The most important challenge facing Australians today is personal rather than political, argues Sydney-based psychiatrist Tanveer Ahmed.
The worsening mental health of young people became a sensitive topic during the pandemic lockdowns. In the battles over safety, children became political footballs. In the early days of lockdowns, public health authorities claimed they were protecting children from harm. Meanwhile, doubters pointed out the negative impacts of disrupted schooling and stay-at-home mandates. The mental health crisis among young people has now been acknowledged. Qualified counsellors are in massive demand. Certainly, I have seen it in my own clinical practice. But the COVID-19 pandemic did not so much cause these issues, as it did reveal and accelerate them.
Children have long been the ‘canaries in the coal mine’ for mental health in the broader community, as children and adolescents are the first to show signs of social disruption. Self-harm and anxiety disorders among adolescents already had been increasing across the Western world. Just as the pandemic was speeding up, historical trends such as digitisation, the statistical rise in youth self-harm, eating disorders, and substance abuse was already occurring.
The more we survey the scene, however, the more we see it has a moral dimension beyond what can be captured with medical and therapeutic language. We live in times of great prosperity but lack purpose, at least at higher levels. There can be a sterility to modern life as we accumulate ever larger amounts of wealth. A sense of the sacred and the metaphysical is largely snuffed out, as is the place of ritual which often connects us to groups or spirituality. Traditional religions have become vestiges of the past and we are not sure how to revive ancient traditions for a modern, polyglot world.
This article reviews the state of knowledge regarding mental health from the medical and therapeutical perspective, before placing it in the wider context of the development of character and purpose, and what we can call self-reliance. A firm conclusion that remedies of the former sort cannot be wholly effective until society addresses the latter.
With the support of the Institute of Public Affairs I have recently produced a series of three videos drawing attention to these aspects of the problem, and outlining some solutions, which are titled:
- Character and a Life Worth Living
- Self-reliance is Critical to a Meaningful Life
- The Lack of Purpose in the Modern World – and what to do about it
They are designed to present the issues outlined in this article to a wider audience.
The NSW Ombudsman last year delivered the ‘Biannual Report of the Deaths of Children in NSW’, confirming suicide as the leading cause of death for people aged 15 to 17 in 2018 and 2019, increasing significantly for all children aged 10 to 17 since 2005. A similar crisis has played out Victoria, where figures to the end of May 2021 highlight an average of 156 teens a week taken to hospital after self-harming and having thoughts of suicide. That is an 88 per cent increase on the previous year.
Poor mental health is an issue for which traditional political processes fail to find answers.
The British Children’s Institute suggests self-harm incidents have tripled over the past two decades. And in America, a study in The Journal of Pediatrics found a 268 per cent increase in self harm among children between the ages of 10 and 12 from 2010 to 2017. This study illustrates that not only is the incidence of self-harm increasing, but it is showing up in greater numbers among younger kids. In the US, the screening tests also show a shocking rise in depression in a short period of time: 56 per cent more teens experienced a major depressive episode in 2015 than in 2010, and 60 per cent more experienced severe impairment.
Forty-six per cent more 15- to 19-year-olds committed suicide in 2015 than in 2007, and two-and-a-half times more 12- to 14-year-olds committed suicide. The homicide rate among teens has declined, but the suicide rate has increased. The steady decline in teen homicide from 2007 to 2014 has tracked almost directly the proportionate decline in in-person social interaction.
The issue is an appropriately hot button one that goes to the heart of how we raise families and, to some extent, organise society. The father of modern sociology, Emile Durkheim, coined the term ‘anomie’ to describe a social condition defined by an uprooting or breakdown of moral values, standards, or guidance for individuals to follow. Durkheim said that when societies hit such a civilisational break, the suicide rate soars.
Poor mental health is one of the issues—like family breakdown, loneliness, or unfulfilling jobs—for which traditional political processes fail to find answers. At a time of enormous collective material wealth, there has never been a bigger psychological dimension to public policy, including in the difficult to measure metrics of status and esteem. Youth mental health falls into such a category. Classical liberals or libertarians might believe it was up to individuals how to self-organise, but the government increasingly intervenes in such matters through welfare policy, aged care, family law, and early childhood education, or through schools expanding into areas previously reserved for families.
