Zibby Owens: I’m here today with Lisa Damour, PhD, who is the New York Times best-selling author of Untangled and her latest book, Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls. She is the monthly Adolescence columnist for The New York Times. A graduate of Yale University with honors where she worked at the Yale Child Study Center, which by the way, so did I when I was at Yale, Dr. Damour earned her doctorate from the University of Michigan. She has written many academic papers related to child development and education. Dr. Damour currently directs Laurel School’s Center for Research on Girls. She maintains a private psychotherapy practice, consults, speaks internationally, and is a senior advisor to the Schubert Center for Child Studies at Case Western Reserve University. She currently lives in Shaker Heights, Ohio, with her husband and two daughters.

Welcome, Dr. Damour. Thanks for coming on “Moms Don’t Have Time to Read Books.”

Dr. Lisa Damour: You’re welcome. I’m delighted to be here.

Zibby: We’ve had a little session. I feel like you’ve already helped me out in my emotional issues.

Lisa: Psychologists are here to make people feel better. That’s our job.

Zibby: Thank you. Thanks, I got a little freebie or something on our way upstairs. Your most recent book, Under Pressure, please tell listeners what it’s about.

Lisa: The subtitle is Confronting the Epidemic of Stress and Anxiety in Girls. What it’s about is that I’ve been practicing for almost twenty-five years now. In that time, I would say it wasn’t until about ten years ago that I started hearing stress and anxiety come up a lot in conversations. Then I would say within the last five years, it is the conversation. That told me that it was a piece I probably wanted to work on. Also, what I have been hearing in the broad culture doesn’t actually match what we know in psychology about stress and anxiety. The culture as a whole talks about stress and anxiety as though they are always harmful, always pathological, that we want to avoid them. This is not at all the view in psychology. We actually appreciate that both stress and anxiety have a very wide band of healthy and that there is such a thing as unhealthy stress and unhealthy anxiety, but that’s a small percentage of it. I felt that I could write a book that I hoped would be reassuring in terms of articulating what we know as psychologists. I really mean the word know, not things that we’re thinking through, not fresh stuff in the field, not controversial information. Then to really try to give parents lots of ways to then respond helpfully when their daughter is stressed and anxious. I would say eighty percent of everything I write also applies to boy. Usually, it’s tipped towards girls.

Zibby: I know, you did have something in here about it happening more to women, this feeling of stress. In the beginning of your book, you talked about how teens these days feel more stressed than their parents, which I found very interesting. Although, some days my parents seemed to be very stressed. “They experience the emotional and physical symptoms of chronic tension like edginess and fatigue. Adolescents who report being highly anxious and coping with emotional problems are on the rise.” You wrote that “These trends do not affect our sons and daughters equally. It’s the girls who suffer more.” Why is that?

Lisa: There’s probably a couple reasons. One is that anxiety disorders have always been disproportionally diagnosed in girls and women as opposed to boys and men. It’s usually been a two-to-one ratio in terms of anxiety disorder diagnoses. The reason for this is we think it’s largely socialization, that girls and women are taught that if they’re distressed, to sort of collapse in on themselves, depression, anxiety, things like that. Boys and men are taught by the culture when they’re distressed, to act out, to mix it up, to get themselves in trouble. It’s not that boys and men don’t suffer. They don’t suffer as often as girls and women suffer in terms of feeling highly anxious and having, the technical term is internalizing disorders, holding it all in. There’s that reason. The other thing, though, if we think about why is it getting worse, what’s happening now, why does this feel like it’s taken this particular shape? I worry that we keep adding stuff to girls’ plates and nothing’s coming off. Girls are crushing it academically. And they’re incredible athletes. And they’re incredible musicians. And they’re starting businesses. And they’re still supposed to be cute. And they’re still supposed to be nice. And they’re supposed to still make everyone feel comfortable and maintain a whole lot of social ties and be agreeable doing the things we ask them to do. I think that piece, not that I want to go back to some retrograde moment when girls don’t have all the opportunities they have available, but all of this opportunity without the permission to excuse oneself from culture pressures to be adorable or thin or pleasant all the time isn’t a great recipe for girls.

Zibby: Probably not.

Lisa: That’s my hunch.

Zibby: I’ll go with you. You said also in your book, now that we’ve acknowledged the stress of girls, how to deal with it. You said one of the ways is that girls learn to cope with their stresses by watching their parents, everybody. I read this and I was like, oh, no. How we manage this as parents is going to inform how our kids end up coping. What are you supposed to do if you’re a parent who’s stressed out about stuff? which I’m obviously showing you that I am today about various things. How do you mask it? I feel like kids, even when you pretend like everything’s fine, they have those extrasensory abilities to know that you actually are hiding how you feel. What do you do?

