Stop Pathologizing Life
How therapeutic language and well-intended help often harm kids. And why you need to understand "Prevalence Inflation."
A few years ago, the journal Behavior Research and Therapy published a study of 1,071 Australian teenagers who were observed from 2017 to 2018.
One group received the WISE Teens curriculum—a school-based mental health program.
Another group received the standard health curriculum.
At the end of the study, the results were striking. Students who received the mental health curriculum were more likely to report feeling depressed and anxious, had greater difficulty managing their emotions, and reported worse relationships with their parents.
This finding was not an anomaly. Similar results have appeared repeatedly across studies.
Our attempts to help students’ mental health often do more harm than good.
That educators would try to help makes perfect sense. Rates of mental health disorders among children and young adults have risen dramatically since around 2012. Ignoring this trend would be negligent. Schools are right to ask what is going on—and how they might help.
But as Abigail Shrier has made clear in her book and elsewhere, the help itself often seems to be part of the problem.
There are many contributing factors to the current youth mental health crisis. For a fuller treatment, I recommend The Anxious Generation by Jonathan Haidt and Bad Therapy by Abigail Shrier.
For today, I want to focus on one crucial point:
Our therapeutic culture may itself be driving much of the harm.
Specifically, the way we increasingly pathologize normal emotions, frame everyday struggles in clinical terms, and teach young people to interpret their inner lives through diagnostic labels appears to be making youth mental health worse—not better.
The Oxford psychologist Lucy Foulkes refers to this phenomenon as prevalence inflation. As a New York Times piece explains, prevalence inflation occurs:
“… when greater awareness of mental illness leads people to talk of normal life struggles in terms of ‘symptoms’ and ‘diagnoses.’ These sorts of labels begin to dictate how people view themselves, in ways that can become self-fulfilling.
Teenagers, who are still developing their identities, are especially prone to take psychological labels to heart. Instead of ‘I am nervous about X,’ a teenager might say, ‘I can’t do X because I have anxiety’ — a reframing that research shows undermines resilience by encouraging people to view everyday challenges as insurmountable.”
There has been a well-meaning effort to remove stigma from mental health disorders. Unfortunately, the way we’ve done this may be increasing the mental health problems themselves.
Adolescents, in particular, are falling prey to a pervasive cultural script that teaches them to pathologize nearly every feeling and experience.
Young people are inheriting a world in which ordinary stress is labeled “trauma,” discomfort is framed as damage, and normal emotional fluctuations are treated as symptoms. While this tendency exists in the broader culture, it is dramatically amplified online.
As the Time article continues:
“It’s generally a sign of progress when diagnoses that were once whispered in shameful secrecy enter our everyday vocabulary and shed their stigma. But especially online, where therapy ‘influencers’ flood social media feeds with content about trauma, panic attacks and personality disorders, greater awareness of mental health problems risks encouraging self-diagnosis and the pathologizing of commonplace emotions — what Dr. Foulkes calls ‘problems of living.’
When teenagers gravitate toward such content on their social media feeds, algorithms serve them more of it, intensifying the feedback loop.”
Freya India details this disturbing tendency here.
There are no simple fixes to a cultural problem of this scale. But a few principles matter enormously:
Delay smartphones and social media for as long as possible. As Freya India explains, internet algorithms often act as conveyor belts that amplify every fear, neuroses, and insecurity.
Model a strong, capable mindset for your children.
Avoid the language of pathology whenever you can.
I say this last part as someone who experienced a very real mental health disorder in college. I remember the relief I felt when I finally received a diagnosis. But the relief came because it felt like progress—something concrete I could research, understand, and overcome.
It was not an identity I wanted to wear for the rest of my life. It was a problem to solve.
And that is what it helped me do.
That process taught me a great deal about how the mind works. The mind operates according to relatively simple principles—and it can be trained.
More than that, it is always being trained.
It is trained by what we consume.
It is trained by our actions and daily practices.
And it is trained by what we repeatedly avoid.
Much of modern therapy focuses heavily on excavating the past in search of a breakthrough. But durable mental health is often less about endlessly revisiting what happened to us and more about what we do. We must take action.
This idea is captured powerfully in The Talent Code by Dan Coyle, in an excerpt with major implications for both adults and children:
“We believe that people are shy not because they lack social skills but because they haven’t practiced them sufficiently,” said therapist Nicole Shiloff. “Talking on the phone or asking someone on a date is a learnable skill, exactly like a tennis forehand. The key is that people have to linger in that uncomfortable area, learn to tolerate the anxiety. If you practice, you can get to the level you want.”
The godfather of this kind of therapy is Dr. Albert Ellis. Ellis, who was born in 1913 and raised in the Bronx, was a painfully shy teenager, unable to bring himself to speak to women. But one afternoon he decided to make a change. He sat on a bench near the New York Botanical Garden and chatted with every woman who sat down. In one month he spoke with 130 women.
“Thirty walked away immediately,” he said. “I talked with the other hundred, for the first time in my life, no matter how anxious I was. Nobody vomited and ran away. Nobody called the cops.”
Ellis, who went on to write dozens of books, built a straight-talk, action-oriented approach that challenged the Freudian model of examining childhood experience.
“Neurosis is just a high-class word for whining,” he said. “The trouble with most therapy is that it helps you to feel better. But you don’t get better: You have to back it up with action, action, action.”
Ellis’s approach, combined with that of Dr. Aaron Beck, became known as cognitive-behavioral therapy, which has been shown, according to The New York Times, to be equal to or better than prescription drugs for combating depression, anxiety, and obsessive-compulsive disorder. —The Talent Code, p. 212
Of all the gifts we can give our children, mindset may be the most powerful.
There is no disadvantage like an orientation that fixates on unfairness or casts the self as a perpetual victim of circumstance.
And there is no advantage like a belief in personal responsibility and the confidence that problems—however real—can be addressed, adapted to, and overcome.
We teach this not primarily through lessons or curricula, but through our expectations and our example.
Thank you for reading and sharing
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Carry the fire!
Shane
In my view, while the intention behind mental health programs is to provide support, they can inadvertently contribute to the rise in mental health issues by pathologizing normal emotional experiences. Labels like "anxiety" or "trauma" often become self-fulfilling prophecies, reinforcing feelings of helplessness instead of resilience. To address this, we should encourage a more action-oriented approach to mental health, where difficulties are seen as challenges to overcome rather than conditions to endure. This can be achieved by promoting coping skills, personal responsibility, and a mindset that normalizes discomfort as part of growth, rather than framing it as something to fix. Social media also needs stricter regulation to avoid amplifying harmful narratives.