Bad Therapy Review: Fifties Dad Mental Health

In praise of occasionally thinking about feelings

Pictured: a mental health role model.

I.

Abigail Shrier is an author best known for her book Irreversible Damage, which argues that teenagers believe they have gender dysphoria due to peer influence and aren’t actually transgender. She recently published a book, Bad Therapy, about how the current culture around mental health is making teenagers more depressed.

I agreed with much of the content in Bad Therapy, which made this a remarkable reading experience. I watched my opinions being filtered through someone who’s both stupid and evil.

Much of Shrier’s book is devoted to critiquing Internet Mental Health Culture, which I discussed here. I broadly agree with her critiques.

But Abigail Shrier’s preferred alternative to Internet Mental Health Culture is what you might call Fifties Dad Mindset. She’s quite explicit about this: multiple times in Bad Therapy, she asks readers to adopt the behavior of their own parents and grandparents.

Personally, my grandfather had untreated PTSD from World War II, which caused him to beat his children and send them to school in shoes with holes because he drank up his entire paycheck. My father repressed his anxiety so hard that he had a seizure. I’ve never abused anyone or had any seizures, so Therapy 1, Fifties Dads 0.

II.

As a Fifties Dad, you should make sure that, no matter how upset your child is, you don’t change your behavior in any way.

For example, studies show that exposure therapy works to treat phobias. Therefore, Shrier concludes, no one should ever allow someone with anxiety to avoid doing something because they’re scared. It doesn't seem to have occurred to Shrier that exposure therapy occurs in a controlled environment. In exposure therapy, the patient is prepared to face their fears, always has control over what’s going on, and is in no real danger. If someone is helpless, already overwhelmed, and at risk of being hurt, facing their fears might well make their anxiety worse.¹

At least exposure therapy for anxiety actually works. Shrier extends exposure therapy to, um, sleep?

Force a kid to sleep in a house beset by the normal sounds of snoring siblings, whistling of winds, or creaking of joists, and eventually she will sleep. She’ll realize, more importantly, that she can.

Proper sleep hygiene—including sound machines or earplugs if noise keeps waking the sleeper up—is important for light sleepers to have sound and refreshing sleep. No reputable sleep specialist recommends the “sleep deprive your child and see what happens” approach to treating situational insomnia.

It’s not only such commonplace experiences as anxiety and sleep that a good Fifties Dad ignores. What if your child struggles with a legitimate mental illness, such as self-harm?

Cognitive behavioral psychologist Roger McFillin told me he believes even minor cutting isn’t necessarily a dire crisis in every instance. “We are aware that when self-harm serves the purpose of seeking nurturing, attention, or evading responsibility, responding to such behavior in this manner² will only reinforce its occurrence. Regrettably, some adolescents have acquired the skill of weaponizing self-injury.”

Shrier explicitly says that the right response to “minor cutting” is to ignore it. Great parenting!

“Weaponizing self-injury” is a profoundly unempathetic way to respond to people who are in a great deal of emotional pain. Your teenager isn’t self-harming at you. If someone is so in need of nurturing or attention, or so overwhelmed by what they have to do, that they slice open their own skin about it, there is a problem!

It’s true that you shouldn’t reward individual instances of self-harm with attention or nurturing. But the right approach isn’t just ignoring the problem altogether, but rather meeting your child’s emotional needs in a way that isn’t contingent on the self-harm. Maybe you should make more of an effort to be sympathetic rather than judgmental or scolding, or set aside time each day to listen to your child when they tell you about their interests, or chill out about whether your child needs to do literally every extracurricular. But that would involve noticing and caring when your child is distressed, which is exactly what a Fifties Dad doesn’t do.

III.

Ignoring your child’s distress is a good first step towards the ultimate goal of Fifties Dadhood, which is convincing your child to ignore their feelings altogether. Shrier writes:

Placing undue importance on your emotions is a little like stepping onto a swivel chair to reach something on a high shelf. Emotions are likely to skitter out from under you, casters and all. Worse, attending to our feelings often causes them to intensify. Leading kids to focus on their emotions can encourage them to be more emotional.

