The Morning: Talking mental health

May 6, 2024

Good morning. My colleague Ellen Barry offers a fresh way to think about growing mental health problems among young people. We're also covering the Israel-Hamas war, women in China and abstract art. — David Leonhardt

A top-down view of a child's hands coloring in a

At a mental health fair. Rebecca Kiger for The New York Times

Too much talk?

By Ellen Barry

She covers mental illness.

For years now, policymakers have sought an explanation for the mental health crisis among young people. Suicide attempts and psychiatric hospitalizations were rising even before the pandemic. Then the rates of anxiety and depression doubled worldwide.

Why is this happening? The social psychologist Jonathan Haidt points to smartphones, and the algorithms that draw kids away from healthy play and into dangerous, addictive thought loops. No, his critics say. The real problem is a grim social landscape of school shootings, poverty and global warming. Or academic pressure. Or insufficient health care.

A group of researchers in Britain now propose another, at least partial, explanation: We talk about mental disorders so much. I cover this notion in a story The Times published today.

This hypothesis is called "prevalence inflation." It holds that our society has become so saturated with discussion of mental health that young people may interpret mild, transient suffering as symptoms of a medical disorder.

This is a problem, they say, because identifying with a psychiatric diagnosis may not be helpful. Students who self-label as anxious or depressed are more likely than similar students who don't self-label to view themselves as powerless over the disorder, recent studies have shown. They may respond by avoiding stressful situations like parties or public speaking, which could make their problems worse.

One of the psychologists behind the prevalence inflation theory, Lucy Foulkes of the University of Oxford, traces her skepticism back to 2018, when she began teaching undergraduates. They were "bombarded" with messages warning that they might be in crisis, she said. "It seemed like the more we were trying to raise awareness about it, it wasn't getting better, and in fact, it only seemed to be getting worse."

She grew critical of curricula that teach children to recognize and manage their emotions, sometimes referred to as social emotional learning. Schools have introduced an array of programs, teaching children the basics of techniques like mindfulness and cognitive behavioral therapy, which have proved beneficial in adults.

Several recent studies have found lackluster or negative effects for students who received trainings, especially those who started out with more severe symptoms. That evidence has done little to dampen their popularity, Foulkes said.

An urgent need

Many experts in the field of adolescent mental health defend awareness campaigns and school-based trainings. "Especially with teens, we need more universal interventions, not less," said Zachary Blumkin, a child psychologist at Columbia University Irving Medical Center.

The main reason, they say, is that traditional, one-on-one therapy and psychiatric care is not easily available. Teenagers in crisis can wait months to see a clinician. They often land in emergency rooms as a last resort.

For that reason, the field has gravitated toward preventive models. These teach all students — not just the troubled ones — to manage distressing emotions. A 2023 meta-analysis of 252 such programs concluded that, generally, children benefit from them. There is also promise in a more tailored approach, one that lets schools focus on kids with the most acute needs.

Some experts also disagree that over-diagnosis is a problem.

Andrew Gerber, a child psychiatrist, says we should think of mental illness as a spectrum: Disorders like anxiety or depression occur in a bell curve distribution, so they're more like hypertension than appendicitis. And like hypertension, he said, they're worth treating early in their progression, with medication and therapy. "Anyone who tries to define a sharp line between 'real' illness and what is not real, no matter where they put the line, is doomed to get it wrong and do damage in the process," said Gerber, the president and medical director at Silver Hill Hospital in New Canaan, Conn.

A portrait of Lucy Foulkes, who wears a gray sweater and black pants and sits at a garden area outside the department of experimental psychology in Oxford, England.

Lucy Foulkes Sandra Mickiewicz for The New York Times

Foulkes disagrees. Even when we have good treatments, we're bad at identifying whose disorder is likely to deteriorate, she said. And some children struggle because something is wrong at home, like domestic abuse or poverty or bullying. Mindfulness trainings are unlikely to help these kids.

"A lot of the time, what's causing the problem is not something that's going to improve with medication or therapy," she said. "You're running the risk of just telling people they have a problem without helping alleviate it."

A generation is growing up fluent in the language of mental health, something that will benefit teens who badly need treatment. But others may apply medical diagnoses to the painful, normal adversity of growing up.

The "prevalence inflation" hypothesis asks us to keep an eye on those excesses. People hurt after breakups and struggle to adjust to new schools; negative feelings aren't always a sign of mental illness. They can even teach us resilience.

For more

Rates of mental health disorders are rising among American adolescents. Read one 13-year-old's story.
There aren't always enough resources to support teenagers' mental health. As schools search for solutions, some student-led clubs step in.
Are smartphones driving teenagers to depression? It's complicated, writes David Wallace-Wells in Times Opinion.

THE LATEST NEWS

Israel-Hamas War

In Rafah, in southern Gaza. Hatem Khaled/Reuters

The Israeli military said it was asking tens of thousands of Gazans sheltering in eastern Rafah to temporarily evacuate to what it described as a humanitarian zone.
Hamas claimed responsibility for a rocket attack that Israeli officials said killed three soldiers and left three more critically wounded.
Israel moved to shut down local operations of Al Jazeera, a Qatar-based news outlet.
Cease-fire talks between Israel and Hamas are at an impasse. The main obstacle is the duration of a pause.
Four children from Gaza arrived in the U.S. to receive urgent medical treatment. They were greeted at Kennedy Airport with toys and balloons.

