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The teen years are a trope and a meme in our culture. We’re inevitably warned the minute we have a baby and admire her cute little face at a family gathering, in a restaurant, waiting in the checkout at the grocery: Just wait until she’s – or he’s – a teen. And it’s no wonder – the teen years – which we all remember too – are fraught with big changes: big hormonal shifts, changes in our neurobiology, changes in how we see our place in the world, changes in how we see our parents. It’s complicated.
And it’s become more complicated – for both teens and their parents- in recent years. If you read the news, and certainly if you’re a parent, you can’t have missed the many headlines that have come out in recent years, from the impact of social media on our daughters, the impact of lockdown during COVID on our teen's mental health, and complicated issues around gender and identity.
My guest today, Dr. Lisa Damour, is here to help us unpack the mystery of teenagers and to support parents of teens. This is a must listen even if you still just have a babe in arms, or if you’re a grandparent, auntie, or healthcare provider.
Dr Damour is a graduate of Yale University, where she worked for the Yale Child Study Center before earning her doctorate in Clinical Psychology at the University of Michigan. The author of three New York Times best sellers: Untangled, Under Pressure, and The Emotional Lives of Teenagers, which have been translated into twenty-three languages, she works in collaboration with UNICEF, is a senior advisor at Case Western Reserve University’s Schubert Center for Child Studies and is recognized as a thought leader by the American Psychological Association. Her latest book, The Emotional Lives of Teenagers gives parents the much-needed roadmap to support our teens through the bumpy yet transformational journey into adulthood, a topic we’re going to explore today.
You can follow Lisa at https://drlisadamour.com, on Instagram @lisa.damour, and on the Ask Lisa podcast
Enjoy and please share the love by sending this to someone in your life who could benefit from the kinds of things we talk about in this space. Make sure to follow me on Instagram @dr.avivaromm to join the conversation.
Lisa: Oh, thank you for having me. I really appreciate being here.
Aviva: You have a busy schedule, so I'm always just so grateful when people are able to make the time and share the work they're doing. So I want to dive right in with a discussion of something that you shared with me in the pre-interview questionnaire, which gives me some insights into, before we get into the conversation, what people are thinking of, what blows their hair back, what keeps them up at night as professionals. And one of the things that you said I wasn't actually expecting and I really appreciated it, and you said one powerful tenet or takeaway that you would love folks to have is that mental health is not just about feeling good, it's about having feelings that fit the situation and managing them well. So can we start there with a basic exploration and explanation of mental health and not just for teens, but for all of us? What do you mean by that?
Lisa: I would love to start there. Thank you for taking us right there. Yes, and I'll say this idea, which is not my idea, this is how we understand things as psychologists is probably the main reason why I wrote The Emotional Lives of Teenagers. When I did that, there were two things happening. One was the pandemic, which just t-boned adolescence. And so I tried to write a book that thought about what does this mean for their mental health going forward and what are we going to do about this? And the other is a very widespread misunderstanding in the culture about what it means to be mentally healthy. There are a lot of messages around us that suggest that you are only mentally healthy if you feel good or calm or relaxed and also or if your kid feels that way. And I'm all for people feeling good.
I like happiness. I got no problem with any of that. That is not how we as psychologists assess questions of mental health. We are looking for two things. Number one, do the feelings you have make sense in the context fit what's happening. So if your best friend moves away, you should be upset. If you're a kid and you've got a huge test tomorrow and you have not studied, you should be anxious. So those are negative emotions that are proof of mental health, not grounds for concern. Then the other part of the definition that we pay attention to is upon having a negative emotion, what happens next? And I will tell you that's really where psychologists train our attention because we fully expect to stress. That's sort of a non-issue for us. Of course, people are going to get upset, but does the kid whose best friend is moving away, have a good cry, take comfort, go find the dog, cuddle, make plans to see that friend.
All of these things we would just call healthy and adaptive coping. Or does that kid say, you know what? I'm so upset I'm going to smoke a ton of weed and that's how I'm going to get through this and then I'm going to be completely miserable to live with for a month, and that's how I'm going to take my feelings out on everybody. It's that divide whether coping happens in a way that brings relief and does no harm, or whether coping happens, always coping. Coping happens in a way that brings relief, smoking marijuana, bothering everybody else, but comes at a cost only that corner of things. Only when people suffer and then go about managing in ways that aren't going to work well only then do psychologists perk up and say, okay, now we have a mental health concern. This feels really important to level set in the culture in general with families and with everyone, and especially right now,
Aviva: I just absolutely love what you're saying. First of all, it's kind of a humorous aside, but as a New Yorker who grew up in a home of a certain type of immigrant Jewish family, certain things like loud voices or emotional expression were not actually defined as negative emotions. And it's funny, my husband grew up in a much more gentile southern home, and for him, a raised voice or intense emotions are just terrifying. And so it's really interesting even what one person defines as a negative emotion and what other person defines as a negative emotion or what, as you say, our level set is. My husband's level set is life is supposed to be pretty much calm and big emotions suggest that there's something going wrong, there's instability. Whereas for me, big emotions are just like, Hey, it's like a car hum.
Lisa: Now we're connecting.
Aviva: Yeah, yeah. Or it's funny, we were driving, we raised our kids in Atlanta and we were driving up to New York City at one point and we were coming across the Jersey turnpike. We were getting to the toll and a little car cut in front started to try to cut in front of a big truck and the truck driver rolls his window down and this was like you could see where it was going. And my kids who grew up in this southern home and my husband were kind of anxious, the little car rolled its window down, you can hear the FU and the screaming, and they were all getting worried. And I was like, just watch for one minute, just watch what happens for one minute. And it was like one minute of like blah, blah, blah, blah, blah, blah, all the F words and the F bombs and stuff. And then after less than a minute, the truck driver's like, all right, great, go ahead, go ahead. And everyone's like, have a nice day. And it was kind of done, but I really love this idea that we are sort of defining negative emotions as a mental health problem or even defining them as negative.