Adults should be telling kids how imperfect and unreliable their emotions can be, Chentsova Dutton says. Very often, kids should be skeptical that their feelings reflect an accurate picture of the world and even ignore their feelings entirely. (Gasp!) You read that right: a healthy emotional life involves a certain amount of daily repression.

How is a child supposed to get through a day of school if she’s never learned to put aside her hurt feelings and concentrate on the lessons in front of her? How will she ever be a good friend if her own feelings are always, at every instant, front and center? How will she ever hope to function at work?

She can’t. She won’t. They aren’t.

Psychologists have studied the states of mind that tend to make us more successful, whatever the challenge. There are at least two we can adopt: “action orientation” and “state orientation.” Adopting an action orientation means focusing on the task ahead with no thought to your current emotional or physical state. A state orientation means you’re thinking principally about yourself: how prepared you feel in that moment, the worry you feel over a text left unanswered, the light prickling at the back of your throat, that crick blossoming in your neck. Adopting an action orientation, it turns out, makes it much more likely that you accomplish the task...

If you want to win—if you want to accomplish anything—among the worst things you can do is attend to your disappointments, discomforts, and painful relationships right now. No winning head coach asks his players to consider their feelings at halftime because thinking about yourself shatters your ability to get things done.

“State orientation keeps you from being successful in anything,” Linden said.

These statements aren’t wrong, exactly. Emotions aren’t always a reliable guide to truth. Ruminating makes your emotions more intense. It’s useful to be able to set aside your feelings and think about something else. It’s a bad idea to think about your breakup while playing a football game.

But they’re half-truths, and the other half of the truth is nowhere in Bad Therapy.

Emotions can be mistaken, but they normally point towards truth. This statement might seem wrong, because we usually think about emotions when they’re problematic in some way. But we experience dozens of emotions a day, most of which are completely accurate. I’m joyful when playing with my son, because I like spending time with him. I’m sad when I read about a natural disaster, because natural disasters are bad. I’m angry when a friend’s girlfriend is mistreating him, because she’s violating my subculture’s social norms. I feel guilty when I say something mean to someone, because it goes against my values.

Even seemingly “distorted” emotions can point towards truth. During one of my first experiences of therapy, I told my therapist that I felt like my friends didn’t want to spend time with me and were just tolerating me. We did CBT worksheet after CBT worksheet to try to correct my distorted thoughts and social anxiety. Years passed and I got a different circle of friends. Once I knew what it was like to be around people who actually liked me, I quickly realized that my previous social circle didn’t want to spend time with me and was just tolerating me. I had been completely right! The CBT worksheets were a waste of time that I should have spent finding actual friends.

It’s true that sometimes an adult needs to set aside her feelings and focus on the problem in front of her. But if she represses her feelings all the time, they’ll come out in ways she’d prefer they wouldn’t.³ Never having a “state orientation” is a recipe for taking your anger out at your partner, bursting into tears at inopportune moments, or binging Netflix while wondering why you can’t ever get yourself to do anything. Once you’re done setting your emotions aside to get work done, you should talk about your feelings with a friend, write bad poetry, make yourself some tea and drink it while not thinking about anything, or go for a run until your head clears.

Because emotions are normally pretty accurate, consistently ignoring your emotions shuts you off from an important source of knowledge. Maybe you’re always angry at your boss because she’s mistreating you. Maybe you dread hanging out with your frinds because you don’t like them very much. Maybe you’re scared of speaking in public because you know that you’re underprepared. Maybe you feel guilty because you’re actually doing something wrong.

According to Shrier, any attempts to think about your emotions are “rumination”, which causes depression:

Kennair’s response was elegant and astonishing: being overly prone to talking about your emotional pain is itself a symptom of depression. “If you do this”—habitually give voice to your negative thoughts or personal problems—“you’re co-ruminating at least. But I believe they are ruminating more. And rumination is the major predictor for depression.”

I can’t overstate how much Shrier thinks it’s ruminating to talk in any way about your unhappy feelings or bad things that happen to you. A representative example:

[A teacher] “goes out to lunch where this young student sits, and she always says ‘hi’ to him. And she has casual interactions with him.” And one day, he told her that his dad was getting out of jail. “Nobody else knew that,” Azzam said.

