The authors hypothesize that for some children, framing their struggles as mental health disorders that require treatment can actually worsen their situation by causing them to ruminate on it.
Anecdotally, this isn’t limited to adolescents. There is a weird trend toward over-diagnosing common life struggles as major clinical health issues requiring intervention. I think this comes from a place of good intentions, where people don’t want to miss anyone who might have a major mental health issue that will benefit from treatment. However, over-diagnosing mental health conditions and convincing kids they even common struggles are actually mental health issues that require advanced treatment techniques has the opposite effect of amplifying common struggles into something much bigger.
There’s a secondary phenomenon in some demographics wherein having a mental health diagnosis is perceived as providing some social advantage, as weird as that sounds. This isn’t just conjecture, it’s actual policy in some schools. It’s well-known among kids that having an ADHD diagnosis will grant people extra time to take tests in some schools, which becomes a cheat code for getting a leg up. I’ve also witnessed young adults swapping tips on how to say the right things to get certain mental health diagnoses and get specific drugs: Xanax for anxiety, etc. They were even swapping names of doctors and notes about who was more lenient about prescribing certain drugs in a Slack community. Coming up with rules to stop that behavior without triggering complaints about stigmatizing mental illness was a challenge.
> The authors hypothesize that for some children, framing their struggles as mental health disorders that require treatment can actually worsen their situation by causing them to ruminate on it.
Not just to children, just in general, the narratives we use to interpret the things that happen to us can actually cause more harm than the event itself.
Simplistic example, but take a culture where scars are a mark of pride, say from surviving battle, compared to one where they are seen as ugly and so shameful. The physical harm in each case is the same, but the mental impact is very different.
We even see this in trauma, like with sexual assault. Being pitied and told something that happened to you was the worst thing that can possibly happen to someone, it makes a far worse mental impact than it otherwise might have made without that framing.
There are a number of reasons for this, but I think in general, disempowering people by removing their sense of control and the notion that they're resilient becomes something of a self-fulfilling prophecy.
Sometimes, some people really are less resilient or lose their sense of control in some circumstances, and then they do need that help, but that should probably not be the default approach. We've had a bit too much of an over correction to the old, "suck it up and walk it off" mentality.
> There is a weird trend toward over-diagnosing common life struggles as major clinical health issues requiring intervention. I think this comes from a place of good intentions, where people don’t want to miss anyone who might have a major mental health issue that will benefit from treatment. However, over-diagnosing mental health conditions and convincing kids they even common struggles are actually mental health issues that require advanced treatment techniques has the opposite effect of amplifying common struggles into something much bigger.
My subjective unprofessional opinion is that this tendency is also an over-compensation in trying to destigmatize mental illness, and to treat mental illness as illness and sufferers thereof as victims, rather than blaming them for lacking motivation or whatever unempathetic BS people used to think.
Hopefully this is a short-lived trend and things will balance somewhere a little more sensible.
> There’s a secondary phenomenon in some demographics wherein having a mental health diagnosis is perceived as providing some social advantage,
Mental illness had some degree of social gravity (not necessarily clout or advantage) when I was a teenager back in the "emo" and "scene" days of the 00s. The phenomenon has clearly evolved somewhat, but I don't think it's entirely new. What is new is its reach.
I would take the "tips on how to say the right things" in a more favorable light. It can be extremely difficult to get proper help or diagnosis, especially if you're marginalized (gay, black, female, transgender, poor, bad at speaking...) I've definitely seen shit like black boys not being diagnosed with autism or young girls not getting diagnosed with adhd
When I was in college in the 90s some of the fraternities had systemized this.
You’d get a diagnosis, get a drug that had value for sale or you could take it, and the reasonable accommodation for ADHD was taking a test in a private room with open book.
I was pissed when I found out as tests were usually graded in a curve, and these idiots broke the curve for the rest of us.
I would argue that any test which is a race against the clock is a bad test. Whatever you are trying to test you are almost certainly not measuring (i suppose reality doesn't care and people still have to deal with bad tests).
Basically every test has a time limit in school. No one save a small number of learning disabled kids struggles to finish in time. If it takes you the whole time you don't know it!
