Over the last ten years, there has been an alarming rise in the prevalence of mental illness among young people throughout most of the developed world. (Figure 1). It began well before COVID and has been observed throughout the Anglosphere (USA, UK, New Zealand, Australia) and most Western European nations, so it cannot simply be blamed on lockdowns or idiosyncrasies of American society.

Figure 1 The Anxious Generation, Figure 1.2, used with permission

Baseline levels of anxiety and depression had been relatively stable for decades, then began to rise steeply around 2012. What happened in 2012? According to Jonathan Haidt (The Righteous Mind, The Coddling of the American Mind) and Jean Twenge (Generation Me, The Narcissism Epidemic, Generations), internationally renowned social psychologists, that was the year that smartphone adoption crossed the 50% threshold. Of course, “correlation doesn’t prove causality,” but an overused cliché does not grant license to dismiss. Correlation is usually the first clue to causality. Establishing causality requires at least two things. First, other reasonable explanations should be excluded, and second, a plausible mechanism of action should be offered.

In early 2023, Haidt launched the After Babel substack, a discussion platform for collecting research on the possible relationship between mental illness and smartphone usage. This project was instrumental in leading to the publication of The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness in March of this year.

As mentioned earlier, in order to make a credible argument for causality, alternative explanations need to be ruled out. Are young people simply more willing to seek care? Was it the economy? Jean Twenge from San Diego State University considered thirteen alternative explanations for the increasing levels of mental illness and effectively shows that none of them is consistent with all of the data.

In the opening chapter, “The Surge of Suffering,” Haidt lays out the data showing a widespread rise of mental illness among young people. It is difficult to deny that the phenomenon is real. Many of us physicians have had ring-side seats to the spectacle.

Part 2 of the book, “The Backstory,” describes the rise of safetyism and the decline of traditional play-based childhood across the 90s and early 2000s. The idea of “safetyism” was introduced by Haidt and Greg Lukianoff in The Coddling of the American Mind (2018) and refers to “a culture or belief system in which safety has become a sacred value, which means that people become unwilling to make tradeoffs demanded by other practical and moral concerns. ‘Safety’ trumps everything else, no matter how unlikely or trivial the potential danger.” (page 27)

Children need a certain amount of independence and risk to develop self-confidence and courage.

Unfortunately, safetyism is counterproductive to healthy emotional development. It is reasonably well-established that children need a certain amount of independence and risk to develop self-confidence and courage. Without it, they are considerably more likely to remain immature, uncertain, anxious, and fearful.

Part 3, “The Great Rewiring,” shows how the vacuum left by the decline of healthy play has been filled by more time online and alone. While internet access can be indispensable for learning, research, and communication with friends and family, the downside is that vulnerable children are exposed to misinformation, disinformation, extreme forms of social comparison, overuse and addiction, pornography, and predators. Only the most informed and tech-savvy parents have much chance of protecting their children from such malign influences – and only a slight chance at that. There are just too many ways to evade restrictions and access content.

The upshot of safetyism on the one hand and screen-based childhood on the other is that parents and other responsible adults overprotect in the real world but underprotect in the virtual one.

What other evidence do we have that smartphones and screen time are driving the rise of mental illness? Besides the strong correlation in time, the existence of plausible mechanisms, and the absence of other good explanations, two additional lines of evidence support a causal relationship. First, there’s a positive “dose-response” relationship: the more time spent on screens and social media, the greater the effect (Figure 2).

Figure 2 The Anxious Generation, Fig 6.2, used with permission

Additional evidence of a positive dose response is that the earlier a child starts using a smartphone, the worse the outcome. On After Babel, Haidt and Rausch dedicate an entire post to presenting the evidence. Figure 3 shows a direct relationship: the older a girl is before getting her first smartphone, the better her mental health at ages 18-24.