Lisa: I think you’re right that we should work with the assumption that our kids know us better than we know ourselves. They can detect a change in the weather that we don’t even know has happened to us internally. There’s a few ways to tackle it. One is for us to be accepting of our own stress, to say, oh man, I had such a day. I am really feeling the force of it. I am really pretty tapped out right now. You may notice I’m a little bit tense. I’ll be better later, but right now, I’m feeling it. There’s a way you don’t have to hide it. There’s a way to talk about it that doesn’t seem frightened of it or worried about the implications of feeling stressed at all. That was part of why I wrote this book. I thought with the culture giving stress and anxiety such a bad name, kids now get stressed about being stressed and anxious about being anxious.

Part of how we can actually help them is to be like, man, I’m pretty stressed, but while saying in a sense of like, so be it. I’ll be okay. This will come. This will go. There’s that piece. Then a thing I’m really interested in is how we model coping because you’re always going to need to cope. Then I think there’s a smorgasbord board of what coping looks like. Sometimes coping looks like reaching out to someone you think can be helpful and asking their thoughts and guidance. It can be going for a walk. It can be watching what I call brain-rinse television, like really dumb stuff that just gives us tremendous relief. It can be being super crabby with everybody. It can be having too much wine. I think it’s less about keeping stress at bay or cloaking it and more about talking openly about stress and anxiety as a natural part of being human and then modeling excellent coping with it, would be my way for us to walk up to this as parents.

Zibby: What are a couple hacks for good coping?

Lisa: Good coping would be something like — I have two daughters. I’ll say, “Hey, will you take a lap around the block with me? I just need some fresh air. Just getting outside, I’ll feel better. I bet you’ll feel better. Would you do that with me?” So something like that. For me, walking actually is really a big relief. Our thing around our house is actually to goof a lot and to play in a goofy space. I would say playing with some version — every family’s got their own atmosphere and how they do it. I have a funny story, actually, about my kids being playful with me and me being playful with them. It involves saying the word ass, so I hope that’s okay on your podcast.

Zibby: It is now.

Lisa: That’s cleared, okay. I had been speaking at a school in Columbus, Ohio. The head of the school was a lovely guy, big, tall guy. Somehow, we got talking about our dream cars. He told me this story that I thought was really funny. He said that he’d always wanted a Mini Fiat. Then the day finally came where he could get a Mini Fiat. He picked it out at the dealer. His wife came down. His wife looked at this big, tall guy standing next to this Mini Fiat. He wife said to him, “You are a grown-ass man.” That just cracked me up so much. He’s like, “So I’ve got this SUV I don’t even want.” I thought this was so funny. I came home, and I told my two daughters who are nine and sixteen. They thought it was so funny.

Then a few weeks after that, I needed to give a talk. I live in Shaker Heights, Ohio. I got to give a talk at MetroHealth in Cleveland which is one of our hospitals that does some of the heaviest lifting on caring for the poorest members of our community. It’s in a very complex and tangle-y neighborhood to get to. I get lost extremely easily. I was complaining to my daughters that morning. I was like, “You guys, I have to go down to Metro. I’m afraid I’m going to get lost. This is the moment when maybe I’ll take an Uber just so I don’t have to deal with it.” My nine-year-old goes, “You are a grown-ass woman. You need to just get yourself down to Metro.” That kind of playful, get over yourself kind of thing, it just cracked me up so much. It actually really helped. It was really funny. That’s now this running joke in the family. It’s not always going to be the right thing at the right time, but that’s an example of where if a kid is really feeling — every once in a while, we’ll bust out, “Hey, you’re a grown-ass woman. Why don’t you just deal with that test?” Every family’s going to find their own formula. It’s okay to have things be hard. We can’t be frightened of those things if we don’t want our kids to be frightened of them.

Zibby: I love that. I’m going to try to use that in an appropriate way.

Lisa: Or not.

Zibby: Or maybe not. I loved in the book how you drew attention to the words stinks and handle, and how you say those more often than not when talking to teen girls. Tell me how you use them and how they’ve been so helpful to you.

