The

Kids

Are Not

All Right

American teens areanxious, depressed andoverwhelmed. Experts

are struggling over howto help them

By Susanna Schrobsdorff

THE FIRST TIME FAITH-ANN BISHOP CUTherself, she was in eighth grade. It was 2in the morning, and as her parents slept,she sat on the edge of the tub at her homeoutside Bangor, Maine, with a metal clipfrom a pen in her hand. Then she slicedinto the soft skin near her ribs. There wasblood—and a sense of deep relief. “It makesthe world very quiet for a few seconds,” saysFaith-Ann. “For a while I didn’t want to stop,because it was my only coping mechanism. Ihadn’t learned any other way.”

The pain of the superficial wound was amomentary escape from the anxiety she wasfighting constantly, about grades, about herfuture, about relationships, about every-thing. Many days she felt ill before school.Sometimes she’d throw up, other times she’dstay home. “It was like asking me to climb

Mental Health

PHOTOGR APHS BY LISE SARFATI FOR TIME

Alison Heyland, 18, shown at her homein Maine, was part of a group that

makes films to raise awareness aboutdepression, anxiety and self-harm

46 TIME November 7, 2016

Mount Everest in high heels,” she says.It would be three years before Faith-

Ann, now 20 and a film student in LosAngeles, told her parents about the depthof her distress. She hid the marks on hertorso and arms, and hid the sadnessshe couldn’t explain and didn’t feel wasjustified. On paper, she had a good life.She loved her parents and knew they’d

symptom of a broader psychologicalproblem: a spectrum of angst that plagues21st century teens.

Adolescents today have a reputationfor being more fragile, less resilient andmore overwhelmed than their parentswere when they were growing up. Some-times they’re called spoiled or coddled orhelicoptered. But a closer look paints a far

be supportive if she asked for help.She just couldn’t bear seeing the worryon their faces.

For Faith-Ann, cutting was a secret,compulsive manifestation of the depres-sion and anxiety that she and millions ofteenagers in the U.S. are struggling with.Self-harm, which some experts say is onthe rise, is perhaps the most disturbing

47

more heartbreaking portrait of why youngpeople are suffering. Anxiety and depres-sion in high school kids have been on therise since 2012 after several years of sta-bility. It’s a phenomenon that cuts across

all demographics—suburban, urban andrural; those who are college bound andthose who aren’t. Family financial stresscan exacerbate these issues, and studiesshow that girls are more at risk than boys.

In 2015, about 3 million teens ages12 to 17 had had at least one major de-pressive episode in the past year, accord-ing to the Department of Health andHuman Services. More than 2 millionreport experiencing depression that im-pairs their daily function. About 30% ofgirls and 20% of boys—totaling 6.3 mil-lion teens—have had an anxiety disorder,according to data from the National In-stitute of Mental Health.

Experts suspect that these statisticsare on the low end of what’s really hap-pening, since many people do not seekhelp for anxiety and depression. A 2015report from the Child Mind Institutefound that only about 20% of young peo-ple with a diagnosable anxiety disorderget treatment. It’s also hard to quantifybehaviors related to depression and anx-iety, like nonsuicidal self-harm, becausethey are deliberately secretive.

Still, the number of distressed youngpeople is on the rise, experts say, and theyare trying to figure out how best to help.Teen minds have always craved stimula-tion, and their emotional reactions are bynature urgent and sometimes debilitat-ing. The biggest variable, then, is the cli-mate in which teens navigate this stageof development.

They are the post-9/11 generation,raised in an era of economic and nationalinsecurity. They’ve never known a timewhen terrorism and school shootingsweren’t the norm. They grew up watchingtheir parents weather a severe recession,and, perhaps most important, they hitpuberty at a time when technology andsocial media were transforming society.

“If you wanted to create an environ-ment to churn out really angsty people,we’ve done it,” says Janis Whitlock, di-rector of the Cornell Research Programon Self-Injury and Recovery. Sure, paren-tal micromanaging can be a factor, as canschool stress, but Whitlock doesn’t thinkthose things are the main drivers of thisepidemic. “It’s that they’re in a cauldronof stimulus they can’t get away from, ordon’t want to get away from, or don’t knowhow to get away from,” she says.

