Opinion | Our Obsession With Wellness Is Hurting Teens — and Adults (2023)


ezra klein

Last week, we released an episode with a research psychologist Jean Twenge, diving deep into the data on the teen mental health crisis. You should listen to that one first, I think, if you haven’t. But I wanted to follow it up with an episode that operated more at the individual and clinical level.

What does it mean to be a teenager right now? What does it mean to be a teenager in general? What is happening to your mind at that time of life? And why, then, are these two things interacting in the present in such a dangerous way for people’s mental health?

Lisa Damour is a clinical psychologist. She’s the author of “The Emotional Lives of Teenagers” and the book “Under Pressure.” So she’s done a lot of work on teenagers in general, on teen girls in particular. She’s also the co-host of the podcast “Ask Lisa.”

And one thing she points out across her work is that our culture has come to have a kind of pathological view of negative emotions. We treat stress and anxiety and sadness as enemies to be eliminated from our lives and the lives of our kids at all costs. But the cost of that, in turn, can become losing the ability to have a normal relationship with these emotions and treating them as emergencies and then being in a constant state of emergency.

So here, we tackle mental health on both an individual and cultural level. And I think this is one of those episodes that while it’s primarily about teenagers, it’s actually got quite a bit of relevance to adults.

As always, my email — ezrakleinshow@nytimes.com.

Lisa Damour, welcome to the show.

lisa damour

Thank you so much for having me.

ezra klein

So there’s this tension right now between all this data showing there’s something going quite wrong for teenagers right now and then the knowledge that it’s kind of always been hard to be a teenager. And you wrote a book about the emotional lives of teenagers, so I want to start in that broader story. What has always been difficult about being a teenager?

lisa damour

Well, we have a few cardinal rules in psychology, and one is that change equals stress. And if you look at an 11-year-old, which is typically when we mark the beginning of adolescence, and you look at a, say, 17 or 18-year-old, so someone who’s pretty far down the line of being a teenager, you’re looking at six or seven years, and you’re looking at so much change. I mean, an 11-year-old next to an 18-year-old — they’re hardly from the same species anymore.

If you pack that much change into a short period of time, it’s an inherently stressful thing. So I think that’s the baseline of all baselines, just that they’re changing so much and so fast that they experience it as stressful, and everyone around them is impacted by those changes and the stress on the teenager, and it’s stressful for the people around the teenager.

Then there’s a whole bunch of nuance that you can bring into that — the ways in which kids are trying to figure out where they fit in their peer world and how to handle really powerful emotions that come back on the scene, and what they want to do with themselves over time in terms of planning for the future. And then becoming a romantic person — that also happens in this phase of time. And figuring out how to take really good care of yourself as that work gets handed over from adults to you.

So, I mean, the jobs of being a teenager are so many, the change that is compressed into a very short period of time is tremendous. It’s not easy.

ezra klein

And when you say change, do you mean social change? Do you mean biological change? What’s happening in the brain during this period?

lisa damour

So I think about in terms of the change of who this person is — who this person is as an 11-year-old versus who this person becomes at 18, 19, 20. I mean, these are — just so much development happens. Neurologically, we mark the beginning of adolescence when puberty is sort of underway, and puberty is often underway before the outward signs are visible. So I always do want to emphasize that 10 or 11 kids are underway with being teenagers, and I think it’s important to say that because I think people notice this, that they’re 10 and 11-year-old becomes more private, more reactive.

ezra klein

I don’t like hearing this. I thought I had more time before my four-year-old became a teenager.

lisa damour

But teenagers are the greatest, so you can look forward to it.

ezra klein

That is not what I’ve heard. We’re going to fact check that. [LAUGHS]

lisa damour

We’re going to come back to that.

ezra klein

I’m not sure that’s going to hold up in fact-checking.

lisa damour

But I think it’s important to know because I think often people notice their 10 or 11-year-old shifting and think whoa, whoa, whoa, I thought I had more time, just like you said. I thought I had till 13 at least. But what we know is that the brain is starting to remodel, that it actually becomes faster and more powerful and more efficient over the course of adolescence, but that it also — that it remodels in the order in which it developed initially, which is from the lower order regions where the emotions are housed to the higher order regions where perspective-maintaining lives.

And so one of the hardest things about being a teenager and raising a teenager is that adolescence, especially around ages 12, 13, 14, they’re in a juncture where they have what we could call a gawky brain, that their emotion centers are upgraded and extremely powerful, and their ability to maintain perspective when they’re stirred up is comparatively weak. And it’s hard when you’re in that moment.

And what we know when we look at the data is, actually, emotionality tends to peak at around age 13, 14, and it’s often driven by when the child entered puberty. And that, actually, at ages 15, 16, 17, 18, teenagers level out a bit. Parents of older teenagers will tell you that their 17-year-old is a lot less reactive than that same teenager was at 14.

ezra klein

One thing I’ve never understood about the development path here, at least stereotypically, is you have a little kid you have a four-year-old, as I do, or a five-year-old. And we know that the emotionality is very high. Executive function is very low. And there’s a sense that 7, 8, 9, 10-year-olds are sweeter, that they’re very fun, they’re very playful, they’re more in control of themselves.

And then 13, 14, 15-year-olds are, as you say, kind of at an emotional peak. They’re more difficult, again, in sort of the cultural narrative of this. And that seems a little weird. You would kind of expect that there’d be a linear increase in executive function, and kids would just get easier every year.

So what is the explanation for this shift from tough at 4, easier at 8, harder again at 12? What is different between the 8-year-old and the 12-year-old?

lisa damour

Well, so the way we understand this developmentally is that we actually talk about these phases of development.

So we call early childhood, which is basically 5 and under, and you can basically say it’s intense. There’s a lot going on. They are a handful.

And then we have always described ages 6 to 10 — we call it latency, which is when all of that intense emotionality goes quiet. They still have feelings that are important and sometimes powerful, but the relative balance of their ability to regulate their emotions versus the strength of the emotions is more favorable from 6 to 10.

And then, as a result of these neurological changes, latency ends around 11. Adolescence begins. And all of that emotional power comes back to the fore.

And so we’ve never, on the academic and clinical side, articulated a linear path. We’ve always thought 0 to 5 is intense. 6 to 10 is often, like you said, peaceful, easygoing, quite a lovely enjoyable time of family life in that latency age kids — they’re fun to be with. They think we’re funny. They want to go to the grocery store with us. They don’t react too strongly.

