The Teen Mental Health Crisis and How Adolescence Shapes Us, with Lucy Foulkes and Pandora Sykes (Part 2)
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Today's episode is part two of our live recording from our recent event in London's Pleasance Theatre with Lucy Foulkes, academic psychologist at the University of Oxford and author of Coming of Age: How Adolescence Shapes Us. Joining Lucy on stage to discuss it

was journalist and broadcaster Pandora Sykes. If you're an Intelligence Squared Plus subscriber, you can get access to the full conversation right now, including our audience Q&A. Without further ado, let's get back into part two with Lucy Foulkes and Pandora Sykes. What's obviously happening a lot now is people, I mean, my kids' school does it where you will sign a pact for your children not to have a phone before a certain age.

which I am fine with, but I sort of want to know what you think because I feel like you might. I think there's something genuinely useful about parents being in it together because you don't want to be in a position where your teenager is the only one who doesn't have one. No.

Because that has its own social consequences. So, I think there is something useful about kind of banding together with other parents about to have this discussion that no one knows the answer to about when is it that you gradually introduce this technology. Also, I suppose the logistics of that would also, you know, at their school, they're 60 in a year, not 150. Yeah.

150 parents becomes a different beast. Yeah, exactly. You're going to come up against this again and again. Your point is always that adolescent anxiety is multifactorial. And it's something that we have heard a lot in that conversation where it's got this very simple message is that there's no other way to explain the sharp uptick

in poor mental health in teenagers than smartphones. But you believe this is correlation, not causation, don't you? Can you talk a little bit about that kind of multifactorial element? Yeah. So, the sharp uptake that he portrays isn't as neat as

as hate has presented it to be, particularly if you look across multiple different countries. So, it's not necessarily the case that you see this spike at this exact moment when smartphones are launched. It's not necessarily correlation. I mean, it probably is doing something in terms of the introduction of smartphones and social media. But there are lots and lots of other potential explanations that get ignored. And I think that's what's interesting, that

we tend to latch on to the increase in social media as being kind of the explanation. Whereas I think there's lots of other things going on in terms of changing economic circumstances and an increase in poverty and all that kind of thing that gets a bit lost, I think. What are some of the other things you think are contributing to teenage anxiety? So, there's definitely been a change in academic pressure, the demands on young people in schools, particularly around the change of more...

young people going to university. People feel more pressure now in school to perform than previous generations did. So, I think that's relevant. Certainly, economic factors like the increase in poverty after austerity measures were introduced. COVID is a more recent thing. This was happening before COVID. But I think certainly for at least some young people, COVID really hasn't helped.

Even interesting factors like increase in obesity is at least correlated with the increase in mental health problems. So, then you start thinking about, well, have there been changes in diet and exercise that might have contributed to... So, basically, it's like, have there been changes in diet and exercise? Yeah. So, there was a really interesting paper that I'm thinking of about...

tracking across time, increase in obesity, and then that having a knock-on effect on people's mental health. Diet-wise, there have been changes in diet. I'm trying to think if anyone's actually specific. The trouble is to figure out if it's actually having a causal effect.

is a really difficult one. There's so much messiness and different possible explanations. But I think the most important thing is that social media is probably doing something, but I don't think we should focus all the energy there. You think it's working in tandem with other things? Yeah, I think so. The diet one's interesting because I would have thought we've got so much more awareness now of eating

like the public health around food seems to be so much better than it was 15 years ago. Is that not having a positive? Yeah, I don't know, to be honest. I agree with you. I don't, that the messaging is better, but the interesting question is whether it's actually changed. Yeah.

Sugar. I had no idea what a balance to be. No, me neither. I had a lot of sugar as a teenager. And it took a long time to realize that that wasn't good for me. Whereas my nieces who are teenagers are now really aware. Really honest. Yeah, yeah. They'll talk about what they're eating and how it will make them feel or it will be good for this. Yeah.

Which, yeah, you would hope would have a good impact, but I don't really know. The other important thing to talk about as a potential explainer of the increase in mental health problems is the fact that we're talking about it more, and we have much better awareness about mental health problems. And it doesn't get talked about enough when we're trying to understand these increase in rates, is the fact that this is basically all self-report data.

So, it's very difficult to figure out from generation to generation whether they're answering the questions in the same way or whether they're more readily saying. One of the items that gets used a lot to measure mental health problems is, "I worry a lot." And you say, "No, somewhat true, true a lot."