Lisa: Much of caring for teenagers, whether it’s at home or in a practice like I do, is they just complain about stuff. They’ve got a lot of complaints. They’re unhappy about a lot of things. I generally think they’re almost a hundred percent accurate about what they find to be not the way they wish it were and maybe not even as it should be. One thing that I notice is a common misstep, and I make this constantly in my own life, is that when teenagers complain to us, we’re pretty quick to rush in with suggestions and solutions. Then we’re shocked, shocked, when they don’t seem to want to take our advice. I have found that the word stinks is my placeholder. What it reminds me of is that empathy is intensely therapeutic. We blow right past it, forget its utility, and then jump in with ideas, which most teenagers don’t want or don’t want right away. For me, when a teenager is unloading, whatever the miseries are of the day, I listen really intently. I’m not just waiting until they stop talking. Then I say, “Man, that stinks. That one stinks.” There’s something so economic about the word because it’s just got enough of a point on it that they feel like you heard them. It also has a little bit of, it’s within the realm of stuff that happens, not great, but in the realm of stuff that happens if you leave the house. Then after we’ve sat with it, I’ll say, “I think it’s something you can handle.” For me, handle is this critical word around managing stress and anxiety.

When teenagers are upset, the world for them can suddenly divide into two categories: stuff they like and stuff they consider a crisis. The role of adults is to constantly reintroduce the enormous middle category that takes up most of life, which is stuff we neither like, nor is a crisis. It’s just the stuff we handle. I feel like it’s my way of trying to reintroduce this idea of, you don’t have to like it, nor does anybody have to step in. This is in the handle category. I don’t like manage because manage feels like you’re still under it a little bit. For me, handle is, you’re a grown-ass woman. You can get in there and deal with that while not liking it at all. When I was in my training, I had a really fabulous and also kind of mean supervisor. She would say to me when I was learning how to take care of patients, “You get eight words per utterance, no more.” That’s really hard to do. The discipline that one gains is you realize if you’re going on and on, you’ve already lost the person. When psychologists are doing our best work, we’re very surgical in our use of language. We just go right for it quickly and directly and right to the heart of it if we can. For me, stinks and handle are my really solid old standbys on that.

Zibby: Eight words? That’s really tough.

Lisa: It is.

Zibby: Wait, how many was that? Eight words, that’s really tough. That was five.

Lisa: In twenty-five years of practicing, every time I really felt like I helped someone really shift, it was a sentence that maybe we built up to over months. I think about a young woman who was having a hard time leaving a job that had been given to her at a time when she didn’t really deserve it, and she knew it. Then she went in and just did a phenomenal job, actually turned a whole group around. She was feeling incredibly bad about leaving. I remember I said to her, “They saved you before you saved them.” I don’t know how many words that is, but it was just enough to let us pivot into something else.

Zibby: I think it’s seven.

Lisa: Okay, that’s pretty good. If you think about this versus if I were like, “Well, you know what happened, first you got there and you were feeling guilty. Now you’re not feeling guilty,” you’re already deep in the weeds. You’re in the head, not in the heart. It’s not like everything now I say is eight words. I’m lazier the longer I practice, but if I really want to get somewhere, the fewer words the better.

Zibby: It’s true because when you say, “You know what advice so-and-so gave me,” you never regurgitate lots and lots of things. They say, this is the one thing, like the highlight quote or topline. What are some other things you learned to be a great psychologist?

Lisa: Oh, man. Mostly, good psychologists, in my book, are intensely humble. It’s a funny thing in training where we get these grad students and we pour into their head, all this theory. We encourage them to make all these inferences about what’s going on with people. Then the work of actually practicing over years is to become more and more agnostic and more and more clear in one’s mind that you have no idea what anyone else’s experience is unless they tell you their experience. Even what they’re telling you may be their belief about what happened. It may not even be an accurate accounting. I would say any good clinician who’s been practicing over time just becomes a listener and then really waits for data to line up and line up and line up, and then makes conjectures with total humility about the likelihood that it may not be accurate. You feel your way step by step. There’s no formula. There’s, here’s my next best guess about what might be helpful. Let’s try it out and see if it lands. If it doesn’t land, I’m on the wrong path. We’ll find another. I think in some ways, the longer you practice, the more reserved and neutral you get and at the same time, much better as a clinician than when I was active and felt I knew what I was talking about.

Zibby: Isn’t that one of those things, like when you get older, all you do is realize how little you actually know? It’s like the same thing, right?

Lisa: Yeah, and you’re just a much better clinician. You’re like, “I don’t know. You tell me your story.” Then you think, gosh, isn’t that a rare gift? That would be psychotherapy at its best, like, “Hey, I want to hear your story. I come to it without any skin in the game. I’ve got no angle here. Let’s figure out your story. Let’s figure out where you’re stuck. Then I’ll watch while you figure out how to get unstuck.” It doesn’t look like much, but it’s actually a very rare way to be with people.

Zibby: I want that job.

