Teens who frequently checked social media showed an increasing sensitivity to peer feedback, although the cause of the changes was not clear.The effect of social media use on children is a fraught area of research, as parents and policymakers try to ascertain the results of a vast experiment already in full swing. Successive studies have added pieces to the puzzle, fleshing out the implications of a nearly constant stream of virtual interactions beginning in childhood.A new study by neuroscientists at the University of North Carolina tries something new, conducting successive brain scans of middle schoolers between the ages of 12 and 15, a period of especially rapid brain development.The researchers found that children who habitually checked their social media feeds at around age 12 showed a distinct trajectory, with their sensitivity to social rewards from peers heightening over time. Teenagers with less engagement in social media followed the opposite path, with a declining interest in social rewards.The study, published on Tuesday in JAMA Pediatrics, is among the first attempts to capture changes to brain function correlated with social media use over a period of years.The study has important limitations, the authors acknowledge. Because adolescence is a period of expanding social relationships, the brain differences could reflect a natural pivot toward peers, which could be driving more frequent social media use.“We can’t make causal claims that social media is changing the brain,” said Eva H. Telzer, an associate professor of psychology and neuroscience at the University of North Carolina, Chapel Hill, and one of the authors of the study.But, she added, “teens who are habitually checking their social media are showing these pretty dramatic changes in the way their brains are responding, which could potentially have long-term consequences well into adulthood, sort of setting the stage for brain development over time.”A team of researchers studied an ethnically diverse group of 169 students in the sixth and seventh grades from a middle school in rural North Carolina, splitting them into groups according to how often they reported checking Facebook, Instagram and Snapchat feeds.At around age 12, the students already showed distinct patterns of behavior. Habitual users reported checking their feeds 15 or more times a day; moderate users checked between one and 14 times; nonhabitual users checked less than once a day.The subjects received full brain scans three times, at approximately one-year intervals, as they played a computerized game that delivered rewards and punishment in the form of smiling or scowling peers.While carrying out the task, the frequent checkers showed increasing activation of three brain areas: reward-processing circuits, which also respond to experiences like winning money or risk-taking behavior; brain regions that determine salience, picking out what stands out in the environment; and the prefrontal cortex, which helps with regulation and control.The results showed that “teens who grow up checking social media more often are becoming hypersensitive to feedback from their peers,” Dr. Telzer said.The findings do not capture the magnitude of the brain changes, only their trajectory. And it is unclear, authors said, whether the changes are beneficial or harmful. Social sensitivity could be adaptive, showing that the teenagers are learning to connect with others; or it could lead to social anxiety and depression if social needs are not met.Researchers in the field of social media warned against drawing sweeping conclusions based on the findings.“They are showing that the way you use it at one point in your life does influence the way your brain develops, but we don’t know by how much, or whether it’s good or bad,” said Jeff Hancock, the founding director of the Stanford Social Media Lab, who was not involved in the study. He said that many other variables could have contributed to these changes.“What if these people joined a new team — a hockey team or a volleyball team — so started getting a lot more social interaction?” he said. It could be, he added, that the researchers are “picking up on the development of extroversion, and extroverts are more likely to check their social media.”He described the paper as “a very sophisticated piece of work,” contributing to research that has emerged recently showing that sensitivity to social media varies from person to person.“There are people who have a neurological state that means they are more likely to be attracted to checking frequently,” he said. “We’re not all the same, and we should stop thinking that social media is the same for everyone.”Over the last decade, social media has remapped the central experiences of adolescence, a period of rapid brain development.Nearly all American teenagers engage through social media, with 97 percent going online every day and 46 percent reporting that they are online “almost constantly,” according to the Pew Research Center. Black and Latino adolescents spend more hours on social media than their white counterparts, research has shown.Researchers have documented a range of effects on children’s mental health. Some studies have linked use of social media with depression and anxiety, while others found little connection. A 2018 study of lesbian, gay and bisexual teenagers found that social media provided them validation and support, but also exposed them to hate speech.Experts who reviewed the study said that because the researchers measured students’ social media use only once, around age 12, it was impossible to know how it changed over time, or to rule out other factors that might also affect brain development.Without more information about other aspects of the students’ lives, “it is challenging to discern how specific differences in brain development are to social media checking,” said Adriana Galvan, a specialist in adolescent brain development at the University of California Los Angeles, who was not involved in the study.Jennifer Pfeifer, a professor of psychology at the University of Oregon and co-director of the National Scientific Council on Adolescence, said, “All experience accumulates and is reflected in the brain.”“I think you want to put it into this context,” she said. “So many other experiences that adolescents have will also be changing the brain. So we don’t want to get into some kind of moral panic about the idea that social media is use is changing adolescents’ brains.”Dr. Telzer, one of the study’s authors, described the rising sensitivity to social feedback as “neither good nor bad.”“It’s helping them connect to others and obtain rewards from the things that are common in their social world, which is engaging in social interactions online,” she said.“This is the new norm,” she added. “Understanding how this new digital world is influencing teens is important. It may be associated with changes in the brain, but that may be for good or for bad. We don’t necessarily know the long-term implications yet.”

Many parents bring children to emergency rooms to manage aggressive behaviors. But the visits offer little long-term benefit, doctors said.For emergency room doctors, they are a dispiriting and familiar sight: Children who return again and again in the grip of mental health crises, brought in by caregivers who are frightened or overwhelmed.Much has been written about the surge in pediatric mental health emergency visits in recent years, as rates of depression and suicidal behavior among teens surged. Patients often spend days or weeks in exam rooms waiting for a rare psychiatric bed to open up, sharply reducing hospital capacity.But a large study published on Tuesday found a surprising trend among adolescents who repeatedly visited the hospital. The patients most likely to reappear in emergency rooms were not patients who harmed themselves, but rather those whose agitation and aggressive behavior proved too much for their caregivers to manage.In many cases, repeat visitors had previously received sedatives or other drugs to restrain them when their behavior became disruptive.“Families come in with their children who have severe behavioral problems, and the families really just are at their wit’s end, you know,” said Dr. Anna M. Cushing, a pediatric emergency room physician at Children’s Hospital Los Angeles and one of the authors of the study. “Their child’s behavior may be a danger to themselves, but also to the parents, to the other children in the home.”The findings, published in the journal JAMA Pediatrics, analyzed more than 308,000 mental health visits at 38 hospitals between 2015 and 2020.Compared with patients presenting with suicidal or self-harming behavior, those with psychotic disorders were 42 percent more likely to revisit the emergency department within six months, the study found; patients with impulse control disorders were 36 percent more likely; and patients with disorders like autism and A.D.H.D. were 22 percent more likely. Patients who required medications to subdue them were 22 percent more likely to revisit than patients who did not.Tips for Parents to Help Their Struggling TeensCard 1 of 6Are you concerned for your teen?

The psychiatrist E. Fuller Torrey has been advocating tougher involuntary psychiatric treatment policies for 40 years. Now it’s paying off.BETHESDA, Md. — The psychiatrist E. Fuller Torrey is 85 years old and has Parkinson’s disease, the tremors at times so strong that his hand beats like a drum on the table.Still, every morning when he reads the newspapers, he looks for accounts of violent behavior by people with severe mental illness, to add to an archive he has maintained since the 1980s.His records include reports of people who, in the grip of psychosis, assaulted political figures or pushed strangers into the path of subway trains; parents who, while delusional, killed their children by smothering, drowning or beating them; adult children who, while off medication, killed their parents with swords, axes or hammers.Dr. Torrey, who has done pioneering research into the biological basis of schizophrenia, has used these stories in service of an argument: that it was a mistake for the United States to shut down its public psychiatric hospitals without adequate follow-up care. And that to remedy this, the government should create systems to compel seriously mentally ill people in the community to get treatment.For much of his career, Dr. Torrey was a lonely voice on this issue, disavowed by patient advocacy groups and by organized psychiatry. But his ideas are now animating major policy shifts, including the announcement by Mayor Eric Adams of New York last month that city officials would send people with untreated mental illnesses to hospitals, even if they posed no threat to others.“This is the largest single attempt to change the thing that we said we wanted to change,” Dr. Torrey said.“I think the stakes are large,” he added. “Because if it fails, if you have no improvement at all, I think people give up for another decade, just live with it for another decade before somebody else comes along with a new idea.”Dr. Torrey’s influence on New York City’s policy is profound. The mayor’s adviser on this matter is Brian Stettin, who was thrust into mental health policy in 1999 when, as an assistant attorney general for New York State, he was asked to draft Kendra’s Law, named for a woman who was pushed in front of a subway train by a man with schizophrenia. The law allows a court to order a person with mental illness to comply with an outpatient treatment plan, risking involuntary commitment if the person refuses.At the time, Mr. Stettin turned to Dr. Torrey’s organization, the Treatment Advocacy Center, for guidance and became such a believer that after leaving state government, he spent more than a decade as the group’s policy director. In an interview, Mr. Stettin described Dr. Torrey as “the single greatest influence on my thinking about the role of law and policy in ensuring the medical treatment of severe mental illness.”Ira A. Burnim, the legal director of the Bazelon Center for Mental Health Law, said that in the course of arguing for his ideas, Dr. Torrey had overstated the dangerousness of people with severe mental illness, changing the way they are viewed.“Every time there was a sensational crime involving a person with mental illness, Fuller Torrey would be out there, saying this is what happens when you have our current civil commitment laws,” he said. “Among the outcomes of Fuller’s work is the fear of people with mental illness.”He added that Dr. Torrey had been extraordinarily effective at building a consensus in favor of compulsory outpatient treatment. “That’s where Torrey wants to go — if you need treatment, you can be picked up,” he said. “We’ve lost. You’ve got to understand, we’ve lost.”The education of a skepticDr. Torrey appeared on C-SPAN in 2008 to discuss his book “The Insanity Offense: How America’s Failure to Treat the Seriously Mentally Ill Endangers Its Citizens.”C-SPANIt is, perhaps, no surprise that Dr. Torrey became an outlier in his profession. He was a sophomore at Princeton when his mother called to tell him something was wrong with his sister, Rhoda, who had just turned 18 and was due to start college in the fall. She was lying on the front lawn, shouting, “The British are coming!”He accompanied his mother to meetings with eminent psychiatrists, who lectured them on the possible causes of his sister’s schizophrenia. The chief of psychiatry at Massachusetts General Hospital suggested it was the trauma of his father’s death. The chairman of Columbia’s psychiatry department pointed to “family problems.”