Good therapists know that it may be counterproductive to push a kid to share his trauma at school. Good therapists are trained specifically to avoid encouraging rumination. But school staff who play therapist rarely seem aware that they might be encouraging rumination as they stalk a kid at lunch, waiting to see if he’ll open up about his father’s incarceration minutes before a history test.

Can’t believe that a child whose father is imprisoned might want to talk about it with a caring and supportive adult! As far as I can tell, Shrier thinks that being comforted about bad things that happen to you is, like, the number two cause of depression behind school surveys.⁴

Rumination is a real thing. Dwelling endlessly on things that are bad about your life makes you sad. But simply acknowledging bad things that happen to you isn’t rumination. Seeking comfort, advice, reassurance, or an outside view isn’t rumination either.

There’s an easy test to see if you’re ruminating or not. If you’re ruminating, you feel worse: your problems are bigger, your goals are more impossible to reach, the guy you hate has even more depths of awfulness and even fewer redeeming features than you thought, and everything good about your life is a mirage. Rumination is oddly compelling, which is why we do it. But it’s compelling like picking at a scab: you know it’s going to hurt you but you can’t stop.

If you’re processing your feelings, you feel better. You have a good cry and get a hug and you move on with your life. Your friend offers a new perspective on your problem and you realize that it isn’t as serious as you were building it up to be in your head. You journal, and you feel like you have control over your life. You go for a walk to think about things, and you come back with a plan.

Shrier extends her anti-emotional-processing beliefs to therapy. She argues that therapists shouldn't ask people to think about their pasts and what went wrong, or about what might happen in the future and what the most likely outcomes are. Instead, therapists should do cognitive behavioral therapy. I’m not sure what Shrier thinks is involved in cognitive behavioral therapy, but it absolutely does involve thinking about the past and the future.

Cognitive behavioral therapy isn’t the only therapy that Shrier misrepresents:

There are therapies, like dialectical behavior therapy, that take a better approach than the model that insists that you can only be cured if you are compelled to “talk about it.”

Many people equate dialectical behavioral therapy (DBT) with the DBT skills training classes. It’s true that DBT skills training doesn’t involve talking about your trauma, for the same reason that learning to drive or speak Yiddish or cook souffles doesn’t involve talking about your trauma. But DBT skills training is only one component in the overall DBT program, and should always be given alongside individual therapy.

And DBT individual therapy absolutely involves talking about your trauma. You’re not supposed to dwell on your trauma or ruminate about it, to be sure. But emotionally dysregulated people need to be able to think about their trauma the same way healthy people think about anything else that happened to them. In DBT individual therapy, clients learn to conceive of their trauma as something that happened and was bad, but that doesn't define their lives and that they don't need to flinch away from ever contemplating. Taking about trauma in DBT is, well, it’s exposure therapy—exactly what Shrier claims to support.

But Shrier’s approach to mental health is fundamentally aesthetic. A Fifties Dad is brave about new things, so exposure therapy is good, but he doesn't dwell on his trauma, so exposure therapy is bad. The evidence doesn’t really enter into it.

IV.

A tangent—after pages and pages and pages where Shrier blames rumination for everything from poor grades to Black Lives Matter, we’re treated to:

In a controversial but highly intriguing hypothesis, Thomson and evolutionary psychologist Paul Andrews argue that depression may even spur a deeper form of analytical thinking, known as Type 2 thinking. Depression’s well-known symptom—stopping you from engaging in social activity—may be evolution’s way of curtailing distraction so that you can reflect unimpeded on your problem. It is no accident that Churchill’s and Lincoln’s deep moral insights were preceded by periods of depression, Andrews told me. “The function of the depressed mood is to employ this Type 2 thinking to try and help you analyze and hopefully solve your problems,” he said.

When I read this paragraph, I spluttered for three minutes.