And then along comes adolescence, and the emotions are put on steroids again.

ezra klein

One of the striking things I learned from your book is that during this teenage cognitive upgrade, you get this big rise in dopamine in the teenage brain. Tell me a bit about what that’s doing.

lisa damour

Well, what it means is that teenagers feel things more intensely than younger kids do and then adults do, that the charge of an emotion is more pronounced and amplified for them. And this, of course, is true for all of their emotions. So it means that when they’re low — and I think all of us can plug into memories of having really hard moments as a teenager — the bad times feel so bad, so intense, and that they’ll last forever and go in a million miles in all directions.

It also means — and we don’t talk about this enough — teenagers feel joys and pleasures more potently than little kids or adults do. I have memories of growing up — I grew up in Colorado, and I worked as a bus girl until I could buy myself a car, and I had my own car at 16. And I have memories of driving that car with the windows down and music on in the beauty of Colorado, and the level of delight in that is not a feeling I can regain at 52 in my car. So it’s just a powerful time — that there’s just a huge charge to their experiences.

ezra klein

So this has been fairly stable. Our brains haven’t changed, I think, that much in recent years. And yet there’s really big shifts, as best I can tell, on what it is like to be a teenager — sort of what world those brains are interacting with. So a couple of years back, you wrote this book “Under Pressure.” And I want to read a quote from it. You write, “A recent report from the American Psychological Association found that adolescence can no longer be characterized as an exuberant time of life, full of carefree experimentation, except for during the summer months. Today’s teens now, for the first time, feel more stressed than their parents do.” Why do you think that is?

lisa damour

My thinking on it can probably best be headlined with, like, too much input, too much output. The teenagers are taking in so much more data than we ever were. And, obviously, a large part of this is delivered to them by digital technology. But they are awash in information about the world around them, about the news, about what their friends did yesterday, about what’s happening right this minute with everybody they know. So I think it’s a huge amount to try to integrate all of that. And I think it’s very stressful.

And then we ask far more of teenagers than we used to, that not just for affluent kids, there’s tremendous achievement pressures for kids in many socioeconomic areas. I look at what we ask kids who are applying to college to deliver today versus what I was asked when I was going through that process. So I think a lot about the combined effect of so much input and the expectation of so much output. There’s no way that’s not going to be stressful for kids.

ezra klein

And a certain amount of that stress is turning truly toxic. So I’ve been really bowled over, I think is the right term for it, by this stat from the C.D.C.‘s Youth Risk Behavioral Survey. The survey, as you know, of kids in the 9th to 12th grade, and it found that, quote, “In 2021, almost 60 percent of female students experienced persistent feelings of sadness or hopelessness during the past year. 25 percent” — 25 percent — “made a suicide plan.”

When you heard that, what did you think? Did it track with what you see? How did that fit into your sense of what it is like to be a teenager now?

lisa damour

It’s certainly tracked with what I was seeing clinically at the time those data were collected. So those were fall of 2021, and when that report came out, of course, I was as alarmed as everybody else was by it. I actually had to pull my notes on writing I was doing at that time about what was going on for teenagers in the fall of 2021 because in that way that the whole pandemic sometimes can feel like a blur, I was like, OK, where were we then?

And what I found in my notes is that teenagers were miserable. They were entering their third school year disrupted by the pandemic, and they were under a lot of different configurations. Some kids were going back masked, and many of them were very anxious about what the social realities would be of being masked at school. Some were going back to schools that weren’t requiring masks, and a good chunk of those kids were very worried about their own safety. And some were still in hybrid situations, which they were very unhappy about.

And even the teenagers where things started to feel like they were normalizing or felt better, what they were telling me, clinically, was that they didn’t trust it. They were like, we’re going to get back into our lives, and it’s all going to be ripped away from us again.

So I think it’s important to locate those data in time. That was a very hard time to be a teenager. They’re alarming no matter what. I’m very interested to see new data as it keeps coming out because what I can tell you from being on the ground, working with adolescents, is that we’re seeing a very mixed picture now. There are a lot of teenagers who are doing not just fine but actually thriving and have the pandemic very far in their rearview mirror. There are a lot of kids who are suffering tremendously, either as a result of the pandemic or as a result of new things.

There’s also a story that isn’t getting as much discussion as it should, which is we’re seeing a huge percentage of kids who don’t go to school like they used to, who just don’t physically show up at school. And those data, I think, are still going to come out. But I’m hearing it anecdotally across all S.E.S. groups and all kinds of schools that there’s a huge amount more school avoidance or truancy or absenteeism, whatever you want to call it. So the current picture is pretty mixed. And we’re going to have to make sense of it.

ezra klein

I take your point on locating the 2021 survey in time. But what I look at the data here, what I see is really not a huge pandemic spike, but a spike that begins — it depends on how you look at it and what you’re specifically looking at, but 2011, 2012, 2013, something begins happening really sharply. And depression is going up, anxiety is going up, suicide is going way up.

And the pandemic, compared to whatever begins in that kind of 2012-ish era, looks a lot smaller. So something begins happening that continues — and I don’t want to take anything away from how hard the pandemic was for teens or for anybody else — but something is going on before it that is spiking suicide, for instance, in a way that it’s pretty unnerving. What do you think it is?

lisa damour

I mean, the honest answer is we don’t really know. We have a lot of things that we point to and that we worry about. I think one thing that we don’t talk nearly enough about are the data on worsening sleep in teenagers because, certainly, starting right in that same time frame — 2011, 2012, 2013 — you see this incredibly steep climb in the data on the proportion of teenagers who sleep fewer than seven hours a night. And it maps, actually, very cleanly onto the data about worsening mental health problems. And we also know that sleep disruption and suicide are closely connected.

And so I’m always interested in sleep, partly because there’s no controversy about its role in our overall health and mental health. Everybody’s in agreement that sleep is the glue that holds us together. But I also think it gives us a way to tease apart questions of, OK, for any given teenager, what’s keeping them up at night? Is it their social media is it outrageous academic program? Is it that they’re working two jobs and trying to do school or doing child care for their family and aren’t getting enough sleep?

