Abigail Shrier’s Bad Therapy: Why the Kids Aren’t Growing Up is not really about therapy. Instead, it’s about parents who let competitors for their authority usurp their role in raising their children and the harm such people can cause. Shrier focuses her journalistic instincts and love of research on a clear problem: the therapeutic industry is larger than ever yet has failed to improve mental health. Instead, the rising generation appears to be the least capable of self-government on record. Shrier identifies at least three forces that threaten to replace parents: therapists, teachers, and the culture of psychiatric study. These options allow parents to outsource their authority to someone else, and Shrier contends that such outsourcing harms children. The solution is simple: parents need to parent, for the good of their children.
Shrier begins by describing Gen Z:
The 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. Forty-two percent of the rising generation currently has a mental health diagnosis, rendering “normal” increasingly abnormal. One in six US children aged two to eight years old has a diagnosed mental, behavioral, or developmental disorder. More than 10 percent of American kids have an ADHD diagnosis—double the expected prevalence rate based on population surveys in other countries. Nearly 10 percent of kids now have a diagnosed anxiety disorder.
These children have received more therapeutic care than previous generations would have thought possible, leading to substantial expansion of the therapeutic industry. But to what end? Shrier focuses on three flaws of modern therapy.
First, the economic incentives are off: “Shrinks are badly incentivized. … A doctor may decide that a patient would no longer benefit from thyroid medication, discontinue it, and keep the patient. A therapist gets paid by the dose. Once she decides you don’t need therapy, she loses a customer.”
Second, therapy has become less scientifically rigorous: “Medical doctors (psychiatrists), who once dominated therapeutic practice, largely withdrew from it in recent decades. The medical authority they lent to therapy fell to those without medical training, many of whom lacked even evidentiary backing to their methods.”
Third, Shrier spends significant space on the concept of iatrogenesis: “From the Greek word iatros, meaning ‘healer,’ iatrogenesis literally means ‘originating with the healer’ and refers to the phenomenon of a healer harming a patient in the course of treatment.” If therapy has the capacity to heal wounds, it also has a corollary power to harm if misused. Far from dismissing all psychiatrists or therapists, Shrier distinguishes between those who recognize potential dangers in their methods and those who do not. She cites Dr. Camilo Ortiz, professor of clinical psychiatry at Long Island University, as an example of what therapists should do: “Ortiz discloses the risk of iatrogenesis in a waiver to his therapy clients because he wants them to be on the lookout for iatrogenic effects; he wants them to avoid harm. ‘I talk to my clients about the fact that in some percentage of cases, people get worse in therapy. It’s not a big percentage, but it can happen.’”
Shrier makes the case that parents turn to therapy too quickly. In so doing, they rob their children of natural cures for stress like laughter: “But if you want to allow your child one of the soul’s best defenses in an unpredictable world, drop your guard, just this once, and let things be funny again.” Kids also need to focus less on their emotions. Shrier considers the practices of successful coaches: “No winning head coach asks his players to consider their feelings at halftime, because thinking about yourself shatters your ability to get anything done.”
Rather than learning to express their emotions, children often need to learn to repress them for a time: “Adults should be telling kids how imperfect and unreliable their emotions can be. … Very often, kids should be skeptical that their feelings reflect an accurate picture of the world and even ignore their feelings entirely. (Gasp!) You read that right: a healthy emotional life involves a certain amount of daily repression.”
In short, Shrier argues that “Any intervention potent enough to cure is also powerful enough to hurt. Therapy is no benign folk remedy. It can provide relief. It can also deliver unintended harm and does so in up to 20 percent of patients.” Parents should be cautious about beginning therapy and assume that they need to select carefully a professional who is aware of these potential harms.
Shrier next points to teachers as a category of professionals who seek to step into the place of parents and even therapists. She describes teachers who hold therapeutic discussions, prompt emotional focuses, and seek a therapeutic tone in their classrooms, following the current emphasis on “social emotional learning (SEL).” But teachers lack both the training and professional ethics of therapists.
When role-playing as therapists, Shrier claims, teachers raise emotional concerns they are unequipped to handle. She cites students reflecting on parents divorcing, sharing about abuse, and other deeply personal moments arising in the classroom in response to the teacher’s prompting. Teachers are not trained to handle these scenarios, and asking children to share about their emotional traumas makes the classroom something other than a place for learning. “One wonders how educators get away with a pretext so transparent,” writes Shrier, “but succeed, they do. For more than a decade, they have been quietly increasing and expanding their interventions, transforming every school into an outpatient mental health clinic, staffed largely by those with no real training in mental health.” The arguments Shrier makes about iatrogenic effects of bad therapy apply just as well to therapeutic emphases in teaching. Teachers should focus on curriculum content and not turn their classrooms into therapy centers.
Shrier then considers the rise in suicidality, among other themes, in recent years and suggests that one element in play may be the therapeutic surveys that seek to determine if students have considered suicide, what methods they may have contemplated, and if they would do so again.
There are no doubt children who are abused, neglected, who use drugs in middle school, and are raped. No one would deny that. Every decent human being wants to help those kids. These surveys do not help those kids. (They are anonymized, after all.) These surveys simply present to all children the ontology of a darkly degraded world and convince them that they inhabit it.
Such surveys, Shrier argues, introduce dark elements to students’ minds and suggest that, if they are not contemplating such subjects, they are somehow abnormal. Shrier interviewed Dr. Jordan Peterson on this topic, and his comments about such surveys are instructive. Shrier summarizes: “Because suicide and self-harm are so contagious among teens, Peterson said, adults must be extremely careful not to ask kids leading questions.” She quotes Peterson directly: “Like [the question], ‘When was the last time you thought about cutting your wrists?’ Do you know how much information there is in that statement? First of all, the information is—Well, people do this. The next piece of information is: You could be doing this. … It’s so likely that you’re doing this that I can just ask it as a casual question.” The ultimate implication is, disastrously: “Well, what the hell’s wrong with you if you’re not doing this?”
Shrier then offers examples from various state-level surveys highlighting the frequency with which students are asked to consider their own mental health, arguing that raising these questions, again, reinforces the idea that students should have mental health problems.
Bad Therapy is far from a perfect book; it suffers from insufficient editing, with three passages this reviewer found redundant. Plus, Shrier’s argument would be stronger with a clearer demarcation between good and badtherapy, or even a wholesale rejection of therapy. Even with these qualifications, Bad Therapy is still an important book, highlighting the unique role of parents in raising their own children. “For years, therapeutic experts have attempted to iron out the idiosyncrasies of parent-child interaction—and in the last two decades, all but succeeded. They injected ideology and faux perfectionism into the parent-child relationship, and subjected every aspect to their examination and judgment.”
In an era that values expertise too highly, Shrier reminds her readers that parents are the natural stewards of their children:
We lost this somewhere along the way: the sense that these kids we raise, they’re ours. Our responsibility and our privilege. We are not the subordinates of the school psychologist or the pediatrician or our kids’ teachers. We are more important than all of them combined—as far as our kids are concerned. We gave our kids life, we sustained it, and we are the ones who bear the direct emotional consequences of how those lives turn out. It’s time we acted like it.
When parents exercise responsibility for their children and refuse to cede that responsibility to the well-meaning, disincentivized expert, children have a far greater chance of flourishing. Bad Therapy highlights a problem in our society, and reminds parents that they are the answer: “I don’t know how to raise your kid. But you do.”