Lisa: And here's the real flip from the dominant discourse. The dominant discourse right now is that distress is equivalent to a mental health concern. What's actually true is that often distress is proof of mental health. If your best friend moves away and you feel nothing, that is weird. If you have a huge test tomorrow and you are not ready and you are totally comfortable with that, that is a problem. And so I'm so glad we're starting the conversation here because this feels so critical to try to correct because we are actually working with the opposite definition of what is true.
Aviva: And so one of the things that you say in the emotional lives of teenagers is that for teenagers powerful emotions, which I really love that phrase, we're kind of getting away from the negative emotions because all emotions are messages of something and it could be right distress, it's trying to find a way to express itself or not being able to cope for whatever reason, whether that's a high ace score or poor resilience or actual limited coping skills for whatever reason. But you say that for teenagers, powerful emotions are a feature, not a bug. And I love that. And how is it that we've lost sight of this and become so I guess intolerant of all this, what it sounds like you're defining as much more normal teen emotions and behaviors.
Lisa: Totally normal. I don't really know where we lost our way, but I will say one of the things that has happened is that there's now parenting industry. There are a lot of people who are offering a lot of guidance about parenting, some with more training than others, and I think that some of the parenting content out there can wrongly give the suggestion that if you just do this ninja move and that ninja move, do this thing, do that thing, then parenting will be fun and easy. Okay. That's easy to sell. Yeah. You and I both as parents know, it's not really how this works.
Aviva: And you know what else that I'm seeing is not even just that parenting will be fun and easy, but that there's actually a recipe if you do all these things right now correctly, now I'm doing air quotes around correct. For those of you who are listening that somehow that is a guarantee or a recipe that your child will have amazing resilience, become an adult who is perfectly well adjusted. There will be no intergenerational trauma, no trauma, and that is really, I feel one misleading two, it still puts a lot of blame on the parents in this sort of neo Freudian way, if you will.
Lisa: I think it feels really loaded, right? Yeah. I think obviously all I do is parenting guidance, so I can't say it's all bad. I hope it's not all bad, but I do think that my experience of how I can be most useful as somebody offering parenting guidance is I can lay out for families what we know about how development works and what I know as a psychologist is that development is a machine, an engine within our kids, and it advances forward. You don't have to make kids develop, they develop, and there are predictable events that will occur in the course of development that are a sign of natural and healthy forward progress. Now, the problem is many of these events are not all that fun for the family. So the three-year old gets into power struggles. The 4-year-old shows off the five-year-old likes to leave people out.
The 6-year-old is anxious about perfectionism. I mean these are just known milestones or known by psychologist milestones. Then six to 8, 9, 10 tends to be kind of wonderful and mellow, kind of easier time raising kids. Boom, adolescence begins at 11. It has always begun at 11, we've always said that your kid is going to start to close their door. Your kid is going to start to not want you to call them cutie patootie anymore. Your kid is going to become much more private. 13, your kid is going to have a lot more meltdowns. 14, your kid is going to start to question everything you say.
Aviva: Right? 14. I call it, especially for girls, the eye roll developmental stage,
Lisa: They're like, exactly, I'm no longer buying anything you are selling. Okay, so I can rattle these down. These are known NOs, but we have to tell parents because what I so often hear, and it is like sweet and also heartbreaking, is I will give a talk and a parent will come up to me and it's often a mom and she'll say, okay, my daughter's 10 or 11 right now and I think we're going to be okay. We get along really well. We have a great time together. I think we're going to be okay. And what I can hear, and it's what you're describing is this wish that because I have put in the time, because we are so well connected, because we get along so well right now, she's not going to turn on me like those less parented children do. And I say, you are going to be okay, and your kid is going to become more private and they're going to start to close their door and they have to do this and they have to do this. I'll give one reason. It's a big one because they actually have to become increasingly independent so they can eventually move out. Yes,
Aviva: They have to individuate, right?
Lisa: They have to do it and they have to do it while living with you. So in order to become independent while entirely under your roof, they withdraw. They accomplish a psychological independence. It's actually brilliant. And I would say that if I had to give a subtitle to all of my work, it would be, none of this is as personal as it feels. And when I wrote untangled, the goal was to just lay out this is the roadmap. This is what to expect when you're expecting a teenager. And my goal in that was to not have parents feel like adolescence is something their kid is doing to them, but to have parents understand that adolescence is a very complex and challenging developmental time that kids are working their way through.
Aviva: Let's talk more about this separation individuation process and what is happening neurodevelopmentally in kids that gets triggered. Is there something that's happening with hormones that also triggers this neurobiological response that says, time to individuate, time to, as you say, the several months where your teenager can't stand, how you chew, what's actually happening that we know?
Lisa: So at the neurological level, I would say, and you're the physician, so I'm going to defer to you on this. I would say the big changes have to do with the intensity of emotion that when they get upset, they get really upset and their ability to, they're all gas and no breaks neurologically because of how the brain is remodeling through the course of adolescence with the emotion centers getting upgraded in advance of the perspective maintaining systems. And yes, it's a gawky brain is what we say, and it's very gawky, broad gender strokes, most gawky around 13 for girls, 14 for boys. Just in terms of how puberty unfolds, I'm sure there's a neurological underpinning for this. I don't know it, but there's also simultaneous with this heightened emotionality, this sense of I need to start to establish my own identity to, the way I talk about it in the book is I need to build my own brand, building my own brand.
