In a New York Time ideas story that ran this past week, Jia Lynn Yang opens with a bang: “One of the more bewildering aspects of the already high-stress endeavor of 21st-century American parenting is that at some point your child is likely to be identified with a psychiatric diagnosis of one kind or another. Many exist in a gray zone that previous generations of parents never encountered.”

For those with tweens and teens, this might seem obvious. For those with younger ones, buckle up.

In Yang’s story, she focuses on the role schools play. Failures in education may lead to an increase of psychiatric diagnoses like ADHD — alongside IEPs or maybe medications — as a means to catch up kids who are being lost in crowded, test-reliant, merit-funded schools. Of course, even Yang points out that schools are only one part of the puzzle. There’s screens and social media taking over our emotional lives and psychiatric development; the pandemic’s long-felt chilling effect on socialization; the adult world of division and anger in politics and everywhere else; and of course changes within the Mental Health Industrial Complex.

It’s this last piece that Dr. Sami Timimi, a child and adolescent psychiatrist and psychotherapist at the National Health Service in the United Kingdom is focused on. He's the author of six books including Naughty Boys: Anti-Social Behavior, ADHD, and the Role of Culture and his most recent book, Searching for Normal, which promises to outline a new approach to understanding mental health, distress and neurodiversity. There little doubt we could use some advice here — and a bit of demystification around the mental health crises that seems to have taken over childhood.

Tyghe Trimble,

Fatherly

This interview has been edited for length and clarity.

I frankly found Searching for Normal to be a difficult book. The science and ideas are very clearly laid out, but you're throwing a lot of stones systemically and culturally that are not often cast. As a layperson and a parent with a house filled with diagnoses, medications, cultural shame, and lots of doubts about our mental health journey, the paralysis you describe feels very close to home. Given all this, I'm wondering, big picture, what is the main takeaway you'd want a parent to walk away with from your book?

Dr. Sami Timimi: It is a difficult read because we have a public narrative that's been around for a while that's really created a mythology around what we think of in terms of mental health and behavioral difference. My main message is that what we are calling psychiatric diagnosis aren't really diagnoses. And be careful where the culture of diagnoses might lead you to, because we have so much evidence now that the way we're approaching mental health has resulted in something called the treatment prevention paradox, where at a population level we're seeing increasing prevalence of mental conditions and mental health diagnoses. At the same time we're seeing an increasing number of people accessing various types of treatments associated with these diagnoses.

But we're not seeing an improvement in the outcomes. If we saw an improvement in the outcomes, we would expect at least a stabilization and hopefully a reduction in prevalence of certain conditions because they would be being effectively treated. I don't think there's actually much disagreement with this in most of the academic literature on what's going on because mental health does seem to be an outlier compared to we've seen a lot of progress in physical health.

For example, when I was a kid, if I got leukemia, my chances of survival into adulthood was around 20%. Now it's around 80%. So this is what happens when you have approaches that are built on technical knowledge that allows you to understand what's going on and make specific treatments for it. But it seems to be the case in mental health that we're going in the wrong direction. What are the assumptions that go missing when we approach mental health as if it's physical health? Because we have to remember, there's no brain scan for ADHD, there's no blood test for anxiety. You can't examine a thought under a microscope. And it becomes difficult to sit in that area of uncertainty and curiosity.

You talk about the TikTok contagion of health disorders and you cite the, I think it was 2023 research about Canadian teen girls presenting with a variety of self-described disorders that are all relatively rare. I'm wondering if you can describe the phenomenon and then I wonder, what does it change for parents on the ground? We have to take their thoughts seriously, no?

Yeah, that's a difficult one, isn't it? It's interesting because I heard about this research from a colleague and friend of mine who's a psychiatrist in Canada who shared this paper and it happened just at the point where I was seeing that in my clinical work as well, I was seeing young people who were brought by their parents, parents very worried, with presentations that are generally considered to be quite rare presentations. So, for example, I saw a number of kids who were coming and saying that they had these Tourette's symptoms but they had no history of it. It's like it suddenly emerged.

