The Kids Are Actually Alright

Emily Oster:

I reached out to you because of your absolutely fantastic New York Times article, which was entitled “Anxious Parents Are the Ones Who Need Help.” I made my husband read it immediately, and it really came into what I see as a pretty active conversation about mental health for kids, some of which is quite, almost apocalyptic. 

Mathilde Ross:

Yeah. I did not know you were allowed to say, “Get a grip” in the New York Times.

Emily:

They have some restrictions, but that’s not one of them.

Mathilde:

The language of crisis isn’t helping, or it’s getting to the wrong audience. There is a mental health crisis out there, but it is mostly not what people are talking about. The root cause of most serious mental health problems globally is poverty. Second to that, it is the terrible things that people do to each other. Trauma, child abuse, sexual violence — those are the serious problems in mental health, and those are the people we need to reach. 

Mathilde:

Going to therapy’s fine. I am hard-pressed to think of a time when going to therapy harms someone. There are exceptions to that, but it’s weirdly academic and not relevant to most listeners. But what I wrote in my article is, so, it’s not that therapy’s going to harm anyone; it’s that what is the impact on your real-world relationship if you go to therapy, as opposed to working things out with the loved ones that you already have, or with the people that are in your life and going to stay in your life?

Emily:

It’s interesting. I think that there’s a parallel to — even one step further — I think we, as adults, scaffold quite a lot of kid conflict relative to when I was a kid. When I was a kid, there was a lot more “Everyone’s really mean at school and people are doing all kinds of terrible stuff,” but it was ignored or it was like, “You guys are going to work this out, and sorry that you feel terrible, but it’s not the teacher’s job to fix this.” In the current environment, I think, it’s way more like, “It’s the teacher’s job to fix this. Let’s have a meeting, have a counseling session.” 

Mathilde:

Right, and the stuff that you’re fixing on your own as a kid is usually pretty small-stakes. But doing that stuff is practice for when you’re a teenager or an adult and it’s much, much higher-stakes. 

Mathilde:

So, I see them when they turn 18. I see the consequences of all these decisions. The biggest threats to their health and safety are going to be decisions they make themselves. That’s what to consume and put in your body, who to get in a car with, who to be in relationships with. For the most part, those are the big things that 18-year-olds in our culture are going to be needing to make important decisions about. When they’re little, your role is to protect them, but as they mature, they have to take on more and more of that themselves. Those two things are at odds.

Emily:

Yeah. Jon Haidt talks about this idea of the cycle of incompetence: of treating your kids as helpless, or in this case, protecting them and then being scared that later they haven’t developed those skills. The way that I sometimes think about it is, it’s so easy to see the elements of safety that are visible, the physical; it’s so easy to understand the idea of freezing, the frostbite. You understand, you know what frostbite is. You’re familiar with it. 

Emily:

This is ParentData. I’m Emily Oster. 

Newsclip:

Even before the pandemic American kids have been dealing with a crisis, rising rates of suicide, self-harm, anxiety, and depression.

Emily:

Teenagers are being ruined by social media. They’re stuck in an arrested development. They’ve been damaged by the Covid pandemic, they’re having sex later or not at all. They’re being coddled by their parents. The overwhelming feeling can be that they need to be propped up, that teenagers have gotten more fragile, that they need our help, that they need us to be paying more attention to them.

Newsclip:

New guidelines suggests screening all teens for depression starting at age 12.

Newsclip:

How do you know that this isn’t just “They’re being a teen, they don’t want me around,” and that there’s severe depression? You have to really look for warning signs. There are some clear warning signs.

Newsclip:

Excessive irritability, trouble sleeping or excessive sleeping, sudden severe weight gain or weight loss, a sudden drop in grades in school, sudden loss of interest in activities they used to enjoy.

Newsclip:

If all of a sudden your child went from being the most outgoing, happy-go-lucky kid that you’ve ever seen, to all of a sudden they’re recluse. They don’t want to hang out with their friends or they’ve got an entirely new group of friends. They’re not eating the way…

Emily:

Today on the podcast, my guest has a different perspective. Dr. Mathilde Ross, who goes by Tildy, is the senior staff psychiatrist at Boston University Health Services. She works with college students with serious problems and college students with less serious problems. I came to her because she wrote an op-ed in the New York Times about how parents should get out of their own children’s way. In her view, some of this horror story, some of this talk about the teenage mental health crisis is overblown, that in fact parents are more worried about most of their kids than they should be. One of the things she says in the article is, “Anxiety about anxiety has gotten so bad that some parents actually worry if their teen isn’t anxious.” She also tells parents to “Get a grip,” which is what actually pulled me into calling her.

