“How can he be so stupid?” a dad asked me in a telehealth visit. His voice shook with fear and rage as he described his adolescent son sneaking out to meet friends against legal and family orders to stay at home.
As a child psychiatrist, I’ve been fielding many such calls.
“What if he’s not stupid?” I asked. Youths who ignore orders to shelter in place are cast as insensitive, short sighted, and foolish by media and politicians. But what if adults are missing their logic? What if adolescents and young adults are actually acting according to the American ideals of self-interest and self-sufficiency that have been modeled for them?
Leadership happens by example. Lawmakers and other adults have set very poor examples about acting selflessly to protect vulnerable populations. When nearly 8,000 Americans aged 24 and younger died from gun violence in 2018, youths’ pleas for gun control fell on deaf ears. After nearly 11,000 young American lives were lost to suicide and drug overdoses in 2018, mental health and substance abuse treatment has remained limited and difficult to access. Efforts to reduce climate change, despite urgent pleas to do so, have been sparse.
Should young Americans now be asked to protect the older adults who failed to protect them? Is that fair?
If adults expect adolescents and young adults to act in ways we have not demonstrated and modeled for them, we are the stupid and selfish ones. Lawmakers are demanding enormous sacrifices from young Americans: their educations, their social lives, and sometimes their safety, as many of the 1 million abused and neglected American kids are now isolated at home with their abusers, with no plan to ensure their safety.
Young people have low odds of dying from Covid-19. As I write this, the Centers for Disease Control and Prevention reports that 25 Americans aged 24 or younger have died of Covid-19 in 2020, or 0.1% of the lives claimed by suicide and unintentional drug overdoses in this age group in 2018. (For comparison, 477 children and adolescents under age 17 in the United States died of influenza in the 2018-2019 flu season.)
No graduations. No sports. No time with friends. Lonely teenagers are more likely to become depressed, obese, and unhealthy adults. Social isolation in childhood is linked to poor health, high blood pressure, high cholesterol, and obesity in adulthood. Even in good times, about 8% of American teens try to kill themselves each year and about 70% suffer from loneliness. In 2020, these numbers will likely be higher.
Is it shocking that some young people see social isolation measures as a more deadly threat than Covid-19? Is it rational?
Our medical system’s insufficient capacity to treat Covid-19 patients is a crisis that needs urgent intervention. Meanwhile, we’ve brushed aside the same medical system’s insufficient capacity to treat the issues threatening the lives of America’s youths for years.
Rationing health care — an issue now in the news in the Covid-19 era — is something I was tasked to do from my first day as a psychiatrist. There were never enough beds in the psychiatric units for young people at risk of death from suicide or addiction. Now, as the need for mental health treatment rises, the pandemic has forced hospitals to further reduce their capacity to treat mental health issues.
All of the teens and young adults I treat have made valiant efforts to isolate themselves to protect others, even knowing that they are extremely unlikely to die from Covid-19. For the first two weeks, they did well. Now they are suffering. Some hit their limits and can’t do it anymore. More teens and young adults tell me this with each passing week. Their restlessness and boredom have morphed into depression, anxiety, and anger.
Is anyone considering them in deciding how our country moves forward? Is anyone thanking them for their selfless sacrifices?
Quite the opposite. They are shamed in the rare instances when they can’t, or refuse to, sacrifice their own well-being for the greater good. They are shamed for acting like teenagers — and for acting American.
Youths lack voting and spending power, so their voices don’t get heard. I am writing on their behalf because their perspectives matter. They will inherit the leadership of our troubled society and we are foolish not to prioritize their well-being.
While social isolation is necessary to reduce deaths and to keep hospitals functioning, I believe a more nuanced and sophisticated discussion of the risks and benefits to key groups is warranted. If we want our children and teens to help protect us, we must protect them first.
Lisa Jacobs, M.D., is a child, adolescent, and adult psychiatrist in Menlo Park, Calif., the assistant director of The Pegasus Physician Writers at Stanford, and editor at large of The Pegasus Review.