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As a relatively new psychotherapist practicing since 2021, I’ve had a front row seat to what’s going on with our collective mental health. Based on my personal experience, empirical data, and discussions with my more experienced peers, some who’ve been practicing for over 40 years, we seem to be more psychologically fragile now than at any previous point in modern American history, and this is even more acute for young people. Anxiety, depression, ADHD, and suicidality are at all time highs across American society—and many other countries as well. For young people, the numbers are staggering with the CDC noting a 66% increase in depression and a 72% increase in the number of adolescents actually planning suicide between 2011 and 2021. The World Health Organization reports that one in every 100 deaths worldwide now happens by suicide. The number would be higher in the U.S. if it were not for so many gun deaths. So, what’s going on here?
First, humans have always struggled with some level of mental health issues, particularly manifestations of depression, anxiety, more rarely schizophrenia, and some level of what we refer to as personality disorders. That’s the deal with human beings: Environmental inputs generate psychological outputs. But something qualitatively different is going on over the last decade or so, particularly on the extremes of the life span, with both young folks and the elderly experiencing higher levels of mental “illness.” The challenges are even more alarming for LGBTQ+ youth, who attempt suicide at 4 times the rate of their “straight” peers, not because they’re queer, but because they are ostracized for being queer.
Some of the growth in contemporary mental health problems could be explained by better, and therefore increased recognition of issues that have always been there, but previously hidden by ignorance, stigma, and cultural values that diminished the significance of mental health in relation to physical health. For example, the Affordable Care Act, which finally required insurance companies to cover mental health conditions, dramatically increased access to mental health care in the last several years. However, the potential reasons noted above would only explain a small part of the increase in the societal-level mental health challenges we are facing today. In short, in many ways, the past was more brutal, but also more simple. Even in rarely recent times such as the cold war, for example, absurd nuclear drills in schools were frightening, but also temporary, and for most children, left behind after the school day. Today’s version of that, “live shooter” drills, represent real, concrete threat, that generate genuine fear. There have been nearly 400 actual mass shootings in American schools since Columbine in 1999.
It is much more likely that the sudden, dramatically greater prevalence of mental health issues across all strata of society is explained by a genuine, quantitative increase in psychological “illnesses” similar to what we are seeing with diabetes, autoimmune disorders, and earlier onset cancers, for example. In all cases, the causes are likely environmental, and in many cases, the same environmental inputs cause both physical and mental health problems. Importantly, I put illnesses in quotes because troubling psychological symptoms are only illnesses or disorders when viewed through a medical, pathology-based, lens that separates individuals from their experience and environment. When viewed more holistically, the symptoms are what we would expect as a natural, predictable, even adaptive response to psychic threat.
As this relates to mental health, there is likely a “perfect storm” of factors that have frankly never been experienced all at once since humans have been on earth. To be clear, over human history, we have faced, horrific, existential crises, both natural and manmade, including everything from volcanoes burying entire settlements and cities to war, genocide and slavery. The “victims” of these crises experienced PTSD, depression, anxiety, hopelessness, and a host of other psychological and somatic symptoms long before we had names for them. With some exceptions, such as colonialism, slavery, and generational oppression, one difference now is that most of the existential crises we’ve experienced in the past were relatively limited in both geography and time, and typically much less ambiguous. Another difference is that only recently has basic human survival been consistent enough that we actually have time, over extended lifespans, for other complicating variables to present themselves in our lives. As an example, for most of human history our entire life spans encompassed a few decades. As a result, there were no “midlife” crises as we experience now, nor did people endure the challenges of what now qualifies as old age. And the time over which we had to manage relationships was a fraction of what it is now. There was no work stress or divorce court or bankruptcy. Yes, as noted earlier, life was very hard and there were existential threats, but we were biologically designed for those situations. The fight, flight or freeze response, for example, was brilliantly designed for momentary physical threats. It is frankly a lousy system for addressing the “threat” of an accusatory email or loss of a job, yet that’s the system that gets triggered when we feel an emotional threat. Anxiety, after all, is just fear based on a false alarm.