Mathilde:

I’m happy to be here. Thanks for the invitation.

Emily:

I’d love to have you introduce yourself a little bit. Let us know who you are, what you do, and then we’ll dive into mental health.

Mathilde:

Great. I am a psychiatrist. I went to medical school and have a full medical license and did a residency in psychiatry, and there’s also a board certification process, so it is different from a psychologist, but people often mix them up, which is fine because we do have very overlapping roles and work together quite a bit. I work at Boston University in the student health services, so most colleges and universities have a counseling center where students can go for mental health issues. I am finishing my 16th year, which is enough to graduate from college four times over. What does that translate to? Every year I am involved in the care of around 200 patients, all of which are BU students, mostly undergrads ,so 200 a year multiplied by 16, 3200 patients. That is going to be the experience base that I’m going to be talking to you from.

Emily:

Amazing. We’re going to talk about mental health for kids, and I reached out to you because of your absolutely fantastic New York Times article, which was entitled, Anxious Parents Are the Ones Who Need Help. I made my husband to read it immediately, and it really came into what I see as a pretty active conversation about mental health for kids, some of which is quite almost apocalyptic. There’s a sense of mental health for kids is declining, it’s the lowest it’s ever been. Your article doesn’t take that frame, or at least I think isn’t quite the same level of concern. I’d love you to talk a little bit about that discourse and how that feels to you from where you sit with the students.

Mathilde:

Yeah. Okay. I’m going to tell you as a small piece of background that when I found out the article was accepted, I went to our director and I’m like, “I just got accepted into the New York Times.” I wanted her to read it and know it was about to go out there and she read it and first of all, she was laughing at all the right parts, which was awesome. She put it down and she said, “The narrative of crisis has got to stop.”

Emily:

Can I just pause you to read… To give people who haven’t read this a flavor of the article, this is the part of where I laugh the most, “But I do have some advice for parents. The first thing I’d like to say, and I mean it in the kindest way possible is get a grip.” That’s a little bit of the tone of the article. Okay. Please continue.

Mathilde:

Yeah. I did not know you were allowed to say, “Get a grip,” in the New York Times.

Emily:

They have some restrictions, but that’s not one of them.

Mathilde:

The language of crisis isn’t helping or it’s getting to the wrong audience. There is a mental health crisis out there, but it is mostly not what people are talking about. The root cause of most serious mental health problems globally is poverty. Second to that, it is the terrible things that people do to each other. Trauma, child abuse, sexual violence, those are the serious problems in mental health, and those are the people we need to reach. Now I want to, is it okay if I give you a metaphor? I think it’s-

Emily:

I love a good metaphor.

Mathilde:

Great, okay. This is a little bit of a long one, but I think it’s necessary to capture the complexity. I live in Boston and the greater Boston area is rather notorious for its weather. Partly the weather is often bad, but partly just because it changes so much. If you live in this area and have to go outside at all, you pretty much have to do a weather check pretty much every day. I do, and most people I know do. Oh, there’s the little caveat that October to April maybe keep an eye on the long range forecast of those nor’easters, right? Every morning, look out the window, is it raining, yes or no? Today it was, I wore a raincoat. Now, what happens if instead of looking out the window I decide to call the National Weather Service? It would probably be awesome.

Emily:

I like this metaphor. I think it connects to what you say in the article, which is the kids are mostly fine, that for the most part kids are doing okay. But what’s interesting about that metaphor is that even if things are mostly fine, people are still seeking out help that they would need if things were not fine and having somehow the impression that this is a thing that you do when you need to know whether to wear a raincoat. As opposed to this is a thing that you do if you are needing to operate airplanes in the metaphor.

Mathilde:

Right. Sometimes kids are not fine, but mostly they’re not fine in a way that can be handled by the adults in their world. There are going to be the exceptions, the more serious things, but what kids mostly need, and what I wanted to give the message of parent empowerment regarding what kids mostly need is for their parents to be there, to not really freak out about the situation, to handle it and help them move through it. I feel like parents at the moment don’t really feel like this is okay. I feel like they think they’re not doing enough if they don’t get an expert, even if getting an expert opinion isn’t always the right thing.