In my dozens of conversations with

teens, parents, clinicians and schoolcounselors across the country, there wasa pervasive sense that being a teenagertoday is a draining full-time job that in-cludes doing schoolwork, managing asocial-media identity and fretting aboutcareer, climate change, sexism, racism—you name it. Every fight or slight is docu-mented online for hours or days after theincident. It’s exhausting.

“We’re the first generation that cannotescape our problems at all,” says Faith-Ann. “We’re all like little volcanoes. We’regetting this constant pressure, from ourphones, from our relationships, from theway things are today.”

Steve Schneider, a counselor at She-boygan South High School in southeast-ern Wisconsin, says the situation is like ascab that’s constantly being picked. “Atno point do you get to remove yourselffrom it and get perspective,” he says.

IT’S HARD FOR MANY ADULTS to under-stand how much of teenagers’ emotionallife is lived within the small screens ontheir phones, but a CNN special reportin 2015 conducted with researchers atthe University of California, Davis, andthe University of Texas at Dallas exam-ined the social-media use of more than200 13-year-olds. Their analysis foundthat “there is no firm line between theirreal and online worlds,” according tothe researchers.

Phoebe Gariepy, a 17-year-old inArundel, Maine, describes following onInstagram a girl in Los Angeles whomshe’d never met because she liked thephotos she posted. Then the girl stoppedposting. Phoebe later heard she’d beenkidnapped and was found on the sideof a road, dead. “I started bawling, and Ididn’t even know this girl,” says Phoebe.

△Phoebe Gariepy, 17, a high schoolsenior in Maine, learned to avoid

places online that glorified sadnessand self-destructive acts

‘We’re the first

generation that

cannot escape our

problems at all.’—Faith-Ann Bishop, 20

48 TIME November 7, 2016

“I felt really extremely connected to thatsituation even though it was in L.A.”

That hyperconnectedness nowextends everywhere, engulfing even ruralteens in a national thicket of Internetdrama. Daniel Champer, the director ofschool-based services for Intermountainin Helena, Mont., says the one wordhe’d use to describe the kids in his stateis overexposed. Montana’s kids may bein a big, sparsely populated state, butthey are not isolated anymore. A suicidemight happen on the other side of thestate and the kids often know beforethe adults, says Champer. This makes ithard for counselors to help. And nearly30% of the state’s teens said they feltsad and hopeless almost every day forat least two weeks in a row, according tothe 2015 Montana Youth Risk BehaviorSurvey. To address what they considera cry for help from the state’s teens,officials in Montana are working onexpanding access to school-based andtele-based counseling.

Megan Moreno, head of social mediaand adolescent health research at SeattleChildren’s Hospital, notes a big differencebetween the mobile-social-tech revolu-tion of the past 15 years and things likethe introduction of the telephone or TV.In the olden days, your mom told you toget off the family phone or turn off theTV, and you did it. This time, kids are inthe driver’s seat.

Parents are also mimicking teen be-havior. “Not in all cases, obviously, butin many cases the adults are learning touse their phones in the way that the teensdo,” says Moreno. “They’re zoning out.They’re ignoring people. They’re answer-ing calls during dinner rather than saying,‘O.K., we have this technology. Here arethe rules about when we use it.’”

She cautions against demonizing tech-nology entirely. “I often tell parents mysimplest analogy is it’s like a hammer.You know, you can build a house that’snever existed before and you can smashsomeone’s head in, and it’s the same tool.”Sometimes phones rob teens’ developingbrains of essential downtime. But othertimes they’re a way to maintain healthysocial connections and get support.

Nora Carden, 17, of Brooklyn, whostarted college in upstate New York thisfall, says she’s relieved when she goeson a trip that requires her to leave her

phone for a while. “It’s like the wholeschool is in your bag, waiting for ananswer,” she says.

