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America’s Intimacy Problem

www.theatlantic.com › newsletters › archive › 2023 › 04 › americas-intimacy-problem › 673907

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In recent years, Americans appear to be getting more and more uncomfortable with intimacy. Why? And is this trend reversible?

First, here are three new stories from The Atlantic:

The GOP’s unworkable work requirements Why won’t powerful men learn? Just wait until Trump is a chatbot. Disconnected People

When my colleague Faith Hill recently interviewed Michael Hilgers, a therapist with more than 20 years of experience, he painted a worrying picture of intimacy in America: “It’s painful to watch just how disconnected people are,” he said. Even when Hilgers can sense that clients do want to pursue deep social connections, “there’s a lot of confusion and fear in terms of how to get there,” he noted.

One might say that America is in its insecure-attachment era.

Let’s back up a little: Insecure attachment is a term used to describe three of the four basic human “attachment styles” that researchers have identified. The framework has risen in popularity in recent years, appearing alongside astrology signs and Enneagram types as social-media-friendly ways to understand the self. Faith lays out the four styles in her recent article:

People with a secure style feel that they can depend on others and that others can depend on them too. Those with a dismissing style—more commonly known as “avoidant”—are overly committed to independence and don’t feel that they need much deep emotional connection. People with a preoccupied (or “anxious”) style badly want intimacy but, fearing rejection, cling or search for validation. And people with fearful (or “disorganized”) attachment crave intimacy, too—but like those with the dismissing style, they distrust people and end up pushing them away.

Over the past few decades, researchers have noticed a decline in secure attachment and an increase in the dismissing and fearful styles. These two insecure styles are “associated with lack of trust and self-isolation,” Faith explains. She notes that American distrust in institutions has also been on the rise for years—it’s well known that more and more Americans are feeling skeptical of the government, organized religion, the media, corporations, and police. But recent research and anecdotal evidence suggest that Americans are growing more wary not only of “hypothetical, nameless Americans,” but of their own colleagues, neighbors, friends, partners, and parents.

The root causes of America’s trust issues are impossible to diagnose with certainty, but they could well be a reflection of Americans’ worries about societal problems. One psychologist who did research into Americans’ insecure-attachment trend “rattled off a list of fears that people may be wrestling with,” Faith writes: “war in Europe, ChatGPT threatening to transform jobs, constant school shootings in the news,” as well as financial precarity. As Faith puts it: “When society feels scary, that fear can seep into your closest relationships.”

Some researchers argue for other likely suspects, such as smartphone use or the fact that more Americans than ever are living alone. The decline in emotional intimacy is also happening against the backdrop of a decline in physical intimacy. Our senior editor Kate Julian explored this “sex recession,” particularly among young adults, in her 2018 magazine cover story.

A lack of trust is showing up in the workplace as well. In 2021, our contributing writer Jerry Useem reported on studies suggesting that trust among colleagues is declining in the era of remote and hybrid work:

The longer employees were apart from one another during the pandemic, a recent study of more than 5,400 Finnish workers found, the more their faith in colleagues fell. Ward van Zoonen of Erasmus University, in the Netherlands, began measuring trust among those office workers early in 2020. He asked them: How much did they trust their peers? How much did they trust their supervisors? And how much did they believe that those people trusted them? What he found was unsettling. In March 2020, trust levels were fairly high. By May, they had slipped. By October—about seven months into the pandemic—the employees’ degree of confidence in one another was down substantially.

All in all, as Faith writes, “we can’t determine why people are putting up walls, growing further and further away from one another. We just know it’s happening.” The good news is that if humans have the capacity to lose trust in one another, they can also work to build it back up. “The experts I spoke with were surprisingly hopeful,” Faith concludes:

Hilgers [the therapist] knows firsthand that it’s possible for people with attachment issues to change—he’s helped many of them do it. Our culture puts a lot of value on trusting your gut, he told me, but that’s not always the right move if your intuition tells you that it’s a mistake to let people in. So he gently guides them to override that instinct; when people make connections and nothing bad happens, their gut feeling slowly starts to change.”