Emily:

Yeah. I think this relates, I want to turn to this question of what is the problem with the parents? Some of what you’re saying relates to some of these points in Abigail Shrier’s book, Bad Therapy, which I’ve talked about on the podcast before, which I’m sure you’ve read, and her view that we’re defaulting to therapy too frequently, that we’re pathologizing even pretty typical behaviors and that a lot of the problems that kids have are in fact caused by therapy as opposed to help.

Mathilde:

Well, I have not read the book, so I am conservative enough to think if I haven’t read the book, I should probably not have a public opinion.

Emily:

Fair enough.

Mathilde:

But I did listen to your podcast with Dr. Becky.

Emily:

Okay, there you go.

Mathilde:

Which was a totally awesome podcast, by the way. I thought Dr. Becky was right on. She’s great, so no, going to therapy’s fine. I am hard pressed to think of a time when going to therapy harms someone. There are exceptions to that, but it’s weirdly academic and not relevant to most listeners. But what I wrote in my article is, so it’s not that therapy’s going to harm anyone, it’s that what is the impact on your real world relationship if you go to therapy as opposed to working things out with the loved ones that you already have, or with the people that are in your life and going to stay in your life? If you go to therapy for some issue and you go to therapy for several weeks and then you feel better and the issue is resolved, what you learn from that is, “Wow, my therapist really helped me.”

Emily:

It’s interesting. I think that there’s a parallel to even one step further. I think we, as adults, scaffold quite a lot of kid conflict relative to when I was a kid. When I was a kid, there was a lot more, “Everyone’s really mean at school and people are doing all kinds of terrible stuff,” but it was ignored or it was like, “You guys are going to work this out and sorry that you feel terrible, but it’s not the teacher’s job to fix this.” In the current environment, I think, is way more like “It’s the teacher’s job to fix this. Let’s have a meeting, have a counseling session.” There’s some aspects of that that I think are very good, but at some point I sent one of my kids to camp to sleepaway camp, and one feature of sleepaway camp is it’s like Lord of the Flies.

Mathilde:

Right, and the stuff that you’re fixing on your own as a kid is usually pretty small stakes. But doing that stuff is practice for when you’re a teenager or an adult and it’s much, much higher stakes. Emily, parent used to be a noun and now it is a verb.

Emily:

So like the 1970s?

Mathilde:

Yes. Now, it is a verb. When I grew up, I’m a little older than you, but when I grew up, parents were nouns. They stood around drinking wine, talking to the other parents. If something was-

Emily:

Cocktails, having a cigarette.

Mathilde:

If something was wrong, you went to your parents, probably your mom, and they gave you a kiss and talked to the other parents. Then when you finally got bored of the adult conversation, you left and joined the other kids. I’m not saying that things were perfect back then. As you alluded to, I think bullying was really, really bad when we were growing up.

Emily:

Much worse.

Mathilde:

In fact, I know it was really bad. Also, serious accidents, there really were terrible things that would happen to kids who were unsupervised around water, or things with wheels, or the kitchen. I don’t think that things were perfect back then, but now parenting is a verb and every aspect of it requires thought, and energy, and consternation, and consulting with your friends and reading a book. I think it’s swung way too far. I think it makes being a parent way less fun and the kids don’t like it. They don’t want parents to be micromanaging their activities, or their friends, or their sports, or their grades, or their college choices or their career. They just want their parents to be there like a noun.

Emily:

You see a lot of college students, you treat college students and I teach college students and there’s more parental involvement than one might hope. Do you see that?

Mathilde:

Where do I even begin? I hear stories of students whose parents are tracking them on Find my iPhone and call them when they’re not in class. I would say it is not at all surprising to hear about parents who call multiple times a day.

Emily:

What do you think… That seems, it sounds in some ways ridiculous, but how do we get there? How do I, as a parent get to calling my kid to see if they’re in class when they’re 19? What happened?

Mathilde:

Yeah. First of all, I am not anti-parent. I love parents.

Emily:

No, I love parents. Look, I love parents.

Mathilde:

You’re literally doing a parenting podcast.