Among teenagers, the combination of smartphones and social media is often raised as a key factor with regards to any growing psychological malaise. Teens spend more hours on screens and engage in physical contact through mediating rituals, such as texts requesting contact IRL (in real life). American psychoanalyst Sherry Turkle documented how teens can be taken aback if forced to take calls without warning. Modern teens, and to a lesser extent millennials before them, have taken flight from conversation—at least the kinds that might be open-ended and spontaneous.
They follow a slower life strategy in parallel with families having fewer children and more intense cultivation of each child. American author Nora Ephron described modern child rearing in 2006: “Parenting [is] not simply about raising a child, it [is] about transforming a child, force-feeding it like a foie gras goose.”
The smartphone represents the apex of delivering information through the exploitation of our lizard brain, namely the co-opting of our biological vulnerabilities by consumer products. This feature is known as evolutionary mismatch, much like how our taste buds evolved in a time of calorie scarcity.
The rise of the smartphone offers a new risk of lost practice in the empathic arts, such as listening to others for not just the content but also the tone and delivery. The importance of eye contact, further elevated in an era of masks, is downgraded when mediated by technology. The bulk of in-person communication is nonverbal. American studies at summer camp show that in just five days after bans upon electronic devices, most children show an increased capacity for empathy as measured by their ability to identify the feelings of others.
In her book Reclaiming Conversation: The Power of Talk in a Digital Age (Sentinel, 2016), MIT-based Turkle says:
We slip into thinking that always being connected is going to make us less lonely. But we are at risk because it is actually the reverse: If we are unable to be alone, we will be more lonely.
Consumerism’s history is one of increasing sophistication to co-opt our primitive psychology for the usage of goods and services. Fatty food, internet pornography, and illicit drugs all prosper from sparking the same neural pleasure pathways. Social media and technology take this to another level by exploiting our insecurities about status, connection, and belonging in any hierarchy.
Willingness to delay gratification is increasingly lacking for many of our children.
This is the flip side of technology in the ability to further exploit our reptilian natures—the part of our brain lurking underneath a sophisticated but fragile layer of rationality—has never been greater. This is especially true online through the feedback loop of algorithms and human actors. This is why the implications of the 1972 Stanford marshmallow experiment have only become more important. In the study of instant gratification conducted by Austrian-born American psychologist Walter Mischel, a child was offered to either have a marshmallow immediately, or if they waited a period of time they could have two comparable rewards. When the same children in the study were followed up years later, those who were able to wait performed better in measures of education, work, and relationships.
This teaching of impulse control and its associated task of being able to self-soothe when one does not receive what they want is one of the most important tasks of early parenting, along with healthy attachment. Attachment is the formation of a trusting bond with the primary caregiver, usually the mother, which then sets up a mental model informing future relationships.
Individual self-control, hard work, and a willingness to delay gratification may have been norms for our parents but is increasingly lacking for many of our children. A significant contributor to social and income inequalities are the variations in psychological frailties. What was once called character has increasingly been replaced with the term personality—a connotation that is more medical than moral.
The most effective period for investments in cognitive and non-cognitive skills are the early years, when we are the most malleable, flexible, and able to be imprinted by parents and culture. Cognitive skills tend to be solidified before adolescence, which is why interventions in character skills have more chance at success in the teenage years. Unfortunately, this is also the period where disruptions in bonding with caregivers or conflicted families leave long-term imprints, often exposed in adolescence when there are greater social and academic pressures.
The cushioning of vulnerable people that stable families and clans used to provide has largely been outsourced to the State. The modern family has suited higher socio-economic groups, but ravaged the poor and disadvantaged. The class dimension of youth mental health is not clear cut, but those presenting are likely to have had a disrupted upbringing. A growing body of evidence from neuroscientists shows that experiencing your early years in a poor, stressful environment limits the development of the pre-frontal cortex, the part of the brain responsible for emotional self-regulation.
The greatest buffers to early life difficulties, including poverty, are good parenting and a strong civic society. The civic and institutional aspects may require greater attention than we are currently providing, as all the measures of civic life have been in steady decline in recent decades, as widely documented among social scientists. In Australia barely 15 per cent of workers are members of unions. Church attendance has dropped dramatically, especially among educated Anglo-Saxon groups. The bulk of active churches in urban centres are dominated by ethnic groups. Only the evangelical sections of Christian churches have recorded growth.
