* Certain names have been changed to protect privacy.
Here at The Depot, a popular teen center in Darien, Justin Carver*, a high school senior with a mop of dark curls, is sitting in a diner-style booth, fidgeting, scratching, tapping his foot. He never sits still. Especially not now, as he recounts the first day of his junior year at Darien High School, the day anxiety overwhelmed him. “I was like, ‘I’m not anxious, I’m just sick. First day of school—just relax.’ But I was freaking out. So I went to school that morning, and then I went and yakked up in the bathroom. I was shaking, like, ‘I can’t do this.’ ”
JUSTIN IS HARDLY ALONE. ABOUT 25.1 PERCENT OF YOUTHS 13 TO 18 SUFFER FROM ANXIETY
disorders at the present moment, and 31.9 percent have ever suffered from them, according to the National Institute of Mental Health. On college campuses, anxiety is the top complaint of students seeking mental health services, having overtaken depression. In 2016 the American College Health Association found that 62 percent of students reported feeling “overwhelming anxiety” in the past year, up from 50 percent in 2011. “Twenty percent of college freshmen are utilizing psychiatric services—that’s gone up exponentially,” says Meghan Skelton, a social worker at Weston’s high school and middle school. “By the time they graduate, 50 percent are accessing some sort of mental health services at college.”
Over the past decade, high schools have witnessed a troubling rise in the number of students who, like Justin, get so anxious they can’t bring themselves to go. Psychiatrists call the phenomenon “school refusal” or “school avoidance.” While anxiety disorders generally are quite treatable, says Dylan Kollman, author of Solving the Anxiety Dilemma (2016) and founder of the Anxiety Institute of Connecticut in Westport, “school refusal can be difficult—it’s a sticky problem.”
Kristin Hunter*, whose daughter, Caroline*, left Staples High School last year when anxiety overpowered her, likens school refusal to “grooves in a record” that deepen as the missed days pile up. “The longer you wait, the harder it is,” she says. Kristin shows us a photo of a fit, attractive sixteen-year-old with a radiant smile. “As a parent, it’s confusing. My daughter will go on stage and be in a play. But when she’s walking down the hallway or goes into a store on Main Street, she thinks everyone’s looking at her and negatively judging her.” (Caroline has since enrolled at a small private school, where she is faring better. Kristin hastens to note that Staples was “amazing” in their sensitivity to the problem: “They deal with a lot of this, you can tell.”)
Panic attacks have also become routine in schools, sending kids to the nurse’s office or worse. “I would hyperventilate and pass out and have to go to the hospital,” says Lauren Quinn*, a classmate of Justin’s whom we also met at The Depot. “I’d have probably four or five panic attacks a week. It started when I was in seventh grade. Since I’ve gotten older and worked with my doctors, I can now feel them coming and I can handle them better. But every now and then they’ll still get really bad.”
Justin thinks that anxiety is far more common among his peers than the adults of Fairfield County know: “I’d say like nine out of ten kids have it.” Lauren agrees. “It’s a huge problem,” she says. “If you talk to any student, I guarantee they’ll be like, ‘I have anxiety.’ There are so many people who don’t get it diagnosed and are suffering from it.”
“Over the last forty years, we’ve seen a 700-percent increase in anxiety, most of it coming over the past ten to fifteen years,” says Dan Villiers, cofounder of the Anxiety Institute in Greenwich, an intensive day-treatment pro-gram for adolescents, and of Mountain Valley Treatment Center in New Hampshire, the first residential treatment center for adolescent anxiety in the United States.
The experts are calling this strange turn in the culture an “anxiety epidemic.” But what does that mean? Anxiety has always been with man as an anticipatory response to danger: Confronted with a tiger in the grass, or merely the idea of one, he readied to fight or flee. The same neurochemical response (emanating largely from the amygdala, a center deep in the brain that regulates fear but also pleasure) helps modern man rise alertly to the task at hand, whether in the classroom or on the playing field. “Anxiety should, in theory, have an adaptive function,” notes Howard Weiner, a psychiatrist at Silver Hill Hospital for Mental Health and Addiction in New Canaan. “We all know that we need a certain amount of anxiety on a test—but too much is bad, and too little isn’t right, either.”