So I think if we thread through that path of sleep, I feel like we’re always on sturdy ground, and I think we can tell very specific stories, or parents can interrogate it very specifically about their own kid in terms of what the disruption might be.

ezra klein

We spoke with Jean Twenge for an earlier episode here, who I didn’t realize, until you told me it, but that you all went to school together way back when. And her very strong view is that data is explained by smartphones and social media, that that’s what is displacing sleep, that is also what is displacing time spent with friends, and that explains why you’re seeing such a sharp rise right around 2012 when more social media becomes algorithmic and smartphones become kind of everywhere and everybody’s on social media. Do you buy that?

lisa damour

I definitely agree with the displacement argument. I’m such a fan and proponent of sleep that if a phone or digital technology in any form is getting in the way of sleep, I’m on the side of sleep and not on the side of that technology. So I think that’s a huge piece. And I don’t know that I can say with such confidence that displacing in-person time is as powerful as the loss of sleep. I’m kind of agnostic on that. But I do know sleep really matters.

I think, again, we have to be very careful when we get into the conversation about social media because I don’t think there’s a kid on the planet for whom it’s not simultaneously a positive and negative experience. And if we’re not engaging that either directly with teens or as parents thinking about it in that form, I think it’s very hard to have meaningful conversations with teenagers about how to take good care of themselves in the landscape of a lot of digital technology and a lot of social media.

ezra klein

So to get more granular here, what uses of smartphones and social media do you think are healthy for teens or good for them? What does the research show there — versus which ones are unhealthy?

lisa damour

So we have some — I would call it preliminary data that help us to make a distinction about how kids actually use this stuff, and what those data show us is that if kids are engaging, if they’re commenting, if they’re interacting with peers, that seems to be associated with actually psychological benefits and certainly less psychological harm than if kids are just scrolling and scrolling and scrolling and scrolling.

And so I think there’s a lot that gets collapsed in the discourse. Social media gets collapsed. There’s a whole lot of different things going on in social media, some that I think is clearly bad for kids, other stuff that is either benign or neutral or good. And even screens — that’s something that gets collapsed. There’s a lot of different stuff that happens on screens, some of it great for kids, some of it you wouldn’t want your kids anywhere near. So I think what’s hard is that the conversation that is the most accurate is probably also going to be the most detailed and nuanced and hard to pin down at times.

ezra klein

There’s an argument that you’ll hear pretty often now, which I would frame it as parents have become insufficiently paternalistic about this. So I could reframe that argument to be provocative about it to say there’s not a smoker who doesn’t have both a positive and a negative experience of smoking because it’s enjoyable when you’re doing it. Then, of course, there are terrible health consequences. And so our kind of answer to that was it’s not legal before you’re 18.

And there are bunch of people — Senator Josh Hawley has put out a bill like this who just say this is ridiculous. You shouldn’t be able to have this before 16, even if you like it, because we don’t think it’s good for you. We think the data is clear enough at this point, and that this sort of thing everybody’s in of an individual negotiation, it’s just a lose-lose situation, that it needs to be a collective decision. How do you think about that?

lisa damour

Well, I, of course, operate at the level of the individual kid in the individual family. So the way I think about things like that is that I don’t disagree that social media can be incredibly hard on kids and their mental health. Social isolation is also incredibly hard on kids and their mental health. And so as long as kids feel — and I think this cannot be unpacked a bit — feel that they need to have some digital technology to stay connected to their peers. That’s really important. And I think needs to be honored. And what that technology is and what the platforms are involved, that is in the details of it.

But the way I think we could walk into it while we wait for legislation or figure out what the communal response is going to be is that I encourage parents to think about looking for an inflection point. How much digital technology does your kid need to stay meaningfully connected to the kids they know? And what’s, I think, not discussed enough is often texting will get kids very far for a long time. And you can give a kid — if you want to give them an iPhone — you can give them an iPhone with no browser and no social media apps — it’s a texting machine — and then watch and see how long can they stay connected?

And I do completely agree that we should push the introduction of social media as deep into development as we can. It’s a very different thing for 12, 13, 14-year-olds to be using TikTok and Snap and all the ones they love versus a 17, 18, 19-year-old. But I think it’s critical that we don’t make it so simple as you either give kids social media or you don’t. I think that we can say they need connections. They need to be part of their friendship groups. And increasingly, those things do get mediated through online environments. And so can you go so slowly to make sure they’re still connected but they’re not in over their heads.

ezra klein

That’s a place where I think the question of displacement — again, here — collectively becomes profound. So I’ve been really struck by this finding that by early 2020 — so prepandemic — 8th and 10th graders were going out with friends about a full weekday less often in person than they had been in the 1990s, when Gen Xers were teens.

And I think back on my own teenage experience and just when I remember being a teenager — and I didn’t love it for a bunch of reasons — but the real thing I remember now and the thing that more than anything still shapes my life now because I mean they’re still my best friends today it is sitting around playing Tony Hawk on the PlayStation after school. And when you look at the numbers on how much less in-person socializing there is now, it’s pretty big. I’m curious both what you think about that as a trend and, also, if you buy or believe that it might be behind or contributor to some of the worsening mental health outcomes.

lisa damour

On the worsening mental health outcomes, I’m just going to say I don’t know. I don’t know. I haven’t heard that from kids, that longing to be more in person is part of what’s getting in the way of their mental health, and I take seriously teenagers’ assessment of their own experience. But I also do know what you mean about that big, open unstructured time of hanging out with the people that were your people in high school. And I had that too.

And when I think now about what displaces that — I mean, some of it may be social media for a lot of kids, but I think there could be other things. We have kids much more protected than we used to. We don’t let them roam like we used to. In some sectors, kids are just busier. They just have so much more going on in terms of the demands on them after school and the expectations. And

so I think it’s important and interesting that kids don’t spend as much in time in-person time with the people that they are close with but I’m not quite ready to lay that all of the feet of social media and then say that that’s what’s causing all this distress.


ezra klein

One thing you see very clearly in the data is that teenage girls are suffering much more in terms of anxiety, in terms of depression, in terms of suicidal ideation than teenage boys. And you’ve written a whole book about the particular pressures on teenage girls. So what has changed about being a teenage girl?

lisa damour

Well, there’s two issues there. One is the kind of questions we ask, and then what are the particular stresses on girls. So just to pull back the lens a little bit, we have always, in psychology, had another rule, which is girls tend to internalize, boys tend to externalize, which is that when girls are in distress, they tend to collapse in on themselves, report and experience more depression and anxiety, whereas boys are more likely, when under distress, to act out, to get themselves in trouble, to be hard on the people around them.

