Jun 22, 2024

Bad Therapy


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My highlights from Bad Therapy: Why the Kids Aren't Growing Up, by Abigail Shrier

cover of book bad therapy

We perfected the “time-out” and provided thorough explanation for any punishment (which we then rebranded as a “consequence” to remove any associated shame and make us feel less authoritarian).

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Parents often assume that therapy with a well-meaning professional can only help a child or adolescent’s emotional development. Big mistake.

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“Iatrogenesis” is the word for all of it. From the Greek, iatrogenesis literally means “originating with the healer” and refers to the phenomenon of a healer harming a patient in the course of treatment. Most often, it is not malpractice, though it can be. Much of iatrogenesis occurs not because a doctor is malicious or incompetent but because treatment exposes a patient to exogenous risks.

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Well-meaning therapists often act as though talking through your problems with a professional is good for everyone. That isn’t so.[8] Nor is it the case that as long as the therapist is following protocols, and has good intentions, the patient is bound to get better.

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Therapy can hijack our normal processes of resilience, interrupting our psyche’s ability to heal itself, in its own way, at its own time.

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Even if I am having a good day, coming here makes me think about all the negative things.”

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I remembered saving up emotional injuries to report to my therapist so that we would have something to talk about at our session—injuries I might have just let go.

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Participating in group therapy to discuss a problem you didn’t already have? That may be sufficient to introduce it.

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Teenage communication today is more constant, largely digital, and, even among teen girls, far more superficial than it was a generation ago. Less baring of souls, more trading of memes. Even to their best friends, they communicate only this: that they are going through something bad and serious, something that will require their friends’ sympathy and indulgence.

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Nearly 10 percent of kids now have a diagnosed anxiety disorder.[8] Teens today so profoundly identify with these diagnoses, they display them in social media profiles, alongside a picture and family name.

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A decade ago, a writer for Slate noted that instead of using moral language to describe misbehavior, educated parents had begun employing therapeutic language.

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They published a peer-reviewed paper titled “More Treatment but No Less Depression: The Treatment-Prevalence Paradox.”

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Therapists typically discourage parents ever from taking away a teen’s smartphone, on the grounds that doing so will only sabotage the parent-child relationship.

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Parents who follow the therapists’ direction and embrace their children’s despair breathe life into the monster under the bed.

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With some notable exceptions, placing an adolescent’s worries into perspective is not what therapy does—nor even what it seeks to do. That wouldn’t be affirming the patient.

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But today’s mental health experts rarely consider that there is any problem facing today’s youth to which they are not the invariable solution. So, more therapy, then. How much more? Loads.

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“As therapeutic points of view and practice gain general acceptance, more and more people find themselves disqualified, in effect, from the performance of adult responsibilities and become dependent on some form of medical authority.”[65]

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For most problems, Ortiz says, individual therapy has almost no proven benefit for kids. “The evidence is pretty clear that parent-based approaches are more effective.” Meaning, a therapist should treat a kid’s anxiety by treating the kid’s parents. Parents often unwittingly transmit their own anxiety to their kids. And parents are in the best position to help a child deal with her worries on an ongoing basis.

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Therapy, when it works for adults, gets its power from the patient’s buy-in.

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Almost necessarily, the presence of the intermediary will alter a parent’s relationship with her child, whether the parent realizes this or not.

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“Emotions are highly reactive to our attention to them. Certain kinds of attention to emotions, focus on emotions, can increase emotional distress. And I’m worried that when we try to help our young adults, help our children, what we do is throw oil into the fire.”

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“We are basically telling them that this deeply imperfect signal”—that is, what they are feeling—“is always valid, is always important to track, pay attention, and then use to guide your behavior, use it to guide how you act in a situation.”

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In an individualistic society like ours, we incline toward the erroneous belief that feelings accurately signal who we are in the moment. But in fact, “feelings are responsive to so many cues, and because of that, so often are off.”

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Of our sixty-thousand wakeful seconds each day, only a tiny percentage are spent in a state we would call “happy.” Most of the time we are simply “okay” or “fine,” trying to ignore some minor discomfort: feeling a little tired, run down, upset, stressed out, irritated, allergic, or in pain. Regularly prompting someone to reflect on their current state will—if they are being honest—elicit a raft of negative responses.

