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Press Releases All the Way Down: On the New York Times and the Teen Mental Health Crisis

Recently, the morning newsletter of the New York Times suggested that the teen mental health crisis stems from “talking” too much about mental health. In this blog post, I will not evaluate that claim. What I want to do instead is evaluate the series of slippages whereby the nation’s paper of record produced such clickbait.

 

Academic articles that pass peer review have to keep a moderate tone. In the empirical disciplines, they are expected to include a Discussion section in which the authors discuss all the limitations of their results and hedge their conclusions. It’s well known, though, among students of science journalism that this moderation sometimes goes out the window in the press release. For example, when critical psychiatrist Joanna Moncrieff and colleagues published a review article in 2022 attempting to debunk “the serotonin theory of depression,” they were careful not to say much about selective serotonin reuptake inhibitors (SSRIs), one of the classes of psychiatric medications for depression. (Think Prozac, Zoloft, Lexapro, etc.) But—and I’m going to go off of memory here, rather than dig around for the link—in the accompanying press release, Moncrieff was much less reserved about the supposed inefficacy of SSRIs. Something similar happened on the way from the infamous Wakefield paper about the MMRI vaccine and autism to the press release, as Steve Silberman discusses in his book on the history of autism (which I wrote about recently on this blog). A tenuous and hesitant probing became a full-blown alarm about the dangers of vaccines.

 

A few days ago, the New York Times decided to up the ante by press-release-distorting its own article, which was already a distortion of another article. Let’s see how this works.

 

Last year, two psychologists, Lucy Foulkes and Jack Andrews, published a paper suggesting that “prevalence inflation,” or increased awareness of mental health problems from public awareness campaigns, may be leading teens to overinterpret their distress, thereby generating a self-fulfilling prophecy. In other words, they suggest that self-labeling may be driving the highly-mediatized teen mental health crisis. This is not, to be clear, a claim that the kids are really OK; the suggestion is that self-labeling is actually making the kids worse.

 

Now, it’s worth noting that this paper presents no new data. The subtitle is “A Call to Test the Prevalence Inflation Hypothesis.” There is some speculation around existing research, but deriving conclusions about one research question from data gathered in pursuit of a very different research question is always fraught. The authors are not reporting findings. They are arguing, rather, that their hypothesis should be tested. Moreover, the authors hardly are claiming that everyone who self-labels ends up actually getting worse. Rather, they are suggesting the following:

 

“Improved recognition describes how awareness efforts have led some individuals to better recognize and report their previously under-reported mental health problems. In contrast, overinterpretation is problematic, and describes how awareness efforts have led some individuals to overpathologize common psychological experiences. In some cases, this has become a self-fulfilling prophecy: interpreting difficulties as a mental health problem can lead to changes in self-concept and behavior that ultimately exacerbate symptoms and distress.”

 

Notice how tentative this is. Increased awareness of mental health issues may cause some people to overinterpret mild experiences, which may further cause some people to undergo changes that produce genuine mental illness. This all seems quite plausible to me. After all, it fits nicely with the underlying theory in cognitive therapy, namely, that catastrophic and hopeless interpretations of experiences drive psychopathology. But this is only plausible as long as it is a claim about some people, and it’s a double some here.

 

On May 6, 2024, Ellen Barry’s article “Are We Talking Too Much about Mental Health?” appeared in the New York Times. This is the lede: “Recent studies cast doubt on whether large-scale mental health interventions are making young people better. Some even suggest they can have a negative effect.” The article discusses three recent large studies of school-based preventive interventions for children and adolescents, rooted in cognitive behavioral therapy, dialectical behavior therapy, and mindfulness. I was familiar with the latter of these, the large MYRIAD study in Britain, where the experimental group, which consisted of 11-13 year-olds, reported worse depression and anxiety scores versus controls after participating in school-based mindfulness training. This study appeared in 2022, back when mental health Twitter was still alive and well, and I remember a lot of fascinating discussion of its implications at the time. Maybe at some point down the road I will write more about what I see as the benefits and risks of mindfulness interventions, as well as the literature on their adverse effects.

 

Barry mentions the prevalence inflation hypothesis and does discuss it as some length, then, but it is sandwiched within a much broader discussion of these three studies. The framing of “talking too much,” incidentally, confuses the issue of programs for school children with things like public awareness campaigns that appear on billboards or celebrities speaking out. Barry goes on to note that a recent meta-analysis suggesting that social and emotional learning (SEL) programs for children do typically lead to improvements, rather than adverse outcomes. I took a quick look at this meta-analysis, so I will add something Barry does not say, which is that the effect sizes reported for the different outcome variables are positive but in the small range, usually somewhere between g = 0.1 and 0.3. In other words, on average, the experimental group differed from the control group by somewhere between 0.1 and 0.3 standard deviations.

 

Whether such a small difference is a good use of scarce resources is an open question. I don’t want to dismiss SEL programs entirely, especially because, as the authors of the meta-analysis note, there are many different types of SEL programs. However, I tend to agree with this opinion piece, which appeared in Nature after the MYRIAD results were first released: “To be more universally effective, efforts to prevent depression might ultimately need to demand less of teachers and kids, and focus more on poverty, violence, homelessness, food insecurity and other structural problems that affect children’s mental health.”

 

Let’s come back to the New York Times. Notice that Barry’s article hamfistedly conjoins two separate topics: the efficacy of SEL programs for children and adolescents and the question of whether we are “talking too much about mental health.” These are not the same question. But Barry then takes the slippage a step further in her article for the New York Times morning newsletter the same day, “A Fresh Approach to a Crisis.” This is the thing you can get in your email inbox every morning, and these days it’s usual all I read from the Times. Here, Barry pitches her own article as a discussion of a novel explanation for the teen mental health crisis: “For years now, policymakers have sought an explanation for the mental health crisis among young people…. A group of researchers in Britain now propose another, at least partial, explanation: We talk about mental disorders so much. I cover this notion in a story The Times published today.”

 

Now, as I’ve already shown, Barry manifestly does not “cover this notion” in her article. She mentions it in passing, in the context of a topic distinct from the question of the underlying causes of the teen mental health crisis. If the article had been on that topic, it would have had to give adequate space to alternative explanations and objections to the prevalence inflation hypothesis. It would have also had to discuss the fact that the prevalence inflation hypothesis is very much just a hypothesis, without a single study that directly tests it.

 

There should be a name for this rhetorical sleight-of-hand. Maybe there already is. It seems to me more or less like a series of non sequiturs leading to an alarmist conclusion: WE ARE TALKING TOO MUCH ABOUT MENTAL HEALTH.

 

Now, I am sympathetic to the idea that in our society we sometimes medicalize or psychiatrize “problems in living” that would be better handled in non-medical ways. I am sympathetic to the idea that, if we want to get serious about preventing mental health problems, we should focus our energy on things like poverty (actually, I’m old-fashioned, so I prefer to say class oppression and exploitation) and racism. I am sympathetic to the idea that some, maybe many, public awareness campaigns around mental health are not productive or are even counterproductive. But we can think all of those things and still think that in some places, in some contexts, in some ways, we should talk more about mental health.

 

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