The pandemic drove major increases in depression, anxiety, and ADHD. But rates of ADHD–and its treatment–have been skyrocketing even before the pandemic. Abdul reflects on how our surroundings may be driving this. He sits down with Casey Schwartz, author of “Attention, a Love Story” to learn more about the history and future of ADHD.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: The Biden administration plans to offer next generation vaccine boosters to the public after Labor Day. Dr. Anthony Fauci, the face of the federal government’s COVID 19 response, will retire in December. Polio virus has been discovered in New York’s wastewater, which the CDC has declared a public health emergency. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Hey friends! Today, we’re going to talk about ADHD or Attention Deficit/ Hyperactivity Disorder. I’ve been thinking a lot about ADHD as I’ve found myself struggling to focus on everything from work to books to even Netflix. So today I wanted to talk to someone who’s thought a bit more about ADHD than me, and you’ll hear our conversation soon. First, let me set it up a bit. The set up? Well, sweat glands. Wait what? Bear with me. I only want a bit of your attention to connect the dots. Look, I hate being hot, like, hate it. It’s a good thing I live in Michigan where, let’s be honest, it doesn’t get that hot all that often. But what I hate about being hot isn’t just the heat, it’s the humidity. I know that’s such a cliche, but the thing about most cliches is that there are cliches because they’re often true. I’ve been happy in a clam in temperatures over 100 degrees. As long as it’s dry heat. But the minute the humidity goes up over 50%, it’s over. It’s the sweating for me. I blame it on my desert ancestry. When long ago, my people lived in the Sahara Desert in Egypt. The sweat helped them. It carried heat off their bodies as it evaporated. And that’s why somewhere along the line, my ancestors were selected for sweating. But for someone living in North America, I really wish that wasn’t the case. In humid conditions, sweating doesn’t really help you because, well, the moisture in the environment keeps the sweat from efficiently evaporating. So what was a nifty system of physiological air conditioning becomes a coat of liquid that insulates your already hot body. It backfires and it’s a sweaty mess. That maladaptation to new environments. It explains a lot of disease that we face. Obesity is one. It isn’t simply about calories in and calories out. It’s actually about our bodies adapting to an environment where food was limited. Our hunter gatherer ancestors had to make do on limited supplies of food. And so their bodies became really efficient at storing energy in the form of adipose tissue, otherwise known as fat. That’s not the best for our energy rich environment, where food is plentiful and we have to artificially burn excess calories to avoid accumulating too much adipose. Sometimes I wonder what our hunter gatherer ancestors would make of rows and rows of us running in place at a modern day gym. But just like some people like me sweat more in humid climates and others are more susceptible to accumulating adipose tissue. It’s easy to forget that these issues are less about differences between individuals and more about the environments in which we find ourselves. I told you I’d get back to ADHD. So here we are. ADHD is an increasingly common, debilitating, neurodevelopmental disorder. It hampers the ability to pay attention, control impulses and sit still. It usually affects children, but it’s more commonly being diagnosed in adults, too. Rates of ADHD are skyrocketing, up 30% over the past ten years alone. We’re just starting to understand it. And there are important debates about whether or not the increase in ADHD represents a real increase in the disease itself or simply more diagnosis as more people and providers become aware of the disorder. And yet ADHD, like obesity or even sweating, probably has a lot to do with our environments. Thankfully, I never struggled with my attention as a child. I could sit and play with Legos or Teenage Mutant Ninja Turtles for hours, and as I got older, that ability to concentrate meant that I could focus on homework and other tasks without trouble. But as a 37 year old grown ass man, I struggle to keep my attention on the task in front of me. And that’s because, well, the environment where I do my work, the Internet is literally teeming with distractions. There are the pings and dings from my messaging apps, my email, slack. But then there are the endless rabbit holes of hyperlinks in articles I’m reading to other articles I could be reading. Oh, and then there’s the irresistible urge to Google anything that comes to my mind as something I could know, and that that doesn’t even get to the wide world of social media. Corporations that literally exist to take my attention from me. I literally pay them my attention. Those things didn’t exist when I was a kid. They exist in a big way now. And it’s not just that I’m the same person in a far more attention grabbing environment. No, I worry that they’ve changed me. I mean, I crave them now. And it’s not just me. It’s the way my daughter, four, doesn’t know a world without ubiquitous screens. Her mother and I have worked hard to limit them, but even if she doesn’t get all the screentime she may want, she watches us consume those screens big and small. And in doing that, well, we’re unwittingly setting what’s normal for how an adult behaves. A normal that is really, well, quite abnormal. This whole thing. It’s made me wonder how much of the skyrocketing ADHD is about a changing environment rather than simply individual disorder. Don’t get me wrong. ADHD is real and it’s important that people get the treatment they need to function. But in a world where corporations make billions upon billions monetizing our attention, how do we actually hold on to it? Is ADHD really about a hypersensitivity to an attention scarce environment rather than some inborn deficit? Treating individuals for ADHD without thinking about the public health implications of how our environment is savaging our attention en masse is like trying to pick off one wasp at a time without finding the nest, especially as that nest is spending billions to make billions by harvesting the very thing we’re trying to get back our attention. Okay, I stretch that analogy a bit, but you get what I mean. So today, with all of these thoughts about attention and ADHD, I wanted to talk to someone who had some answers to my questions, and my guest today has been paying a lot of attention to, well, attention. Casey Schwartz is journalist and author of the new book Attention: A Love Story, about her own attention journey. In the book, she explores her own experience with ADHD and its treatment. It’s a great exploration of what it means to struggle with attention at baseline and then within a world ever more driven by an attention economy. I talked to Casey about her journey, about the world’s recent rise in ADHD diagnoses and what blame we can place, if any, on the rise of the Internet and smartphones. Here’s my conversation with Casey Schwartz. 

