Category: Policy

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.

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:

• Among fifth graders, the association between physical aggression and media violence exposure is robust and persistent.
• The more violent media adolescents and young adults watch, the more likely they exhibit seriously violent behavior.
• Exposure to violent video games increases children’s dangerous behavior around real firearms.

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.)