We speak with psychiatrist Dr. Chiké Nwankwo, who offers his perspective on students’ mental health. He discusses how we see achievement, how our relationship to technology may be increasing our anxiety, and most importantly, how students and parents can change their mindsets to better manage stress.
Can you tell our readers a bit about your background and what you do now?
I’ve always been interested in both the hard sciences and the humanities. After considering surgery in med school, I settled on psychiatry as a nice blend of those two fields. My approach is a based on a biological/psychological/social model; I’ve always been fascinated by the way the brain works, which is an area where we have truly just begun scratching the surface in terms of knowledge.
I work in adult psychiatry, but I also spent two years specializing in work with kids, which includes teens. Those patients require a different approach, because they rarely show up of their own volition. Usually they’re in my office because their parents are concerned and have required them to come see me.
What I really like about working with kids is that they don’t care what fancy degrees I have hanging on my wall. They just want to hear somebody say “I know things are rough for you right now. Let’s figure out how to make your life easier.” Kids really resonate with that kind of dialogue, because so often they’re not approached with that level of respect. For all my patients, regardless of age, it’s important that they take ownership of their treatment, their medications, and their decision-making.
What are you seeing in your practice in terms of stress and anxiety in students these days?
To describe what I’m currently seeing in my practice, I need to back up a little and explain what it’s like to live in Seoul, Korea. I lived and worked in Seoul for a number of years in the 90s, and one of the big jokes there is that people are asleep everywhere. It’s a joke, but it’s also absolutely true. The reason is that everybody there works such long hours, including Saturdays and evenings, that they literally don’t have enough time to sleep.
You even saw this happening with kids. They go to school full time, then after school they have English lessons, taekwondo, tutoring, and homework, and they’re completely exhausted. The older you got, the more stress and pressure you felt to keep up with this pace. The cultural norm was to be constantly working and constantly overtired.
In my practice in the Boston area, I’m seeing things move more and more in the direction of what I experienced in Seoul. It seems like the NY Times has an article about stress and students every other week. Parents are talking about the stress their kids face, but they’re overstressed too. Parents are working later, so they’re keeping their kids up later to be able to spend time with them, or getting up to see their kids in the morning because they know they’ll be in bed by the time they get home at night. The kids are running around to sports practices and club meetings, and they have larger and larger piles of homework to tackle on top of that.
What do you think is driving this push to work harder and get more done?
That’s a big question. Frankly, part of it is that we’re bad at managing the technology we’ve created. We can use the technology, but it’s important to ask whether it’s actually working for us. We struggle with setting boundaries around things like email, and that’s accelerated significantly with smartphone usage. At this point, it seems we are starting to realize the toll technology is taking on us, and that although those emails feel urgent, we don’t actually have to respond to them right away.
Do you have recommendations for how parents and students can improve their relationship to technology?
Technology is a tool. Your smartphone is like a hammer: it’s useful, but only if it’s serving its purpose. In general, bringing mindfulness to your technology usage can be very helpful. Notice how often you are checking your emails or scrolling through social media. A few pieces of advice I’ve read that seem especially helpful are only checking your email at specific times throughout the day, keeping your phone on silent unless you’re expecting a call, and starting your day early so you have some quiet time before the emails start flooding in.
Even though technology is part of the problem, it seems like there must be an underlying root cause creating this frenzied push to constantly achieve more.
Absolutely. I was in Seoul before this big technology boom, and people were still overworked and overtired. Technology adds fuel to the fire, but the underlying cause is that emphasis on achievement, like you mentioned, and the notion that as people get more efficient, they should be expected to produce more work.
In terms of parents and children, parents probably harbor a lot of fear that their children won’t be able to achieve the same level of success as they have, assuming you’re defining success in terms of financial security and a certain quality of life. The middle class is undoubtedly shrinking in this country, and people want their progeny to be as successful as possible.
There’s also some evidence that today people are working harder than ever, but not necessarily more efficiently than ever. Science has shown that when you’re interrupted, for example, you lose not just the time of the interruption, but also a chunk of time re-engaging in whatever you were previously doing. Again, we see technology and the culture of distraction playing a role in the way we work today.
Do you see a connection between achievement and happiness?
I do, to a certain extent. Studies have shown that happiness does improve when people earn more money, but only up to a point. After you have achieved a specific level of income, which isn’t as high as you might think, having more money brings diminishing returns on happiness.
Achievement is best defined by the individual. It could mean security, self-worth, adventure, facing your fears, overcoming challenges, or something else. We all have a relationship to achievement, and that can be informed by our current culture, our family of origin, and how we grew up. There are many myths and stories about achievement and life’s journey that are passed down through various cultures.
For some individuals, achievement means freedom or leaving a life-threatening situation. For others, it’s an obligation to avoid bringing shame or a loss of status on the family. This could influence whether students view achieving as a fun and exciting challenge, or as an act fueled by fear. If possible, I prefer students who are motivated by the former. These students view failures, including potential academic setbacks, as a natural part of progress. Because the reality is if you’re performing at the top edge of your potential, you’re going to fail now and then.
One way to start unpacking all of these ideas about achievement is to ask why. Why do I want to reach this goal? Why do I want a certain level of success? If the answers are grounded in what matters most to that individual, they’ll have fresh perspective on the hard work it takes to get there. Helping students assert their autonomy is really valuable for high schoolers, and it can also prevent the classic “teenage rebellion,” which often comes from a desire for independence.
You see teens dealing with academic burnout as a result of all the pressures we’ve discussed. How do you work with them to help manage their stress, anxiety, or depression?
First, I acknowledge that it’s brave for them to be in my office. They are willing to admit that something is not working, and they are also willing to look at why. It’s a vulnerable situation to be in, and many people aren’t willing to do it. I approach the work from a place of unpacking it and making sense of it together. “Let’s find out what happened, how you got here, and where you want to go.” One of the responsibilities of a physician is to decrease suffering, so that’s where I’m coming from. I want to decrease my patients’ suffering whenever I can.
What advice do you have for parents who see that their kids are pushing themselves too hard, maybe heading toward this place of burnout?
I would start by telling parents that although I may be the expert on kids in general, they are the experts about their own kids. They should trust their instincts on what’s happening with their children.
It’s also important for parents to take care of themselves. It’s easy to place the blame on parents, but many adults are just as overwhelmed as their high schoolers. A parent who is stretched too thin will have a harder time caring for their children. If you’re depleted, you can’t fill anybody else up. Operate from a calm, relaxed place as often as you can, especially when trying to help your children. Learn from your setbacks, and make sure you’re modelling good behavior. At that age, kids may be watching what you do more than listening to what you say.
Dr. Chiké Nwankwo is an adult and child psychiatrist. He completed his medical training at Harvard and is a TEDx presenter. Dr. Chiké currently treats adults and children in his practice in Brookline, MA.