CHAPTER 1
Sicker, Not Smarter
IN LATE 2010 I received an email from Saint Louis University School of Medicine professor and pediatrician Stuart Slavin, who was concerned about the health effects of excessive performance pressure on children. One passage in it sticks with me to this day:
My personal feeling is that we are conducting an enormous and unprecedented social experiment on an entire generation of American children, and the evidence of a negative impact on adolescent mental health is overwhelming. This is particularly disturbing given the fact that having mental health problems in the teen years predisposes to mental health problems in adulthood. It is even more profoundly disturbing when one considers that there is absolutely no evidence that this educational approach actually leads to better educational outcomes.
The science shows that Slavin is right: Our children are paying a high price for our cultural misdirection. Thousands of students are suffering from withering anxiety, depression, eating disorders, insecurity, dangerous sleep deprivation, and even thoughts of suicide. And itâs not just our childrenâs mental health thatâs in jeopardy (which would be worrisome enough by itself); itâs their physical health, too. The result of the Race to Nowhere is a public health crisis on a scale that we have yet to fully recognize.
Before we turn to solutions, which are the heart of this book, itâs important to take a chapter to demonstrate that studentsâ stories are backed up by hard dataâto take stock of the science of just what weâre fighting for. In fact, the price of the achieve-at-all-costs approach includes more than sickness. It produces a drill-like mode of education that deadens lessons and narrows studentsâ chances to explore broadly or think creatively. We see even young students disengaging from school experiences that feel impersonal and irrelevant, high school grads arriving at college in need of remediation, and rampant cheating among students of all ages. Ironically, the constant pressure also physiologically impairs childrenâs capacity for learning. In other words, it backfires, undermining the very achievement that itâs meant to promote.
All told, the outcome is a school environment that deprives children of both sound health and vibrant learning. These grave consequences are at the heart of what makes our work to transform childhood so urgent. Whatâs at stake is no less than raising healthy, thriving kids andâas they become adultsâa healthy, thriving society.
Fremont, California: A Crisis Visible
Irvington High School is a sprawling, single-story beige building wrapped around a central courtyard with picnic tables and a few redwood trees. The city of Fremont spreads out around it, pancake flat and pasted with strip malls and small ranch houses, the bare brown hills of California rising in the background.
Over the past five years, Assistant Principal Jay Jackson has watched this school community transform. He taught world history and sports psychology here for eight years before becoming an administrator. With close-cropped hair and the compact build of a lightweight wrestler, Jackson is the kind of compassionate teacher whom students instinctively trust. He has an Elvis Presley shrine in his officeâreplete with Elvis figurines, Elvis clocks, Elvis PEZ dispensers, and even a life-size Elvis cardboard cutoutâmade up of gifts from past students, who kept giving him the knickknacks as a kind of joke, even though he insists heâs not that big of a fan. During his teaching years in the 2000s, Jackson recalls, the student population here was mixed: about half of them were academically oriented and intent on college, the other half not. When, in 2010, the auto plant that had employed many of the studentsâ parents shut down, taking nearly five thousand mostly blue-collar jobs away with it, the demographics of the school district began to shift. Around the same time, the district redrew neighborhood boundaries, delivering to Irvington a flood of students from a more affluent part of town. Many of these new studentsâ parents were immigrants, drawn to the technology industry in nearby San Jose with high hopes for their childrenâs futures in this land of opportunity.
The schoolâs standardized test scores shot upâas did its rates of student anxiety, sleep deprivation, and stress-induced illnesses. When Jackson became assistant principal in 2012, the change was already under way.
âTwo or three weeks into the school year, you start seeing students coming into the office with these issues, with stress, breaking down crying,â even cutting themselves, he remembers. The problem hadnât been as obvious from the vantage point of his classroom, where students put their best face on and their late nights spent laboring over piles of do-or-die assignments werenât so visible. But you go to work in the school office, the crossroads of studentsâ difficulties, and, he says, âYou see enough.â
Enough, that is, to deeply alarm Jackson, whoâs also a father of two boys in elementary school. It convinced him that Irvington has a serious health crisis on its hands. Jackson organized an online survey of students in fall 2013, to see if his instincts matched the teensâ own experiences. The measure wasnât perfectâonly about one in six students completed the survey. But this much was clear: if even a small percentage of Irvington students overall felt the same way as those who answered the questionnaire did, the situation was dire.
