Surgeon General Takes On Parental Stress And Mental Health

IRA FLATOW: This is Science Friday. I’m Ira Flatow.

If you’re a parent, you know that parenting is a tough job. Some days are just absolutely, overwhelming. And you might be balancing your job, your home, and your child’s needs. One thing goes wrong, and it’s like a house of cards falling apart.

And you’re keenly aware of how the parents around you are doing, too. Are you keeping up?

Surgeon General Dr. Vivek Murthy is keeping up and paying close attention. His most recent advisory is about parental stress and mental health.

It’s been a busy summer for Dr. Murthy. He’s called for a warning label on social media because of its effects on mental health, he’s declared gun violence a public health crisis, and he joins me now to talk more about all of these initiatives.

Dr. Murthy, welcome back to Science Friday.

VIVEK MURTHY: Well, thank you so much, Ira. I’m so glad to be back.

IRA FLATOW: Good to have you back. Let’s start with your recent advisory about the stress and mental health challenges of parenting, entitled Parents Under Pressure.

Now, you wrote something really interesting. That, when it comes to parenting, “chasing unreasonable expectations has left many families feeling exhausted, burned out, and perpetually behind.” Tell us more about what you mean by that.

VIVEK MURTHY: Well, I think, many parents, and I include myself in this, as a parent of two young kids who are six and eight, many of us feel caught in this wheel that’s going faster and faster, where we’re chasing expectations. Sometimes, some of these are old expectations that generations have faced because raising kids has never been easy.

But there are also new expectations that are often accelerated and amplified, you know, online, particularly on social media. And we chase those because we feel we have to do that to be successful as parents or to do right by our children. And it is impossible to keep up.

Right now, what’s happening in our country, Ira, is millions of parents are struggling with overwhelming stress. And it’s time for us to pull back the curtain on this silent struggle, and talk about what they’re actually going through, and how to get them the support that they need.

When I put together this advisory, it was actually not something I had planned three and a half years ago when I started in office. It was something that I decided to do because of conversations that I was having with families across the country. And it began when I was working on the youth mental health crisis. And I quickly came to see that our kids aren’t the only ones who are in crisis. That parents, too, are struggling.

And if we don’t address what’s happening with parents, if we don’t address the fact that 48% of parents are saying that most days their stress is completely overwhelming, then we actually can’t solve the youth mental health crisis, because we now know that the mental health of parents does, in fact, affect the mental health of their kids.

IRA FLATOW: So how is this different, though, from raising kids when we were kids? I mean, the old saying, “It takes a village,” what is there about our current moment that makes it especially challenging?

VIVEK MURTHY: Yeah, this is a really important question because some of the dialogue that I have seen since our advisory came out has actually focused on this, with some people saying, “Hey, hasn’t parenting always been hard? Isn’t this the same old?”

And the truth is, yes, parenting has never been easy. And there are some familiar challenges parents are dealing with today that they’ve been contending with for generations. For example, worrying about the safety of your kids, worrying about whether your kids are going to be healthy and well, worrying about how to manage the teenage years when your kids are striving and looking for more independence. These have always been challenging.

But there are new things that the current generations of parents are dealing with that prior generations didn’t have to. For example, managing phones and social media, which is one of the top two sources of stress that parents cite.

The other issue is think about the youth mental health crisis that we’re living through, with extraordinarily high levels of depression, anxiety, and suicide among kids. This is an extraordinary source of stress in parents lives as well, as is the broader loneliness epidemic that is hitting kids particularly hard and worrying parents deeply.

But in addition to all of that, just think about the fact that gun violence has now become the number one cause of death among children and adolescents aged one through 19.

IRA FLATOW: That is so hard to believe. That is unbelievable.

VIVEK MURTHY: Well, it is unbelievable. And it’s also something that we should not just assume is the new normal and accept as just the way things are or have to be, because this is not normal.

When I talk to parents around the country, they tell me they’re worried about what’s going to happen each day when they drop their kids off at school. They’re worried about sending their kid to the mall or to a concert or sometimes, even to church, because these have all been places where we have seen shootings take place in communities.

