The Importance of Being Earnestly Unhappy

I don’t know if anyone is interested in an old pediatrician’s thoughts about the current crisis in the mental health of teens and college students. But the 4,000 children and their families I’ve seen over more than four decades in a predominantly suburban Bay Area behavioral pediatric practice have given me a particular window over time on the decline of teen/young adult mental health.

Without question, the primary factors affecting the mental health of most American children are poverty, racism, violence and substance abuse in the parents. But this group of stressed children is not the one represented in the surge of ER visits for teens’ mental health and the overwhelming demand for the services of college mental health teams. It is precisely my group of kids—white middle/upper middle class, grown up—that compromises most of the emotionally flailing young adults.

Many theories have been offered to explain the decline in young people’s mental health. Mind you, every generation since the ancient Greeks has written and complained about the younger generation. The list of cogent suspects this time includes the continuing decline of the American standard of living, which places greater and greater emphasis on performance. Increasing income inequality doesn’t help. Worrying about climate change and school shootings also make the list. One must add social media to the mixture, acting as a peer accelerant leading to melt downs.

And then there was the lockdown/personal isolation associated with the pandemic. But the crisis in adolescent health began before the lockdown. And the kids have been back at school for over a year and a half, but there doesn’t seem to be any slowing in the growth of the sadness and anxiety.

Let me offer my theory because it may make a difference on how we handle our youngest kids now. It’s really the same reason why I shifted from my general pediatric training to my specialty of behavioral/developmental pediatrics.

Feelings, especially bad feelings of sadness and anger, had become more important to the parents of the children I was seeing. Feelings have always been around and been described. But beginning in the 1960s, the cultural importance attached to feelings began to increase. It’s very hard to pinpoint the reasons for the ascendancy of feelings (increasing standards of living and Freud come to mind), but without question the importance of being happy—and avoiding unhappiness—has become almost a tyranny over parents, teachers and mental health professionals dealing with children.

No one wants to be unhappy, but learning to tolerate distress and unhappiness is one of the key coping skills that must be learned by children in order to manage a world that is filled with frustrations and stressors. The tyranny of the pursuit of happiness and avoiding unhappiness has altered, over the decades, the way adults address and handle the feelings and needs of children.

An example or two pop into my head. Many preschools in upscale communities promote their environment to parents by offering alternatives to the strategy of time-out (removal from the group or activity) for an emotionally out-of-control child. Any number of multiple alternative choices/activities are offered that may soothe instead. Time-out has developed such a negative connotation in some communities that the programs that continue the strategy euphemistically call this removal “break time” instead. Nonetheless, there’s an underlying growing feeling that any adverse response to a child’s behavior undermines their feelings and a positive self-image (another tyranny).

Fears of damaging a child’s self-esteem (along with potential angry-parents’ lawsuits) have led to school situations where the entire class leaves a room instead of the out-of-control child—actually, in my opinion, a much worse experience for the kid than being escorted to the hallway or principal’s office.

A whole industry of mental health professionals and learning specialists has grown to address the needs of the child. These groups, while well-intentioned, overall promote accommodating to the children’s problems rather than finding a balance between helping a child learn to cope with the environment versus the environment adapting to the child.

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Parent and professional efforts, while perhaps able to protect the child through elementary school, find their strategies beginning to fail in middle school, when children are no longer willing to accommodate one another. The peer problems grow. Then, these young people must start dealing with the expectations (including their own) of becoming more independent, facing classes and living environments (college) on their own. They just don’t seem prepared.

I’m not suggesting or advocating a return to spare the rod, spoil the child. I’m also certain that my concerns could be misused by conservative/religious groups to advocate rolling back any number of progressive ideas. To be clear, I think children’s feelings should still be acknowledged and validated.

But children, parents, and professionals need to relearn how to sit with and tolerate their children’s distress and their own—and see that it is often short term—and they all can get through it. Without such practice at an early age, these children grown up, will have to learn how to manage unhappiness when the stakes are much higher—in the school of hard knocks. There’s just no getting around it.