Chapter 1 The Surge of Suffering

Chapter 1

The Surge of Suffering

When I talk with parents of adolescents, the conversation often turns to smartphones, social media, and video games. The stories parents tell me tend to fall into a few common patterns. One is the “constant conflict” story: Parents try to lay down rules and enforce limits, but there are just so many devices, so many arguments about why a rule needs to be relaxed, and so many ways around the rules, that family life has come to be dominated by disagreements about technology. Maintaining family rituals and basic human connections can feel like resisting an ever-rising tide, one that engulfs parents as well as children.

For most of the parents I talk to, their stories don’t center on any diagnosed mental illness. Instead, there is an underlying worry that something unnatural is going on, and that their children are missing something—really, almost everything—as their online hours accumulate.

But sometimes the stories parents tell me are darker. Parents feel that they have lost their child. A mother I spoke with in Boston told me about the efforts she and her husband had made to keep their fourteen-year-old daughter, Emily, [1] away from Instagram. They could see the damaging effects it was having on her. To curb her access, they tried various programs to monitor and limit the apps on her phone. However, family life devolved into a constant struggle in which Emily eventually found ways around the restrictions. In one distressing episode, she got into her mother’s phone, disabled the monitoring software, and threatened to kill herself if her parents reinstalled it. Her mother told me:

It feels like the only way to remove social media and the smartphone from her life is to move to a deserted island. She attended summer camp for six weeks each summer where no phones were permitted—no electronics at all. Whenever we picked her up from camp she was her normal self. But as soon as she started using her phone again it was back to the same agitation and glumness. Last year I took her phone away for two months and gave her a flip phone and she returned to her normal self.

When I hear such stories about boys, they usually involve video games (and sometimes pornography) rather than social media, particularly when a boy makes the transition from being a casual gamer to a heavy gamer. I met a carpenter who told me about his 14-year-old son, James, who has mild autism. James had been making good progress in school before COVID arrived, and also in the martial art of judo. But once schools were shut down, when James was eleven, his parents bought him a PlayStation, because they had to find something for him to do at home.

At first it improved James’s life—he really enjoyed the games and social connections. But as he started playing Fortnite for lengthening periods of time, his behavior began to change. “That’s when all the depression, anger, and laziness came out. That’s when he started snapping at us,” the father told me. To address James’s sudden change in behavior, he and his wife took all of his electronics away. When they did this, James showed withdrawal symptoms, including irritability and aggressiveness, and he refused to come out of his room. Although the intensity of his symptoms lessened after a few days, his parents still felt trapped: “We tried to limit his use, but he doesn’t have any friends, other than those he communicates with online, so how much can we cut him off?”

No matter the pattern or severity of their story, what is common among parents is the feeling that they are trapped and powerless. Most parents don’t want their children to have a phone-based childhood, but somehow the world has reconfigured itself so that any parent who resists is condemning their children to social isolation.

In the rest of this chapter, I’m going to show you evidence that something big is happening, something changed in the lives of young people in the early 2010s that made their mental health plunge. But before we immerse ourselves in the data, I wanted to share with you the voices of parents who feel that their children were in some sense swept away, and who are now struggling to get them back.

The Wave Begins

There was little sign of an impending mental illness crisis among adolescents in the 2000s. [2] Then, quite suddenly, in the early 2010s, things changed. Each case of mental illness has many causes; there is always a complex backstory involving genes, childhood experiences, and sociological factors. My focus is on why rates of mental illness went up in so many countries between 2010 and 2015 for Gen Z (and some late millennials) while older generations were much less affected. Why was there a synchronized international increase in rates of adolescent anxiety and depression?

Greg and I finished writing The Coddling of the American Mind in early 2018. Figure 1.1 is based on a graph that we included in our book, with data through 2016. I have updated it to show what has happened since. In a survey conducted every year by the U.S. government, teens are asked a series of questions about their drug use, along with a few questions about their mental health. Examples include asking whether you have experienced a long period of feeling “sad, empty, or depressed,” or a long period in which you “lost interest and became bored with most of the things you usually enjoy”? Those who answered yes to more than five out of nine questions about symptoms of major depression are classified as being highly likely to have suffered from a “major depressive episode” in the past year.

