Anticipatory Anxiety

In the​ 1980s the term ‘anxiety’ was almost eliminated from the lexicon of American psychiatry. The infamous DSM-III (the third edition of the Diagnostic and Statistical Manual of Mental Disorders) took an axe to various legacies of psychoanalysis that had dominated psychiatric thinking in the postwar decades. Among them was a preoccupation with anxiety. Anything and everything could, it seemed, be attributed to anxiety: whether it presented as a specific phobia or a panic attack, a somatic symptom or just a lurking sense of dread, anxiety was at the root. It was this sort of all-purpose explanation, with no apparent scientific rigour or falsifiability, that the authors of DSM-III were trying to root out.

It wasn’t just psychoanalysts and their psychiatrist co-travellers who had given so much credence to anxiety. Existentialists from Kierkegaard to Sartre had also turned to it in their search for fundamental truths about human beings. In the literature and philosophy of the interwar and postwar period, anxiety figured as the mood appropriate to a time of freedom, contingency and godlessness – a modernity that had torn the old world down but failed to build anything secure or meaningful in its place. Anxiety was isolating, but isolation was the truth.

For those who sought to place psychiatry on a medical footing (something that also suited the US health insurance industry), ‘anxiety’ had become too heavily freighted with theory. In place of the sweeping Freudian language of neurosis, the authors of DSM-III drew up an extensive menu of disaggregated disorders, along with checklists of their defining symptoms. Patients who might once have been diagnosed with ‘anxious neurosis’ could now be assigned to the new categories of ‘panic disorder’ or ‘somatisation disorder’. There was a growing concern with depression – now understood in wholly non-Freudian terms as a collapse of energy and pleasure – which intensified with the launch of SSRIs, a new class of antidepressant, in the late 1980s. Anxiety staggered on in DSM-III in the form of ‘generalised anxiety disorder’ (a catch-all for cases that didn’t fit other diagnoses, not least because they seemed to be unresponsive to antidepressants), but by the turn of the century it was the language of depression that was most often used to articulate alienation and unease.

Yet within a few years, anxiety had come to the fore again. ‘Anxiety disorders’ began to rise precipitously after 2008, becoming the world’s most common mental health disorder by 2019, affecting an estimated 4 per cent of the global population. More often than not, anxiety and depression are comorbid, and the increase in the incidence of anxiety disorders was partly the result of clinicians’ realisation that they had applied the term ‘depression’ too liberally in the past. There is, after all, a difference between a debilitating low mood and a debilitating sense of dread, even if the two often coincide. In the 1980s and 1990s it was the low mood that experts were more attentive to, today it is the dread.

The demography of distress has changed too. The sharpest rise in mental health diagnoses after 2008 was among the young, girls and women especially. In The Anxious Generation, the social psychologist Jonathan Haidt draws on an extensive range of evidence – rates of diagnosis, self-harm, suicide – to show the ways in which the mental health of young people has deteriorated. In the US between 2010 and 2018, self-reported anxiety rose by 18 per cent for those aged between 35 and 49, but by 92 per cent for those aged between 18 and 25. In the UK, acute mental health problems among children have overwhelmed the available service provision. Last summer, it was reported that the number of urgent referrals to mental health crisis teams had reached 3500 a month, three times higher than in 2019. Anyone working in children’s services or education will be familiar with the problems of young people who find it nearly impossible to leave the house, go to school or campus, or speak in front of strangers. More than 250,000 children are on the waiting list for an appointment with Child and Adolescent Mental Health Services, 40,000 of them have been waiting for longer than two years.

The mental health crisis among young people is now having a significant impact on the labour market and the welfare state in the UK. In 2019, the then prime minister, Theresa May, declared Britain’s mental health record one of the ‘burning injustices’ she aimed to remedy. But now that levels of economic inactivity and government spending on disability benefits are on the rise – driven especially since Covid-19 by the number of people in their twenties unable to work because of mental and behavioural problems – Conservative politicians are taking a sterner line. Right-wing newspapers have dusted off tirades against ‘sicknote culture’, while Tory politicians have taken to speculating about what really lies behind the surge in diagnoses, with the outgoing secretary of state for work and pensions, Mel Stride, blaming online influencers for making too much of mental health awareness.

The fiscal impact is real, but behind it is an extraordinary and still barely comprehended transformation in the social distribution of distress. The Resolution Foundation recently reported that people in their early twenties are more likely to be economically inactive because of ill-health than those in their early forties. Young people in the UK now suffer higher rates of mental health disorders than any other age group; twenty years ago young people had the lowest incidence of these problems. This is evidence of an epic failure in Britain’s post-crash social, economic and political model, yet until it started to show up as a problem in Treasury spreadsheets it was hardly recognised – except, of course, by the millions of sufferers and their families.