And it hits very hard around 13, 14, eighth, ninth grade. And what I discovered, and I will say some of this came through parenting. I had my training where I was like, ah, separation, individuation. And then I have my kitchen where I'm like, oh my gosh, are you kidding? This is what it actually looks like in my house. Yeah, okay, so here's what it looks like when a kid is building their own brand, separating individuating, anything that the parent does because we are still so intertwined. Anything that we do that doesn't line up with the brand they see themselves developing is annoying to them. So this can take the form, and I've written about this of the kid who has to tell the parent what the parent will be wearing to eighth grade orientation because the parent reflects on that kid and the kid needs the parents to not mortify them with those shabby gene.
So anything the parent does that is unlike how the child sees themselves becoming is mortifying at the same time because kids are building their own brand. Anything that the parent does that overlaps with how the child sees themselves becoming is also annoying. I remember with my older daughter who's now 20, when she was 13, she discovered Beyonce. Okay, Beyonce's great. I have liked Beyonce for a long time too. So we have a moment where I have Beyonce playing in the kitchen. I am bopping along to Beyonce in walks my kid and she's like, ma, stop. Beyonce was hers. I was stepping on her brand.
At the height of this. Anything we do that is unlike how our kids see themselves becoming is annoying to them. Anything we do that is how they see themselves becoming is annoying to them. Everything we do is annoying and it's luckily very short-lived. You can also say to a kid in this like, look, there's a few ways we can be together. You can be friendly. That's my favorite. You can be polite, that's the bare minimum, or you can tell me you need space, but you can't be on my case all the time. And that usually gets you through.
Aviva: I like that. It's really important. So for you having a lot of training as you were also raising daughters through their teen years, how did you cope with, and I don't know they went through this, but if they did go through some really intense individuation because teens can be pretty brutal and I find that teen girls can be, especially I have a son and then three daughters and my son. In his individuation process, it was really more about becoming just himself. I didn't feel like he was individuating against me, if you will. I wasn't the measure, but with my girls, I was the constant measure against which they were judging and defining everything. And I will say I didn't always not take it personally. It was really hard. And even with them as adults, sometimes still things come up and I do find that it's very painful, especially when you love your kids so much and you do feel so attached.
How do you encourage parents? Not theoretically, but in the heat of it, your teenage daughter's really attacking you. How do you cope?
Lisa: Okay, it's so essential. So I think the first thing is you can't let kids be awful to you. Kids. There are lines, and I really don't believe there's home behavior and there's outside the home behavior. I feel like I live with the rule. No one's going to think our kids are as cute as we think they are. You don't get to be a jerk at home and think you're not going to be a jerk out in the world. So I would say there are lines that cannot be crossed and teenagers will cross them. And so they'll say things that are mean or unfair or rude, and I think that's a really good time for the adult to say, that's out of line. If you have feedback from me, I'm interested, but you can't talk to me that way. I think that that's essential. And I think teenagers are looking for that.
They're waiting for that, they expect it, and it's frightening for them. If it doesn't come, then there's feedback from teenagers about our shortcomings and this starts to come fast and furious, especially round 14. It does and it doesn't feel great. But here is again, I feel like this is my whole job. I live in the space between teenagers and parents. I'm on no one's team. I'm in the space between, here's the view from the teenager. All of a sudden they're like, okay, wait a minute, you guys are my only parent or you are my only parent. This is the hand I'm dealt and I can see all of your shortcomings, which of course they can. They have phenomenal acuity for the shortcomings of adults. Is there anything I can do to improve you? Well, what if I tell you all of the ways I wish you were better so then maybe my parenting hand could be improved before I am out of this house?
So think about it that way. And here's what I will tell you, I'm a vastly better person for parenting teenagers. If you can tolerate their feedback and if it's within the lines, doesn't mean it's going to be nice or gentle, but if it's not over the line, having a teenager can make you a much, much better person. And so I think that's a way to take it. In the last thing I will say, no one should go into parenting, a teenager having their self-esteem hinge on how their teenager is treating them. It's easy with little kids. They like us, they want to come to the grocery store with us. They're so exciting when we come home, right?
Aviva: Totally. I was just saying that to my husband this morning. We just had one of our kids unexpectedly living with us for five months and she's a grown adult. And so it was almost like this weird thing of having a teenager back in the house. She kind of wanted us to treat her like a teenager, but then she's also a grown adult and expected us to treat her that way. And I was like, oh man, this is so nice with our grandkids who are nine and 12 and they still think we walk on water, I remembered that shift of when they love you no matter what to when they really are picking you apart,
Lisa: Picking you apart. So I would say part of how you withstand that is I love my work. I have always had taken tremendous pleasure in my work. I enjoy a lot of positive feedback about my work that's helped me. People need their clubs, their hobbies, their activities, their girlfriends, their boyfriends, I mean the people who love on them because your teenager is not going to be a reliable source of self-esteem.
Aviva: And I think that it's so interesting because I was not a helicopter parent, but I was a hippie attachment mama parent and I put so much of myself into raising my kids in a certain way in order to create a certain outcome, if you will, that was in alignment with reinforcing my worldview. That was part of my self-esteem. And it's been a lesson of evolving as a parent, still parenting grown kids to really now as a women's health physician working with so many mamas to really encourage mamas to not base their self-esteem on their children's outcomes or how their children succeed in the world or don't succeed at any given time or you can't make your kids be who you want them to be. I feel like our job as a parent is almost more to show up as a guide for who they actually are. And it's really been a big shift for me. I don't know what you think of all that.
Lisa: Well, there's a saying in schools that parents are adults are shepherds, not engineers.
Aviva: I love that.
Lisa: And I think that's a good saying.