Major Depression Among Teens

Figure 1.1. Percent of U.S. teens (ages 12–17) who had at least one major depressive episode in the past year, by self-report based on a symptom checklist. This was figure 7.1 in The Coddling of the American Mind , now updated with data beyond 2016. (Source: U.S. National Survey on Drug Use and Health.) [3]

You can see a sudden and very large upturn in major depressive episodes, beginning around 2012. (In Figure 1.1, and in most of the graphs to follow, I have added a shaded area to make it easy for you to judge whether or not something changed between 2010 and 2015, which is the period I call “The Great Rewiring.”) The increase for girls was much larger than the increase for boys in absolute terms (the number of additional cases since 2010), and a hockey stick shape jumps out more clearly. However, boys started at a lower level than girls, so in relative terms (the percent change since 2010, which I’ll always use as the baseline), the increases were similar for both sexes—roughly 150%. In other words, depression became roughly two and a half times more prevalent . The increases happened across all races and social classes. [4] The data for 2020 was collected partly before and partly after COVID shutdowns, and by then one out of every four American teen girls had experienced a major depressive episode in the previous year. You can also see that things got worse in 2021; the lines tilt more steeply upward after 2020. But the great majority of the rise was in place before the COVID pandemic.

The Nature of the Surge

What on earth happened to teens in the early 2010s? We need to figure out who is suffering from what , beginning when . It is extremely important to answer these questions precisely, in order to identify the causes of the surge and to identify potential ways to reverse it. That is what my team set out to do, and this chapter will lay out in some detail how we came to our conclusions.

We found important clues to this mystery by digging into more data on adolescent mental health. [5] The first clue is that the rise is concentrated in disorders related to anxiety and depression, which are classed together in the psychiatric category known as internalizing disorders . These are disorders in which a person feels strong distress and experiences the symptoms inwardly . The person with an internalizing disorder feels emotions such as anxiety, fear, sadness, and hopelessness. They ruminate. They often withdraw from social engagement.

In contrast, externalizing disorders are those in which a person feels distress and turns the symptoms and responses outward , aimed at other people. These conditions include conduct disorder, difficulty with anger management, and tendencies toward violence and excessive risk-taking. Across ages, cultures, and countries, girls and women suffer higher rates of internalizing disorders, while boys and men suffer from higher rates of externalizing disorders. [6] That said, both sexes suffer from both, and both sexes have been experiencing more internalizing disorders and fewer externalizing disorders since the early 2010s. [7]

You can see the ballooning rates of internalizing disorders in figure 1.2, which shows the percentage of college students who said that they had received various diagnoses from a professional. The data comes from standardized surveys by universities, aggregated by the American College Health Association. [8] The lines for depression and anxiety start out much higher than all other diagnoses and then increase more than any other in both relative and absolute terms. Nearly all of the increases in mental illness on college campuses in the 2010s came from increases in anxiety and/or depression. [10]

Mental Illness Among College Students

Figure 1.2. Percent of U.S. undergraduates with each of several mental illnesses. Rates of diagnosis of various mental illnesses increased in the 2010s among college students, especially for anxiety and depression. (Source: American College Health Association.) [9]

A second clue is that the surge is concentrated in Gen Z, with some spillover to younger millennials. You can see this in figure 1.3, which shows the percentage of respondents in four age-groups who reported feeling nervous in the past month “most of the time” or “all of the time.” There is no trend for any of the four age-groups before 2012, but then the youngest group (which Gen Z begins to enter in 2014) starts to rise sharply. The next-older group (mostly millennials) rises too, though not as much, and the two oldest groups are relatively flat: a slight rise for Gen X (born 1965–1980) and a slight decrease for the baby boomers (born 1946–1964).

What Is Anxiety?

Anxiety is related to fear, but is not the same thing. The diagnostic manual of psychiatry ( DSM-5-TR ) defines fear as “the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat.” [12] Both can be healthy responses to reality, but when excessive, they can become disorders.