Campus Protests

U.C.L.A. said that it would resume in-person classes today and that it had created a new campus security office.
New York Magazine and the Columbia student newspaper surveyed the campus about the protests. More than 60 percent of respondents said they had views on the conflict they avoided saying publicly.
More college professors — many of whom came of age during the era of Vietnam War protests — are joining student demonstrations, The Wall Street Journal reports.

More International News

Wang Xia sits next to another woman at a table in a brightly lit room seen through a window.

In Shanghai. Qilai Shen for The New York Times

Around Shanghai, women gather in bars and bookstores to debate their place in a country ruled by men.
Panamanians elected José Raúl Mulino, a former public security minister, as their next president.
Paris committed to making the Olympics more accessible for people with disabilities. Advocacy groups are concerned that the city remains unprepared.
In the 19th century, Belgian troops decapitated a Congolese leader and took his skull as a trophy. The leader's descendants are struggling to have his remains returned.

Business

Kim Godwin, the first Black woman to run a broadcast news division, said she would step down as president of ABC News after a tumultuous tenure.
Sony and the private equity firm Apollo are in talks to acquire Paramount.

MORNING READS

José Estuardo wears a red jersey, white shorts and red socks. He ties his shoe as it rests on a scooter. In the background people stand on a soccer field.

In Queens, N.Y. Raúl Vilchis for The New York Times

Community: For generations of immigrants, Sunday soccer in a park in Queens is more than a game.

Health: Ultraprocessed foods are linked to poor health. But what are they exactly?

Loneliness: Social connection experts offer advice on cultivating a sense of belonging.

Ask Vanessa: "How do I know if my untucked shirt is too long?"

Kocktails: As nonalcoholic cocktails become a staple on American menus, some children have begun to partake.

Metropolitan Diary: A necklace rescue in Midtown.

Lives Lived: Bernard Hill was a British actor who incarnated humble masculine leadership as Capt. Edward J. Smith in "Titanic" and as Théoden, the king of Rohan, in two "Lord of the Rings" films. He died at 79.

SPORTS

McLaren workers, dressed in orange, toss Lando Morris in the air.

Lando Norris Giorgio Viera/Agence France-Presse — Getty Images

Formula One: McLaren's Lando Norris secured his first victory at the Miami Grand Prix.

No punches pulled: At a live Netflix comedy roast, former Patriots players and Kevin Hart among others roasted Tom Brady about his divorce and Deflategate.

N.H.L.: The Dallas Stars eliminated the defending Stanley Cup champion Las Vegas Golden Knights in a thrilling 2-1 Game 7 win.

N.B.A.: Donovan Mitchell's 24 second-half points led the Cleveland Cavaliers to a comeback win in their own Game 7 against the Orlando Magic.

ARTS AND IDEAS

The artist Frank Stella looks up at a giant multicolored work of abstraction in 2015.

Frank Stella Frank Stella/Artists Rights Society (ARS), New York; Photo by Todd Heisler/The New York Times

The artist Frank Stella, who helped usher in the Minimalist movement of the 1960s, died on Saturday at 87. His career began during the Eisenhower era, when artistic tendencies — much like ideas about gender and sexuality — fell into fixed categories: one was either a figurative artist or an abstract one. Things changed, the critic Deborah Solomon writes, but Stella did not. "He never stopped insisting on the inherent superiority of abstract painting," she adds. Read her full appraisal of Stella.

More on culture

A blond woman in a corset is visible on a large screen at a concert, while a crowd is seen before her, and other screens display a grid of black-and-white photos of faces.

At Copacabana Beach, in Rio de Janeiro. Maria Magdalena Arrellaga for The New York Times

Madonna ended her retrospective Celebration Tour with a free show in Rio de Janeiro, which was attended by an estimated 1.6 million people.
Trying to find your own song of the summer? Vulture has published a bracket to sort through this year's pop deluge.
The HBO series "The Sympathizer" is a rebuttal to a Hollywood staple. It is its own Vietnam War movie and a detailed work of film criticism, James Poniewozik writes.
Over the weekend, "The Fall Guy," starring Ryan Gosling, earned only $28.5 million. It is Hollywood's lowest start to the summer box office season since 1995.

THE MORNING RECOMMENDS …

An image of a plate of pecan cake topped with frosting and coconut shavings.

Andrew Scrivani for The New York Times

Make Dolester Miles's famous coconut pecan cake.

Watch the Met Gala red carpet tonight.

Stargaze with a telescope for beginners.

Clear your phone's camera roll.

Take our news quiz.

GAMES

Here is today's Spelling Bee. Yesterday's pangram was maypole.

And here are today's Mini Crossword, Wordle, Sudoku, Connections and Strands.

Thanks for spending part of your morning with The Times. See you tomorrow.

Correction: Yesterday's newsletter named two different Kentucky Derby winners. The winner was Mystik Dan, not Sierra Leone.

Editor: David Leonhardt

Deputy Editor: Adam B. Kushner

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News Staff: Desiree Ibekwe, Sean Kawasaki-Culligan, Brent Lewis, German Lopez, Ian Prasad Philbrick, Ashley Wu

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