“I knew it was nonsense from the beginning,” he said. “It made no sense whatsoever.”Later, when he became a psychiatrist himself, Dr. Torrey fantasized about rounding up all the psychiatrists “who had these nonsense theories” and putting them on trial in a football stadium full of patients’ families. As a researcher, he plunged into the task of searching for biological causes for the disease. But it was too late for his mother, who took the Columbia chairman’s word for it.“This was a very important man,” he said. “I think she died thinking it was true.”In the 1970s, when the country was discharging hundreds of thousands of patients from public psychiatric hospitals, it was the era of “One Flew Over the Cuckoo’s Nest,” and the move was lauded as a forward-thinking reform. But Dr. Torrey warned that many former patients were being left wandering city streets untreated, describing them in his writing as “a legion of the inner-city damned.”He recalled a woman he had encountered while treating patients at a homeless shelter in Washington, D.C. She struck him as familiar, so he pulled out her records: A decade earlier, while psychotic, she had been treated at St. Elizabeths, the public psychiatric hospital where he had worked, after attacking her daughter so brutally that the girl lost her arm. The woman had refused medication once she left the hospital.“I said, ‘There’s something very wrong with this system,’” he said. “How is this woman allowed to be completely psychotic again?”Dr. Torrey and his sister, Rhoda, in the mid-1940s.via E. Fuller TorreyIt was unusual for a psychiatrist to take such a blistering stance against deinstitutionalization, which been celebrated by liberals. Over the years that followed, Dr. Torrey said, his arguments found more support from conservatives, landing on the opinion pages of The Wall Street Journal.He went on to challenge all of the profession’s power centers. He lambasted the National Institutes of Mental Health for funding too little research on treatments for debilitating illnesses like schizophrenia. He fell out with the National Alliance for the Mentally Ill over his advocacy of outpatient commitment. He refused to pay dues to his local chapter of the American Psychiatric Association — an act of protest over its spending on a lobbyist — and was expelled, he said.“I’m a longtime friend and colleague of Fuller’s, but Fuller caused institutional psychiatry a big pain in the butt,” said Dr. John Talbott, 87, a past president of the American Psychiatric Association. He traced the friction to deinstitutionalization. “Fuller was one of the few people who said from the very beginning that it was a big mistake. In part, he said it because of his sister.”After her diagnosis, Dr. Torrey’s sister never lived independently again, moving from a public hospital to a series of group homes. She died at 70. It wasn’t a good life, Dr. Torrey said, but someone was always looking after her.He could not say the same of the former residents of public psychiatric hospitals, who, as a result of deinstitutionalization, dispersed to a more isolated, precarious existence in apartment buildings or nursing homes.“Most of us who would be on the street would say, ‘Oh, we’d love to have our own place,’” he said. “I think a lot of these people don’t want their own place. They do better in a group home.” A few of them, he said, discovered a strategy that would send them right back to the state hospital: They set fire to their rooms.An idea takes holdMayor Eric Adams in City Hall in October. “I think that Adams is brave to try it,” Dr. Torrey said. “It’s going to be difficult. Does it make me nervous that it might fail? Yeah.”Dave Sanders for The New York TimesDr. Torrey’s tiny organization, the Treatment Advocacy Center, or TAC, set about changing laws with a twofold strategy.His team sought out legislators who were sympathetic because they had relatives with schizophrenia or had worked with severely mentally ill people. And they pushed for legislation after acts of violence, using the window of public dismay to put forward bills, like Kendra’s Law, that allowed for mandatory outpatient treatment.The group’s record has been striking. Forty-seven states now have laws on assisted outpatient treatment, 30 of them developed with the involvement of TAC. Federal funds began flowing into outpatient commitment programs in 2016, and TAC has received a federal grant to develop programs around the country.In the course of this campaign, Dr. Torrey has used statistics selectively to send a simplified message that untreated mental illnesses are a major cause of violence, said Jeff W. Swanson, a sociologist at the Duke University School of Medicine who has researched dangerousness.“Unfortunately, that doesn’t comport with what the epidemiological research says,” he said. About 4 percent of violent acts can be directly attributed to mental illness, and many of them are low-level assaults, he said, “things like pushing and shoving and slapping people.” But the fear that followed catastrophic incidents proved powerful, politically.“Fuller is a communicator — he wants to put information out there that moves hearts and minds and policymakers,” Dr. Swanson said. He also worried, like other experts interviewed, that tougher commitment laws could work only if mental health services like psychiatric beds and clinical care were widely available, which they are not.“It’s absolutely correct that we need to get severely mentally ill people off the streets and out of awful conditions and into some sort of care,” said Dr. Talbott, who served as superintendent at Manhattan State Hospital, which is now Manhattan Psychiatric Center. “But we have destroyed the care system in large parts. So I don’t know how to do it overnight.”Dr. Torrey said he shared that worry and had little sense of whether New York was prepared.“I think that Adams is brave to try it,” he said. “This is difficult. It’s going to be difficult.” He added: “Does it make me nervous that it might fail? Yeah. If I was 20 years younger, would I go up to New York and help them? I might.”But policy is not the first thing Dr. Torrey thinks of when he wakes up in the morning. What he wants to know is why his sister got sick.He was exuberant last week about new research that had found that wolves in Yellowstone Park made more risky decisions when they were infected with a parasite, toxoplasma gondii. His own research has found evidence that the same parasite plays a role in schizophrenia. He thinks he knows who passed it to Rhoda: the family cat, Butterball.Dr. Torrey also knows that his time is limited. The tremor in his hand began just after his 77th birthday, and he knew right away that it was Parkinson’s. Since then, he has tracked the progress of the disease with close attention that verges, at times, on enthusiasm.“I’ve tried to learn about the brain my whole life, and now my brain’s gone south,” he said. “I get to observe it! That’s exciting! The brain is fascinating! It is me! I am an N of one!”He is now in his 12th year with the disease. By year 15, he said, 80 percent of people with the disease have develop dementia. This is something he wanted Mr. Adams to know.“They better work fast in New York,” he said. “I want to know what happens. I want to see the results of this experiment before I become demented.”

A landmark 1979 study found that depressed people had a more realistic view of their influence over events. New research calls that into question.Forty-three years ago, two young psychologists, Lauren B. Alloy and Lyn Y. Abramson, reported the results of a simple experiment that led to a seminal idea in psychology.Their aim was to test the “helplessness theory,” that depressed people tend to underestimate their ability to influence the world around them.Dr. Alloy and Dr. Abramson categorized college student volunteers as depressed and nondepressed, based on self-reported symptoms, and provided each person with a button and a light that flashed occasionally. They then asked the volunteers to assess how much control they had over the light when they pressed the button.What they discovered was surprising. The depressed people, it turned out, had a more accurate reading of their ability to affect outcomes. Thus was born the hypothesis of “depressive realism” — the idea that at times depressed people have a more realistic view of their conditions, because they are free of the optimistic bias of their cheerful peers.This idea, summarized in the original paper as “sadder but wiser,” has been taught to decades of Intro Psych students and cited more than two thousand times by other scholars. It also percolated through our culture, introducing the idea that depression, for all its pain, may also provide its sufferers with some gifts.A study published this month in the journal Collabra: Psychology by Amelia S. Dev and others calls that conclusion into question.Recreating the original experiment, in which subjects must assess whether their button-pushing affected the light, the new research team found no association between depressive symptoms and outcome bias. In one sample, the patients with more depressive symptoms overestimated their control; in the second, depressive symptoms did not predict any particular bias.“Across two samples, we find no evidence that depressive symptoms is tied to greater realism,” the study said.Don A. Moore, one of the authors of the new study, said that the team had coalesced around the question of whether “positive illusions” can enhance performance, and that this had led them to back to the 1979 study.“Its impact has been huge, and it’s been pervasive in so many aspects of research and pop culture that it can be hard to wind it back up,” Dr. Moore, a psychological researcher and a professor at the University of California, Berkeley’s Haas School of Business, said of the original study.Under the influence of this theory, many psychologists taught that “a little bit of self-delusion is helpful for getting through life,” he said. “You have to believe in yourself a little more than reality warrants.”“What we knew,” he said, “made us wonder whether that effect would hold up.”Already, a 2012 meta-analysis of 75 studies on depressive realism had found that the overall effect of depressive realism was small, and that results were influenced by the study’s methodology. But it remained such a well-established notion that “we faced skeptical reviewers along the way,” Dr. Moore said.“If you’re trying to disprove a false positive that has made its way into the literature, that is an uphill climb,” he said.Dr. Alloy, one of the two psychologists who designed the original experiment, said in an interview that she did not believe the new work constituted a major challenge to depressive realism, because the research team failed to directly replicate the original 1979 experiment.“When they say they did a direct replication of our study, they did not,” Dr. Alloy, a professor of psychology at Temple University, said. “It’s not a major challenge. The original findings still hold.”She said differences in the design of the two experiments may account for the variance in results. The new team did not find an “illusion of control” among the nondepressed subjects, as the 1979 team did, which she said was unusual and made it difficult to interpret any results.The new team repeatedly asked subjects to assess the probability of the bulb lighting if they pushed the button throughout the experiment, rather than waiting until the end, as the original researchers did. Also, she said, the new researchers prescreened subjects for symptoms of depression, rather than screening them on the day of the experiment, so their mood may have shifted in that time.She also said the research team recreated only the second of the four experiments in the 1979 paper, which had the least robust findings.Finally, she took issue with the researchers’ characterization of depressive realism, which she said occurred only under certain conditions.“It simply isn’t true that depressed people are more accurate in their perception of the world,” she said. “That is too broad and general a statement.” Subsequent studies identified conditions under which depressive realism was present, which led to “more nuanced, sophisticated conclusions,” she said. “What’s out there in the public might not have kept up with that.”Over the four decades since Dr. Alloy and Dr. Abramson published their paper, the “sadder but wiser” idea has not guided emerging treatments. Clinicians have gravitated to cognitive behavioral therapy, which helps depressed patients identify distortions in their thoughts.“We would do a disservice to the client by accepting that what they say is a reality, rather than through a gentle Socratic process, to ask them to explore and examine their pattern of thinking,” said Allen Miller, a clinical psychologist at the Beck Institute, who was not involved in the study.Dr. Miller described the new paper as “a reasonable attempt to replicate it, which of course they were not able to do.”Brian A. Nosek, a psychology professor at the University of Virginia who coordinated the 2015 Reproducibility Project, described the Dev study as “a solid piece of work, well designed and well reported.”“Inevitably, it does confront us to revise our confidence in prior findings,” he said. “But no replication is definitive.”A decade ago, when young scientists began efforts to replicate published findings, they were often “seen as an attack” on established researchers, Dr. Nosek said. Since then, though, they have “become much more normalized” as part of an ongoing scientific dialogue. Still, he said, “we all have our egos, and our findings are like possessions.”And challenging blockbuster work like the 1979 study, which “provoke such engagement with the mysteries of human behavior and the mind,” has a ripple effect, he added.“This is a classic finding that I really want to be true, and many people do — it gives the Eeyores in all of us a little hope,” he said. “That obviously has implications. Are we pulling down the icons of the field? What is left when we pull those down?”