Aviva: It's a great saying. One of the fundamental beautiful principles that your work seems to be built on is that foundationally, it's our relationships with our children and the strength of those relationships with our teens. That can be some of the strongest support and guides for them. And yet we're trying to give that love and support often to people who are pushing us away. So what are some of your, if you had a top, I'm not going to make you say five, but a top five of how to maintain and nurture relationship with our teens while they are simultaneously shutting us out or rolling their eyes or like, oh god, mom, don't do this. I don't want to talk to you. I don't want to talk about that. How do you build a strong relationship?
Lisa: Anyone who wants to talk about teenagers is my favorite person. And so I'm just so enjoying this conversation.
Aviva: I love working with teens. My first work as a midwife was actually around teen sexual health and my husband was a high school teacher in high school principal for a decade and a half. So as the midwife wife of the high school teacher principal, I spent a lot of time with teens, many of them who are now in their forties and friends. But it's a really exciting formative time, much easier if you're not the parent. And I do think as part of this relationship conversation, one of the things that I really encourage parents to do is to encourage their teens to have another adult that a trusted adult that is also relational leave safe.
Lisa: So let's start with where you started. Okay, so the single most powerful force for adolescent mental health is strong relationships with caring adults. Full stop. It's great if those are caring adults at home. It's even better if there's other adults outside the home. Sometimes for some kids, that's who they have their strong relationships with. Things aren't working at home, but they're working outside of the house. Adults matter tremendously, and I think a lot of people are surprised to hear this for the reason that you're saying that teenagers seem like they want distance and are disinterested. They do want autonomy, they also want connection. Now here's the key, and I'll try to do five because I really, I love a challenge. Awesome. What we think is connection is not what they think is connection. So our script for connecting with teenagers is, Hey, how was school? And the kid's like, oh, here's what happened, and then this happened, and then this dilemma, what advice do you have for me? And we say, oh, many wise things because I'm 53 and I can share my wisdom with you and keep you from making the same mistakes. And our teenager goes, oh my gosh, that was so helpful. Thank you so much. Okay, that's our script. That's not most teenager scripts. I don't even know if it's any teenager script.
Aviva: No young grasshoppers out there, huh?
Lisa: Exactly. Here's the teenager script for connection. I come home, I've had a very long tiring day. I am down. You say, are you okay? And I say, oh. And you say, I want some tea. I want to go watch a show together. Or I'm going to be going and doing my work in the dining room. I got a bunch of dumb emails to write. Do you want to sit next to me while I do those? You do your homework present, available, and agenda-less their idea of connection with adults.
Aviva: It sounds like there's also like some connection adjacent happening in what you're describing. You're not demanding a conversation, you're more being in the sidecar. Yeah, I'm here. I like that.
Lisa: And I'm offering comfort. And I think that it's so rare that teenagers get to be with adults who don't have an agenda. They're so grateful for the agenda. I wrote a piece ages ago for the New York Times called . They want us around, but they don't always want us asking so many questions. Okay, so that's one. Another thing I think that can help us stay in connection with teenagers is doing, and I think this is probably the hardest thing in all of parenting, teenagers not holding grudges. Okay, so here's what this looks like in my house. I bet it looks like this. In many houses, it's busy morning. Your kid is in a rush or cranky or you're cranky or whatever. You ask them a fair question, you get a sharp, not totally over the line, but kind of answer.
They're rude, they hurt your feelings, they're out the door. You may nurse that injury all day, I promise you, by the end of the day, the kid either doesn't remember or doesn't want to go back there or is a million miles past that. And if they walk in the door and you are still hung up on what happened at 7:45 and you are cold or you are salty on the back of that, you're going to miss out on a kid who may be in a perfectly good mood and want to connect. So I would say the number one thing that I find so important is just letting it go, letting it be a moment, and knowing that teenagers are up and down all day and greeting them.
I've been thinking about this. You know how I don't have a dog right now, but we have had a dog. You know how the dog doesn't remember how you left. The dog's just excited. I think, kind of that right? Being a bit of a goldfish about it, three seconds we're onto the new thing. I think that helps with connection because teenagers can sense when we're not okay with them. And if they're like, are you serious, from this morning? 400 things have happened since then, are we really going to get stuck there? So that's two. I think three. I think we miss conversational bids from teenagers not coming when we think we want to have conversations. So over dinner we're like, what happened? And they're like, at school today, they're like, nothing. And you're like, really?
Aviva: And then at 11 o'clock when you're getting in bed and ready to read your book or go to bed…
Lisa: … there they are. And I think I unpack that late night thing in my book. And I think a lot of it is, it's a beautiful moment where they want both autonomy and connection simultaneously. So they want to connect, but they want to control how. So if they wait till we're in bed, they decide if we're talking, they decide how long we're talking and they decide what we're talking about because, and I love those. Teenagers have said to me at night, my parents, they don't ask so many questions and they don't bring up new topics. So being available when they want to talk, right? And even if it means we lose a little sleep, they're not in the house that long. Right? It's worth it. Okay. I think that's three. Have I done three?
Aviva: Okay, you got three.
Lisa: Okay. Lemme see if I can, I think this is adjacent to the one I just said – also being interested in what they're interested in.
So, talking when they want to talk, but listening for what they bring up. And actually I will say this often when teenagers want to talk about delicate or spicy topics, they'll bring it up in a kind of casual way related to somebody else. Yeah, there's a ton of weed at this party, they'll say, and there's a lot happening in that moment. And it's very easy as a parent to blow it and be like, what? Wait, you can't go over there or where were the adults? Or whatever. And that kind of usually kills the conversation. And so I think instead saying like, oh, well what do you think that anytime a kid brings up spicy behavior, even if they bring it up really neutrally, they're bringing it up for a reason and they're usually bringing it up, not so sure it's okay. And so if the adult says, oh, what do you think about that? Usually the teenager is like, it wasn't okay, and then you can have a conversation. So I think that piece that sometimes the provocative stuff can very easily break into a very painful conversation or actually very fruitful conversation. Okay.