As Faith argued in an earlier article, attachment styles are not destiny, despite what the internet might lead you to believe. “Your attachment style is not so much a fixed category you fall into, like an astrology sign, but rather a tendency that can vary among different relationships and, in turn, is continuously shaped by those relationships,” she wrote. “Perhaps most important, you can take steps to change it”—and connect with others better as a result.

Related:

America is in its insecure-attachment era. The trait that “super friends” have in common Today’s News Russia’s Defense Ministry said that it had targeted Ukrainian army reserve units with high-precision missile strikes to prevent them from reaching the front lines. A Utah judge postponed ruling on a statewide abortion-clinic ban to next week, following the failure yesterday of two anti-abortion bills in Nebraska and South Carolina. Former Vice President Mike Pence reportedly appeared before a federal grand jury for more than seven hours to testify in a criminal investigation into alleged efforts by Donald Trump to overturn the results of the 2020 election. Dispatches Books Briefing: We need to make room for more voices in philosophy, Kate Cray writes. With a wider canon, enlightenment could come from anywhere. Work in Progress: AI tools are a waste of time, Derek Thompson argues. Many people are simply using them as toys.

Explore all of our newsletters here.

Evening Read Maskot / Getty

A Teen Gender-Care Debate Is Spreading Across Europe

By Frieda Klotz

As Republicans across the U.S. intensify their efforts to legislate against transgender rights, they are finding aid and comfort in an unlikely place: Western Europe, where governments and medical authorities in at least five countries that once led the way on gender-affirming treatments for children and adolescents are now reversing course, arguing that the science undergirding these treatments is unproven, and their benefits unclear.

The about-face by these countries concerns the so-called Dutch protocol, which has for at least a decade been viewed by many clinicians as the gold-standard approach to care for children and teenagers with gender dysphoria.

Read the full article.

America’s Adult-ADHD Problem

found Apr '23 The Atlantic

www.theatlantic.com › newsletters › archive › 2023 › 04 › americas-adult-adhd-problem › 673886

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More than six months after the FDA announced a shortage of the ADHD drug Adderall and its generic variations, many Americans who rely on the medication continue struggling to obtain it. This supply crisis points to serious inadequacies in the diagnosis and treatment of the disorder, especially in adults.

First, here are three new stories from The Atlantic:

America is in its insecure-attachment era. “I don’t want to see you get high.” Clarence Thomas is winning his war on transparency. Dangerous Gaps

Much has been written about the toll of the ongoing Adderall shortage on Americans with ADHD, a population that includes me. But we don’t get enough credit for our ingenuity.

This week, for instance, I repeated the baroque prescription-refill process that I first developed last summer—months before the FDA’s formal announcement of a supply shortage in October, but by which point the shortage was apparent to legion prescribers and patients across the country. Among other steps too tedious to detail here, the task involves placing prescription orders at small neighborhood pharmacies (which are more likely than national chains to have the drug in stock) with somewhat restrictive hours of operation. On the whole, this strategy has worked out; throughout the supply shortage, I’ve gone very few days without access to medication. Many others have been less lucky.

As my colleague Yasmin Tayag noted in a recent Atlantic article, this medication shortage is the result of a “perfect storm” of manufacturing and regulatory factors, compounded by a dramatic surge in demand. Although the pandemic accelerated that trend, it’s been in motion for years: From 2007 to 2016, adult-ADHD diagnoses shot up by 123 percent in the U.S., and adults replaced children as the primary consumers of the medications typically prescribed to treat the condition. Both the acute spike and the longer-running pattern can be attributed, at least in part, to growing awareness about the presentation of ADHD and other executive-functioning disorders.

More recently, COVID-19 lockdowns disrupted daily routines and forced many people to adapt to new schedules that posed conflicting demands on their attention. For some, this highlighted difficulties with time management, organization, and focus. Increased stress and anxiety likely also exacerbated ADHD symptoms, or made them more apparent.