A unique research project is tracking hundreds of people at risk for suicide, using data from smartphones and wearable biosensors to identify periods of high danger — and intervene.CAMBRIDGE, Mass. — In March, Katelin Cruz left her latest psychiatric hospitalization with a familiar mix of feelings. She was, on the one hand, relieved to leave the ward, where aides took away her shoelaces and sometimes followed her into the shower to ensure that she would not harm herself.But her life on the outside was as unsettled as ever, she said in an interview, with a stack of unpaid bills and no permanent home. It was easy to slide back into suicidal thoughts. For fragile patients, the weeks after discharge from a psychiatric facility are a notoriously difficult period, with a suicide rate around 15 times the national rate, according to one study.This time, however, Ms. Cruz, 29, left the hospital as part of a vast research project which attempts to use advances in artificial intelligence to do something that has eluded psychiatrists for centuries: to predict who is likely to attempt suicide and when that person is likely to attempt it, and then, to intervene.On her wrist, she wore a Fitbit programmed to track her sleep and physical activity. On her smartphone, an app was collecting data about her moods, her movement and her social interactions. Each device was providing a continuous stream of information to a team of researchers on the 12th floor of the William James Building, which houses Harvard’s psychology department.In the field of mental health, few new areas generate as much excitement as machine learning, which uses computer algorithms to better predict human behavior. There is, at the same time, exploding interest in biosensors that can track a person’s mood in real time, factoring in music choices, social media posts, facial expression and vocal expression.Matthew K. Nock, a Harvard psychologist who is one of the nation’s top suicide researchers, hopes to knit these technologies together into a kind of early-warning system that could be used when an at-risk patient is released from the hospital.He offers this example of how it could work: The sensor reports that a patient’s sleep is disturbed, she reports a low mood on questionnaires and GPS shows she is not leaving the house. But an accelerometer on her phone shows that she is moving around a lot, suggesting agitation. The algorithm flags the patient. A ping sounds on a dashboard. And, at just the right time, a clinician reaches out with a phone call or a message.There are plenty of reasons to doubt that an algorithm can ever achieve this level of accuracy. Suicide is such a rare event, even among those at highest risk, that any effort to predict it is bound to result in false positives, forcing interventions on people who may not need them. False negatives could thrust legal responsibility onto clinicians.Algorithms require granular, long-term data from a large number of people, and it’s nearly impossible to observe large numbers of people who die by suicide. Finally, the data needed for this kind of monitoring raises red flags about invading the privacy of some of society’s most vulnerable people.Dr. Nock is familiar with all these arguments but has persisted, in part out of sheer frustration. “With all due respect to people who’ve been doing this work for decades, for a century, we haven’t learned a great deal about how to identify people at risk and how to intervene,” he said. “The suicide rate now is the same it was literally 100 years ago. So just if we’re being honest, we’re not getting better.”The gray zoneSurvey questions popped up on an app Ms. Cruz was given by the researchers, one of several digital check-ins she receives each day.Kayana Szymczak for The New York TimesFor psychiatrists, few tasks are more nerve-racking than caring for patients they know to be at risk for suicide while they are at home and unsupervised.Dr. Karen L. Swartz, a professor of psychiatry at Johns Hopkins University, calls it “the gray zone.” She was fresh out of training when she first wrestled with this problem, caring for a prickly, intelligent woman who admitted she had suicidal thoughts, and even alluded to a plan, but dreaded the thought of being hospitalized.Dr. Swartz turned to the woman’s husband for advice. If you force her into the hospital, he said, she will fire you.So Dr. Swartz decided to take the risk, allowing the woman to remain at home, tweaking her medications and waiting. She spent the next weeks on tenterhooks, and, slowly, the patient improved. “It was one of those things where I just genuinely hoped I was right,” she said. It never gets easier, said Dr. Swartz, who now trains young psychiatrists: With experience, it only becomes clearer that suicidal thoughts can come and go without warning.“We are asked to predict something that is highly unpredictable,” she said.Increasingly, health care systems are turning to machine learning to make this call. Algorithms based on vast data sets — drawn from electronic medical records as well as scores of other factors — are used to assign patients a risk score, so that individuals at exceptionally high risk can be provided with extra attention.Algorithms have proven more accurate than traditional methods, which, according to a 2017 review of published research, had not improved in 50 years and were only slightly better than chance at predicting an outcome. These methods are already used in some clinical settings. Since 2017, the Department of Veterans Affairs has used an algorithm to flag the 0.1 percent of veterans at the highest risk for suicide, a few hundred patients in a population of six million.This approach has yielded some success. A study published last year in JAMA Network Open found that veterans enrolled in REACH VET, a program for at-risk patients, were 5 percent less likely to have a documented suicide attempt, and less likely to be admitted to a psychiatric facility or visit the emergency room. But the study found no significant change in the rate of suicide.The expectations that have built up around this research are so high that experts take pains to temper them. Michael Schoenbaum, a senior adviser at the National Institute of Mental Health, compared it to the excitement, 25 years ago, around the search for biological markers for mental illnesses — a case in which, he pointed out, “the optimists were wrong.”“We are waiting to see when and where and maybe even whether signals like that are valid and reliable,” he said. “The evidence so far, it’s exciting in the sense that any signal is promising. This is something that we couldn’t do before at all.” But, he warned, “we are looking for something we haven’t found yet.”And some of Dr. Nock’s colleagues say they doubt algorithmic predictions will ever be precise enough to intervene in the narrow window that precedes a suicide attempt.“It’s certainly not an easily solvable problem,” said Nick Allen, the director of the Center for Digital Mental Health at the University of Oregon, who helped develop EARS, an app that tracks mood based on factors like music choice, facial expression and the use of language.“It’s probably, in some senses, not a solvable problem, for the same reason that we have school shootings and the same reason that we can’t predict a lot of this kind of stuff,” Dr. Allen said. “You know, the math is just really daunting.”A fire hose of dataMatthew Nock, a professor of psychology at Harvard and a leading suicide researcher. “The suicide rate now is the same it was literally 100 years ago,” he said. “So just if we’re being honest, we’re not getting better.”Kayana Szymczak for The New York TimesOn an August afternoon in the William James building, a lanky data scientist named Adam Bear sat in front of a monitor in Dr. Nock’s lab, wearing flip-flops and baggy shorts, staring at the zigzagging graphs of a subject’s stress levels over the course of a week.When moods are mapped as data, patterns emerge, and it’s Mr. Bear’s job to look for them. He spent his summer poring through the days and hours of 571 subjects who, after seeking medical care for suicidal thoughts, agreed to be tracked continuously for six months. While they were being tracked, two died by suicide and between 50 and 100 made attempts.It is, Dr. Nock believes, the largest reservoir of information ever collected about the daily lives of people struggling with suicidal thoughts.The team is most interested in the days preceding suicide attempts, which would allow time for intervention. Already, some signs have emerged: Although suicidal urges often do not change in the period before an attempt, the ability to resist those urges does seem to diminish. Something simple — sleep deprivation — seems to contribute to that.Dr. Nock has been looking for ways to study these patients since 1994, when he had an experience that shocked him profoundly. During an undergraduate internship in the United Kingdom, he was assigned to a locked unit for violent and self-injurious patients. There, he saw things he had never encountered: Patients had cuts up and down their arms. One of them pulled out his own eyeball. A young man he befriended, who seemed to be improving, was later found in the Thames.Another shock came when he began to pepper the clinicians with questions about treating these patients and realized how little they knew: He recalls being told, “We give them some medicine, we talk to them and we hope they get better.”One reason, he concluded, was that it had never been possible to study a large number of people with suicidal ideation in the same way that we are able to observe patients with heart disease or tuberculosis. “Psychology hasn’t advanced as much as other sciences because we’ve been largely doing it wrong,” he said. “We haven’t gone out and found some behavior that is important in nature, and gone out and observed it.”But with the advent of phone-based apps and wearable sensors, he added, “we have data from so many different channels, and we have, increasingly, the ability to analyze those data, and observe people as they’re out living their lives.” One dilemma in designing the study was what to do when participants expressed a strong desire to hurt themselves. Dr. Nock decided they should intervene.“There’s a downside to this because you get fewer attempts and fewer suicides, because, scientifically, we’re now decreasing our likelihood of finding a signal,” he said. But, he added, “I keep coming back to the issue of, what if it was my child?”Interventions have become a routine part of life in the lab. If, in a routine questionnaire, a subject reports a strong desire to harm themselves, and it is between the hours of 9 a.m. and 9 p.m., they receive a call within 15 minutes from one of the researchers, who asks whether they have made an attempt.“We’re kind of this faceless person, so there’s less discomfort,” said Narise Ramlal, a research assistant in the lab. But Dr. Nock wonders — and hopes to test — whether digital interventions may prove to be more effective.