As with other examples such as diet, the sudden attention on mental health reflects a kind of privilege as well. For people who have lived under endemic racism and other kinds of oppression, there has always been a higher incidence of both physical and mental health problems, worsened because the very nature of being second class and othered within myriad societal structures has also diminished both the recognition of health problems and access to healthcare! It may simply be now that more privileged members of society are being exposed to environmental factors that compromise mental health, such that it now receives recognition it has not had in the past. If so, what are these factors?
Since the increase in mental health problems for many Americans (and globally) is empirically documented, it is helpful to identify environmental factors that are also objectively different. A good place to start may be the dissolution of societal institutions that historically provided collective support and identity in less divisive and tribal ways than we see today, keeping in mind that these experiences are far different for “mainstream,” privileged folks than less privileged and, of course, oppressed members of society.
Examples include things like places of worship, public schools, and neighborhoods. Although these same institutions were sometimes powerful sources of “othering,” as well as segregated protectors of privilege for many, they were also often sources of stability, support, and predictability across societal strata. It is arguable that what remains of such institutions today is as much about deep tribalism and isolation as about supporting the collective good.
Potentially greater differences today include influences such as the internet, social media, perpetual digital tethers, and the effects of late-stage capitalism. There has been some form of media for the last few centuries, as well as peer pressure, but at no time in human history have we, particularly younger people, been exposed to such ubiquitous, often toxic digital content, with—and this is critical—almost no extended respite. Previous, analogue media was not only physically fixed in time and space, presenting limited daily exposure to consumers, but there were no such things as digital algorithms designed to play on human psychological frailties and neurochemistry, driving us into ever more divisive, tribal bubbles and content purposely designed to make us feel inadequate. That dynamic feeds mental health vulnerabilities and it changes our behaviors, often leading to actions that hurt us and those around us. Although it is difficult to prove causation between specific social media exposures and subsequent mental health issues, three likely outcomes of extended exposure are social anxiety, depression, and decreased self-esteem. This is frankly a mass experiment, the likes of which are unprecedented in human history, and the problem is not just the effect of digital media itself, it is the displacement of interactions and behaviors that are no longer happening, but that have been central to human wellbeing over millennia. In short, constant engagement with digital media and other elements of economic culture designed to separate us from ourselves and each other, preempt other activities that might support in person, in the moment, human connection and mindfulness, not to mention physical activity, thus exacerbating technology’s inherent dangers. As Gabor Maté notes in The Myth of Normal, “by its very nature, our social and economic culture generates chronic stressors that undermine well-being in the most serious of ways, as they have done with increasing force over the past several decades.” If we think in evolutionary terms, about 99% of hominid existence has taken place primarily outdoors and with significant physical activity on a daily basis. Even if we think only about the existence of humans as a species we recognize today, merely 5% of that history has taken place under some kind of “civilization.” We are simply not wired for the indoor, sedentary, technology mediated, capitalist lives we currently live. As Maté succinctly notes, “The evolutionary crucible that formed who we are and what we need was subject to very different conditions than our own.”
Another challenge we see with many youth today is a profound struggle to differentiate from parents and to confidently make decisions on their own, which is not surprising since all Gen Zers and younger millennials have never experienced extended periods of time disconnected from electronic devices, and by extension, their parents. How can they possibly learn to be comfortable by themselves and to make decisions in the absence of parental influence? Ironically, this parental influence is often connected to fear and control rather than the nurturing that would actually benefit young people. Moreover, their brains are being fundamentally rewired for a real-time, never-off, digital existence in which virtually every element of their lives, including their most intimate relationships, are mediated through technology! While we don’t know for sure exactly how constant connection to digital devices relates to decreasing mental health, we can assume that a profound shift in how humans interacted for millennia, as well as unceasing messages that we are not, and cannot be, enough, is in some way central to psychological distress, including manifestations such as eating disorders and suicidality. We do know, however, the mechanism that keeps us constantly checking our devices (and so do the inventors of those devices and content): It activates the same dopamine reward system that both chemical and other behavioral “addictions” activate.