Figure 3 Haidt & Rausch, May 15, 2023

Interventions aimed at reducing usage have demonstrated significant improvements in mental well-being, providing additional evidence that the phone is a cause of mental illness. A multicenter, prospective study from 2018 found that deactivating Facebook for the four weeks before the midterm elections led to increased time with friends, reduced political polarization, and increased subjective well-being. A longitudinal study from Germany randomized subjects to reduce social media use by 30 minutes daily, increase physical activity by 30 minutes daily, or both. Compared to the control group, all study groups showed a significant reduction in depression with increases in life satisfaction and subjective happiness, with the greatest improvement in the group assigned to both reduced social media use and increased physical activity. A comprehensive report from Norway found that banning smartphones at school significantly decreased mental health disorders in girls while improving their GPA. Bullying decreased for both boys and girls.

The final section includes chapters on what parents, schools, and governments can do to tame the monster and restore a healthy semblance of reality to modern youth culture. The core recommendations consist of:

1. No smartphones before high school
   
2. No social media before age 16
   
3. Phone-free schools
   
4. Far more unsupervised play and childhood independence
   

All four suggestions are modest and easily implemented but require a certain degree of community cooperation. Implementing them alone could be rather difficult for parents immersed in a group culture that runs strongly in the other direction, and it would be hard on the children as well.

Spiritual connections

Haidt and his colleagues did identify one group of youth who experienced a much more benign trajectory over the last decade: conservative, religious young people.

A subtitle from Zach Rausch’s post on After Babel from June 10 declares unambiguously, Religion protects young people’s mental health. Around the world, social scientists find that religious people have lower rates of depression, anxiety, drug addiction, and suicide. Figure 4 shows how many teens experience strong negative thoughts harmful to their mental well-being:

Figure 4 “Religious teens reported fewer issues with their emotional well-being. Source: Monitoring the Future, 1977-2019 , Rausch, 6/10/2024.

Rausch asks, “What are religious conservative teens doing differently?” He observes that conservative and religious families tend to emphasize structure and duty, while liberal and secular families tend to emphasize personal expression and exploration. (The implication for LGTBQ identification, another contributor to poor mental well-being, seems rather apparent here). Rauch hypothesizes that conservative religious parents may be more restrictive over their children’s use of technology, and data indeed shows that religious and conservative teenage girls are less likely to be heavy users of social media than their secular liberal peers.

Rauch shows that religious and conservative youth are more engaged with their local communities, have more social support, spend more time with responsible adults, and enjoy more in-person time with friends.

Rauch does not suggest the particular beliefs of the religion matter, but there are many reasons why the actual doctrine might make a difference. Specific Christian teachings on marriage and sexuality oppose the pervasive lies found online. Lisa Littman and Abigail Schrier, for instance, document how internet influencers, particularly on YouTube and TikTok, recruit and seduce young women into believing they might be transgender. The transgender identity, in turn, initiates a cascade of social and psychological disruption. Religious youth are still likely to encounter such messaging, but they are also more likely to benefit from counter-messaging at home and at church.

Specific Christian teachings on marriage and sexuality oppose the pervasive lies found online.

Christian (and Biblical) teaching on attitudes of a healthy mind anticipated the core principles of Cognitive Behavioral Therapy by about 2000 years. Children raised to think Biblically, therefore, are less vulnerable to the catastrophizing and sense of helplessness that contribute to depression. Humility, as taught in Scripture, is a cornerstone of mental well-being.

Conclusion

In their work on After Babel, Haidt, Twenge, and Rausch argue eloquently and persuasively that the dual trends of reduced free play and increased time online are detrimental to the mental and social well-being of developing young people. Physicians and church leaders should be alert to the danger and be proactive in reducing the risk. Church youth activities can, and probably should, be made phone-free. Church and school leaders might re-evaluate their own use of WhatsApp, Instagram, Snapchat, and similar tools to communicate and connect. Earlier generations got along without them and emerged much healthier.

We also must recognize that nobody is alleging that smartphones are the cause of all mental illness. Other well-established causes remain operative in putting young people at risk, particularly parenting and family structure, but also genetics (to a certain degree) and environmental influences outside the family. We shouldn’t be so fixated on the impact of smartphones that we ignore risk factors that were well-established before 2012.