Dr. Abdul El-Sayed: Let’s uh press record. 

Casey Schwartz: Okay, here we go. 

Dr. Abdul El-Sayed: All right. Um, can you introduce yourself for the tape? 

Casey Schwartz: Sure. Um, Hello, Abdul. I’m Casey Schwartz. I’m an author and a journalist. I’ve written a couple books, most recently Attention: A Love Story. And um I contribute regularly to The New York Times. 

Dr. Abdul El-Sayed: Casey, I really appreciate you uh making the time to join us to talk about um your newest book about attention. Stepping back, why did you write this book? 

Casey Schwartz: I was looking for a subject that felt urgent. This was 2015, 2016. And um the most urgent issue to me, it seemed, was the drastic change affecting how we attend to the world around us. And I lot– I sort of landed on that subject just kind of lamenting the fact that we had gotten so casual in giving away our attention so thoughtlessly. Um, and I then stepped back and realized, Oh, I personally have a long and tortured history with my own attention and spent a decade on attention enhancing medication. Um, so I realized it was not only culturally resonant, it was personally resonant. Um, and that’s that’s why I embarked on this subject. 

Dr. Abdul El-Sayed: Can you tell us a little bit about that, that personal journey? Um, when when did you first start to experience um inattention? And what what was your journey uh through your own treatment and through um your your choice to come off treatment? And what was it about that journey that was so compelling? 

Casey Schwartz: Well, um I arrived in college in 2000. And at that point and I feel your I think you’re a little bit younger than me, Abdul, um but I at that point, Adderall had been on the American market for only four years. So, um you know, there were older, there were pills, there was Ritalin, but there wasn’t this sort of supercharged ADHD pill until until Adderall came along in the mid-nineties. And so when I got to college, I was not familiar with it. Um and I you know, I went to one of my friends. It was freshman year. I said, I have an essay due tomorrow. I haven’t even read the book. She said, here, try an Adderall. I can’t stand it. It makes me want to do cartwheels down the hall all night. And that for her was like a deal breaker, but for me was like an incredible advertisement. Um and I took it. And indeed, it was like that mythical silver bullet where you feel the sort of the key and the lock. And I was up all night and I read the book. I wrote the essay. I had energy to spare, energy to burn. And I thought, you know, that was sort of that was the beginning of the great Adderall seduction, where I thought, like, why would I ever go through life not on this medication? Um and so, I know, it’s sort of like one of those chicken and egg things where, you know, in retrospect, I sort of look back and I think, you know, maybe I did always struggle with attention, but it was only when I had taken this magical, so-called magical attention pill that I became I sort of I just sort of landed on the explanation, like, yeah, my natural attention isn’t enough and it’s not going to be enough. So I need to take this pill. And, you know, it started from there and Adderall was around. There’s alw– there’s a black market on every single college campus. I think there’s the most recent statistic is like 25% of American teenagers have taken Adderall or a similar stimulant off label. It’s like more popular than cannabis at this point. Um, and it just built and built from there. And I finally got my own prescription shortly after graduating from college, and I spent my entire twenties taking this drug. But as the older I got, the more I understood this was a Faustian bargain, and I was actually drifting away from my real self in the service of this, like, sort of chemical false self. And I was finally able to get off this drug at 30. Um and then I would just say one other thing, which is like there’s sort of an irony because at the time that I was taking the Adderall, I didn’t truly think that I had ADHD, although it was very, very easy to get a prescription. Um but now that I’m not on Adderall, I’m actually not so sure that I don’t have ADHD. And I guess we can we can revisit that um when we talk a little bit more about ADHD and its symptoms. 