Lisa: It’s a good one. I love my job. The reason I love my job is I cannot imagine retiring. I will learn something every day. I will never achieve mastery. That, for me, I think I’m kind of a learning addict. This idea of trying to learn people, it’s got no bottom, which is just perfect for me.

Zibby: That’s so cool. I love that. I was interested, though, in the book you do point out that at times you can be a very not-nice person. I am shocked. I was shocked even reading it because I was like, she seems pretty nice. I don’t know her yet. Now that I see you, you seem even more nice. What do you mean by that? What does your bad day look like? How bad do you get?

Lisa: I feel like in all honesty, we should ask my family.

Zibby: I’ll call them next.

Lisa: You call them next. Mostly, I have a very, very strong sense of there’s ways people treat each other. In our house, no mistreats anyone. That is out of bounds. I would like to think I don’t ever do that anywhere else in my life. When I said that in the book, I also have strong opinions. I know what fits for me and what doesn’t. My instincts are my best friends. If they don’t like something, they don’t like something. There’s nothing I can do about it. I think it’s more that I can be, it might come off as cynical, but not accepting of everything that comes my way and not even accepting of some things that I feel people around me might be accepting of. I’m trying to think of a good example. Right now, it’s the wellness industry. I’m really not loving the wellness industry right now. I’m all for well-being. I like the idea of wellness. I am really not loving the monetization of well-being, the idea that it’s acquired through the use of particular products, particular oils, particular weighted blankets, particular apps. I don’t think people in the well-being industry are ill-intentioned, but I worry that if we can first sell the idea that everybody’s supposed to be calm and relaxed all the time, which is not true, it’s grossly untrue, then the moment people don’t feel calm and relaxed, which usually takes within five minutes of waking, then we can show up with a fail. Oh, you don’t feel calm and relaxed? Here’s this item, this product to try to reestablish your, somehow it went missing, well-being. This, to me, I feel is really harmful.

I actually feel it’s a pretty dangerous path because there’s no way to feel good all the time. No generation before us was ever seeking that. I think that’s probably an example where I can have a kind of hairy eyeball about stuff that could come off as cynical or jaundiced. I’d like to think it’s all rooted in, I’m watching this not working for kids. I’m watching this back kids into corners they do not belong in. The way that I test this and think I might be on the right path is I often speak to groups of students. When I say, “Look, you’re supposed to be stressed. School’s really hard. You’re supposed to be anxious from time to time because it alerts you when something’s wrong,” their overwhelming response is they instantly feel so much better to hear that they’re supposed to be stressed at times. My goodness, they’re in seventh grade. Of course it’s anxiety central. What else would it be? Then I think, okay, we cannot be selling you anything suggesting that you’re not supposed to feel that way from time to time, if not often.

Zibby: As someone who has purchased more than one weighted blanket, I am sucker for a sales pitch. So far, no effect other than perhaps building up my biceps getting into bed.

Lisa: I’m sure it feels good. That’s great. But is it going to cure your problems? No. This is a more light-hearted look at it. You know how teenage girls love those face masks? They’re all into the face masks.

Zibby: Oh, yeah.

Lisa: Next time you encounter one, flip it over to the back and see what it says on the back. They promise a life of bliss. It’s really quite remarkable. This is the not-nice part of me. Then I’m in my grocery store. I see on the shelf, a jar of Noxzema. I pull it off. I’m like, there, look. See? Noxzema promises nothing because these things do nothing. This is my kind of face cream. It is telling the truth. These face masks, they lie. They lie. That’s the darker, cynical side of me.

Zibby: I love that. You can always trust Noxzema there in a pinch.

Lisa: You can.

Zibby: You’ve mentioned in the book that girls with learning disorders have elevated levels of anxiety, which of course makes sense. Is there anything you can do there? Do you treat the anxiety first? Do you treat the learning disorder first?

Lisa: I would probably go after the learning disorder first. If we zoom out for a minute, the issue here is kids are in school all day. School is their world. School is their social life. It is their job. It is their universe. If you happen to have a brain that was not designed to be taught the way most schools teach, that means you spend all day feeling like you’re kind of knocking on the door of a room that everybody else is in. Just the psychological wear and tear of that is hard to even think about, really. I’m always blown away by kids with learning disorders who keep trying. I’m like, why would you even keep trying? I would’ve given up years ago if I were you, these earnest kiddos who are just knocking and knocking on this door that just was not built to accommodate them. I would say first get them into the right setting or get them the supports that make their all day, every day not feel so, frankly, humiliating. That is the experience of kids. Then see what’s left to address. We have an extraordinary school in our community, Lawrence School in the suburbs of Cleveland, for kids with learning needs. They save kids’ lives. They save kids’ lives. I just feel like every community should have schools like this. Every kid should have access to schools that don’t make them feel like a square peg always trying to get into a round hole.