Anxiety Prevalence by Age

Figure 1.3. Percent of U.S. adults reporting high levels of anxiety by age group. (Source: U.S. National Survey on Drug Use and Health.) [11]

Anxiety and its associated disorders seem to be the defining mental illnesses of young people today. Across a variety of mental health diagnoses, you can see that anxiety rates rose most in figure 1.2, with depression following closely behind. A 2022 study of more than 37,000 high school students in Wisconsin found an increase in the prevalence of anxiety from 34% in 2012 to 44% in 2018, with larger increases among girls and LGBTQ teens. [13] A 2023 study of American college students found that 37% reported feeling anxious “always” or “most of the time,” while an additional 31% felt this way “about half the time.” This means that only one-third of college students said they feel anxiety less than half the time or never. [14]

Fear is arguably the most important emotion for survival across the animal kingdom. In a world rife with predators, those with lightning-fast responses were more likely to pass on their genes. In fact, quick responses to threats are so important that the brains of mammals can trigger a fear response before information from the eyes has even made it to the visual centers in the back of the brain for full processing. [15] This is why we can feel a wave of fear, or jump out of the way of an oncoming car, before we’re even conscious of what we’re looking at. Fear is an alarm bell connected to a rapid response system. Once the threat is over, the alarm stops ringing, stress hormones stop flowing, and the feeling of fear subsides.

While fear triggers the full response system at the moment of danger, anxiety triggers parts of the same system when a threat is merely perceived as possible. It is healthy to be anxious and on alert when one is in a situation where there really could be dangers lurking. But when our alarm bell is on a hair trigger so that it is frequently activated by ordinary events—including many that pose no real threat—it keeps us in a perpetual state of distress. This is when ordinary, healthy, temporary anxiety turns into an anxiety disorder.

It is also important to note that our alarm bell did not just evolve as a response to physical threats. Our evolutionary advantage came from our larger brains and our capacity to form strong social groups, thus making us particularly attuned to social threats such as being shunned or shamed. People—and particularly adolescents—are often more concerned about the threat of “social death” than physical death.

Anxiety affects the mind and body in multiple ways. For many, anxiety is felt in the body as tension or tightness and as discomfort in the abdomen and chest cavity. [16] Emotionally, anxiety is experienced as dread, worry, and, after a while, exhaustion. Cognitively, it often becomes difficult to think clearly, pulling people into states of unproductive rumination and provoking cognitive distortions that are the focus of cognitive behavioral therapy (CBT), such as catastrophizing, overgeneralizing, and black-and-white thinking. For those with anxiety disorders, these distorted thinking patterns often elicit uncomfortable physical symptoms, which then induce feelings of fear and worry, which then trigger more anxious thinking, perpetuating a vicious cycle.

The second most common psychological disorder among young people today is depression, as you can see in figure 1.2. The main psychiatric category here is called major depressive disorder (MDD). Its two key symptoms are depressed mood (feeling sad, empty, hopeless) and a loss of interest or pleasure in most or all activities. [17] “How weary, stale, flat and unprofitable, seem to me all the uses of this world,” said Hamlet, [18] immediately after lamenting God’s prohibition against “self-slaughter.” For a diagnosis of MDD, these symptoms must be consistently present for at least two weeks. They are often accompanied by physical symptoms, including significant weight loss or weight gain, sleeping far less or far more than normal, and fatigue. They are also accompanied by disordered thinking, including an inability to concentrate, dwelling on one’s transgressions or failings (causing feelings of guilt) and the many cognitive distortions that CBT tries to counteract. People experiencing a depressive disorder are likely to think about suicide because it feels like their current suffering will never end, and death is an end.

An important feature of depression for this book is its link to social relationships. People are more likely to become depressed when they become (or feel) more socially disconnected, and depression then makes people less interested and able to seek out social connection. As with anxiety, there is a vicious circle. So I’ll be paying close attention to friendship and social relationships in this book. We’ll see that a play-based childhood strengthens them, while a phone-based childhood weakens them.

I am not generally prone to anxiety or depression, yet I have suffered from prolonged anxiety, requiring medication, during three periods of my life. One included a diagnosis of major depression. So I can, to an extent, sympathize with what many young people are going through. I know that adolescents with anxiety or depressive disorders can’t just “snap out of it” or decide to “toughen up.” These disorders are caused by a combination of genes (some people are more predisposed to them), thought patterns (which can be learned and unlearned), and social or environmental conditions. But because genes didn’t change between 2010 and 2015, we must figure out what thought patterns and social/environmental conditions changed to cause this tidal wave of anxiety and depression.

It’s Not Real, Is It?