Dr. Abdul El-Sayed: You know, your story highlights uh so much about the duality of this particular challenge around attention. In part, it is uh individual. It is about one’s own experience and capacity to maintain attention and focus attention as they need to, but a lot of it is also about um living in a world where our attention is parsed in so many different ways. Literally, corporations monetize our attention in some pretty profound ways. And, you know, they um you can think about their product as like an intention robbing substance. I mean, that’s that’s that’s the whole point. Um, all in service of trying to sell you something. And so, you know, in some respects, you’re talking about two moving pieces about whether or not, you know, the natural, normal human attention span, whatever that is, um is uh is capable of competing with an environment that is entirely about trying to take your attention away from you. And it’s also about, you know, our our own challenges and um the differences in or we’ll just say the natural distribution of um the amount of attention someone can marshal, for how long they can marshal it, and the intensity of what that attention is uh and the the experience of being able to take a medication that empowers you to marshal that attention. And in as many ways as the book is about attention, it’s also about the way we pathologize inattention. And in some respects, that’s like the contra position of these different kinds of uh environments, like it’s the world that you know allows you to just look at TikTok for 20 minutes or sit in rows of desks in chairs for 30 minutes while an extremely boring person talks to you. And so just just thinking about the advent of ADHD, maybe that’s a good place for us to start. What is ADHD. 

Casey Schwartz: Um Attention Deficit Hyperactivity Disorder. Um in a nutshell. But before there was ADHD, there was ADD which appeared for the first time in the DSM and as recently as 1980. And then there were precursors to ADD. There was minimal brain dysfunction. That was actually the term that was used for decades. But the problem was that no one could ever locate the so-called dysfunction. And actually, there’s a wonderful book on the subject by Alan Schwarz, who wrote ADHD Nation, no relation. Um and he he actually points out that like in the 1700s, there was a doctor named Alexander Crichton talking about diseases of attention. Like so this is the idea that something can be profoundly off um with one’s attention is actually not new to the 20th century. But we got these labels and names in actually in very recent decades. 

Dr. Abdul El-Sayed: And as we think about um how that manifests today, what are the symptoms of ADHD um and how is it treated? 

Casey Schwartz: Um, well, so here’s the thing. There are all these sort of behaviors that are considered um very typical of ADHD. Right? So an example, you know, like, well, the classics are like impulsivity, um difficulty paying attention, difficulty staying still. But they’re clusters of behaviors that are considered ADHD, behaviors like you’re messy, your disorganized, you lose things, you’re late, or your sense of time is not quite right. Um your sense of how long things take and timing and things like that. You’re moody, you’re irritable, you can attend brilliantly well to those things that you’re interested in, but you struggle to attend to things that you’re not intrinsically motivated to, to want to engage with or master. And your working memory can be a little bit screwy. So like the, you know, like, you know, the ability to hold seven digits in your head, things like, you know, that’s that’s what they mean by working memory. And when I hear these, I identify every single thing that I just listed. I completely identify with. I mean, my sense of timing goes the other way where I’m always like an hour early for things, but everything else is very, very typical um ADHD. I lose a credit card every other month, you know, and I think this is the this is the sort of interesting thing about the ADHD behaviors is a lot of people resonate with these things, right? And they may not have ADHD, but they could have sort of like subclinical what’s called subclinical ADHD. But the point is, I think it can be for some people very easy to see yourself in this particular diagnosis. 

Dr. Abdul El-Sayed: Even before the pandemic. And we’ll talk about the impact of the pandemic in a bit. But even before the pandemic, um the incidence of diagnosed ADHD was on the rise. Do we understand why? 

