In June 2021, I got a call from a friend I’ve known since middle school. We caught up briefly about what had happened in our lives and our families since we last talked, and then she said, “Actually, there’s a reason I’m calling . . . I’m really worried about Will. Can I run something by you?”
“Of course,” I replied, recalling that her son Will, like my own older daughter, was about to be a high school senior.
“A couple of weeks ago, we learned that my husband’s company is transferring us to Seattle. We’re moving at the end of the summer and Will is a mess about it. He loves his friends and his school here in Denver and he can’t believe that we’re uprooting him right before his senior year. He’s been incredibly cranky, and in the last couple of days he’s even gotten tearful about it. I don’t know what to say to make things better, and I’m getting worried that he might be depressed.”
“Is his mood down all the time, or does it rise and fall in waves?” I asked.
“It rises and falls. When he’s not thinking about moving, he actually seems to be okay. He has a job that he likes, and he’s plenty happy when he’s hanging out with his friends. But when the topic of the move comes up, he gets so, so sad. I don’t know what to do, and can’t tell if I should be worried.”
“Listen,” I said, “I don’t think he’s depressed. But let’s stay in close touch, because I’ll want to know if his mood stops going up and down and instead he starts spending most of his time feeling cranky, numb, or blue. From what you’re telling me, it sounds as if he’s unhappy specifically about the move—that he’s feeling sad and angry about it.”
“Absolutely,” said my friend.
“But I don’t consider these grounds for concern. Actually, I think those feelings are evidence of his good mental health.”
“Well, being upset about moving right before senior year—especially when he’s happy in Denver—is an entirely appropriate response. I’d actually be more worried about Will if it didn’t bother him at all.”
“That makes sense, I guess,” my friend said, “but how am I supposed to help him through it?”
“There are two things you can do. First, reassure Will that he’s having the right reaction. Just as it’s hard for you to see him so upset, having such painful emotions is probably uncomfortable for him, too. You can help to put his mind at ease by letting him know that what he’s feeling makes sense. Second, try to get comfortable with the idea that he’s probably going to continue to be unhappy about the situation, at least until he gets settled in the fall. Rather than working to prevent or chase away his discomfort, focus your attention on helping him find ways to manage the distress he’s feeling.”
For teenagers, powerful emotions are a feature, not a bug. This has always been true, but these days it seems to be less widely understood. The past decade especially has been marked by a dramatic shift in how we talk and think about feelings in general and, in particular, about the intense emotions that characterize adolescence.
To put it bluntly, somewhere along the way we became afraid of being unhappy.
When I received my first license to practice clinically as a psychologist nearly thirty years ago, I had been steeped in a training program that embraced the full range of emotion—a spectrum of feelings from the most pleasant to the least—as an expectable and essential aspect of the human experience.
My training taught me to regard adolescents’ emotional landscapes with an observant, unafraid eye. I have always understood psychotherapy to be a joint enterprise in which I guide the teenagers in my care to share my curiosity about their inner lives. We work from the unspoken assumption that every one of their emotions makes sense, that their difficult feelings—anger, frustration, sadness, worry, and the rest—happen for a reason, even when the reasons for them are unclear. Though of course I’m there to help them feel better, the aim of our work is less about comfort and more about insight. When teenagers understand what they are feeling and why, they suddenly have choices that were not available to them before.
To me, this is axiomatic. I have never doubted or questioned the value of welcoming even the most distressing or disturbing emotions into the light of my office. But as I’ve worked away in my practice, watching the process of young people discovering, understanding, and accepting their emotions and receiving much-needed and deserved relief, I have sensed the culture around me changing. Twenty years ago, I still felt myself to be part of a broader society that accepted, albeit begrudgingly, that painful feelings are a natural part of life. Today, I am trying to figure out how uncomfortable feelings came to be seen as psychological states that ought to be prevented or, failing that, banished as quickly as possible.
What changed? How did essential aspects of the human condition become unacceptable?
How exactly this happened I can’t know for sure, but I have some ideas. Since the time of my training, three trends have emerged that may help explain the shift in how we view psychological distress: the proliferation of effective psychiatric medications, the rise of the wellness industry, and the climbing numbers of young people who suffer from mental health disorders. Let’s weigh these one by one.
Antidepressant medications have been available since the 1950s, but they were not widely prescribed until the late 1980s, when Prozac hit the market. Let me say right here that Prozac and the many other psychiatric medications that have been developed in recent years dramatically improve, and sometimes save, lives. Before physicians began to prescribe Prozac in 1987, they worked with so-called “first generation” antidepressant medications. While these drugs were often effective, they caused miserable side effects and could be lethal in overdose (a tragic problem when caring for suicidal patients). Then along came Prozac and, soon after, an entire “second generation” of medications that lifted depression and had minimal side effects. Suddenly, prescription drugs became a low-risk option for mood improvement.