Emily:

Literally it’s my entire job is parents.

Mathilde:

I am a parent and almost all my friends are parents. It is the world’s hardest job. I think it is extremely well-intentioned. I think parents are doing what they think they are supposed to do. If you think about it, yeah, you’re told to be involved, you’re told to be an involved parent, you’re told to pay attention.

Emily:

You’re never told that there’s a limit to that. It’s like more involved, more time, more time on the floor every moment that you’re with your kid, that’s investment. Yeah.

Mathilde:

I have to say that doing this work has been really helpful for me because in the moment you can recognize the urge to get involved. One of the things that has guided my parenting, sorry, verb…

Emily:

My position as a parent.

Mathilde:

When they turn 18, so I see them when they turn 18, I see the consequences of all these decisions. The biggest threats to their health and safety are going to be decisions they make themselves. That’s what to consume and put in your body, who to get in a car with, who to be in relationships with. For the most part, those are the big things that 18 year olds in our culture are going to be needing to make important decisions about. When they’re little, your role is to protect them, but as they mature, they have to take on more and more of that themselves. Those two things are at odds.

Emily:

Yeah. Jon Haidt talks about this idea of cycle of incompetence, of treating your kids as helpless, or in this case, protecting them and then being scared that later they haven’t developed those skills. The way that I always sometimes think about it is it’s so easy to see the elements of safety that are visible, the physical, it’s so easy to understand the idea of freezing, the frostbite. You understand you know what frostbite is. You’re familiar with it. You watch some videos about Everest. That can happen, probably not to your kid, whatever. That’s very visible.

Mathilde:

Yeah. I would add that sometimes the path of least resistance just favors doing it yourself in some way.

Emily:

Most of the time. Did you ever watch the three-year-old put their shoes on?

Mathilde:

Yeah. Right. It can be so painful getting out the door with toddlers, and yet they’ve got to learn how to put their coat and shoes on. Yeah, sometimes when you’re in a hurry, you got to just tie their shoes for them or whatever, but if you do that every single time, you’re still going to be doing it when they’re 12. Just like it’s easier to remind them to bring their lunchbox or even maybe put it in their hand when they’re on the way out the door, when actually the consequence of forgetting your lunchbox is not having lunch. You learn a lot better from that than you learn from being nagged yet again by your mom.

Emily:

This strikes me as an interesting, there are two things that we over-scaffold that then you see in the potentially the older kids. One is the how do you make your own decisions and learn to make good choices when there are bad choices available? The second is just literally how do you learn to get up in the morning and function as a person where I think this is partly why people’s parents call them before every class because that’s what they did in high school. They got them up every morning. Now, without mom, maybe they can’t get up, or at least the parent’s perception is, “Without me, my child will never learn to get up out of the bed.”

Mathilde:

Yeah, it’s the parent’s perception.

Emily:

All right. You think people who are familiar… Children, college students are able to get out of the bed if they choose.

Mathilde:

Right? They absolutely are. If they don’t, there are going to be natural consequences that in the bad old days when we were in college, you probably were just going to get a zero for your participation grade and maybe fail the class. Now, the world is much kinder, and if you’re not getting up for class, probably someone calls an office like mine and we outreach and we drag you in here and figure out what’s going on. Either way, your parents don’t need to be involved in that. To some degree, if you’re propping them up too much, you can protect them from the natural consequences. Over the long run, that isn’t really a good situation.

Emily:

In an ideal world, you would’ve developed some of these skills before they got to college, but I guess what you’re saying is even if you didn’t, it’s okay. They will learn about alarm clocks.

Mathilde:

There’s a reason we call them college kids because they’re kids. There are armies of people like me, who are non-faculty, university employees whose job it is to help them become adults. Most of it just happens on its own, but some of them do need a little bit of propping up. Yes, everybody loves to complain about administrative bloat. Universities probably complain about it.

Emily:

They do love that.

Mathilde:

They probably complain about that at Brown too. But you’re probably glad that you have a counseling center so that you don’t actually have to figure out why someone isn’t coming to your class. You can just turf it out to another department.

Emily:

Yeah, I do like that. That’s a fair point. When I drop my kid at college, should I just not call? What should I do? I’m tempted to call. It’s eight o’clock in the morning. I know she’s got class. How should I control myself?