Casey Schwartz: Um, you know, there’s such a there’s such an interesting but possibly unresolvable debate about that, Abdul. I mean, is it that our children’s brains and our adult brains are changing now more than ever and were developing ADHD more commonly? Or is it that doctors are looking for it and therefore finding it? More than they ever had before. I mean, the numbers are astonishing. Like, what is it like 15% of American children now have this diagnosis? Or is it more. Um and, you know, and the original estimate given, I think, by the CDC was like 5% and suddenly it’s like triple that. Um and when kids come in and get diagnosed with ADHD, something that commonly happens is that suddenly their parents realize, well, they have it, too, but they just weren’t diagnosed as children. Right? So I think this I mean, I can’t answer this and there has been no satisfying answer. But that that’s the debate is, you know, is the pathology expanding or are we newly sensitized to it? 

Dr. Abdul El-Sayed: You know, it’s the conversation is is fascinating because at the core of most mental illness is the the challenge that we don’t actually have the ability to map the symptomatology of a mental illness to the pathology of that mental illness. Right? Like just take a heart attack for a second. Heart attack is what happens when blood flow stops to a piece of the heart and the downstream part of that heart starts to die. And, you know, a heart attack because of the symptoms of a heart attack, and although those symptoms can come out in a number of different ways and tend to look different in, you know, say, men versus women. Um there is a symptomatology thing that you feel and then you can go to the heart and you if you were to open up somebody’s heart, you would literally find the occlusion. I mean, there was that’s the what the reason why we do certain kinds of tests to see the blood flow into a heart and then find the occlusion and either bust it with some medications or go in, you know, usually through a vein and bust it. And um and so there’s a mapping of a pathology to a set of symptoms, whereas in mental illness, it’s really, really difficult actually, because we are usually doing what we call um diagnosing empirically. Meaning if you have a certain constellation of symptoms, we call it a certain disease and we define that disease based on the constellation of symptoms. All right. That’s what the DSM-5 is, the Diagnostic and Statistical Manual of Disease. It literally is a constellation of symptoms that we call and cluster certain disease. And then we found over time that certain treatments will help the symptoms. But what’s missing there and what we have in most of the rest of uh health care and medicine is a very, very clear understanding of what the pathology is and when we think about the constellation of symptoms. Underneath ADHD, it’s challenging to think about why it’s growing because so much of the environment around our attention is shifting. So you know when I was young, um one of the things I never really had trouble thankfully, with attention. I could sit and play for hours at the same thing. And I could I could then shift. And I never had trouble with that. I find myself as an adult at 37 years old, um far more challenged with my attention than I ever was as a kid. And I don’t know if that’s because my mind has changed and or that’s because the environment in which I’m operating has changed. Because when I was a kid and, you know, you and I are somewhat close in age. We didn’t come up in a time when um  the alternative to what we were supposed to be paying attention to, based on what the adults told us, was something as addictive as social media. Right? Or uh we didn’t have the choice to watch anything we wanted at any given time uh on a library on our television. We just had what was on at the time. I remember sitting and waiting for what seemed like hours, but really was only like, you know, 30 minutes to watch Teenage Mutant Ninja Turtles. And it only came on at 4:00 and I could only watch one episode at a time. And that was that, for the rest of the time, I could, you know, do the analog stuff like play with Legos or go ride my bike or do any number of things that existed in the real world. And nowadays. Right. I can’t imagine what it’s like for kids growing up in the kind of information rich environment in which they’re coming up. And so I wonder how much of this diagnosis is a stand in for a change, a rapid change in the information environment that our attention is contending with? And how much of it is potentially a change in actual fundamental baseline capacity to keep attention? 

Casey Schwartz: And I think that that question is like the question of the decade, um and I think we’re going to hear such amazing and revelatory findings like, you know, as I’m sure you know Abdul like now there’s no proof that screens cause ADHD. No one has shown that. But what they have shown is that there is major correlation between having ADHD and spending time on screens. Right? So the more ADHD symptoms you have, some research has found, the more time you’re going to spend engaging with screenlife. Um so that’s interesting. That’s not causal, um but that’s such a good point about the fact that it’s not only the screens, it’s like the plethora of choices because I watch my two and a half year old and like I’m ashamed to admit he’s even on an iPad. Right? But he is on an iPad. But then he sits down and he says, no, I don’t want this episode of Blippi. I want another. He always says like another one. Another one. And that almost alarms me more than the iPad itself. It’s like this endless selection um so that there’s always the option to jump to the next thing. And I and I really do worry about the implication of that. Um anyway. But the one the one other thing to say about it is, you know, there are credible scientists out there who have in no way ruled out that screen time can induce adult ADHD. So um I feel like it’s it’s a fascinating space to watch and wait. 