So all of these are relatively new sources of stress, but keep in mind, also, that something different has happened with how parents are spending their time compared to a few decades ago. Parents, moms and dads, are both spending not only more time at work, but they’re also actually spending more time taking care of their kids, which may surprise people.

And so the question is, where is that extra time coming from? Well, it’s coming from the time parents used to spend recuperating, resting, socializing with friends, which are a vital source of sustenance for your well-being.

IRA FLATOW: Do we need a cultural reset, in terms of what is expected of parents? Are parents putting their own expectations too high on themselves, and is that part of this stress you’re talking about?

VIVEK MURTHY: Well, I do think that the stress is coming in part from expectations that are high and unrealistic. And a lot of those expectations are being driven by dialogue and culture online, which involves us comparing ourselves constantly to other people.

Now, here, also, is something that– look, for millennia people have been comparing themselves to others, but there’s a massive difference between the kind of comparison that occurred a generation or two ago, where maybe you compared yourself to the parents in your neighborhood or maybe in your church group or maybe in your workplace. But now parents, especially online and through social media, sometimes are comparing themselves to thousands of other parents, including many parents they don’t know.

They’re seeing trends about everything from how to optimize your child’s diet, to how many extracurriculars your kids should be in, to how to ensure that they’re learning six instruments, four sports, three languages in order to be successful as a human being, and all of that ratchets up the pressure. And you can say, on one hand, you step back and say, well, no parent should feel pressured by those. Those are clearly unrealistic.

Well, I’ll tell you this. When you’re a parent caught in the middle of this vortex of comparison, it doesn’t necessarily feel like it’s clearly ridiculous. It feels like, no, this is the reality. And especially when you look at the future, a future that is increasingly hard to predict and understand given the rapid pace of change, then parents, you know, feel that they need to grasp on to more and more, in terms of predictable, you know, patterns, schedules, et cetera, that will help their kids be successful. So I do think that the pressure has become enormous on parents.

There’s one last thing that’s missing that for generations has helped us deal with pressure that we are increasingly missing today, and that’s our villages, our community, our social connection. That old notion that raising children takes a village, that is actually quite accurate, and in fact, that’s quite historically descriptive of how we’ve typically raised children.

But somehow, we’ve come into this notion that the job of raising a child is solely and exclusively and only the responsibility of their parents, and that no one else seems to have a role here. And we’ve also– this has collided with the loneliness epidemic we’re dealing with, where many people have lost their actual villages. And this is made even the older stresses that we had to deal with as parents much harder to deal with because social connection, at the end of the day, is a natural and powerful buffer for stress.

IRA FLATOW: You know what else is something unexpected? I can tell you as a grandparent, because of the stresses on our children, we grandparents are feeling stresses in our senior ages that we never thought we would be feeling. You know? It’s not easy for senior citizens to keep up with taking care of the things that the stressful parents can’t take care of in our old age. So I just would throw that in, as someone who is involved in that at an older age.

VIVEK MURTHY: I read that– I just want to underscore that that’s a really important point, you just brought up, because it’s not just mothers and fathers who are struggling. It’s caregivers more broadly. And we are seeing, increasingly, that more grandparents have had to step into those caregiver or parental roles, and people are adopting children more. Others are stepping in to play these caregiver roles, and many of them are experiencing this kind of stress.

We do fundamentally need a cultural shift in our country with regard to parenting. A shift that allows us and I think, compels us to recognize and value parenting for the invaluable work that it is, and then to ultimately invest in supporting parents and kids so that– not so that we can remove 100% all the stresses of parenting, parenting will always be hard, but so that we can make it a little bit more manageable so that parents can make it through without sacrificing their mental health.

IRA FLATOW: And we don’t have guaranteed parental leave. There’s a lack of affordable childcare. And to really make a dent in this parental stress, does it require policy solutions? Is that what you’re advocating for?

VIVEK MURTHY: It is one of the things, yes, I’m advocating for. I think many of these challenges are cultural, but they’re also structural and can be addressed with policies and programs.