Many mental health experts were initially skeptical that these large increases in anxiety and depression reflected real increases in mental illness. The day after we published The Coddling of the American Mind , an essay appeared in The New York Times with the headline “The Big Myth About Teenage Anxiety.” [19] In it, a psychiatrist raised several important objections to what he saw as a rising moral panic around teens and smartphones. He pointed out that most of the studies showing a rise in mental illness were based on “self-reports,” like the data in figure 1.2. A change in self-reports does not necessarily mean that there is a change in underlying rates of mental illness. Perhaps young people just became more willing to self-diagnose or more willing to talk honestly about their symptoms? Or perhaps they started to mistake mild symptoms of anxiety for a mental disorder?

Emergency Room Visits for Self-Harm

Figure 1.4. The rate per 100,000 in the U.S. population at which adolescents (ages 10–14) are treated in hospital emergency rooms for nonfatal self-injury. (Source: U.S. Centers for Disease Control, National Center for Injury Prevention and Control.) [20]

Was the psychiatrist right to be skeptical? He was certainly right that we need to look at multiple indicators to know if mental illness really is increasing. A good way to do that is to look at changes in measures not self-reported by teens. For example, many studies chart changes in the number of adolescents brought in for emergency psychiatric care, or admitted to hospitals each year because they deliberately harmed themselves. This can either be in a suicide attempt, commonly done by overdosing on medications, or in what is called nonsuicidal self-injury (NSSI), often done by cutting oneself without the intent to die. Figure 1.4 shows the data for visits to emergency rooms in the United States, and it shows a pattern similar to the rising rates of depression that we saw in figure 1.1, especially for girls.

The rate of self-harm for these young adolescent girls nearly tripled from 2010 to 2020. The rate for older girls (ages 15–19) doubled, while the rate for women over 24 actually went down during that time (see online supplement). [21] So whatever happened in the early 2010s, it hit preteen and young teen girls harder than any other group . This is a major clue. Acts of intentional self-harm in figure 1.4 include both nonfatal suicide attempts, which indicate very high levels of distress and hopelessness, and NSSI, such as cutting. The latter are better understood as coping behaviors that some people (especially girls and young women) use to manage debilitating anxiety and depression.

Suicide Rates for Younger Adolescents

Figure 1.5 . Suicide rates for U.S. adolescents, ages 10–14. (Source: U.S. Centers for Disease Control, National Center for Injury Prevention and Control.) [22]

Adolescent suicide in the United States shows a time trend generally similar to depression, anxiety, and self-harm, although the period of rapid increase begins a few years earlier. Figure 1.5 shows the suicide rate, expressed as the number of children aged 10–14, per 100,000 such children in the U.S. population, who died by suicide in each year. [23] For suicide, the rates are nearly always higher for boys than for girls in Western nations, while attempted suicides and nonsuicidal self-harm are higher for girls, as we saw above. [24]

Figure 1.5 shows that the suicide rate for young adolescent girls began to rise in 2008, with a surge in 2012, after having bounced around within a limited range since the 1980s. From 2010 to 2021, the rate increased 167%. This too is a clue guiding us to ask: What changed for preteen and younger teen girls in the early 2010s?

The rapid increases in rates of self-harm and suicide, in conjunction with the self-report studies showing increases in anxiety and depression, offer a strong rebuttal to those who were skeptical about the existence of a mental health crisis. I am not saying that none of the increase in anxiety and depression is due to a greater willingness to report these conditions (which is a good thing) or due to some adolescents who began to pathologize normal anxiety and discomfort (which is not a good thing). But the pairing of self-reported suffering with behavioral changes tells us that something big changed in the lives of adolescents in the early 2010s, perhaps beginning in the late 2000s.

Smartphones and the CREATION of Gen Z

The arrival of the smartphone changed life for everyone after its introduction in 2007. Like radio and television before it, the smartphone swept the nation and the world. Figure 1.6 shows the percentage of American homes that had purchased various communication technologies over the last century. As you can see, these new technologies spread quickly, always including an early phase where the line seems to go nearly straight up. That’s the decade or so in which “everyone” seems to be buying it.

Communication Technology Adoption

Figure 1.6 . The share of U.S. households using specific technologies. The smartphone was adopted faster than any other communication technology in history. (Source: Our World in Data.) [25]

Figure 1.6 shows us something important about the internet era: It came in two waves. The 1990s saw a rapid increase in the paired technologies of personal computers and internet access (via modem, back then), both of which could be found in most homes by 2001. Over the next 10 years, there was no decline in teen mental health. [26] Millennial teens, who grew up playing in that first wave, were slightly happier, on average, than Gen X had been when they were teens. The second wave was the rapid increase in the paired technologies of social media and the smartphone, which reached a majority of homes by 2012 or 2013. That is when girls’ mental health began to collapse, and when boys’ mental health changed in a more diffuse set of ways.