Aviva: Do you think it's because we get triggered and we're so afraid and want to protect them so much that we go into fear and teaching mode and inadvertently shut down rather than just Yeah,
Lisa: I mean it's so scary to have a teenager. And the reality is there's an irreducible quality to this. Teenagers by their nature seek out novelty and excitement. That's part of what's happening neurologically. And teenagers because of timing suddenly have access to drugs, drinking sex and cars. Okay, this is terrifying. And there's nothing to be done about it. You cannot lock your kid in the house. And so I think, let's go to number five. This is the key. This is the key. When safety questions come up, Aviva, here is something I feel completely clear on in my mind. The safest teenagers are the ones who feel close to an adult. The least safe teenagers feel close to no adults. So when safety questions come up, the posture I want adults to take is I am your partner and safety not I'm here to bust you. I'm here to catch you.
You're going to get in so much trouble, but I am your partner in safety. So when the kid says, yeah, there was a ton of weed at this party, first thing you say is, okay, what do you think about that? Have that conversation. And then you say, what do you need from us to stay safe in those situations? Do you want to tell your friends that we test your pee? We're not going to test your pee, but if you want to tell your friends, we will feel free. I blame your good behavior on us. Do you want to make sure that we have a car available so that you're always driving so you have an easy excuse for why you're not engaging? We are a team. You are a teenager. You will go into situations that are inherently unsafe. That is the nature of being an adolescent. I am here to think with you about how you're going to come out of that safe.
Aviva: I love the parent as a safety valve. Just encouraging our kids to use us as a foil I think is a really powerful tool. Even I've heard parents who have our kids were a little bit pre major cell phone era when they were in those teen years, but parents who just have a safe word. You text me and you say the word blue, and I know that I'm going to call you right now and tell you Auntie Fran, who doesn't exist just died and we have to leave, right?
Lisa: Yeah, absolutely. Absolutely. Give them an out. And sometimes people will be like, oh, but shouldn't teenagers be able to say to their peers, weed's illegal, or I want to protect my brain. I'm like, they're teenagers. It's their job to save face with their peers. That's not a realistic expectation. And we want safety more than anything in the whole wide world. That's what wins. And if they're more likely to be safe making stuff up, they can make up anything as far as I'm concerned.
Aviva: Where's the boundary that you might define or discuss where teens are, as you say, naturally experimental. They are naturally pushing the boundaries. They're naturally trying out and dipping their fingers into different things in the world, which may include weed or drinking or sex. In fact, most teenagers these days have had some form of sex by the time they graduate high school. So how do you encourage parents to, on the one hand, give space for some of these natural experimental behaviors and create safety or your child's definition? Your teen's definition of safety may be different than your own.
Lisa: Okay, you're going to like this. Let's take sex and put it over here and let's talk about drugs and drinking and driving over here. Okay? And I'll tell you why. Sex, you know more than anyone else, it's part of normal and healthy development. And I think it's really important that we walk up to it through that lens. Drugs drinking and unsafe driving are not. So I think that we do want to be realistic about the fact that kids have access to dicey things. And I think we do want to be realistic about the fact that there are two systems that work for teenagers neurologically, the cold system and the hot system. The cold system is their very excellent reasoning. They do when they're talking about it with us at four o'clock in the afternoon. The hot reasoning is what's going to take over when they are at the party and it's 11 o'clock at night and that cute kid offers them a beer.
What we know is at four, they're like, yeah, I'm definitely not drinking at 11. They're like, sure, I'll have two. Right? And we know that, and that's also terrifying. So one thing that I always recommend is that we talk with teenagers under cold conditions about risks that are likely to unfold, though we can't imagine everything. And then we also say to them, great, but then what happens if you get to the party and that kid you have a crush on is there and drinking and wants you to join them? What's the plan? So you use cold conditions to make a plan for hot conditions that can improve safety. The other thing I will say is if you say nothing else to your teenager, say to them, I will never make you sorry that you asked for my help. Teenagers do not have parties with engraved invitations.
They do not always know where they're going to end up. They do not always know how things are going to unfold or who's going to be there. And if a kid is in a jam and they will find themselves in these, you do not want your kid to think, I am safer to ride this out and see where the party goes than I am to call my parent and have them come spring me. You want to be the safest option. So that's what I would say on that. As for sex, the way I like to talk with teenagers about the development of physical romance is I like to say to them, okay, when you think about physical intimacy, there's four things you have to think about. And this is the order. Number one, what do I want? What would feel good to me? Our culture presumes desire in boys.
We do not endow girls with desire and we know that this actually gets in the way of them taking good care of themselves in sexual contexts. Number two, what does my partner want? What is that person interested in? And when I'm talking with teenagers, they'll say, this is why you probably want to know the person, or at least be able to have conversations or not have just met them. You want to talk this through. Number three, what do we both want? And I will say to them often, this is where we get into questions of consent. Yes, we're talking consent, but I hate the word consent and here's why I hate the word consent. It is a legal term. It is the lowest possible bar, and it happens all the time. You've seen this where, and we'll just use sort of traditional gender tropes. A girl's not sure and the boy's like, come on, come on, come on, come on, come on.
And then she finally says, fine. Okay, he got consent. No, this is not okay. So it's what do I want? What do you want? What do we both really want? So enthusiastic agreement. And then number four, are there risks involved? Could someone get pregnant? Could there be an STI? Could there be a misunderstanding about what this means about the nature of our relationship and how do we manage those risks? So thinking it through in that way. And what I will say to teenagers is, until you are ready to take these steps, you're not ready for sex. And I don't care if you're 35, if you are not able to do it in this way, you're not ready for sex.