More than four in five of the teens who responded said they felt moderate or high stress about school. They reported doing hours of homework a night and sleeping too little. A majority were taking multiple AP and honors classes, and the most common reason they gave for enrolling in those classes (cited by 61 percent of students) was that it would help them get into a better college; trailing far behind, the next reason (cited by just 42 percent) was that they were actually interested in the subject matter. Nearly half of the teens admitted to cheating on tests or homework in the past year, primarily because they didnât have enough time to study or finish the assignment. Perhaps saddest of all, when asked, âWhat is your main purpose for being in high school?â more students checked âTo get into a good collegeâ than âTo learn.â
Stress levels were high when I visited Irvington in the fall of 2014. Sitting with a classroom full of juniors, I casually asked, âHow stressed are you, on a scale of one to ten?â The teens replied with a chorus of groans: âTen!â One said eleven.
I went on: âWho gets seven hours of sleep a night? Raise your hand.â A couple of hands went up. âSix hours?â A few more. âFive?â And there the bulk of the class raised their hands. Growing ever more incredulous, I asked: âFour?â Up went the last couple of hands. Even as the discussion continued, many students were scribbling in their notebooks, not sparing a moment that could be spent on schoolwork. Finally, I put the critical question to them: âIs it worth it?â They mumbled yes. âWhy?â One boy with a blondish mop of hair answered for his peers: âTo better your future.â
Afterward, Jackson strode down the hall away from the classroom, his frustration showing in his gait. âIt pains me to go into those classes because theyâre really stressed, and my assumption is weâre doing this to them,â he said. âTheyâre all messed up.â
A student had died by suicide the previous spring. And just the day before my visit, Jackson said, heâd checked a student into the home-and-hospital program. Thatâs an alternative education program for students who are too sick to come to school. What was this girlâs ailment? The doctor couldnât diagnose the precise cause of her bodily pains and ulcers, but mysteriously, they went away during the summer and returned two weeks before the start of school. âItâs driving me crazy,â said Jackson, âbecause whatâs going on is flawed, but weâre not brave enough to change it.â
The fact is that he and his colleagues at Irvington actually are taking courageous steps to change the schoolâs high-stakes culture and rebuild student healthâmost notably by restraining students from overloading on AP classes and working with Dr. Slavin to research what kind of support they most need, as weâll learn more about later. The progress is just slower than Jackson would like.
The questions I didnât ask in that classroom at Irvington were these: What makes you so sure itâs worth it? Is this sprint to achieve a certain version of âsuccessâ (reaching the top of the class, the top college, the top job, and the top life) really helping? Or is it actually making you sicker, not smarterâthe kind of sick that will likely last through your adulthoodâand causing you to miss opportunities to build the real-life skills that really matter?
Letâs examine the facts about what is happening to childrenâs health. The implications are long-lasting, as there is an avalanche of evidence that an unhealthy youth sets the stage for an unhealthy life. Iâll begin with the effects that we can see right now: the current frayed state of our childrenâs and teensâ health.
Unhealthy Hearts and Minds
Students these days are incredibly stressed. On the American Psychological Associationâs Stress in America survey, teens rate their stress levels during the school year higher than adults rate their own. Nearly one in three teens says the stress drives them to sadness or depression. And what are the top sources of their stress? Eighty-three percent of the thousand teens surveyed named school, and 69 percent named getting into a good college or deciding what to do after high school. Meanwhile, 30 percent of high schoolers said on a government survey that they had felt sad or hopeless almost every day for two weeks or more within the past year.
Young Americansâ mental health has deteriorated dramatically since the postwar days of the 1950s. Jean Twenge, a psychology professor at San Diego State University and author of the book Generation Me, has scoured and crunched decadesâ worth of data to illuminate these trends. By her calculations, five to eight times more college students today report serious mental health problems than did students at midcentury. This doesnât bode well for their future health, as depression raises a personâs risk of heart disease, diabetes, and other illnesses, and having depression early in life significantly increases the risk of having it again as an adult.
Federal data also show that suicide rates more than doubled among youth age fifteen to twenty-four between 1950 and 2010 and more than tripled (though the rate is still much lower) among younger children. Whatâs less well known but equally worrisome is how many kids consider taking their own lives. In a Centers for Disease Control and Prevention (CDC) survey of high school studentsâchildren as young as fourteenânearly one in six said they had seriously thought about suicide. Half that many had made an attempt within the past year.
It makes me wonder: How much torment happens below the surface, beneath the game faces that adults can see? And how much is hidden behind the airbrushed lives todayâs teens present on Twitter and Instagram, where one kidâs seemingly effortless achievements only make the next kid feel she must do more?
Behind these numbers are stories like that of an alarmed mother in Orange County, California, whose seventeen-year-old son had once ranked first in his high school out of a class of 764, taking six AP classes (out of seven total) in his junior year and sleeping only five hours a night. His worried mother wrote:
I discouraged him from taking on this load, but he insisted and continued this into his senior year by taking the International Baccalaureate, and now the chronic stress and lack of sleep has taken its toll. . . .