[AD BREAK]

Dr. Abdul El-Sayed: You know, it’s interesting because if you sort of think about the long range consequences, it’s like we’ve we’ve introduced a technology. That can allow a number of really, really big, very powerful, um very high uh capacity corporations to steal as much of our attention from us as possible in the guise that we willingly choose it. And then um in some respects we’re pathologizing the fact that our own attention can’t compete with the power, wealth and capacity of those corporations to take it. Right? And I’ve struggled a lot with asking this question. And then the other problem scientifically. Right? As an epidemiologist, you can only really study something that’s not ubiquitous. Right? So, for example, um if you were to immediately take away all of the oxygen on earth, everyone would die within a couple of minutes. But you couldn’t actually technically prove that it was the lack of oxygen because you didn’t have a control group. Right? You could say, well, from the past there was oxygen and now there’s not oxygen. But the obvious thing is that when you took all the oxygen from Earth, everyone died because they couldn’t breathe oxygen. Even though our ability to prove it doesn’t exist and in some respects right, the existence of screens and screen time is so ubiquitous that actually identifying a strong control group to say, yup, this is the contrast that we’re looking for to demonstrate the effect is actually almost impossible because everyone is affected. And, you know, I say and I say everyone in the sense that it’s not just a US problem, it is a problem that it is existing across the world. And I think about my you know family in in Egypt, a middle income country. They still have everyone has a cell phone, no matter how poor they may be. And that cell phone usually. Right. Can access a set of things that didn’t exist in the past. And so, you know, it just sets up a really, really challenging both clinical and scientific um problem. I want to I want to ask you, um you know, what have we learned about about ADHD treatment? You’ve talked about your own experience with Adderall. And in some respects, the thing about Adderall is that, um you know, really, no matter who you are, it’s going to give you to some level at some dose, the ability to concentrate your attention in ways that um can help you, whether or not you have diagnosable ADHD or not. How has the existence of Adderall, to the degree that it has been used, um how has it changed the conversation about about ADHD and about attention? 

Casey Schwartz: Um. Yeah, I mean, and of course, just that just to say that stimulants are the the first line of treatment for for ADHD, the most common treatment um and kind of one of the only treatments. Right. So if you got an ADHD diagnosis, you’re very likely to get a stimulant prescription. But, you know, they say that like, hey, if you give Adderall to a child with ADHD, um they’ll calm down, you know, rather than get um sort of alert and energized. Um and I don’t know whether or not that’s true um in every case, but they sort of say, like, that’s how you can tell it’s legitimately ADHD. Um, I’ve heard that, um and I don’t know if that’s true. It certainly wasn’t true for me. I didn’t feel calm. I felt um hyper alert and hyper vigilant the entire time I was taking Adderall. And only later did I sort of I got I got more clarity on that and the implication of that when I read research out of Martha Farah’s lab at Penn showing that Adderall actually only helps performance. It’s sort of like an upside down U-shape, where if that is, if you’re sort of average to good to begin with and you’re taking Adderall, it can kind of bring you down. So it only helps to a certain extent. It’s not the the perfect performance drug that we might hope it would be. Um and there are you know, there are there really are sort of major disadvantages to what it can do for you intellectually. 

Dr. Abdul El-Sayed: Thinking through um you know, treatments for ADHD in some respects. Right. We talked a little bit about the changing delta, the difference between the environment that we’re asking uh particularly young people to focus in versus the the uh environment that they can sort of lavish their attention in otherwise. And how that’s increasing with the advent of technology, the, you know, the on demand capacity to watch and see and read and listen to whatever you want, whenever you want to. Um how much are we failing uh our young people by persisting in um asking them to adapt in environments that were a lot more sensible in the past? I mean, how much investment um has there been and should there be in sort of upgrading um the kinds of learning environments and the kinds of spaces in which we’re asking um students to pay attention? 

