The news cycle has been extraordinarily bleak for more than two years now. First, there was the pandemic, the widespread anxiety in the media of a repeat of the 1918 influenza pandemic, daily briefings on death and disaster, and report after report suggesting that the disruptions of lockdown were permanently damaging education and the future prospects of a generation. Before we were over all that came the invasion of Ukraine, threats of nuclear war, and media agitation over a return to the anxieties of the Cold War or World War III. Then came the economic crisis, the shortages, the strikes and travel disruption, the daily warnings of worse to come, and of famine for many millions. Not to be dismissed as a source of worry for the young (and the rest of us) are the news stories warning of threats to the very future of democracy – the rise of the ‘far right’, and stories of prominent Western leaders who flout the law, or in one case, is actually accused of trying to mount a coup rather than concede electoral defeat. Or the frequent school and shop shootings in the United States (US), shootings in places of worship around the world, the horrific memories of the Grenfell tower fire back in the media on the 5th anniversary of the event, in June this year. And as a constant underlying background to all this there are the progressively apocalyptic claims for the imminence of climate change disaster and mass extinctions.
This is a truly extraordinary conjunction of disasters. Not since the Second World War have we faced threats on many different fronts at the same time. And even then, there were not so many simultaneous threats as now. We are living through a ‘perfect storm’: a conjunction of bad news of historic proportion. And none of these problems look likely to be resolved any time soon. How will this affect our young? What can we do to support them?
Early days for research
Research takes time. As yet, what we have tends to address one, or at most two or three potential stressors in the news cycle at a time. There is much useful information in that research, but there are many issues that have not yet been addressed.
For example, our perfect storm combines issues that may be proximate and practical for the individual (e.g. the pandemic lockdowns, the economic crisis), with issues that are more distant, affecting others rather than the self (the plight of Ukrainians under shelling, the appalling school shooting in Texas, the prospect of famine in Africa and so forth), and issues that may have little immediate practical impact for the majority, but which are existential threats for us all (climate change, mass extinctions, the possibility of a nuclear war). As yet there is virtually no research that looks at how threats at those different levels will interact to affect the young (or the rest us, for that matter). Yet we need to know, to know how best to offer support.
‘This is a truly extraordinary conjunction of disasters. Not since the Second World War have we faced threats on many different fronts at the same time.’
‘As yet there is virtually no research that looks at how threats at those different levels [proximate and distant] will interact to affect the young.’
Maslow (1943) argued that there is a hierarchy of needs: that proximate issues of survival will take precedence over, preclude more esoteric issues such as the spiritual or the existential. Is that right? Research has not resolved that question. At a behavioural level, intuition suggests that Maslow is at least partly right: the starving will spend their days working to find food rather than contemplating ‘self-actualisation’. But it is far from clear that those struggling to stave off starvation do not, in their ‘down from work’ moments, their dark nights, ask themselves the existential questions about the point of their lives, the meaning of the universe, the reason for their suffering. In fact, archaeological discoveries of monumental constructions apparently intended to appease the gods suggest that the existential is a constant worry, even – perhaps especially – for the starving and threatened.
To put this another way: will the mental health of a 13-year-old in a basement under shelling in Ukraine still be affected by stories of climate disaster, or will their proximate horror obliterate existential sources of anxiety? Will the mental health of a 16-year-old in the UK facing exams this summer primarily reflect anxiety over schooling missed in the pandemic, limitations in family resources, or will our young also be affected by the distant and the existential threats they see in the media? If the proximate threats reduce, will the reaction be relief and renewed wellbeing, or will issues higher up Maslow's hierarchy cut in? In other words, can we, at a practical level, address threats to the mental health of our young ‘one thing at a time’ or should we assume that there may be an interaction between threats at the proximate, the distant and the existential levels, perhaps a cascade of interactions between one class of threat and another? We do not yet have the research to know. But with that cavil, what research we do have allows some conclusions.
Direct and indirect effects of bad events
Direct experience of bad events adversely affects mental health. We know, for example, that child and youth mental health is affected by direct exposure to economic difficulty in the family (UNICEF Innocenti, 2014; Knapp et al, 2016; Thornton 2022a); of living through pandemic lockdowns (Zhou et al, 2020; Thornton, 2022a, Thornton 2022b), of living proximate to acts of terrorism and violence (Ahmed, 2007; Whalley and Brewin, 2007), of becoming a refugee (Vitus, 2010), or living through natural, industrial or man-made disaster (Makwana, 2019).
We also know that those whose exposure to such disasters is entirely indirect, entirely through media reporting are also affected. For example, research (Whalley and Brewin, 2007) following the ‘9/11’ terrorist attacks found that 60% of school age children in New York were reported by their parents as showing severe anxiety following 9/11, even though they were not personally directly affected by the disaster (though it was, of course, ‘on their doorstep’). More formal professional assessments showed that over 28% of these young had at least one diagnosable anxiety disorder 6 months after the event (e.g. agoraphobia, separation anxiety, PTSD).
