Are we being anxious about anxiety?

Haidt's diagnosis of a 'doomed' youth is off. Instead, we should learn from them.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A child sits atop a bunk bed holding a phone in front.

It’s common these days to hear about social anxiety, health anxiety, or climate anxiety – but I think I can see that a new pathology is beginning to emerge: anxiety anxiety. This is where parents, politicians, academics, or just members of society in general, start to get anxious about the fact that everybody is anxious. Diagnosis rates of clinical anxiety have shown a steep increase in the past decade, and numbers, we assume, don’t lie.

Of the many outcomes of ‘anxiety anxiety’, one is going to be people who (with the absolute best intentions) want to suggest solutions. One such person is Jonathan Haidt, with his book The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness.

From the spaceman on the cover to the opening vignette about sending our children to Mars, Haidt’s premise is clear: smartphones are the alien invaders of our society. These electronic parasites are feasting on the brain matter of our young people, directly causing what is now an epidemic of clinical anxiety and depression.

I’m quite ready to read a sensible analysis of the impact of smartphone culture on mental health, so I was disappointed to find that Haidt’s book falls so far short of that. From a scientific perspective, the argument is a barrage of statistics, arranged to the tune of ‘correlation equals causation’. Given Haidt’s seniority in his field, this approach is surprisingly unsubtle, something which has already been heavily criticised by peer review. Numbers, it seems, do lie – or at least they can be easily curated to prove your point.

But even if we accept Haidt’s point – which is that rates of smart-phone use (particularly social media) and rates of young people being diagnosed with anxiety disorders have increased over the same time period – what can be done? Haidt’s solution is to ban young people from owning smartphones at all until the age of 14, and from using social media until the age of 16, or even better 18. In this way, owning and managing one’s own device and its access becomes a rite of passage into adulthood. But note: whilst parents are urged to implement these unyielding boundaries for their children’s device-habits, Haidt does not ask grown-ups to make any changes to their own. Adults can continue with their current norms of smartphone use, ostensibly because their brains are fully developed, and they therefore have the maturity to handle their own risk to mental health.

Smartphones are not aliens – they were designed by humans, and are willingly bought by humans, in response to the human need to communicate.

Of course, it does not suit Haidt’s argument to analyse why adult mental health is also seeing an increase in diagnosis of anxiety disorders. It may be true to say that rates are rising more quickly amongst young people, but there is still no consensus as to how much of that can be attributed to young people simply being better informed about mental health and more empowered to seek help than the generations before them. Noticeably, young people today have a language to talk about anxiety that simply didn’t exist when I was a teenager in the 1990s, and ironically enough, it is social media that has made that possible. Although suicide rates are on the rise, they are still quite significantly lower among young people than they are for those aged over 35, and it should be noted that a proven pathway to suicide prevention amongst young people is access to self-help via smartphone apps.

So whilst I am quite ready to believe that smartphone culture is one of many factors impacting the health and wellbeing of young people today, I think characterising smartphones as alien invaders, or as invasive parasites that have been selectively bred by Silicon Valley billionaires to infest the minds of our young people, seems to be a disingenuous response – and one that only serves to increase parental anxiety by implying that smartphones are sly, sentient beings, and out of our control.

Smartphones are not aliens – they were designed by humans, and are willingly bought by humans, in response to the human need to communicate and a perfectly natural human desire to seek out entertainment and culture. True, technology and software are developed by billionaires, and marketing and algorithms can influence our choices – but at the end of the day, any developer will tell you that products only ever evolve in response to what the market demands. Adults: we have the money in our pockets; we are the market.

As a more empathetic and intelligent generation, it seems they could probably teach us a few things about how to harness smartphone culture.

In other words, we (the adults) selectively bred these ‘aliens’ ourselves – and rather than try (and no doubt fail) to lock up our experiment in a lab (or, as Haidt suggests, a lockable phone-pouch) we, the adults, have more than enough agency to continue that process of developing smartphones into devices that meet needs and provide entertainment in the way that they were always meant to do. In his defence, Haidt does refer to this approach briefly, but still only with a view to making the phones be for ‘us’ (the adults) and not ‘them’ (the young people) by removing content that appeals to a younger audience. To me feels like we are victim shaming the youth of today for the fact that they have inherited a problem created by their parents.

One day when Jesus was teaching a crowd of followers, he advised them “Why do you look at the speck of sawdust in your brother’s eye and pay no attention to the plank in your own eye? How can you say to your brother, ‘Let me take the speck out of your eye,’ when all the time there is a plank in your own?” His point was about hypocrisy – it is far easier to judge someone else’s behaviour than it is to take responsibility for our own. Where did any of us last read or hear terrifying information about the decline in young people’s mental health? Was it on our smartphones?

Here are a few things that Haidt’s selection of statistics doesn’t say about the youth of today. They are the most compassionate and empathetic generation that we have seen for decades (Konrath et. al., 2023). They are able to wait longer for rewards than their parent’s generation (Protzko, 2020), they are also less lazy, less narcissistic, more cooperative and more intelligent (Kriegel, 2016). In addition, whilst obvious damage is done by ‘filters’ on Instagram photos, making some young people strive for unattainable standards of beauty, it was the previous generation of smartphone users who began this trend, and it is the current generation of young people who can be credited with the #nofilter #nomakeup countertrends. This same generation is now fuelling the rise of insurgent social media sites such as Bereal, which emphasise the importance of authentic photos and meaningful connection with friends online.

Overall, perhaps instead of restricting and controlling our young people’s online lives, as Haidt would have us do, we ought to be talking to them? As a more empathetic and intelligent generation, it seems they could probably teach us a few things about how to harness smartphone culture and develop it towards solutions to the problems that we ourselves created.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.