The question of too much anxiety among too many people began to occupy students of the brain about 150 years ago. In 1881 George Miller Beard, a neurologist from Montville, Connecticut, published American Nervousness, a book that, though it got much wrong (hay fever a “nervous disorder”?), managed to touch on something important: “The chief and primary cause of this…very rapid increase of nervousness is modern civilization.” Genetics, capricious parenting and family strife contribute to anxiety in children—but these factors have always been with us. Beard was talking about the massive technological and cultural change that was then spreading across the land. Train travel, electric light, the telegraph and mass media were still fairly new, and the automobile and powered flight were just around the corner. The French writer Charles Péguy wrote in 1913: “The world has changed less since the time of Jesus Christ than it has in the last thirty years.”
Before now, however, no anxiety epidemic had ever been recorded among America’s young. Where did it come from? The answer is complex. Ours is a moment marked by political contentiousness and mass shootings, which, teachers and social workers tells us, have penetrated school walls as noxious psychic forces. “For kids to feel unsafe about going to school, and teachers to feel unsafe going to work, is a big deal,” Meghan Skelton says. (Staples had dealt with a serious threat the week of our interview.)
While granting these influences, the experts we consulted train their focus on two other twenty-first-century phenomena: a vastly ramped-up culture of achievement, centered on the golden ticket of admission to a prestigious college and the good life it promises; and kids’ near-umbilical attachment to the smartphone.
As it turns out, the two are intimately related.
Suniya Luthar is a psychology professor at Arizona State known for her study of youths who attend high-achieving schools in affluent communities across the country. In twenty years of researching such schools (including Staples and Wilton high schools), Luthar has found serious maladjustment in all of them, without exception. “They should be better than national norms given their resources, right? If anything, these kids should be happier. Not only are they not happier, but in every single case, there’s at least one if not more areas in which there’s significant concern—whether it’s depression, anxiety, eating problems, self-harm or substances. It’s stunning.”
She contends that pressure is the core of the problem—“the intense amount of pressure these kids experience to excel in just about everything they do,” Luthar says. “The question is, where does this pressure come from? And the answer is, where does it not come from?”
“All of my friends, they feel like they’re under a microscope and have to perform at such a high level,” Lauren Quinn says. “It applies everywhere: sports, school, music, being in a club. Everyone’s worried about, like, ‘I have to be better than I was before, I have to be better than the next person.’ That’s when the anxiety kicks in, because you feel like you’re never doing quite enough. ‘I only got a B. I should have gotten an A.’ ”
The kids admit they put some pressure on themselves. But Luthar says they’re also internalizing a cultural condition they can’t escape. Justin puts it starkly: “I think the culture of Darien is that the weak fall to the bottom and the strong rise to the top. New Canaan, too. Wilton. Fairfield County. It’s hard to meet the expectation around here. There’s so much that can upset you in an environment like this, where it’s like, ‘you’ve got to be the best to be happy.’ It’s almost impossible not to be anxious, you know?”
Janice Marzano, who heads The Depot and is a beloved confidante of Darien’s young, remarks, “Kids are playing sports they don’t even like, just to get into college.”
Students describe their days as being relentlessly mapped out. Lauren rises at 5 a.m. for physical therapy and does not stop until she turns out the light at night, after completing her homework. “There’s literally no time to be a kid,” she says. Her classmate Maria Price* says she’ll “step back” and put off her work when she’s overwhelmed, “which makes it even more stressful in the end.”
Is gaining admittance to college really much harder these days? It’s a contested issue. But this much is true: The applicant pool has grown dramatically as colleges seek more diverse and more global student bodies; students are applying to more schools than they used to; and acceptance rates at the best schools have shrunk by as much as half over the past twenty years. “When I applied to Kenyon,” Dan Villiers says, “the acceptance rate was something like 55 percent. Now it’s 20 or 25 percent. I don’t think I could get in today.” (Many of the teens Villiers treats, not surprisingly, come to him with “fear about the future, fear of failure, doubts about themselves”—a complex of worries called generalized anxiety disorder.)
At one point in the conversation with Lauren, she pauses and waves her hand before her eyes, checking a flow of tears. A friend of hers committed suicide, she says. “In a letter, she kind of explained it all. She felt she was letting her family down, and letting her friends down, because she just wasn’t good enough.” Lauren furrows her brow at the thought of it. “She was getting B-pluses in everything. She was a really smart girl. Everyone loved her. If you’d met her, you would have never thought there was this darkness inside of her. It’s so sad to think that if she was born like, twenty years ago, she never would’ve had the issues that she had.”