Of course, teens had cell phones since the late 1990s, but they were “basic” phones with no internet access, often known at the time as flip phones because the most popular design could be flipped open with a flick of the wrist. Basic phones were mostly useful for communicating directly with friends and family, one-on-one. You could call people, and you could text them using cumbersome thumb presses on a numeric keypad. Smartphones are very different. They connect you to the internet 24/7, they can run millions of apps, and they quickly became the home of social media platforms, which can ping you continually throughout the day, urging you to check out what everyone is saying and doing. This kind of connectivity offers few of the benefits of talking directly with friends. In fact, for many young people, it’s poisonous. [27]

There are several sources for data on the early smartphone era. A 2012 report on cell phone ownership from Pew Research found that in 2011, 77% of American teens had a phone but just 23% had a smartphone . [28] That means most teens had to access social media using a computer. Often it was their parents’ computer or the family computer, so they had limited privacy and access, and there was no easy way to get online when away from home. In the United States, laptop computers became increasingly common in this period, as did high-speed internet, so some teens started gaining increased access to the internet even before they got their own smartphones.

But it wasn’t until teens got smartphones that they could be online all the time , even when away from home. According to a survey of U.S. parents conducted by the nonprofit Common Sense Media, by 2016, 79% of teens owned a smartphone , as did 28% of children between the ages of 8 and 12. [29]

As adolescents got smartphones, they began spending more time in the virtual world. A 2015 Common Sense report found that teens with a social media account reported spending about two hours a day on social media, and teens overall reported spending an average of nearly seven hours a day of leisure time (not counting school and homework) on screen media, which includes playing video games and watching videos on Netflix, YouTube, or pornography sites. [30] A 2015 report by Pew Research [31] confirms these high numbers: One out of every four teens said that they were online “almost constantly.” By 2022, that number had nearly doubled, to 46%. [32]

These “almost constantly” numbers are startling and may be the key to explaining the sudden collapse of adolescent mental health. These extraordinarily high rates suggest that even when members of Gen Z are not on their devices and appear to be doing something in the real world, such as sitting in class, eating a meal, or talking with you, a substantial portion of their attention is monitoring or worrying (being anxious) about events in the social metaverse. As the MIT professor Sherry Turkle wrote in 2015 about life with smartphones, “We are forever elsewhere.” [33] This is a profound transformation of human consciousness and relationships, and it occurred, for American teens, between 2010 and 2015. This is the birth of the phone-based childhood. It marks the definitive end of the play-based childhood.

An important detail in this story is that the iPhone 4 was introduced in June 2010. [34] It was the first iPhone with a front-facing camera, which made it far easier to take photos and videos of oneself. Samsung offered one on its Galaxy S that same month. That same year, Instagram was created as an app that could be used only on smartphones. For the first few years, there was no way to use it on a desktop or laptop. [35] Instagram had a small user base until 2012, when it was purchased by Facebook. Its user base then grew rapidly (from 10 million near the end of 2011 [36] to 90 million by early 2013 [37] ). We might therefore say that the smartphone and selfie-based social media ecosystem that we know today emerged in 2012, with Facebook’s purchase of Instagram following the introduction of the front-facing camera. By 2012, many teen girls would have felt that “everyone” was getting a smartphone and an Instagram account, and everyone was comparing themselves with everyone else.

Over the next few years the social media ecosystem became even more enticing with the introduction of ever more powerful “filters” and editing software within Instagram and via external apps such as Facetune. Whether she used filters or not, the reflection each girl saw in the mirror got less and less attractive relative to the girls she saw on her phone.

While girls’ social lives moved onto social media platforms, boys burrowed deeper into the virtual world as they engaged in a variety of digital activities, particularly immersive online multiplayer video games, YouTube, Reddit, and hardcore pornography—all of which became available anytime, anywhere, for free, right on their smartphones.

With so many new and exciting virtual activities, many adolescents (and adults) lost the ability to be fully present with the people around them, which changed social life for everyone, even for the small minority that did not use these platforms. That is why I refer to the period from 2010 to 2015 as the Great Rewiring of Childhood. Social patterns, role models, emotions, physical activity, and even sleep patterns were fundamentally recast, for adolescents, over the course of just five years. The daily life, consciousness, and social relationships of 13-year-olds with iPhones in 2013 (who were born in 2000) were profoundly different from those of 13-year-olds with flip phones in 2007 (who were born in 1994).

