Bad Therapy — is the ‘cure’ for children worse than the disease?

The younger generation is in crisis, according to the headlines. Anxiously hooked on social media, more and more children are taking antidepressants, self-harming or being diagnosed with disorders like ADHD.

For the investigative journalist Abigail Shrier, this is evidence of a massive failing on the part of a mental health “industry” that finds trauma in everyday ups and downs and demotes parents to helpless bystanders.

Her book Bad Therapy is a pacy, no-holds barred attack on mental health professionals and parenting experts that will upset many therapists. But it asks an important question: why has more mental health treatment for Gen Z — those born between 1997 and 2012 — not resulted in less depression? Since 1986, Shrier writes, every decade has seen a near-doubling of US expenditure on mental health. Almost 40 per cent of the rising generation has received treatment from a mental health professional — compared with 26 per cent of Gen Xers. Yet unlike breast cancer deaths, which have plummeted with early detection, or tooth decay, which nosedived with more access to dental care, adolescent anxiety and depression have “ballooned”.

Some of the stories feel, to this European at least, as a bit too much of a middle-class America caricature: spoilt six-year-olds coming to Shrier’s house and rudely demanding different food; a father wracked with guilt after yelling at his toddler for almost killing his newborn brother; Shrier’s own story of having sought therapy in her late twenties for something fairly banal. She eventually decided that this “really expensive friend” wasn’t helping, and she seems to have developed a hatred of therapy at that moment — with the exception of cognitive behavioural therapy, a talking therapy that helps people change how they react to situations, which she grudgingly admits is evidence-based.

Many of her points, though, are devastating. Shrier tackles well-worn issues such as over-medicalisation and smartphone use, but also offers some startling new analysis. She reveals a widespread use of school surveys that ask young children leading questions about their feelings. In Florida, 14-year-olds are asked “during the past 12 months, how many times did you attempt suicide?”. In Colorado, elementary school children are asked to agree or disagree with questions like: “Important people in my life often let me down.” In some states, parental consent is assumed, says Shrier; and parents wouldn’t even know about these questions were it not for freedom of information requests made by dogged campaigners.

Many British parents will recognise this trend of school staff clumsily “playing therapist”, and leaving parents out of the loop. Shrier describes horrific-sounding “restorative justice” sessions in some American high schools, where victims are forced to sit down with school bullies in a cosy circle “which imagines all bad behaviour as a cry for help”. She talks to teachers who are afraid to speak out about this “quasi-therapy” that has led to a worsening of academic outcomes.

The book is peppered with interviews with doctors and psychologists, including Frank Furedi and Jordan Peterson, but also many less controversial names, sounding the alarm in different ways over what Bad Therapy claims is an industry out of control. The statistics are certainly terrible. More than 10 per cent of Americans have an ADHD diagnosis — double the expected prevalence rate based on population surveys in other countries. One in six US children aged between two and eight has a diagnosed mental, behavioural or developmental disorder.

Shrier argues that parents are being encouraged to seek such diagnoses, and then hide behind them, preferring to blame a child’s “sensitivity” than set clear boundaries. “Permissive” parenting is now widespread, with adults desperate to make their children “happy”. But ceding too much power to teenagers, who use their mental health issues “like a conversation piece”, is guaranteed to make them unhappy.

Deeply sympathetic to parents, Shrier reserves her greatest contempt for parenting “experts” — whose books and podcasts draw big audiences — who encourage an unhealthy obsession with ruminating on problems, and in some cases propound fake diagnoses. Parents have successfully raised balanced citizens over centuries without being patronised, Shrier argues. And indeed, reading Bad Therapy made me realise, for the first time, that some of the parenting books I read while my three children were small probably did undermine my confidence in my own instincts. She is too harsh, in my view, on therapy. But she is unequivocally on the side of parents and teenagers: which makes this a thought-provoking, though uncomfortable, read.

Bad Therapy: Why the Kids Aren’t Growing Up by Abigail Shrier Swift Press £20, 288 pages

Camilla Cavendish is a contributing editor and columnist at the FT

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Letter in response to this article:

Society is too quick to see unhappiness as a mental health issue / From Brendan Kelly, Professor of Psychiatry, Trinity College Dublin, Ireland