Abigail Shrier’s Crude Oversimplification of Mental Health

A review of Bad Therapy: Why the Kids Aren't Growing Up

Image by Slate

It seems like everyone’s asking: are the kids okay? And the answer is a resounding no. Increasingly it’s clear that there is a Gen Z mental health problem.

While self-reported rates of anxiety and depression going up could signify diagnosis creep, wherein the definition of ill is expanding, increasing hospitalizations for self-harm and suicide attempts make the problem transparent.

In Abigail Shrier’s book, Bad Therapy: Why the Kids Aren’t Growing Up, she summarizes this in the first few pages, brushing over the increase in hospitalizations, to argue that the kids aren’t actually that sick, they just need some tough love.

She spends less than half a page at the outset of the book saying that we’re conflating the profoundly mentally ill with a second group. “This book is about a second, far larger cohort: the worriers; the fearful; the lonely, lost and sad. College coeds who can’t apply for a job without three or ten calls to Mom. We tend not to call their problem ‘mental illness,’ but nor would we say they are thriving. They go looking for diagnoses to explain the way they feel. They think they’ve found ‘it,’ but the ‘it’ is always shifting.”¹ While her entire book is reportedly aimed toward this second group, she spends almost no time defining the group. If the group is comprised of “worriers” who call mom a few too many times a week, then why is the suicide attempt rate increasing so rapidly?

Shrier goes on to argue the problem is therapy culture, which I too have criticisms of, but her entire argument is grounded on the premise the reader agrees with her two-group distinction. I’m not sure these two groups are so distinct. There are, undoubtedly, people who are profoundly and evidently mentally ill—people who cannot shower for months, who cannot eat, who have visual and auditory hallucinations, etc. But the options are not as simple as being so mentally ill that one cannot function in the world at all or being just a “worrier” who is “lonely, lost, and sad.” The line is blurry. Many people can function enough to do basic hygiene most of the time, but experience more than worry or sadness. They experience a number of ramifications that affect their social and romantic life, their job prospects, their health, and it’s not just a lack of autonomy driven by therapy or gentle parenting, but caused by a disorder.

In mainstream psychology, a “disorder” is typically characterized based on whether the symptoms impinge on the life of the patient. But what are the metrics for impingement? And what if someone designed their life to minimize encounters with metrics they struggle with?

From the outside, I might look like the worrier Shrier describes. I’m someone who can function fairly normally—studying, graduating, getting a job. If I always get A’s, I’m considered functional, right? But I don’t go to parties or on dates because I grew up with panic attacks and I couldn’t. Now, as an adult, I can manage, but I also intentionally created a life where I am not asked to parties or on dates.

Loneliness and sadness does not capture that I have been suicidal. It does not capture the two decades of panic attacks, the few years of which did make me non-functional because I was so ill I would throw up daily. But like any resilient kid, I found a way to survive. Survival included not going to parties or hanging out with friends outside of school; not being in touch with my emotions or my body. Survival included reading and scrolling on my phone—things that were safely in my comfort zone. It’s not simply that I have to call my mom a few too many times or follow a friend around at a party because I have a touch of social anxiety, it’s a survival adaptation.

I would propose, at least from my experience, what Shrier is seeing is not people who are lost and need to toughen up, at least some of that group are people who did toughen up. People who were ill, but were told to suck it up in a world that offered more coping mechanisms than humanity has ever known.

In her book, Shrier critiques gentle parenting, arguing that kids need an authoritative home. Parents should not cater to their children’s sensory needs; they should be the ones to decide when their child is in crisis rather than outsourcing their judgment to a mental health professional. My parents probably weren’t as authoritative as Shrier suggests and neither were they gentle parents. They rarely punished me and sometimes catered to my sensory needs—I recall a year or two in elementary school when I only wore corduroys because I hated the texture of jeans. But they also, as Shrier suggests, decided I was not in crisis as a child. It was a “Suck it up, buttercup” household. And just as she suggested, I suppressed my emotions, pushed through, tried to appear normal and competent, and achieved.