SCHOOL PRESSURES also play a role, par-ticularly with stress. Nora got counselingfor her anxiety, which became crushing asthe college-application process rampedup. She’d fear getting an answer wrongwhen a teacher called on her, and oftenfelt she was not qualified to be in a par-ticular class. “I don’t have pressure frommy parents. I’m the one putting pressureon myself,” she says.

“The competitiveness, the lack ofclarity about where things are going[economically] have all created a sense ofreal stress,” says Victor Schwartz of theJed Foundation, a nonprofit that workswith colleges and universities on mental-health programs and services. “Ten yearsago, the most prominent thing kids talkedabout was feeling depressed. And nowanxiety has overtaken that in the lastcouple of years.”

Tommy La Guardia, a high-achieving18-year-old senior in Kent, Wash., is thefirst college-bound kid in his family.He recently became a finalist for pres-tigious scholarships, all while work-ing 10 to 15 hours a week at a Microsoftinternship and helping to care for hisyounger brothers.

His mom, Catherine Moimoi, says hedoesn’t talk about the pressure he’s under.They don’t have a lot of resources, yet hemanages everything himself, includingcollege tours and applications. “He’s agood kid. He never complains,” she says.“But there are many nights I go to sleepwondering how he does it.”

Tommy admits that the past year was

tough. “It’s hard to describe the stress,” hesays. “I’m calm on the outside, but insideit’s like a demon in your stomach tryingto consume you.” He deals with thoseemotions on his own. “I don’t want tomake it someone else’s problem.”

Alison Heyland, 18, a recent highschool graduate, was part of a group inMaine called Project AWARE, whosemembers seek to help their peers manageanxiety and depression by making films.“We’re such a fragile and emotionalgeneration,” she says. “It’s tempting forparents to tell kids, ‘Just suck it up.’” But,says Alison, “I feel like it really is lessrealistic for you to go after your dreamjob today. You’re more apt to go do a jobthat you don’t really like because it paysbetter and you’ll be in less debt.”

Meanwhile, evidence suggests the anx-iety wrought by school pressures and tech-nology is affecting younger and youngerkids. Ellen Chance, co-president of thePalm Beach School Counselor Associa-tion, says technology and online bullyingare affecting kids as early as fifth grade.

The strain on guidance counselorshas increased since No Child Left Behindstandardized testing protocols were im-plemented in the past decade. Tests canrun from January through May, and sincecounselors in Chance’s county are oftenthe ones who administer the exams, theyhave less time to deal with students’mental-health issues.

“I couldn’t tell you how many studentsare being nasty to each other over Insta-gram or Snapchat,” she says of the elemen-tary school where she’s the sole counselorfor more than 500 kids. “I’ve had caseswhere girls don’t want to come to schoolbecause they feel outcasted and targeted.I deal with it on a weekly basis.”

CONVENTIONAL WISDOM says kids todayare oversupervised, prompting someparenting critics to look back fondly tothe days of latchkey kids. But now, eventhough teens may be in the same roomwith their parents, they might also, thanksto their phones, be immersed in a pain-ful emotional tangle with dozens of theirclassmates. Or they’re looking at otherpeople’s lives on Instagram and feelingself-loathing (or worse). Or they’re caughtup in a discussion about suicide with abunch of people on the other side of thecountry they’ve never even met via an

‘If you wanted

to create an

environment to churn

out really angsty

people, we’ve done it.’—Janis Whitlock, Cornell University

49

app that most adults have never heard of.Phoebe Gariepy says she remembers

being in the backseat of a car with herheadphones on, sitting next to her momwhile looking at disturbing photos onher phone on social-media feeds aboutcutting. “I was so distant, I was so sepa-rated,” she says. She says it was hard toget out of that online community, as goryas it was, because her online life felt likeher real life. “It’s almost like a reality-TVshow. That’s the most triggering part of it,knowing that those real people were outthere.” It would be hard for most peopleto know that the girl sitting there scrollingthrough her phone was engaged in muchmore than superficial selfies.