For those keeping track at home: a kid whose dad is coming home from prison seeking emotional support is rumination, which is bad. A depressed person self-isolating to spend more time reflecting on their life problems is… fine? Not rumination? A source of deep moral insight and analytical thinking?

V.

Abigail Shrier has a vendetta against asking children about their feelings:

Hang around families with young children for an afternoon, and you’ll hear parents check that their kids are enjoying their ice cream, excited about school the next day, that they had fun at the park. In so many ways, we signal to kids: your happiness is the ultimate goal.

That’s very different from asking a kid the sorts of things adults have always asked kids: “How is school going?” “How do you like your teachers?” “How’s the baseball team?” “How is the seventh grade?” “How’s your family?” “What are you learning in school?” “What’s your favorite class?” All great questions that may prompt personal reflection on a child’s life. But in every instance, the conceit is the same: You are part of a social fabric, a society, a community, a family, a team. What do you think about our broader world?

But ask a kid: “How are you feeling today?” as our schools now do on a routine basis, and you tear kids from that social fabric. You ask them to conceive of themselves as free radicals, hurtling through the universe without a tether. This sort of contemplation is inherently destabilizing. It may even be indistinguishable from unhappiness itself.

For an author who claims to believe in resilience, Shrier thinks that children are awfully fragile. Personally, I think my kid will grow up fine even if I slip sometimes and say “How are you feeling about school?” instead of the approved “How is school going?”

The reason for this prohibition is the wildest section in the entire book.

Michael Linden, a professor of psychiatry at the Charité University Hospital in Berlin, thinks this is a terrible practice. “Asking somebody ‘how are you feeling?’ is inducing negative feelings. You shouldn’t do that.”

Why? I asked. If all you’re doing is asking, each morning, How are we feeling today, Brayden?, isn’t the child as free to provide a positive answer as a negative one?

That isn’t true, Linden shot back. “Nobody feels great,” he said. “Never, never ever. Sit in the bus and look at the people opposite from you. They don’t look happy. Happiness is not the emotion of the day.”…

If you track a person’s emotions over the course of a day or even a week, Linden told me, happiness is actually a very rare emotion, statistically speaking. Of our sixty-thousand wakeful seconds each day, only a tiny percentage are spent in a state we would call “happy.” Most of the time we are simply “okay” or “fine,” trying to ignore some minor discomfort: feeling a little tired, run down, upset, stressed out, irritated, allergic, or in pain. Regularly prompting someone to reflect on their current state will—if they are being honest—elicit a raft of negative responses.

Linden saw my surprise, so he asked me to consider how I was feeling right then, during our interview. I was inclined to say “good,” but he jumped in: “You don’t feel happy in this moment. You are concentrating on the interview.”

He was right. It was five a.m. in California when we spoke, and I am, to put it mildly, not a morning person. I was acutely aware that the three sleeping children one floor above me might, at any moment, wake and interrupt the interview. I disliked how tired I looked on my webcam. Having allotted every spare minute to sleep, I had run out of time to apply makeup. I hadn’t downed my morning coffee.

"If you start your day by asking yourself whether you are happy, the result can only be that you’re not happy. And then you think you need help to become happy. And then you go to a psychotherapist and he’ll make you really unhappy in the end.”

But why can’t the answer always be “I’m happy”?

Because it will never be true, Linden says.

I know that you’re not allowed to diagnose people from a few pages of a book that they didn’t even write, but it really seems to me like Linden has severe treatment-resistant depression.

People I know have a lot of bad things happen in their lives. They have anxiety, psychosis, chronic pain, chronic fatigue, cancer, heart problems. They want to be married and can’t find anyone. They’re going through divorces. Their loved ones die. They have preschoolers with discipline problems or newborns who will not sleep. They have too much to do and not enough time to do it in. They don’t have enough money. They live in cramped, overcrowded houses because of the Bay Area housing crisis.

And yet—most people I know are happy most of the time. Because most people’s lives don’t consist exclusively of misery. Their lives have friends and lovers and spouses, good meals and good music and good sex, D&D games and costume parties and classes on mushroom identification, indie movies and bad webnovels and video games from your childhood, playing with children and comforting sad people and donating to charity, flow states and meditatively finicky tasks and the satisfaction of a job well done, memes and sunsets and The Boat That Got Stuck.