More strikingly, although those living in New York were the worst affected, children and teenagers living far away were not immune: parental reports suggest that even in Seattle, on the very far side of the US, 35% of the young were anxious after 9/11. Formal professional studies suggest that 8% in those areas had symptoms amounting to PTSD a month after the event. These reactions can only have been in response to media reports.
Equally, we have evidence that the young are made anxious by media reports of existential threats, which may be terrible but can seem less imminently apparent or personally relevant to the majority, such as climate change or mass extinctions (Ojala, 2013; Strife, 2012). Again, the vector for anxiety here is clearly media reportage.
The extra hazard of a vivid and dramatic media
There is evidence, therefore, that negative news cycles per se have an adverse effect on the young, even when the bad events reported do not impinge on them personally in any immediate way. There is also evidence that it is not just the fact that bad events are reported that affects mental health in the young. The intensity and style of reportage of those events also play a key role. The more vivid and dramatic a story, the more often reported, the more memorable it is, and the more probable it seems that this could happen, and happen to me (Kahneman et al, 1982). This is the ‘availability heuristic’ and is the reason why more people fear plane crash (very rare, but very dramatically reported) than fear car crash (much more common, but less dramatically reported in the media). Even young children draw inferences about probability in this way (Thornton, 1996). All the crises of our perfect storm are reported very vividly and dramatically.
In this context, it may be even more worrying that children and young people progressively look to social media to find out what is happening in the world, and to form opinions. A Gallup poll suggests that 45% of them rely on social media in this way (compared to 17% of older people). As yet there is scant research on the issues this may raise, when the world endures not only crises, but conspiracy theories about those crises.
A predicted mental health crisis in the young
Given the scale of our perfect storm of bad news and the ubiquitous, vivid and dramatic reportage, it is no surprise that anecdotal reports from parents and professionals suggest that there has indeed been a rise in mental health problems in the young. This is supported by surveys of children and young people, where the number describing themselves as depressed or anxious has doubled, and the number of referrals for mental health problems has risen sharply (Ford et al, 2021). The data so far primarily reflect the pandemic – we may predict that the subsequent crises of 2022 will have further impact.
This rise in problems is widely described in the media as a crisis in youth mental health, on top of already high levels of such issues. There certainly are matters for concern here. But the situation is far more complex than current public discourse – or the dire predictions of many professionals and journalists – suggests. A more nuanced view may be more useful in addressing the issues.
A core issue concerns what is appropriate or useful to mean by ‘mental health problem’. In recent years mental health has become a hot topic, with celebrities, sportsmen and women, and even a prince airing their woes and misfortunes in very public ways. Some experts believe that we have become prone to medicalising many emotions which, while sometimes unpleasant, were previously, and should be now accepted as normal human reactions to the stresses of life.
For example, there was fierce debate in this area over revisions of the diagnostic ‘bible’, the DSM-5, which proposed to pathologise grief (Wakefield, 2013). It was proposed that anything but a short period of mourning, a mere few weeks, after the death of a spouse, a child, a parent, a friend was mental illness requiring medical intervention. Critics suggested that this reflects a profound misunderstanding of the existential issues involved in grief, the way we value those we love, even after death. It is surely normal and natural to hold those we have lost in our hearts, and to miss them sorely, perhaps forever, and while that will sometimes involve joyful memories, it will also involve a profound sadness. This is a normal aspect of the human condition rather than a pathology.
By the same token: is it really ‘mental illness’ to react with anxiety and depression when the news cycle, and the events it reports is so bleak? Surely such reactions are a normal, natural reaction in such circumstances, and not signs of a medical problem? The issues here are complex. Obviously, where an individual's anxiety, depression or other reaction (PTSD, for instance) to bad news (or bereavement, or other life events) is devastatingly debilitating, there is a case for viewing this as outside the normal range of reactions and offering a medical diagnosis and intervention. But it might be counter-productive to encourage the majority who are currently anxious and depressed to view themselves – or to be viewed by others – as having mental health problems. Such labels are not without cost, affecting how we perceive ourselves and are perceived by others, how we behave, and how we are treated, not always in constructive ways (Thornton, 2004). In fact, a degree of anxiety and depression in the face of our perfect storm of tragic events may be not only normal and natural but adaptive, preparing us to address a new reality, to face new challenges, find new solutions.
‘A second feature of much media reporting of mental health issues in response to the current cycle of bad news is the implicit assumption that the problems will be fairly universal: that a whole generation will be damaged. Research suggests that this is not so.’