In addition to all of the factors noted above, the last 15 years or so have also forced all of us to deal with “unsolvable,” global, existential threats beyond our control. Gen Zers, for example, have only known a life of climate crisis, economic crisis, political division and manipulation, police brutality, a global pandemic, and serial wars, both involving American troops and other nations. One could even argue that the fact of having a narcissistic president precipitated vicarious trauma in some individuals who witnessed daily anti-social behavior perpetrated by the most powerful person in the country. And importantly, 24/7 mass and social media have made exposure to the external threats noted above inescapable for most people.
Relatedly, it is only recently that American society, via millennials and Gen Zers has called “BS” on previous generations, peeling back centuries of self-serving denial. Despite silly, last gasp claims to the contrary, privilege is real. Patriarchy is real. Systemic racism is real. Capitalism has winners and losers, and profound inequality. Duh. All of those things can be true in a country worth living in and defending. The problem related to mental health is that it is exhausting and debilitating to see what’s obvious, yet be consistently gaslit by powerful elements of society that what you see and know to be true is just a “woke” political agenda. Even the concept of woke was stolen and repurposed! It’s possible that no previous generation has had to carry more dissonance than young people today.
One other factor that bears exploration is the extent to which our new level of comfort with discussing mental health is also a potential element in a self-fulfilling prophecy. I’m aware that this point will be highly controversial among some readers, but there is a clinical argument for why a focus on trigger warnings and safe spaces may be counterproductive. A principle of cognitive behavior and exposure therapies is that avoidance of triggers actually validates the perceived threat in our minds, thus worsening the effect of the trigger and mitigating against resilience. In other words, a common treatment for anxiety, phobias, and other fears is to face them, i.e., “touch the ghost,” such that they lose their power over us. This often begins through imagining the threat, then progresses to actual real-life exposure, but either way, it may be that our efforts to protect ourselves from uncomfortable stimuli may make us more rather than less vulnerable. Relatedly, when we resist distressful feelings, that act of resistance itself can actually increase the discomfort. In fact, a principle of Dialectical Behavior Therapy (DBT) is that the difference between pain (unavoidable human experience) and suffering (avoidable anguish) is acceptance. However, to be clear, I am not suggesting that individuals with untreated trauma should just “suck it up” and face their demons in uncontrolled settings. It is always preferable to directly treat trauma in a safe, supportive environment as a precursor to subsequent environmental exposures. Moreover, there are some situations, such as facing an abuser in real life, that may never be helpful. Having said that, our inclination to protect ourselves and others with trigger warnings and safe spaces may be counterproductive.
In summary, based on the work I now do with clients in my psychotherapy practice, I’ve come to believe that modern life may, in some fundamental ways, be simply incompatible with the human psyche, which is foundationally hundreds of thousands of years old and designed for a very different life experience. To reference Gabor Maté, physician, philosopher and writer again, in modern life, trauma may simply be a spectrum of human experience, rather than something that only happens to some people. I suspect he may be right, and would add, that due to everything I’ve described in this essay, what we call complex and “little t” trauma, has become far more common on that spectrum. The combination of chaotic and abusive childhoods, bullying, damaging relationships, and toxic school, work, and other social environments, have conspired to crush our souls. As Maté insightfully notes, “Today’s culture hastens human development along unhealthy lines from conception onward, leading to a ‘normal,’ that, from the perspective of the needs and evolutionary history of our species, is utterly aberrant.” This would explain why I don’t think I’ve seen a client who does not bring some kind of trauma history to therapy.
The primary takeaway of my experience so far is twofold. One is that our mental health symptoms are simply a reflection of our lived experience. Initially, our reactions and behaviors were rational and effective as coping mechanisms to address psychic threats. Over time, however, many of those same responses have become maladaptive and even pathological. The second takeaway is that regardless of how we define it, trauma seems to have become endemic to human experience, probably because the human experience, as we know it now, is at odds with our evolutionary needs as humans. It’s not an “if,” but “when” phenomenon that certainly varies in severity from person to person, but as my own very wise therapist notes, “no one escapes unscathed.” Fortunately, my work has also taught me that we have effective tools, a therapeutic renaissance really, for addressing our mental health challenges, and more importantly, we humans have an innate capacity for healing if we can just remove the toxic inputs and tap into internal sources of resilience.