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“If you start your day by asking yourself whether you are happy, the result can only be that you’re not happy. And then you think you need help to become happy.

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“We know that people who are really strongly desiring to be happy are not particularly happy and that the desire to be happy serves as a vulnerability factor.”

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yes, therapists can reinforce a child’s or adolescent’s outsized fears. Therapists can make kids’ anxiety worse.

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Banishing normal chaos from a child’s world is precisely the opposite of what you would do if you wanted to produce an adult capable of enjoying life’s intrinsic bittersweetness,

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adding monitoring to a child’s life is functionally equivalent to adding anxiety.

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Real play, of the developmentally beneficial sort, involves risk, negotiation, and privacy from adults:

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Things that are joyful to children: danger, discovery, dirt. Games whose rules they invented with that ridiculous cast of characters they call friends. Their hearts aren’t fooled by Mom’s carefully arranged simulacra: the hypoallergenic, nontoxic “slime” she begs all the kids to make with her from a kit that arrived from Amazon. Isn’t this fun? It’s so gross! Right, girls?!

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“A diagnosis is saying that a person does not only have a problem, but is sick,” Dr. Linden said. “One of the side effects that we see is that people learn how difficult their situation is. They didn’t think that before. It’s demoralization.”

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With children and adolescents, there’s far less proof of antidepressants’ efficacy than for adult patients.

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When you start a child on meds, you risk numbing him to life at the very moment he’s learning to calibrate risks and handle life’s ups and downs.

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One of the most significant failings of psychotherapy, Byng says, is its refusal to acknowledge that not everyone is helped by talking about their problems. Many patients, he says, are harmed by it.

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Instead, we demand that they locate any dark feelings and share them. We may already be seeing the fruits: a generation of kids who can never ignore any pain, no matter how trivial.

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One of the most damaging ideas to leach into the cultural bloodstream, according to Coleman, is that all unhappiness in adults is traceable to childhood trauma. Therapists have made endless mischief from this baseless and unfalsifiable assertion.

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Worse, it leaves those grandkids with the impression that they descend from terrible people. People so twisted and irredeemable, Mom won’t let them in the house.

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Children learn that all relationships are expendable—even within the parent-child dyad.

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I asked Barsky which hypochondriacs are most resistant to treatment. Those who have turned their distress into what he calls an “organizing principle.” They join online groups devoted to their mysterious illnesses, stop going to work and rearrange their social lives as a shrine to their symptoms.

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Emotional regulation is learned that way, too. You get a bad grade on a test. You throw a fit and cry. Classmates shoot you weird looks and shy away from you. The next time, you study harder, or learn to take the disappointment in stride.

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Never do the materials seem to consider that undermining a child’s relationship even with imperfect parents creates psychological damage all its own.

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Nikolas Cruz, a student at Marjory Stoneman Douglas High School, had committed violent and menacing acts for years. He was assigned a shadow—his mom.[9] “The Parkland shooter” later took seventeen lives.

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Adults who know they are suffering in the present are motivated to find explanations in their past and are highly suggestible to whichever ones the researcher finds interesting.

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“I think we are destroying our children by telling them they can’t get over whatever hurts. And I’m not saying that there isn’t racism. I’m not saying that there aren’t people who do really bad things and are horrible. But what I’m saying is that it’s not serving our children to say that they’re constant victims,” she said.

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“I think one big problem with the field of academic psychology is that it has become limited to the privileged and the wealthy,” Camilo Ortiz said. Very few mental health experts have ever been poor, much less weathered forced migration or the incarceration of parents,[9] as Ortiz did. It’s easy for them to exaggerate the degree to which minor upsets scar adolescents’ psyches.

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The great Israeli sociologist Eva Illouz notes that the trauma narrative is plotted backward—from present adult dissatisfaction to the epiphany of a childhood spent in a dysfunctional family. “What is a dysfunctional family? A family where one’s needs are not met. And how does one know that one’s needs were not met in childhood? Simply by looking at one’s present situation,” Illouz writes. “The nature of the tautology is obvious: any present predicament points to a past injury.”

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Captivated by his idea that we’re all damaged, people who have never seen any combat (or, really, any brutal experience) discover their hidden traumas, reasoning backward from a disappointing adult life to the parent who failed them.

