Bad Therapy: Why the Kids Aren’t Growing Up, by Abigail Shrier (Sentinel, 320 pp., $30)
Abigail Shrier’s first book, 2020’s Irreversible Damage, launched the mother of all cancel campaigns. Because the book attributed the sudden and inexplicable rise in juvenile gender anxiety to social contagion rather than the activist-approved explanation of social progress, Shrier, an occasional contributor to City Journal, was branded a “transphobe.” Amazon employees demanded the company remove the book from its virtual shelves. Unlike the suits at Target, who briefly did exactly that, Amazon stopped short of cancelling the book and settled for banning any paid advertising. Despite growing questions about juvenile transgender treatment, including among practitioners, many libraries continue to treat Irreversible Damage as radioactive. Only last month, a Japanese publisher reneged on plans to publish the book, proving that, whether or not transgenderism is contagious, the urge to cancel those out of line with approved ideas unquestionably is.
Shrier’s new book Bad Therapy, an astute and impassioned analysis of the mental-health crisis now afflicting adolescents, may cause a similar emotional meltdown in some corners of American culture. Shrier’s target is more expansive than it was in Irreversible Damage; she aims her fire at the therapeutic mindset that pervades not just the offices of psychologists and counsellors, but elementary, middle, and high school classrooms, best-seller lists, middle-class homes, and government agencies. It’s a pernicious development because a therapeutic mindset easily paralyzes kids’ natural defenses and resilience, hence the crisis we confront today. Assuming a Bad Therapy backlash comes, it is unlikely to be as heated as it was in the case of Irreversible Damage—therapists, who have the most to lose if Shrier’s analysis were to win out, are a more sedate crowd than trans activists—but one hopes that for the sake of the rising generation, any pushback won’t prevent people from heeding the warnings of this important book.
Shrier’s general thesis is that Gen Z’s distress is iatrogenic in origin. That is, it is caused in large part by the treatment—in this case, bad therapy—meant to cure it. She begins by showing how thoroughly therapeutic thinking has twisted parents’ understanding of their role in socializing their children. A generation of mothers and fathers ill-disposed to displays of authority has come to view harsh words and punishment as outmoded power moves bound to leave their children emotionally stunted; they try to reason, cajole, beg, and blackmail the kids to put their shoes on, take a bath, or go to sleep. When they fail to wrangle their progeny, they turn to self-anointed experts to diagnose and solve the problem. The experts select an answer from a grab bag of recently minted labels that are often more like placebos for parental frustration over their powerlessness than scientifically tested judgements: the child has “sensory processing issues,” “oppositional defiant disorder,” “social anxiety disorder,” ADHD, or some other novel ailment. Stunning numbers from the CDC speak to the extent of bad therapy’s impact: 42 percent of the rising generation has received a mental-health diagnosis.
On its own, iatrogenesis is too easy an answer for as complex a socio-psychological problem as the mental-health crisis, but Shrier makes a powerful case that bad efforts at prevention can boomerang in the credulous minds of the young. The once-touted anti-drug DARE program, for instance, was supposed to scare kids away from taking drugs; instead, according to several studies, it stirred up their curiosity and led to more experimentation. Researchers are beginning to notice that this same dynamic applies to other techniques for improving mental well-being. “More Treatment but No Less Depression: The Treatment Prevalence Paradox,” the title of a study of mental health and treatment in Western countries, captures the contradiction of the current situation.
Part of the problem is that mental-health professionals often seem oblivious to children’s impressionability, failing to notice how easy it is to implant negative thoughts and feelings kids might not otherwise have had. Shrier tells how she took her ten-year-old son to a clinic for help with a stubborn stomachache. During the visit, a nurse used a survey to interview the boy with questions like: “1. In the past few weeks, have you wished you were dead? 2. In the past few weeks, have you felt that you or your family would be better off if you were dead? 3. In the past week, have you been having thoughts about killing yourself? If yes, please describe.” Keep in mind a few facts of the case: this was an appointment for a stomachache. The child was only ten years old. The health-care worker had no indication of any mental distress. With the best of intentions, an adult was implying that thoughts of suicide are something children typically have to a child who was in all likelihood largely spending his time obsessing over baseball statistics and Minecraft. That the nurse asked Shrier to leave the room before beginning the interview—because supposedly children are more forthcoming about their inner life with a complete stranger with a clipboard than their parents—only adds to the incoherence of the activity.
