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

Assisted dying

Care

Culture

Death & life

13 November 2024

8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

a doctor consults a tablet against the backdrop of a Canadian flag.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.