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These methodological flaws aren’t unique to the work of trauma researchers; all retrospective surveys—in which participants are polled about their past—suffer from these.

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But we have no proof that childhood trauma causes specific adult mental health problems. Studies that purport to show this are riven with sources of bias.[45] What we can say is that childhood trauma is neither necessary nor sufficient to produce adult psychopathology.

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“Memory works a little bit more like a Wikipedia page,” she has said.[51] “You can go in there and change it—but so can other people.”

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If therapists and teachers and parents are looking for childhood trauma when they question children, kids are likely to supply it.

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These surveys do not help those kids. (They are anonymized, after all.) These surveys simply present to all children the ontology of a darkly degraded world and convince them that they inhabit it.

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Anxiety and depression may be different aspects of the same habits of mind: excessive thinking about yourself.

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Mental health professionals typically assume that sanity is somehow inside your head. But it isn’t—at least not entirely. “Sanity is the harmony that emerges as a consequence of being embedded in multiple social institutions,” he said.

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But ask a kid: “How are you feeling today?” as our schools now do on a routine basis, and you tear kids from that social fabric. You ask them to conceive of themselves as free radicals, hurtling through the universe without a tether. This sort of contemplation is inherently destabilizing. It may even be indistinguishable from unhappiness itself.

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Empathy invariably involves a choice of whose feelings to coronate and whose to disregard.

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“You must stop this. Sometimes they will like the piano; sometimes they won’t. This is normal. Stop asking.”

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Where had I gotten the idea that at every moment of their lives, my boys were supposed to be gleefully engaged?

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We assumed with perfect faith (and wholly without evidence) that gentler parenting could only produce thriving children. Shouldn’t flowers bloom in powdered sugar? Turns out, they grow best in dirt.

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Rules had exceptions and workarounds, but “knock it off” signaled a parent’s disinclination to become entangled in them.

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The approach to bad behavior is always therapeutic—meaning it is nonjudgmental. It’s the parent’s job to understand a child’s frustration—never the child’s job to learn to control his impulses.

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When one Slate mom, Liz, writes to complain that her “emotional roller coaster” of a five-year-old daughter often collapsed in screaming fits in the weeks after she broke her arm, Slate parents rush in with diagnoses. “It sounds like she is having a trauma response,” opines Brian. “Remember, Post Traumatic Stress is a normal reaction to an abnormal traumatic event.” (No, actually, it isn’t; resilience is the normal response.)

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As neuropsychologist Rita Eichenstein told me, parents who accommodate kids’ sensitivities often inadvertently help create sensitive children. The environment they curate is so frictionless, it offers the child no preparation for the normal chaos of the world.

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Pediatricians tell us what our kids need from us emotionally (and not only medically); school psychologists inform us how to talk to our kids about hard things, or send home prompts for important “social emotional discussions.” No one solicits parents’ advice because our advice is nonexpert and, therefore, presumably without worth.

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After studying the ways parents attempt to control the behavior of children, Baumrind discerned three general approaches: permissive, authoritative, and authoritarian.

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The “authoritative parent,” however, is loving and rule based. She attempts to direct the child’s activities in a rational manner, encourages a give-and-take with her child, but “exerts firm control at points of parent-child divergence.” Where her point of view on a household rule ultimately conflicts with that of her child, she wins. She maintains high standards for her child’s behavior “and does not base her decisions on group consensus or the individual child’s desires.”

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There’s an intriguing book that tidily makes this point: Hunt, Gather, Parent, by Michaeleen Doucleff. Western parents, Doucleff decides, have no idea what they’re doing.

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The moment our support and affirmation were made explicitly unconditional and entirely indestructible, our kids knew they didn’t have to do anything to sustain our permanent high regard.

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And the young adults who are cutting off their parents in record numbers are often those raised by the most indulgent and devoted parents.

NOTE: Citation

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When young adults can’t excise mom’s anxious and needy voice from their heads—they may feel the need to banish her from their lives.

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soul-searching was never the point of punishment. Self-reflection is the therapeutic quest.

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And while Baumrind did not advocate spanking, she found that “occasional, mild spanking” did not traumatize children.[25] Cue the outrage. But it’s true: studies have been unable to support supposed links between spanking and externalizing disorders.