Aren’t They Right to Be Anxious and Depressed?

When I present these findings in public, someone often objects by saying something like “Of course Gen Z is depressed; just look at the state of the world in the 21st century! It begins with the 9/11 attacks, the wars in Afghanistan and Iraq, and the global financial crisis. They’re growing up with global warming, school shootings, political polarization, inequality, and ever-rising student loan debt. You point to 2012 as the pivotal year? That was the year of the Sandy Hook Elementary School shooting!” [38]

The 2021 book Generation Disaster offered exactly this argument for the mental health problems of Gen Z. [39] But while I agree that the 21st century is off to a bad start, the timing does not support the argument that Gen Z is anxious and depressed because of objective facts about rising national or global threats.

Even if we were to accept the premise that the events from 9/11 through the global financial crisis had substantial effects on adolescent mental health, they would have most heavily affected the millennial generation (born 1981 through 1995), who found their happy childhood world shattered and their prospects for upward mobility reduced. But this did not happen; their rates of mental illness did not worsen during their teenage years. Also, had the financial crisis and other economic concerns been major contributors, adolescent mental health in the United States would have plummeted in 2009, during the darkest year of the financial crisis, and it would have improved throughout the 2010s as the unemployment rate fell, the stock market rose, and the economy heated up. Neither of these trends is borne out in the data. In figure 1.7, I superimposed figure 1.1, about teen depression, on a graph of the U.S. unemployment rate, which spiked in 2008 and 2009 as companies threw employees overboard at the start of the crisis. Unemployment then began a long, steady decline from 2010 to 2019, hitting a historic low of just 3.6% in early 2019.

Teenage Depression vs. Adult Unemployment

Figure 1.7. The U.S. unemployment rate (percent of adults in the labor market who are unemployed) fell continuously as the adolescent mental health crisis got worse. (Sources: U.S. Bureau of Labor Statistics and the U.S. National Survey Drug Use and Health.) [40]

There is just no way to pin the surge of adolescent anxiety and depression on any economic event or trend that I can find. Also, it’s hard to see why an economic crisis would have harmed girls more than boys, and preteen girls more than everyone else.

The other explanation I often hear is that Gen Z is anxious and depressed because of climate change, which will affect their lives more than those of older generations. I do not deny that their concern is legitimate, but I want to point out that impending threats to a nation or generation (as opposed to an individual) do not historically cause rates of mental illness to rise. When countries are attacked, either by military force or by terrorism, citizens usually rally around the flag and each other. They are infused with a strong sense of purpose, suicide rates drop, [41] and researchers find that decades later, people who were teens during the start of the war show higher levels of trust and cooperation in lab experiments. [42] When young people rally together around a political cause, from opposing the Vietnam War in the 1960s through peak periods of earlier climate activism in the 1970s and 1990s, they become energized , not dispirited or depressed. Every generation grows up during a disaster or under the threat of an impending disaster, from the Great Depression and World War II through threats of nuclear annihilation, environmental degradation, overpopulation, and ruinous national debt. People don’t get depressed when they face threats collectively; they get depressed when they feel isolated, lonely, or useless. As I’ll show in later chapters, this is what the Great Rewiring did to Gen Z.

Collective anxiety can bind people together and motivate them to take action, and collective action is thrilling, especially when it is carried out in person. Among previous generations, researchers often found that those engaged in political activism were happier and more energized than average. “There is something about activism itself that is beneficial for well-being,” said Tim Kasser, coauthor of a 2009 study on college students, activism, and flourishing. [43] Yet more recent studies of young activists, including climate activists, find the opposite: Those who are politically active nowadays usually have worse mental health. [44] Threats and risks have always haunted the future, but the ways that young people are responding, with activism carried out mostly in the virtual world, seem to be affecting them very differently compared to previous generations, whose activism was carried out mostly in the real world.

The climate change hypothesis also fails to explain some of the demographic particularities here. Why do we usually see the biggest relative increases of anxiety and depression among preteen girls? Wouldn’t an increased awareness of climate issues affect the oldest teens and college students more, because they are more aware of global and political events? It also fails to fit the timing: Why the spike in mental illness in the early 2010s, in so many countries? The Swedish climate activist Greta Thunberg (born 2003) galvanized young people around the world, but only after she addressed a UN Climate Change conference in 2018.

