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Policy

The Word “Mental” in Project 2025. (iii)

Just to formally close out the series on Project 2025 and its intersections with mental health, let me comment on the third instance where “mental” shows up in the document. (The series starts here.) In short, the authors advocate that parents have unconditional and prompt access to all information their children share with schools, including:

surveys, about political affiliations or beliefs; mental or psychological issues (emphasis mine); sexual behaviors or attitudes; critical appraisals of family members; illegal or self-incriminating behavior; religious practices or beliefs; privileged relationships, as with doctors and clergy; and family income, unless for program eligibility.

The section cites two laws, the Family Educational Rights and Privacy Act (FERPA) and Protection of Pupil Rights Amendment (PPRA), both of which reportedly “require[s] schools to obtain parental consent before asking questions”. However, it sounds like some schools do not routinely obtain parental consent to ask questions of students. The authors suggest that concerned parents don’t have many options to enforce these laws.

Here’s the entire (and lengthy) paragraph on page 344:

At the same time, Congress should also consider equipping parents with a private right of action. Two federal laws provide certain privacy protections for students attending educational institutions or programs funded by the department. The Family Educational Rights and Privacy Act (FERPA) protects the privacy of student education records and allows parents and students over the age of 18 to inspect and review the student’s education records maintained by the school and to request corrections to those records. FERPA also authorizes a number of exceptions to this records privacy protection that allow schools to disclose the student’s education records without the consent or knowledge of the parent or student. The Protection of Pupil Rights Amendment (PPRA) requires schools to obtain parental consent before asking questions, including surveys, about political affiliations or beliefs; mental or psychological issues; sexual behaviors or attitudes; critical appraisals of family members; illegal or self-incriminating behavior; religious practices or beliefs; privileged relationships, as with doctors and clergy; and family income, unless for program eligibility. The difficulty for parents is that FERPA and PPRA do not authorize a private right of action. If a school refuses to comply with either statute, the only remedy is for the parent or student (if over the age of 18) to file an administrative complaint with the U.S. Department of Education, which must then work with the school to obtain compliance before taking any action to suspend or terminate federal financial assistance. Investigations can take months if not years. The department has never suspended or terminated the funding for an educational institution or agency for violating FERPA or PPRA. In essence, Congress has granted parents and students important statutory rights without an effective remedy to assert those rights.

In an effort to prevent “perfect” from becoming the enemy of “good enough”, I’ve abandoned trying to learn more about FERPA and PPRA. Rules and regulations related to education are not my expertise. All of us who work in health care, though, can comment on why privacy related to a person’s health is valuable, even if they are not yet 18 years old.

Yes, in an ideal world, all people under the age of 18 have trusting, caring, and safe relationships with their parents or caregivers. Civil conversations about mental health, sexuality, politics, and religion would be norms within households.

However, we don’t live in an ideal world.

There are reasons why young people don’t share their thoughts and feelings with their adults or caregivers. Sometimes the reasons aren’t valid. Young people sometimes underestimate their parents or have unjustified fears about their caregivers’ reactions.

However, there are other instances where a youth’s best option is to withhold information from their parents. Sometimes children feel that they must protect their caregivers. Sometimes kids realize that their parents cannot tolerate another worry. Sometimes children understand that their own health and safety are at risk because of the behavior of their caregivers.

Sometimes kids feel safer and more secure at school.

The authors of Project 2025 start from the assumption that parents know best, that their authority is the ultimate authority. Maybe parents do know best, but they don’t always behave the best. Some adults can and do misuse their authority. (To be clear, this can happen at school, too.)

This push to keep parents as the center of a young person’s life makes me think of Erik Erikson’s stages of psychosocial development. Erikson was a psychologist who came up with a model of psychological developmental milestones. You can review the stages here, which are presented in pairs to highlight the tension of the stage. For young people in school, the relevant stages are:

  • Initiative vs. Guilt
  • Industry vs. Inferiority
  • Identity vs. Identity confusion

Erikson proposed that the stage before “initiative vs. guilt” is “autonomy vs. shame, doubt”. I can’t read the minds of the Project 2025 authors, though in reviewing where the word “mental” shows up in Project 2025, there seems to be an emphasis on limiting the autonomy of multiple groups of people (women, transgender people, youth). External forces can induce feelings of shame and doubt, which people can then internalize. The world gets smaller: You feel constrained in who you can be and what you can do. Shame and doubt are strong inhibitors. Your autonomy disappears.

