Sibyl

Nicci used to tell me she didn’t want to live past 35 and that one day, I’d understand why.

It wasn’t a suicidal sentiment. More a sibylline warning from a 19-year-old wise already (too soon) to the grave reality of the human condition.

A trailblazer in caustic chic, Nicci wore sardonic disenchantment and wry despondency decades before teenage nihilism was fashionable. And it wasn’t an act. Nor any sort of cry for attention, crying being anathema to her constitution. “Why cry? Things just are what they are,” she might’ve said.

Mordancy aside, she didn’t present as a tortured soul. The opposite, really. An island native and a regular heliophile, Nicci spent so much time on the beach that even the tanned locals mistook her for Hispanic. She observed precisely no local ordinances, and harbored a special disdain for the island’s traffic laws, which she flouted as a matter of course, pushing her Isuzu Rodeo to its functional limits while whooshing through low-hanging Spanish moss and blaring the Pixies’ “Monkey Gone to Heaven” to aggravated alarm from nettled Low Country fauna.

We met there, on that South Carolina island, before either of us could legally drink, but as I’m sure’s still the case today, being too young was no obstacle to bar-hopping for determined young adults. If it’s a tiny town in the 21st century (and it is), that island was positively diminutive in the 20th. Born and raised, Nicci knew seemingly everyone five years on either side of her, including a lot of bartenders more than happy to serve a misfit they cherished as a wayward younger sister. They would’ve served me too, but I like finding my own solutions, even when (especially when) there isn’t a problem.

Back then, and assuming you didn’t know a bartender, the best way to get into bars underage was to borrow an ID from someone older you vaguely resembled. It didn’t have to be a perfect match. You didn’t need to find your elder doppelganger. The goal wasn’t to fool bartenders, just to give them plausible deniability: “What do you want me to tell you, officer? His ID was valid, and it looked like him to me.” But the idea of begging someone two or three years my senior to borrow their driver’s license was demeaning, so instead, I made my own state ID. From scratch. In those days, you could do that if you were the enterprising, exacting type. That ID not only worked at bars, it worked at liquor stores too and as far as I can remember, everywhere else I might’ve had cause to present it. It kept on working for nearly two years such that I almost forgot it wasn’t real.

For humans, life’s a tragicomedy. Nicci was in on the joke seemingly from the time she was old enough to be fully conscious, and certainly from the day I met her. She was also in on my joke from the very beginning, which put her a decade (at least) ahead of me in that regard. She saw straight through my masquerades and manifold personal pretenses years before I was aware of them myself.

Never have I been so perpetually back-footed by another human being. Even when, a very long time later, our economic fortunes diverged to such a degree that our lives were entirely incomparable, Nicci retained the psychological upper-hand. Her capacity to pick up the thread of a life story (mine) she hadn’t featured prominently in since cars came standard with tape decks and CD players were a “premium” option, was little short of preternatural. All she needed (and this is still the case) were a few basic facts about my current situation and she could read my contemporaneous internal monologue back to me, pretty much verbatim.

Nicci didn’t buy the conventional wisdom about me which, even among people who had every reason to the rue the day we met, said I was a good person or at least had the potential to be. In her estimation, that was wishful thinking at best, and dangerously naive at worst. She gave me the benefit of her friendship but never the doubt, and the wisdom of her approach was borne out in others’ misery time and again. She even refused to call me by my first name, insisting instead on my middle initial (“J”) perhaps as a way of delineating between the person she knew and the person everyone else thought they knew.

The last time I saw Nicci in person she was back on the island where our paths first crossed so many moons ago, and I was too. She sauntered up the stairs, took a look around and pointed to the door off the breakfast nook. “That’s a deck?” “It sure looks that way,” I joked. (The blinds were open. It was clearly a deck.) She dismissed me — “Fuck you, J” — walked onto the balcony, and lit a cigarette. I followed her out.

“Who smokes American Spirits?” “Me, apparently.” “You gonna offer me one?” She held the pack up and flipped the top open with her thumb. “No thanks. I haven’t smoked in years,” I told her. She scoffed. “Of course you haven’t.”

“So why are you here?” She wasn’t one to visit family voluntarily, so I could only assume someone was dead or sick. Or sick and dying. I was sort of right. “Because you entertain me.” “Not here, here” I said. “Here on the island, I mean.” She dragged and, on the exhale: “No reason.” I smirked. “Come on. You hate this place.”