Aviva: I always love it when a teen or an adult woman says to me, oh, I just could never talk with my partner about that. And I'm like, wait, but you're doing that sexually in a bed or car, but you can't talk about it. So interesting how our vocabulary and our ability to have conversations with a partner is so still steeped, limited language, limited understanding of basic body parts and just shame and embarrassment.
Lisa: I hope teenagers are better than the generations out of them.
Aviva: How do you encourage teenagers, especially teenage girls, to get comfortable knowing what they want and asking for what they want, communicating that?
Lisa: I think honestly just telling them that that's step number one. I have done this. I was in a room full of ninth grade girls and I gave the rundown that I just gave you, and it started with number one, what is it that you want? And a ninth grade girl, they're usually so well behaved, blurted out. She goes, no one has ever said that to me. And I was like, that's right, we don't, but I'm saying it to you right now. So they're here for it. They're not hearing it from us very often.
Aviva: Absolutely.
Okay, this is going to take a little bit of a darker turn, but I've been deeply concerned, as I'm sure you have, and in some ways deeply grateful that my kids are a little bit older right now, though I have grandkids. We're seeing rising rates of sadness, anxiety, suicidal thoughts among teens, especially girls. And this was even before the pandemic. We've seen this sort of parallel march to greater anxiety and depression with cell phone use. Some data that you have in your book is from 2009 to 2019, the percent of high school students who reported feeling persistently sad or hopeless rose from 26 to 37%. And those who made a suicide plan rose from 11 to 16% and then figures rose further to 42 and 22% respectively in Covid in the pandemic. So a couple of questions here, excuse me for stacking questions, but one is just, we've talked about teens naturally having big emotions, big feelings, big ups and downs. How can parents distinguish between normal healthy teen emotionality and a potential serious mental health crisis? When is that teen locking themselves in their room because they just want privacy versus when we should worry? When is that teen creating a more healthy eating plan and thinking about being a vegetarian versus having an eating disorder? When is an emotional outburst that versus depression or something else?
Lisa: So I'm going to give two things that I want adults to look for. One is typical teenage emotions are all over the map. Kids are high and low, high and low all day. It only becomes worrisome if they go to a dark or concerning place and stay there. We do not expect teenagers to be down for 24 hours in a row. That's a very long time in the life of a teenager, 36 hours is very long or paralyzed by anxiety or beastly awful to live with. So if your kid is pushing 24 36 hours or it's shorter than that and you just have a very bad feeling, go get help for your kid, that we expect mood to fluctuate. We don't expect it to get stuck in scary places. The other thing to look for is what I call costly coping. So they're coping, but they're doing it by smoking a ton of weed or they're coping by self-harm or they're coping by stirring up endless drama on social media as a way to distract themselves from their pain. If the way they're coping has a real price tag attached to it, go get them help.
Aviva: And what are some of the ways that parents can seek effective help? I mean, I will tell you as a primary care physician, we're doing 80 to 90% of the mental health in this country. And even in my medical practice experience, especially being in a community setting in a community clinic, at the time it was very hard. This is why we're doing so much for the men. It's very hard to get mental health even when families can afford it. So what are some thoughts?
Lisa: Well, this is true and it's not good. I mean, I'm not going to sugarcoat this. And it's interesting because there's been so much talk as there should be about the adolescent mental health crisis, but it's a two part thing. We only talk about one part. So one part of the crisis is we had this huge surge in distress. It was rising and then the pandemic took it to all new levels. The other part of the crisis is it was hard to find a clinician for a teenager before all of this. And taking care of teenagers clinically is very specialized work. Not everyone wants to do it. And even if you're into it, it takes a long time to get trained to be good at it. So when we had this huge surge in need, it's not like we could sort of magically triple the population of clinicians who were equipped to handle the work.
And so those two things together have deepened a crisis that was already underway prior to the pandemic of trying to find care for kids. I mean, that's a real issue. So here's what I would say. Talk to your pediatrician. They often know who the local talent is. They know your kid. They can often make a good match, get on waiting lists, take the waiting lists. There are also some things that do lend themselves to home care. Anxiety and its treatment can be quite pain by numbers. There's very good books on the management of anxiety. Obviously depression, especially if it's emergent, like you're going to get your kid help, you may have to go through the er, which is terrifying for everybody, but if you need to do it, you got to do it. I'll also tell you my Ask Lisa podcast isn't the answer, but it's an attempt at an answer.
We are Rena, my phenomenal co-host and I are like, we're well past 150 episodes. Every episode answers a question from a parent. Every episode is just about half an hour long if shorter. And so that has been our effort to democratize mental healthcare for families. It's all questions about teenagers and it's all the what to do, how to help. The last thing I will say, if you were stuck on a waiting list, which you may be, do not underestimate the power of the basics. Make sure your kid is getting enough sleep. Make sure your kid is getting high quality nutrition. Make sure that your kid is physically active. Have your kid if you can be busy with purposeful activities, my view of what constitutes a therapeutic interaction for teenagers is very wide. Not because it has to be, because this is what I've learned. Some kids are going to benefit from therapy.
Other kids are actually going to be surprisingly improved by getting a job where they feel good about themselves and they're making money. Or going to a theater program where the adult running it gets kids, connects with kids, supports kids. It doesn't always have to be a clinician in an office to help kids get better. Now, of course, there's some kids where they need and deserve nothing but clinical care, like no question. But the basics, help, connections, help feeling counted on in some meaningful way helps kids. And so those are some of the things adults can do, especially if they can't find the clinician they're looking for right away.