The fact that nearly every test has a time limit isn't proof that time limits are useful. Furthermore the majority of tests taken in school are completely forgotten even a year later, meaning that students didn't "know" the information in the first place, they were just able to regurgitate it for a useless exercise in stress and make-work.
Tests are useful as spaced repetition, and spaced repetition is good for remembering. That students may not remember a specific test a year later doesn't seem relevant. Time limits are necessary because everything is time limited, even when applying this knowledge in a job, and if you're struggling to finish in time, then that indicates areas that need work.
Most (tech) jobs put a premium on being right over being fast. Nobody cares if you get the wrong answer quickly. Person who takes longer but gets a better answer will usually do better in their career.
Learning you're getting the wrong answer quickly is a big part of why we test.
Taking longer can help your career, but there's a limit. Test times were always very generous for people ahead of the curve, short for people below, and just about right for everyone else, because that's how they're designed.
Most tests i've taken are not structured that way. Most of the time you need a multipart question to get significant benefit of realizing you are wrong fast. In a world of multiple choice tests, that is pretty rare.
Ancedotal, but when i was in school i remember people top of the class were often last to finish their test (i guess because they double checked things more).
Well that's the point though isn't it? A good test might technically have a time limit, but time won't be the limiting factor for most people, so nobody will think extra time is some "unfair" advantage.
Paper says that for some kids, CBT and mindfulness can increase negative symptoms, or have no effect.
Not surprising, because they don't address the fundamental issues. Why would mindfulness help with depression, better than teaching these kids how to grieve in an effective, healthy way?
CBT can be helpful, but it 'intellectualizes' problems too much. How about teaching these kids how to increase their self-confidence? How to identify their emotional needs? How to build their social skills, resolve conflicts in relationships, and assert their personal boundaries? Most sure aren't learning that from their parents.
These interventions are far too superficial to obtain the intended results. I'll be pointlessly provocative now: they almost seem intended so that teachers/interveners can avoid having to deal head-on, one-on-one, with their students' "messy" emotions. No need for school adults to have empathic, difficult conversations with kids whose parents are undergoing a divorce. Instead, just teach the kids (as a group) how to intellectualize their emotions, or distance themselves from them. It minimizes the role of teachers and other trusted adults as a social support system, it places the onus on kids to "fix themselves", and it downplays the importance of emotions in causing these problems in the first place. It makes things very impersonal. Imagine if sex-ed classes were founded on Victorian notions of decency, would they be of any help? It concerns me that so many intelligent, thoughtful scientists are barking up the wrong trees. If they refocused their efforts, they could be far more effective.
>Imagine if sex-ed classes were founded on Victorian notions of decency, would they be of any help?
Fun fact: abstinence-only sex education actually increases the rate of teen pregnancies, not just compared to comprehensive sex ed but to no sex ed at all.
It’s because we don’t follow it up with shunning and shame if a pregnancy occurs. Essentially cancel culture Victorian style.
So of course if you tell kids not to fuck and they have a million outlets to help burden the consequence then it’s a non-functional system not in coherence with todays reality. Living in the past is useless. But it doesn’t mean the values of the past are bad. Just incompatible with modern society.
Rather than baselessly asserting this, why don't you ask a pregnant teenager (or someone who was pregnant as a teenager) whether they were shunned or shamed?
I think you'll find that most experienced one or the other, and probably both. Being supported by your parents and other authority figures is the exception, not the norm.
No, in the olden times this didn't work. Women were shunned and shamed when out-of-wedlock pregnancy occurred, and not only was it common, it was so common that there were multiple institutions set up by religious organizations that such women were forced into by their families where many of them died from the mistreatment. Check out "mother and baby homes" where thousands of unmarried women and children died.
To the degree these "solutions" (in all their varying degrees of effectiveness) did not solve the problem they intended and caused new harms, then yeah, those values and mechanisms of social control are bad.
Judging by rates of illegitimate pregnancy and birth as reflected in prosecutions of same before and during the Victorian era, those values were incompatible with the society of their own time, too. Odd that never seems to noticeably deter the "forward into the past!" crowd from no-true-Scotsmaning their favored social prescriptions every bit as loudly as the most ardent communist handwaves Stalin.
It’s on a completely different level today and it’s not even close. How many babies are born out of wedlock? Now multiply that by a huge number to get the number aborted. It’s massively different than it was. Rates too I’m sure. Sex without consequences has been the siren song of the last 60+ years and for good reason if you take care.