Yes, we do need paid time off for parents so that they can be with their child who’s sick. We need families to be able to get reliable mental health care that’s affordable when they or when their children are struggling with their mental health.

But we’ve also got to address the lack of safety of social media. We’ve got to address the threat of gun violence. These are major stressors for parents that a parent can’t solve alone.

I may be as dedicated to my kids as anyone could be as a dad, but that doesn’t mean that I can single-handedly make social media safer for my kids or solve the problem of gun violence. This is where policymakers need to step up.

Then, my hope is that we can make the kind of investments and prioritize making parenting better supported, because it’s one thing, again, to say parenting is important, it’s another thing to say it’s a priority. And right now, I think, we’d all agree, it’s important, but we have not, as a society, made it the priority that it needs to be.

IRA FLATOW: Taking off on that issue of youth mental health, I want to point out that earlier this summer you called for a warning label on social media platforms. What would that kind of warning accomplish?

VIVEK MURTHY: Well, a warning label on social media would help inform parents, caregivers, and young people themselves about what we now know, which is that social media is associated with significant mental health harms for adolescents. It would also help parents understand that social media has not been demonstrated to be safe.

Now, this may be a surprise to many parents out there who are used to medications for children, car seats, and other products that kids use undergoing rigorous safety testing. Yet, we have taken a product that 95% plus of children are using, and we have failed to subject it to rigorous safety tests. And instead, in the face of growing evidence of harm, we have failed to do anything to intervene as a country.

And this is, I think, an example of where, I think from a policy perspective, we have fundamentally dropped the ball on our most sacred responsibility, which is to protect our children. And it’s time for us to correct that.

A warning label is just one part of that. I want to be clear about that. There are a number of other changes we have to make to make social media safer, which I called for last year in an advisory issued on this topic of social media and youth mental health. And they include putting in requirements that companies have to share all the data they have on the impact of their platforms on mental health. It puts in– it also involves putting in place policies that protect our kids from harmful content, from features that would seek to manipulate their developing brains into excessive use, and from other dangers that we are now seeing kids talk about, you know, with regard to social media, but we, to this point, fail to address.

IRA FLATOW: Last week we had on Dr. Emily Weinstein, the co-director of the Center for Digital Thriving at Harvard University, and she talked about the research on the effects of social media as being somewhat, nuanced. And she explained it this way.

EMILY WEINSTEIN: Researchers are actually quite divided about whether social media and smartphones are a cause, the cause, or a symptom of a problem that actually has different roots.

IRA FLATOW: Dr. Murthy, what do you think?

VIVEK MURTHY: Well, I think you have to look at the question of safety and harms broadly. There’s nobody I have met in the research community, much less among parents or others, who can test the fact that social media has not been proven to be safe, that it’s not been held to any safety standards the way we do other products and medications that kids use. That lack of safety, that lack of putting safety first should be a concern in and of itself.

But then go beyond that, yes, there are questions– more research questions we have to answer about the kind of harms and nature of harms that are accruing to kids from social media. But we do know, from multiple studies, that there is an association with harm. We see that kids, adolescents who have used social media for three hours or more per day, that that’s associated with a doubling of risk of anxiety and depression symptoms.

But let’s also look at the data more broadly. Let’s look at what adolescents are telling us themselves.

In surveys, adolescents are saying, nearly 50% of them, that using social media makes them feel worse about their body image. A third of adolescent girls are saying they feel addicted to social media. A third of adolescents are saying that they are staying up to midnight or later on school nights using their devices, and much of that is social media use.

They are having a hard time getting off of these platforms. And the truth is, I see this and I hear this when I travel around the country, having now talked to thousands and thousands of adolescents and young adults. That they say, yes, I don’t like how social media makes me feel.

Now, that can coexist with some benefits that they may perceive, as well. Some say that social media does give them a chance to express themselves, to reconnect with old friends, and sometimes to feel like they’re learning about new information. But when you ask them about how that balances out against the harms that they’re experiencing, that’s when you get the more full picture. And many of them are deeply worried about the harms, as are their parents.