But even people without ADHD have likely experienced a range of emotional and cognitive effects of pandemic-related stress—difficulty concentrating, irritability, restlessness—that resemble ADHD symptoms. And in the U.S., where the diagnosis of adult ADHD largely relies on self-reported symptoms, clinicians may not always be able to tell whether a patient’s account of their experience is accurate. As such, it’s plausible that the pandemic drove an increase in ADHD misdiagnoses, which, in turn, contributed to greater overall demand for Adderall. (It’s important to note that the passing similarities between ADHD symptoms and other human responses to the quotidian challenges of 21st-century life are also responsible for some of the lingering stigma that surrounds the disorder, including the common misperception that it isn’t “real”—a misperception that is at least partly to blame for the likelihood that the overwhelming majority of adults who meet the diagnostic criteria for ADHD remain undiagnosed.)

The problem is double-pronged. For one, as Yasmin pointed out, the U.S. lacks standardized clinical guidelines for identifying ADHD in adults. In an interview for The Guardian last year, the clinical psychologist and ADHD researcher Margaret Sibley told me that, in an ideal world, the assessment process for ADHD would involve hours of legwork on the part of practitioners: talking to the individuals, assessing their medical histories, and even reaching out to family members to get their perspective. In other words, the best-practice scenario would require time investments that are completely untenable within the current health-care system.

For patients to benefit from such a comprehensive evaluation by a licensed mental-health clinician, they would need to have access to those services in the first place, and the time off work with which to use them. In a country without universal health care, let alone universal mental-health care, the logistical arithmetic doesn’t add up for the millions of people who might otherwise benefit from procedural improvements in diagnosing ADHD and all kinds of other disorders.

Which leads us to the second issue: treatment. In the United States, prescription psychostimulant medications such as Adderall are almost always the first course of action after an ADHD diagnosis, but stimulants aren’t necessarily the safest treatment route, let alone the most effective. Moreover, the Drug Enforcement Administration classifies these medicines as Schedule II drugs with a high potential for addiction or misuse. What this means, in practice, is that sharp increases in ADHD diagnosis—and thus greater demand for ADHD medication—aren’t guaranteed to be met with expanded drug-production allotments by the DEA. And although limiting the circulation of Schedule II medications is, in theory, sound public-health policy, the approach creates new challenges when those medications are the first-line treatment for a chronic condition.

There are no simple solutions here, but the Adderall shortage has sharpened the picture of the ripple effects produced by mental-health-care access gaps. And although my geographic and financial privilege will likely keep working in my favor for as long as these drugs remain difficult to obtain, scores of other Americans with ADHD will be forced to make do with no recourse.

Related:

Adult ADHD is the Wild West of psychiatry. ADHD is different for women. Today’s News At a news conference in Jerusalem, Florida Governor Ron DeSantis said that the recent lawsuit filed by the Walt Disney Co. was “political.” Carolyn Bryant Donham, whose accusation resulted in the brutal murder of Emmett Till, has died. South Korean President Yoon Suk Yeol addressed a joint session of Congress and urged North Korea to end its nuclear provocations. Evening Read Illustration by The Atlantic. Source: Getty.

You Will Miss Bed Bath & Beyond

By Amanda Mull

On the first day of the rest of my life, I went to Bed Bath & Beyond. It was a rainy spring Monday in 2011, and like generations of optimistic 20-somethings before me, I had just washed up on New York City’s shores with two bulging suitcases and the keys to a tiny, dingy apartment. I had spent most of the previous year saving every cent possible so that I could rent and furnish a bedroom in an unfashionable, relatively cheap part of Manhattan, but before I could unpack my clothes or sleep in the new bed I had scheduled for delivery the next day, I needed to buy everything else: sheets, blankets, pillows, towels, hangers, a hamper.

This shopping trip was the kind of minor domestic milestone that abounds in young adulthood. I had no idea how to navigate anything about New York, and I was looking everywhere for signals that this new life would be viable for me. On that first day, I began the process of figuring all of that out by getting myself to a store that sold affordable bed linens.

Read the full article.