If we believe that all people have the “unalienable rights of life, liberty and the pursuit of happiness“, that means that we must allow and help people develop their own thoughtful autonomy so they can exercise those rights. Instead of insisting that schools abstain from having conversations about real issues with students, parents and caregivers can help young people develop thoughtful autonomy. Shame and doubt are not inherently bad; these feelings foster social bonds and a cooperative society. We don’t need to fear either autonomy or shame. For our individual and community mental wellness we need both.

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Consult-Liaison Observations

Observations from the Trump-Zelensky Meeting.

For your consideration, here are a few observations about the Trump-Vance-Zelensky argument in the Oval Office today from a psychiatrist:

Vice President Vance began attacking President Zelensky after Zelensky suggested that American diplomacy was not working. Vance started with: “What makes America a good country is America engaging in diplomacy. That’s what President Trump is doing.” After some back and forth, Zelensky said: “But after that, [Putin] broke the ceasefire, he killed our people, and he didn’t exchange prisoners. We signed the exchange of prisoners. But he didn’t do it. What kind of diplomacy, JD, you are speaking about? What do you mean?”

The insinuation here is that if the diplomacy of Trump, the face of America, was effective, Putin would have not broken the ceasefire and killed people. Vance reacted to Zelensky without providing an actual description of diplomatic efforts. He instead immediately pivoted: “Mr. President, with respect, I think it’s disrespectful for you to come into the Oval Office to try to litigate this in front of the American media.”

A couple things here: Zelensky’s body language prior to Vance’s reaction is open and engaged. He is leaning forward and making solid eye contact in Vance’s direction. He is making emphatic gestures. The tone of his voice when he asks, “What kind of diplomacy, JD, you are speaking about?” suggests disagreement, but not hostility.

When Vance responds, Zelensky’s body language immediately shuts down: He sits back and crosses his arms. He looks away. His eyebrows do heavy lifting here; he looks perplexed. His mouth hangs open a bit. Perhaps he is restraining himself from saying things he will later regret. Vance, for his part, gets pointy, both in his speech and with his index finger.

There is little that is respectful in Vance’s statement of “Mr. President, with respect, I think it’s disrespectful for you to come into the Oval Office to try to litigate this in front of the American media”. To criticize a leader’s character in front of cameras is not respectful. To physically point and wag the pointing finger at the president is not respectful. Just because you say “with respect” doesn’t make it respectful. Whenever speech and behavior contradict each other, behavior is more likely to convey the true sentiment.

President Trump began to attack President Zelensky after Zelensky used the word “feel”. Here’s the exchange:

Zelenskyy: “First of all, during the war, everybody has problems, even you. But you have nice ocean and don’t feel now. But you will feel it in the future. God bless –”

Trump: “You don’t know that. You don’t know that. Don’t tell us what we’re going to feel. We’re trying to solve a problem. Don’t tell us what we’re going to feel.”

It’s not even clear what feelings either man is talking about. Zelensky tries to elaborate by saying “You will feel influenced.” Trump immediately disagrees: “We are going to feel very good and very strong.”

Let me get pedantic here: “Influenced” is not an emotion. Neither is “very good” or “very strong”. In reading context clues, my guess is that Zelensky was trying to convey that the United States would feel “threatened” (which is not an emotion, either; fear is the emotion that underlies threats). Trump, whose behavior consistently reveals that he is obsessed with status, can’t tolerate the idea of feeling fear. He seems to believe that feeling fear means you are a beta.

Furthermore, Trump likely views Zelensky as having lower status than him. How dare someone who is “lower” than him tell him how he is going to feel! And in front of cameras! You are not the boss of me!

Maybe I am reading too much into Trump’s reactions to “feelings”, but…

President Trump gets red in the face as they continue to talk about feelings. They don’t linger on feelings for long; soon the conversation shifts to the metaphor of playing cards.