The pressures mainstream Australians are under was documented in a 2021 report by the IPA, The Fair Go – Going, Gone: The Decline Of The Australian Way Of Life, 2000 to 2020.
In his book Disconnected (NewSouth, 2010), Federal Labor MP Andrew Leigh outlined how since the mid-1980s the number of people who said they lacked a confidant or someone to turn to in crisis had increased from 11 to 18 per cent. We know we are less likely to know our neighbours.
Studies on this topic suggest a woman with a child is among the biggest predictors of whether a household interacts with the neighbours. There is no question Australians are very generous when it comes to donating and volunteering. The huge giving during the bushfire crisis was a case in point. But there is also evidence we are more likely to do this in a low commitment way. Leigh highlights research by American political scientist Robert Putnam that suggests social media is more like a television than a telephone.
Children used to be useful but are now protected.
But for the most part, families have steadily moved to a design that can help maximise opportunities for individual fulfilment. Marriage was previously a public institution linked to raising children and binding oneself to a community, but has been redefined as a vessel for mutual fulfillment.
The New York Times columnist David Brooks writes of the nuclear family:
… while social conservatives have a philosophy of family life they can’t operationalise, because it no longer is relevant, progressives have no philosophy of family life at all, because they don’t want to seem judgmental.
Children used to be useful but are now protected. Before the category of ‘teenager’ was invented, they worked the fields, helped in mills, or cared for their siblings. From the moment of birth, people were enmeshed in a complex web of obligations. Now the primary role of parents is to cultivate their children. As New York-based journalist Jennifer Senior outlined in her book All Joy And No Fun: The Paradox of Modern Parenthood (Ecco, 2014), parents are no longer custodians of old traditions but are instead required to invent new ones.
Educational psychologist Professor Donna Cross of the University of Western Australia argues that as other sites of community and character formation have declined, schools are under more pressure to rectify the fragmentation. Teachers become unofficial parents of children from broken families, especially in lower socio-economic areas, and schools adopt a greater therapeutic focus. During her travels overseas to study other educational systems, Cross discovered behavioural disturbance among children was more pronounced in Australia. In fact, we rank 70th among 77 OECD countries on this measure. In countries such as Singapore, it is likely that their educational scores may reflect the fact Confucian systems more intentionally cultivate character strengths such as self-control and perseverance.
In lower socioeconomic groups emotional disturbance may be expressed, especially among boys, through bad behaviour, whereas among the middle classes neuroses is more common. The greater medicalisation of middle-class distress, which adds greater legitimacy and privileges through disability provisions (‘special consideration’), is widening the education and character divide. This is a pointer that the potential decline in character traits is growing among the wealthy, providing evidence that affluence can undercut discipline. In a rich society, postponing immediate pleasures for the future can be harder. The striving for success in a highly competitive environment, one undergirded by ideas of meritocracy and achieved identities, is especially apparent in elite private and selective schools.
An especially important aspect in discussing youth mental health is the decline in representations of suffering. Young people have fewer myths that give context to adversity. This may explain the huge popularity of Harry Potter—which has that dimension—a set of stories that almost form a sacred text for upcoming generations.
An aspect of Canadian psychologist Jordan Peterson’s success is his ability to articulately communicate Biblical stories and Jungian concepts such as universal archetypes. Jung teaches that meaning in life comes not just in ‘love and work’ as Freud said, but is made intelligible through recurring cultural patterns, namely myths.
Public interest depends on private virtue.
Myths shape our perception and help us contend with the chaos of existence through providing the protective cloak of responsibility, purpose, and self-reliance. In his first book Maps of Meaning (Routledge, 1999), Peterson describes myths as “the distilled essence of the stories we tell ourselves about the patterns of our behaviour”.
For the most part people who feel useful to others and have at least a small number of close relationships remain on kilter through what might be described as having ‘projects and intimacy’. Some form of competency is essential for young people. For all the New Age spirituality, life does not have be terribly complicated.