Casey Schwartz: I mean, it’s definitely true that like the whole sort of idea of asking children to sit still for 8 hours a day starting really early in the morning is not natural. I mean, it’s not um it’s sort of, you know, and actually, Johann Hari in his most recent book um goes into this in great detail that like the very structure of the classroom and the very rhythm of it um for a lot of children is just simply not what their brain can do. And and I think, you know, the result of that has been for children who don’t conform to that structure in that setting. Like there can be this enormous pressure then to have them prescribe stimulants because, you know, you end up with the diagnosis of ADHD sometimes when, you know, you just it’s sort of like this sort of one size fits all environment isn’t working for you. And there are a lot of cases of parents who felt pressure to get their children prescribed stimulants coming from the school. 

Dr. Abdul El-Sayed: And I really appreciate that point because, you know, I think my line of questioning can come off as skeptical, um but it’s not. I very much believe that ADHD is a a real debilitating uh diagnosis, that that does affect a lot of people. But the reason I keep asking these questions is because I do think that the nature of our systems is to find the easiest individual level solution to a structural social level challenge. And um you know that the structures are so aligned against us paying attention um that I worry that oftentimes, while there are many people who have um very serious functional challenges because of ADHD, there are always going to be easier solutions to a disruptive or a um very engaging child um in a situation where we’re increasingly asking them to do something that the attention economy is making substantially harder. And, you know, when you can sell a medication on the back end of making a particular diagnosis, that is easy for everyone involved, the parents and the teachers, then that that’s what’s going to happen. And and so we really ought to be asking big picture questions about um whether or not, right? The kind of information economy, the kind of attention grabbing products that are being produced are in the best interests of our kids, whether or not our um learning environments have adapted to what’s on the other side of choosing not to pay attention, uh and whether or not um there isn’t a broader societal set of questions that we should be asking, given we’re seeing these ADHD rates climb, the rate of treatment climb, and in this environment, getting more and more weaponized against people being able to pay attention. 

Casey Schwartz: Absolutely. Absolutely. And and I do think it’s this idea that the individual has um control um at this point with this saturated screen life we’re living, is just not realistic. You know, and there are advocates for like, hey, you know, we should all be able to sort of control our attention and hone and refine our attention like someone like Nir Eyal who wrote Indistractible, sort of, I think argues that it’s that it’s down to the to the individual level. Um and, you know, for me personally, that doesn’t seem resonant or realistic when we’re so ensconced in this like surveillance capitalism model. 

Dr. Abdul El-Sayed: Yeah, I really appreciate that point. The other context that we have to remember is that ADHD is not the only um mental illness that’s on the rise. And so much of the context for our mental health um and mental illness generally over the past two and a half years has been the pandemic which robbed us of one another. And the alternative to one another was the online analog of one another, which again is intermediated by corporations who want to take as much of our attention as possible. You wrote a really compelling essay about what you called distract depression. What is that? And um how should we be thinking about it in the context of this pandemic? 

Casey Schwartz: Um right. So that article, The Age of Distracted Depression, that um I’ll credit to my editor for the headline, um was a recent New York Times piece. And it just started as the question like, hey, what’s been going on with pills for Americans since COVID started? Simple question, right? Um a lot of that information is not publicly available, um but we were able to get um a couple different databases and other research out there and to start to put together a picture of like what pills, what prescription pills for mental health were Americans turning to since COVID started? Um and it was really fascinating to see the breakdown um in terms of ages and pills and like so, for example, with stimulants, I went into this article thinking like, I’m sure that kids and teenagers were prescribed um attention pills at astronomic rates through COVID, right? Because Zoom is so shattered. However, that wasn’t true. According to this data, it actually had kind of leveled off for that age group, but it had doubled for the 20 to 44s. Right. And like, that’s the information we got. So I but my immediate assumption was, oh, those are the moms and the dads. That’s sort of like where my mind goes, um because you think about the burnout, the fatigue, the lack of childcare, the lack of support, uh and the lack of energy. And then but then for the younger, the teens, the teenagers, the 13 to 19 year olds, like the rate of anxiety medication had gone up 17.4% from the two years of Covid compared to it was like 9% in the two year rate of change in the two years leading up to Covid. So an enormous jump in the anxiety medication category for teenagers and the use of antidepressant for teenagers since 2017 is like 41% increase. Um so that that’s that is both Covid and the two years before Covid and that’s also a big jump. So it’s really, really interesting. So, I mean, you know, anti-depressants are American’s most popular mental health drug, um but stimulants are also popular and getting more popular. And it’s just um so interesting that, you know, that these teenagers, I thought, um has showed such a big jump in in anxiety medication since COVID started. Make of this what you will, because for for now, all we have are the figures. And of course, like there are some mitigating factors like, you know, it could be that, hey, people were stuck at home for the first time with enough time to seek health care. And that could explain part of the jump in taking pills. Um but we know that a lot of that mental health really suffered during the pandemic. Um and the these prescriptions really kind of went along with that with that story. 