So we do get this pattern in the data where the girls look quite a bit worse than the boys, which isn’t to say they’re not, but we’re asking about the kinds of things from which girls tend to suffer and from which girls tend to report suffering, whereas we’re not as good at detecting how boys may be suffering because, often, we’re asking self-report questions and so then saying have you been kind of a jerk lately, and are you looking at stuff online that is like harsh and misogynistic? We’re not asking those questions, and yet, I think, that’s a lot of how boys are going to let us know they’re suffering.

ezra klein

But isn’t this data somewhat validated by things like who’s ending up in the emergency room for cutting, for a suicide attempt, for an O.D. attempt, that kind of thing?

lisa damour

Certainly, we do see girls who are attempting suicide more than boys. We also know, when we look at the data over time, actually, boys are more likely to complete a suicide. So we want to be careful about leaving boys out of the distress conversation, and not that you are, but I just always want to acknowledge that.

So then for the girls who are reporting rising rates, I think some of it is the pandemic. I’m not going to count it out. I think there is a truth to the ways in which digital technology, for girls, especially young girls, can foment a lot of comparison, a lot of questions about their appearance.

I think there’s both very obviously toxic versions of this time spent on the side of TikTok — which is how kids describe what their algorithm is serving up — a side of TikTok that is very focused on ultra thinness, ultra fitness. I mean, that’s hugely concerning, and I worry a lot about that and eating disorders.

There’s also, I think, something subtler that happens for girls online. And I think there is a boy version of this, but I hear a lot about it with girls. It’s sort of called the that-girl phenomenon, where there are posts and videos that are highly aspirational about this incredibly put-together young woman, and she may have a body that looks normal and healthy and she may be eating fabulous foods, but she’s got a journal that is like perfectly detailed and beautiful pastel colors and a to-do list that she is crushing.

And it’s meant to be inspirational. It’s meant to show a young woman who’s really got it together and is living a healthy life. And I look at that and I think and I talk with teenagers, like, there’s really not a way to look at that without feeling like you haven’t made good use of your day. So I think there’s both obviously concerning harms that girls especially may be vulnerable to, and then I think there’s subtler stuff that goes on online that actually doesn’t get enough attention.

ezra klein

You sort of predicted, a minute ago, where I was about to go with boys, which is there’s something strange and revealing, maybe, in the data, which is that if you look at report on suffering — am I anxious, am my depressed, am I making a suicide plan, am I hopeless — you see much, much worse numbers among young women.

And if you look at outcomes, boys look terrible right now compared to — I had Richard Reeves, who wrote the book “Of Boys and Men,” on the show a couple of months back, and he was talking about how badly men are doing compared to women in terms of academic achievement, in terms of whether or not they actually complete high school, complete college, how they end up doing in many ways in the labor market — being in the bottom half of the income distribution.

And then, as you mentioned, in terms of actual things like suicide — I mean, it’s such a horrible phrase — suicide completion, death by suicide, but also death through violence. Boys, on a lot of levels, when you look at the mental health data, are looking better. And then you look at the outcomes data, and they’re looking worse. Why do you think that is?

lisa damour

The lens that I brought to it in my most recent book, “The Emotional Lives of Teenagers,” I have a section — I don’t actually remember what I called it. But you could have called it “It’s Very Hard to Be a Sixth Grade Boy.” And what I unpack in that section are the data on the neurological differences that are pretty much in place by sixth grade that really put girls in an extraordinary advantage.

And there’s also a physical advantage too, that because they come to puberty earlier, sixth grade girls, as a group, are more sophisticated in their thinking. Their brains have been upgraded in a way that allows them to be more powerful in their cognition. They’ve been better students since the day they walked in school.

And so this, combined with an increasing kind of neurological firepower, gives them a lot of strength in the classroom. And then, also, in sixth grade, and for part of seventh grade, girls were also taller, stronger, faster than boys. That shifts as eighth grade comes along, but as I was working on this book, I was thinking, you know, oh my gosh, imagine being a sixth grade boy that you’re sitting in class, and the girls are just running laps around you as a group. And then you go outside, and they are physically running laps around you. That’s got to feel horrible — to have that all happening at a moment when you’re trying, as some boys, are to consolidate a sense of masculinity.

And one of the boys I interviewed for my book — he just hit it on the nose. He said, at that time, there’s nothing worse in the world than being beat by a girl, when you’re trying to figure out what you’re all about as a coming-into-masculinity boy.

And so I think there’s something really powerful happening. And what I line that up with in my book were the data showing that that’s when sexual harassment begins. And I think people often think it occurs a lot later in development. Sixth grade is usually when it starts to kick up. And I thought, oh, I can imagine that there may be some boys who are, you know what, I’ve got to take these girls down a few pegs, and this is a way I can do it.

ezra klein

I can imagine two responses to that story. And I think one of them is, well, we really need to teach a masculinity that doesn’t feel there’s nothing worse than being beaten by a girl.

And then there’s another response, maybe not mutually exclusive with the first, and this is more of a policy response — this is one of Richard Reeves’s big arguments — is that we are actually making a mistake here, and we should redshirt boys and hold them back a year and have them start school a year later, because they’re just going to do better. They’re going to be more ready and more capable, and putting girls and boys on the exact same track when they are on developmentally different tracks is not good for anyone. So I’m curious how you’d answer both of those responses?

lisa damour

I think the first one feels very challenging to me, and what I mean by that is, so much of how boys who are trying to sort out a sense of masculinity do that by fifth, sixth, or seventh grade. It’s actually at recess that they are policing one another in a very deliberate and often very aggressive way. And so I’m interested in the idea that we could try to teach 10, 11, 12-year-old boys a more expansive view of masculinity. I think that, obviously, would be a great way to go. I don’t think you can do that in the classroom without accounting for what’s happening at recess and finding a way to address it.

As for the redshirting boys, I think it’s a pretty interesting idea. I know it’s not without downsides, but I care about boys because I care about kids. But I also feel like, well, even if you really feel like your interests are largely in the girls, don’t we want the girls to have male classmates who feel that they enjoy the same behavioral controls and intellectual strength that the girls do? I think there’s value in that too. And so I think interventions like that, if they benefit boys, they probably also benefit girls.

ezra klein

Tell me a bit, in your practice, in terms of seeing kids, what are the differences in what you hear between the modal girl who comes in for help and the modal boy? How are they experiencing this era differently?

lisa damour

So it’s hard to do modal girl in a private practice because you’re just looking at one kid in depth. And what I’ll say is the kids who are coming now mostly are coming because of what’s happening now in their lives. It’s very specific to them. It’s very individual to their concerns or needs.

