Date read: 07-04-2024

Author: Abigail Shrier

How strongly I recommend it: 7/10

Buy the book

Read more summaries

Therapy has become like antibiotics: You may not be taking the real thing all the time, but it’s already in your food because your food is eating antibiotics. Same for therapeutic ideas–Even if you’re not attending therapy personally, their ideas are already around you.

This book can read more like a boomer rant about the good old days. There are also dubious arguments, probable cherry-picking of evidence, and right-wing dogwhistling.

That said, I think Abigail Shrier raises good points about the introduction of therapeutic ideas into education, parenting, and daily life—most of whom are not well-equipped to even implement them in the first place.

She also raises good points about parenting: There should be no such thing as ‘expert consensus’ when it comes to parenting; after all each child is different and parenting has to be customised. Yet, the current generation onwards have been made to feel like they don’t know much about parenting, there’s an expert consensus (but with dubious methodology and conclusions), and cannot rely on previous generations’ parenting methods (because they’re all “abusive”, etc.) Is that really the right thing to do?

My takeaway: Do we really need that much therapy?

My notes

Instead, with unprecedented help from mental health experts, we have raised the loneliest, most anxious, depressed, pessimistic, helpless, and fearful generation on record. Why?

Parents seek answers from mental health experts, and when our kids inevitable receive a diagnosis, they grasp it with pride and relief: a whole life, reduced to a single point.

No industry refuses the prospect of exponential growth, and mental health experts are no exception. By feeing normal kids with normal problems into an unending pipeline, the mental health industry is minting patients faster than it can cure them.

Well-meaning therapists often act as though talking through your problems with a professional is good for everyone. That isn’t so. Nor is it the case that as long as the therapist is following protocols, and has good intentions, the patient is bound to get better.

Any intervention potent enough to cure is also powerful enough to hurt. Therapy is no benign folk remedy. It can provide relief. It can also deliver unintended harm and does so in up to 20 percent of patients.

Therapy can hijack our normal processes of resilience, interrupting our psyche’s ability to heal itself, in its own way, at its own time.

Why don’t therapists typically admit that their methods can cause iatrogenic harm?

A group of researchers considered the question and concluded that, unlike the doctor, the “psychotherapist is the ‘producer’ of treatment,” and is “therefore responsible, if not liable, for all negative effects.” The therapist often doesn’t want to acknowledge that the medicine isn’t working—because she is the medicine. The admission is a little personal.

A group of academic researchers recently noticed the same. They published a peer-reviewed paper titled “More Treatment but No Less Depression: The Treatment-Prevalence Paradox.” The authors note that treatment for major depression has become much more widely available (and, in their view, improved) since the 1980s worldwide. And yet in not a single Western country has this treatment made a dent in the incident of major depressive disorder. Many countries saw an increase.

The social critic Christopher Lasch once observed that therapy “simultaneously pronounces the patient unfit to manage his own life and delivers him into the hands of a specialist.” And I couldn’t help thinking of Becca’s predicament when I read this from Lasch: “As therapeutic points of view and practice gain general acceptance, more and more people find themselves disqualified, in effect, from the performance of adult responsibilities and become dependent on some form of medical authority.”

So what makes someone a good therapist for adolescents? For one thing, he (Ortiz) said, a good therapist doesn’t treat therapy with a teen as an annuity. “If your therapist doesn’t talk to you about termination [of psychotherapy] during your first session, it’s probably not a good therapist.”

But he has enough respect for the power of therapy to reject the idea that everyone should be in therapy, a notion Ortiz likens to a surgeon who ventures: Well, he looks healthy, but let’s open him up and see what we find.

A rich emotional vocabulary can help children describe their feelings. But many of our therapeutic interventions with children, she says, go far beyond supplying one. “We are basically telling them that this deeply imperfect signal”—that is what they are feeling—”is always valid, is always important to track, pay attention, and then use to guide your behavior, use it to guide how you act in a situation.”

Adults should be telling kids how imperfect and unreliable their emotions can be, Chentsova Dutton says. Very often, kids should be skeptical that their feelings reflect an accurate picture of the world and even ignore their feelings entirely. You read that right: a healthy emotional life involves a certain amount of daily repression.

According to the best research, we have it all backward. If we wanted our kids to be happy, the last thing we would do is to communicate that happiness is the goal. The more vigorously you hunt happiness, the more likely you are to be disappointed. This is true irrespective of the objective conditions of your life.

“Kids today are always under the situation of an observer,” said Peter Gray, a professor of psychologyat Boston College and author of the classic introductory textbook on psychology. “At home, the parents are watching them. At school, they’re being observed by teachers. Out of school, they’re in adult-directed activities. They have almost no privacy.”