This tragedy of this young woman is part of an alarming trend. Since 2007, teen suicides have been climbing steadily, the boys’ rate rising by a third, and the traditionally stable girls’ rate doubling. From 2008 to 2015, the number of children hospitalized for suicidal thoughts also doubled, with October, not surprisingly, being the peak admissions month. (But are they admitted for anxiety or depression? Often the two are “co-morbid,” or occurring together, and not neatly separable.)
The uphill suicide graph correlates eerily with the introduction of the iPhone in 2007 and the saturation of smartphones generally by 2012—at which point the graph turns steeper still. Phones and suicide? Last year, California psychologist Jean Twenge published a groundbreaking book titled iGen, which documents a powerfully suggestive link between phones—the obsessive, time-devouring use of social media on them—and anxiety and depression. Twenge writes, “The sudden, sharp rise in depressive symptoms occurred at almost exactly the same time that smartphones became ubiquitous and in-person interaction plummeted.”
“I was a little skeptical at first,” says Dylan Kollman. “It felt a little old-mannish to me: ‘Oh, it’s TV. Oh, it’s video games, or rap music.’ But her data is really strong. And you just kind of feel it with kids, that there’s something unhealthy about unadulterated access to these phones.”
Why should this be so? With the advent of smart-phones, multiple studies say, young people are spending more time alone than they used to; their “real” adventures out in the neighborhood, among flesh-and-blood people, have become rare; mediating their worlds so incessantly through the smartphone inhibits their maturity; and constant digital stimulation weakens their ability to concentrate on tasks that require sustained attention, not to mention their ability to cope with uncomfortable emotions like boredom. Tracey Masella, a social worker at Silver Hill who deals extensively with adolescents, observes, “We’re breeding kids who have no tolerance for discomfort, whether it be boredom or anxiety or sadness or rejection or failure.”
Howard Weiner adds, “Something has changed in the expectation we have of getting through life without distress.” He notes a disconcerting paradox: smartphones are contributing to kids’ distress, yet the kids are turning to them to lessen the selfsame distress—like lab rats hitting the sugar lever. As Dan Villiers puts it: “They’re self-medicating through instant access to the smartphone. That’s a fact.”
A broader point is that young people’s powers of resilience—of handling setbacks or uncomfortable situations—have seriously eroded. (The phones are but one cause. Masella also notes a shift in today’s parenting, whereby many parents’ reluctant to say “no” to their kids muddle the family’s authority structure, with chaotic results.) Jean Twenge mentions the new college habit of disinviting guest speakers for fear of causing students “emotional injury,” to borrow a remarkable phrase used by Williams College’s student editorialists. Twenge writes, “If some people might be upset, the thinking goes, we’ll ban the speaker.”
This brew of high expectation and emotional frailty is bad enough. What makes it worse, though in ways we don’t yet fully understand, is smartphones’ power to amplify. (Who could have predicted the clout of the Tweet?) Lauren Quinn describes the smartphone world as a world of mirrors in which one is always found wanting. “It’s horrible—you see these people who look like supermodels. Even someone who goes to your school. They post a picture and you think it’s so cool, and everyone else loves it, you’re just like, ‘I want to be like that. I need to be skinnier. I need to do cooler things. I need to own nicer clothes.’ It just causes so much more unnecessary stress and anxiety.”
The research indicates that Lauren’s feelings are widespread. “One thing our data is showing is that these kids think other people’s lives are always better than their own,” Suniya Luthar says. “ ‘My friends are happier than I am, more popular than I am, more successful in their love life.’ That aspect of social media is particularly damaging in terms of young people’s well-being.”
This is to say nothing of cyber-bullying and the like, that not-so-brave new world where one can practice nastiness at a safe digital remove.
Anyone would agree: Smartphones have their virtues. But Lauren has decided the vices outweigh them. She’s tired of the phones’ Pavlovian pull. “Literally the other day, I asked my mom for a flip phone,” she says. “I was like, ‘I don’t want my iPhone anymore.’ ” The engineers of Silicon Valley would applaud her. Justin Rosenstein, who helped create the “like” button for Facebook, banned himself from Snapchat—teens’ social app of choice—which he likens to heroin. Rosenstein is among a growing number of tech engineers who deem their own products unhealthy, a fact that should give us all pause.