But when I think over time about girls I’ve cared for, boys I’ve cared for, and, of course, we’re working with a pretty strict gender binary here, but I think what I see is girls suffer, but they also, as a function of how we socialize them, they tend to enjoy a lot more conversation around them about emotion, a lot more latitude to express their suffering in language, a lot more support that actually comes their way as a result of being able to talk about how bad they feel.

This can go down a rope that turns into rumination, where they’re talking and talking and talking and their friends are talking and talking and talking about negative emotions in a way that isn’t helping. But until it takes that turn, being able to express emotions in words is an extraordinary asset to anyone who can do it.

Whereas the boys I’ve cared for have largely not been encouraged or felt that they were allowed to talk about their internal worlds publicly, or to even come up with a language for them. And I talk about a boy in my book who when his mom would ask them what’s going on, how do you feel, he told me the only word I can think of is static. So he was aware of an agitation but didn’t have a label for it and there’s nothing that means a girl should be better at labeling emotions than boys in terms of their biological endowment. But it is how we socialize, and it is what we allow.

And so I find, for boys, it’s like they’ve got one hand tied behind their back when they come up against something that’s emotionally painful because they don’t have the permission or the practice in our culture to put that experience into words. And as soon as you get it into words, it comes down to size. It is shareable, it can be observed, and it can often be modified.

ezra klein

One of the core threads of your book, “The Emotional Lives of Teenagers,” is I would call it a critique of how our culture now treats negative emotions. When we talk about anxiety, when we talk about sadness, when we talk about depression, it isn’t that those can’t be pathological, but I think it’d be fair to say that you’re arguing we are treating them almost as too pathological in a way that itself has become part of the problem. So tell me a bit about that argument you’re making.

lisa damour

That is actually one of the main reasons I wrote the book was a worry about where the discourse had moved. And one of the ways I can describe it is that as I’ve watched the headlines come out in the pandemic and after the pandemic about teenagers, so often, psychological distress is rolled up with mental health concern as though they are one and the same. And we have never, as academic or clinical psychologists, seen it that way.

And, in fact, what I hope we can maybe move toward is an understanding that it’s actually often the inverse, that much of the time, the presence of distress, the experience of distress, is evidence of mental health. And what I mean by that is there are lots of circumstances in daily life where we fully expect to see distress. If a kid’s best friend moves away, we expect to see sadness. We are more concerned about its absence. If a kid has a huge test and they have not started studying and that test is tomorrow, we expect to see anxiety. That is actually what we would rather see than a kid who is indifferent.

And I think what I feel I’m working against, what my field is working against, is this strange equation that has evolved in the discourse where being mentally healthy is equated with feeling good or calm or relaxed. And those are all lovely things, but those are not how we, as psychologists, assess mental health.

We’re looking for two things — do the feelings fit the situation, even if they are negative, unwanted, unpleasant? And then, second, and perhaps more important, are they managed effectively? Are they managed in a way that brings relief and does no harm, or are they managed in a way that does bring relief but is going to come at a cost?

ezra klein

Let’s take anxiety here as the example, because it’s one of the two I’m more personally familiar with. And one thing that was interesting to me in reading your book was thinking on my own experience of, one, at a certain point in my life, coming to a label — I’m an anxious person. And two, as that became an easier label, an easier concept for me to apply to my own internal experience, I notice that I was classifying more things as anxiety and not just becoming averse, then, to the experience of it but, in many ways, averse to the things. I think that spaces where I might have understood it at another point as anticipation, excitement, a kind of edginess, it all began to feel like, well, I don’t to feel that, and so I shouldn’t do that.

And I wonder how much, in your experience, there is some relationship, like the shadow side of becoming much more open and accepting and even eliciting of the negative emotional experiences of kids, but also of adults, also creates an overreliance on them. And, for that matter, because we then treat them as bad experiences, creates a kind of aversion to things that people, at another point, might have just understood to be part of life.

lisa damour

I think that’s a worry. I think that if we, consciously or not, operate with this idea that you’re supposed to feel good, and then if you come up against something that doesn’t feel good, you should be very wary of it. I think it can have unintended consequences.

And one of the arguments that threads through my book is actually about the value of psychological distress. And this is something that seems strange to say at this moment in time, that there’s value in psychological distress because we are so set against it as a culture, but I can tell you from the side of psychology and certainly the side of development, this has not really been something that is controversial or that we’ve questioned.

And what I mean by that is emotions — there’s a lot of value in the negative ones across a lot of different domains, like one is they’re informational. If you notice that you’ve got a particularly uncomfortable feeling every time you’re in somebody’s presence, there’s value in figuring out what that’s about. It helps us make decisions. It helps us guide our thinking. They’re also growth-giving. You know, Ezra, I’ve practiced a long time, and I’ve cared for kids who’ve come up against horrible tragedies.

And it’s very painful work to be with them as they work through intense grief, intense distress. And yet there’s something kind of extraordinary about how much maturation arrives as a function of them actually grappling with a very painful feeling. They become more broad-minded. They become more philosophical. And there’s actually, for me, almost a universal marker of when this is happening, which is that they become actually very annoyed with their age mates for having concerns that feel, to them, very petty or minor.

And they only arrive at that point by having gone through something very, very painful. And so psychologists — we’re surprisingly agnostic about emotions. We don’t really prefer positive ones over negative ones. To us, they’re all data, they are all growth-giving in their own way, and occasionally, the situation derails, and a person has a feeling that does not make any sense and we need to figure out why. Or they have a feeling that is getting in the way of their ability to live a rich and full life, and we need to take care of that. A huge percentage of the time, we just sort of see it as data coming across the transom that can be put to good use.

ezra klein

Are negative emotions — and, for that matter, positive emotions — on a societal level contagious? And when I ask that, one thing in my mind is we know that if kids are hearing more about suicide, they’re more likely to commit suicide. We know there are concerns around school shootings and whether or not you report the names of the shooters because we know there is copycat tendencies. And we know there are also generational and cohort effects on how people deal with emotions.