Trump becoming red in the face at this point is noteworthy because once Trump and Zelensky are talking at and over each other, Zelensky’s body language opens up. He uncrosses his arms, drops them to his lap, and makes some gestures. His eyebrows return to heavy labor; he again looks perplexed and ultimately looks away. These changes in body language indicate an effort (maybe nonconscious, though Zelensky has a history as an actor) to de-escalate the situation. What we learn here is that Zelensky is showing some deference to Trump that he did not show to Vance. Trump either doesn’t recognize or acknowledge Zelensky’s efforts to re-establish rapport. He gets red in the face, his voice gets louder, and he becomes more animated. What button did Zelensky push? Was the button labeled “feelings”?

President Trump settles down after Vice President Vance intervenes. What breaks the cross-talk between Trump and Zelensky is Vance asking Zelensky, “Have you said thank you once?”

I wonder if Vance has learned when to intervene to uphold Trump’s perceived status. Maybe Vance knew that, if this interaction continued, Trump would say or do something foolish that would result in an undeniable drop in his status in front of cameras. Zelensky’s body language was beginning to match Trump’s, suggesting that his deference from moments before was disappearing. What better way to artificially elevate one person’s status by coercing the other person to say “thank you”?

Among pro-social people, saying “thank you” is a gracious way to promote and sustain social bonds. We say “thank you” because it is an expression of cooperation, not conflict. However, some people view the phrase “thank you” as an act of submission: YOU are thanking ME because I bestowed something on YOU which means I have more power than YOU.

Following this cue, we hear Trump make comparisons to elevate his status because Zelensky does not say “thank you” to Trump; he does not submit. Trump says Biden is “not a smart person” (implying that he is); Trump asserts that “Obama gave sheets, and Trump gave Javelins”.

Zelensky, ambushed and outnumbered, looks resigned: His shoulders droop, he slowly rubs his fingers over his clasped hands. His eyebrows can no longer do all the work, so the worry spills all over his face.

What we witnessed today, like so many days in the past month, was ugly and cruel. Cowards only jeer when they are playing at home.

Categories
Reflection

Obituary for Yang the Elder.

Yang the Elder died at the age of 77 on February 8th, 2025. He would not approve of this obituary.

Mourning his death are his two older brothers, but his favorite (and only) child misses him the most.

He was born in Yangzhou, China, though, six months later, his parents scooped him and his three older brothers up and left the country. They settled in Taiwan and it was there that he met his future wife (who preceded him in death).

After graduating from college in Taichung with high marks and completing mandatory military service, he was accepted at the University of Detroit to earn a Master’s degree in applied math. This was his ticket to the United States to pursue the American Dream.

He was a computer programmer before it was cool. As one of the few people who knew how to operate mainframe computers, which occupied entire rooms, he had a productive career in systems programming. This amazing immigrant worked at major American corporations like IBM, Amtrak, Boeing, and McDonnell Douglas. It was with enthusiasm and wonder that he introduced his family to the “World Wide Web” in the early 1990s. He continued to be an early adopter of computer technology, which is why he used emojis with ease up until the last year of his life.

He loved the idea of America. He believed in and defended democracy. After the Tiananmen Square Massacre, he took his family to the federal building in Los Angeles to protest the Chinese government’s actions. Later, during what started out as a peaceful family picnic in Yosemite Valley at his favorite national park, he ended up arguing with tourists from China about how the Chinese government was wrong to kill their own people.

He appreciated many aspects of American culture: He never missed a senior discount shopping day. Music by Simon and Garfunkel, the Beatles, Judy Collins, and Stevie Wonder brought him pleasure. He continued to shout encouragement at the Washington Redskins (now Commanders) on TV even after the family moved to California. His collection of Converse shoes (all purchased on sale) was spectacular, particularly a maroon pair with matching polka-dot laces.

Kindness and courtesy were important to him: He learned the names of people who helped him and greeted them by name whenever he saw them. He routinely gave small snacks to familiar grocery clerks, building janitors, and the barber. He said “thank you” whenever the opportunity arose.

