“Mental health gets better when life gets better – and when we get better at life”: Dr Meg Jay

By Apoorva Gairola

The ‘frailty’ of youth receives much flak. Yet, when today’s youth set out to seek help, they often risk being over-diagnosed and over-medicated. Research has shown that the most stressed and least happy of all age groups are our youngest adults. Yet, there aren’t enough resources that cater specifically to early adulthood. This has resulted in the young-adult mental-health crisis.

Dr Meg Jay, a developmental clinical psychologist and educator specialising in 20-somethings, addresses this gap in her latest book, The Twentysomething Treatment: A Revolutionary Remedy for an Uncertain Age (HarperCollins India, INR 499).

The book prescribes “an age-specific approach to young-adult mental health”. The text focuses on key routes to better mental health including education, experience and expectations. It takes up issues most relevant to the current generation, such as the effects of social media, which Dr Jay refers to as “an evolutionary trap”, “a venue where tears and fears abound” and “a fertile ground for social contagion”.

While focusing on building skills that 20-somethings need, the author touches upon multiple aspects of their lives including how to think and feel, how to love and have sex, and even how to make decisions, find and choose purpose.

Advocating for “skills over pills”, the book highlights the ill effects of psychiatric medication such as numbing, being habit-forming, discontinuation syndrome and the fact that medication – despite addressing symptoms in the short term – does not teach a young adult any needed life skills.

Based in Charlottesville, Virginia, Dr Jay has authored three books on young-adult mental health. Her TED talk ‘Why 30 Is Not the New 20’ has garnered over four million views. She gives us a glimpse into what her latest book is all about.

⁠Treatment in mental health requires a significant degree of attention to context. How does your model aim to address subjectivity and achieve precision?

In my opinion, young-adult mental health absolutely needs to be placed in context. The 20s are the most uncertain years of life, and the brain interprets uncertainty as danger. So, it’s common and normal to feel anxious and hopeless, but that doesn’t mean you have a mental-health disorder.

Unfortunately, not enough clinicians or physicians do put young adults in context. They listen to their symptoms and decide that they meet criteria for mental-health disorders (which is very easy to do as a 20-something) and hand out diagnoses and medications, often without asking what might be going on in someone’s life. Most young adults feel anxious or depressed or scattered for a reason: new jobs or lack thereof, difficult relationships, poor habits.

You talk about the nocebo effect. Living in times of information overload and digital dependency, it seems impossible to not be exposed to mental-health content holes. How would you advise a young adult to navigate this space, especially if they are not enrolled in therapy or have access to it?

I assume most young adults will not be able to afford or access therapy, and that’s why I write books: because education is an intervention. So, here’s something important to understand. The nocebo effect is the power of negative expectations. When we tell young adults they have a disorder, or when they read online that they have lifelong problems or will always need medications, they lose hope.

When you let people know that it’s normal to struggle in your 20s and that life gets better, however, you are giving people hope. Hope is an elixir; it’s helpful and even healing. Young adults who have hope are less likely to feel anxious and depressed, more likely to work toward the future, more likely to engage in healthy behaviours, and less likely to think about ending their lives. It’s the power of positive expectations.

The book has been written keeping the young adult population in the United States in mind. Was that the only intended target audience? As a 30-something from South Asia, I found many things that are quite helpful and applicable to my life too.  

The target audience was 20-somethings all over the world. Most of the themes apply across oceans and borders. And, to your point, there is nothing in my books The Twentysomething Treatment or The Defining Decade that does not also apply to 30-somethings and beyond.

Both books are the science of adult development. I just happen to target 20-somethings and try to get the word out as early as possible. I know that 20-somethings are struggling worldwide, and I also know that therapy is not scalable.

If the last decade and more is anything to go by, social media is here to stay. As a psychologist, what changes would you like to see in this digital space, so as to minimise the ill effects if not completely eradicate them?

For kids and adolescents, I would like to see parents and institutions and corporations doing the hard work of limiting device use rather than just giving in. But because I work with young adults, I try to help them be more aware and intentional about their own device use.

Devices are like cigarettes, alcohol, drugs, food. You can have healthy or unhealthy habits. I ask clients to track their device use and pay attention to the results. How do they feel about how much time they are spending on screens? What do they think about how this time makes them feel? What would they like to do differently and what are their strategies for that?

I have never once had a 20-something tell me that they wished they spent more time on their phones.

How does one make a distinction between a ‘mental health problem’ and a ‘life problem’ at an individual level? Or is it something that can only be done in a clinician’s office?

Although medication is sometimes useful or necessary, 20-somethings need skills, not just pills. We need to talk more about empirically-validated developmental remedies – ones without dangerous side effects – such as helping young adults find and succeed at work; making friends; engaging in physical activity and healthy eating; choosing intimacy over porn; having healthier relationships with devices and substances; making decisions; learning to cook; finding purpose; finding love.

Life is the best therapist, and it is affordable and accessible and right outside your door. Mental health gets better when life gets better – and when we get better at life. That said, most young adults who are on medication don’t want to be on them forever, and no mental-health problems are best treated with meds alone, so all 20-somethings would benefit from building their skills.

India is a young country where therapy remains highly stigmatised and inaccessible. The primary mode of treatment remains psychopharmacology. How can change can be introduced in such a demographic?

The majority of young adults don’t need medication or psychotherapy. They need better information. Better jobs. Better relationships. Growth experiences. Young-adult mental health gets better when life gets better and so my work both as a therapist and as a writer is about helping people get better at life.

You’ve mentioned that believing in the possibility of positive outcomes is a route to better mental health. How can one possibly bracket the continual influx of negativity and cultivate and sustain the capacity for positive expectations?

The brain is wired to keep you alive, not happy. So, when life is uncertain, the brain assumes the worst and defaults to “catastrophic thinking”. You probably won’t be able to stop your brain from negative “what ifs”; it’s automatic and normal when you feel unsure of the world and yourself. What you can do is counter that by also taking time to think about positive “what ifs” as in “What if life goes well? What does that look like?”

The last chapter titled ‘The Tonic of Hope’ highlights the importance of employing the power of imagination for better mental health. Where would you draw the line between imagining and affirming that life might go well and deluding oneself?

When I talk about imagining life going well, I’m not talking about stopping there and hoping for the best. That’s manifesting. I’m talking about spending more time thinking about the life you want – thinking about hopes and dreams over fears and anxieties – and then asking yourself what you can to do now to get there.

You’ve written an entire book advising young people on how to live through the loneliest years of their lives. What is the one single most important piece of advice you wish they take home from this?

When faced with uncertainty and difficulty in your 20s, use a growth mindset. Too many 20-somethings think their 20s are going to be the best years of their lives, and it’s all downhill from there. In fact, your 20s are probably not going to be the best years of your life, and that’s good news.

Wellbeing follows a J-shaped curve across our lifespan. It takes a dip from childhood to young adulthood and then rises steadily in the decades after that. Mental health improves across every decade of adulthood from the 20s to the 80s. So do happiness and satisfaction, close relationships, financial stability, and meaning and purpose.

This may seem like bad news for 20-somethings but it’s good news for their future selves. I tell my clients that if your 20s turn out to be the best years of your life, then something has gone terribly wrong. Or, as a client put it to me once, “Don’t peak in your 20s!” Life should get better as you go.

How did you end up choosing psychology for a career?

I chose my career the same way I would advise my clients to: I tried the things that interested me, and I paid attention to the results. Psychology was a field that checked all the boxes for me: I was good at it; I enjoyed it; it was meaningful work; it paid the bills; and it offered a lot of flexibility. Over the years, and sometimes all at once, I’ve been a therapist, professor, consultant, speaker, and author. I’m largely in charge of what I do.

What can we look forward to, from you, in the future?

I’m actually thinking about moving backward and writing a book about college.

Apoorva Gairola is a psychology professional and former journalist/writer who is passionate about mental health, women’s and gender issues.