She put her cigarette out on the bannister and held up the butt. “Don’t flick it.” I pointed to a citronella bucket candle in the corner. “Just put it in there.” We walked back inside and sat down. “So?” “So?” “Why are you here?” “I don’t know,” she shrugged. “I guess I’m depressed. I thought the sun might help.” “Well, not to be morbid or anything but –” She cut me off. “I know. I’m 36.”

What’s wrong with the kids?

A Gallup poll conducted in 2023 suggested clinically diagnosable depression rates in America have never been higher.

In the survey, nearly three in 10 US adults said they were diagnosed with depression “at some point in their lifetime,” up almost 10ppt in less than a decade. The same poll showed the share currently experiencing, or being treated for, depression stood at nearly 18% in 2023, up dramatically since 2015.

Those rates continue to notch new highs in Gallup’s polling, consistent with rising public awareness regarding the scope of the problem, which by almost every account worsened materially during the pandemic. It’s possible the same increase in public awareness is driving the number of diagnoses higher, and may even be contributing to the problem, but that’s difficult to pin down, so I won’t dwell on it.

As the figure shows, the share who said they’ve been told at one point or another by a medical professional that they have depression is higher now than it was in 2021 when, notwithstanding how much fun some Americans had staying home and gambling stimulus money on meme stocks and crypto, a sizable cohort struggled to keep it together in the wake of a generational socioeconomic shock brought on by one of the worst human tragedies in a century.

By gender, women are hardest hit, experiencing depression at almost twice the rate of men (it’s reasonable to ask if the figure for men is under-reported given the extent to which some men may equate depression with weakness, preventing them from seeking help). Geography matters. A CDC study conducted in 2020 showed people tend to be more depressed in West Virginia than in Hawaii, for example. Depression rates were highest in Appalachia and in the southern Mississippi Valley, suggesting an overlap with the opioid epidemic and poverty.

By age, adolescents are disproportionately affected. Indeed, many in the medical community describe a full-on mental health crisis among young Americans. According to a New York Times analysis of CDC data, emergency room visits for self-harm among Americans aged 10-19 jumped from around 200 per 100,000 in 2009 to more than 350 in 2019. For females, the increase was much more pronounced: From 250 per 100,000 to more than 550 a decade later.

Although exacerbated by COVID, the Times was keen to note in an alarmingly dour 2022 piece that “the decline in mental health among teenagers… predated [the pandemic]” and spans “racial and ethnic groups, urban and rural areas and the socioeconomic divide.”

Similarly, a 2023 Pew study documenting “the age of anxiety” in America emphasized that “even before the pandemic,” nearly three-quarters of US teenagers identified depression as a “major problem” for people their age. The latest polling from Pew on the subject, released earlier this month, found depression again topping the list of teens’ problems.

As the figure shows, nearly seven in 10 US teenagers said depression and anxiety were common among their classmates, outstripping yesteryear’s concerns by a country mile. Note that 60% said alcohol use was either “not too common” or not common “at all” at their school. Suffice to say the good ol’ days when all parents had to worry about on Friday nights were fiery, drunken car crashes are long gone.

In 2021, then US Surgeon General Vivek Murthy issued a public health advisory warning on the daunting nature of the challenges facing “today’s generation of young people” in America. Murthy described an “unprecedented and uniquely hard-to-navigate” path to adulthood, and the “devastating” impact on adolescent mental health.

Among the voluminous research Murthy cited in the advisory was the Youth Risk Behavior Survey Data Summary & Trends Report from the CDC. It’s updated every two years with the goal of “provid[ing] data on health behaviors and experiences of high school students” in the US. The latest version’s from 2023, and as the figure below, which splices together earlier versions of the survey to get a longer series, shows, the trend in mental health outcomes for young adults is concerning, even if the situation improved at the margins since the height of the pandemic.

If the subject weren’t so grave, the increase illustrated by the red line might not be viewed as especially alarming. But we’re talking about serious suicidal ideation among teenagers, which is to say a parent’s worst nightmare — a problem as grave as problems get. So, a 6ppt increase (8ppt from 2009 to the peak in 2021) in less than half a generation is disturbingly large. The trajectory strongly suggests that by 2030, the rate of serious suicidal ideation among teenagers in America will have doubled in just 20 years.