One interesting alternative to a medical model of mental illness in this context is the idea that we should view responses to life stress in terms of the distinction between flourishing and languishing (Keyes, 2002). Flourishing is a state of positive mental wellbeing, active engagement and motivation. Languishing, by contrast, is an absence of mental wellbeing characterised by apathy, losing motivation, fatigue, everything seems to take so much effort. It includes feelings of emptiness, stagnation, monotony, and lost joie de vivre. Flourishing and languishing are alternative existential reactions to life stresses, not states of health or illness. Some research suggests that the general changes in emotional welfare in our children and young people through the pandemic are better interpreted as languishing rather than mental disorder (Fielding, 2021). This alternative perspective has practical implications. Illness may require medical treatments, which are essentially ‘cures’ provided by others – a perspective that disempowers the individual. By contrast, languishing challenges us to problem solve, to address our life stresses in a new way, finding ways to constructively address our changed world – a more empowering perspective.
Variation in vulnerability
A second feature of much media reporting of mental health issues in response to the current cycle of bad news is the implicit assumption that the problems will be fairly universal: that a whole generation will be damaged. Research suggests that this is not so. The practical implication of the research is that we should focus limited resources more on groups at greatest risk than spreading them across the board.
Pre-existing mental health problems
Those most vulnerable to serious adverse reactions through the pandemic were those who had pre-existing mental health problems (and though it is too early for direct research here, we may assume that there is a similar increased vulnerability in the face of other threats). For example, a survey in the UK found that 83% of those with such pre-existing problems said that their mental health had deteriorated through the pandemic (YoungMinds, 2020). Predictably, this effect was marked in those with pre-existing diagnosis of depression or anxiety disorder, but other mental health problems, such as obsessive-compulsive disorder (Nissen et al, 2020), also increased vulnerability to a deteriorating mental health.
Socio-economic situation
We have long known that low socio-economic status, financial difficulty in the family, ethnic minority and resultant discrimination, and poor support from family or peers is generally associated with poorer outcomes whatever the issue. These factors were predictably associated with greater vulnerability to mental health problems through the pandemic (Deng et al, 2021; Hussong et al, 2021; Hollenstein et al, 2021). Alas, these risk factors often co-occur, presenting a cascade of effects that multiply disadvantage. By contrast teenagers from more affluent backgrounds with supportive families and friends were more likely to cope well with the pandemic, even experiencing reductions in anxiety and other emotional issues and overall improvements in mental health (Deng et al, 2021; Hussong et al, 2021; Hollenstein et al, 2021). Again, these protective factors tend to co-occur, creating a multiplying cascade of advantage. We may predict similar variability in reactions across socio-economic circumstances in the face of the other current threats in the news.
Personal resilience
Individuals across all social backgrounds vary in how resiliently they cope with setbacks and adversity (Ellis et al, 2017). Lionetti et al (2018) identified a useful typology of resilience: there are ‘dandelion’ types, who, like that resilient plant, thrive even in the most adverse of circumstances. Then there are ‘orchids’, who like those delicate plants, are very vulnerable to stressors. And in between there are tulips, who are neither so robust as the dandelions nor so fragile as the orchids. Over various studies, Lionetti and her colleagues have found that on average, 41–44% of children and teenagers are tulips, around 25% to 35% score as dandelions, and 25% to 35% score as orchids.
Research shows that this typology strongly reflects innate temperament (Maul et al, 2020). But though temperament is primarily genetic (Rothbart, 2011), it is not the only factor shaping resilience. Parenting styles, experience in school and in the wider community also play a role (Masten, 2018; Thornton and Gliga, 2021). This reflects the fact that resilience requires not only the self-belief inherent in a positive ‘can do’ orientation to life, but also a high degree of cognitive or executive control, the ability to focus attention, to evaluate what is or is not working, the ability to switch attention to new strategies flexibly and the ability to regulate emotional reactions (Hauser et al, 2006). These things can be learnt.
Conclusions
It seems likely that the bad news cycle will trigger anxiety and depression in many children and young people, and in some cases, this will amount to a mental health problem that can benefit from medical intervention. But the sad truth is that these difficult events are not going away any time soon. Even if the proximate issues, the economic and food supply problems, the continuing evolution of SARS-CoV-2 variants could be sorted out quite quickly, the existential challenges will persist. Our world has radically changed. The complacency of past decades is over. Now we know how fragile our world is: that a new pandemic may come, that a new war may come, that a nuclear strike somewhere is not unthinkable, that climate change is real and here, that the very fabric of life may be disrupted by events. Our young are going to have to learn to live with such threats all their lives. What we need is not to turn their very natural reactions into pathologies, but to help them create expectations and coping strategies that will be constructive in this new reality. How we might do that will be discussed in the next article in this series.