Everything may seem broken, but that was just as true when I was growing up in the 1970s and when my parents were growing up in the 1930s. It is the story of humanity. If world events played a role in the current mental health crisis, it’s not because world events suddenly got worse around 2012; it’s because world events were suddenly being pumped into adolescents’ brains through their phones, not as news stories, but as social media posts in which other young people expressed their emotions about a collapsing world, emotions that are contagious on social media.

All Over the Anglosphere

One way to tell if American adolescents became anxious and depressed due to current events is to compare their mental health trends with those in other countries with different current events and different levels of cultural distance from the United States. Below I do this for a variety of countries: those that are culturally similar but had different major news events, such as Canada and the U.K.; those with different languages and cultures, namely the Nordic countries; and finally for 37 countries from around the world that participate in a survey of their 15-year-olds every three years. As I demonstrate, all of these show a similar pattern and timing: Something changed in the early 2010s.

Let’s start with Canada, which shares much of its culture with the United States yet lacks many of America’s potentially damaging sociological and economic features, such as high levels of economic insecurity. Canada has avoided America’s frequent wars and high rates of violent crime. Canada also largely avoided the effects of the global financial crisis. [45] Yet even with all these advantages, adolescents in Canada experienced a sharp decline in mental health at the same time and in the same way as those in the United States. [46]

Figure 1.8 shows the percent of Canadian girls and women who reported that their mental health was either “excellent” or “very good.” If you stopped collecting data in 2009, you’d conclude that the youngest group (aged 15–30) was the happiest, and you’d see no reason for concern. But in 2011 the line for the youngest women began to dip and then went into free fall while the line for the oldest group of women (aged 47 and up) didn’t budge. The graph for boys and men shows the same pattern, though with a smaller decline. (You can find that graph and many more in the online supplement, which has a separate Google Doc for each chapter in this book. See anxiousgeneration.com/supplement .)

Excellent or Very Good Mental Health, Canadian Women

Figure 1.8. Percent of girls and women in Ontario, Canada, who reported that their mental health was either “excellent” or “very good.” (Source: D. Garriguet [2021], Portrait of youth in Canada: Data report.) [47]

As in the United States, changes in behavior match changes in self-reported mental health. When we plot the rate of psychiatric emergency department visits for self-harm for Canadian teens, we find almost exactly the same pattern as for American teens in figure 1.4. [48]

It’s the same story in the U.K., which has somewhat more cultural distance from the United States than does Canada. Nonetheless, its teens suffered in the same way and at the same time as those in the United States. Rates of anxiety and depression rose in the early 2010s, especially for girls. [49] And once again, we see the same sudden increase when we look at behavioral data. Figure 1.9 shows the rates at which U.K. teens deliberately harmed themselves, according to a study of medical records. As in the United States and Canada, something seems to have happened to British teens in the early 2010s that caused a sudden and large increase in the number of teens harming themselves. [50]

Self-Harm Episodes, U.K. Teens

Figure 1.9 . U.K. teens’ (ages 13–16) self-harm episodes. (Source: Cybulski et al., 2021, drawing from two databases of anonymized British medical records.) [51]

Mental Health Hospitalizations, Australia

Figure 1.10. Rate at which Australian teens (ages 12–24) were kept in hospitals overnight for mental health reasons. (Source: Australia’s Health 2022 Data Insights.) [53]

We see similar trends in the other major Anglosphere nations, including Ireland, New Zealand, and Australia. [52] For example, figure 1.10 shows the rate at which Australian teens and young adults were admitted to hospitals for psychiatric emergencies. As in the other Anglo countries, if you stopped your data collection at the beginning of the Great Rewiring (2010), you’d see nothing, but by 2015 teens were in deep trouble.

The Rest of the World

In 2020, I hired Zach Rausch, a late millennial (born 1994) earning a master’s degree in psychology, as a part-time research assistant. He quickly rose to become my full-time research partner for this book. Zach has gathered mental health data from all over the world and published several in-depth reports at the After Babel Substack (which we created to test out ideas for this book and my next one). In one report, Zach examined the five Nordic countries and found the same patterns as in the five Anglosphere countries. Figure 1.11 shows the percent of teens in Finland, Sweden, Denmark, Norway, and Iceland who reported high levels of psychological distress between 2002 and 2018. [54] The pattern is indistinguishable from those found repeatedly among the Anglo countries: If you cut off the graphs in 2010, at the start of the Great Rewiring, you see no sign of a problem. If you look at data through 2015, there’s a big problem.