Josh, who did not want his real namepublished, is a high school sophomore inMaine who says he remembers how hisparents began checking on him after theSandy Hook shooting that killed 20 chil-dren and six adults. Despite their vigi-lance, he says, they’re largely unaware

of the pain he’s been in. “They’re bothheterosexual cis people, so they wouldn’tknow that I’m bisexual. They wouldn’tknow that I cut, that I use red wine, thatI’ve attempted suicide,” he says. “Theythink I’m a normal kid, but I’m not.”

In the CNN study, researchers foundthat even when parents try their best tomonitor their children’s Instagram, Twit-ter and Facebook feeds, they are likely un-able to recognize the subtle slights and so-cial exclusions that cause kids pain.

Finding disturbing things in a child’sdigital identity, or that they’re self-harming, can stun some parents. “Everysingle week we have a girl who comes tothe ER after some social-media rumor orincident has upset her [and then she cutherself],” says Fadi Haddad, a psychiatristwho helped start the child and adoles-cent psychiatric emergency departmentat Bellevue hospital in New York City,the first of its kind at a public hospital.Teens who end up there are often sent by

△Faith-Ann Bishop, 20, had severe

depression in high school. Now she’sa film student in L.A.

administrators at their school. When Had-dad calls the parents, they can be unawareof just how distressed their child is. Ac-cording to Haddad, this includes parentswho feel they’re very involved in their chil-dren’s lives: they’re at every sports game,they supervise the homework, they’re partof the school community.

Sometimes when he calls, they’reangry. One mother whose child Haddadtreated told him that she found out herdaughter had 17 Facebook accounts,which the mother shut down. “But whatgood does that do?” says Haddad. “Therewill be an 18th.”

For some parents who discover, asFaith-Ann’s parents Bret and TammyBishop did a few years ago, that their childhas been severely depressed, anxiety-ridden or self-harming for years, it’s ashock laden with guilt.

50 TIME November 7, 2016

Bret says Faith-Ann had been makingcuts on her legs and ribs for three yearsbefore she got the courage to tell her par-ents. “You wonder, What could I havedone better?” he says. Looking back, herealizes that he was distracted too muchof the time.

“Even for us as adults, you’re neveraway from work now. Before, there wasn’tanything to worry about till I got backon Monday. But now it’s always on yourphone. Sometimes when you’re home,you’re not home,” Bret says.

When Bret and Tammy joined a groupfor parents of kids with depression, hediscovered that there were many girls andsome boys who were also depressed andhurting themselves, and that few parentshad any idea of what was going on.

Tammy said she wishes she’d followedher gut and taken Faith-Ann for counsel-ing earlier. “I knew something was wrong,and I couldn’t figure it out,” she says.

SELF-HARM IS CERTAINLYnot universalamong kids with depression and anxiety,but it does appear to be the signaturesymptom of this generation’s mental-health difficulties. All of the nearly twodozen teens I spoke with for this storyknew someone who had engaged inself-harm or had done it themselves.It’s hard to quantify the behavior, butits impact is easier to monitor: a SeattleChildren’s Hospital study that trackedhashtags people use on Instagram totalk about self-harm found a dramaticincrease in their use in the past two years.Researchers got 1.7 million search resultsfor “#selfharmmm” in 2014; by 2015 thenumber was more than 2.4 million.

While girls appear more likely toengage in this behavior, boys are notimmune: as many as 30% to 40% of thosewho’ve ever self-injured are male.

The academic study of this behav-ior is nascent, but researchers are devel-oping a deeper understanding of howphysical pain may relieve the psycho-logical pain of some people who prac-tice it. That knowledge may help expertsbetter understand why it can be hardfor some people to stop self-harmingonce they start. Whitlock, the directorof the self-injury research program atCornell, explains that studies are pretty

consistent in showing that people whoinjure themselves do it to cope withanxiety or depression.

It’s hard to know why self-harm hassurfaced at this time, and it’s possiblewe’re just more aware of it now becausewe live in a world where we’re more awareof everything. Whitlock thinks there’s acultural element to it. Starting in the late1990s, the body became a kind of bill-board for self-expression—that’s whentattoos and piercings went mainstream.“As that was starting to happen, the ideaof etching your emotional pain into yourbody was not a big step from the body asa canvas as an idea,” she says.

