Familial Support Is the Antidote to Bad Therapy

Can more therapy lead to worse mental health? This is the central question that Abigail Shrier explores in her new book Bad Therapy: Why the Kids Aren’t Growing Up, which argues that an increased focus on children’s mental well-being appears to have produced the opposite of its intended effect.

Early in the book, Shrier offers some sobering statistics: 

The rising generation has received more therapy than any prior generation. Nearly 40 percent of the rising generation has received treatment from a mental health professional—compared with 26 percent of Gen Xers. Forty-two percent of the rising generation currently has a mental health diagnosis.

Much has been said about the ill effects of technology on mental health, particularly among children and adolescents. Yet Shrier takes a different approach, arguing somewhat counterintuitively that therapists themselves are exacerbating the very problem they’re supposedly here to solve.

Even as we’ve dedicated greater resources to the mental health of young people—most notably by increasing access to therapists both in and out of school—the overall well-being of Gen Z Americans seems to have declined by a number of important markers. “With unprecedented help from mental health experts,” Shrier writes, “we have raised the loneliest, most anxious, depressed, pessimistic, helpless, and fearful generation on record. Why?”

The simplest version of Shrier’s answer might be found in this line: “Recasting personality variation as a chiaroscuro of dysfunction, the mental health experts trained kids to regard themselves as disordered.” In other words, parents’ fixation on their kids’ mental health has produced a set of perverse incentives, most notably because it has led to regular interaction with psychology professionals, and to overreliance on school officials who see mental health trouble lurking around every corner. It seems we have molded a generation of kids more inclined to experience psychological problems than if they had been left to their own devices more often than not.

Shrier’s argument relies heavily on the concept of iatrogenesis, the notion that any medical intervention designed to heal also carries the risk of doing harm. Ideally, in any medical intervention the good will outweigh the related harms. Shrier notes that a doctor ought not perform surgery on a healthy person, yet now we subject people to psychological intervention when they don’t really need it. This reality in the field of psychological treatment is particularly problematic when it comes to working with kids. “The power imbalance between child and therapist is too great,” Shrier argues. “Children’s and adolescents’ sense of self is still developing. They cannot correct the interpretations or recommendations of a therapist.” 

Meanwhile, unlike other medical professionals, many therapists seem disinclined to acknowledge the risks of what they do. Against this backdrop, it sounds even more disconcerting when Shrier informs us that one in six children in the U.S. between two and eight years old has a diagnosed mental, behavioral, or developmental disorder.

There is much to praise about Shrier’s work, but one word of critique: she could have done more to affirm that a greater social recognition of mental health problems has had upsides, in addition to provoking the issues she so ably skewers. While she does offer a brief author’s note clarifying that her argument is not meant to address cases of “profound mental illness,” at no point does she say, for instance, that there might be instances where therapy or accommodations of some kind can be helpful for anyone other than the most troubled individuals. The message that permeates the book is that, for nearly every kid, a simple “pick yourself up and dust yourself off” is the most appropriate way to handle all forms of adversity, no matter the magnitude.

But if we believe that disorders such as ADHD, anxiety, and depression are real, then it’s at least worth mentioning the positive effects of living in a society far more willing to identify and assist kids with these experiences. Shrier makes a compelling case that the pendulum has swung too far in the opposite direction. But at the same time, we needn’t ignore that many people are getting much-needed psychological help where once they would’ve been dismissed or outright mistreated.

Consider as one example these hypotheticals Shrier offers up for ridicule in her critique of “gentle parenting”: “Believing their kids may have ‘sensory’ issues, [parents] hunt for cumulous fabrics, snip the tags from every undershirt. When their kids express aural discomfort at the roar of a toilet, the parents search for a school with a quieter flush.”

But one of these things is not like the other, and the distinction is worth noting, because Shrier makes this sort of conflation more than once throughout the book. Seeking a school where your child can escape toilet noise is, to be sure, a fool’s errand. Yet as someone belatedly diagnosed with ADHD, who has always found myself painfully distracted by uncomfortable clothing, I can attest that my parents’ willingness to help me remove pesky tags was a helpful feature of their parenting, not a bug. The “shake it off” parenting model she advocates might well have called for them to laugh off my discomfort and tell me to tough it out, trusting that I’d be okay in the end. Of course, I would have been; struggling with itchy tags doesn’t require medication or therapy. But neither did my parents’ care and attention make me soft and weak; it made it easier for me to focus as I went about my day.

In other words, parents can consider kids’ individual experiences and needs without babying them. But Shrier doesn’t leave much room for that reality because she lumps all sorts of accommodations—reasonable and overzealous alike—under the same umbrella of foolishness. These sorts of omissions don’t undermine her argument. At times, though, she comes across as a bit too reactionary, too un-nuanced, too willing to throw out the baby with the bathwater because the excesses and deficiencies of mental-health culture are simply too troubling.