Lastly, he enjoyed being outside and taking long walks. If a tree was bearing fruit, he’d casually pluck one from a branch, peel it open, and taste it. He could identify all the skyscrapers in downtown Seattle by name. He always looked for life in the water and among the clouds.

Per his wishes, there will not be a funeral or memorial.

If you live in or around Seattle, his favorite parks included the Washington Arboretum, Seward Park, and Myrtle Edwards Park. Regardless of where you are, in his memory, take a walk outside and marvel at the trees, water, and sky.

Categories
Policy Reading

The Word “Mental” in Project 2025. (xiv + xv + xvi)

Guys, we’re getting to the end of this project! We’ve made it to the last three instances (14, 15, and 16) of the word “mental” in Project 2025. (I still need to return to the third instance; that will follow soon.) This will also be a short post because there’s not much to analyze in these last three instances.

The 14th instance of the word “mental” in Project 2025 is on page 879, in the closing section about the FTC:

Conservative approaches to antitrust and consumer protection continue to trust markets, not government, to give people what they want and provide the prosperity and material resources Americans need for flourishing, productive, and meaningful lives. At the same time, conservatives cannot be blind to certain developments in the American economy that appear to make government–private sector collusion more likely, threaten vital democratic institutions, such as free speech, and threaten the happiness and mental well-being of many Americans, particularly children. Many, but not all, conservatives believe that these developments may warrant the FTC’s making a careful recalibration of certain aspects of antitrust and consumer protection law and enforcement.

The 15th instance is a footnote at the end of the FTC chapter:

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is the authoritative publication of the American Psychiatric Association.

(Comment: Yes, the DSM-5-TR is an authoritative publication, though it’s not without problems.)

The 16th instance is also a footnote and contains a reference:

Allcott, supra note 19; see also Jean M. Twenge, Jonathan Haidt, Jimmy Lozano, and Kevin M. Cummins, “Specification Curve Analysis Shows that Social Media Use Is Linked to Poor Mental Health, Especially Among Girls,” Acta Psychologica, Vol. 224 (2022), p.103512, https://doi.org/10.1016/j.actpsy.2022.103512 (accessed March 23, 2023).

I don’t have anything more to add to what I noted earlier:

… there’s ambivalence in this chapter about the role of the FTC. Children’s mental health is used chiefly as a potential subject of regulation. Who is better poised to regulate social media and its effects on children? The government? Or parents? Surprisingly, this seems open to debate in this section.

The reference to the Acta Psychologica journal article (16th instance) is also interesting. We’ve discussed elsewhere in this series how the authors of Project 2025 have often ignored published data because it does not support their policy platform. We’ve also observed that this chapter on the FTC is notably less inflammatory than other chapters. Of all the articles they could have referenced that draws associations between social media and adverse mental health, they chose that one? (And only one?) Yours truly wasn’t put on retainer to find evidence to support that argument and found more than one robust and relevant resource to do so.

The Presidential inauguration is happening in less than one month. Thanks for reading along with me. We together can watch how the new administration implements policies from Project 2025 and uses “mental health” as the reason why. We will know if they are using data and evidence, or just making things up because they can. If you have found this series useful, please share with others what you’ve learned.

Categories
Policy

The Word “Mental” in Project 2025. (xii)

The twelfth (and thirteenth) instance of the word “mental” in Project 2025 is on page 876, still in the section about the Federal Trade Commission:

Other conservatives are more skeptical concerning the effect of online experience on the young, comparing the concern about social media to concern about video games, television, and bicycle safety. They point out, as does Cato fellow Jeffrey A. Singer, that the psychiatric profession has yet to designate “internet addiction” or “social media addiction” as a mental disorder in the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). These conservatives also maintain that calling for regulation undermines conservatives’ calls for parental empowerment on education or vaccines as well as personal parenting responsibility.

Although Project 2025 already decries social media companies in at least two earlier sections in the text, here the authors equivocate: Maybe social media isn’t that harmful to young people. Or maybe it’s better if we leave the regulation of kids’ social media use to parents.