It is hard because first of all, I don't blame social media for causing these things because actually a lot of this is narratives that's been suggested and started out. The bigger phenomena are these influencers who say that they have ADHD or autism or anxiety and they publicize it online and they talk about things that are signs of potentially having these conditions. And we have to remember, growing up is tough. Try to remember what I was like as a 13, 14-year-old — it is a struggle. There's a lot of changes going on.

“What social media is doing is a kind of a social contagion. It's turbocharging these ideas and spreading them out.”

You're in a phase of your life where you're seeking meaning and you're seeking belonging and you're involved in those existential type of scenarios where you're trying to figure out where do I fit in? What's my life all about? And so what's been happening is because they watch a lot of these things online with a lot of the influencers just taking up concepts that have been given to them by certain branches of academic psychiatry. And so what social media is doing is a kind of a social contagion. It's turbocharging these ideas and spreading them out.

This goes alongside a trend that's been happening in parenting.

I think a lot of parents have lost their trust that they know what they're doing. I think a lot of parents have lost their confidence. They feel the need to go to see a professional to try and understand. And it's difficult when a lot of the professionals are also involved in what I call the Mental Health Industrial Complex. This is how they get paid, this is how they earn a living.

“Don't be scared of your children. Don't be scared of their intense emotions and don't be scared of conflict. “

And so one of the things that I do encourage parents to do is don't be scared of your children. Don't be scared of their intense emotions and don't be scared of conflict. Conflict happens. What has I think happened as we've exported the knowledge base to professionals is we've also developed a curious form of something that some people refer to as cognitive parenting. I know the concept of helicopter parenting, cognitive parenting is a little bit different where you try to reason things through, where you treat your children as if they're already developed adults.

So what role should parents take?

If you don't think this is good for your children, tell them. If you want to put some boundaries around them, don't be afraid of their conflicts.

I liken it a little bit to a referee in, well, for us it's a soccer match. Whenever they, say, blow the whistle that there's a foul committed, the offending team that you've blown the whistle for will complain. That's what happens.

The crowd will complain as well and say the referee is biased and so on. So when you are a rule enforcer, one way to think about it is you're not going to get any good feedback. You're always going to get protests. You have to ride that out. But a good referee delivers the consequence. The consequence is usually fairly short, it's fairly immediate. Don't delay the consequences because you don't say, well, I've seen you doing that foul, but the next match you have, if you do that again, then the next match you have, I'm going to give this or that. Whatever consequence it is, immediate, short-lived, doesn't have to be long. Just something that shows that you disapprove and this is not allowed.

“When you are a rule enforcer, one way to think about it is you're not going to get any good feedback. You're always going to get protests.”

And the other thing you do is you don't argue with them. So in soccer matches, you have a half-time where the teams go into the dressing room for 15 minutes before coming. You don't see a referee running after the player who's committed the foul telling them, “I've seen you, I've seen you doing this in other matches. You think you're going to get away with it. You never learn, you never listen.” A good referee spots the infringement, knows that they're going to get back chatted and they're going to get flak, needs to develop a thick skin to ride that out, not rise to it and doesn't get involved in nagging them and so on. And once the consequence is delivered, it's over. Don't need to talk about it again. It's finished.

What happens when you get caught in what you call the Mental Health Industrial Complex? A quote in the book that really resonated with me, asks “What might happen if instead of shaping the treatment around diagnosis, it was put to one side and the specific challenges, fears, and context were engaged with instead?” Can you answer the question you pose? What does that exactly look like?

So one of the things, understanding that what we call psychiatric diagnoses are not actually diagnoses, they're descriptions. They're what a branch of therapy referred to as narrative therapy ...[which] basically says that our life is made up of stories. It's the stories we hear about ourselves, the stories others tell about us, and we build up a set of stories to understand ourselves. We're surrounded by narratives. And the narratives we tell ourselves have a powerful impact on how we experience our emotions.

