On Wellness

The post-millennial mental health crisis – and what to do about it

The post-millennial generation is here, and they are falling into a mental health crisis.

In typical millennial self-absorption, I was surprised to realize my own generation is no longer the youngest stratum in society with a moniker – the generation receiving the most coddling, concern, and criticism.

Just kidding. I did know they had arrived, and are having a childhood very different from my own. The iGen kids and young adults, as Jean Twenge dubs them in her fascinating generational studies, have been my patients. I have witnessed the emerging social/mental health crisis as well. As their pediatrician, I have called involuntary admissions for kids contemplating suicide because of social media comments and tried to revive the ones who did attempt and almost succeeded. I ask about cyber-bullying in my clinic visits with anyone above the age of 7, and have never had a patient tell me they didn’t understand the question.

Teen depression and suicide are not new, but the exploding prevalence, position within pop culture, and new reasons behind the current trend are unprecedented. Even outside the mental health crisis, the fact that today’s youngest generation carries out a large portion of their lives online is something I can see but cannot truly relate to.

I am less than 10 years older than iGen, but already I look at them across a large generational gap. We were the pioneers of social media, the first ones to have Facebook when it burst outside Harvard Yard in 2006. But we were also the last to grow up without the internet in early childhood, and the last, it seems, to have our default free time spent outside, roaming in body and not in cell service.

I deleted Facebook a few years ago, never started Instagram, and my Twitter is mostly professional and informational. I go to great lengths to make my phone only go off for important communication from people I know, and my idea of refuge is a place with trees and zero cell service. Admittedly, I am an odd under-user of personal social media for my own generation. But even for my peers who are very active across all these platforms, their use of the virtual world is still more to enhance their life than to replace it.

Instagram every meal? Sure. Facebook FOMO? We coined that term. Yet, millennials are actually starting to take a small step back from social media and set some boundaries with Facebook. I don’t think it’s because we are getting older, but because we experienced the internet as an external development instead of something intrinsic to the world, like oxygen. We are able to feel suffocated by it because, as children, we traded friendship bracelets instead of Likes and couldn’t wait to get our driver’s licenses to go places. In short, we had a childhood IRL. 

Every generation is a product of its time in history. It’s not iGen’s fault or weakness to be so controlled by their online presence – it is the inevitable outcome of subjecting young people, at their most psychologically vulnerable time, to the Wild Wild West of the web’s exposure and social pressures. I consider it blind luck to have had the protection of a screen-free upbringing, and know it is not realistic today, but I am concerned for the health and safety of those coming of age. Today’s kids are physically safer — teen pregnancy, homicide, alcohol consumption and car accidents are at an all time low — because they are literally not leaving the house anymore, but we can’t just celebrate these numbers and downplay their sinister hint that kids are less “together” in real life. While the unsafe behaviors we associate with adolescence are usually a phase, the fact that suicide has tripled among young girls and doubled in young boys points to the kind of mental health damage that will outlast the next 10 iPhones.

I had a precocious 9-year-old patient in clinic one day and had extra time to chat because my next patient canceled. He was clearly already too smart for his level in school and brought a thick book to the doctor’s appointment. We talked about science, nutrition, and Star Wars (read: he taught me the hidden themes in Star Wars). Then he admitted that kids make fun of him online.
“I know I shouldn’t care, but it’s always there even when I’m not in school.” He said, the first layers of self-consciousness coming over the childish openness he had a minute ago.
I told him it was okay to feel sad or frustrated, asked mom if the behavior has been addressed by the teachers and parents, and tried my best to reassure him that the world awaiting him is big and needs people exactly like him. It will get better, I promised him, but will it? What will happen to his generation if this epidemic of isolation and depression does not change?

The way forward is uncertain. It is standard for pediatricians to ask if the child has more than two hours of daily screen time – the official recommendation. This is the lazy approach, and is clearly not working. Some students need more than two hours of screen time just to complete their homework, and some schools assign digital resources from wonderful platforms like Khan Academy. Simply limiting the amount of time is reductive, not to mention ineffective. Instead, we have to change the relationship between people and their smart devices, and it begins with ourselves.

Children emulate much better than they obey. Policing is not the answer. Telling a young person to put down their phone while looking at our own device is akin to telling a teen not to smoke while dangling a cigarette between our lips. This epidemic is not the parents’ fault. We are just beginning to realize the concrete dangers of losing ourselves in digital lives. As millennials enter parenthood, we need to be pioneers once again – this time in steering the tide towards controlling our relationship with technology instead of letting it control our relationships with each other.

I am a proponent of technology. This blog was created in part to imagine what innovations can do for medicine and for doctors. But my friends also know me as a cautious skeptic in the addition of some technology to the personal sphere. The happy medium, then, is intention. It’s no longer difficult to make newer and bigger technology, but we have to be intentional about making it good – augment its potential to connect us, minimize its disruption of mindfulness, and use the free time it gives us meaningfully.

Am I going to let my kids have smartphones? Probably. But my hope is when that time comes, they will be so enticed by the outdoors, conversation, and books printed on paper, that the silly screens will be put in their place as tools and not be the lens through which life is experienced.