And finally, let’s just keep this in mind. There are now hundreds, if not thousands, of examples of cases where parents and kids have experienced harms directly and have spoken publicly about it or reported it directly to platforms. I, myself, as a single individual, have encountered countless parents who have told me that their child engaged in self-harm and in some cases, ultimately took their own life, after being encouraged to do so by videos that the algorithm fed them on social media.

That is one of the most painful experiences I’ve had as surgeon general is sitting across from a parent who has lost their child, and hearing this story about how it happened.

And many of these parents say this should never happen. My child should, you know, at a moment where they are vulnerable, where they broke up with, you know, in terms of a relationship or they had a major disappointment and they went to social media looking for comfort, they should not be fed videos that are encouraging them to take their own life and walking them through the nuts and bolts of how they would do that.

And if that seems like an obvious should never happen, it is. Yet, it is continuing to happen to so many children. So if you look at any of these instances and you say that we should just keep doing more research and asking more questions and not take any action now, well then, I think, that you have failed to understand what’s fundamentally happening to our children.

And if this happened with a medication, can you imagine if I told you that there was a new medication on the market and 10 children, let’s say, had lost their lives after taking this medication? We wouldn’t say, well, you know what, let’s just keep gathering information and not change anything about what we’re doing. Let’s just– there’s nothing to see here.

We would say that’s preposterous. We should investigate. We should understand. Because when the lives of our kids are at stake, nothing else is more important.

And my question is, why have we failed to do this on this particular issue when we behave so differently with other products that our children use? That’s why I issued this advisory last year. It’s why I called for warning labels as part of a broader suite of solutions.

And this is a real test for us as a society. Do we say our kids are important to us, or are we willing to back that up with action? And it’s a question that policymakers, in particular, need to grapple with.

IRA FLATOW: This is Science Friday. I’m Ira Flatow. If you’re just joining us, I’m continuing my conversation with Surgeon General Dr. Vivek Murthy.

When we first had you on the show the first time, in 2021, we were talking about COVID. Everybody was talking about COVID. And usually, the nation’s surgeon general talks about opioids or smoking or general advice like that, but you told me back then that you would be turning toward mental illness, talking about mental illness.

When did you see that? When did you make that turn and decide this is where you’re going to plant your flag?

VIVEK MURTHY: Well, it’s interesting, Ira. I actually started to see the broader mental health challenges during my first term as surgeon general, because that was between 2014 to 2017, because I was traveling around the country and doing as much listening as I could. And I started to hear the stress, the strain, the stories of depression and anxiety that adults and kids were contending with.

When I finished that term, I hadn’t been able to really build the kind of mental health initiatives I would have liked to, but this was on my mind when I came back, because as a private citizen, observing what happened during that first year of COVID, I was not only just struck and deeply disturbed by the loss of life, but I was, also, very concerned about the ripples, in terms of the mental health impact, that the pandemic was going to have. And I continued to see just more and more evidence that the mental health challenges I saw during my first term had actually gotten a lot worse during this second term.

Because the truth is, mental health is our fuel. It’s what allows us to show up at work, for our families, and our neighborhood, and schools. And if we aren’t taking care of our mental health, if we’re not investing and strengthening that, then I worry that we’re ignoring a vital part of people’s overall well-being. And I think we’re seeing the consequences of that now.

IRA FLATOW: I want to pivot slightly to talk about another advisory you issued earlier this summer, when you declared gun violence as a public health crisis and connected the issue to mental health. How is the threat of gun violence contributing to a decline in mental health?

VIVEK MURTHY: Well, gun violence has had far-reaching consequences for our country. I worry that it has led to severe mental health consequences that are often invisible and behind the shadows, so we don’t fully appreciate it.

There’s no doubt that the greatest consequence we pay for gun violence are in lives lost, and we sadly lose nearly 50,000 lives a year to gun violence.

But if you think about the profound ripple effects of gun violence– you think about the people who are shot but who survive and live with the physical and mental trauma of that. You think about the family members and others who survive, the community members who witness these incidents, the children who are scared to go to school because they’re worried about a shooting in their school, as more than 50% of our kids are– and you start to realize that the fear of gun violence has really infiltrated the psyche of America in ways that have profoundly changed how we live our lives, and how we worry.