One way to interpret the data is to suppose that the diagnostic and demographic shifts are related. Depression, beyond its definition as an illness, has very often been viewed as an affliction of mid-life – a period of excessive responsibility, debt, guilt, when one becomes accountable for what one has done and who one has become. It involves self-reproach, a sense that options have narrowed and that there is nobody to blame but oneself. Research on ‘subjective wellbeing’ consistently finds that it bottoms out when people are in their late forties (at 47, to be precise) before rising again until they are in their seventies.

Anxiety has often been interpreted as the consequence of an excess of freedom, of there being too much that might happen and not enough that definitely will. Existentialists and psychoanalysts agreed that anxiety has an anticipatory quality, stemming from the indeterminacy of the future. A person with acute social anxiety may have experienced many social situations that passed off without a hitch, but there’s no guarantee that the next one won’t be catastrophic. When this converts into somatic symptoms – racing heart, tightness of the throat, sweating – fears become self-fulfilling prophecies. Rituals and traditions are useful protections: they demonstrate that, contrary to our worst fears, in important ways the future will be like the past. By the same logic, modernity generates anxiety by insisting that change is constantly round the corner.

We should be cautious of generalisations about the youth mental health crisis. Yet some kind of narrative is needed, if the post-2008 trend is to be recognised as a political and economic phenomenon, rather than just left as a blizzard of disparate statistics and diagnoses. Perhaps the reasons so many young people are crippled with anxiety (as well as depression) have something to do with the anticipatory dimension of a society governed in the interests of finance and in which there are no guarantees about the future. To be young today is to face the future – the planet’s as well as one’s own – at a time when social safety nets and familiar institutional pathways are being eroded. Education has been recast as an individual investment, whose consequences for good and ill extend for decades. Millions of young people find ordinary parts of life such as school or work impossibly dangerous. If depression represents a grinding to an exhausted standstill, anxiety is a terror of ever getting started – but that must be at least in part because the road ahead appears so long and arduous.

Haidt isn’t particularly interested in the distinction between depression and anxiety, although The Anxious Generation shares the supposition of his 2018 book, The Coddling of the American Mind (co-authored with Greg Lukianoff), that young people have grown unreasonably fragile. Haidt’s long-standing supposition, that ‘identity politics’ has led young people to revel in feelings of victimhood, has seen him celebrated on the right as a defender of robust debate and Enlightenment values. This is also a preoccupation with anxiety: exaggerated fears of everyday situations, potentially escalating to acute mental illness manifested in self-harm and suicidal ideation. The Coddling of the American Mind focused on campus politics and ‘safetyism’ among students, but Haidt’s attention is now on two ‘experience blockers’ that interrupt the all-important years of adolescent development: a culture of ‘overprotection’ that stems from ideas about childrearing which have evolved since the 1980s, and the more recent rise of smartphones.

Haidt starts from the uncontroversial proposition that free, unstructured play is a crucial part of childhood. It is through sometimes uncomfortable experiences of peer-to-peer relations and risk-taking that children acquire a sense of security in the world. By navigating difficult social and physical situations, they begin to develop a realistic sense of the dangers the world presents. Adult supervision, no matter how well-intentioned, disrupts the way children gradually ‘learn to tolerate bruises, handle their emotions, read other children’s emotions, take turns, resolve conflicts and play fair’. But in the 1980s, and even more in the 1990s, American society in particular became fixated on risks to children (whether accidents or deliberate acts) and on the constant work of ‘parenting’, which had the result of reducing the time children spend away from adults. The rise of what has elsewhere been termed ‘schoolification’, whereby a child’s free time is increasingly organised into structured (often paid-for) activities, is another dimension of the same problem. The Anxious Generation is a manifesto for a ‘play-based childhood’ that encourages parents and risk assessors to back off. In practical terms, Haidt suggests more hanging out in the park or walking to school with friends, at an earlier age than many parents are currently comfortable with.