We don't know if a teenager reading that today has the same understanding of what worry is or has the same understanding of what a lot means as a teenager 20 years ago. So you could see this shift in the numbers, in the data, but we don't know definitively if that means today's teenagers are actually worrying more. There's also obviously self-report data.

by nature fallible and teenagers I mean as adults we're variable in mood but teenagers moods are even more like that so they might worry a lot on the day of the self-report data and worry not at all the next day so I imagine it becomes incredibly hard to build yeah and it's

It's really tricky with mental health symptoms, especially if we're doing it at scale. It's really all that we have is self-report stuff, but it's, yeah, it's imperfect. So those studies need to be huge in order to get...

use clinical interviews but then that's very expensive and time-consuming yeah um you wrote a piece i can't remember if it's one you wrote in 2021 or if it's one you wrote earlier this year but i thought about it so much because i think like you it would have really affected how i sort of moved through the world as a teenager but you said that the increase in psychiatric language and the public conversation around mental health is obviously a

a positive step, but in some ways it might have done a disservice to teens. He wrote, "'The current conversation could be summed up as follows. You should notice, scrutinize, and seek help for negative psychological experiences. Of course, for some people, this message will be essential. For those who are suicidal, it can be life-saving. But the message misfires when it implies that all negative states are problems.'"

health problems and things that can and should be fixed. That's not how life works. And it made me think about how much, because we are having this conversation a lot and teenagers are being told a lot that they're the most anxious generation.

But then where do they go from there? Because as far as I know, there hasn't been a big shift in the curriculum to include like sort of, you know, a whole public health thing about how to cultivate resilience or how to kind of emotionally regulate. So is that what you mean by we're sort of doing one thing, but then we haven't got anything the other end of that? Yeah, well, it's interesting. So, and this isn't to criticize schools at all, because they are...

really stuck about what they're supposed to do in response to this conversation. But there's all sorts of different things going on in schools, sometimes designed within the school themselves, sometimes bought a program that someone is selling to them about this is how to boost resilience or go and teach your students.

teenagers' mindfulness. So, teenagers are receiving all sorts of messages in schools about mental health. They're being bombarded about the possibility that they're experiencing mental health problems. And it comes from a very good place.

But I think it's really difficult if you're a teenager experiencing even typical ups and downs and often massive emotional challenges of being an adolescent. And then the language that you're being handed from every direction is that it's a mental health problem. And then they go on their own social media and they see more information about mental health.

So I think it's in it. And so this is what I kind of spent my day job trying to figure out. But it's a really difficult message to talk about because you do not want to be dismissive of any of them that are experiencing challenges. But in particular, you don't want to dismiss the ones who are really, really struggling. Because I think the skepticism now, I think there's been a kind of backlash to this idea

Willingness to talk about mental health more and you get a lot of skepticism towards people who talk about their own mental health I mean that's kind of across the board isn't it? I was thinking obviously the increase in ADHD Diagnosis and now you have skepticism there that you're jumping on a bandwagon Exactly So it ends up really harming what this is too far exactly and so we

with a colleague who recently published a study where we looked at attitudes towards self-diagnosis as described in Reddit comments. It was really, really interesting. There was definitely this sense that self-diagnosis

from some posters that self-diagnosis kind of by default is inaccurate and this massive dismissal that people are doing it for attention or they don't understand or they're trying to be cool. And yeah, the trouble, and you've certainly seen people with ADHD being really frustrated about this, you know, that word has been undermined and diluted. So you get all this aggro towards people who are just trying to

use the word to describe that, obviously, that they're experiencing something difficult. There's a huge amount of skepticism now. And the whole point of all these campaigns was to try and help people be believed and taken seriously. So it's frustrating.

There's a lot of concept creep as well, isn't there, around psychological terms. So when people are going, oh, I'm so depressed when they have low mood or I'm so anxious when they're worried about something specific. What's the...

what's the answer with i mean i would say that's kind of happening like across culture as well like people and i think this is probably because the internet kind of encourages hyperbole where we're either so happy or so sad or so it's all just like extremes now how do we kind of get back towards a more moderate place can we get back towards so one interesting um

piece of evidence about that is that we recently finished a study where we interviewed mental health clinicians about their experience of self-diagnosis with teenagers. So what happens when a teenager turns up to a therapy with a really clear idea in their head of what they think they have?