Aviva: I love that you give such a broad range. And of course, having four children myself, just even in that little microcosm, it's so easy as parents to kind of come up with these defining ways that we raise our children or parent, but each child is so powerfully individual that as you say, one child may need the job, one child may need the theater program and one child may benefit from all of the above, plus a therapist or medication or different nutrition, whatever it may be. So thank you for really giving that broad toolkit. What about a child, a teenager who is resistant to getting help or even to resistant to recognizing that there's a problem? And I've seen this so often in my practice, for example, with teens with eating disorders, young women with eating disorder, and it may even be that a sports program or dance program actually positively reinforces the problem.
Lisa: Yeah, yeah, no, I've seen that plenty and it makes me bananas.
Aviva: Or kids who, one of the areas too to add to that is kids with perfectionism who their anxiety stems from performance issues in school and the need to succeed.
Lisa: So in the generic, when a kid refuses help, there's two ways to think about it. One is to say to them, okay, but what you're doing isn't working so you got to do something else. What's it going to be? They're just doing what we're doing isn't going to continue because you're depressed or you're under functioning or you're not going to school or whatever. We're not going to keep doing this. So I'm offering therapy. What else you got if you don't want that? So we can take that approach. The other thing I will say, and I think this is critical, early in my training when I started working with teenagers a lot, a supervisor said to me, you need to work with the assumption that all teenagers secretly worry that there's something really wrong with them. And when it was said to me, I was like, really? I don't know.
Aviva: So heartbreaking though, isn't it? It's like, oh, it's right.
Lisa: But then I thought about it, okay, wait, you're 13. Your emotions have gone completely haywire. You're 14 and a dimension has been added to your thinking. That makes the world look much more complex as it is than you've ever seen it before. There's a lot happening that can feel very, very destabilizing in the course of normal development. And it is true. I think that teenagers wonder if there's something really wrong with them sometimes because they feel themselves changing and sometimes in ways that are strange. And so then if you have a kid who's sitting there worried that they're broken and you roll up on them and they're like, you know what you need? You need therapy. They're like, ah, worst case, worst fear.
Aviva: She agrees. She thinks I'm broken too.
Lisa: Exactly. Instead, when I need to recommend therapy to a kid, I will say, listen, I cannot believe that you are managing as well as you are given what you are describing to me. You deserve way more support than you have right now. Let's get you that support. You need someone in your corner who can help you through this. That is a way to get kids there. Okay, separately eating disorders. The nature of an eating disorder is that the eating disorder corrupts thinking, undermines reasoning, and can quickly trap people into protecting the eating disorder of all other things. We are vastly better at treating eating disorders than we've ever been, way better outcomes than we were getting 20, 30 years ago. But early treatment, the proper treatment intensive treatment is required.
Aviva: Yeah, it's a definitely highly potentially debilitating, but even life-threatening condition. Yes, the pandemic was really hard on teens. Any bits of wisdom, thoughts of support for parents who are kind of now post pandemic with this microgeneration of kids who were really disrupted? What do you think we can do to give them a little extra support? Or do you think they need it? Are they just resilient and getting through it for the most part?
Lisa: I would say there's a mix, right? I mean, I think there are plenty of teenagers who are like rear view mirror, so glad that's over. Nobody mentioned it and they are just blasting forward and doing great. And I think that's a lot of kids. I think there's also kids where it really left a mark or it changed their trajectory. The number one way I see this is they're using avoidance to manage anxiety much more. We are seeing massive, massive problems with school attendance that last and last that are, I mean, literally double what they were before the pandemic in terms of chronic absenteeism. So that is without question, a result of the pandemic and avoidance feeds anxiety. Kids who were anxious about school before that when they were out for a long time, they became very, very anxious about school.
Aviva: Yeah, it's interesting. I'm even seeing a lot of adult women who are telling me they had social anxiety before, actually felt huge relief during the pandemic, and now going back is just not what they want to do.
Lisa: And avoidance feeds anxiety. We know this is psychologists and the solution is always exposure. You just got to go do the thing and you have to be able to manage anxiety and there's tools to do that, so you can't. But here's what I would say to parents in general, development has always been a bumpy road, and I will tell you nothing held me in bedstead through the pandemic as a clinician than the fact that I'd been taking care of teenagers for 25 years before the pandemic. And so all this distress, I was like, well, some of this is the pandemic and a lot of this is just teenagers. And so what I would say to parents is development has always been on a bumpy road. We were in a ditch for 18 months to two years. We are now back on the bumpy road. There is no smooth and easy version of raising kids. There's definitely no smooth and easy version of raising teenagers. There are a couple new bumps. Our shocks are worn, but the fact that raising a teenager is taxing and stressful for the kid and for you is not a sign that someone is messing up or that your kid is struggling or that you're doing it wrong. This is what raising teenagers looks like.
Aviva: So powerful to just remind ourselves it's, it's hard and it's hard because it's hard and we're not failing at it. That's beautiful. Quick thought on social media for our teenagers and especially our girls, and we do know that there's this increased anxiety, increased depression, increased suicidality. What are your thoughts on how to protect our kids and especially our girls with social media?
Lisa: Okay, so it's complex to say the least. The data are murky in terms of the causal relationship between social media and mental health. Also, the data you are right report very heavily on what's happening for girls. I think this is actually an artifact in how we collect information when we ask. These are often self-report surveys. In self-report surveys, we ask about what we call internalizing symptoms, anxiety and depression. Girls are vastly more likely to report internalizing symptoms than boys are. When they're in distress, boys are more likely to externalize, to act out, to get themselves in trouble. We do not ask about these kinds of things on self-report surveys. So a lot of the data that is I think quite rightly pointing to distress in girls is I think missing the boat on boys because we're not asking the kinds of questions that boys are going to endorse.