As for depression more generally (“persistent feelings of sadness and hopelessness” in the CDC survey), the trend’s even worse. In an effort to contextualize and otherwise animate the statistic, the 2023 vintage of the survey noted that four in 10 US high school students “felt so sad or hopeless almost every day for at least two weeks in a row that they stopped doing their usual activities.” Four in 10.

Virtually all of the trends are dramatically more pronounced for females, and there are reasons for that. But again, my guess is the incidence of depression’s under-reported for young males, and even as documented, the prevalence of depression and serious suicidal ideation for males in the CDC report rose from 19% to 28% and from 10% to 14%, respectively, from 2009 to 2023.

Consistent with the CDC data summarized by the Times in 2022, a study cited by Murthy in the same public health advisory showed that between 2011 and 2015, emergency room visits “for psychiatric purposes” rose 54% among adolescents, while “suicide-related visits” for the same cohort rose 2.5-fold over the same stretch.

Another wholly alarming figure comes from a 2020 National Vital Statistics Report (those are regularly-issued CDC statistical bulletins covering a variety of data) which found that after remaining “statistically stable” from 2000 to 2007, the suicide rate for Americans aged 10-24 rose almost 60% from 2007 to 2018 a period which, I’d be remiss not to note, overlaps the proliferation of smartphones and the rise of modern social media.

There are, as you might imagine, economic consequences for these trends. In 2021, a study published in PharmacoEconomics updated previous estimates of the economic cost to the US of major depressive disorder, the incidence of which rose nearly 13% from 2010 to 2018 due entirely (and then some) to those aged 18-34.

The fact that the comparison year’s dated (i.e., 2018 instead of, say, 2024) is actually beneficial here, as it obviates the need to control for the pandemic. Over that eight-year period, the economic burden of adults with MDD rose by 38% from $237 billion to $326 billion, again driven by a sharp increase in MDD among Americans aged 18-34.

In April of 2024, researchers from Columbia, Yale and the University of Wisconsin-Madison, published what they described as “an economic theory of mental health.” The paper, which spans 71 pages including references and charts, quantifies what scarcely needed mathematical verification: The “societal burden” of mental illness, with depression and anxiety being the most common manifestations, is profound.

“In our model, individuals experiencing mental illness have pessimistic expectations and lose time due to rumination,” the authors wrote. “As a result, they work less, consume less, invest less in risky assets and forego treatment, which in turn reinforces mental illness.”

Among the study’s main findings: Interventions to promote treatment of mental health problems among adolescents and young adults resulted in disproportionately large (relative to other age cohorts) gains in a consumption equivalent measure.

Bursting the bubble

Tempting as it is to blame Facebook, Twitter and all the rest, the truth is that no one really knows what’s behind the demonstrably deleterious trends in adolescent and young adult mental health. Not definitively anyway. In 2021, when Murthy released his public health notice, the Times said simply that scientific research into the “underlying causes has been insufficient.”

Indeed, it feels as though psychologists and psychiatrists aren’t even sure where to start. As one PhD at the UCLA–Duke University National Center for Child Traumatic Stress put it, in remarks to the American Psychological Association for a 2023 article, “The idea of a ‘mental health crisis’ is really broad.” The nebulous character of the problem, she said, is itself a source of anxiety both “for providers and parents.”

In an April 2024 piece for Politico, Daniel Payne underscored the point. “State and local governments across the country are scrambling to find new strategies to slow an epidemic of kids’ mental illness,” he wrote. “But there’s a problem: No one knows what’s causing the spike.” The article’s a painstakingly laborious effort comprised of dozens of interviews and more than 1,000 survey responses from a poll of health care professionals. Payne describes “desperation” on the part of clinicians, parents and politicians to address a pressing but maddeningly elusive concern.

In the 2024 edition of the World Happiness Report (which regular readers will recognize from “Oblivion,” the July 2023 Monthly Letter), North America stood out as an anomaly: Youth happiness has fallen so sharply in the region that the young are now less happy than the old. The trend dates back nine or so years, and it marks a break with conventional wisdom in the West.