Shrier’s chapters on the schools’ contribution to this era of bad therapy make the most compelling case for iatrogenesis. Schools are now wedded to Social and Emotional Learning, one of the latest of the recurring fads that regularly excite American educators. SEL has the effect of promoting “unceasing attention to feelings” and nourishes hyper vigilance and, she argues, anxiety. Teachers schedule “mindfulness minutes” (to bring attention back to the present moment) and “emotion check ins” (how are we feeling today?) Though untrained and without any thought-out theory of the juvenile mind, teachers encourage kids to share thoughts making them sad or angry—their parents’ divorce, a fight with a father—in front of other kids. Woe to the shy or introverted child: educators seem intent on subjecting their students to the stares and gossip of their classmates, though they may be effectively preparing them for the TMI spirit of social media.
Moreover, as in the case of the nurse with the child-suicide inventory, SEL-inspired professionals are quick to insert themselves between parents and children. In a number of states, laws allow 13-year-olds to go to a counsellor without notifying their parents. In a number of school districts, a similarly misguided deference for juvenile privacy applies to kids who ask teachers to change their pronouns and names in an effort to change their sex with no parental input. “Social-emotional learning,” Shrier quips, “turns out to be a lot like the Holy Roman Empire, neither social, nor good for emotional health, nor something that can be learned.”
When fragility is adults’ default assumption about children, when trauma is assumed to be omnipresent—Atlantic writer Derek Thompson notes that the TikTok hashtag #Trauma has more than 6 billion views—it has a pernicious effect on children’s perceptions. It frames their expectations and understanding of their experience, denying them opportunities to learn how to exercise their natural resilience. By the time they are in high school, they are walking psychiatric manuals, casually reciting all their friends’ maladies. One 16-year-old whom Shrier interviews speaks of a friend with “Trichotillomania,” also known as “hair-pulling disorder,” the urge to pull out hair from the scalp, eyelashes, and eyebrows. Other classmates, the teen says, suffer from “exam anxiety” or “social phobia"; she could have also mentioned anorexia, self-cutting, dissociative identity disorder, gender dysphoria, and the like. None of this oversharing reflects a maturing capacity for self-reflection or deep friendships; it’s more like a “trading of memes.”
For all its considerable intelligence, Bad Therapy is bound to get the sort of criticism that speculative arguments are often subject to. Not everyone, especially academics and dug-in parents and teachers, will be as open to Shrier’s thesis as this reviewer. Shrier is writing, she says, about “the worriers; the fearful; the lonely, lost, and sad,” rather than the genuinely mentally ill. But surely some kids are deeply anxious, lonely, lost, and sad for non-iatrogenic reasons. After all, plenty of such children existed in the past who were not victims of bad therapy.
More pointedly, naysayers will likely object to a paucity of data and experimental research. Shrier has a good answer here: there simply isn’t much of either available. Nor is there likely to be. Educators are often secretive, especially when treading in areas that parents have reason to find intrusive. Social scientists struggle to get accurate, measurable information about people’s emotional states; it’s even harder when those people are minors. A bigger obstacle still is how to study “therapy,” whose very meaning is hard to pin down. The APA defines it this way: “any psychological service provided by a trained professional that primarily uses forms of communication and interaction to assess, diagnose, and treat dysfunctional emotional reactions, ways of thinking, and behavior patterns.” Meantime, professionals may be trained in one of many different approaches. Some, like Cognitive Behavioral Therapy, even promote resilience rather than the obsessive navel-gazing that Bad Therapy justly warns about.
It’s a good thing that Shrier has shown herself to be a brave and determined woman in the (continuing) rocky aftermath of Irreversible Damage. She is likely to need those qualities once the mental-health establishment and educators get a look at Bad Therapy.
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