Nevertheless, the book does contain alarming evidence of malpractice in the therapeutic industry, exposing plenty of experts who create the need for more of their expertise by stoking parental anxieties and preying on suggestible kids. Perhaps the most interesting question we can ask about this state of affairs is: Why are their efforts working?

Shrier points out that, rather than using moral language to describe misbehavior, our society now tends to use primarily therapeutic language. “Suddenly, every shy kid had ‘social anxiety,’ or ‘generalized anxiety disorder.’ Every weird or awkward teen was ‘on the spectrum’ or, at least, ‘spectrumy,’” she writes: 

Loners had “depression.” Clumsy kids had “dyspraxia.” Parents ceased to chide “picky eaters” and instead diagnosed and accommodated the “food avoidant.” . . . No telling kids with the blues that it takes time to adjust to a new town or new school (they have “relocation depression”). No reassuring them that it’s normal to miss their friends over the summer (“summer anxiety”).

Not only have we been hasty to cast kids’ most common struggles in terms of a diagnosable mental health issue, Shrier argues, but we have underestimated how this would form children who learn to view themselves through the lens of what they hear from therapists and teachers trained to use “social-emotional learning.”

Shrier shares an interview she had with one teen girl who says her high-school friends struggle with issues such as anxiety, depression, conflict with their parents, self-harm, and anorexia, among other serious concerns. In the course of their conversation, the young woman nervously divulged: “I’ve noticed with a lot of people who’ll use their mental issues—it’s almost like a conversation piece. It’s almost like a trend.”

This admission is even more striking if you consider something Shrier shares later on: “Teens today so profoundly identify with these diagnoses, they display them in social media profiles, alongside a picture and family name.” This is perhaps the most important observation that unifies the argument in Bad Therapy. Kids don’t see their struggles as red flags pointing them in the direction of eventual healing; they’re identifying with their diagnoses, clinging to them because these terms offer an explanation of who they are.

Here we might draw on what Shrier covered in her previous book, Irreversible Damage. There she argued that skyrocketing rates of gender dysphoria among young girls are best understood as a form of social contagion among troubled youth: they are trying to understand who they are at a social moment characterized by deep confusion about sex and gender. It strikes me that she’s chronicling something similar here. Kids unsure about their identity are being offered a fairly simple roadmap for existence—one that explains away all of their troubles by slapping the comforting veneer of a psychological explanation onto whatever issue they might face. Never before have kids been given such a convenient, simple proposition about why growing up feels hard and why they feel like they simply don’t belong. And it comes with a handy solution: a combination of drugs and therapy to ease whatever pain they’re experiencing.

In short, it would be a mistake to target psychological experts as the root of the problem that Shrier outlines. Though she demonstrates that there are plenty of bad actors involved in the therapy industry, this isn’t the whole story, and it’s far less interesting than the story lurking underneath. Experts of all kinds have always clamored to be the ones that we trust enough to put in charge permanently. The more interesting question is why we as a society—and why kids and parents in particular—are interacting with this industry the way we do.

Kids today are especially vulnerable to this type of exploitation; and the most fitting way to account for it, to my mind, is that they have a decreased sense of belonging either to their family or to any particular religion. This leaves them unmoored, responsible for crafting their own meaning.

“The rising generation is strikingly different from those prior, according to academic psychologist and author of several books on Gen Z, Jean Twenge,” Shrier notes. “It isn’t simply the rates of diagnosed mental illness that make them so distinctive. They are far more obedient to authority, agreeable, and tied to Mom.”

That last clause bears particular notice. To what extent might we point to fatherlessness as a culprit, whether in cases where fathers are absent altogether or where they are present but markedly disengaged? Loving, attentive fathers tend to be the primary means by which children develop the confidence and ability to undertake challenges and risks while still knowing that they remain safe. A lack of engaged fatherhood helps to explain both the overreliance on mothers and the increased anxiety that children feel when tackling the challenges inherent in growing up.

More broadly, we seem to be witnessing a society-wide loss of confidence among parents, which has gone hand in hand with too much deference to supposed experts. We’ve seen this mentality emerge when it comes to education more broadly—the notion that experts or public figures have your child’s best interests at heart and know more about your child’s needs than you do. Perhaps some parents are too busy to be bothered, but most are probably uncertain about their own ability to help their kids; or they are anxious about being judged by peers or school leaders for failing to entrust their kids to therapists.

We should keep in mind that parental reluctance to be the primary support for their children—and the accompanying haste to foist them off onto paid experts—is a form of disengagement that might contribute to the issues that make therapists appear necessary in the first place. One has to imagine that, in many cases, it would make a tremendous difference for a child to have Mom or Dad regularly take the time to listen and provide reassurance. A life grounded in familial care and support is what most kids desire, far more than the ear of a stranger paid to listen to their problems, no matter how well-meaning that stranger might be.

Ultimately, Bad Therapy is much more than a critique of the therapy industry. It’s an exhortation to parents to set aside their uncertainty and trust themselves to be the primary support for their children as they learn to navigate an uncertain world.

Image by anaumenko and licensed via Adobe Stock.