And one thing that was consistently said across clinicians was that no teenagers are diagnosed with anxiety and depression because it's like everyone has those ones. So they're actually coming in with what some call the big ticket items. So it's the tendency to say, I have bipolar, I have borderline personality disorder, I have dissociative identity disorder, because there's so much...

noise that basically everyone has anxiety and depression, so those ones don't really count anymore, which is obviously a problem. I don't know what the end point is. I actually gave a talk in a school, and a teenager who was in the sixth form, so maybe 16 or 17, said to me, where do you think this is going? Do you think it's just going to carry on and on and on?

And I don't know. I don't know what the solution is. I hope there will be kind of a correction where we won't lean so readily on psychiatric terms to explain our experiences and that if we can start to calm it all down a bit, we can use that language, can we gain some meaning? I suppose the first generation is always a bit anarchic, right? Yeah.

That's why everything's all a bit chaotic with phones now. In like 50 years, you know, they'll become the new microwave. I mean, I forgot to panic when it was about microwaves. I remember when everyone was panicking about eggs. You only had to be like, one egg or something. So is there, yeah, could it be that it will, once we've got 20 years of knowing these terms and it not being, you know, the whole stiff upper lip thing, that then everything comes a bit more...

I really don't know. It just takes time for things to settle. It's not that fun to live through. No, exactly. To right now be trying to say that you have those problems. I mean, I guess maybe fewer people will start self-diagnosing if they feel like those terms don't have value anymore. If everyone has depression or everyone has ADHD, then maybe people will start to...

be more skeptical and more cautious about using it to describe themselves and then maybe it will gradually calm down but I don't know if you can yeah influence that or enforce it no a ban definitely wouldn't help no exactly imagine what's possible when learning doesn't get in the way of life at Capella University our game-changing flex path learning format lets you set your own deadline so you can learn at a time and pace that works for you

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I wanted to ask you about porn. How much do you think that has changed teenage sex? The philosopher Amir Srinivasan observed in The Right to Sex that every one of her students had learned about sex from porn. Either they had watched it or they had been

intimate with someone who had learned what they knew from porn. There's obviously also a big panic around porn, particularly because it's so unregulated and it's often violent and misogynistic. What is the truth in that panic? So, it's very difficult to really know because no one wants to do research into it and ask. Why?

I'm just trying to envisage the ethics application. Basically, no one wants to ask teenagers about it. I think the tricky thing is that you can...

You can ask them what they're watching and you can ask them what they're doing and you can see if it correlates in terms of seeing whether watching violent porn increases problematic sex behaviors in real life. And some people have done that and they found that those two things are correlated. Fewer people have looked to see whether that's happening longitudinally. So to see whether it's actually causal because it

What's very plausible is that people who are prone to doing that anyway seek out that kind of material online. So, I think there's a lot of fear that watching stuff will turn someone who wouldn't otherwise have wanted to do that, will then make them want to go and enact that in the real world. But it's quite difficult in terms of a scientific study to separate that from

Did this person want to do that anyway? And they've gone and sought out that content and behaved that way in real life. So it's actually quite difficult to test. And then also people are just spooked and don't want to actually have to go and ask teenagers about it themselves.

I think it's very plausible to be worried about it. I think in terms of the volume that's available and the ease with which it's available is obviously very different to teenagers growing up 20 or 30 years ago. So, I think it's reasonable to be worried about it. Equally, I think teenagers are not stupid and lots of them are capable of

being disinterested or horrified themselves about that content, or capable of learning about the realities of what's going on behind the scenes. So, I think it's justified why people are worried, but I also think there is some hope there in that I don't... It's not new. And yeah, I think there is some room to teach teenagers about

you know, how to frame it and how to understand it, hopefully. What does seem to have come with that is an awareness of kind of more extreme or niche forms of sex. Like I was reading something around Lauren Greenfield's new documentary where a 14-year-old boy was asked about choking and he said, yeah, that's what all the girls like now. Yeah.

And I did have said, I did read that and think, oh my God. Obviously, that's just one person saying it, but it's terrifying to read that. Yeah. And that has, I've read that before. And then it becomes a difficult question that it's not straightforward to remove that content. I know the government had an idea that you'd have to put in your credit card or something. And then that just quietly died. Yeah, it's not going to work. So, I think then it's

Given the reality that it exists, how can we best sort of educate and guide young people through... Is it making it part of sex education? I mean, I actually don't know what the curriculum's like on that. So, yeah. So, they do cover it in sex education. But the really tricky thing is what age you teach sex.