The second of the two ‘experience blockers’ is the one that has attracted attention since Haidt’s book was published, prompting an international policy debate that briefly gave Downing Street something to campaign about. Smartphones became a mass phenomenon in 2007, and Haidt’s central contention is that this is the explanation for the dramatic increase in youth mental illness in the years that followed, as ‘play-based childhood’ was supplanted by ‘phone-based childhood’. Haidt thinks that smartphones are responsible for four identifiable harms: the loss of face-to-face social contact outside school, sleep deprivation, attention fragmentation and addiction. A crucial factor, he argues, is whether or not a young person has a smartphone while they are going through puberty: one of his recommendations is that the legal age limit for possessing a social media account (the most significant use of a smartphone for a teenager) should be raised from thirteen to sixteen, and parents should hold off giving their child a smartphone until they are fourteen. The physiological transition out of childhood is fraught with anxiety and conflict at the best of times, and throwing Instagram and TikTok into the mix scrambles the processes that otherwise set the child up for a healthy and psychologically secure adulthood.

As a founder of the Heterodox Academy, a campaigning organisation aimed at defending ‘viewpoint diversity’ from the tyranny of progressive ideologies, Haidt would make no apology for any gender essentialism. Social media is, he says, worse for girls than for boys, because they are more likely to channel their aggression towards one another by means of social and reputational tactics, while boys are more likely to do so physically. Girls want community; boys want agency. Visually oriented social media platforms such as Instagram weaponise the female instinct to gain social approval, and one result of this is that girls spend far more of their time on them than boys, and get more anxious and depressed. Boys, meanwhile, are swamped with instantly available pornography and violence – although social media is nurturing a mindset of toxic social comparison for them too. It’s true that the statistics on youth mental health (anxiety disorders in particular) show unambiguously that girls are doing worse than boys. We also know from the testimony of the Facebook whistleblower Frances Haugen that the company’s own research showed that Instagram (which is owned by Facebook’s parent company, Meta) was doing demonstrable harm to girls’ mental health. The question is how much weight to grant social media when we try to explain wider demographic trends and their gender discrepancies.

It is the loss of non-screen-based activities, added to the rise of ‘fearful parenting’, that concerns Haidt as much as anything. Encounters with nature, aimless messing around and physical synchronicity (when dancing or playing sport) are features of healthy human development that are obstructed by a ‘phone-based childhood’, not just because teenagers stop sharing physical spaces, but also because their interactions are increasingly asynchronous. At times, The Anxious Generation echoes sociological critiques of post-Fordism: a society that has lost all sense of rhythm, adults seeking to turn their offspring into a ‘superior product’, the tyranny of risk management. Too often it relies on the sort of neuro-balls (phones laying down ‘new paths in the brains of Gen Z’), anthropological anecdote and Jordan Peterson-style secular religiosity that plays well on the TED Talk circuit. (One of Haidt’s TED Talks has had 2.6 million views online.)

Haidt would not identify as a political ‘conservative’ in the American sense, but there is undoubtedly a conservative tenor to his analysis, as reflected in its warm reception both from Downing Street and such right-wing think tanks as Policy Exchange. Tories claim not to like banning things, but the idea of enforcing ‘phone-free schools’ has gained traction thanks not least to the noise generated by The Anxious Generation. Analogies are made between tobacco and smartphones, and the delay in recognising the harms of both. A grassroots campaign called Smartphone Free Childhood emerged in the UK shortly before Haidt’s book appeared, and aimed at pushing up the normal age at which a child is given a smartphone (getting one when starting at secondary school aged eleven has become a rite of passage, though Ofcom reports that nearly a quarter of five to seven-year-olds have them).

Haidt is not the messenger that anyone on the left, or indeed many experts, would want to hear from on these matters. He has form as a woke-basher, and wades into academic disciplines wielding the crude biological reductionism that is the hallmark of so many ‘free speech’ campaigners. One of his data points, which apparently shows that boys have increasingly ‘internalised’ their problems since 2010 (in a way more commonly seen in girls), thereby substituting self-directed harms for outwardly-directed ones, is that hospital admissions for unintentional injuries among young men have fallen. Rarely has the ‘school of hard knocks’ been celebrated so literally.

There has already been plenty of criticism of Haidt’s thesis, often pointing out that he mistakes correlation for causation. In a review for Nature, the psychologist Candice Odgers suggests that he may have the causality the wrong way round: children already suffering from anxiety and depression may become heavier users of smartphones and the platforms they make available. ‘As a parent of adolescents, I would also like to identify a simple source for the sadness and pain that this generation is reporting,’ Odgers writes. ‘There are, unfortunately, no simple answers. The onset and development of mental disorders, such as anxiety and depression, are driven by a complex set of genetic and environmental factors.’ She also thinks that Haidt underplays the impact of the 2008 financial crisis on the life chances and economic security available to younger generations. Children’s experts and teachers have criticised the book, too, claiming that banning phones from schools would be counterproductive, that there are already norms in place to limit their use, and that the smartphone and the internet are now so ingrained in childhood that it’s impossible to turn the clock back to a Just William world of muddy knees and tree-climbing.