The idea that self-harm is tied to howwe see the human body tracks with whatmany teens told me when I interviewedthem. As Faith-Ann describes it, “A lot ofvalue is put on our physical beauty now.All of our friends are Photoshopping theirown photos—it’s hard to escape that needto be perfect.” Before the dawn of socialmedia, the disorders that seemed to bethe quintessential reflection of thosesame societal pressures were anorexia orbulimia—which are still serious concerns.

Whitlock says there are two commonexperiences that people have with self-harm. There are those who feel discon-nected or numb. “They don’t feel real, andthere’s something about pain and bloodthat brings them into their body,” she says.

On the other end of the spectrum arepeople who feel an overwhelming amountof emotion, says Whitlock. “If you askedthem to describe those emotions on ascale of 1 to 10, they would say 10, whileyou or I might rate the same experience asa 6 or 7. They need to discharge those feel-ings somehow, and injury becomes theirway,” she explains.

The research on what happens in thebrain and body when someone cuts is stillemerging. Scientists want to better under-stand how self-harm engages the endoge-nous opioid system—which is involved inthe pain response in the brain—and whathappens if and when it does.

Some of the treatments for self-harmare similar to those for addiction, par-ticularly in the focus on identifying un-derlying psychological issues—what’scausing the anxiety and depressionin the first place—and then teaching

3 millionAdolescents ages 12 to 17 in the U.S. who

had at least one major depressiveepisode* in the past year. This number

has increased over time.

Depressionby the numbers

*A MA JOR DEPRESSIVE EPISODE IS DEF INED AS A PERIOD OF T WO WEEKS OR LONGER DURING WHICH THERE IS E ITHER A DEPRESSED MOOD OR LOSS OF INTEREST OR PLE ASURE, AND AT LE AST FOUR OTHER SYMPTOMSTHAT  REFLECT A CHANGE IN FUNCT IONING, L IKE PROBLEMS WITH SLEEP, E AT ING, ENERGY, CONCENTRAT ION OR SELF - IMAGE. SOURCE: U.S. DEPARTMENT OF HE ALTH AND HUMAN SERV ICES

Girls are far more likely to experiencedepression

Male5.8%

Female19.5%

2007

2008

2009

2010

2011

2012

2013

2014

2015

2006

7.9%

12.5%

6.3 millionTeens ages 13 to 18 who have had an

anxiety disorder. That numberrepresents 25% of the population in that

age group in 2015.

13%

11

9

7

Boys are more likely to be anxiousthan depressed

Female30.1%

Male20.3%

Anxietyby the numbers

51

healthy ways to cope. Similarly, thosewho want to stop need a strong level ofinternal motivation.

“You’re not going to stop for some-body else,” explains Phoebe, the teen-ager from Maine. Even thinking abouthow upset her mother was about theself-harm wasn’t enough. “I tried makingpacts with friends. But it doesn’t work.You have to figure it out for yourself. Youhave to make the choice.”

Eventually, Phoebe steered herselfout of the dark, destructive corners ofthe Internet that reinforced her habit byromanticizing and validating her pain.She’s now into holistic healing and looksat positive sites populated by people shecalls “happy hippies.”

Faith-Ann remembers the day hermother Tammy noticed the scars onher arms and realized what they were.By then she was a junior in high school.“I normally cut in places you couldn’t see,but I had messed up and I had a cut on mywrists. I lifted my arm to move my hair,and she saw it. It was scary because thecuts were in a place that people associatewith suicide.” That was not what she wasattempting, however.

“If she’d asked me before that if I wascutting, I would have said no. I wouldn’thave wanted to put that pain on her,”says Faith-Ann. But that night she said,“Yes, I am cutting, and I want to stop.”Tammy cried for a bit, but they movedon. She didn’t ask why, she didn’t freakout, she just asked what she could do tohelp. “That was the exact right thing todo,” says Faith-Ann.

The family got counseling after that.Her parents learned that they weren’talone. And Faith-Ann learned breathingtechniques to calm herself physically andhow to talk to herself positively. Recoverydidn’t happen all at once. There wererelapses, sometimes over tiny things. Butthe Bishops were on the right road.