And the reason I feel very sure that we are missing the but on boys, and this is incredibly grim, is that the surveys that we're talking about where girls are twice as likely to report having thought about suicide twice as likely to have attempted suicide, those we have to line up against the fact that boys die by suicide at twice the rate of girls. So there's something here that we are not asking the questions that we need to be asking. So this is a long way of saying I worry about all teenagers on social media. I think we're doing a better job of detecting it in Girls. For Girls, the concerns that arise are a lot around body image, a lot around comparison. Here's what I think. If we were asking the questions and found a way to do it, I hear from boys, there's a lot of time spent looking at hate content.
There's also a lot of time spent looking at body image stuff for boys, a lot around weightlifting, a lot around fitness, but there are very, very dark parts of social media where boys are spending a lot of time changing how they think about themselves, changing how they think about others in ways that are very negative. Obviously hate content is abhorrent. I also think no kid who feels really good about himself is spending a lot of time there. So I think we have to sort of hold those two ideas simultaneously. So what should a parent do having terrified everybody about all of these things? Here's what I will say. Number one, the later a kid can come to social media, the better. And it's back to that skepticism of the fabulous 14-year-old, 13 and under tends to take things in whole 14 and older tends to be more cynical in ways that can be wildly healthy.
And so to the degree that social media is going to expose your kid to all sorts of stuff, you want that coming through a filtration of not trusting everything that they see. The other thing I will say is know what algorithm your kid is locked in and you can look at their for you page or you can ask them if your kid's social media is all sports clips, cat videos, goofy dances, face cleaning. Okay, fine, whatever. If your kid's algorithm is how to lose weight, the term is anti-feminism. So it's basically a form of misogyny. Racist stuff, offensive stuff. Now you got a problem and you need to know that. The last thing I will say, if you make one rule, one rule for your kid in technology, don't have it go in their bedroom ever, ever. Ideally not in the 24 hour day, definitely not at night. This will limit the amount of time they spend on. This will vastly improve their sleep. Sleep and mental health are ridiculously well correlated. And it'll also keep your kid from doing dumb things at two in the morning because they are all gas, no breaks, because they're tired. So that's a great place to start. Just keep it out of their bedrooms.
Aviva: Do you encourage conversations with parents? Hey, what are you looking at on social media? What's interesting to you? I know we can look at therefore you pages, but also that can lead them to feeling like we've invaded their space too, right?
Lisa: Yeah. I think you got to know your kid. I think that that's the key thing. You really need to know your kid and some of your listeners have kids where you're like, I know what he's looking at. And it's like us. I just know that if you know that about your kid, great. Don't worry about it. Other people are like, eh, this is a spicy one. This kid always seems to find her way to the weirdest or darkest corners of anything. Okay, if that's your kid, you are going to give them social media so slowly that it's going to be painful. But on that line, you can give a kid an iPhone if you want to give them an iPhone with no browser, no social media apps, and they can use it to text and communicate with their friends and stay well plugged in for a very long time. I recommend. That's how all of us start with kids and then see how your kid does on texting. If your kid ends up in the dumbest, meanest text thread ever, do not give them a social media account so you don't have to do this all at once. Yeah, you shouldn't do this all at once.
Aviva: Good boundaries to have.
I have a question that I like to ask all my guests, but I'm going to reframe mine for you a little bit. Usually I say, if you could tell your younger self one thing, how old would she be and what would you tell her? But what I'd love to know is if you could tell your ‘teen parenting mom self’ anything, what would you tell your teen parenting mom? You’re a mom, you've got two teens in the house. What retrospective guidance would you give yourself?
Lisa: Okay, well, so here's really interesting. I have a 20-year-old and I have a 13-year-old. So I've done the arc of adolescence with one kid and she's awesome, and I am walking into it with this second kid. So here's my answer to this question. I'm so excited about my second kid. I was so scared with my first kid. I was like, here we go into these dark and uncertain woods, and now I'm like, here we go into the dark and uncertain woods where it comes out, awesome at the end. And of course who knows what will really happen, but I can tell you I'm actually living it right now in that I get to do it again in relatively short order. And so what I'm saying to myself right now is when my 13-year-old starts rolling her eyes, but she hasn't quite done it yet, I'm going to be like, bring it. We're doing it. It's on.
Aviva: That's amazing. And that's amazing.
Lisa: And I didn't feel that way seven years ago.
Aviva: I remember my first moment. I talked about it in a podcast recently where I had a dear friend who had an adult child at that time, and he said, I remember when she sat on the foot of our bed and rolled her eyes for the first time at 14, and I was a little bit like that mom. You said, who has the 11-year-old? And they're like, oh, we're so close. We're going to be fine. And I was like, my daughter was 13. I was like, no, she's fine. And she was just about to turn 14 and it was like two weeks later, she sat on the foot of my bed and rolled her eyes and I was like, wait, did that just happen? It really did.
Lisa: And she was developing just as one would want.
Aviva: Absolutely. Lisa, thank you so much for your incredible work. You're living in the fire of this space that's so needed. I'm going to have all the show notes for your incredible books, but not everybody looks at those. Some people just listen. How can people best find your work that you want them to get to?
Lisa: So I agree. Reading a book's a big commitment. So I have a weekly podcast, Ask Lisa: The Psychology of Parenting. Comes out every Tuesday. I put a lot of energy into social media, putting up bite-size guidance for families almost every day. My website has a ton of articles and resources and videos. I do a lot of work for UNICEF, make a lot of parenting content for them. I've worked for CBS for years and years. There's like 80 pieces that are written for the Times. They're all there. So I really tried to make available a wide range of content in different forms and different likes.
Aviva: Thank you so much for joining me.
Lisa: Thank you for having me.
Aviva: A pleasure. And enjoy that new walk through the woods with your 13-year-old.
