Despite huge gains in knowledge about the neurophysiological and psychological roots of anxiety, as well as the billions spent each year on psychotropic medications meant to assuage anxiety, Americans are more anxious than ever. Anxiety disorders—OCD, phobias, PTSD, generalized anxiety disorder, social phobia, panic disorder, separation anxiety—are by far the most commonly diagnosed disorders in America, especially among the young. More than 30 percent of children up to age 18 receive one of these diagnoses at some point, and anxiety symptoms are the primary reason parents seek out a mental health professional for their child.
Why are our children so anxious and getting more so? At first, the epidemic of childhood anxiety disorders seems puzzling. After all, we live in the age of “helicopter parents” and ubiquitous child professionals—teachers, counselors, therapists—all trying their best to shield children from feelings of fear, insecurity, uncertainty, or discomfort. Professionals and parents alike seem to share the sentiment that allowing children to feel afraid is tantamount to neglect, like not getting kids vaccinated or withholding antibiotics when they’re ill. We seem to regard a child’s anxiety as a kind of infection, caused by an “anxiety bug” of some sort. As soon as this “pathology” surfaces, we feel we must immediately remove all sources of the pathogen. If the child is afraid of school, keep her home. If he’s afraid to sleep alone, don’t make him. If the child still “gets” a case of anxiety, carpet-bomb it to extinction with psychotropic medications!
But too often in our anxiety to stop the anxiety, we surround the child with an anxiety-reinforcing system, comprised of family, school personnel, physicians, and even therapists, all fixated on protecting the child from any twinge of the dreaded disease. Imposing this array of deeply caring adults not only rewards the anxiety, but encourages it to consume ever more of the child’s life. In short, by building a systemic protective shield around the anxious child, we make sure that the anxiety remains in charge.
In their zeal to create an anxiety-free environment for the child, adults focus on changing the external surroundings—the meds, the furniture, the classroom, the nanny—that trigger or relieve anxiety, never understanding the nature of the beast they’re trying to tame or kill. In many families, anxiety resembles an endlessly shape-shifting alien, taking different forms, settling around different subjects, jumping (anxiously, so to speak) from focus to focus. So do the adults trying to corral it, but the more attention they pay to its ever-changing manifestations, the bigger and more protean it grows. The results would be comic if they weren’t so potentially tragic for children who get locked in a state of continual hypervigilance against their ever-expanding, ever-mutating fears and anxieties, setting the stage for full-fledged anxiety disorders later in life.
Theresa and her 15-year-old daughter, Grace, came to see me several months ago. Grace had been in therapy off and on since the age of 7, and given various diagnoses and medications over the years. Now she was starting in a new school, which had ramped up her anxiety symptoms again. She was having trouble finishing her homework because of obsessive worrying about getting good grades—her parents were, of course, anxious that she should get into a good college—and she said she felt “paralyzed by the pressure.” I asked Theresa what she’d learned from therapists about managing Grace’s anxiety.
“I’ve learned so much,” Theresa said. “Most importantly, Grace needs to know exactly what’s going to happen during her day. She hates surprises. We got her a cell phone early on, and we text each other throughout the day. The school’s been good about making sure she has all her assignments, and she meets every morning with a tutor who checks all her work. She’s an excellent student, but she needs reassurance.”
Grace had been worrying throughout the school day about Rufus, the family dog. She’d frequently text her mother asking how Rufus was. Theresa would take a picture of Rufus and send it to Grace. When Theresa would leave the house, she’d take a picture of the dog in the kitchen, let Grace know where she was going, and then send her another picture of the dog when she returned home. “Our pediatrician said that we needed to make Grace feel safe, so the school allows her to check her phone whenever she needs to.” Such stories are now legion.
Another client of mine, a 12-year-old boy terrified of fire alarms at school, must be warned by his teachers five minutes before a drill and escorted out onto the playing field to wait for his classmates to join him. “As long as I’m outside, I’m okay,” he tells me. Or take Alison, a third-grader who lives in a bucolic little community with a low-to- vanishing crime rate, who was, nonetheless, afraid of robbers. To soothe their daughter’s fears, her parents bought a 150-pound dog to keep her company at night. This wasn’t enough, so her parents installed an expensive, state-of-the-art alarm system in the house and, at her insistence, changed the locks repeatedly. Commonly, kids I see are so afraid of thunderstorms they won’t even go outside if it’s cloudy. Obliging grown-ups teach them how to tune in to the Weather Channel and track pressure systems, not so they’re less afraid to go out in the rain, but to make them more technically informed about how to predict—and thus stay out of—thunder and lightning. In effect, these kids think, “I can’t handle thunderstorms, but now I know much better how to dodge them and stay safe.”
In short, kids and parents are often so anxious about anxiety itself that they must prevent even the least anxious twinge—any feelings of uncertainty and discomfort. As anxious parents try to reassure, comfort, explain, argue, punish, and bribe their child out of the anxiety, they grow more and more emotionally reactive, angry, and distraught, even bursting into tears before ultimately capitulating.
Too often, mental health professionals focus on diagnoses and prescribe medications as the first (and sometimes only) line of anxiety treatment, thereby reinforcing parents’ worst fears about their anxious child. After multiple conversations with school guidance counselors, teachers, family physicians, and mental health providers, worn-out parents arrive in my office scared to death that there’s something horribly and irrevocably wrong with their child. True, the fierce power and often nutty symptoms of anxiety can be overwhelming and mystifying. It’s also true that there’s a genetic predisposition to anxiety, but this is routinely overemphasized to the child’s detriment.