I mean, famously, you go back a couple of generations, and you have much more stoic responses to emotions. I mean, I think many of us have had grandparents who grew up in the World War II era or in the Great Depression era or a more difficult era, and they seem pretty hardy, given what they’ve gone through, pretty, if not upbeat, at least unwilling to wallow. Then, obviously, there’s a much more both open, and I would say, to some degree, wallow-y approach to emotions currently. Is there something here where, when you look at these lines going up and lines going down, that something is causing the line to start, but it can develop its own momentum up or down because these things are contagious? They’re learned social behaviors.

lisa damour

The language I use to think about what you’re describing is a language of norms. And one of the things that you can say about teenagers is that they are very vulnerable to norms, more than children are, more than adults are. And they can be shaped by the norms around them pretty readily. And I think there is a norm, and I think a lot of this actually does get transmitted through digital technology that matches what you describe, where there’s a very heavy focus on feelings which, as a psychologist, of course, I’m all for.

But there can also be, I think, at times, a too-heavy focus on a sense of having a feeling and that being a bit paralyzing, whereas as a psychologist, I think, yeah, you’re going to have a huge range of feelings. Now the question comes down to what’s the coping? How do you cope with that distress? Are you able to talk to someone to feel better, just going for a run to help you feel better? Does watching a TV show you love help you feel better? That’s what we want to see people think about is what their coping strategy is going to be. And, also, we want people to steer clear of coping that’s going to come at a price down the line, whether it’s abusing substances or being hard on people or taking it out on themselves.

And so I think part of why I’ve done the work I’ve done is to try to help advance a conversation where I want people to think about negative emotions more the way that psychologists do of, yeah, anxiety, it happens. It can play a valuable part in your life. Here’s the limit of when it’s helpful to you. Here’s what you do when that happens.

But psychologists don’t feel as paralyzed in the face of negative emotions as, I think, sometimes I can hear in the discourse. For us, they are to be worked with. They are to be soothed. They are to be learned from. But they don’t actually have to stop you in your tracks. And if they are stopping you in your tracks, we then get very serious about treating that so that people can live rich and full lives.

ezra klein

Well, tell me a bit about that distinction. For a parent with a teen or just a person looking at themselves, what separates sadness that is appropriate, healthy, growth-giving, as you put it, and sadness that is depression, that is pathological? Anxiety that is appropriate, growth-giving, difficult, but worth going through with, oh, I have an anxiety disorder. Now I’m an anxious person. I have a real problem here. How do people know what the line is?

lisa damour

So for sadness versus depression, there’s a few things that are easy to point to. So one is when you’re sad, you’re usually sad about something. My dog died. My best friend moved away. Whereas in depression, there’s sort of a cloud that has covered your sun. Everything feels sad or low or blank or, in teenagers, irritable is important to acknowledge, that often depression in adolescence looks like a very prickly porcupine who is annoyed by everybody.

Another distinction between sadness and depression that I find especially useful is often, in sadness, we’re sad because the world has somehow become impoverished, that the dog has died, the friend has moved away, there’s a loss in the world. There’s less of the world.

In depression alone, that sense of impoverishment also extends to the self, that in depression alone, we hear people saying I am no good. I am a burden on my family. It would be better for people if I weren’t here taking up all their time and energy.

You don’t hear that in sadness. That’s depression. You can also look up the diagnostic criteria for a major depressive disorder. They can be helpful. But they’re distinct enough, and they’re easy ways to make the call on that.

As for anxiety versus the anxiety disorder, I think part of what’s so frustrating is that we use the same term both to describe probably adaptive and healthy everyday nerves and also something that we diagnose. So if we talk about anxiety in the day-to-day, the way I like to think about it is anxiety is a gift handed down by evolution to alert us when something’s not right. So if you’re late for an important appointment, getting anxious is going to get you out the door — hopefully, it will activate you and motivate you to get going.

So anxiety is not pathological so long as it actually matches a real threat either in the outside world, such as being late or a terrible driver right around you. I also try to pay attention to anxiety when I’m having it — you know that sense of you’re about to say something, and then you’re not sure if you just say it, you feel a little anxious, and then you say it, and then you wish you hadn’t. That’s functional, useful anxiety.

ezra klein

No, I have no idea what you’re talking about there. I’ve never had that experience as a public figure. [LAUGHS]

lisa damour

[LAUGHS] Exactly. And then you’re like, why didn’t I listen to my anxiety, right? So that’s all healthy. So healthy anxiety is it matches a threat, whether you’re the threat or somebody else is a threat. And it’s proportional to the event. And that’s what’s really important. If a kid hasn’t studied for a test that matters, they should feel some anxiety. Feeling a panic attack is not going to help them. So we would consider the anxiety appropriate — the scale, not so much.

Pathological anxiety, then, can be defined in that way. It shows up when everything’s OK and/or it’s way too big for whatever the problem is. And what I want to make sure to get across is we’re great at treating anxiety disorders. We have had a really good handle, as clinicians, on the treatment of anxiety disorders for decades. There’s very little controversy in the field about this. We know what to do. Medication can be an option, but it’s not always necessary. There’s lots of other options.

And so, again, I walk up to this landscape of talking about emotion, talking about distress, and talking about pathology quite a bit more than we used to, I think, with a lot more hope and a sense of sleeves rolled up than I often hear around me. I think that there can be a kind of unhelpful and, I think, at times, unnecessary sense of there’s nothing to be done or here’s where we are. And that’s just not how we see this as psychologists.

ezra klein

So is your view that a societal unwillingness to tolerate and be open to negative emotion has led to more people experiencing pathological versions of those emotions? Is that, for you, part of what explains this last 10-15 year run up in pretty tough emotional states, both for teens and for adults?

lisa damour

I don’t know that I would go so far as to say this explains or helps to explain why we’re seeing rising rates of clinical disorders. But here’s what I would say — I think it really corners all of us if we continue to equate being mentally healthy with feeling good because the conditions it creates is that a person wakes up and that person can be an adult or a teenager, and they start their day, and it’s a regular day. And something goes wrong, and they feel really lousy.

And what I’m now encountering clinically is caring for people who not only feel lousy about the thing that went wrong, but who now have anxiety about what this means about their overall mental health. And it’s that second round of negative feelings that is not helping us and is not necessary, I think — that people are allowed to be upset about their lousy day, they deserve support around their lousy day, and my job, their job, is to find their way to good coping to manage that lousy day.