You know, six out of 10 adults are worried about losing a loved one. And you can understand that when you recognize that more than half of Americans, that’s 54%, to be exact, have had some experience either themselves or through a loved one with gun violence. And that could be mean– that could mean losing a loved one, it could mean being attacked themselves, it could be having to use a weapon in self-defense when their safety was at risk.

So this is a pervasive issue. What we have to do is to stop looking at it as a political issue, and start seeing it as a public health issue and take the kind of public health approach we’ve taken with tobacco and other challenges, which have allowed us to save lives and make progress.

IRA FLATOW: That’s such a politically charged issue. Do you think there’s any headway that can be made on that?

VIVEK MURTHY: I do. And I wouldn’t do this if I didn’t think that it was both necessary, but also, possible.

IRA FLATOW: For example, what could happen?

VIVEK MURTHY: So here are a few things that could happen. In fact, these are a number of the strategies that I have laid out in my advisory.

Number one, we could see at a community level a greater investment in community violence intervention programs, which we know are powerful and effective in reducing violence. We could see health care systems doing more around safe storage education, which is really vital because we lose so many children, in particular, but adults across the board due to weapons that are unlocked and loaded, left at home, and then, ultimately, used to take a life.

And there are other things we can do at a policy level, as well. Solutions which, it turns out, the majority of Americans actually support. Things like making sure that we have a strong background check system. Making sure we have what are called red flag laws in place, which would transfer weapons out of the hands of people who are in imminent danger of harming themselves or others.

I talk also about the importance of looking at a ban on assault weapons, because assault weapons are associated with greater injury and greater death in mass shootings, compared to such events that take place with other types of weapons. And states in some cases are trying to move these forward on their own, but this is a place where we need a national solution to what has become a national problem.

And I do believe that even some of the recent movement that we’ve seen– a few years ago, we saw Congress finally, after 30 years of starving gun violence, in terms of research funding, we saw finally a modest sum allocated to addressing gun violence research. It was a small drop in the ocean of what’s needed, but that was progress.

Just two years ago, we saw Congress for the first time in three decades pass the first legislation to actually address gun violence in the form of the bipartisan Safer Communities Act. These are all promising steps, but they’re not enough.

IRA FLATOW: So you don’t feel really frustrated, then? We’ve been talking about these issues for years, that you don’t feel that these are intractable, you think– or are you frustrated?

VIVEK MURTHY: Of course, I’m frustrated. I’m frustrated, and I’m upset not just as surgeon general, but as a parent, that we haven’t done more to protect our kids.

You know, when there are kids who are under threat, people step up to respond. And we do that in an individual level.

The other day I was at my school picking up my kids, and a bunch of kids were playing on the playground there. And one of the kids on the monkey bars actually fell down, and it looked like he hurt himself. And his parents weren’t around at that moment, they were somewhere else in the school grounds, but all the other parents rushed up to make sure he was OK.

That is what we do. That is our instinct as human beings. It’s to reach out when we see our kids, in particular, suffering, even if they aren’t our own. Yet, on this issue, where gun violence has become the leading cause of death among children and adolescents, we have not made this the priority that it needs to be. We’ve allowed the politicization of this issue to paralyze us, and the cost can be measured in lives lost and lives altered. And that is what we have to change.

IRA FLATOW: Last question. Do you expect to be staying on through the next administration? And if you’re not, what’s next for you?

VIVEK MURTHY: I don’t know what’s next for me. I really don’t know what comes next, but whatever it is, I hope it will involve contributing to these causes, like loneliness, like mental health, and the overall well-being of our kids that remain just so important to me, not just as surgeon general, but most importantly, as a father.

IRA FLATOW: Dr. Murthy, we thank you for your service, whether you’re back as surgeon general or not. We thank you for the time you’ve always taken over the years to be with us. Thank you very much for taking that time.

VIVEK MURTHY: I always enjoy our conversations. Ira. Thank you for this thoughtful conversation.

IRA FLATOW: You’re welcome. Dr. Vivek Murthy, US Surgeon General, joining us from Washington, DC.

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