Bad Therapy addresses the question: “Why are our kids so messed up?”

Abigail Shrier does not care about conventional wisdom, nor what the gatekeepers of polite opinion think of her. Shrier is an independent journalist, and a regular contributor at the Wall Street Journal. She holds an A.B. from Columbia College, a B. Phil from Oxford University, and a J.D. from Yale Law School. Her first book, titled Irreversible Damage: The Transgender Craze Seducing Our Daughters (Regnery, 2020) was named “Best Book” by The Economist and the Times of London.

Shrier, in that first book, had the temerity to point out that the rapid increase in young girls identifying as boys and going on testosterone injections and seeking surgeries was not normal. There were multiple campaigns to suppress, cancel, deplatform, and remove her book from shelves of bookstores and retailers. In late 2020, Shrier’s book was targeted on Twitter by an activist who complained to Target that the book was “transphobic.” Target acted quickly, pulling it and another book challenging the new gender-affirming consensus. After a public uproar, however, Target reinstated it a few days later. But, quietly, the book was again removed for violating “guidelines.” It was an embarrassing episode, but disquieting for the “market place of ideas” for sure.

Shrier had clearly touched a nerve, daring to notice that many of the harms visited upon hurting girls and young women in the name of “gender affirming” care caused irreversible damage and this “care” was done with the express encouragement by a mental health establishment captured by ideological forces, and counterfeit expertise.

The growing youth mental health crisis

In Bad Therapy: Why the Kids Aren’t Growing Up, Shrier now turns her attention to the mental health establishment itself, asking the simple but obvious question: why are our kids so messed up? This book will likewise make very few friends for Shrier, as she is taking on a behemoth of under-appreciated size and reach, a new Leviathan—the Mental Health machine. But that is to her credit. What she lays out in her new book is important for everyone in the fields of medicine and education. But, most importantly, those of us with skin in the game: parents.

Teaching for the past 25 years has given me a front-row seat to what can only be called a mental health catastrophe. Our kids are not all right and Shrier has given us not only the playbook on how it all went down, but perhaps a way out as well. This book immediately struck me as true, with many pages containing ideas, concepts, and illustrations that left me with the sense that I had seen almost all of these things up close. I teach at a high-stakes, high-pressure prep school, and for half of that time, I was a dean. If there was a problem (and there was always a problem), I was a hub through which students, teachers, and parents all passed through. It became clear to me that parenting had changed. As a Gen Xer, my parents would never have run interference for me if things went sideways at school. If they got the call from the school, there was no question: I was in the wrong. It was my fault even if it wasn’t my fault. The authority of the teacher was sacrosanct. So too for any adult. But in my roles at school, accommodations were the coin of the realm, and there was no more valuable gold coin than a note from a doctor.

The book is divided into three parts, under the headings of “Healers Can Harm,” “Therapy Goes Airborne” and “Maybe There’s Nothing Wrong with Our Kids”. The first section covers the crucial idea of iatrogenic harm, the second demonstrates how the bad therapy has leapt from the “lab” of the therapist’s office and entered the schools, and the final section is a call to remember what you already know, with a stirring ferverino to parents to reclaim their authority.

If, like me, you have lived in the trenches, you know that our youth mental health crisis is real. And because I have interacted with a wide array of students, parents, and teachers over three decades, this is not an isolated problem. The trends all point in one direction. It is getting worse. Shrier notes “with unprecedented help from mental health experts, we have raised the loneliest, most anxious, depressed, pessimistic, helpless, and fearful generation on record.” Though the rise of negative mental health markers can be explained in part by an increased awareness of mental health disorders, it cannot account for the sheer ubiquity, nor the continued rise amid increase in treatment. The more readily available treatments should lead to a decrease, but distress and disorder has ballooned instead. She calls this the “Treatment-Prevalence Paradox.” The ineffectiveness of treatments, despite their rapid and widespread expansion, raises serious questions: does the treatment work? Imagine if we were prescribed a medication for headaches but it did not ameliorate the pain, and in some cases actually made the pain worse. Would we still recommend that a person take the medication? Would you?

The mental health establishment has been very successful in raising awareness but also in convincing us that we need their help: “[t]he rising generation has received more therapy than any prior generation. Nearly 40 percent of the rising generation has received treatment from a mental health professional—compared with 26 percent of Gen Xers.”

She goes on to note that nearly forty-two percent of the rising generation has a current diagnosis, “rendering ‘normal’ increasingly abnormal.” She asks the professionals why we are seeing such increases, and the usual factors are invoked: smart phones, climate change, and COVID-19 lockdowns. None of these experts consider the culprit, according to Shrier: the mental health professionals and their treatments.

Diagnosing the diagnosticians

One of the most salient ideas Shrier puts forth is the notion of iatrogenesis, in which harm is visited upon the patient by the intervention. “Parents often assume that therapy with a well-meaning professional can only help a child or adolescent’s emotional development. Big mistake. Like any intervention with the potential to help, therapy can harm.”