Dr. Abdul El-Sayed: Do you feel like after the pandemic we’re going to be able to come back from the consequences? Uh or do you feel like this is just a stepwise increase, that that accelerated a lot of the trends that we’d seen before the pandemic? 

Casey Schwartz: Um, it’s so hard to generalize because people come into this with such different circumstances. So I think it really depends on like your personal resources, your family, your school, your environment, like what what you have around you. I wouldn’t really want to generalize. I don’t think it’s really possible, um but it’s so hard to know. I mean, Abdul I’m sure you remember that, like we used to have conversations about like, hey, when Covid’s over and it feels like those conversations have stopped and we don’t think COVID that we never we’re not going to return to pre-COVID. So it’s hard to know. 

Dr. Abdul El-Sayed: Yeah. And all that puts a bit of an exclamation point on the environmental aspect of this. That, you know, the way that things move and change around us shape and change uh our ability to cope with it. And um we live in a time when uh there is a lot that is anxiety provoking, a lot that’s that’s very sad and a lot that’s taking our attention. Uh and that has led to um a level of of uh mental illness and lack of mental wellness that I think is is really quite profound. Um if you were to think about trying to redesign uh the world around us, the things that we are all asked to do and engage with in the world um around trying to take on these these growing rates of mental illness, what where would you start and what are the kinds of things that you would do? 

Casey Schwartz: Number one, more time together physically. Um, meaning not on screens, um simply the simple, like literally the simplest interventions like just togetherness in the same physical space, less screen time. And it’s so cliche, but it’s so true. And those probably are my two biggest ones. But I really think that like, you know, the whole. Don’t you find that, like, you’re never happier than when you’re in conversation with friends? Because I keep I like come back to that again and again and it’s such a little underrated fact of life. You know? 

Dr. Abdul El-Sayed: My my fear is that for a whole generation whose interactions have been more and more intermediated by a screen. That the implicit joy engagement of in-person interaction may actually go away. Right. And, you know, anecdotally, uh if you’re under the age of 35, um you probably don’t want a phone call. You want to text. And if you want to talk by phone, that text is an introduction to the potential for a phone call. Whereas I think you and I are probably old enough to be on the tail end where if you want to talk to someone, you just call them to have a a voice conversation, which of course is a clear analog to an in-person conversation than a text conversation is. Um I worry that uh we may be headed into sort of a technological lock in of screen mediated conversation, which makes the in-person time less and less effective because it may come with a certain level of anxiety um because that’s just not how conversations are had. Um, do you do you see a sort of generational difference in the kinds of interventions that can be helpful? And um if so, you know, is there a way to like prevent that kind of lock in? 

Casey Schwartz: I think the magic of in-person um interaction is more robust than that. I really do. And even like to play devil’s advocate for the phone. Like, is it that? And actually, I’m asking this genuinely, is it that young people don’t want to talk on the phone or are they afraid that when they call someone, it will be like a bad time to call them? Like they’re afraid of initiating the phone call, but once they’re on the phone, they can engage and enjoy. I’m not sure like because I have terrible fear of like cold calling and it’s a bad time, although I do it constantly. So maybe like once you’re past the initial hump of that, you can still engage even if you’re 19. 

Dr. Abdul El-Sayed: To your point, um I also find that young people are more likely to enjoy a face time conversation than a phone conversation. So maybe it just is an anachronism of like a whole generation of people for whom the phone was like the only way of talking to each other if you weren’t in person. So, um you know, the kids are alright. And uh on that note, um I really, really appreciate both the book and uh you taking the time to talk to us um. Our guest today was Casey Schwartz. She is an author and a journalist. She’s a contributor to the New York Times and author of her most recent book, Attention: A Love Story. Casey, thank you so much for taking the time. 