“Many people don’t want a human to contact them when they’re a high risk,” he said. “Not to say that we’re going to replace humans with machines, but they can probably be a lot more efficient than we are now.”Telling the truth to a computerMs. Cruz said the app’s questions at first felt intrusive, then comforting. “It felt like I wasn’t being ignored,” she said. “To have somebody know how I feel, that takes some of the weight off.” Kayana Szymczak for The New York TimesIt was around 9 p.m., a few weeks into the six-month study, when the question popped up on Ms. Cruz’s phone: “Right now how strong is your desire to kill yourself?”Without stopping to think, she dragged her finger all the way to the end of the bar: 10. A few seconds later, she was asked to choose between two statements: “I am definitely not going to kill myself today” and “I am definitely going kill myself today.” She scrolled to the second.Fifteen minutes later, her phone rang. It was a member of the research team calling her. The woman called 911 and kept Ms. Cruz on the line until the police knocked on her door, and she passed out. Later, when she regained consciousness, a medical team was giving her a sternum rub, a painful procedure used to revive people after overdoses.Ms. Cruz has a pale, seraphic face and a fringe of dark curls. She had been studying for a nursing degree when a cascade of mental health crises sent her life swerving in a different direction. She maintains an A-student’s nerdy interest in science, joking that the rib cage on her T-shirt is “totally anatomically correct.”Right away, she had been intrigued by the trial, and she responded dutifully six times a day, when the apps on her phone surveyed her about her suicidal thoughts. The pings were intrusive, but also comforting. “It felt like I wasn’t being ignored,” she said. “To have somebody know how I feel, that takes some of the weight off.”On the night of her attempt, she was alone in a hotel room in Concord. She didn’t have enough money for another night there, and her possessions were mounded in trash bags on the floor. She was tired, she said, “of feeling like I had nobody and nothing.” Looking back, Ms. Cruz said she thought the technology — its anonymity and lack of judgment — made it easier to ask for help.“I think it’s almost easier to tell the truth to a computer,” she said.But many in the field are wary of the idea that technology can ever substitute for a clinician’s care. One reason is that patients in a crisis become skilled at deception, said Justin Melnick, 24, a doctoral student who survived a suicide attempt in 2019 and is now an advocate for people with mental illness.He recalled cutting short telephone conversations with his mother, the person best able to pull him off “the precipice,” and then switching his phone off. “And it was like, OK, that door has been closed,” he said. He described these evasions as “an act of defiance.” Why, he asked, would a person in that frame of mind agree to wear a sensor?In the end, he said, what helped him turn the corner was people — a support group, which met weekly in a circle of chairs for sessions of dialectical behavioral therapy, and a network of friends, family and clinicians who know him well enough to recognize his behavior. When that happens, he said, “we can generally ride that wave together.”Ms. Cruz does not have a network like that. Last month, as temperatures in Massachusetts were dipping into the 40s, she was living in a tent with her boyfriend, huddling together under a blanket for warmth. In the morning, they waited until McDonald’s opened so they could dry out their sweatshirts and shoes and charge their devices.She was faithful about taking her medications — five of them — but was scrambling to find a new therapist: The only one in her area who accepts Medicaid has an eight-month waiting list.Last week, as the six-month clinical trial came to an end, she filled out her final questionnaire with a twinge of sorrow. She would miss the $1 she received for each response. And she would miss the sense that someone was watching her, even if it was someone faceless, at a distance, through a device.“Honestly, it makes me feel a little bit safer to know that somebody cares enough to read that data every day, you know?” she said. “I’ll be kind of sad when it’s over.”If you are having thoughts of suicide, text the National Suicide Prevention Lifeline at 988 or go to SpeakingOfSuicide.com/resources for a list of additional resources.

American teenagers are reporting severe levels of anxiety and depression. But when Connecticut moved to expand mental health services in schools, it ran into fierce opposition in one town.KILLINGLY, Conn. — One evening in March, a high school senior named Sydney Zicolella stood before the school board in this rural, blue-collar Connecticut town and described her psychiatric history, beginning in the sixth grade, when she was “by definition, clinically depressed.”Ms. Zicolella, 17, who wore her dark, curly hair pulled back, is the third of four children in a devout Christian family, and the editor of the newspaper at Killingly High School.Many students there were struggling, she told the board. She had seen kids “walked, carried and cradled out of counseling, hysterical, not wanting to go to the hospital, but also not wanting to be sad anymore.”It was not uncommon, she said, for friends to “disappear for months, only to find out that they had been at a mental health hospital right down the road to my house.” She urged the board to approve the placement of a mental health clinic in the school, part of a push by the state of Connecticut to dramatically expand access to care for teenagers.Convincing the board was a long shot, she knew that. Her own mother, Lisa, 49, who, by her own account, grew up in “the generation of toughing things out,” didn’t support the clinic.It wasn’t that Lisa entirely disapproved of therapy — when Sydney was in crisis, she scoured northeastern Connecticut in search of a therapist who would take her insurance — but she feared school-based therapists would end up advising teens on matters like gender identity or birth control, which she felt belonged firmly in the grip of parents.“I do personally believe there’s a lot of agendas out there,” Lisa said. “And children are very malleable.”This debate has divided Killingly, and its families, since January, when Robert J. Angeli, the superintendent of schools, presented a plan to open a state-funded mental health clinic in the high school.Legislation to expand Connecticut’s network of school-based clinics had sailed through the legislature, passing the House by a vote of 143 to 4. When Mr. Angeli presented the plan before the town’s Board of Education, though, it ran into a solid wall of resistance, mostly on the grounds that it infringed on the rights of parents.In March, Killingly’s board members rejected the plan by a vote of 6 to 3. After that, dozens of supporters of the clinic filed a complaint with Connecticut’s Board of Education, asking the state to “investigate and take corrective action.”Pledging allegiance before a Board of Education meeting last month in Killingly.Christopher Capozziello for The New York TimesSince then, Killingly’s school board meetings have become a battleground for competing views on mental health, exposing divisions that are both partisan and generational. Teenagers have picketed on the well-manicured town common, where petunias grow around a memorial to the Civil War dead, with signs reading “14.7 PERCENT HAVE MADE A SUICIDE PLAN” and “TALK TO YOUR CHILDREN ABOUT MENTAL HEALTH.”Standoffs like the one in Killingly are being watched apprehensively by mental health advocates. During the pandemic, the mental health of children shot to the top of the agenda for both political parties. School-based services, which studies suggest can significantly decrease suicidal behavior and substance abuse, have emerged as a first-line policy response.Over the last year, legislators in more than 30 states have considered an expansion of school-based services, according to Inseparable, a mental health policy group, and eight states, including Connecticut, have passed legislation to do so. Before the services reach students, though, they must be embraced by American communities.In Connecticut, which already has more than 100 school-based health clinics, Killingly is an outlier. But lawmakers and conservative activists have targeted mental health curriculum in several states, often taking aim at social and emotional learning programs, known as SEL, which train students to manage emotions and practice conflict resolution. Lawmakers in Indiana and Oklahoma have put forward bills that would limit the use of SEL in the classroom.A plan is rejectedOlivia McOsker, 17, a senior at Killingly High School, spoke during public comment at the Board of Education meeting in support of the clinic.Christopher Capozziello for The New York TimesOn the January evening when the superintendent introduced staff from Generations Family Health Center, the nonprofit health care group that was to provide services in the school, the visitors peered out of Zoom screens with cheery smiles.The plan was for licensed therapists from Generations to work in a space on the school’s third floor. Students could be referred by teachers or family members, or could come in themselves, and therapy sessions would be scheduled during school hours. Therapists would bill insurance based on a sliding fee scale, using federal funds if necessary, so there would be no cost to the school and little, if any, to the families.Then a chill entered the room as the board members began peppering them with questions. The visitors’ smiles faded.Would they advise students on birth control or abortion? (They wouldn’t give medical advice, but might discuss if it comes up.) If children were referred and didn’t want therapy, would they be forced to do it? (No.) Would students be seen by peers going into treatment, exposing them to ridicule and stigma? (Hopefully not.) Could they get therapy without their parents knowing about it?Conceivably, yes, was the answer. By law, clinicians in Connecticut can provide six sessions of mental health treatment to minors without parental consent under a narrow set of circumstances — if the minor sought treatment, it was deemed clinically necessary and if requiring parental notification would deter the minor from receiving it.This provision is used rarely; in the nearby town of Putnam, which has hosted a school-based mental health clinic for nine years, treating hundreds of students, no child has ever been treated without parental permission, said Michael Morrill, a Putnam school board member.But it was a major sticking point for Norm Ferron, one of the Killingly board members, who said the arrangement would “give a student a lot more access to counseling without seeking parental approval, and I’m not real keen on that.”Another board member, Jason Muscara, said he had already heard enough to make his mind up.