“The received wisdom was that the young are the happiest and that happiness thereafter declines until middle age, followed by substantial recovery, but since 2006-10, happiness among [those] aged 15-24 has fallen sharply in North America,” the report said, adding that “youth happiness has also fallen in Western Europe.”

In the same vein, from 2021-2023, life evaluations in North America, Australia and New Zealand “were lowest among the young, rising gradually with age to be highest among the old.” The gap — the happiness spread in favor of the old — is “much larger in the United States and Canada,” the report emphasized.

As the figure shows, the United States, Canada, the UK, Germany, France, Australia and New Zealand all score far better in overall happiness than in youth happiness, and the disparity’s particularly pronounced in the US and Canada. (A lower score’s better, as it indicates a higher happiness ranking. For example, Finland was #1 again in overall happiness and #7 in youth happiness.)

That data prompted Derek Thompson, a staff writer at The Atlantic, to suggest America’s “top export may be anxiety.” In an article published last year, Thompson quoted John Helliwell, who co-authors the World Happiness Report. “If you’re looking for something that’s special about the countries where youth unhappiness is rising, they’re mostly Western developed countries [a]nd for the most part, they speak English.”

That, I think, may offer a clue as to what’s actually behind the trend. It’s possible that young people in prosperous Western democracies are having a difficult time reconciling the world as it’s “supposed to be” and the world as it actually is.

Before social media, young adults in the West (and remember, “West” in this context isn’t strictly a geographic term, it describes a socioeconomic umbrella) weren’t constantly exposed to the brutal realities of life outside the Western bubble. Before the internet, a teenager would’ve needed to watch the evening news or, even less likely, read a newspaper, to be apprised of, say, a famine in Somalia. Or a mosque bombing in the Middle East. Or ethnic cleansing in Bosnia.

Even during the internet’s first decade, youth depression linked to disaffection with the generally shitty state of the world was rare, or it that’s not statistically accurate, you might say it was an oddity begging to be stereotyped — the sort of thing you’d see during the bleeding heart phase for your favorite TV family daughter (think Meadow Soprano at Columbia). It wasn’t until social media took over teenagers’ lives that every young adult with a smartphone became Nicci: Suddenly aware of the macabre joke that is the human condition.

Murthy almost made the connection, as have any number of concerned observers, but most can’t quite get there, as evidenced by a failure to connect the dots between what they imagine are two discrete issues. Writing in 2021, Murthy said that “too often, young people are bombarded with messages through the media and popular culture that erode their sense of self-worth — telling them they are not good looking enough, popular enough, smart enough or rich enough.” In the very next breath, he said young adults are frustrated by slow progress on “legitimate, and distressing, issues like climate change, income inequality, racial injustice, the opioid epidemic and gun violence.”

Consider how striking the juxtaposition must feel for, say, a 14-year-old girl, between an Instagram video of a celebutante bouncing around a Louis Vuitton boutique in L.A. and footage from the aftermath of an Israeli airstrike in Gaza, complete with a wailing mother cradling the charred remains of her toddler.

Jorge Alvarez, who Politico described in the linked article above as “a youth mental health advocate who has taken young people’s perspectives to federal officials,” captured it well. “I’ll open up my feed and one video is someone dancing and then the next one is a global catastrophe,” he told Payne, the Politico reporter. “It’s very dystopian at times.”

Yes, it is. Dystopian. It’s also disorienting, particularly for young adults who, from one minute to the next, can’t figure out whether to be aggrieved they don’t look or dress like a pop star, or grateful they’re not mourning a sibling killed by a wayward missile.

Those sorts of ghastly collocations are commonplace on social media, and the cumulative effect for young adults’ psychological development can’t be healthy. At the least, it forces adolescent minds to ask what kind of world this is where we revel in splendor and wallow in depravity simultaneously — and pretend the former doesn’t clearly suggest the latter’s unnecessary.

This comes at a time when, recent electoral backlash notwithstanding, moral relativism and secular liberalism are ascendant in Western democracies. When you combine that shift — i.e., the jettisoning of cultural lodestars, for better or worse — with the grotesquely incongruent menagerie of opulence and indigence on display across an always-on, visual echo chamber of alternating delights and horrors, it’s small wonder young adults in the West are plagued by confused anxiety and occasionally ponder checking out early.

