Michael Dowling: The many reasons we've spawned 'The Anxious Generation'

Fifteen years ago, we started a mental health program geared toward the plethora of college students struggling with severe anxiety, depression and bipolar and psychotic disorders. Based at one of Northwell's psychiatric facilities, Zucker Hillside Hospital in New York City, the Behavioral Health College Partnership Program has grown rapidly over the years, treating more than 7,000 students from 96 New York colleges and universities. Demand has been so intense, we've had to add new locations.

Most of the program's patients are part of what social psychologist Jonathan Haidt, PhD, characterizes as "The Anxious Generation" in his best-selling book of the same name. He attributes the mental illness epidemic among America's young people to the decline of play-based childhoods that began in 1990 with parental fears of kidnapping and sexual assaults, and the emergence of "phone-based childhoods" that started around 2010 with the advent of smartphones and manipulative social media apps.

This "great rewiring of childhood," Dr. Haidt contends, has led to social isolation among teens (including a 50 percent drop in adolescents' in-person interactions with friends), sleep deprivation that causes depression, anxiety, irritability, cognitive deficits, poor learning and lower grades, attention fragmentation from seemingly constant phone alerts, and a dopamine-like addiction to their phones.

Teens' mental health problems don't suddenly disappear when they head off to college. On the contrary, they often get worse once they enter a new environment. In its 2022 National College Health Assessment, the American College Health Association found that 34.6%of college students reported they had been diagnosed with an anxiety disorder, with 77% experiencing moderate to serious psychological distress. A separate study published last year found that about 17% of college students had been prescribed medication for a mental health issue, mostly antidepressants, anti-anxiety and psychostimulants, with anxiety disorders the most prevalent underlying problem.

As head of Zucker Hillside's Behavioral Health College Partnership since its inception in 2009, Laura Braider, PhD, has seen the mental health plunge among students firsthand. About 60% of her patients suffer from major depression or borderline personality disorders. Dr. Braider's program and its impact on patients admitted for inpatient care will be featured in a two-part documentary entitled "One South: Portrait of a Psych Unit," that will premier Tuesday, June 25, at 9 p.m. EST, on HBO's streaming platform Max.

Young people's obsession with their smartphones is certainly contributing to their struggles, she says, noting, "Taking a (student's) phone away is like taking meat away from a tiger." But for many, she says, the larger issues can be traced back to parenting styles and a culture that have made young people more fragile and socially isolated, depriving them of the opportunity to develop many meaningful relationships and master the day-to-day skills needed to thrive in the real world, all of which can lead to anxiety and problems with socializing once they get to college. 

Another factor, Dr. Braider says, is unrealistic expectations. "We have this idea that everyone should be happy all the time. The majority of life is not a euphoric existence."

As Dr. Haidt argues in his book, children and adolescents need to be challenged; they need to experience occasional disappointment to prepare them for the ups and downs they'll encounter in adulthood, all of which are important lessons learned when kids participate in unsupervised play with their peers.

From a historical perspective, Dr. Haidt and many sociologists point to another factor that drove the decline in play-based childhood, one that continues to impact American society and our overall mental health:  the great deterioration of the local community. In the two decades after World War II, Dr. Haidt says, "Civic groups, voluntary associations and interfamily networks thrived in this era, giving Americans a strong sense of belonging as well as an abundance of community networks." Those strong community ties began to fray with baby boomers and subsequent generations, he says, as suburbs sprawled, televisions became a fixture in nearly all Americans' homes in the 1960s, car use surged in the 1970s, shopping malls became the center of American social life in the 1980s and church attendance dwindled. "People stopped hanging out with their neighbors and were no longer available to watch kids on their streets. They stopped shopping locally, and had less and less time to give to local institutions and associations. Family life moved decisively indoors as the television became the new family hearth," Dr. Haidt says.

At a time when AI is threatening to lure our kids even further away from reality and into the virtual world, we need to figure out a way to rebuild that sense of community lost more than a half-century ago – and entice young people to put down their smartphones and engage with others, whether it be in schools, parks, civic associations, churches, commercial centers or other places where they can build personal relationships. 

While sounding the alarm about the crime, school violence, family disintegration, addiction, alienation and despair that has infected so many American cities and towns, rich and poor, urban and rural, author Seth Kaplan, PhD, offers a roadmap to recovery in his book, "Fragile Neighborhoods: Repairing American Society, One Zip Code at a Time," writing about pioneering new approaches that are proving successful in "revitalizing local institutions and the social ties that knit them together," turning neighborhoods into places where people and families can thrive.  

As Harvard researchers learned in a longitudinal study on happiness that has spanned 86 years, having strong, personal relationships enable us to enjoy longer, more fulfilling and meaningful lives. We can get there by embracing our communities and each other, not spending most of our waking hours on a smartphone.

Michael J. Dowling is president & CEO of Northwell Health, New York's largest health care provider and private employer.

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