“I am not going to make it easier for kids to go around their parents,” he said. “I don’t think we should be helping a kid to walk into a mental health facility in a school and say, ‘I’m thinking about an abortion, let’s talk about that,’ without the parents knowing, for up to six visits.”Chris Viens, a member of the Board of Education, supports the expanded mental health program. He said he expected a little pushback, but was shocked by the vehemence of the opposition.Christopher Capozziello for The New York TimesKillingly’s school board, swept up in the culture wars of the Trump era, has repeatedly cast itself as a bulwark against liberalism and government intrusion. Several of its members were elected in 2020, amid popular outrage over a decision to retire the school’s mascot, the Redmen, at the urging of a student group who said it was offensive. After the election, the new board voted 5 to 4 to reinstate the mascot.The proposed mental health clinic has reopened those divisions, this time around psychotherapy and the values it might instill.At one meeting, a school board member said that, years ago, a therapist had “meddled with my teenaged son’s mind, because at that age they are most vulnerable and they want someone to talk to.” A local man got up to say that “our modern-day psychology is rooted in occultism,” noting that Sigmund Freud used drugs while writing his thesis and Karl Jung channeled spirit guides.Their wariness has resonated with some people in this community.Gerry Golob, 33, a house painter, said his view of psychiatry was shaped when his mother was committed to a state mental hospital, where “they just drug people up.” Plenty of people in Killingly receive mental health treatment, he said — he called the town “a walking pharmaceutical clinic” — but he doesn’t want his children exposed to it. If a clinic were placed in the school, he said, “I would remove my kids instantly.”The vehemence of the opposition to the clinic has come as a shock to Chris Viens, 49, one of three board members who has supported the idea. He said he expected “a little bit of pushback” but “really wasn’t prepared for the idea that we were going to have this long, drawn-out experience.”“It almost seems like there’s a fear that something about their belief system is under attack,” Mr. Viens said in an interview, adding that he was offering his views as a citizen, rather than a board member. “They seem to think that they have to stop it here. It’s almost like this line you don’t cross.”The superintendent, Mr. Angeli, and other members of the school board declined to comment for this article. ‘Why are we treating this like it’s taboo?’Jen Simpson runs a salon in Killingly where she said she hears teenage clients speaking with sophistication about mental health, a subject that was “taboo” when she was their age. Christopher Capozziello for The New York TimesOn the night in March when the Board of Education voted down the mental health center, Ms. Zicolella was at work, at a Mexican restaurant in Dayville. A mother from the school came up to the cash register, told her about the vote and burst into tears.“It was crazy, it made such an outpouring of emotion,” Ms. Zicolella said.For Sydney and her close friends, mental health was a frank topic of discussion. Many of them had struggled after a series of deaths in the school community when they were seventh-graders, she said. In high school, she was diagnosed with depression and generalized anxiety disorder.“Knowing what is going on in your head — being able to call it something official — helps you cope with those things,” she said. By the time they were seniors, her classmates were open about their diagnoses and treatments. “We do consider it part of our identity,” she said.Jen Simpson, 28, said she listens to teenage customers who come in to her salon, BeautyHaus, and is startled by their sophisticated discussion of anxiety and trauma, a vocabulary she assumes they have picked up from social media.Tips for Parents to Help Their Struggling TeensCard 1 of 6Are you concerned for your teen?

In 1972, Dr. John Fryer risked his career to tell his colleagues that gay people were not mentally ill. His act sent ripples through the legal, medical and justice systems.On the second day of the annual convention of the American Psychiatric Association in 1972, something extraordinary happened.While the assembled psychiatrists, mostly white men in dark suits, settled into rows of chairs in the Danish Room at the Adolphus Hotel in Dallas, a disguised figure had been smuggled through the back corridors. At the last minute, he stepped through a side curtain and took his place at the front of the room.There was an intake of breath in the audience. The man’s appearance was grotesque. His face was covered by a rubber Nixon mask, and he was wearing a garish, oversized tuxedo and a curly fright wig. But the outlandishness of his outfit diminished in importance once he began to speak.“I am a homosexual,” he began. “I am a psychiatrist.”For the next 10 minutes, Henry Anonymous, M.D. — this is what he had asked to be called — described the secret world of gay psychiatrists. Officially, they did not exist; homosexuality was categorized as a mental illness, so acknowledging it would result in the revocation of one’s medical license, and the loss of a career. In 42 states, sodomy was a crime.The reality was that there were plenty of gay people in the A.P.A., psychiatry’s most influential professional body, the masked doctor explained. But they lived in hiding, concealing every trace of their private life from their colleagues.“All of us have something to lose,” he said. “We may not be under consideration for a professorship; the analyst down the street may stop referring us his overflow; our supervisor may ask us to take a leave of absence.”This was the trade-off that had formed the basis of the masked man’s life. But the cost was too high. That’s what he had come to tell them.“We are taking an even bigger risk, however, in not living fully our humanity,” he said. “This is the greatest loss, our honest humanity.”He took his seat to a standing ovation.Dr. Fryer’s speechListen to Dr. Fryer deliver his remarks in their entirety as “Dr. Henry Anonymous,” May 2, 1972.The 10-minute speech, delivered 50 years ago Monday, was a tipping point in the history of gay rights. The following year, the A.P.A. announced that it would reverse its nearly century-old position, declaring that homosexuality was not a mental disorder.It is rare for psychiatrists to transform the culture that surrounds them, but that is what happened in 1973.By removing the diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., psychiatry removed the legal basis for a wide range of discriminatory practices: for denying gay people the right to employment, citizenship, housing and the custody of children; for excluding them from the clergy and the military and the institution of marriage. The long process of rolling back those practices could begin.When referred to psychiatrists, gay people would no longer be sent to be “cured” — injected with hormones, subjected to aversion therapy or pored over by analysts — but instead told that, from the point of view of science, there was nothing intrinsically wrong with them.The Great ReadMore fascinating tales you can’t help but read all the way to the end.One hundred years ago, the British spy Cruxy O’Connor was caught in what appears to be the I.R.A.’s only authorized attack on American soil.​​Here’s how Viola Davis drew on a life of private hardship to become one of the greatest actors of her generation.The tale is oft-repeated: A lover of Shakespeare released dozens of European starlings in New York City as an ode to the Bard, starting a North American invasion. Crucial parts of the story are not true.After delivering his speech, the man in the mask, John Ercel Fryer, 34, flew from Dallas to his home in Philadelphia, noting in his journal just how terrifying and profound the experience had been.“The day has passed, it has come and gone and I am still alive. For the first time I have identified with a force that is akin to my selfhood,” he wrote, in excerpts included in “Cured,” a 2018 documentary.Still — he didn’t tell his mother he had done it. He didn’t tell his sister. He didn’t tell his closest childhood friend. He barely told anybody for 20 years.‘What the hell is going on here?’Dr. Fryer in an undated yearbook photo from Transylvania University, where he was pre-med.Transylvania UniversityDr. Fryer, circa 1990, when he was a professor at Temple University.Historical Society of PennsylvaniaDr. Fryer, who died in 2003 at the age of 65, stood out for his size (he was 6-foot-4 and 300 pounds), for his flashing intelligence, and for the fact that he was obviously gay.Betty Lollis, a friend from Winchester, Ky., recalled him as the round-faced boy who was led into her second-grade class, dressed by his mother in a sailor suit. He was a prodigy, she said, and also “just a boy the boys laughed at or teased.”Decades later, Ms. Lollis said, some of their classmates apologized to Dr. Fryer for the way they had treated him. “These people that were painful for him were also all he had,” she said. “Those are his dearest friends.”He sailed through his classes, enrolling in college at 15 and medical school at 19. But again and again, his path was blocked when supervisors learned he was gay.The most crushing of these setbacks occurred in 1964. He had relocated to the freer atmosphere of the East Coast, and was a few months into a residency at the University of Pennsylvania when he let his guard down, telling a family friend at dinner that he was gay.The young man immediately reported this to his father, who reported it to the department chairman at Penn, Dr. Fryer said in a 2002 interview with the Journal of Gay and Lesbian Psychiatry. The department chairman called Dr. Fryer into his office and said: “You can either resign or I’ll fire you.”It took years of humiliating assignments at a state-run psychiatric hospital, the only institution that accepted him, for Dr. Fryer to complete his residency. After that he faced a long, uncertain path to tenure. For these reasons, coming out had little appeal, he said in a 2001 interview for “This American Life,” much of which has not been published until now.