It’s no wonder these drugs took off. In 1987 only 37 percent of those being treated for depression received an antidepressant. By 2015 that number had risen to 81 percent. During that same period, the number of people receiving psychotherapy for depression dropped by 20 percent. What drove these two trends? First, it’s likely that antidepressant medication provided some individuals with enough relief that psychotherapy no longer felt necessary. Second, it’s also true that insurance companies are far more willing to pay for pills than for sometimes costly talk therapy.
To these explanations, I’ll also add a third possibility: The proliferation of safe and effective medications to treat depression—and also to reduce anxiety, improve sleep, and focus attention—has altered our cultural stance toward emotional discomfort. Instead of regarding psychological unease as something to be explored and understood, we have increasingly come to view emotional pain as something that can be deterred or contained with chemical interventions. Numbers don’t lie: Since the early 2000s, antidepressants have been on par with blood pressure and cholesterol medications as the most prescribed drugs in adult outpatient visits.
To be clear: There is no question that psychiatric drugs ease human suffering. Further, no conscientious clinician prescribes these medications with the promise that they will solve life’s problems or make people happy, because they don’t. That said, I can’t help but wonder whether the widespread use of mood-altering drugs has stoked the belief that somehow we and our children might and should be spared the reality that being human comes with feeling emotional pain.
I do not, however, think that the rapid proliferation of psychiatric medications can, alone, account for the fact that we’ve become so uneasy with psychological discomfort. So let’s turn our attention to a second factor: the wellness industry.
Wellness is hardly new. Yoga, mindfulness, aromatherapy, and a host of nonmedical practices and products associated with psychological health have been around for millennia. What is new? The pervasive and aggressive marketing of wellness goods and services. In 2010, a business article in The New York Times referred to wellness as an “emerging” industry. Since then, the commercial wellness market has done nothing short of exploding. Now an economic juggernaut, the mental wellness industry alone accounts for $131 billion of the global wellness economy. To put this number in perspective, the mental wellness industry now outmatches the $100 billion global entertainment industry.
Of course this isn’t bad news. Studies consistently demonstrate that meditation, mindfulness, and yoga practices can ease psychological discomfort and improve mental well-being. Botanical-infused lotions, aromatic candles, weighted blankets, and other products that delight or soothe the senses can, without question, bring about short-term feelings of peace and relief.
All the same, it seems to be the case that massive economic incentives are now driving the wellness industry to make promises it cannot keep. Advertisements for self-care products often declare or imply that the product for sale (be it a mindfulness app, a scented oil, or a fruity tea) will both grant feelings of ease and ward off unwanted emotions. This might sound great in theory, but common sense tells us that’s not how life actually works. Enjoying your yoga class won’t keep the school principal from calling with news that your kid hit a classmate on the playground. Getting your family to commit to a regular mindfulness practice won’t keep a global pandemic from delivering years of misery to your door. Wellness products or practices can temporarily lift our spirits or help us regain a passing sense of equilibrium. They cannot shield us, or our teenagers, from emotional distress.
We know this and we don’t. It’s incredibly tempting to believe in the possibility of attaining and preserving a state of psychological ease, especially when ubiquitous wellness ads suggest that an unruffled Zen state can be achieved. Or at least purchased.
While the expectations set by the wellness industry border on the ridiculous, their impact is no joke. I now care for teenagers in my practice who feel as if they are “failing at wellness.” They’ve taken to heart the dangerous message, often promoted through social media marketing, that committing to self-care—and the goods and services that come with it—will keep them from feeling stressed or anxious. Then semester exams hit. When this happens, our teens naturally experience the tension and nerves that always come with taking big tests. But now they feel worse than we ever did at the end of the term, as wall-to-wall advertising suggests that their discomfort was somehow preventable. Our already stressed teenagers now feel bad about feeling bad.
Further, the rise of the wellness industry seems to have shifted how our culture defines psychological health. In roughly the last ten years—the same span in which mental wellness became a multi-billion-dollar industry—psychological health has become equated with feeling good. Of course, it’s great to feel good (or calm, or relaxed), but the reality is that pleasant psychological states come and go as we move through our day. No matter what we do, there’s no guarantee that any one of us can sustain an extended period of untroubled ease.