In August of 2024, in still another piece documenting America’s mental health crisis, the Times explained the persistence of depression three years on from the pandemic by noting that young adults’ “symptoms were tied to problems other than the virus, like economic precarity, the housing crisis, social isolation and political turmoil.” The article quoted Emma Adam, a psychologist at Northwestern. “There [are] so many things affecting adolescents and young adults that are about uncertainty with their future,” she said. “And that hasn’t changed” just because COVID’s no longer front-page news.

In rich, Western democracies, children — from the middle-class on up, anyway — are raised from an early age to expect structure and predictability. To believe outcomes are manageable, and to think the world makes sense. But the reality of the world outside that bubble is encroaching on the lives of Westerners earlier and more frequently. And it doesn’t doesn’t look very structured, nor predictable nor manageable. Quite often, it appears to make no sense whatsoever.

Successive shocks — 9/11, the financial crisis and the pandemic — likely exacerbated feelings of disillusionment. Westerners, and particularly North Americans separated by an ocean from the often terrifying vagaries of the “over there,” are ill-equipped to cope mentally with a lack of certainty and the inability to control outcomes.

Recently, the freelance reporter Suzan Gaber traveled to the West Bank to interview 21-year-old Hisham Awartani, one of three Palestinian students shot in Burlington, Vermont in 2023. At dinner in Ramallah with Awartani’s family, Gaber asked about the prospect of Israeli annexation. In the voiceover accompanying the interview (which was published as a podcast by The New Yorker last week), she reminded the world that for Palestinians, annexation isn’t a hypothetical, it’s a fact of life — an already-unfolding process.

“It’s getting worse, but it’s not something that’s like, so jarring –” Awartani, who was paralyzed from the waist down in the Vermont shooting, said. “What would be so jarring?” Gaber asked. “Uhh, killing everybody here, I don’t know –” Awartani quipped, grimly. Gaber expressed surprise at Awartani’s nonchalant cadence, which to her seemed markedly “more carefree” than when the two spoke about annexation back in the states. “You’d think,” she said in the podcast, that “it’d be scarier to contemplate from within The West Bank.”

As the dinner conversation progressed, someone else in the room — a female member of Awartani’s family — explained the psychology of “uncertainty” and how it differs depending on where you are. “We live with the knowledge that we could be killed at any moment,” she said. “When you’re in the US, you have anxiety because you expect you can control more. But when you’re here, you’re like, ‘Eh, whatever happens happens.'”

Life after death

“What do you think?” I’d sent her the first 200 or so words, not expecting a response.

A day passed. A week. Two. Three. Then, at 7:28 PM on March 4, I got a text. It was Nicci: “I wasn’t driving the Jeep?”

“Hmm. I don’t think so. It was grey, whatever it was,” I typed back.

“It was definitely the Rodeo,” she confirmed. “Thought so. Wanna talk?” “I’ve been drinking,” she warned.

When you talk to Nicci, you have to parachute straight into the middle of the conversation. You have to pretend the last conversation never stopped, even if it’s been years since you spoke. Questions like, “So how have you been?” get you laughed at. (“Try again.”) You have to piece together the recent history of her life by way of tangential questions. If you’re not sufficiently clever in that effort — or if she gets bored with it — she’ll just hang up. If she’s entertained, she’ll talk to you all night. A call with Nicci can last five seconds or it can last five hours. This one lasted three. Hours.

From what I could surmise, life at 43 for Nicci’s a case study in deliberate deprivation. From someone with a college degree from a major state university with a 2023 undergraduate enrollment approaching 30,000.

She’s not an addict. She’s not lazy. She doesn’t suffer from schizophrenia, nor from any other acute condition which could readily explain what’s morphed, in the several years since we last spoke, into a self-professed penchant for impecuniousness. As far as I could tell, there isn’t anything — no condition, no trauma, no life event — that might account for her withdrawal from any sort of economic activity.

“Sounds like you didn’t live much past 35,” I joked. Her tolerance for gallows humor had apparently dissipated over the years. “And you did?” she shot back. “Actually –” I was going to say “no.” I was going tell her that in fact, every day spent playing a macro-market maven leaves me feeling more depressingly disconnected from myself than the last. That I’m no more alive than she is, notwithstanding my fortuitous economic circumstances.

But she beat me to it. “You’re alive to a bunch of people who don’t know you, and dead to everyone who does,” she said, and hung up the phone.

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