“It was a way, if you came out as gay, to not have any power,” he said. “And I wanted to be powerful. So being a straight, closeted physician enabled me to have power.”In 1970, Frank Kameny, an astronomer who had been dismissed from the military because he was gay, led a small group of gay rights activists to protest the A.P.A.’s annual convention, demanding that the diagnosis be declassified.Dr. Fryer was a full-fledged member of the “Gay P.A.,” a group of closeted A.P.A. members. who gathered in secret on the edges of the association, and he watched with distaste as the protesters stormed into panel discussions and heckled the speakers. “I was embarrassed by it, and I wished that they would shut up,” he said.But the following year, Barbara Gittings, one of the activists, approached Dr. Fryer to ask for his help.Younger, more progressive leaders were rising through the ranks of the A.P.A., and the activists sensed an opening. They had an idea: Instead of picketing, they could shake things up by confronting the psychiatrists with one of their own, a gay psychiatrist. If only they could find someone who would agree to do it.Ms. Gittings, left, at a “Gay, Proud and Healthy” display at the Dallas convention in 1972.Kay Tobin/Manuscripts and Archives Division, The New York Public Library“My first reaction was: No way,” Dr. Fryer recalled. “I had no security, and I did not want to do anything to jeopardize the possibility that I could get a faculty position somewhere. There was no way at that point that I was going to do that as an open thing.”Over the months that followed, though, Ms. Gittings kept calling. She updated Dr. Fryer as she approached a dozen of his gay colleagues and each said no, the risk was too great.Their refusals bothered Dr. Fryer. And Ms. Gittings, as he put it, kept “upping the ante.” What if she paid his way to Dallas? What if he wore a disguise, so that no one knew it was him?“She planted in my mind the possibility that I could do something,” he said. “And that I could do something that would be helpful without ruining my career.”Dr. Fryer’s lover at the time was a drama student, and the two threw themselves into the project of devising a disguise that would conceal his identity: a vastly oversized tuxedo, a rubber mask melted to distort its features, and a wig with a low hairline opposite to his own.Stepping onto the stage that day, Dr. Fryer said, “I felt a great freedom, a great sense of freedom.”There was pride, too, that he was the only one of his colleagues who dared.“To do that thing, to be willing to do that thing, when none of my colleagues in the Gay P.A. would be wiling to do it, openly or otherwise,” he said. “They were all in the audience. They were clapping.”The sight of Dr. Fryer had a powerful emotional effect on the psychiatrists gathered in the room, said Dr. Saul Levin, who in 2013 became the first openly gay man to serve as the A.P.A.’s chief executive and medical director.“It obviously really shook them,” he said. “Here was this huge audience for the time, seeing someone come out in a very weird costume. It made them a little disoriented — what the hell is going on here? And then this person comes out with such an eloquent speech.”Dr. Fryer was giddy as he left the stage, so exhilarated that, before returning to Philadelphia, he splurged on a manual harpsichord, which he wryly described as “among the least wise choices of my life.”As he returned to his hotel room to change out of his disguise, he passed the chairman of the psychiatry department at the University of Pennsylvania, who had fired him from his residency. Neither man showed any sign of recognition.‘It was over for me’Dr. Fryer in his Germantown home with one of his Doberman pinschers, circa 1975.Harry Adamson, via Historical Society of PennsylvaniaDr. Fryer returned to the rambling, Victorian house where he lived in Germantown with his Doberman pinschers and the medical students he took in as boarders.He remained himself — by turns generous and overbearing, charismatic and acerbic, switching on his Kentucky accent when it suited him.He still didn’t have tenure, and his career path was as tenuous as ever. In 1973, the A.P.A. voted to declassify homosexuality. And Dr. Fryer lost another job, this one at Friends Hospital.Again, an administrator called him into his office. “If you were gay and not flamboyant, we would keep you,” Dr. Fryer recalled him saying. “If you were flamboyant and not gay, we would keep you. But since you are both gay and flamboyant, we cannot keep you.”Dr. Fryer watched as his colleagues got promoted and won tenure. The Gay P.A. faded, as a new, more activist generation stepped forward as an open force within psychiatry, forming the Association of Gay and Lesbian Psychiatrists. But Dr. Fryer took no part in it.“I ran away again,” he said. “I didn’t go to the meetings. It was like I just sort of disappeared.” It was as if, he said, “I had done my thing and it was over for me.”Every now and then, he would tell someone about what he had done.Dr. Karen Kelly, 67, who rented a room from Dr. Fryer as a medical student, said he told her over dinner some time in the late 1970s, and never mentioned it again.Ms. Lollis, 85, said she and Dr. Fryer confided in one another later in life, sometimes speaking on the phone several times a week. But she didn’t find out that he was Dr. Anonymous until 2002, when he sent her the episode of “This American Life” that described the speech.“He just didn’t share it with anyone,” she said. “Not his mother, not his sister.”Circa 1970. Dr. Fryer was a musician and a choirmaster of his local church for 30 years.Historical Society of PennsylvaniaAt Temple University with colleagues around 1975.Historical Society of PennsylvaniaDr. Fryer would eventually get tenure at Temple University, where he built a specialty in bereavement and helped pioneer the hospice movement. After teaching all day and having dinner, he would often see patients until 11 p.m., Dr. Kelly recalled. He sat with many of his patients while they were dying.He threw big parties, and sometimes his famous friends, like the anthropologist Margaret Mead or the writer Gail Sheehy, would show up. He wore dashikis. Traveling for conferences, “he’d end up in a tiki restaurant with my cousins, dancing with the hula dancer,” Dr. Kelly said.But a sense of resentment clung to him, said Dr. David Scasta, who got to know Dr. Fryer as a medical resident at Temple University and interviewed him about his life in 2002.He felt isolated from the gay community, said Dr. Scasta, a past president of the Association of Gay and Lesbian Psychiatrists. He never had a long-term relationship. And he always felt that his career was not what it could have been.“There was always a sense of sadness at not being fully accepted,” he said. “John always felt he was on the fringe.”Decades would pass before historians of gay rights fully understood the significance of the Dr. Anonymous speech, that it had “a Stonewall riots kind of importance,” Dr. Scasta added. In that case, too, the surge of forward motion was driven by unlikely people.“It’s not always the law-abiding, nice people who did it, it’s the ones who are on the periphery who can make change,” he said.On Monday, the 50th anniversary of the Dr. Anonymous speech will be celebrated with speeches and proclamations in Philadelphia, which has declared May 2 John Fryer Day.Public celebration of his act had already begun in the years before Dr. Fryer’s death, and in 2001 he remarked on it caustically, saying he “sort of was trundled out as an exhibit every time someone wanted an exhibit.”At the time, though, it was secrecy that gave his act its power, he said.“As this person who was in disguise, I could say whatever I wanted,” he said, adding, “I did this one isolated event, which changed my life, which helped change the culture in my profession, and I disappeared.”

As the White House pleads with Republicans in Congress for emergency aid to fight the coronavirus, the federal government said that a fund established to reimburse doctors for care for uninsured Covid patients was no longer accepting claims for testing and treatment “due to lack of sufficient funds.”Some U.S. health care providers are informing uninsured people they can no longer be tested for the virus free of charge, and will have to pay for the service.Quest Diagnostics, which operates one of the largest networks of testing sites and laboratories in the United States, last week began to notify clients that the reimbursement was no longer available, Kimberly B. Gorode, a spokesperson for the chain, said on Sunday.Patients “are being told they can’t get it for free,” she said. Uninsured people will now have to pay $125 to be tested at Quest Diagnostics, while other testing services may charge up to $195.Customers enrolled in a private insurance plan, or covered by Medicare or Medicaid, are not affected, she said.The federal Covid uninsured program was established in 2020 to pay the medical bills of coronavirus patients who lack health coverage. Early this year, during the Omicron wave, the program allowed leading laboratories to perform 500,000 tests a month free of charge to uninsured individuals, according to the American Clinical Laboratory Association.In 2021, the program spent $130 million to reimburse providers for testing, treating and vaccinating uninsured people.Around 31.2 million Americans are uninsured, according to federal data in 2020. Uninsured people were more likely to be people of color or from low-income families.The White House recently requested $22.5 billion in emergency Covid aid, but Republicans in Congress have said they will not approve another aid package unless the White House finds another way to source the funds and lawmakers were still struggling to break through the impasse. An initial deal to use about $7 billion in state government coronavirus aid to help pay for a smaller, $15.6 billion package collapsed earlier this month when rank-and-file House Democrats and governors objected to clawing back that money.On Wednesday, the federal Heath Resources and Services Administration stopped accepting claims for testing and treatment for uninsured patients. On April 6, the agency will stop reimbursing providers for vaccinating uninsured people.Top federal health officials reiterated their concerns on Wednesday about the impact of stalled funding amid the spread of BA.2, a highly transmissible Omicron subvariant accounting for about 35 percent of new U.S. cases and a form of the virus similar to the version that swept through the nation this winter.Xavier Becerra, the health and human services secretary, warned last week that reimbursements for testing were ending.“Continued execution requires continued support from Congress,” he said, referring to President Biden’s recently released Covid response plan. “And at this stage, our resources are depleted.”Pharmacies operate 20,000 testing sites across the country, and, until this month, many have used federal emergency funds to provide tests and vaccinations to uninsured Americans.“This places health care providers in an extremely tenuous position,” the National Association of Chain Drug Stores wrote in a recent letter to the White House and congressional leaders.Cutting off funding “could create extreme confusion at the pharmacy counter,” the letter said, and “could result in the tragedy of increasing disparities in access to critically needed care and patients forgoing care.”The American Hospital Association urged Congress to release relief funds, describing the uninsured program as one of the services “essential to our country’s ability to respond to Covid-19.”In some cases, county, state or other federal programs may provide an alterative for uninsured people.