One frustrating thing about this debate is how much space a figure like Haidt takes up. Some of the success of his book no doubt reflects the force of the truths it contains, but these would once have stirred the left as much as the right. Why has human suffering on the scale Haidt describes failed to provoke more of a critical and political response over the past fifteen years? In the past, critical psychologists and cultural theorists were ready with conjectures which may have simplified the ‘complex set of genetic and environmental factors’ involved in mental illness, but contributed nonetheless to building a narrative that considered where society was going wrong. It may be partly that there has been a long-term decline in the status of critical psychology and anti-psychiatry, but today it is the right and grifters such as Johann Hari who are politicising mental health and the scourge of Big Tech.

To give Haidt his due, the rise of the ‘phone-based childhood’ is only half of his explanation for the downward trend in young people’s mental health. He isn’t wrong on the facts concerning the decline of ‘play-based childhood’. A recent survey found that the average age when children are allowed to play outside unsupervised is now eleven, compared to nine in their parents’ generation. Time-use studies have made the finding – perplexing, but only at first glance – that both men and women are spending both more hours a week ‘parenting’ and more hours doing paid work than was the case in the 1970s. Children are seen less as people with their own lives, milling around doing what children do; they are now seen as a project. Parents get exhausted by the incessant activities and demands, and that’s when most of us, more or less guiltily, hand a child a screen.

Haidt doesn’t have much to say about the way these dynamics intersect with class, inequality and the post-2008 economic landscape. Contrary to the tabloid suspicion that the youth mental health crisis is driven by ‘zoomers’, shopping around for diagnoses so they can spend more time in the park, the statistics suggest that material factors are at work. NHS figures show a strong correlation between the incidence of mental health diagnoses in children and the economic insecurity of their parents. A report by the Joseph Rowntree Foundation, Anxiety Nation?, shows that being a homeowner and having savings goes along with better mental health across a wide range of indicators, such as good sleep and feelings of self-worth. Prescriptions for anti-depressants are issued in greatest numbers in the most deprived areas, to children as well as adults. Whatever else might be going on, mental health disorders are certainly not a symptom of privilege.

Parents who are worrying about money, and perhaps suffering from depression and anxiety themselves, are less likely to provide a secure emotional environment for their children. One question is what children who aren’t being enthusiastically ‘parented’ are doing with their time. Haidt notes that, in the US, ‘lower-income, Black and Latino children put in more screen time and have less supervision of their electronic lives, on average, than children from wealthy families and white families.’ This being the case, ‘the “digital divide” is no longer that poor kids and racial minorities have less access to the internet, as was feared in the early 2000s; it is now that they have less protection from it.’

It needn’t be the case that the only options for children are hanging out on street corners, scrolling through TikTok in their bedrooms, or taking endless violin and ceramics lessons. There is another possibility: invest in public institutions for children. In the UK at least, the post-2008 environment has been a disaster in this respect. At the time of the 2010 election, 3631 Sure Start centres were providing support for early years development (and for parents), receiving £1.8 billion in funding. By 2023, that funding had fallen by two-thirds, and there were only 2204 centres left. The YMCA found that local authority funding for youth services in England fell by 75 per cent between 2010 and 2023. To say that austerity has been a war on the young isn’t just to complain about university tuition fees.

Labour has pledged to create the ‘healthiest generation of children ever’ through a mixture of targeted NHS investment and banning things like vaping and the advertising of junk food. Fine. But what institutions could be created to help teenagers discover a sense of autonomy and self-worth, in a safe environment that isn’t controlled by their parents? Local government has taken such a fiscal battering over the last fourteen years that youth clubs and other youth services scarcely get a look in. Extracurricular provision in schools is the last remaining safety net, and a significant share of the current levels of distress must be attributed to the school closures of 2020 and 2021, from which (as experts warned at the time) many children may never fully recover. The costs and benefits of those closures will never be conclusively established, and hindsight is in any case a bad guide to the chaotic, fearful atmosphere of pandemic politics. What was clear even at the time, though, was that while school closures were fought over by teachers’ unions and their sworn enemies in the Department for Education and the press, children were given barely any say in the matter. Lest we forget where our national priorities lie, pubs were reopened before schools.