I’m even pretty happy on the bus. The bus usually takes me to places I’m looking forward to going to!

What Linden says is a self-fulfilling prophecy. If someone with a PhD authoritatively tell someone she’s unhappy right now, she’ll probably think about all the bad things in her life and decide he’s right.

Perhaps Abigail Shrier’s experience interviewing Linden was legitimately immiserating; I myself would be unhappy if I had to talk to Linden. But, I suspect, she could have said to herself: “I’m a competent professional who’s good at my job. I’m so lucky that I’m paid to talk to some of the world’s greatest experts about whatever I’m curious about. I’m adeptly balancing work and raising three children. I’m learning new things about the world.” With that self-narrative, would being a bit tired and not being pretty enough really be the most important thing?

This is why rumination, real rumination, is so awful. You can be unhappy on a vacation to the Caribbean if you spend all your time thinking about how the wifi sucks and there might be mosquitos tonight and maybe you should have gone to Alaska instead. And you can be happy doing the dishes if you think about the birds singing out the window and your date tonight and how nice it’ll be to have a clean sink. You can’t Pollyanna your way into being blissful while your child’s in the ICU, but in everyday life a lot of happiness is about your perspective.

For most people, most of the time, happiness is a choice made up of thousands of smaller choices. You can do small things that bring you joy, like putting on your favorite outfit or choosing a slightly longer path that goes past beautiful flowers. You can plan a week of meals you enjoy, schedule hangouts with friends you really like, or set aside time to read your favorite book. You can make miserable experiences a little nicer: listen to music while cleaning, text your friends while you’re at the DMV, mentally play buzzword bingo during boring meetings. You can choose to stop doing things that make you miserable, like doomscrolling or enforcing unnecessary rules on your child or spending time with people who make you feel pathetic and small. You can figure out what matters to you—art, adventure, romance, your community, your family, your children, making the world better—and make sure that it’s actually a priority in your life. You can do all those things that annoying people keep telling you to do, like being grateful and taking joy in small things and not worrying about things you can’t change.

But you aren’t going to do any of those things if you think nobody feels great, that happiness is a very rare emotion, that thinking about what you’re feeling will reveal you’re secretly miserable all the time.

But this is where the Fifties Dad mindset ends up. You keep doing things that make you feel like shit, especially if it might inconvenience other people to stop. You don’t set aside time to work through your feelings and take care of yourself when you’re unhappy. You assume your emotions are meaningless noise that give you no insight into what you should be doing. And then, of course, you’re miserable.

But everyone is miserable, right? Happiness is rare and fleeting. If anyone introspects, they’ll discover they’re unhappy. Best to avoid being present in the moment, to avoid feeling what you’re feeling, to avoid ever thinking about whether you actually like the way your life is going. Best to focus on reaching the goals you picked because they pleased the people around you, or because it’s what everyone else was doing, or because there’s a number attached and you can get a high score and therefore win—and certainly not because you wanted to or it brings you joy. Everyone else has a life like this. There’s no better way.

Who made the world?
Who made the swan, and the black bear?
Who made the grasshopper?
This grasshopper, I mean—
the one who has flung herself out of the grass,
the one who is eating sugar out of my hand,
who is moving her jaws back and forth instead of up and down—
who is gazing around with her enormous and complicated eyes.
Now she lifts her pale forearms and thoroughly washes her face.
Now she snaps her wings open, and floats away.
I don't know exactly what a prayer is.
I do know how to pay attention, how to fall down
into the grass, how to kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?

The Summer Day, Mary Olivier.

1. I’m phobic of mind-altering substances. Instead of doing exposure therapy, I just don’t drink or smoke weed. It’s fine to just be scared of something if it’ll never come up in your life! There’s no obligation to fix your anxiety! But Shrier isn’t ready for this conversation.

2. Ozy’s footnote: Shrier doesn’t specify what “this manner” is.

3. Like child abuse, alcoholism, and seizures.

4. This is called Foreshadowing For Later In The Series.