Is There an Anxiety Epidemic in Today's Youth?
The data offer a different story than the alarmist media.
Posted Sep 11, 2018
This blog post details a talk I gave as part of a Mental Health and Applied Psychology panel at the first ever Heterodox Psychology Workshop held at Chapman University in August 2018—designed to inject diverse viewpoints and thinking into the field.
Let me begin with the ending - we can hold two competing ideas at the same time.
- There is a great deal of suffering in society and access to adequate mental health care is needed.
- There is an influx of societal changes that are unhealthy including an assumption that emotional reactions are evidence that another person or a culture is objectively problematic. Compassion for people who are suffering does not mean accepting emotional reactions as an indicator of objective reality.
Recently, scientists and media pundits have been describing a rising epidemic of anxiety, depression, loneliness, and mental health problems in society, and in particular, on college campuses. This epidemic is part of a larger narrative that bemoans trigger warnings, safe spaces, a restriction in free speech, helicopter parenting, and the unique, fragile nature of youth today.
There are a few historical milestones for the proposition that there has been a recent surge in mental health problems. In 2014, Bradley Campbell and Jason Manning wrote a sociological article on the rise of victimhood culture. In this landmark article, the authors contrast the three main cultures that exist today: dignity, honor, and victimhood. Here are brief definitions of all three:
A dignity culture, they explain, has a set of moral values and behavioral norms designed to promote the idea that each human life possesses immutable worth. If an individual has been brutalized or exists at the bottom of a social pecking order, she still has human worth. In a dignity culture, children are encouraged to try their best and are taught aphorisms such as “sticks and stones make break my bones, but words will never hurt me.”
By contrast, in an honor culture, being on the bottom of a social pecking order is associated with great shame. Victims are tainted and often punished for bringing dishonor to their families. In some extreme circumstances, they may even be killed.
Victim cultures share in common with honor cultures the sensitivity to slights or insults, but whereas those in an honor culture might try to retaliate (physically or otherwise), people in a victim culture will instead appeal to a powerful, omnipresent state/legal authority. Classic examples are Mao’s China and Stalin’s Russia. In contrast to honor cultures that expect victims to be strong and stern enough to defend themselves, and dignity cultures that expect victims to be calm and charitable when in a dispute or disagreement, victim cultures emphasize how complainants are emotionally or physically fragile, vulnerable, and weak. In order to have high status in a victim culture, one must perfect and dramatize a personal “narrative of suffering.” Confidently espousing one’s own weakness, frailty, and suffering might seem, perhaps, dishonorable or shameful from an honor culture perspective, or gratuitous and self-absorbed from a dignity culture perspective.
Campbell and Manning find this victim culture emerging anew in Western society, particularly on university campuses and especially on elite ivy-league schools. These places contain all of the components necessary for a victim culture to arise: (1) campuses tend to be racially/ethnically diverse (relative to other institutions in society), (2) an ethic of equal treatment under a shared identity (“student”) is emphasized, (3) students tend to come from relatively comfortable middle-class backgrounds, and (4) universities are largely run by powerful administrative bureaucracies prone to stretching their authority (in the form of Title IX offices, student conduct offices, or multicultural/diversity offices, for example). These administrative bureaucracies serve as “state”-like authorities on university campuses, justifying their existence through the allegedly necessary enforcement of speech codes, dress codes, sex codes, etc. And, indeed, this administrative bureaucracy grows larger by the year—over the last half decade or so, faculty and student enrollment has increased by about 50 percent, while administrative staff has increased a staggering 240 percent.
One of several consequences of the rise of victimhood culture is discussed by Jonathan Haidt. In 2015, Greg Lukianoff and Haidt published a widely read article in The Atlantic titled, The Coddling of the American Mind (now expanded into a full-length book). In it, they discuss an unintentional consequence of societal progress:
as progress is made toward a more equal and humane society, it takes a smaller and smaller offense to trigger a high level of outrage. The goalposts shift, allowing participants to maintain a constant level of anger and constant level of perceived victimization.
The intentions are good, to reduce and even eliminate racism, sexism, homophobia, anti-semitism, and their evil ilk. But there has been concept creep as what is unacceptable has expanded to innocent, curious questions such as "where are you from?" or "I believe the most qualified person should get the job" (see a list of racial microaggressions posted by the University of Minnesota). We can and should address this issue in two ways:
- Teach people to be less offensive and more friendly in social interactions; including an offering of goodwill and the assumption of benevolent intent until proven otherwise. With practice, people can start to ask someone with an exotic name how to pronounce it instead of adding the statement "your name is so weird/unusual". The world would be better if everyone was less of a jerk. The world would be better if people had difficult, direct conversations instead of relying on authority figures to shut people down.
- Teach people to be emotionally agile. This includes resisting the relentless search for offending content. Teach people to be assertive when something bothers them. Rely on face-to-face conversations instead of trying to denounce people online or in other public settings (behaving in a way to win social media affection is not the best way to deal with conflict or cognitive diversity). Public shaming is the exact opposite strategy for an initial attempt at trying to persuade a friend, colleague, or neighbor to alter their thinking or behavior. Learn the skills to be more resilient in the face of offenses. You don't just become resilient, you must train yourself. The notion of being less reactive to external events has persisted for thousands of years. Here are just a few notable quotes from Marcus Aurelius, the philosopher king of stoicism:
“Don’t let your imagination be crushed by life as a whole. Don’t try to picture everything bad that could possibly happen. Stick with the situation at hand, and ask, “Why is this so unbearable? Why can’t I endure it?” You’ll be embarrassed to answer. Then remind yourself that past and future have no power over you. Only the present—and even that can be minimized. Just mark off its limits. And if your mind tries to claim that it can’t hold out against that…well, then, heap shame upon it.”