So what I was describing there is instead of falling down the root of imagining that if you get a diagnosis you found the meaning for what it is that is going on that's troubling you, there is a different way of trying to find out what it is you're trying to achieve, what is it the difference that you're trying to make, that a diagnosis can't do. So one thing I do in my clinical life is a form of what's referred to as Socratic questioning.

“We're surrounded by narratives. And the narratives we tell ourselves have a powerful impact on how we experience our emotions.”

Let's say you got a diagnosis and it was the perfect diagnosis and you felt it fitted. What difference do you imagine this is going to make to your life? What difference is that going to make to your life?

A diagnosis in a sense is an abstract thing. It doesn't really tell you specifically materially what's going on in your world. Is it that actually you're having trouble with friendships? Is it that your family is under stress and you're under stress because you think your parents are about to split up? Is it that you're finding yourself out of your depth at school? So you're trying to get to the specifics of what it is that people are wanting to see change in their life.

Right. Keep questioning the outcomes and ideas. I really like this tool for parents.

And the other thing is I'm trying to help people move past the idea that experiencing intense emotions is a sign that there's something wrong in them. Experiencing intense emotions is something that we all have to go through. If we don't go through it, we have less of a chance to develop psychologically.

“All life involves struggle and suffering at some level. How can we know joy if we don't know sadness? It's impossible.”

In a sense, the role of parents is to be careful about saving your children from struggle and suffering because that is an unrealistic goal. All life involves struggle and suffering at some level. How can we know joy if we don't know sadness? It's impossible.

You say this is the most pathologized generation ever. Given that, do you have a checklist for parents to look through and say, is my child being pathologized?

That's an interesting question. I may be averse to the whole concept of checklists, partly because in understanding that all our definitions of mental health are subjective. So our understanding of what is and isn't a kind of looming problem that needs some sort of professional intervention. There is no formula that will allow you to figure this one out. It's going to have to be situation, person and family specific.

One thing I say to parents is, look, all good parents feel guilty. That's just a given. I cannot help you with that. Whatever I do, whatever anybody does, you'll carry on feeling guilty or worry, have I done too much of this? Have I interviewed too little? Have I given too much advice? Have I given the wrong? That's what good parents do. Be careful about that guilt driving you to do too much. And I think that's now a bigger danger than the opposite. So we end up intervening perhaps unnecessarily without holding our own anxiety and our own guilt. So one of my little messages is don't try too hard.

On that note, what do you do with the big feelings in a household? How do you let issues not get carried away?

So one of the things that I try to work with with families is understanding, I use the metaphor of a dance, that there's emotional flow going between people and that emotional flow defines how that relationship works. And sometimes what happens is that anger becomes the dominant way in which connection happens.

The other thing I think about in terms of emotions, I think of emotions as being viral. You catch the emotions of the person closest to you. If your kid is angry with you, it's very hard not to get angry back at them. So kind of developing an awareness of that emotional flow of how it's working in your particular relationship and developing an understanding that that has become a dance.

For example, I know there was a period in my own kid's life where there was a lot of tension, a lot of sibling rivalry to the point where our son and daughter were getting physical and losing temper. And we thought, me and my wife thought only one of them would survive in childhood. That's what it felt like to us.

Anyway, so I thought, okay, well I have to try and do something about this. So I started writing little post-its at the end of each day, just a few, a sentence or two about things that I liked that happened and I just stuck it above their bed before they went to bed.

After a couple of weeks of doing this, my daughter said to me, "Dad, you're being weird." And I said, "What do you mean I'm being weird?"

"Why do you keep putting these post-its and saying these nice things?" I said, "Okay, do you like it?"

"Yeah."

So just something also a bit playful a bit, but it's just about trying to refine that emotional connection somewhere other than what's become the defining dance.

A little bit of, “all you need is love.” And I think you had it at the top of one of your chapters, quoting Confucius.

Exactly. The journey of a thousand miles starts with the first step.