‘Self-reliance’ was coined by American philosopher Ralph Waldo Emerson (1803–1882) almost two centuries ago. His writings form the cornerstone of an American brand of rugged individualism, reinventing oneself at the frontier.
Nowadays, the self-sufficiency it implies is in popular culture—and in therapeutic settings—more often associated with a stigmatised male archetype of repression and a psychic impenetrability.
Nevertheless, the concept has been picked up within the ‘positive psychology’ movement and has strong overlaps with resilience, being able to bounce back from adversity.
The term resilience has become ubiquitous, used not just in psychology but in fields as disparate as fire rescue to engineering.
The ancient Greek and Roman republics identified character formation as a central political task. In The Theory of Moral Sentiments (1759), Scottish economist and philosopher Adam Smith (1723–1790) identified “the virtue of prudence” as the most useful:
The qualities most useful to ourselves are, first of all superior reason and understanding, by which we are capable of discerning the remote consequences of our actions … and secondly, self-command, by which we are enabled to abstain from present pleasure or to endure present pain, in order to obtain a greater pleasure or to avoid a greater pain in some future time. In the union of those two qualities consists of the virtue of prudence, of all the virtues that which is most useful to the individual.
English philosopher John Stuart Mill (1806–1873) and French political scientist Alexis de Tocqueville (1805–1859) were preoccupied with the building of character because they believed being both good and free were essential if liberal democracies were to succeed. In Considerations on Representative Government (1861), Mill wrote: “The most important point of excellence which any government can possess is to promote the virtue and intelligence of the people themselves.”
For The Public Interest journal (Autumn 1985), American political scientist and conservative thinker James Q. Wilson (1931–2012) wrote:
… for most social problems that deeply trouble us, the need is to explore, carefully and experimentally, ways of strengthening the formation of character among the very young. In the long run, the public interest depends on private virtue.
Prudence in particular is essential for financial planning. We typically discount the value of a day in the distant future in comparison to the present. A 2009 Pew study discovered children of low-income parents who were above average savers had a 20 per cent higher chance of moving off the lowest rungs of the income ladder. The savings may help in paying for educational expenses, but the mere propensity to do so signals the ethic of prudence. If a child’s most obvious role models exhibit impulsive behaviours, it is much harder for a child to defer gratification. Similarly, Martin Seligman—virtually the father of positive psychology—said “poverty is a state of present mindedness”.
Nobel Laureate and economist James Heckman argues end outcomes and economic distribution after the fact are too heavily prioritised in inequality debates, whereas prior efforts to encourage positive character traits should occur in parallel and would yield better results.
The challenges of technology are real. Smartphones may merely be exposing the fault lines lying beneath, but may nevertheless warrant a light touch regulation. British philosopher Avner Offer writes in Self-Control and Well-Being in the United States and Britain since 1950 (Oxford University Press, 2006) that such technological novelty has never been more accessible. But Offer warns that prosperity speeds the flow of this novelty and is occurring in parallel to the decline of what he calls commitment devices, which is the scaffolding that families and social stigma once provided for moderating the ravages of such disruption.
At the same time there is a multiplicity of trends that have rendered a generation more vulnerable, including ‘positivity’, the medicalisation of emotional distress, the disruption of early attachments, and the decline of mitigating institutions such as community. There also appear to be some fundamental changes as to how upcoming generations communicate that affect qualities such as empathy and the capacity to tolerate solitude.
The noncognitive skills of character—particularly of persistence, prudence, and the deferral of gratification—are being undermined. In combination with a lesser capacity to make sense of suffering and adversity, future generations are ill-equipped to cope with the avalanche of instant gratification vehicles that are now perpetually accessible.
Overcoming the loss of self-reliance requires ending the dependency feedback loop of a society which encourages ‘safetyism’, gratification from the smartphone, and the avoidance of all risk. This has the effect of creating psychological fragility and an inability to deal with the vagaries of life, which then creates demand for even greater protections.
The development of such skills, which may have once been called character, is arguably the central task of any civilised society, and the most important facing Australia today.
Tanveer Ahmed is a Sydney-based psychiatrist and author of an IPA Research Paper, published in April 2022, ‘Self-reliance, Youth and the Task of Character’.