And I didn’t say it’s a solution because it’s not. It’s good advice for various reasons but it needs to be supplemented with lots of knowledge on how to protect yourself too.
Last I checked, rates of out of wedlock pregnancy are down. What confuses the issue is total births have fallen even faster.
But frankly married couples regularly having 10+ kids wasn’t something to celebrate.
Really though these are the kinds of statistics people love to mess with. Do you count rates of pregnancy for unmarried adult women, or rates of unmarried pregnancy out of the adult/total population, or even rates of unmarried pregnancy out of the total number of pregnancies? Why not look at them all and pick whichever one supports the point you’re trying to make…
> Last I checked, rates of out of wedlock pregnancy are down.
What on earth? When did you last check that? Percent of births to unmarried women has gone from 5% in the early 1900s to 15% by 1980 and then ballooned to 40% this decade
Again, that doesn’t mean the rate of unmarried women having children has increased because the rate of married women having children has declined. Similarly the percentage of married women has fallen dramatically. And of course the US in 1900 is hardly the beginning of time.
"These interventions are far too superficial to obtain the intended results."
In my limited and probably too absolute opinion (there's more nuance than what I have here), schools seem to either be about checking boxes to say "see we did everything!" or have some naive administration with a savior complex.
Most people don't care about getting to the root issues, or are blinded by their biases. I feel like there's no real community left and no real hope for many. It's hard to give a damn about the future when you know your's is fucked but everyone is still putting on the pressure to be successful.
> How about teaching these kids how to increase their self-confidence? How to identify their emotional needs? How to build their social skills, resolve conflicts in relationships, and assert their personal boundaries? Most sure aren't learning that from their parents.
Well, I'd say that based on what I know about CBT and mindfulness, both of those are well supported methods for accomplishing all that, CBT especially because of its emphasis on reframing situations and recognizing negative thought patterns.
On a personal level I find positive reframing to be a super power that CBT and others reinforce. It's helped me with all kinds of problems.
Mindfulness frankly doesn't help a student with things like being bullied/harassed, having a bad home life, or food/shelter insecurity. Reframing helps in thinking about specific situations but, frankly, teenagers aren't equipped legally or otherwise to handle things themselves.
It's not clear from the paper what the goalpost even is.
They refer to mental health issues but don't give any concrete examples. The most specific they get is depression and anxiety; but aren't depression and anxiety symptoms of underlying problems?
At the end of the day, therapy is just an attempt to help someone with a problem. I think we've all experienced a well-intentioned person who made things worse, and it shouldn't be surprising that someone attempting to follow a formula like CBT or DBT or ACT or whatever, might still be the opposite of helpful.
I like and have benefitted from some of these frameworks, but none of them is a silver bullet.
> CBT can be helpful, but it 'intellectualizes' problems too much. How about teaching these kids how to increase their self-confidence? How to identify their emotional needs? How to build their social skills, resolve conflicts in relationships, and assert their personal boundaries? Most sure aren't learning that from their parents.
All the things you listed are already directly addressed within CBT.
I received CBT, and that's not my experience. Learning the thought patterns involved in these behaviors is different from learning the underlying skills needed to improve those behaviors. Just like reflecting on the thought patterns behind piano-playing won't help me play the piano. It might help me improve the way I practice, but it doesn't teach me what to do with the keys. And CBT frames emotions as being caused by thought-patterns, when the causality is not quite that "clean".
I'm not rejecting CBT's usefulness. It's a good tool. But I found it better at improving symptom management than at addressing underlying problems.
Interesting. I've been doing psychoanalysis for over a year now, and I have similar complaints: I know exactly what went wrong with my life but I have no idea WTF to do with it. It's like I'm just picking the wounds
Aside from the dollars spent on therapy, is that outcome worse than being confused about why you are suffering? Or thinking that god or society just hates you? At least in some cases, it could lead to positive change, at least as a warning to others.
They use CBT for anger management classes, so I think you are right about this. It doesn't stop you from lashing out. It gives you resources that might help you head off that process that usually results in you lashing out.
It doesn't cover underlying causes there. CBT doesn't work by alone. It needs other therapies to complete the cycle.