But there’s a deeper point to be made. Between the push to achieve and the compulsion to live digitally, the young are conditioned to fixate on outcomes and rewards—not on the pleasure of doing a thing, much less on the care of the soul. “It’s a hard way to live, if your sense of self-worth is all tied in with the splendor of your accomplishments,” says Luthar. Howard Weiner adds, “If that’s all you have, there’s not a lot to fall back on when you don’t succeed.”
It’s touching to hear Lauren Quinn recall the pre-saturation days of her childhood: “We were lucky, because we were the last kids who didn’t grow up with smartphones—we had flip phones. So we got to play outside still.” The generation now in elementary school has never known a world in which people were not slaves to their gadgets. How will these children grow up? Count Dan Villiers among the concerned. “What’s so valuable in a child and an adolescent is to develop a sense of self-worth, self-confidence. And you do that by growing independence.” Too often we’re doing the opposite, he says. “We’re actually regressing them. We’re developing a generation of anxious and avoidant kids.”
Changing the culture is, obviously, a tall order, since it involves “the entire ecosystem of kids” and then some, Meghan Skelton of the Weston schools says. “Everyone’s got to jump on board.”
The schools do appear to be finding their footing as they recognize the enormity of the problem. Justin Carver says Darien High lightened his workload at critical times. Kristin Hunter recalls how Staples sent a small delegation to her house to delicately coax her daughter back to school, one class at a time. In 2013 the school’s guidance department launched the Staples Resilience Project in response to rising anxiety and depression; it’s designed to foster “emotional agility”—to help students gain a healthier perspective on inevitabilities like failure and rejection. Last year, Darien inaugurated Fitch Academy as an alternative high-school program for kids dealing with severe anxiety and related issues. And as schools put mental health and well-being at the forefront of their agendas, they turn increasingly to cutting-edge outfits like the Yale Center for Emotional Intelligence in New Haven. The new emphasis on emotional skills (starting with the ability to understand one’s own emotions and to read others’ emotions) is hardly accidental: They are essential for healthy growth and learning, and yet numerous studies show they are under assault.
Meanwhile, the hope is that students who need help will ask for it rather than suffer in silence. Consider Justin. “I’m feeling great,” he says, drumming the tabletop. “The anxiety still comes in little waves—but it used to be this big tsunami. Now, like Japan or New Orleans, we’re cleaning up, and sooner or later it’ll be a nice city again.”
5 FACES OF ANXIETY
Anxiety is a catch-all term. Therapists look to identify one of these specific problems:
1. PANIC DISORDER is “a misfiring of your fear response,” says Westport therapist Dylan Kollman. “It’s a false alarm—it would be a real alarm if a cheetah were there.” Still, the fear is so acute that people feel as if they are going to die.
2. GENERALIZED ANXIETY DISORDER is marked by feeling worried or on-edge and by an inability to escape negative thinking.
3. SOCIAL ANXIETY DISORDER or social phobia, the most common anxiety disorder, is characterized by a fear of social situations and, more specifically, by a fear of being unfavorably judged by others.
4. OBSESSIVE-COMPULSIVE DISORDER has been given its own heading in the Diagnostic and Statistical Manual of Mental Disorders. It involves intrusive thoughts and repetitive behaviors, like hand-washing.
5. POST-TRAUMATIC STRESS DISODER has also been given its own heading in the manual. It stems from traumatic experiences, like being attacked or witnessing violence, and therapists see little of it among teens.
TREATING ANXIETY DISORDERS
Therapists say most types of anxiety are fairly easy to treat—astonishing news to those who can’t stop worrying or who suffer repeated bouts of sweaty, white-knuckled terror.
“The whole secret of treating anxiety—which 95 percent of people don’t do—is learning how to increase it, not decrease it,” says Dan Villiers, founder of the Anxiety Institute in Greenwich. “Treating anxiety is immersing yourself in it.” What does he mean? Picture whatever situation lies at the heart of your anxiety—flying in a plane or attending a class that requires speaking. Although you’re in no physical danger, your brain sprays out its danger hormones, causing you deep dread or outright panic. No time soon will you expose yourself again to this danger, you tell yourself. Thus begins avoidance, a word you hear a lot from anxiety therapists. “People come here because of anxiety, but it’s really the way they avoid anxiety that causes the problems,” says Dylan Kollman, a therapist who heads the Anxiety Institute of Connecticut in Westport (no relation to the Greenwich institute).