This now widespread message that mental health means feeling good has led many parents and teenagers to its logical corollary, that feeling bad is grounds for serious concern. I worry that the wellness movement has left parents and their teens unduly frightened of garden variety adversity. Now, far more than in years past, I find myself needing to reassure adolescents and their folks that a rough day or a rough week is unlikely to be a sign that “something is really wrong.”
Which brings us to the third factor that might explain how we find ourselves at a time when teenagers and their parents feel more uneasy than ever about emotional distress: Adolescents, as a group, actually do feel worse than they used to.
Some of this has to do with the fact that our teenagers face the unsettling prospect of a future marked by ongoing environmental, social, and political turmoil. A 2018 survey conducted by the American Psychological Association found that, compared to adults overall, people between the ages of fifteen and twenty-one express higher levels of concern about the direction in which the nation is headed, the prevalence of mass shootings, and climate change.
Among teenagers, more serious mental health concerns have also been on the rise. From 2009 to 2019, the percentage of high school students who reported feeling persistently sad or hopeless jumped from 26 percent to 37 percent; the percentage who told survey takers they had made a suicide plan grew from an already startling 11 percent to an even more alarming 16 percent. In about the same time frame, the percentage of high school students reporting significant levels of anxiety rose from 34 percent to 44 percent. These grim statistics, as you likely noticed, reflect how teenagers were feeling before a pandemic crashed into their formative years.
While the pandemic was horrible for everyone, teenagers faced unique challenges, precisely because COVID-19 derailed the central developmental tasks of adolescence, namely, spending time with peers and becoming increasingly independent. Global studies found that symptoms of depression and anxiety among teens doubled during the pandemic and that many started to have difficulty sleeping, withdrew from their families, or became aggressive. Studies conducted by emergency medicine departments in early 2021 found that visits for suspected suicide attempts increased by 51 percent among teenage girls and 4 percent among teenage boys, compared to visits in early 2019. Experts are not entirely sure what accounts for the huge gender disparity in increased attempts but suspect that girls may have felt the social isolation of the pandemic more acutely than boys did.
The situation was even worse for teenagers belonging to racial and ethnic groups that have long been marginalized and discriminated against. Compared to white teenagers, Black, Asian American, and multiracial adolescents experienced higher levels of pandemic-related psychological distress. The pandemic was of course also overlaid with a great number of other national crises that affected our teenagers: intense political polarization, rising violence, and a painful and necessary reckoning with the killing of Black Americans by police.
It’s no wonder that so many of today’s parents worry about their teens’ mental health. Being a teenager has always been hard; coming of age during a time of widespread disruption makes the work of being a teenager—or raising one—that much more difficult. With crisis, though, often comes opportunity, and in fact I believe there has never been a better time to get serious about how we support teenagers and their emotional lives.
In the decade prior to the pandemic, I wrote two books that focused on the challenges faced specifically by girls and young women. Under COVID-19, my attention shifted unsurprisingly to the pressing emotional needs of all teenagers, irrespective of gender. This was an easy transition, as in more than three decades as a clinician I’ve cared for many boys and young men. Further, my New York Times articles about adolescence and my Ask Lisa podcast have never been gender-specific. Throughout this book, examples from my clinical work with both boys and girls will illustrate key ideas. For these, all identifying details have been altered, and in a few cases I’ve presented composites in order to maintain the confidentiality of the young people who have been in my care.
You are reading this book because you care about adolescents. You want to help teens navigate a challenging phase of life during a challenging time in history. You want to raise them to have rich and rewarding emotional lives, to be caring and connected in their relationships, to remain steady and capable in good times and bad, and to develop true emotional strength.
This book will help you do just that. In the first chapter we’ll dispel widely held and misleading myths about how feelings operate and instead ground our exploration of the emotional lives of teenagers in psychological science. Chapter 2 will address how traditional gender roles shape the experience and expression of adolescent emotion and unpack what new understandings of gender mean for teenagers and their parents. In chapter 3 we’ll look at what is unique about emotions during adolescence and how they put a new spin on everyday life for teens and their families. Chapters 4 and 5 draw on clinical research and theory to offer parents concrete, practical guidance on helping teenagers develop independent emotional lives by finding healthy ways to express their emotions and, when needed, bring them under control.
Perhaps most important, this book will ditch the dangerous view that adolescents are mentally healthy only when they can sustain a sense of feeling good. In its place, we’ll get to know a truly useful and psychologically accurate definition of emotional health: having the right feelings at the right time and being able to manage those feelings effectively.
Let’s not wait another moment to better understand and support the teenagers we love.