The latest edition of the DSM-5, sometimes known as “psychiatry’s bible,” includes a controversial new diagnosis: prolonged grief disorder.After more than a decade of argument, psychiatry’s most powerful body in the United States added a new disorder this week to its diagnostic manual: prolonged grief.The decision marks an end to a long debate within the field of mental health, steering researchers and clinicians to view intense grief as a target for medical treatment, at a moment when many Americans are overwhelmed by loss.The new diagnosis, prolonged grief disorder, was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.Its inclusion in the Diagnostic and Statistical Manual of Mental Disorders means that clinicians can now bill insurance companies for treating people for the condition.It will most likely open a stream of funding for research into treatments — naltrexone, a drug used to help treat addiction, is currently in clinical trials as a form of grief therapy — and set off a competition for approval of medicines by the Food and Drug Administration.Since the 1990s, a number of researchers have argued that intense forms of grief should be classified as a mental illness, saying that society tends to accept the suffering of bereaved people as natural and that it fails to steer them toward treatment that could help.A diagnosis, they hope, will allow clinicians to aid a part of the population that has, throughout history, withdrawn into isolation after terrible losses.“They were the widows who wore black for the rest of their lives, who withdrew from social contacts and lived the rest of their lives in memory of the husband or wife who they had lost,” said Dr. Paul S. Appelbaum, who is chair of the steering committee overseeing revisions to the fifth edition of the D.S.M.“They were the parents who never got over it, and that was how we talked about them,” he said. “Colloquially, we would say they never got over the loss of that child.”Throughout that time, critics of the idea have argued vigorously against categorizing grief as a mental disorder, saying that the designation risks pathologizing a fundamental aspect of the human experience.They warn that there will be false positives — grieving people told by doctors that they have mental illnesses when they are actually emerging, slowly but naturally, from their losses.And they fear grief will be seen as a growth market by drug companies that will try to persuade the public that they need medical treatment to emerge from mourning.“I completely, utterly disagree that grief is a mental illness,” said Joanne Cacciatore, an associate professor of social work at Arizona State University who has published widely on grief, and who operates the Selah Carefarm, a retreat for bereaved people.“When someone who is a quote-unquote expert tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions,” Dr. Cacciatore said. “To me, that is an incredibly dangerous move, and short sighted.”“I completely, utterly disagree that grief is a mental illness,” said Joanne Cacciatore, an associate professor of social work at Arizona State University who operates the Selah Carefarm, a retreat for bereaved people.Adriana Zehbrauskas for The New York Times‘We don’t worry about grief’The origins of the new diagnosis can be traced back to the 1990s, when Holly G. Prigerson, a psychiatric epidemiologist, was studying a group of patients in late life, gathering data on the effectiveness of depression treatment.She noticed something odd: In many cases, patients were responding well to antidepressant medications, but their grief, as measured by a standard inventory of questions, was unaffected, remaining stubbornly high. When she pointed this out to psychiatrists on the team, they showed little interest.“Grief is normal,” she recalls being told. “We’re psychiatrists, and we don’t worry about grief. We worry about depression and anxiety.” Her response was, “Well, how do you know that’s not a problem?”Dr. Prigerson set about gathering data. Many symptoms of intense grief, like “yearning and pining and craving,” were distinct from depression, she concluded, and predicted bad outcomes like high blood pressure and suicidal ideation.Her research showed that for most people, symptoms of grief peaked in the six months after the death. A group of outliers — she estimates it at 4 percent of bereaved individuals — remained “stuck and miserable,” she said, and would continue to struggle with mood, functioning and sleep over the long term.“You’re not getting another soul mate and you’re kind of eking out your days,” she said.In 2010, when the American Psychiatric Association proposed expanding the definition of depression to include grieving people, it provoked a backlash, feeding into a broader critique that mental health professionals were overdiagnosing and overmedicating patients.“You’ve got to understand that clinicians want diagnoses so they can categorize people coming through the door and get reimbursement,” said Jerome C. Wakefield, a professor of social work at New York University. “That is a huge pressure on the D.S.M.”Still, researchers kept working on grief, increasingly viewing it as distinct from depression and more closely related to stress disorders, like post-traumatic stress disorder. Among them was Dr. M. Katherine Shear, a psychiatry professor at Columbia University, who developed a 16-week program of psychotherapy that draws heavily on exposure techniques used for victims of trauma.By 2016, data from clinical trials showed that Dr. Shear’s therapy had good results for patients suffering from intense grief, and that it outperformed antidepressants and other depression therapies. Those findings bolstered the argument for including the new diagnosis in the manual, said Dr. Appelbaum, who is chair of the committee in charge of revisions to the manual.In 2019, Dr. Appelbaum convened a group that included Dr. Shear, of Columbia, and Dr. Prigerson, now a professor at Weill Cornell Medical College, to agree on criteria that would distinguish normal grief from the disorder.The most sensitive question of all was this: How long is prolonged?Though both teams of researchers felt that they could identify the disorder six months after a bereavement, the A.P.A. “begged and pleaded” to define the syndrome more conservatively — a year after death — to avoid a public backlash, Dr. Prigerson said.“I have to say that they were kind of politically smart about that,” she added. The concern was that the public was “going to be outraged, because everyone feels because they still feel some grief — even if it’s their grandmother at six months, they are still missing them,” she said. “It just seems like you’re pathologizing love.”Measured at the year mark, she said, the criteria should apply to around 4 percent of bereaved people.The new diagnosis, published this week in the manual’s revised edition, is a breakthrough for those who have argued, for years, that intensely grieving people need tailored treatment.“It’s kind of like the bar mitzvah of diagnoses,” said Dr. Kenneth S. Kendler, a professor of psychiatry at Virginia Commonwealth University who has played an important role in the last three editions of the diagnostic manual.“It’s sort of an official blessing in the world,” he said. “If we were on the planetary committee of the American Astronomical Society deciding what is a planet or not — this one’s in, and Pluto we kicked out.”If the diagnosis comes into common use, it is likely to popularize Dr. Shear’s treatment and also give rise to a range of new ones, including drug treatments and online interventions.Dr. Shear said it was difficult to predict what treatments would emerge.“I don’t really have any idea, because I don’t know when the last time there was a really brand-new diagnosis,” she said.She added, “I really am in favor of anything that helps people, honestly.”Dr. M. Katherine Shear, a psychiatry professor at Columbia University and a founding director of the Center for Prolonged Grief, has been studying the condition since 1995.Yana Paskova for The New York TimesA loop of griefAmy Cuzzola-Kern, 54, said Dr. Shear’s treatment helped her break out of a terrible loop.Three years earlier, her brother had died suddenly in his sleep of a heart attack. Ms. Cuzzola-Kern found herself compulsively replaying the days and hours leading up to his death, wondering whether she should have noticed he was unwell or nudged him to go to the emergency room.She had withdrawn from social life and had trouble sleeping through the night. Though she had begun a course of antidepressants and seen two therapists, nothing seemed to be working.“I was in such a state of protest — this can’t be, this is a dream,” she said. “I felt like I was living in a suspended reality.”She entered Dr. Shear’s 16-session program, called prolonged grief disorder therapy. In sessions with a therapist, she would narrate her recollection of the day that she learned her brother had died — a painful process, but one that gradually drained the horror out of the memory. By the end, she said, she had accepted the fact of his death.The diagnosis, she said, mattered only because it was a gateway to the proper treatment.“Am I ashamed or embarrassed? Do I feel pathological? No,” she said. “I needed professional help.”Yet, others interviewed said they were wary of any expectation that grief should lift in a particular period of time.“We would never put a time frame around when someone should or shouldn’t feel that they have moved forward,” said Catrina Clemens, who oversees the victim services department of Mothers Against Drunk Driving, which provides services to bereaved relatives and friends. The organization encourages bereaved people to seek mental health care, but has no role in diagnosis, said a spokesperson.Filipp Brunshteyn, whose 3-year-old daughter died after an automobile accident in 2016, said grieving people could be set back by the message that their response was dysfunctional.“Anything we inject into this journey that says, ‘that’s not normal,’ that could cause more harm than good,” he said. “You are already dealing with someone very vulnerable, and they need validation.”To set a year as a point for diagnosis is “arbitrary and kind of cruel,” said Ann Hood, whose memoir, “Comfort: A Journey Through Grief,” describes the death of her 5-year-old daughter from a strep infection. Her own experience, she said, was “full of peaks and valleys and surprises.”The first time Ms. Hood walked into her daughter Grace’s room after her death, she saw a pair of ballet tights lying in a tangle on the floor where the little girl had dropped them. She screamed. “Not the kind of scream that comes from fright,” she later wrote, “but the kind that comes from the deepest grief imaginable.”She slammed the door, left the room untouched and eventually turned off the heat to that part of the house. At the one-year mark, a well-meaning friend told her it was time to clear out the room — “nothing worse than a shrine,” he told her — but she ignored him.Then one morning, three years after Grace’s death, Ms. Hood woke up and returned to the room. She sorted her daughter’s clothes and toys into plastic bins, emptied the bureau and closet and lined up her little shoes at the top of the stairs.To this day, she is not sure how she got from one point to the other. “All of a sudden, you look up,” she said, “and a few years have gone by, and you’re back in the world.”