One especially reliable anxiety-reducing proces is cognitive behavioral therapy. Think of CBT as a two-part affair: talk therapy plus exposure therapy. The talk part isn’t designed to plunge you into Freudian murk, but to examine the irrational underpinnings of your anxiety—to fix the brain’s incorrect suppositions about danger stimuli. (Standing in front of a group of people won’t harm you, even though your brain’s on red alert.) The exposure part desensitizes you, step-by-step, to your over-active danger response. Some therapists, like Villiers, incorporate virtual reality devices as a way to prepare you to confront your real-world fear. Eventually, you leave the office for the “in vivo” part of your exposure therapy, in which you confront, with your therapist, the actual plane or classroom.
The CBT process lasts a few weeks to a few months, and it can be costly. It works especially well with panic disorder and specific phobias. “The success rate for the treatment of panic disorder is 85 or 90 percent, and that’s without medication,” Kollman says. People with generalized anxiety disorder and social anxiety disorder also benefit from CBT, but the success rates are less clear-cut. Often these sufferers couple CBT with anxiety medications such as Xanax; the combination appears to work better than one or the other alone—if by “work better” we mean return people more frequently to their normal routines. Anxiety therapists tend to frown on medication or, at least, a medication-only approach. It masks rather than fixes the problem. Meditation techniques, breathing exercises, and activities like art and equine therapy may also be part of the tool kit.
A recent arrival on the anxiety treatment scene is neurofeedback. Some years ago the medical establishment regarded it as quackish. Now it’s gaining respect as a treatment for ADHD, post-traumatic stress, anxiety and much else. The idea is that we can train the brain to produce its energy in a more harmonious way. Darien High student Justin Carver* (see main story) was initially skeptical, but after several treatments he believes that neurofeedback calms and focuses him. “This is literally me strengthening my brain,” he says, “so that I can healthily make thoughts in the day and I can healthily power down at night.”
5 TIPS FOR PARENTS
Having a child with an anxiety disorder can leave
parents feeling overwhelmed, but therapists say
these practical guidelines provide needed support.
1 Listen. In the hurly-burly of daily life, we may hear our kids without listening to them and, thus, miss their distress signals. Despite appearances, our kids want you to get beyond the monosyllables. So don’t just ask them how their day was; ask them what they think about things. “You know how friends can realize that something is wrong?” asks one Darien High School senior. “A parent could do that if they listen.”
“Be curious, not furious,” advises Kristin Hunter,* a Westport mother whose daughter suffers from anxiety. “Ask them, in an empathetic tone, what they are worried about, what is keeping them from going. Try not to get mad or frustrated or ask what is wrong with them—that just shuts them down.”
Finally, refrain from lecturing. “What they want,” says Weston schools social worker Meghan Skelton, “is to connect.”
2 Limit Screentime. This is a battle in every household, but the evidence is increasingly clear: social-media addiction leaves teens feeling less satisfied with their lives and more depressed and anxious. While social media can be great for connecting, it, ironically, leaves more kids feeling lonely and excluded (ask your teen about FOMO—fear of missing out). “When I take my daughter’s phone away, it’ll be twenty-four hours of hell—and then six days of bliss,” says Kristin Hunter. “Then she says, ‘I don’t feel as stressed. I don’t feel as much pressure to keep checking my phone.’”
While they’re offline, have them read psychology professor Jean Twenge’s iGen, which warns of a looming mental health crisis among our young. If they won’t read it, pin them to a chair and read choice passages aloud.
3 Encourage Good Habits. Do your kids exercise? Do they eat well? Do they go to sleep at a decent hour (social media often leads to nocturnal hours)? Do they get together—in person—with friends? These eternal good habits are among the things getting lost to digital addiction.
4 Lighten the Load. Between multiple AP courses, sports, clubs and volunteer work—the better to build an impressive college application—many kids feel they have too much on their plate and not enough time to discover, explore, imagine. The healthiest choice for your child might be to do less. Distressingly, mental health professionals tell us, it is often the parents who won’t let kids put on the brakes.
5 Understand. Sometimes a parent will view anxiety as a character weakness and encourage his child to “toughen up” or “snap out of it.” Greenwich-based anxiety therapist Dan Villiers’ own father took this view when Villiers suffered from social anxiety in his youth. But it’s misguided, he’ll tell you. Let’s remember that Thomas Jefferson suffered bitterly from anxiety; closer to home, so did Steve Young, the Greenwich-raised Hall of Fame quarterback. Our anxious kids are battling a neurochemistry they cannot hope to defeat—not without guidance, tools, understanding and, in some cases, therapy.