The very notion that therapy carries with it any risk will be shocking to most lay people. Perhaps we know this intuitively such as when a friend comes for advice, and you have to weigh whether your advice is sound or if the advice will be hurtful. Sometimes the advice may be too much for your friend to handle. So, most will default to the experts. But what if the experts do not share your humility? The treatment can harm. That alone is worth considering. She notes:

“Well-meaning therapists often act as though talking through your problems with a professional is good for everyone. That isn’t so. Nor is it the case that as long as the therapist is following protocols, and has good intentions, the patient is bound to get better.”

No. Any intervention carries risk. No intervention can be called “safe and effective” for all. But to admit to risk is to admit that there are harms that are not being tallied. She lays out a convincing counter-narrative, one that strikes at the core of our age: sometimes repression is good.

Shrier lists out the ten steps to “Bad Therapy,” an algorithm that is all too familiar:

1) teach kids to pay close attention to their feelings; 2) induce rumination; 3) make “happiness” a goal but reward emotional suffering; 4) affirm and accommodate; 5) monitor, monitor, monitor; 6) dispense diagnoses liberally; 7) drug ‘em; 8) encourage kids to share their “trauma”; 9) encourage young adults to break contact with “toxic” family; 10) create treatment dependency.

Imagine if this were a strategic plan to undermine family and civilization. And I think this is where the book really works. She diagnoses the diagnosticians. Through a series of interviews and literature reviews, the diagnosticians reveal their biases and their designs. And her wit shines through.

Avoiding the potential iatrogenic risks of therapy is much harder than you might think. Mental health interventions have not been confined to the therapist’s office; they have pervaded the schools. The pretense by which therapy has gone “airborne” is through what educators call “social emotional learning” or SEL. Nearly all schools have been colonized by the priesthood of educators devoted to the methods and goals of therapy for all. The mandate of current educational administrators and teacher trainers is simple: to implement a “trauma-informed education.” Teachers and their formators are motivated by an evangelical sense of purpose and outcome:

Subsequent interviews with dozens of teachers, school counselors, and parents across the country banished all doubt: Therapists weren’t the only ones practicing bad therapy on kids. Bad therapy had gone airborne. For more than a decade, teachers, counselors, and school psychologists have all been playing shrink, introducing iatrogenic risks of therapy to schoolkids, a vast and captive audience.

Chances are very high that your children attend a school with an SEL program. These programs are ordered towards the creation and seeding of a feelings-first curriculum, even in classes that would seem foreign to this ethos as a math class. One presenter at a session entitled “Embedding SEL in Math” claims “I can’t think of a content area that needs more social-emotional learning than mathematics.” I, too, was waiting for the punch line: anxiety, and the pain of not being affirmed in difficult lessons.

The ethos of this ideology rests upon feelings. “How does this make you feel?” is the recurring question. And this therapeutic language undermines healthy functioning. It is the new way of teaching. This novel approach strikes most adults as strange, but it is the ascendent educational philosophy, and according to Shrier, the culprit for so much of the mental mess our children find themselves in.

The Therapeutic Imaginary

What kind of world is this strategy creating? The Canadian philosopher Charles Taylor coined the term “Social Imaginary” to mean “the way we collectively imagine, even pre-theoretically, our social life in the contemporary Western world.” I invoke it here because all schooling seeks, along with religion and culture, to create a shared social imaginary. But we must understand that our own social imaginary is thoroughly therapeutic—we live in the Therapeutic Imaginary. The way that ordinary people understand or imagine the world is now expressed in essentially therapeutic terms. Under this emergent therapuetic imaginary, authority has shifted from parents to experts, and there is no limiting principle to the new work, nor any marker that would signal that the patient is healed. In fact, perhaps the goal is the creation of permanent patients. The work is never done.

In the book’s final section, “Maybe There’s Nothing Wrong with Our Kids” Shrier admonishes us to stop implanting worries in our kids’ heads, stop telling the kids they are weak, stop acting as if they will die if they do not immediately get what they say they want. “Somewhere along the line, we forgot all this. We abjured authority and lost all perspective.” In other words, do not let the experts confound you into forgetting what you know to be true. We remember that the opposite of professional is the amateur, and the amateur is one who loves.

To illustrate this she tells the old joke:

A man walks into the doctor’s office with a complaint: ‘Whenever I drink coffee, I get this sharp pain in my eye.’

The Doctor replies: ‘Try removing the spoon.’

Her point is simple: the solution is poking us right in the eye: we need to stop doing things that hurt. She says “the crisis is not organic. It’s something we ushered into the door.” And I think she nails it here. In an answer to her opening question, our kids are not all right because we have parented them in ways cut off from the received wisdom of past generations. The formation of this new therapeutic imaginary cuts us off from our own inheritance, and then, in turn, cuts our own kids off from us.

In an effective manner, she uses the punch line as a refrain in the closing pages.

Remove the spoons that we have flooded our lives with: the phones, the meds, the diagnoses, the experts. She reminds us that being parents is our calling and we have skin in this game. The experts cannot imagine the depths of our love for our own children.

Remove the spoons!

Bad Therapy: Why the Kids Aren’t Growing Up
By Abigail Shrier
Sentinel/Penguin Random House, 2024
Hardcover, 320 pages