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Want to know why the rising generation of kids doesn’t want to have children of their own? It’s because we made parenting look so damn miserable.

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The kids believed us when we treated their hurt feelings as deadly serious. More than their father’s financial worries—more serious than their grandmother’s poor health. They trusted us that their feelings and worries were the most important things on earth. They are collapsing under the weight of all that worry.

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Worst of all, they don’t believe we can help them. We don’t make them feel secure because we’ve told them—over and over, in so many ways—we’re scared out of our minds, and we aren’t actually in charge. We are just following what the pediatrician, or the therapist, or the teacher, or school counselor, or the occupational therapist told us to do. He’s in charge, she’s in charge, our kids are in charge. We aren’t in charge.

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I heard this from other immigrants: the problem with American parenting is that we do not assert our authority with our own children. We do not make it a priority to pass down our values to our own kids; we seem to expect the culture to do this for us.

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The more he read, the more convinced he became of two things: ADHD—characterized by overstimulation and distractibility—didn’t meet the standard definition of a “disorder.” And Ritalin was no solution at all. There are “4Ds” of abnormal psychology, Ophir reasoned: deviance, distress, dysfunction, and danger. ADHD doesn’t meet any of them.

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Unlike adults who choose to begin a course of psychotropic pharmaceuticals, medicated adolescents may never discover whether they can handle life at full strength. If we don’t allow teens to face the slings and arrows of outrageous fortune, they may never learn to weather them.

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We lost this somewhere along the way: the sense that these kids we raise, they’re ours. Our responsibility and our privilege. We are not the subordinates of the school psychologist or the pediatrician or our kids’ teachers. We are more important than all of them combined—as far as our kids are concerned. We gave our kids life, we sustained it, and we are the ones who bear the direct emotional consequences of how those lives turn out. It’s time we acted like it.

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But parenting is not a skill. It’s a relationship—or, it was. Before the experts professionalized it,

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You don’t give a child independence any more than you give a child confidence, however much it flatters us to think we do. In most circumstances, you simply get out of their way—stop interfering—and independence takes its course.

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When kids miss their “window” of independence—of wanting to hazard a risk and venture something new on their own—they stop asking for it.

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In his clinical practice, based on a similar intuition, psychology professor and cognitive behavioral therapist Camilo Ortiz has begun treating anxious adolescents with independence.

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Each year, as a birthday present, her parents increased the permitted ambit of her tramping about on her own. Each year, they allowed a little more risk, a little more chance for danger—and, necessarily, for learning and growing. Each year, they tantalized her with a slightly greater peek at the joys of the adult world.

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“There’s a huge amount of insecurity about ‘Who am I?’ ” he said, of the young adult patients he’s seen in the last decade. “A good deal of it is not being able to connect up with the past, not being able to have a sense of continuity.

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You are always, in everything you do, monitored by anxious adults.

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You’ve had a diagnosis for at least a year; it’s begun to feel as much a part of you as your own name. Your parents are obviously relieved to have a label for what’s wrong with you. Most of your friends have a diagnosis, too.

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There is nothing scarier to a child than the sight of her parents overmatched and afraid.

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That’s what a happy childhood is: experiencing all of the pains of adulthood, in smaller doses, so that they build up immunity to the poison of heartache and loss.

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“Going to therapy is like learning to ski by focusing on the trees.”

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Counselors worth their salt would say: “We cannot work in this environment. If you want us to help your kids, the first thing we must insist is that all phones are collected at the start of school and not returned until day’s end.” What could be easier? It’s a little like a school nurse insisting, “The first thing I must insist is that we ban smoking on campus. Smoking makes all health problems worse. If you want me to help kids, let’s start by creating the preconditions for good health.”

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In all but the most serious cases, your child is much better off without them. In all but the direst circumstances, your child will benefit immeasurably from knowing you are in charge—and that you don’t think there’s something wrong with her.

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Today, normal teens are being made ill by the unnecessary treatments our mental health experts dispense indiscriminately.

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Perhaps most insidiously, the experts insist on habituating our kids into a never-ending confrontation with the one question no therapist can resist: And how did that make you feel? When looped in a young mind, it’s a question that increases dysregulation, inhibits growth, turns teens into toddlers and young adults into the never-quite-ready.

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