Climate Change Enters the Therapy RoomTen years ago, when psychologists proposed that a wide range of people would suffer anxiety and grief over climate, the idea was seen as a fringe neurosis. But that sSkepticism about that idea is gone.Feb. 6, 2022, 5:00 a.m. ETAlina Black, a mother of two in Portland, Ore., sought a therapist who specialized in climate anxiety to address her mounting panics. “I feel like I have developed a phobia to my way of life,” she said.Credit…Mason Trinca for The New York TimesPORTLAND, Ore. — It would hit Alina Black in the snack aisle at Trader Joe’s, a wave of guilt and shame that made her skin crawl.Something as simple as nuts. They came wrapped in plastic, often in layers of it, that she imagined leaving her house and traveling to a landfill, where it would remain through her lifetime and the lifetime of her children.She longed, really longed, to make less of a mark on the earth. But she had also had a baby in diapers, and a full-time job, and a 5-year-old who wanted snacks. At the age of 37, these conflicting forces were slowly closing on her, like a set of jaws.In the early-morning hours, after nursing the baby, she would slip down a rabbit hole, scrolling through news reports of droughts, fires, mass extinction. Then she would stare into the dark.It was for this reason that, around six months ago, she searched “climate anxiety” and pulled up the name of Thomas J. Doherty, a Portland psychologist who specializes in climate.A decade ago, Dr. Doherty and a colleague, Susan Clayton, a professor of psychology at the University of Wooster, published a paper proposing a new idea. They argued that climate change would have a powerful psychological impact — not just on the people bearing the brunt of it, but on people following it through news and research. At the time, the notion was seen as speculative.That skepticism is fading. Eco-anxiety, a concept introduced by young activists, has entered a mainstream vocabulary. And professional organizations are hurrying to catch up, exploring approaches to treating anxiety that is both existential and, many would argue, rational.Though there is little empirical data on effective treatments, the field is expanding swiftly. The Climate Psychology Alliance provides an online directory of climate-aware therapists; the Good Grief Network, a peer support network modeled on 12-step addiction programs, has spawned more than 50 groups; professional certification programs in climate psychology have begun to appear.As for Dr. Doherty, so many people now come to him for this problem that he has built an entire practice around them: an 18-year-old student who sometimes experiences panic attacks so severe that she can’t get out of bed; a 69-year-old glacial geologist who is sometimes overwhelmed with sadness when he looks at his grandchildren; a man in his 50s who erupts in frustration over his friends’ consumption choices, unable to tolerate their chatter about vacations in Tuscany.The field’s emergence has met resistance, for various reasons. Therapists have long been trained to keep their own views out of their practices. And many leaders in mental health maintain that anxiety over climate change is no different, clinically, from anxiety caused by other societal threats, like terrorism or school shootings. Some climate activists, meanwhile, are leery of viewing anxiety over climate as dysfunctional thinking — to be soothed or, worse, cured.But Ms. Black was not interested in theoretical arguments; she needed help right away.She was no Greta Thunberg type, but a busy, sleep-deprived working mom. Two years of wildfires and heat waves in Portland had stirred up something sleeping inside her, a compulsion to prepare for disaster. She found herself up at night, pricing out water purification systems. For her birthday, she asked for a generator.She understands how privileged she is; she describes her anxiety as a “luxury problem.” But still: The plastic toys in the bathtub made her anxious. The disposable diapers made her anxious. She began to ask herself, what is the relationship between the diapers and the wildfires?“I feel like I have developed a phobia to my way of life,” she said.An Idea on the Edge Spreads OutThomas Doherty in Portland, Ore. He specializes in distress related to climate disaster, or ecopsychology, which was, as he put it, a “woo-woo area” until recently.Mason Trinca for The New York TimesLast fall, Ms. Black logged on for her first meeting with Dr. Doherty, who sat, on video, in front of a large, glossy photograph of evergreens.At 56, he is one of the most visible authorities on climate in psychotherapy, and he hosts a podcast, “Climate Change and Happiness.” In his clinical practice, he reaches beyond standard treatments for anxiety, like cognitive behavioral therapy, to more obscure ones, like existential therapy, conceived to help people fight off despair, and ecotherapy, which explores the client’s relationship to the natural world.He did not take the usual route to psychology; after graduating from Columbia University, he hitchhiked across the country to work on fishing boats in Alaska, then as a whitewater rafting guide — “the whole Jack London thing” — and as a Greenpeace fund-raiser. Entering graduate school in his 30s, he fell in naturally with the discipline of “ecopsychology.”At the time, ecopsychology was, as he put it, a “woo-woo area,” with colleagues delving into shamanic rituals and Jungian deep ecology. Dr. Doherty had a more conventional focus, on the physiological effects of anxiety. But he had picked up on an idea that was, at that time, novel: that people could be affected by environmental decay even if they were not physically caught in a disaster.Recent research has left little doubt that this is happening. A 10-country survey of 10,000 people aged 16 to 25 published last month in The Lancet found startling rates of pessimism. Forty-five percent of respondents said worry about climate negatively affected their daily life. Three-quarters said they believed “the future is frightening,” and 56 percent said “humanity is doomed.”The blow to young people’s confidence appears to be more profound than with previous threats, such as nuclear war, Dr. Clayton said. “We’ve definitely faced big problems before, but climate change is described as an existential threat,” she said. “It undermines people’s sense of security in a basic way.”Caitlin Ecklund, 37, a Portland therapist who finished graduate school in 2016, said that nothing in her training — in subjects like buried trauma, family systems, cultural competence and attachment theory — had prepared her to help the young women who began coming to her describing hopelessness and grief over climate. She looks back on those first interactions as “misses.”“Climate stuff is really scary, so I went more toward soothing or normalizing,” said Ms. Ecklund, who is part of a group of therapists convened by Dr. Dougherty to discuss approaches to climate. It has meant, she said, “deconstructing some of that formal old-school counseling that has implicitly made things people’s individual problems.”‘Obviously, it would be nice to be happy’Caroline Wiese, 18, of New York City experienced “multiday panic episodes” over climate data, which interfered with her schoolwork.Calla Kessler for The New York TimesMany of Dr. Doherty’s clients sought him out after finding it difficult to discuss climate with a previous therapist.Caroline Wiese, 18, described her previous therapist as “a typical New Yorker who likes to follow politics and would read The New York Times, but also really didn’t know what a Keeling Curve was,” referring to the daily record of carbon dioxide concentration.Ms. Wiese had little interest in “Freudian B.S.” She sought out Dr. Doherty for help with a concrete problem: The data she was reading was sending her into “multiday panic episodes” that interfered with her schoolwork.In their sessions, she has worked to carefully manage what she reads, something she says she needs to sustain herself for a lifetime of work on climate. “Obviously, it would be nice to be happy,” she said, “but my goal is to more to just be able to function.”Frank Granshaw, 69, a retired professor of geology, wanted help hanging on to what he calls “realistic hope.”He recalls a morning, years ago, when his granddaughter crawled into his lap and fell asleep, and he found himself overwhelmed with emotion, considering the changes that would occur in her lifetime. These feelings, he said, are simply easier to unpack with a psychologist who is well versed on climate. “I appreciate the fact that he is dealing with emotions that are tied into physical events,” he said.As for Ms. Black, she had never quite accepted her previous therapist’s vague reassurances. Once she made an appointment Dr. Doherty, she counted the days. She had a wild hope that he would say something that would simply cause the weight to lift.That didn’t happen. Much their first session was devoted to her doomscrolling, especially during the nighttime hours. It felt like a baby step.“Do I need to read this 10th article about the climate summit?” she practiced asking herself. “Probably not.”Frank Granshaw, a retired glacial geologist in Portland, sees a psychologist who is well versed on the climate. Mason Trinca for The New York TimesA Knot Loosens: ‘There Will Be Good Days’Several sessions came and went before something really happened.Ms. Black remembers going into an appointment feeling distraught. She had been listening to radio coverage of the Intergovernmental Panel on Climate Change meeting in Glasgow and heard a scientist interviewed. What she perceived in his voice was flat resignation.That summer, Portland had been trapped under a high-pressure system known as a “heat dome,” sending temperatures to 116 degrees. Looking at her own children, terrible images flashed through her head, like a field of fire. She wondered aloud: Were they doomed?Dr. Doherty listened quietly. Then he told her, choosing his words carefully, that the rate of climate change suggested by the data was not as swift as what she was envisioning.“In the future, even with worst-case scenarios, there will be good days,” he told her, according to his notes. “Disasters will happen in certain places. But, around the world, there will be good days. Your children will also have good days.”At this, Ms. Black began to cry.She is a contained person — she tends to deflect frightening thoughts with dark humor — so this was unusual. She recalled the exchange later as a threshold moment, the point when the knot in her chest began to loosen.“I really trust that when I hear information from him, it’s coming from a deep well of knowledge,” she said. “And that gives me a lot of peace.”Dr. Doherty recalled the conversation as “cathartic in a basic way.” It was not unusual, in his practice; many clients harbor dark fears about the future and have no way to express them. “It is a terrible place to be,” he said.A big part of his practice is helping people manage guilt over consumption: He takes a critical view of the notion of a climate footprint, a construct he says was created by corporations in order to shift the burden to individuals.Ms. Black still tears up remembering a moment when Dr. Doherty told her, “In the future, even with worst-case scenarios, there will be good days.” The conversation was “cathartic in a basic way,” Dr. Doherty recalled.Mason Trinca for The New York TimesHe uses elements of cognitive behavioral therapy, like training clients to manage their news intake and look critically at their assumptions.He also draws on logotherapy, or existential therapy, a field founded by Viktor E. Frankl, who survived German concentration camps and then wrote “Man’s Search for Meaning,” which described how prisoners in Auschwitz were able to live fulfilling lives.“I joke, you know it’s bad when you’ve got to bring out the Viktor Frankl,” he said. “But it’s true. It is exactly right. It is of that scale. It is that consolation: that ultimately I make meaning, even in a meaningless world.”At times, over the last few months, Ms. Black could feel some of the stress easing.On weekends, she practices walking in the woods with her family without allowing her mind to flicker to the future. Her conversations with Dr. Doherty, she said, had “opened up my aperture to the idea that it’s not really on us as individuals to solve.”Sometimes, though, she’s not sure that relief is what she wants. Following the news about the climate feels like an obligation, a burden she is meant to carry, at least until she is confident that elected officials are taking action.Her goal is not to be released from her fears about the warming planet, or paralyzed by them, but something in between: She compares it to someone with a fear of flying, who learns to manage their fear well enough to fly.“On a very personal level,” she said, “the small victory is not thinking about this all the time.”