Prior to high school my son was a secure, outgoing well-liked person with many friends. He likes to surf and would design and paint patterns on his boards. He organized camping trips, booking at state parks and organizing his friends without any help from me. He would not be able to do this today. . . . He is now in his senior year and was diagnosed last month with major depression. He has a terror of going to school and has only attended school for about six days in the past two months. . . . We are working with a doctor, a counselor (who brought your film to our community) and the school to try and salvage what we can for him to graduate in June.
What happened to this young man is sadly not uncommon. And unfortunately, our kidsâ poor health outcomes are anything but temporary. The unhealthy, unhappy patterns laid down in the grade school years stay with teens as they enter the nationâs universities, where officials are battling binge-drinking episodes and reporting a rising mental health crisis, as well.
âThey work their tails off to get here, and then reach the finish line and are accepted and get here, and then realize that there is no finish line,â says Kevin Wehmhoefer, a Harvard University clinician and coordinator of outreach, counseling, and mental health services. âI got here and I was blown away by the level of acuity that kids were presenting with.â Wehmhoefer observed extreme anxiety or depression in many students who came to his clinicâand counselors from the University of California to Appalachian State University in North Carolina report the same trend. Surprisingly, though, after final exams ended, Wehmhoefer saw the symptoms for some students resolve within days. Thatâs not typical of clinical depression. The problem, he says, reflects âkids who have been measuring themselves by a lone metric for a long time,â who have no tolerance for failure. And who, crucially, have never learned the emotional skills to manage the acute stress that results.
The scale of the problem is huge. In the latest National Survey of College Counseling Centers, 94 percent of counseling directors said they were seeing rising numbers of students with severe psychological problems. Indeed, more than half of college students in a recent survey reported that theyâd felt overwhelmed by anxiety within the past year. One in three said theyâd felt so depressed it was hard to function. Tulane University, particularly hard hit in fall 2014, lost three students to suicide by Thanksgiving.
âThe increased need for mental health services on our campuses is outstripping our ability to provide those services,â John Stobo, an executive vice president for the University of California system, told the California Report radio program that same fall. The number of students seeking help at UC counseling centers had jumped by more than a third in the previous six years. Reduced stigma around seeking mental health counseling could account for some of that rise. But the increased incidence of emotional distress among college students is dramatic nonetheless: UCLA has surveyed entering freshmen at four-year colleges and universities around the country about their own mental health since 1985. In 2014, these studentsâ ratings hit a record low.
Unhealthy Bodies
Beyond the kinds of mental and emotional pains the college psychologists describe, the health consequences of the childhood rat race are also frequently physical. Many of the pediatricians Iâve met around the country have told me, with grave concern, that theyâre seeing physiological impacts of this stress among their patients. And not just among high schoolers: many report symptoms in children as early as elementary school, just like I saw in Zak in third grade.
Lawrence Rosen, a pediatrician in northern New Jersey, told me that over the past fifteen years heâs seen more and more children diagnosed with depression, anxiety, and physical symptoms of stress such as motor tics and panic attacks. âKids are coming here with migraine headaches, ulcers. Iâm talking about five-, six-, seven-year-olds who are coming in with these conditions. We never used to see that,â Rosen said. âI do a lot of work nationally with other pediatric groups and pediatricians and Iâm hearing this from my colleagues everywhere.â
From Highland Park, Illinois, pediatrician Susan Sirota emailed me the following: âEvery day I see children with some condition that is a direct result of the stress they experience related to school. Interestingly, when I started practice we used to figure this out by asking about what happened to the pain on the weekendâit would go away; now there is no difference since so many children are continuing to âdo extra schoolâ or just not able to relax on the weekends.â
This is how extreme the physical symptoms of childhood stress can get. Edin Randall is a psychologist at a pediatric pain rehabilitation center at Boston Childrenâs Hospital. Her clinic specializes in a poorly understood and severe illness called complex regional pain syndromeâwhich she describes as commonly associated with high-pressure educational and extracurricular settings. This rare disease was described as early as the American Civil War and affects youth and adults in various countries, but its rates are rising, probably due to increased awareness and diagnosis. Randall says a typical case starts with an injury, such as an ankle sprain in a dance recital. The acute pain persists beyond the normal tissue healing process and then becomes chronic. Then, for reasons doctors donât yet understand, the childâs nerves become irritated such that âa light touch will feel like stabbing pain,â Randall explains. Normal treatments donât work for some patients. The pain is so severe that the child stops using that limb, which becomes waxy and stiff from disuse. Many sufferers stop going to school or participating in other activities.
Thereâs been no research done yet to identify a causal link between high-stakes education and such pain disorders, but Randall sees a connection. Many of the children she treats tell her they come from stereotypically high-achieving communities with intense competition and pressure to perform. âItâs a common denominator for a lot of our patients,â she told me. Randall is careful to point out tha...