CBT isn't really appropriate for a big chunk of people with serious anger management issues... that was one of the motivators for the development of DBT.
Other than incredibly vague non-existent definition of what Mindfulness is, it attempts to frame the thought patterns that lead to emotional distress as inherently being the problem themselves.
Most of us have thought patterns because we experience the world around us. Our actual experience of the world might as well just be our thought patterns. If those thought patterns lead to negative thoughts, that doesn't imply I am inherently the problem.
Mindfulness chooses a line and tells the patient it's their problem to deal with. It's merely convenient (and profitable) that we are as individuals able to affect our own thoughts to a significant degree. It is a course in training you to deal with the pain of your own self-awareness without requiring an actual change to those conditions.
If mindfulness told us our job was to affect actual change in our world, it'd be nothing more than a completely irrelevant set of practices.
Yes, and the steps required to get to the equilibria would involve working on the entire system to orbit around emotional growth next to intellectual growth while children have immature development in both.
Why? Because both parents and teachers have more load than they can bear with kids already which also strains their ability to give emotional availability to the deeply irrational stage of being a human being with little intellectual capacity developed to cope.
I'd rather that instead of accusing "scientists" (which?) of being worthy of deep concern when you yourself have not taken into consideration this context as if the authorities in question are purely malicious.
The elephant in the room is that schoolchildren are not empowered to solve their issues. If I'm having a rough day I can let my employer know and take some time off, or quit my job if I have had enough. There's no such flexibility when you are a kid, you are expected to show up and do your time unless you have some strong, tangible proof you are unable to. Iatrogenic harm could be as simple as exposing this fact to the patient, who is trying their best to ignore it. Nobody wants to be reminded they are a virtual slave.
i think it could work like that for many but most don't have the courage to ask. frankly a company where it doesn't work like that is not a healthy work environment to begin with. (like some examples discussed here: https://news.ycombinator.com/item?id=35032286 )
Most physical labour (construction, but also work in harbours etc) just doesn't work this way. Perhaps that's not a healthy work environment, but if it is the only way you can earn the money that feeds you and perhaps your family why does that matter?
There's a body of evidence that some adults that practice mediation will have anxiety or depression worsen instead of improve (~10-25% depending on the study). Even this simple activity with thousands of years of history is not well understood and can do harm. Other interventions have even less history.
One thing about being an adult is that if mindfulness increases your anxiety you can choose not to practice it. Children are often forced into mental health interventions by schools. Imagine being compelled into doing something that worsens your mental health by someone trying to improve your mental health. The authors are correct that we should be selective about which students get which treatments. Often these are applied more broadly than is appropriate. The authors make no claim about the size of the impact of this practice, or the number of students negatively impacted.
Note: I'm from the US, the paper specifically comments on the UK education system.
For those who want to know what 'iatrogenic' means prior to dipping further into this thread: "Induced unintentionally in a patient by a physician. Used especially of an infection or other complication of treatment."
Basically: is it causing the very thing the intervention is intended to help.
At the risk of nitpicking: iatrogensis isn't confined to the very thing the intervention intends to address; it can be any condition induced at the cost of treatment.
Blinding a patient during eye surgery to remove a tumor is an iatrogenic outcome, for example.
Yes. Iatrogenesis doesn't imply an overall negative outcome: livesaving medications and treatments can have iatrogenic consequences that are outweighed by their intended, positive ones (or vice versa).
Whats the iatrogenic rate for use of SSRI and other interventions?
"first do no harm" carries huge burdens. Sometimes, harm is unavoidable because doing nothing itself represents the potential for harm to emerge and if its a conscious choice, you did something: you decided not to do something else.
Oh boy this is just scratching the surface. I would go a LOT further and say the ENTIRE scholastic mental health system is a sham and a massive source of iatrogenic harm that students and teachers are pressured into in order to get more favourable treatment by the schools and government assistance, whereas the schools themselves get more government funding and lowered scrutiny in regards to standardised testing. How can mental health treatment in schools NOT cause harm with such perverse incentives?