Zibby: I agree. That would be amazing, empowering. How do you deal with your own anxiety? You seem very calm to me.

Lisa: No, I would say —

Zibby: Today?

Lisa: I think I’m less anxious over time. One of the strange benefits of my professional life is sometimes I take care of some pretty awful outcomes, unexpected deaths, kids getting killed in car accidents and then taking care of the people around that situation. It’s funny. One of my very close friends is an oncologist who deals with pretty crummy leukemias. I think we like each other because our sense of what constitutes a crisis is pretty similar. No one’s mortally wounded or dying or dead? Okay, we can handle this. I think there is something, and I talk about this in Under Pressure, that dealing with stressful circumstances really does build up your capacity or adjust your yardstick for what’s worth getting amplified about. That does not mean that I walk through the world in a Zen state at all. I was giving a big talk a couple weeks ago. It was different from the kind of talks I usually give. I found myself suddenly becoming incredibly panicked that my flight was not going to get there as it’s supposed to and then trying to figure out if I could arrange a backup flight that I could cancel. Then I left my talk in the hotel room and had to zip back to get it. I had time and I got there. All very unlike me. I thought, I think I was a lot more anxious about that talk than I realized. I did all of this without any awareness that it was probably about the talk. I’m still learning myself, all the time.

Zibby: What do you credit — you’ve been so successful with your practice and these books and all of it. What do you think made you able to do this? I know obviously you’re super bright. When you think about our own daughters going off into the world and being able to internalize all of these coping skills and whatever but then also being able to pursue what they love and achieve and help others…

Lisa: That’s a really kind question. Born on third base, let’s start there. I was given a great education and had easy access to it. I was raised in a setting that was loving and supportive, and supportive of me. Then I would say I had the benefit of very good training very early in my career. I would say that is largely because I knew early on that I wanted to be a psychologist, and so I was able to line things up to move myself towards the kind of training I had in mind. One of the nicest things that was said when Untangled, my first commercial book, took off, a friend of ours in our neighborhood, a British friend, our friend Peter, he said, “Lisa, look at that. Twenty-five years into your career, you’re an overnight success.” I really appreciated it because it’s all I know. This is all I’ve ever done. I signed up for Intro Psych the second I got to college. We were talking about both working at the Yale Child Study Center. I took myself down there as a sophomore and started researching for them. I was collecting data on teenagers as a teenager. I was interviewing adolescents in the community. I think what has happened in terms of the shift into a more public domain is that up to that point, I had probably spent just under twenty years teaching college classes, writing books on the academic side, practicing a lot, working with lots of families, consulting a school in our community, Laurel School, and conducting research and reading research. I think what happened is all of those experiences that I had maintained privately and quietly as lots of working psychologists do, they all just happened to intersect at a point that seemed to be of use to a broader audience. That’s, I think, what happened.

Zibby: Having gone through the writing process now, I know you’ve done a lot of academic work and also your other books, what advice would you have?

Lisa: It is a skill like any other. I am coming up on seven years of writing for The New York Times. I look back on my early columns and I’m like, oh gosh, I would not write it that way at all now. I would just say I was a terrible writer coming out of high school. I was pretty crummy all through college and got incrementally better in grad school, but really didn’t start to hit my stride on it until out of grad school. I coauthored a teaching book with a very dear colleague who also happens to be an English professor. Then I coauthored a textbook in abnormal psychology. My half of that textbook was eight hundred pages long. Then we wrote twice. I have a funny story about that, actually. You get better. There’s no way you don’t.

The funniest thing, when we were writing the textbook, you end up with all this manuscript all around the house. My older daughter is sixteen. She was probably five or six when I was working on that book. I would carry with us everywhere we went, stacks of paper and markers. She would just draw and draw and draw. I could recycle paper all day long because I had so much paper. Then occasionally she would do a really fabulous drawing that I wanted to send to a grandparent. I’d always have to flip it over because the book was in abnormal psych, so I’m like, god, I hope there’s no paraphilias, perversions, on the other side. We can’t send to grandma, the sexual disorders chapters. I was flipping the other side to see what my kid was doing her kid art on. That huge stack, the volume of paper, I still have it. I haven’t gone through all the paper that textbook required.

Zibby: Wow, you have to go back just to see if you missed any art.

Lisa: Exactly, especially if it isn’t on the back of something X-rated.

Zibby: Thanks so much for coming on the show and sharing all your expertise.

Lisa: Thank you for what you do. What a valuable service.

Zibby: Thank you. Thanks.