What about the world beyond the wealthy Anglosphere and Nordic nations? There are several global studies of adult mental health, but there are few global surveys of adolescents . [55] There is, however, a global educational survey called the Program for International Student Assessment, or PISA for short. Every three years since 2000, PISA surveys thousands of 15-year-olds and their parents in each of 37 participating countries. Nestled within hundreds of questions about their academic progress and their home life was a set of six questions about their feelings about school. These asked students to say how much they agreed with statements such as “I feel lonely at school,” “I feel like an outsider (or left out of things) at school,” and “I make friends easily at school” (which was reverse scored). [57]

High Psychological Distress, Nordic Nations

Figure 1.11. Percent of Nordic teens with high psychological distress (ages 11–15). (Source: Data from the Health Behavior in School Age Children Survey.) [56]

Jean Twenge and I analyzed the responses to these six questions and plotted the aggregated scores since 2000 for all 37 countries. [58] Figure 1.12 shows those trends from four major world regions. After staying relatively flat from 2000 through 2012, reports of feeling lonely and friendless at school increased, in all regions except for Asia. Across the Western world, it seems that as soon as teens began carrying smartphones to school and using social media regularly, including during breaks between classes, they found it harder to connect with their fellow students. They were “forever elsewhere.”

Alienation in School, Worldwide

Figure 1.12 . Worldwide school alienation scores over time (age 15). Note that the increase in school loneliness occurs in all regions other than Asia, mostly between 2012 and 2015. (These questions were not asked in the 2006 and 2009 surveys.) Scores range from 1 (low alienation) to 4 (high alienation). (Source: Twenge, Haidt et al. [2021]. Data from PISA.) [59]

The 2008 global financial crisis did not cause this multinational increase in the 2010s, nor did American school shootings or American politics. The only plausible theory I have found that can explain the international decline in teen mental health is the sudden and massive change in the technology that teens were using to connect with each other. [60]

Children born in the late 1990s were the first generation in history who went through puberty in the virtual world. It’s as though we sent Gen Z to grow up on Mars when we gave them smartphones in the early 2010s, in the largest uncontrolled experiment humanity has ever performed on its own children.

In Sum

Between 2010 and 2015, the social lives of American teens moved largely onto smartphones with continuous access to social media, online video games, and other internet-based activities. This Great Rewiring of Childhood, I argue, is the single largest reason for the tidal wave of adolescent mental illness that began in the early 2010s.

The first generation of Americans who went through puberty with smartphones (and the entire internet) in their hands became more anxious, depressed, self-harming, and suicidal. We now call that generation Gen Z, in contrast to the millennial generation, which had largely finished puberty when the Great Rewiring began in 2010.

The tidal wave of anxiety, depression, and self-harm hit girls harder than boys, and it hit preteen girls hardest of all.

The mental health crisis has also hit boys. Their rates of depression and anxiety have also increased a lot, although usually not by as much as for girls. Boys’ technology use and mental health difficulties are somewhat different from those of girls, as I’ll show in chapter 7.

Suicide rates in the United States began rising around 2008 for adolescent boys and girls; they rose much higher in the 2010s.

The increase in suffering was not limited to the United States. The same pattern is seen at roughly the same time among teens in the U.K., Canada, and other major Anglosphere countries, and also in the five Nordic nations. Feelings of alienation in school rose after 2012 across the Western world. Data is less abundant in non-Western nations, and the patterns there are less clear. [61]

No other theory has been able to explain why rates of anxiety and depression surged among adolescents in so many countries at the same time and in the same way. Other factors, of course, contribute to poor mental health, but the unprecedented rise between 2010 and 2015 cannot be explained by the global financial crisis, nor by any set of events that happened in the United States or in any other particular country.

How, exactly, does a phone-based childhood interfere with child development and produce or exacerbate mental illness? To answer that question, we must first consider what childhood is and what children need to do in order to develop into healthy adults. That is my goal in part 2. I’ll tell the backstory to the Great Rewiring, which is the gradual loss—beginning in the 1980s—of the play-based childhood.