One of the most powerful thingsFaith-Ann did to escape the cycle ofanxiety, depression and self-harm wasto channel her feelings into somethingcreative. As part of the Project AWAREteen program in Maine, she wrote anddirected a short film about anxiety anddepression in teens called The Road Back.More than 30 kids worked on the project,and they became a support system for oneanother as she continued to heal.

“I had a place where I could be openand talk about my life and the issues I washaving, and then I could project them inan artistic way,” she says.

BELLEVUE’S FADI HADDAD says that forparents who find out their children aredepressed or hurting themselves, the bestresponse is first to validate their feelings.Don’t get angry or talk about taking awaytheir computers. “Say, ‘I’m sorry you’re inpain. I’m here for you,’” he says.

This straightforward acknowledg-ment of their struggles takes away anyjudgment, which is critical since mental-health issues are still heavily stigma-tized. No adolescent wants to be seenas flawed or vulnerable, and for parents,the idea that their child has debilitatingdepression or anxiety or is self-harmingcan feel like a failure on their part.

Alison Heyland’s dad Neil says thatinitially, it was hard to find people toconfide in about his daughter’s depres-sion. “I see everyone putting up postsabout their family, they look so happyand everyone’s smiling, everything isso perfect and rosy. I kind of feel lessthan,” he says.

For both generations, admitting thatthey need help can be daunting. Even oncethey get past that barrier, the cost and lo-gistics of therapy can be overwhelming.

Faith-Ann still struggles at times withdepression and anxiety. “It’s a conditionthat’s not going to totally disappear frommy life,” she says over the phone fromLos Angeles, where she’s thriving at filmschool. “It’s just learning how to deal in ahealthy way—not self-harming, not lash-ing out at people.”

Of course Bret and Tammy Bishop stillworry about her. They now live in Hamp-stead, N.C., and at first Bret didn’t likethe idea of Faith-Ann’s going to schoolin California. If she was having troublecoping, he and Tammy were a long planeride away. How can you forget that yourchild, someone you’ve dedicated years tokeeping safe from the perils of the world,has deliberately hurt herself? “It’s withyou forever,” says Tammy.

These days, she and Bret are proudof their daughter’s independence andthe new life she’s created. But like a lotof parents who’ve feared for their child’shealth, they don’t take the ordinary forgranted anymore. □

What parentsshould do

If you’re worried about anadolescent and aren’t sure what

to do, heed the advice of FadiHaddad, a psychiatrist and the

co-author of Helping Kids in Crisis

1Talk about the real stuff

Sometimes conversations betweenparents and teens can be all about

achievements, schedules and chores. Gobeyond that. Find out what keeps them

up at night, and ask, “What’s the best partof your day?” Become attuned to their

emotional world so that you understandwhat their dreams are, what they

struggle with and how their life is going.

2Pay attention,

but don’t smother themGive teens space to grow and separatefrom you, but also watch for changes inbehavior. Are they giving up activities

they used to enjoy? Are they staying upall night or eating differently? Is your

outgoing kid now withdrawn? If you’reworried, say so. Show interest in their

internal life without judgment.

3Resist getting angry

When parents find out a teen hasbeen hiding something or is having

behavior issues, the response is oftenanger or punishment. Instead, findout what’s going on. If a kid is actingout, say, “It seems like you’re having

trouble. I’m here to help. Tell me what’shappening with you.”

4Don’t put off getting help

If you’re worried about an adolescent,talk to a school counselor, therapist or

doctor. It’s better to get help early ratherthan when trouble has firmly taken hold.

5Treat the whole family

When a kid is in crisis, many times it’snot enough to treat the child—you

have to change the family dynamic. It’spossible that something about the homeenvironment was causing stress for thechild, so be open to acknowledging thatand getting family counseling if needed.

▶ For more on help for teen mental-healthissues, visit time.com/teenmentalhealth

before anything else, we’re all humanrethink your bias at lovehasnolabels.com

© Time Inc., 2016. All rights reserved. No part of this material may be duplicated orredisseminated without permission.