Mathilde:

Be a noun. Don’t call. Just be there. Be ready for the call when it comes. When I was in college, it’s probably similar for you. We had one shared phone for a whole suite of roommates, and it was probably similar for you. It was like normal to call home on Sundays, pretty much everyone did. It was normal for my peers to call home once a week. That was the high end. Plenty of people, it was once a month. Things have changed and you might want to check in about something small, and there’s texting and there’s lots of different ways of communicating. I think the once a week model is probably never coming back. It’s lovely that parents are more involved in their adult children’s lives, and it’s actually really good for your adult prognosis if you have a good relationship with your parents. But what I would suggest is, and this is what I mean when I say be a noun, let them come to you, follow their lead.

Emily:

Yeah. I think that part is, that last part is really hard that we get so wrapped up in our kids’ success and our kids’ outcomes that to separate is the goal of parenting adults, but it’s pretty hard.

Mathilde:

The job of a parent, actually this is also the job of a good therapist. The job of a parent is to put yourself out of a job.

Emily:

More ParentData, including what college kids are actually struggling with and maybe what we as parents can do to help after the break.

Emily:

I want to tell you that when I was in college, I emailed my mom a lot. We had emails, so that was the method. In the first week I wrote her and told her that she needed to send me AA batteries because I couldn’t get them at school. I went to Harvard and across the street from my dorm was a CVS. Literally, you could see it from the window and they sell batteries there. But somehow I basically was a pretty functional person, but somehow the idea that one purchased batteries, I was just like, “Those just appear.” I never got the lesson about battery purchasing. She sent the batteries. She remembered this story later to tell people why I was an idiot, but she sent the batteries.

Mathilde:

Well, she probably loved it too. You probably were a really independent young woman and just the idea that you still needed her for batteries. Yeah, for batteries.

Emily:

When you worry about kids, about college kids, what do you really worry about? If you say they’re mostly fine, but are there things you’re concerned about?

Mathilde:

Well, so one thing, and I think this is for parents of every age, but I definitely see it at this level, it can be pretty dramatic. One area where I do think you should be involved, I don’t think you should let your kids put all their eggs in one basket. Young people for whom their entire self-worth is tied up in one part of their life. It could be anything. It could be a sport or it could be an instrument that they play. If a young person has an excessive amount of self-worth tied in one thing, or actually grades is a common one, the kid who just can’t tolerate anything below an A. For young people, even for adults, it’s just not good. But if you’re in a situation where you lose that one thing, and I think the reason that I brought up sports is because something that is so easy to lose, because everyone doing a sport is one injury away from not being able to do the sport.

Emily:

Okay, leave that one at that. Wear a bike helmet. Wear a helmet when you’re on those stupid scooters.

Mathilde:

Oh, believe me, I have had that conversation. I’ve had a conversation with a law student and they’re in the office for whatever they’re in the office for. I’ve said to them, look, “You’re here for x, Y, and Z. Your biggest health issue right now is the fact that you don’t wear a helmet on your bike.”

Emily:

Yeah,

Mathilde:

Yeah.

Emily:

Helmets, that’s just necessary. I always want to yell at them. We have all these e-scooters that the Brown kids are on, and every time they go by me with no helmet, I want to be like, “Put on a helmet. Your mom would be upset.”

Mathilde:

No, you should say, “I’m going to dock your grade.” That’ll really get them to wear a helmet.

Emily:

I hope those people are not in my… If I saw somebody in my class on that, forget it. That’s like they’re done. The last thing I want to ask is we see in these big, to go back to this big discussion about the mental health of kids, which I think has gotten a lot of attention with the [inaudible 00:35:44], with Jon Haidt. There’s a bunch of this things swirling around here. We hear a lot about phones, social media. Do you think that that warrants the level of moral panic or again, would you say this is not all that it is made out to be?

Mathilde:

I was hoping you would ask about phones.

Emily:

Nice. Okay, we’re here at phones.

Mathilde:

Okay, so here is where I’m going to start. I mentioned to you that I am speaking from an experience base of around 3,200 patients, and I see the most serious stuff that we see in our office. I have simply never had a patient where I thought their primary issue was the fact that they had a phone, full stop. I have had dozens and dozens of scenarios that I know of personally where a phone has saved someone in an important way. That is speaking from my experience, what do I think about the public conversation? It makes me insane. Yeah. You see these graphs and lots of people are saying it. The reason that it makes me insane is the disconnect because what people are talking about and what I see. I’m like, “Is the whole world wrong or am I wrong?”

