The mere thought of it strikes fear in the heart of many a parent. A tumultuous time of intellectual, physical and moral growth, adolescence can be wondrous, exciting ... and terrifying. Teens and their parents find themselves negotiating every rule -- "Sara's mother lets her stay out until midnight on school nights!" -- each desperately trying to decipher the other's actions, a futile endeavor that often ends when the teen shouts: "You just don't understand me!"
Yet these interactions, parents are told, are part of the normal struggle for autonomy and independence inherent in the teen years. While some of this angst can become fodder for entertainment -- dramatic and/or comic -- this "developmentally appropriate" stage can also trigger a host of psychological problems, particularly depression, substance abuse, aggression and anxiety.
The incidence of psychological problems in teens has been increasing at an alarming rate over the last decade, recent research suggests, especially in a specific -- and some say surprising -- segment of the population.
Nationwide studies of teens from upper-middle-class, well-educated families show they have some of the highest rates of substance abuse, anxiety disorders, depression and psychosomatic complaints of any group of adolescents.
In her recent book, "The Price of Privilege," psychologist Madeline Levine explores these problems through the lens of her clinical practice and a rich body of research, offering sound guidance for both individual and cultural change. The result is a deeply compassionate, insightful, alarming yet hopeful exploration of what Levine defines as "a growing public health concern."
Not surprisingly, in her 25 years of clinical practice Levine has always seen what she calls "a lot of unhappy kids." But in the mid-1990s she noticed changes in her clients' presentation. Instead of showing classic signs of depression -- disregard for personal appearance, a drop in grades, a change in or loss of friends -- her new patients were "well-groomed, popular, played sports and often maintained their grades, but they had a vacant, bland, anhedonic quality," Levine said in an interview. In short, these kids took no joy from their lives.
A number of factors came together in the 1990s that set the stage for this change, Levine said, among them baby boomers having families of their own, creating a new "boomlet" of kids competing for limited space at elite schools -- both public and private. And although research shows no correlation between the particular college one attends and life-long happiness or earning power, Levine said, parents developed a heightened sense that a successful life is dependent upon early achievement and the advantages of a status education.
Parenting styles had changed, as well. Baby boomers who grew up in the "do your own thing" 1960s have "more ambivalence about discipline," Levine said. "Parents want to be friends with their kids; they can't tolerate the rupture with their children that occurs with discipline and limit-setting."
In addition, the heady financial years of the 1980s ushered in an era of unprecedented national wealth and a culture that glorifies materialism, which, Levine said, "encourages people to believe that happiness can be bought." Add to this the "hand of capitalism," seen in the developing industry that feeds on parent's anxieties by publicizing college rankings and packaging test prep courses, college tours and counseling, and you've got what Levine refers to as "a perfect storm."
In 2002, Levine had a particularly revelatory experience with one client: A teenage girl arrived at Levine's office wearing a typical "cutter T-shirt" -- long sleeves pulled down over her wrists, holes cut out for the thumbs. She spoke for a while, then pulled back her sleeve to reveal the word "empty" incised in her forearm. Naturally the girl's self-mutilation disturbed Levine; it also, she said, "epitomized the dangerous shift I'd seen taking place, in which kids look incredibly good on the surface, but roll back their sleeve -- metaphorically -- and you see they're bleeding."
At around the same time, a number of researchers were examining thousands of affluent families across the country. Columbia University's Dr. Suniya Luthar, in particular, quantified the very phenomena Levine and others had been observing with their own clients. As cited in Levine's book, Luthar's research was startling: Among teens in affluent families, girls are three times more likely to suffer clinical depression than girls from any other socioeconomic group, and boys, who tend to externalize their discontent, have substantially higher rates of substance abuse than any other group of teens. In addition, both girls and boys experience anxiety disorders at twice the rate of the general population, and approximately 30 percent to 40 percent of teens from affluent homes exhibit symptoms of "significant emotional impairment."
The confluence of her client's disturbing revelation and the new research "helped crystallize my thoughts," said Levine, prompting her to explore a series of related questions: Why would affluent teens -- the very kids who seem to "have it all" -- be more prone to emotional problems than kids from other socioeconomic groups? What are we doing as parents, and as a culture, that drives our kids to such desperate behaviors? And perhaps most importantly, what can we do to reverse the trend?
Affluent parents often "pay a lopsided attention to two facets of development -- academics and athletics -- while underemphasizing other areas of growth such as social skills, altruism, self-management skills and creativity," Levine said. Without the freedom to explore a range of their interests and abilities, teens are deprived of crucial steps necessary to develop a healthy, authentic identity.