For people to encounter the typical variety of human experience in all of its light and dark and to come to the dark and then feel anxious that they should not be having those feelings, that is not helping us, I think, right now.


ezra klein

I’ve heard you, in your own podcast, describe the way a lot of parents act like a linebacker around teenagers’ negative emotions, as if they’re trying to protect the quarterback from any negative emotion. One thing that I do think is reasonably well-understood is that there has been a shift in parenting, more away from giving kids, as you mentioned earlier, freedom to roam, but I think, also, towards being much more concerned if your kid is unhappy — often for good, right? I think it’s good to be — I mean, I hope it’s good to be attentive to our kids’ emotional states. But that there’s some line where it’s not just the emotional state that can become pathological, but the parents unwillingness to tolerate it too — or at least destructive, that there’s some amount of growth that you are refusing to allow your child to experience.

As a parent, how do you know where that line is between you don’t want your kid to suffer, and also suffering is an important growth-oriented part of life?

lisa damour

So this is critical and, I think, a very critical part of the moment we’re in. And I think there’s a few things to say by way of groundwork. One is I think one of the most natural things to being a parent is that we just hate to see our kids suffer. I mean, it’s just such an instinctive response. And whenever one of my kids had a crummy cold, where they were coughing and their nose was running, I always thought to myself I would rather have those symptoms myself than watch you have them. I hate watching you suffer. So I think I have so much allowance and empathy for the first reaction parents have when their kid is an emotional pain, which is just want to make it stop. And I get that.

And I think I want to layer into that the reality that this has been an extraordinarily difficult time to be a parent. Parenting through the pandemic asked of adults extraordinary things and often beyond all imagination of the kinds of things we would have ever imagined were necessary for maintaining family life. And so I think if you combine, that parents are tired and raw as a function of what they’ve been through, and then in walks their kid who’s had a really lousy day and their kid is suffering, that’s a lot going on in a kitchen and I have a lot of room for parents who just want to shut it down or make it stop or figure out how to keep that feeling from showing up again.

But you get to the issue here, which is those feelings are happening whether we want them to or not. And they may have real value. And if we cannot tolerate our kids’ distress, they will not be able to develop the capacity to tolerate their own distress.

And so the job here — and I think about this all the time — is how do we shore up parents, given all they’ve been through, so that when their kid walks in the door after a really rough day, the parent can serve in the role of a steady presence, even if they maybe don’t feel that way inside all the time so that they can help that young person use the incident of distress as a training ground for figuring out how to manage distress well and not be scared of it and cope with it effectively.

ezra klein

So give me an example here. Let’s say you’ve got a teenager. They’re having a lot of trouble with friends at school. They feel nobody likes them. Nobody sees their worth. They’re lonely. The kid comes in upset. What do you do?

lisa damour

Well, I promise you, you can never go wrong, I think, if your first reaction is just straight-up empathy. If the kid comes in and just lays it down and is just miserable and describes it in vivid detail, that’ll be painful for the parent. I think it’s really valuable, as a first step always, just for the parent to say, like, I am so sorry, or that stinks, or anyone describing what you’re describing would feel horrible right now.

And to give that an opening chance, to give that a chance to help, which it often does, to see where the young person takes that. There’s huge value in that often on its own. Whatever the kid is feeling now, they’re not having to feel it alone. We’re not questioning them. We’re not challenging them.

From there, parents can do things like talk about do you want my help with this? Or what would help you feel better? Or what have you tried? I mean, I think there’s a lot of conversation that can continue from there. But, in my experience, if you don’t start with empathy, anything else you’ve got won’t land in the way you mean for it to.

And often, if you start with empathy, and you actually start by offering it as though it may be enough for that young person in that moment to get through this hard time, at least the day, to me, that actually sort of feels like the all-time steady presence move. You’re hugely present. You’re engaged with what that young person is describing. But you’re not unsteady. You’re not picking up the phone. You’re not canceling plans. You’re not making this bigger than the young person has brought it home as being.

I think there’s real value in that because teenagers are reading us for how upset they should be. And a kid who comes in after a day like that and describes it, if the parent is activated to full blast and becomes very, very upset or very, very anxious, that actually does not usually help the young person get their hands around it. It may, in fact, make them feel like, whoa, I thought this was like a 15-year-old situation. This appears to be 52-year-old scale bad. That can be more upsetting than just offering steady empathy and seeing where the young person wants to go next.

ezra klein

And I know that a lot of your work is with individual families, but you’ve also thought a lot about the broader societal moment here, and we’re seeing something happen societally. So are there actually policies — I mean, if Congress came to you and said, we want to make things better for teenagers across the country, we look at these numbers and the high suicide rate and the high depression/anxiety rates, and we think there’s something really wrong here, and we want to do something, what would you tell them to do?

lisa damour

The first thought I have is that the finding that helps me sleep at night is the knowledge that the strongest force for adolescent mental health are caring relationships with loving adults, that teenagers need adults who get them and back them and are connected to them. Ideally, this would be adults at home, but it doesn’t always work out that way, and it doesn’t have to. So I think a big piece of it actually is shoring up the adults. I think it’s important that adults are in good shape if we want teenagers to be in good shape, so thinking about what’s impacting adult well-being and adult mental health is key.

I also think about these devastating numbers from the pandemic about teen mental health. And one of the dots that doesn’t get connected enough, I think, is that not only were kids not in school, they also weren’t doing their after school programs with, sometimes, phenomenal coaches who really help kids grow or extracurriculars with incredible adults who really are interested in teenagers and like them and make that clear.

And I think about it from the standpoint of what does it mean if we make education such a difficult career to go into and make it so unappealing to adults. I worry that we’ll end up with warm bodies around teenagers when what we need are adults who are incredibly devoted to them and interested in them. And so I think about it the policy level, which is not my strength, how do we take care of adults? How do we make sure that the adults who are around teenagers are the best possible options because that’s how we head off so much distress in adolescence. And that’s how we cultivate thriving in teenagers.

ezra klein

You mentioned, early in our conversation, sleep. Something I’ve often heard suggested is just that high school should start later. Anything where teenagers are going should not start before 9:30, just given the way their body clocks work. Do you think we should do that?

lisa damour

I think it’s a good thing to consider. I think, often, the reason that high school starts so early is just because of the busing plans, that the little kids who’ve been up for hours go last, and the high-schoolers go first, and it’s often just because a single bus service is getting everybody to school. So I think things like that are not good reasons to have teenagers go very early.