I was an easy child—never caused trouble, graduated college early, and got my dream job at 19. Any parent would be proud right? It doesn’t matter that I never caused trouble because I had no energy or confidence, or that I graduated early because I was too burned out to make it another year, or that I got that job because work was the only thing that felt safe to me.

To be clear, I do share many concerns with Shrier. I agree with her axiom that anything powerful enough to heal also has the power to harm, including therapy. I agree that we are generally too quick to therapize and medicalize children and that we should not put children on medication with all of its side effects that could inhibit normal development unless it’s necessary. Like her, I worry that putting children on medications can sedate them, so that they may not understand they actually can withstand life and its inevitable suffering.

I also know that any parent with a mentally ill child is in a tough spot, and I don’t envy the position of having to define “necessary.” I also know Shrier’s proposal that we should all pay less attention to our feelings is another type of sedation. I didn’t sedate myself with pharmaceuticals, I did it with escapism. Binge-reading, watching, and eating.

Ultimately, I am using myself as an example to illustrate the double bind Shrier’s thesis puts her in. I am equally as concerned as her that we seem to be living in a society where the kids are getting sicker, and we keep prescribing medicine that doesn’t seem to be helping. But I have never been on medication—I’ve more or less lived by Shrier’s prescription. I ignored my feelings and tried not to afford myself any special accommodation. It only led to more suffering.

Part of what I worry about is that by arguing that children should only see mental health professionals if they're seriously ill and then not defining “serious.” Shrier provides justification for any parent or child who is prone to trying to suck it up or push through that doing so is always the better choice. It's not. Sometimes getting help is the right choice—not for everyone and not all the time and not in the same way. I can see the way teenage me would have lapped up this book and used it as intellectual backing for an unjustified and emotionally driven anti-therapy stance. Of course, doing so would have been on me, and anyone else who chooses to use it to bolster their anti-psychiatry stances, but Shrier doesn't help by doing sloppy work leaving what she considers serious or unserious undefined.

Shrier, in one of her sweeping generalizations, said that books on trauma let us blame everything on trauma and give our growth a ceiling. I’m sure some books and trauma experts do provide limiting beliefs, but the best ones I have read perpetuated a phrase I’ve come to live by: It’s not your fault, but it is your responsibility.

I’d like to believe I’m not the entitled kid Shrier describes. I’m ambitious. The first therapist I saw, at age 20, said I had a “pull myself up by my bootstraps mentality” as if it was a bad thing. Both my therapist and coach have said I’m too “results oriented.” I suspect Shrier would admire these attributes about me, but she misses that the only way to strike a balance between “results oriented” and happy was for someone to also say my pain was real. Instinctually, I shoulder my life and my actions as my responsibility, but to take responsibility and make progress, the first step is properly diagnosing the problem—admitting it might not have been my fault, maybe someone else fucked me up. To notice how things went wrong and how I got here doesn’t change the fact that it’s my responsibility to move forward from where I am now. Allowing myself, finally, to acknowledge that I am in pain, is the beginning of the recovery process. Shrier does not hold both these truths at once.

I'm more than willing to grant that Shrier has a different experience and perspective than me and that my experience may not align with statistical realities—but Shrier doesn't even try to engage with the questions I pose. The book featured innumerable overly broad generalizations, and cherry-picked expertise—confirmation bias all the way down.

Shrier, for such a sensitive and complex issue, cited less research than I expected. In a well-researched book, I expect to see people regarded in their field as neutral or opposed toward the biases of that author, but she rarely did she note anyone who supported her case who didn't share her biases, nor did she engage directly with disagreers quotes. She made sarcastic comments strawmanning the other side, but never, as far as I can recall, named or quoted anyone who disagreed with her in an attempt to engage with their criticisms.

For example, among the few experts she consulted was Jordan B. Peterson. I have nuanced feelings about Peterson, but he certainly has a distinct view of the world, one that differs from most other psychologists and mostly aligns with Shrier. I cannot speak to whether all of the other experts she cited were cherry-picked to agree with her, but that is the impression I got based on the lack of direct engagement with those who disagreed with her thesis.

Then came the generalizations: “Normal teens are being made ill by the unnecessary treatments our mental health experts dispense indiscriminately. Perhaps most insidiously, the experts insist on habituating our kids into a never-ending confrontation with the one question no therapist can resist: And how did that make you feel?” Paragraphs like this were quite common throughout, and they made me resist even Shrier’s better points because of her constant characterization. It’s not clear exactly who the “experts” are, leaving me only to assume she means everyone practicing in the mental health field and labeling their actions “insidious.” I think we should be careful with who we accuse of being careless and insidious.

She might think these sweeping claims make her case more compelling, but to me, they indicate that her argument was not constructed with care. She didn’t think seriously about the limits of it. I can’t recall her noting that some (or even few) therapists provide amazing life-saving services. She did not need to state that in so many words, but to villainize an entire profession of people without regard to their perspective or societal contribution reads to me as shortsighted and partisan. Frequently, she accuses mental health professionals of driving a wedge between parents and children. Maybe true, it’s worthy of concern and consideration, but rather than blaming the entirety of the mental health field, she could empower parents to build a strong relationship with their kids. Shrier does examine the role of parents and dish them blame as well, but that doesn’t stop her from implying all parents should distrust mental health workers.

So far, I’ve mostly described the vibes of the book—the generalizations and cherry-picked expert quotes—but let me provide a more specific example of neglectful journalism. Shrier dedicates a chapter of the book to critiquing The Body Keeps the Score by Bessel van der Kolk. I’ve never read the book and don’t have a vested interest in it, so I took her criticisms at face value until I saw a rather basic overstatement of a study.

Here is what she says: “The researchers found that, when interviewed as adults, both groups showed essentially identical levels of pain symptoms, indicating that there was no relationship between childhood abuse and medically unexplained pain in adulthood.” To “indicate there was no relationship” is actually quite a high bar. There is a crucial difference between lacking evidence for a hypothesis and proving that a hypothesis is not the case. If you lack evidence for a relationship between childhood abuse and unexplained pain that's a modest claim, backed by science. But if you say one study finding equal amounts of pain between the two groups indicates there is no relationship, that's a claim that requires more evidence and it is on shaky scientific ground unless one can cite several studies that invalidate the link.

It's like the difference between saying “I lack a belief in God” versus “I believe there is no god.” The two claims carry quite different burdens of proof, the second needing to meet a much higher burden. Therefore, indicating there is no relationship needs to meet a higher burden than finding the evidence lacking to support the claim that there is a relationship.

I've read almost all of Shrier's work because we're interested in many of the same problems. As a result, many people I read have promoted her book because, I presume, they agree with her conclusions. As I've said, not all of her conclusions are wrong. I think we should take therapy and medication seriously, especially when it comes to children and we should cultivate independence in kids. It doesn't change the fact that Shrier makes an incredibly flawed case for it. Note, I have not picked it apart for every inconsistency above, I just pulled out what I noticed from the book.

To write in the snarky, sarcastic voice that she does, you have to earn your snark with well-supported claims, and she hasn't. Ironically good therapy (which is hard to find) is supposed to break someone out of the black-and-white thinking Shrier boasts throughout her extended op-ed. I worry she’s gotten used to playing the contrarian for the sake of contrarianism rather than critical thinking. I think the book does more to harm than help my generation. Below I've included what I think are better alternatives to Bad Therapy.

Further Reading

1. The Coddling of The American Mind by Greg Lukianoff and Johnathan Haidt

This book contains many of the same ideas as Shrier about what’s wrong with Gen Z and how to cultivate independence in children, but its case is more thorough and nuanced.

2. Strangers to Ourselves: Unsettled Minds and the Stories That Make Us by Rachel Aviv

This book is not focused on Gen Z, but is a fascinating look at the way psychoanalytical, biomedical, spiritual, and societal narratives for mental illness often fall short. It simultaneously challenges and invites you to draw your own conclusions about what mental illness means.

3. h/t to Meghan Bell for her thorough review of Bad Therapy

1. I, regrettably, did not include page numbers for quotes from the book because I read the book through an online library loan meaning the page numbers varied based on the font size and device I was reading it on. I also returned the book before I finished the essay, scraping the included quotes from screenshots.