I had a particularly fraudulent school psychiatrist. When my IQ tested low enough, my IQ score was reported. When my IQ tested too high, it was censored on the grounds of being "misleading". Parental and teacher evidence was submitted to justify further mental health interventions which was grossly fraudulent (I was portrayed as unable to dress or feed myself) and a cursory 5 minute examination of me would have revealed this. One of the most disgusting things they did was pull me out of gym classes to spend more time sitting in a room with special needs teachers who occasionally nagged me to use a planner and do my homework. Exercise you know, being an extremely evidence based intervention for mental health, unlike whatever that shit was. Being treated as mentally ill and being perceived that way by myself and my peers did nothing to help me, especially since it only helped to reinforce the idea that the lifelong physical health problems which got worse during my school years were nothing but "anxiety" and that consequent declines in my mental health could be attributed to my earlier mental health issues and all the medical fraud helped to confuse the shit out of doctors.
I think the mental health system is a sham and that it doesn't have proof it treats the problems it claims to treat, and if anything the rise of suicidality over the last few decades as scholastic mental health has become more common as well as increases in self-reported, parent-reported, teacher-reported, and physician-reported mental health problems among students proves its somewhere between totally impotent and actively harmful. The final goal of increased mental health interventions is not getting to a point where nobody is sick anymore, it's to create more patients.
The biggest thing that pisses me off is that it's rarely measured if scholastic mental health interventions work, they are just ASSUMED to be positive without evidence. Nobody gives a crap about iatrogenic effects.
That paper is somewhat vague. I get the impression that they're talking around something, but I'm not familiar enough with the field to know what they're talking around.
I can totally believe that middle schools' and high schools' intervention for mental health causes harm, and often. Do not ask for citations on this because I don't have them.
Whether the harm outweighs the good is up for debate. In very affluent neighborhoods, lots of the kids are in therapy already. In lower-middle class or poor neighborhoods, the kids are probably resistant to it and it is, indeed, stigmatizing. So how much good can it possibly do?
In my mind both CBT and ‘mindfulness’ can be pernicious. (Like that time I was suffering from asthma and anxiety at the same time and the last thing I wanted to do was pay attention to my breath.)
Focused breathing (which is not "mindfulness") is a technique for centering oneself and drawing focus to the sensations of breathing, instead of whatever is stressing you out, such as pain or emotions that have become overwhelming.
If you're having an asthma attack, then of course focusing on breathing won't help, because the breathing issues are what's stressing you out. Whenever I've seen focused breathing, literally never have I seen "and it's great for people having an asthma attack!"
Filling up your car with gas is normal and necessary. Would you still try to fill up your car with gas if it were on fire? And then complain that filling up one's car with gas is dangerous and didn't help that one time your car was on fire?
Are you rapidly mouth-breathing? The point of focusing on it is to make sure you are doing slow, steady nose-breathing. Slow nose-breathing causes your body to produce calming biochemical signals (for most people).
Nope, slow nose-breathing. There's a few things that my body does that are kind of the exact opposite of what is supposed to happen, so I don't worry too much about it.
As the headline is phrased, the answer is almost certainly "yes".
Even if you have an objective diagnosis and a rigorously developed treatment, you'd expect far less than 100% success; and you'd also expect side effects and other harm that happens with almost any treatment.
Given that mental health is much less rigorous than some other areas of medicine (because it's hard to make it rigorous), then its compounded by misdiagnosis and treatments where we don't understand the effects.
Anecdotally, this isn’t limited to adolescents. There is a weird trend toward over-diagnosing common life struggles as major clinical health issues requiring intervention. I think this comes from a place of good intentions, where people don’t want to miss anyone who might have a major mental health issue that will benefit from treatment. However, over-diagnosing mental health conditions and convincing kids they even common struggles are actually mental health issues that require advanced treatment techniques has the opposite effect of amplifying common struggles into something much bigger.
There’s a secondary phenomenon in some demographics wherein having a mental health diagnosis is perceived as providing some social advantage, as weird as that sounds. This isn’t just conjecture, it’s actual policy in some schools. It’s well-known among kids that having an ADHD diagnosis will grant people extra time to take tests in some schools, which becomes a cheat code for getting a leg up. I’ve also witnessed young adults swapping tips on how to say the right things to get certain mental health diagnoses and get specific drugs: Xanax for anxiety, etc. They were even swapping names of doctors and notes about who was more lenient about prescribing certain drugs in a Slack community. Coming up with rules to stop that behavior without triggering complaints about stigmatizing mental illness was a challenge.