“When you wake up in the morning, tell yourself: The people I deal with today will be meddling, ungrateful, arrogant, dishonest, jealous, and surly. They are like this because they can’t tell good from evil.”
“Yes, you can–if you do everything as if it were the last thing you were doing in your life, and stop being aimless, stop letting your emotions override what your mind tells you, stop being hypocritical, self-centered, irritable.”
A direct extension of these writings by Bradley Campbell, Jason Manning, Greg Lukianoff, Jonathan Haidt, and others is that as our culture has changed, emotional disturbances are rising. Using alarmist language, a 2018 New York Times article titled, Why are more teenagers than ever suffering from severe anxiety? grabbed the spotlight for months.
Question: How much money would you bet that mental health problems are worse today than ever before? How essential is an anxiety epidemic to the narrative that recent societal changes are problematic? I often worry when people want simple, concise storylines for complex human phenomena.
I read all of the articles above and carefully examined existing data sources to determine whether or not there is truth to the statement that an unprecedented rise in anxiety and emotional problems exist in the youth of today. Here's what I found: the answer is no.
Data Exhibit A:
It is a widespread opinion in the media and by social scientists that “each year more and more people are suffering from anxiety and depressive disorders,” suggesting there has been a relative increase over the past 10, 20, 50, or 100 years. However, it is difficult to find reliable evidence for a change in prevalence rates. To verify the hypothesis that there is an increase in anxiety or depression, we would need a large nationally representative survey and repeat this same survey in the same population in the future. There is one epidemiological program that can provide comparable data for two time points: the National Comorbidity Survey (NCS- 5388 interviews) was performed in the years 1990-1992 and replicated 11 years later (NCS-R – 4319 interviews) in 2001-2003. Do you know what you find over this 11-year period? A prevalence rate over the past 12 months of 29.4 percent and then 30.5 percent. Interestingly, the rate of treatment-seeking increased from 12.2 percent in 1990 to 20.1 percent in 2001, which offers one reason for the impression that these disorders are more frequent. This includes a huge increase in psychiatric services. Likewise, if you examine data from the European Union from 2005 to 2011 you fail to find a significant change in prevalence rates over 7 years. These data tell a clear story—far too many people suffer from psychological disorders and this has remained a stable, societal problem for a long time.
Data Exhibit B:
What if we used a different, larger data source? The Global Burden of Disease Study aggregated datasets from the World Health Organization and elsewhere from 1990 to 2016 to estimate changes in the prevalence of mental and substance use disorders. Globally, mental and substance use disorders are common. Approximately one in six humans (15-20 percent) suffer from a mental or substance use disorder; this translates to over 1.1 billion people worldwide in 2016. Now if you examine the changes in each country from 1990 to 2016, over the course of 26 years, only one thing stands out: a steady trend over the course of time. These data tell a clear story - far too many people suffer from psychological disorders and this has remained a stable, societal problem for a long time. These problems are at around the same rate before and after the onset of smartphones and social media.
Data Exhibit C:
Here is an unheralded study that offers further insight. In 2006, Allan Schwartz published data on students seeking help at one university counseling center. How big is his data set? He presented the results of 3,400 clients spanning 10 years, from 1992 to 2002. Over this decade, anxiety, depression, substance use disorders, and adjustment disorders remained stable. Stable and high, with 72 percent of college students warranting a psychological disorder (Axis I for those fluent in the Diagnostic and Statistical Manual of Mental Disorders). The only change was suicidality, which declined. But similar to Data Exhibit A, there was a 500 percent increase in the amount of psychiatric medication prescribed to students! Remember this is a subset of college students who actively seek counseling services - so make sure not to interpret these findings to mean that 72 percent of college students possess a mental disorder. These data tell a clear story - far too many people suffer from psychological disorders and this has remained a stable, societal problem, congruent with results from Data Exhibit A.
Of course, I have not exhausted all of the data available to reach my conclusions. But the findings across these exhibits offer a counterpoint to a thread in the current narrative about society. The public narrative is that humans are more apt to suffer from debilitating mental illness than ever before. It is an epidemic. It is worse than it looks. We should be pessimistic in this age of fear.
There does appear to be a noticeable fragility among today's students and youth, and this has expanded into faculty and adults. The shift toward a victimhood culture, the increased call for emotional safety and not just physical safety, the tendency to hoard in ideological echo chambers both online and in daily life, the decrease in face-to-face critical conversations, the lowered threshold for discovering offending remarks and being offended, the obsessive concern of parents and other adult figures in keeping kids safe by limiting their functional independence, are all compelling explanations for why fragility seems to be on the rise. I will be looking forward to more research to support these potential causes of fragility and more importantly, the strategies to increase civil discourse and emotional agility. This is what the Heterodox Psychology Workshop (see blog posts by Glenn Geher and Lee Jussim) and Heterodox Academy are all about.
Let's become aware of these issues. Let's improve the psychological immune system of the children we are raising, the kids we are teaching, and us - the supposed adults in the room. If you remove all of the weights from the gym, it is much harder to become stronger. If you remove all of the ideas that disagree with your own and the people who do not hold your worldview, it is much harder to become wiser. All of this can be true without claiming the presence of a mental health epidemic. A careful examination of the data suggests that as a society, we have yet to make headway in reducing the mental health burden in society. It was a problem, remains a problem, and it's time to do something about it.
***NOTE: since curiosity happens to be one of the antidotes being tested for the societal problems mentioned above, check out our new Harvard Business Review article on the topic: The Five Dimensions of Curiosity***