Casey Schwartz: Oh, thank you. Abdul. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. The Biden administration is planning to begin offering next generation COVID vaccine boosters targeting BA-5 after Labor Day. Pfizer and Moderna have submitted for review quote “pre-clinical data about their new Bivalent vaccine”, meaning some combo of the original vaccine and one targeting BA-5. Critically, neither vaccine has undergone full trials in humans. But regulators appear willing to review these next gen vaccines based on their similarity to the original vaccine, according to Dr. Peter Marks, the top vaccine regulator at the FDA. The FDA is planning to review these imminently. In a signal on timing, the CDC has scheduled a meeting of its vaccine advisory board for September 1st and 2nd. This approach to review signals the challenge that vaccine manufacturers and regulators find themselves in. On the one hand, reviewing only pre-clinical data is a departure from the past when it comes to COVID vaccines. And some scientists have expressed concern over approving a vaccine formulation that hasn’t undergone human testing. On the other, this is what we do with new flu vaccine formulations every year. And there’s little reason to believe that this formulation would behave any differently from the others, particularly if there weren’t differences in the behavior in mice. More pressingly awaiting trials would delay approval for months, during which the virus would have evolved, rendering these vaccines less valuable. But there’s a bigger picture. Only about 70% of Americans are twice vaccinated. Only about a third are three times vaccinated. The vast majority of people getting seriously ill with COVID are the unvaccinated. So it’s questionable how effective a new vaccine, a fourth dose, will be against serious illness, which is, of course, what the vaccines were designed to prevent. 

[clip of Dr. Anthony Fauci] It’s never really a good time to leave. But you have to leave some time. I might as well do it now because I want to make sure that when I do leave, I still have the energy and the passion and the health to do the kind of things that I want to do. 

Dr. Abdul El-Sayed, narrating: After 38 years, longer than I’ve been alive, as director of the National Institute for Allergy and Infectious Diseases, the arm of the NIH that oversees infectious diseases, Dr. Anthony Fauci announced that he will retire in December. I don’t have to tell you this. This is a clear loss for public health. Dr. Fauci is the world’s expert on government responses to infectious disease epidemics. He’s been doing this since the early days of HIV back in the eighties. Ebola. Zika. COVID. His combination of technical scientific leadership and his unflappable, fact driven gift for public communication have made him an invaluable public servant who’s worked under seven different presidents. And yet we’re probably not going to see the likes of Dr. Fauci again soon. His example should be an unqualified inspiration to talented young folks looking for a career of service. And yet his example couldn’t survive the political polarization buzzsaw of the Trump years. Here’s an exchange between Fauci and Kentucky Senator Rand Paul. 

[clip of Dr. Anthony Fauci] And you are implying that what we did was responsible for the deaths of individual. I totally resent that. And if anybody is lying here, Senator, it is you. 

Dr. Abdul El-Sayed, narrating: Dr. Fauci is the world’s expert on pandemic responses. Rand Paul, despite his medical training, is a blowhard who exploited the pandemic to play to his base. And that’s just it. 38 years under seven presidents should earn you the respect of not being turned into a political football. But that’s just not the America we live in anymore. I’ll be sad to see Dr. Fauci go. And I’m confident that the best of what he brought to American public health, the lives his work has saved, will last long after blowhards like Rand Paul are flushed down history’s latrine. I only hope that the next generation of Faucis can see that, which is a lot harder considering how hard we’re backsliding on public health more generally right now. That’s right. 

[clip of unnamed news reporter] Polio has now been detected in the United States. It was found in wastewater in New York City. 

Dr. Abdul El-Sayed: Polio, a disease we’d almost eradicated from the entire planet, is now sloshing around in New York City’s wastewater. And that suggests that there is probably a lot more polio than we even know about spreading in communities that are unvaccinated against the disease. Don’t be alarmed, though. If you’re vaccinated against polio, which nearly everyone is, you’ll be fine. But unfortunately, there are pockets of communities that aren’t. And that’s where polio is now spreading. It didn’t have to be like this. And yet the same climate of mis and disinformation, the same politicization of public health that has allowed a consummate public servant like Dr. Fauci to be vilified. It’s created a timeline where in 2022, polio is back on the rise. That’s it for today. On your way out. Don’t forget to rate and review. It does go a long way. Also, if you love the show and want to rep us, help and drop by the Crooked store for some America Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Tara Terpstra. Veronica Simonetti mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening.