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In general, one of the problems with treating depression “is that we’ve got a lot of medications that pretty much do the same thing,” Dr. Aaronson said. And when patients do not respond to those medications, “we don’t have a lot of novel stuff.”

The activity of the vagus nerve is difficult to measure directly, especially given how complex it is. But because some vagus nerve fibers connect with the heart, experts can indirectly measure cardiac vagal tone — or the way in which your nervous system regulates your heart — by looking at your heart rate variability, which are the fluctuations in the amount of time between your heartbeats, on an EKG.

Holding your breath and submerging your face in cold water can trigger the “diving reflex,” a response that slows the heart beat and constricts blood vessels. Some people who have tried it report that it has a calming effect and can even reduce insomnia. Others wrap an ice pack in cloth and place it on their chest to relieve anxiety.

“For wellness, try to maintain high vagus nerve activity through mindfulness, exercise and paced breathing,” Dr. Tracey said. “These are all very good for you.”

The company knows that strong negative emotions, which can be provoked by negative social comparison, keep users’ attention longer than other emotions—and Instagram’s algorithms are expressly designed to push teens toward toxic content so that they stay on the platform.

Instagram is peddling a false narrative that the platform is simply a reflection of its users’ interests and experiences, without distortion or manipulation by the platform. But Instagram knows full well that this not true. In fact, their very business model is predicated on how much they can manipulate users’ behavior to boost engagement and extend time spent on the platform, which the platform then monetizes to sell to advertisers.

The business model, which has proven itself to be exquisitely profitable, is self-reinforcing for investors and top management.

Although it’s a real struggle for parents to keep their kids off social media, they can set limits on its use, for instance by requiring that everyone’s phones go into a basket at mealtimes and at bedtime.

With all that we know today about the harmful effects of social media and its algorithms, combined with the powerful stories of teens, parents, and community advocates, we may finally have the opportunity to get meaningful federal regulation in place.

Using tech devices is addictive, and it's becoming more and more difficult to disengage with their technology.In fact, the average US adult spends more than 11 hours daily in the digital world

These days, we have a world of information at our fingertips via the internet. While this is useful, it does have some drawbacks. Entrepreneur Beth Haggerty said she finds that it "limits pure creative thought, at times, because we are developing habits to Google everything to quickly find an answer."

Technology can have a negative impact on relationships, particularly when it affects how we communicate.One of the primary issues is that misunderstandings are much more likely to occur when communicating via text or email

Another social skill that technology is helping to erode is young people's ability to read body language and nuance in face-to-face encounters.

young adults who use seven to 11 social media platforms had more than three times the risk of depression and anxiety than those who use two or fewer platforms.

Can you imagine doing your job without the help of technology of any kind? What about communicating? Or traveling? Or entertaining yourself?

Smartphone slouch. Desk slump. Text neck. Whatever you call it, the way we hold ourselves when we use devices like phones, computers, and tablets isn't healthy.

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

It would be easy to conclude that an absurdist view of life rules out happiness and leads anyone with any sense to despair at her very existence. And yet in his book, Camus concludes, “One must imagine Sisyphus happy

this unexpected twist in Camus’ philosophy of life and happiness can help you change your perspective and see your daily struggles in a new, more equanimous way.

he argues that despite the hardships of this world, against all apparent odds, human beings regularly experience true happiness. People in terrible circumstances bask in love for one another. They enjoy simple diversions

Even Sisyphus was happy, according to Camus, because “the struggle itself toward the heights is enough to fill a man’s heart.” Simply put, he had something to keep him busy.

Instead of feeling desperation at the futility of life, Camus tells us to embrace its ridiculousness. It’s the only way to arrive at happiness, the most absurd emotion of all under these circumstances

We shouldn’t try to find some cosmic meaning in our relentless routines—getting, spending, eating, working, pushing our own little boulders up our own little hills

Instead, we should laugh uproariously at the fact that there is no meaning, and be happy anyway.

Happiness, for Camus, is an existential declaration of independence. Instead of advising “Don’t worry, be happy,” he offers a rebellious “Tell the universe to go suck eggs, be happy.”

If embracing the ridiculous seems impossible to you, Camus says it’s only because of your pride.

“Those who prefer their principles over their happiness, they refuse to be happy outside the conditions they seem to have attached to their happiness,”

In fact, each of us can consciously implement Camus’ absurdism in order to forge a happier life. Here are three practical ways to find joy in the ridiculous.

1. Stand up to your ennui.

You can’t necessarily change your perception of the world, but, as I have written, you most certainly can change your response to that perception. Meet that feeling of despair with a personal motto, such as “I don’t know what everything means, but I do know I am alive right now, and I will not squander this moment

2. Look for opportunities to do a little good.

One of the best ways to cultivate futility is by focusing on the big things you can’t control—war, natural disasters, hatred—as opposed to the little things you can.

Those little things include bringing a small blessing or source of relief to others.

if your commute to work is a soul-sucking existential nightmare, don’t ruminate on the cars stopped ahead of you. Rather, focus on making space for that poor sap stuck in the wrong lane who’s desperately trying to merge

3. Be fully present.

Absurdity tends to sting only when we see it from the “outside”; for example, when you think about how meaningless it has been to wash the dishes every day in the past only to find them dirty again right now—and imagine the countless dish washings that the rest of your life will comprise.

Confronting the absurd is much more comfortable when you do so with mindfulness.

“While washing the dishes one should only be washing the dishes, which means that while washing the dishes one should be completely aware of the fact that one is washing the dishes.

When the broad sweep of life brings you horror, concentrate on this moment, and savor it. The pleasure and meaning you can find right now are real; the meaninglessness of the future is not.

Some mornings, I wake up seeing only boulders and can’t face pushing them once again up that hill

Those are the days when my old friend Camus comes in handy. Instead of despairing of the absurdity of life, I lean into it, laugh at it, and start my day in a light mood. Then I gather my beloved boulders and set out for the nearest hill.

The corporate gig, as a social media director for a tech platform, was a revelation. “I could just show up to work and do work,” Ms. Tilghman said. After she was done, she could leave. She didn’t have to be a brand. There’s no comments section at an office job.

In 2019, a Morning Consult report found that 54 percent of Gen Z and millennial Americans were interested in becoming influencers. (Eighty-six percent said they would be willing to post sponsored content for money.)

If social media has made audiences anxious, it’s driving creators to the brink. In 2021, the TikTok breakout star Charli D’Amelio said she had “lost the passion” for posting videos. A few months later, Erin Kern announced to her 600,000 Instagram followers that she would be deactivating her account @cottonstem; she had been losing her hair, and her doctors blamed work-induced stress

Other influencers faded without fanfare — teens whose mental health had taken too much of a hit and amateur influencers who stopped posting after an algorithm tweak tanked their metrics. Some had been at this for a decade or more, starting at 12 or 14 or 19.

She posted less, testing out new identities that she hoped wouldn’t touch off the same spiral that wellness had. There were dancing videos, dog photos, interior design. None of it stuck. (“You can change the niche, but you’re still going to be performing your life for content,” she explained over lunch.)

Ms. Tilghman’s problem — as the interest in the workshop, which she decided to cap at 15, demonstrated — is that she has an undeniable knack for this. In 2022, she started a Substack to continue writing, thinking of it as a calling card while she applied to editorial jobs; it soon amassed 20,000 subscribers. It once had a different name, but now it’s called “Offline Time.” The paid tier costs $5 a month.

Casey Lewis, who helms the After School newsletter about Gen Z consumer trends, predicts more pivots and exits. TikTok has elevated creators faster than other platforms and burned them out quicker, she said.

Ms. Lewis expects a swell of former influencers taking jobs with P.R. agencies, marketing firms and product development conglomerates. She pointed out that creators have experience not just in video and photo editing, but in image management, crisis communication and rapid response. “Those skills do transfer,” she said.