35 times as many children it deemed seriously mentally ill.
Is there a plausible explanation for that increase that doesn’t totally rely on a sudden spike in childhood mental illness? Did something else change between 1987 and 2007?
In fact, yes: A major 1990 Supreme Court ruling, Sullivan v. Zebley, relaxed the rules under which children could qualify for SSI. “Following the Supreme Court’s ruling,” reports the National Center for Youth Law, “the Social Security Administration … expanded the list of mental impairments that would qualify a child for SSI.” Congress passed other eligibility expansions into law between 1987 and 2007 too. No doubt, childhood mental illness did increase in those two decades, but Shrier’s “thirty-five fold” jump compares apples to oranges.
Bad Therapy also makes some contradictory arguments. For instance, just 20 pages after the one-in-six line, Shrier criticizes children’s mental health apps—which do sound awful—for citing what appears to be the exact same figure.
“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,” she writes. “They claim that one out of six children in the United States ‘has an impairing mental health disorder.’” It doesn’t have the same age range, but otherwise, this is basically Shrier’s own claim.
Or later in the book, she claims that “restorative justice” models of school discipline led to “no fewer suspensions for male students” and that schools “stopped suspending or expelling” violent students. The only way both can be true is if all the violent kids were girls.
And Shrier approvingly quotes Jordan Peterson (yes, that Jordan Peterson), arguing that there’s “no difference between thinking about yourself and being depressed and anxious. They are the same thing.” This can’t really mesh with her argument, 50 pages on, that anxiety and depression as a short-term response to real stress, grief, or failure may be a good thing—a healthy, protective way for the brain to process loss—distinct from long-term, diagnosable anxiety and depression in adults.
A big grain of salt
These and other questionable details—not to mention my inability to evaluate the many medical and psychological experts Shrier cites while constantly decrying medical and psychological experts—leave me wary of Bad Therapy. My sense is that it contains both needful correctives and ideologically motivated hyperboles, and that many readers will struggle to parse the difference. Read it, if you do, with a big grain of salt.
I’ll end with one critique of Shrier’s ideas on parenting that is particularly relevant to Christian readers. “I don’t know how to raise your kid,” she writes toward the end of the book. “I don’t know your values. And I distrust, instinctively, most who would claim to know these things. I certainly don’t believe that any mental health expert does,” she continues, ticking off ways the industry has failed, before reiterating, “I don’t know how to raise your kid. But you do.”
Do you, though? I don’t always feel as if I do. On a very practical level, I take advice from my husband, elder family members, friends whose children are older than mine, and (inevitably) the internet. Bigger picture, my goal is not simply to follow my instincts and communicate my values, as Shrier prescribes, but to induct our children into communities of faith, family, and friendship.
This reliance on others’ wisdom and communal help strikes me as especially important in an era when phone-addled children struggle to grow up. As I’ve written before at CT, I don’t think the smartphone battle is one parents can win alone. This is a collective action problem, and we need communal reinforcements, ideally via our local congregations.
Shrier’s individualist model—you alone know what’s right for your kids, and, if need be, you must fight the whole world to do it—doesn’t seem to allow for my real need for help from fellow followers of Jesus who sometimes do know better than me. I don’t want to abdicate parental responsibility to misguided experts who know their field but not my child. But neither do I want Shrier’s valorization of go-it-alone parenting that seems to leave no room for the church.
Bonnie Kristian is the editorial director of ideas and books at Christianity Today.