Emily:

That’s so interesting. First of all, my kid has eaten glitter, and it’s fine. It does show up on the other end in a disturbing manner. We can talk about that later. But it’s a very interesting position because I definitely think you’re out. I really hear what you’re saying. Then I think what these guys would come back with is, “Well, even if this isn’t causing the most significant issues, that it is contributing to attention problems and other things for some kids, or it could affect some kids badly.” But I hear what you’re saying, which is we don’t really have any reason to think that’s true in a long period of time in which maybe we might’ve expected to see that.

Mathilde:

Well, so there are definitely issues, and all people of all ages should definitely have limits around their screen time. I sleep with my phone on a different floor of the house. All our kids have technology off by nine. I also think that when a kid is middle school age, there’s this window of opportunity where they still accept your rules and limits. If they’re on their phone too much, then hey, it looks like you’re not mature enough to handle using a phone and you get it taken away for a week or two.

Emily:

Yeah, I think there’s a really, a very important nuance point there, which is that you could think that unfettered, unlimited access to all aspects of phones at all times for children is a mistake, which I think we both do. Also, feel that saying, the problem with mental health is phones, and that’s what we should focus on, that that could also be, that may also be a mistake.

Mathilde:

If you just snapped your finger and eliminated phones from the face of the earth, it would not move the needle on the mental health situation one iota, I guarantee that.

Emily:

It’s all of this idea of speaking in absolutes rather than nuance.

Mathilde:

Using judgment and common sense and paying attention. Yeah.

Emily:

How did you find the reaction to the New York Times piece?

Mathilde:

Oh, well, so honestly, it was really fun. The first part I have to tell you, so my daughter is 16 and she’s on her school newspaper. When she found out I was going to be in the New York Times, she said, “Oh my God, that’s so cool.”

Emily:

Win, that is such a win.

Mathilde:

It was such a win.

Emily:

That’s totally worth it just for that.

Mathilde:

Yeah, so I can also say my husband made me promise not to read the comments, which I have not. I have gotten-

Emily:

Comments were pretty good actually. As a person who, trust me does not read my own comments and should not, your comments were pretty good.

Mathilde:

I benefit from being a mental health professional, so I got a ton of personal messages and emails. Some of the emails I read the first two words and I was like, “Eh, not going to read that.”

Emily:

Oh, no, not for me.

Mathilde:

But a whole lot of the emails were from mental health professionals in various places around the country, and they were overwhelmingly positive. But I was joking about it with my husband later. I was like, what are the chances that a mental health professional is going to reach out to me and be like, “By the way, I hated your article.” It’s just like, not-

Emily:

Trust me. Trust me. People do write to say that they hate your article. It has happened. People do that.

Mathilde:

Oh, no. I bet people do, but mental health professionals are like, they’re either going to say something nice or they’re not going to say anything.

Emily:

Yeah, that’s fair.

Mathilde:

Oh, no. Academics, everyone else. Sure.

Emily:

Yeah, parents.

Mathilde:

Yeah.

Emily:

Well, I’m glad that you could make your… Impressing one’s kids, one’s teenagers is about the biggest. I’m still working on it with my children, but that’s the win.

Mathilde:

It was a win.

Emily:

It’s always the win. Thank you so much for joining me. This was a delight.

Mathilde:

Thanks for having me. This was a lot of fun.

Emily:

ParentData is produced by Tamar Avishai with support from the ParentData team and PRX. If you have thoughts on this episode, please join the conversation on my Instagram @ProfEmilyOster. If you want to support the show, become a subscriber to the ParentData Newsletter at parentdata.org, where I write weekly posts on everything to do with parents and data to help you make better, more informed parenting decisions. For example, earlier this year, I wrote an article about parenting adolescents where I actually got some helpful advice from some former podcast guests, Jennifer Wallace, Vanessa Kroll Bennett, and Cara Natterson about how to stay close to your teenagers and when it’s okay not to. Read and listen at Parentdata.org.

Penelope:

Right, Mom.

Emily:

We’ll see you next time.