And that's when parents often get really angry. Yeah. Well, exactly. So, the trouble is you either wait until they're quite far into secondary school, by which time they've already seen it, or the alternative is that you get in before they've seen it. And they go looking for it. Or they either go looking for it, or you're teaching a nine-year-old about something that they otherwise didn't know about. And that feels very unpalatable as an option. Yeah.

Yes, I can see how that's tricky. You know that the Dutch have a really good relationship with their children when it comes to talking about sex and porn and kind of not saying don't consume it, but here's the context and here's the impact and here's how it might make you feel. That seems relatively straightforward. Is that just something that kind of parents should be doing at home?

I guess so at some age, but it's obviously incredibly difficult. No parent wants to talk to their children about that topic, and no child wants to talk to their parents about it. So, I definitely don't think it's straightforward. I don't know who parents versus schools, who the best source of that information is from, but it's obviously deeply uncomfortable for good reason for lots of adults to talk about that.

maybe that's what needs to change yeah we'll need a bit we need to have it groovier yeah or dutch um do you think the tide will ever turn in regards to online sex would would it ever go back to a time when teenagers learned about sex just through you know fumbling and sleeping well i mean i wasn't even taught sex education because i was at a catholic school okay um

It can be anything in my life. Well, that's the interesting thing about how that doesn't work either, which I talk a bit about in the book. Like it actually actively backfires. Yeah, because that was what was happening in America, obviously at the peak and after the AIDS crisis. And it was the high STDs had never been higher. And pregnancies as well. So the thing is, teenagers want to have sex or some of them do.

they're going to do it anyway whether you tell them how to do it safely or not so actually all you're achieving with abstinence only education is that you haven't told them how to do it safely hide it yes exactly what was the question about sleeping bags um i don't i think in reality there's too much money in the industry to for me to figure out how would how it would

how the solution would be to make the content go away. But I don't know enough about the kind of how it might be regulated or changed. Because I guess that, you know, it would be nice to be able to cut it off at the source. But I don't.

And obviously, yeah, the government had that plan that you could do age verification and that didn't work. I don't know. God, it's kind of impossible. I'm not saying that they don't make some really big mistakes. It's kind of impossible to be a policymaker about so much of this. Yeah. As you say, it's really messy. So, it's like, what? Yeah. And they are trying to...

they don't necessarily have the time or the expertise to go and wade into all the back and forth that's going on in the research. And so they're trying to react to...

we're trying um we are now going to go to audience questions there will be a roving mic please keep your questions brief so everyone who wants to ask a question gets a chance to ask lucy something thank you for the talk i didn't hear much about the importance of the adolescent and parent relationship but i'd love to hear more

So this is interesting because I don't do research into parenting. There are people who are much more expert than I am. And I think in the book and in all my work, I've always operated kind of at the level of the adolescent. I'm very interested in the kind of adolescent to adolescent relationships. So I think my thoughts about parenting is firstly that it's really beneficial for parents to get

more interested in adolescent development in general to understand what it is that is driving their behavior. And I think also acknowledging the enormous need they have to be listened to and to exert some independence and control over their lives, which is often very limited and controlled by other people.

Yeah, the thing that comes up again and again is this very difficult balance between supporting them and providing guidance to them, whilst also gradually allowing them how to figure out the world around them. There are other people who are much better qualified than I am. Like, for example, Anita Clare has recently written a book about parenting teenagers, which I think is really good. I tend to stay thinking about adolescents and adolescents.

Yeah, hi. On the topic of adolescence and how that shapes us, what are the most important factors? About what shapes us? Gosh.

Well, I think your peers massively. I mean, I'm particularly interested in social development, but I think the relationship that you have with your peers in adolescence affects everything. You know, the social status that you have at school, the friendships that you develop, your romantic relationships, whether you're bullied or not, whether you feel excluded by your peers. I think that's a real blueprint for how you develop

view yourself later on, but the kind of relationships you have later on. So I think the way the relationships you have with your peers and the way you believe they feel about you is probably the most impactful thing. But then there's also all sorts of things like, you know, the substances that you take and what kind of school you go to and how wealthy you are and all that kind of thing. But I'm most interested in the social, the importance of social stuff.

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