Actually, Gray said, adding monitoring to a child’s life is functionally equivalent to adding anxiety. “When psychologists do research where they want to add an element of stress, and they want to compare people doing something under stress versus no stress, how do they add stress? They simply add an observer,” Gray said. “If you’re watched by somebody who seems to be assessing your performance, that’s a stress condition.”

Real play, of the developmentally beneficial sort, involves risk, negotiation, and privacy from adults: the fort or treehouse built to block adults’ view. Instead, Gray warns, we are living through a “play deprivation experiment” in which teachers and parents and therapists endlessly instruct children on feelings and emotions—but rarely afford them the space or privacy to develop the capacities that are the subject of their endless preaching. “We have removed the things that are joyful to children, and we have substituted things that are anxiety-provoking, and they would be anxiety-provoking for you and me too,” he said.

But possibly the grimmest risk of antidepressants, antianxiety meds, and stimulants is the primary effect of the drugs themselves: placing a young person in a medicated state while he’s still getting used to the feel and fit of his own skin.

One of the most damaging ideas to leach into the cultural blood-stream, according to Coleman, is that all unhappiness in adults is traceable to childhood trauma. Therapists have made endless mischief from this baseless and unfalsifiable assertion.

Therapists can do harm to someone’s agency and belief in themselves, Dr. Byng told me. Treatment dependency is a common iatrogenic risk of therapy. “I think that’s probably the simplest explanation of the problem: that we’re just teaching people that they’re not adequate humans.”

A patient inducted into the habit of consulting with the therapist may become convinced she cannot ever act without the express approval of an authority figure.

The great Israeli sociologist Eva Illouz notes that the trauma narrative is plotted backward—from present adult dissatisfaction to the epiphany of a childhood spent in a dysfunctional family. “What is a dysfunctional family? A family where one’s needs are not met. And how does one know that one’s needs were not met in childhood? Simply by looking at one’s present situation,” Illouz writes. “The nature of the tautology is obvious: any present predicament points to a past injury.”

In the 1990s, van der Kolk was both a chief architect and major proponent of the idea that our bodies hold onto buried memories of trauma, which require a therapist to unearth. He traveled the country testifying for the prosecution in repressed memory cases, facing off against memory experts like Elizabeth Loftus and Harrison Pope, who insisted that the whole idea wasn’t good science. “Van der Kolk’s testimony was crucial to putting innocent people in prison,” wrote Mark Pendergrast, a science journalist who has covered the false memory scandal extensively. Van der Kolk’s 1994 paper, also titled “The Body Keeps the Score,” supplied scholarly heft to these prosecutions. To this day, van der Kolk has never disavowed the theory; an entire section of his book is dedicated to the “Science of Repressed Memory.”

This idea of “trauma’s shadow on your psyche” has profoundly changed the practice of psychotherapy, education, and how we raise our own children. With their palette of science-ish suggestions and compelling metaphors, Maté and van der Kolk have painted for us a world whose every surface is tinged with trauma’s hues. And the notion that every one of us carries the damage of even our ancestors’ childhoods has become an indelible feature of our societal self-portrait.

Several of the academic psychologists I spoke to think this view is wholly misguided. They wanted me to know that this theory runs contrary to the best research. In fact, their work showed that the opposite was true: resilience—not permanent traumatic response—is the norm. Even for kids subjected to desperate hardship—poverty, alcoholism in the family, family instability, and parental mental illness—studies showed that in all but the most persistently dire circumstances, they typically demonstrate resilience.

“Memories are not stored ‘in the body’ [that is, in muscle tissue], and the notion of ‘body memories’ is foreign to the cognitive neuroscience of memory,” McNally has written, in a paper refuting van der Kolk.

When you’ve experienced a potentially traumatic event, you’re particularly likely to remember it explicitly. There’s no evidence that even survivors of the worst traumas hold memories implicitly or that those memories can be stored outside of the central nervous system.

Academic psychologist Martin Seligman, winner of the APA Award for Lifetime Contributions to Psychology, has reviewed and summarized the studies on childhood trauma this way: “The major traumas of childhood may have some influence on adult personality, but the influence is barely detectable. . . . There is no justification, according to these studies, for blaming your adult depression, anxiety, bad marriage, drug use, sexual problems, unemployment, beating up your children, alcoholism or anger on what happened to you as a child.

A favorite faux diagnosis of so many therapists, “complex PTSD,” was roundly rejected by the editors of the DSM—despite efforts by psychiatrists like van der Kolk, a leading proponent of its inclusion. Nonetheless, popular psychotherapists like LePera promote this diagnosis as if it were a recognized disorder.