And it is true that when kids hit puberty, it is harder for them to fall asleep at a reasonable hour. Given how essential sleep is, I’m open to anything that improves adolescent sleep. And as much as I exercise caution around technology and social media and its connection to mental health concerns, we have really good data showing that if it’s keeping kids up at night, it will mess up their mental health. It will get in the way.

And so I think there’s also rules that feel pretty straightforward, but I don’t know that we’ve done a good job of encouraging adults to implement them, like not having technology in kids’ bedrooms overnight, if that can be helped at all. Adjustments like that can make a big difference. And adults shouldn’t have their tech in their rooms either when we look at what the data say. I think, if we get really serious about sleep, and we look at all of the things that interfere with it, I think a multipronged approach would go very far.

ezra klein

You have a more, I think, nuanced take on social media than I do. I’m a little more alarmed and in the direction of a hammer at this point. But if a parent comes to you because, as you say, we don’t have a huge collective answer any time soon, and say, you know, what’s on the index card here that I should be doing or advising to make sure my teenager is using this stuff well so I know that if I know something is going wrong there, I’m able to intervene. What do you tell them? What is it good sort of two or three or four bullet point set of guidelines or rules that you advise parents to deploy here?

lisa damour

So number one is just go slow. Start them off with texting. If they end up in the meanest text thread ever, they’re probably not ready for social media. I mean, really know your kid and go very slow. The next thing on the card would be, like, these are teenagers. And we need to remember that. And for anything related to safety, Ezra, when it comes to teenagers, you do safety with teenagers, not to teenagers. They have to be in on it with you. And so, then, what I would say is if a teenager is underway with social media, I think it’s actually about a collaborative conversation where the parent says what is it that adults don’t understand about social media? I mean, I think you really need to ask that question. I think it’s not a great idea to just try to give teenagers advice about social media because nobody, teenagers included, really wants advice from somebody who knows way, way less about the thing than the teenager does themselves.

So I think you ask, what is it that adults don’t understand? And this is my favorite question to ask teenagers about anything because they always provide an incredible education.

And then I think an adult should say what do you like? What’s the great stuff? What’s the best stuff out there? And find out why kids spend time on it that gives them pleasure and gives them joy. And then I think the adult can say — and I wouldn’t advise asking all of these questions in a single conversation — what don’t you like? What are the downsides? What is the stuff you come up against that really makes you uneasy or you think is a problem?

And then I think the adult can say what are you doing about that, or what have you done about that? And then I think the adult can say, how can I help, or should I be stepping in here?

I think this is a conversation with, probably, an older teenager. But I think if you’re trying to come in over the top and do safety to a teenager on anything, you’re going to run smack-dab into the fact that teenagers are organized around autonomy and really don’t like to be controlled. And I think it sets up a dynamic that isn’t going to improve your relationship with that kid.

ezra klein

And then when we talk about the healthy and unhealthy coping with negative emotions, something that that brings up for me is, certainly, some of that is modeled — that is modeled by adults, too. It isn’t just how they react to their kids, but how their kids see them reacting to themselves.

So when you think about what is healthy for people to do when they are feeling a lot of anxiety, when they’re feeling a lot of sadness, what are, to you, the kind of healthy coping mechanisms — for things that are nonpathological. You don’t have generalized anxiety disorder or something — versus what are the things that maybe your modeling that you’re modeling not the most healthy strategy in the world?

lisa damour

So when psychologists think about coping and healthy coping, we actually divide the world into two categories. There’s coping by expressing what we’re feeling, and there’s coping by taming or bringing back under control our emotions. So on the menu of healthy coping, if we start on the expressing category, there’s talking about what we’re feeling and seeking social support.

There’s also finding other healthy ways to get feelings out. Teenagers will often listen to music as a way to catalyze the expression of emotion. They’ll put on a sad playlist and cry alongside it. I think, often, teenagers enjoy a much broader and, frankly, more creative repertoire for finding emotional expression. They’ll make things. They’ll do art. They’ll create music. But I think adults do those too. So there’s the expression category of just discharging the emotion in a way that brings relief and does no harm.

And then there’s the taming category. And, as psychologists, we hold these on equal footing. So we also do things to help ourselves feel better, whether it’s going for a walk or taking a bath or finding a food that we love and enjoying it or getting with a TV show that we know we’re going to leave the end of the episode feeling better than we did when we started.

And I think, if we can bring coping forward as the thing to focus on — the distress, that is a done deal. We’re going to feel it. Our kids are going to feel it. It’s the question of how it gets coped with that really sets people down a path towards growth and health, or it can set them down a path where things don’t go well and they end up digging themselves into something that becomes harder to get out of.

So coping is what it’s about, but what you said about modeling, I think the best parenting advice I ever got, actually, was on the inside of a chocolate wrapper. It said, don’t talk about it. Be about it — that kids watch us, and they’re going to do what we’re going to do far more than they’re going to do what we tell them to do.

ezra klein

Then, always our final question, what are three books that have influenced you that you’d recommend to the audience?

lisa damour

As a psychologist, a book I go back to again and again was written by another psychologist, Nancy McWilliams. It’s called “Psychoanalytic Diagnosis.” It’s for clinicians, but it’s written so thoughtfully and clearly that I actually think anyone who’s interested in human psychology would get a huge amount out of it.

Personally, I actually just finished a book called “Transcendent Kingdom” by Yaa Gyasi, a novel — beautiful — about a neuroscientist and also adolescence and development.

And then my favorite graduation gift — so I’m giving it a lot right now — is “A Swim in a Pond in the Rain” by George Saunders, which is kind of about Russian literature, but it’s about much, much more than that. And it’s just a really extraordinary book. So those are the three that I’m thinking of.

ezra klein

Lisa Damour, thank you very much.

lisa damour

Thank you.


This episode of “The Ezra Klein Show” is produced by Annie Galvin. Fact-checking by Mary Marge Locker and Kate Sinclair. Mixing by Jeff Geld. Our production team is Emefa Agawu, Annie Galvin, Jeff Geld, Roge Karma and Kristin Lin. Original music by Isaac Jones. Audience strategy by Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. And special thanks to Sonia Herrero and Kristina Samulewski.

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