The topic here is about the internet, but they make a comparison to earlier forms of media, namely video games and television. There are, in fact, multiple studies that confirm a linkage between video games and television and violent behavior among children:

Prior to the publication of DSM 5, the most recent edition of the text that lists all psychiatric diagnoses in use, some psychiatrists expressed concerns for a diagnosis that seemed like “internet addiction”:

the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and consists of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging.

This came from growing concerns of youth spending a lot of time online in China and South Korea. That article was published in 2008, when social media, though common, had yet to hit its peak.

Some advocated more research into this possible condition because “it is not clear whether internet addiction usually represents a manifestation of an underlying disorder, or is truly a discrete disease“. For example, were people addicted to the internet because they actually had social phobia? Or did people actually have a gambling disorder, and gambling on the internet was easier to access?

From a paper entitled “Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field”:

The umbrella term “Internet addiction” has been criticized for its lack of specificity given the heterogeneity of potentially problematic behaviors that can be engaged in online as well as different underlying etiological mechanisms. This has led to the naming of specific online addictions, the most notable being Internet Gaming Disorder (IGD).

It’s true: People use the internet for a variety of reasons. Some people return to and seemingly cannot leave certain sites: Social media; porn; gambling; games. Would “internet addiction” include both an older person who spends eight hours a day checking their bank balance (because of anxiety? paranoia? dementia?) AND a young man who plays Fortnite for hours instead of sleeping?

“Internet gaming disorder” does appear as a “condition for further study” in DSM-5 (here’s a public-facing page with less detail):

The essential feature of Internet gaming disorder is a pattern of excessive and prolonged participation in Internet gaming that results in a cluster of cognitive and behavioral symptoms, including progressive loss of control over gaming, tolerance, and withdrawal symptoms, analogous to the symptoms of substance use disorders.

The diagnosis excludes social media. This suggests that there was already some question that social media overuse could be its own diagnostic entity:

Excessive use of the Internet not involving playing of online games (e.g., excessive use of social media, such as Facebook; viewing pornography online) is not considered analogous to Internet gaming disorder, and future research on other excessive uses of the Internet would need to follow similar guidelines as suggested herein. Excessive gambling online may qualify for a separate diagnosis of gambling disorder.

The only other place “social media” shows up in DSM 5 is under the proposed condition of “Nonsuicidal Self-Injury Disorder”:

The essential feature of nonsuicidal self-injury disorder is that the individual repeatedly inflicts minor-to-moderate, often painful injuries to the surface of his or her body without suicidal intent. Most commonly, the purpose is to reduce negative emotions, such as tension, anxiety, sadness, or self-reproach, or less often to resolve an interpersonal difficulty.

Additional prospective research is needed to outline the natural history of nonsuicidal self-injury disorder and the factors that promote or inhibit its course. Individuals often learn of the behavior on the recommendation or observation of another, through media outlets, and through social media.

Some literature describes the phenomena of “copycat suicides” and “suicide contagion”, which has prompted the American Foundation for Suicide Prevention to issue safe reporting guidelines for media. The goal is, in part, to help journalists reduce this contagion in their publications. It is unclear if such a contagion exists for nonsuicidal self-injury. It is indeed true that some young people learn about this destructive behavior through social media.

Do I appreciate the deference the authors of Project 2025 show here towards the profession of psychiatry and DSM-5? Not really. I find the overt deference jarring because, as we have seen, the authors of Project 2025 haven’t deferred to scientists and available data to inform other policy positions (e.g., abortion, gender-affirming care, homelessness).

As a reminder, the only reason why the subject of mental health even shows up in the FTC section is to insert parents into any contracts kids might make over the internet:

The FTC can and should institute unfair trade practices proceedings against entities that enter into contracts with children without parental consent.

But, again, the authors here seem to wobble about who is better poised to regulate the internet here: Parents? or the government?

And, like we’ve already seen in this document, the approach seems to be all or nothing. It’s either parents or the government, not both. (This sort of all-or-nothing, black-or-white thinking isn’t limited to people with conservative persuasions alone. Silence doesn’t always mean violence; defunding the police has increased problems for some of the most vulnerable populations; etc.)