By offering material goods to assuage problems -- a practice Levine said is common among busy, often guilt-ridden parents -- parents prevent their children from developing "their own inner resources for managing distress, which will provide a safety net when they are struggling."
Without these resources in self-management, teens become anxious and therefore are more likely to resort to self-destructive behaviors -- often progressing from excessive perfectionism and depression to drug use and cutting -- when faced with life's inevitable disappointments and frustrations.
When parents value material goods over other things in their lives -- friends, family, work -- they also rob their children of crucial connections, since at its worst this materialism "turns even our most valuable relationships into commodities," Levine said.
Feeling connected -- to family, friends, and community -- has been shown to have a protective effect on both physical and mental health. But recent research shows "an inverse relationship between socioeconomic status and connectedness between teens and their parents," Levine said. Although this might seem counterintuitive, "the frantic shuttling to activities and the excessive monitoring of schoolwork in affluent families are often mistaken for emotional availability, but are a poor substitute for the kind of affection and acceptance that is important for healthy child development."
Other child experts agree. Los Angeles psychologist Wendy Mogel, author of "The Blessing of a Skinned Knee," said in an interview, "We're starting to worship at the idol of achievement. If kids bring home good grades and participate in the 'right' extracurricular activities, everything else is secondary. Where is family citizenship, responsibility in the household, all those different -- but equally important -- obligations?"
But what can well-intentioned parents do? After all, aren't we all part of a larger culture that rewards the very qualities -- achievement, competition, acquisitiveness -- that Levine tells us are so out of control?
First and foremost, parents can examine the pressure they place on their kids to be successful. Although it's "clearly part of parents' job to set the bar high," Levine warns parents not to have unrealistic expectations or make kids "feel only as good as their last performance." Not only does this make parental love "feel conditional," it also creates teens who become "good performers but not very good learners, since true learning is about effort, mistakes and improvement."
She advises parents to address the most fundamental level of their relationship with their child, cultivating what she calls an "inviting listening presence." As she explains, parents need to "set aside their own preoccupations long enough to be attuned to the needs of their particular child -- without imposing their expectations and demands on the child."
Try, she said, to see "the child who is in front of you -- not your fantasy child."
For her part, Mogel said she teaches a similar concept, fundamental to her own prescription for sound parenting, through a Chasidic proverb: "If your child has a talent to be a baker, do not expect him to be a doctor."
This can be a challenge, since "we all project some of our own histories, losses and sadness onto our kids," Levine said, "but we can't make them the receptacles of what was wrong in our childhoods."
Parents should also do less for their children. Successful in their own careers, parents sometimes "run their homes like corporations," reflexively stepping in to do things their children should do for themselves -- such as protecting them from getting an F in homework after forgetting their work at home; or from taking a half hour to find the socks you know are buried somewhere in the mess that is their room. Although she said "it can be incredibly painful to let your child struggle with problems or rejection, it's actually a gift of love." Again, while this may seem counterintuitive to many of today's parents, Levine is not alone in her thinking -- hence the "blessing" of the skinned knee that is the central metaphor in Mogel's book.
But this doesn't mean parents should "stand back and be cold," Levine said. When you allow your children to "manage things just outside their comfort zone, you are actually expressing your confidence in them, and they begin to develop their own internal solutions."
Though her book explores these and other parenting strategies in depth, Levine said that parents "can't be expected to swim against the tide on their own." She and other psychologists around the country are advocating for "pervasive institutional change" through various approaches, including advertising campaigns, parent education and school reforms.
She is particularly optimistic about a research and intervention program directed by Denise Pope, a Stanford University lecturer and the author of "Doing School: How We Are Creating a Generation of Stressed Out, Materialistic and Miseducated Students." Called "SOS" (Stressed Out Students), the program encourages decreasing the amount of homework assigned -- thus changing how much time kids have to "kick back" -- while educating parents about the risks of academic stress.
So far, 70 percent to 80 percent of participating kids have reported a reduction of stress, and their standardized test scores have not declined. Levine concludes her book with this reminder: "We've all been injured, neglected, 'unseen' or missed in some ways," and there is no such thing as a "perfect" parent (any more than there is a "perfect" child).
She urges compassion, not only with our kids, but with ourselves. And if we strive to encourage connection, conscience and caring, Levine is confident we can help our kids safely navigate the appropriately rocky road to adulthood.