It isn’t. The candidate diagnosis was rejected because—according to Allen Frances, a psychiatrist and professor emeritus of Duke University School of Medicine—the symptom pattern was so broad it overlapped with most other disorders, the traumas it described were so common as to cover most patients, it was based on poor research, “people pushing it [were] not respected” in the field, and it was “too easily sold as explain-all to gullible therapists/patients.” In other words, it represented one more attempt by the mental health experts to pathologize everyone.

One mom, Ellen, who consults to private school parents, apprised me of a bizarre and chilling trend among the rising generation. Many teens maintain a cache of screenshots to incriminate their friends just in case they should need to retaliate against an accuser.

Parental authority, however, turns out to be indispensable as far as children’s welfare is concerned. Historically, it is “the one source of authority that every society takes seriously from way back in biblical times until very recently,” the great British sociologist Frank Furedi told me.

For thousands of years, until the therapeutic turn in parenting, societies took it for granted that parents’ primary job was to transmit their values to their children. And, of course, parents are the ultimate experts on their own values. Once parents decided the goal of child-rearing was emotional wellness, they effectively conceded that the actual authorities were therapists.

“Instead of saying, ‘I’ll be on his case, I’ll guide that child, I’ll try to understand that child, I’ll take charge of his moral and intellectual development,’ they kind of outsource parental authority to a bunch of schmucks who come in with all these latest rubbish ideas that make matters worse,” Furedi said. Experts have completely ignored good evidence about what actually works with kids because it didn’t grant them the centrality they crave.

The “authoritative parent,” however, is loving and rule based. She attempts to direct the child’s activities in a rational manner, encourages a give-and-take with her child, but “exerts firm control at points of parent-child divergence.” Where her point of view on a household rule ultimately conflicts with that of her child, she wins. She maintains high standards for her child’s behavior “and does not base her decisions on group consensus or the individual child’s desires.”

In studies that still manage to chagrin therapists, Baumrind found that authoritative parenting styles produced the most successful, independent, self-reliant, and best emotionally regulated kids; it also produced the happiest kids—those less likely to report suffering from anxiety and depression.

This is a remarkably sturdy research finding: kids are happiest when raised in a loving environment that holds their behavior to high standards, expects them to contribute meaningfully to the household, and is willing to punish when behavior falls short. And it flies in the face of virtually everything therapists and parenting books now exhort.

We lost this somewhere along the way: the sense that these kids we raise, they’re ours. Our responsibility and our privilege. We are not the subordinates of the school psychologist or the pediatrician or our kids’ teachers. We are more important than all of them combined—as far as our kids are concerned. We gave our kids life, we sustained it, and we are the ones who bear the direct emotional consequences of how those lives turn out. It’s time we acted like it.

The world’s longest-running and most comprehensive psychological review of adult well-being, the Harvard Grant Study, found that the five most effective traits associated with higher life satisfaction were: altruism (focus on others); humor; sublimation (“finding gratifying alternatives to frustration and anger”); anticipation (“being realistic about future challenges”); and suppression (yes, keeping a stiff upper lip in the face of unpleasant thoughts and events). Every one of the five involves taking your own feelings less seriously.

“The secret to life is good and enduring intimate relationships and friendships,” summarized Yale psychiatry professor Charles Barber, reviewing the study. A bunch of people you love and who love you back over a lifetime.

As far as I can tell, the purpose of childhood is to allow kids to take risks—things that involve getting all kinds of hurt—and to practice the skills they will need as adults while they are still safely under their parents’ roofs. Childhood exists to allow kids to hazard an unpredictable friend, lose a ball game, stand up to a bully, pick themselves up, offer another kid a hand. We want them to venture out and get their hearts broken, try and fail, and at last succeed—all while we’re still in the next bedroom.

That’s what a happy childhood is: experiencing all of the pains of adulthood, in smaller doses, so that they build up immunity to the poison of heartache and loss. And when they stumble, most of the time they don’t need a session with a school counselor. They need to be told: shake it off. They need to see in our eyes not worry but faith that they’re going to be just fine. We want all of this to happen when they’re young. If they find themselves facing disappointment or rejection for the first time as adults, something has gone terribly wrong.

So much technology brought endless accommodation. We habituated our kids to a life in which nearly all of their desires were immediately met—to order up any particular show, to stop it the second it bored them, then order up the next; or some food; or new shoes; or even a friend’s face. The slower pace of richer, more meaningful life, the moments that tee up conversation—an elevator ride, a waiting room, a checkout line, a bike ride—became all but intolerable.

I could identify my kids by challenges they face, but it feels like a betrayal even to set them down. Who am I to decide what’s a challenge anyway? These kids are really mine only for the earliest stage of what they will become. Some of the traits I might record as a flaw will turn out, in unexpected contexts, to prove a strength. Or the reason that another person, one day, comes to love them very much. Many people love their spouses for their quirks. I’ve never heard of anyone loving another for her diagnosis.