Why Childhood Mental Health Is Declining - A Psychotherapist’s Warning

Most things in life are multidetermined

TL;DR

• Kosmas's key word is multidetermined. Our behaviour comes from many causes, not one.
• Resilience isn't being a brick wall. It's the ability to adapt, be flexible and bounce back.
• Get teenagers into the land of the living, not the land of the virtual.
• Emotions aren't good or bad. They sit on a continuum.
• If everyone did one thing, Kosmas would have them respect and forgive themselves.

Introduction

Professor Kosmas Smyrnios has had a career that crosses a lot of fields. He started out working with children with disabilities, then in 1978, at 24, began working at what he describes as the first community mental health centre in Australia. He's worked as a child and adolescent psychotherapist, researched family business and entrepreneurship, published over 150 journal articles and supervised 30 PhD students.

He describes himself as going down a lot of rabbit holes, and I loved every one of them. The way he answers questions made me think about things in completely new ways.

Please note: this blog is for general information only and isn't medical or psychological advice. If you or your child are struggling, please speak with your GP, a psychologist or another qualified mental health professional. If you need to talk to someone now, call Lifeline on 13 11 14, or Kids Helpline on 1800 55 1800 for young people.

Lesson 1: Your thoughts shape how you feel and act

Insight: I asked Kosmas whether people are motivated more by past experiences or the future. His answer was a bit of both, plus what's happening now. Your past shapes how you've experienced taking action, and your view of the future comes down to consequences. If you can see a long-term benefit, even an incremental one, you're more likely to act.

When it comes to barriers, he said they're multidetermined. Take someone who wants to learn to surf. One person thinks it's the scariest thing in the world and they could drown. Another sees a challenge and thinks of surfing like their mate. The difference is in how they think about it. In the cognitive behavioural view, your thoughts create your emotions, and those emotions shape your behaviour.

Action: Pick something you've been avoiding, and write down the thought that comes up when you picture doing it.

Outcome: You start to see how your thinking shapes your actions.

Lesson 2: Therapy doesn't have to be one thing

Insight: I asked Kosmas to explain the difference between a psychologist and a psychotherapist. A psychiatrist is medically trained. A psychologist isn't, but can also be a psychotherapist. Other professionals, like social workers, can train in psychotherapy too. There are many forms of therapy and many theoretical approaches.

The goals vary just as much. Some people want insight into themselves. Others just want help with one issue, like sleep or anger, and don't want deeper understanding. Both are valid.

He also thinks therapy doesn't have to be one long, open-ended commitment. He's worked on focused, time-limited approaches with children and their parents, and he sees therapy as something you can come back to at different stages of your life, depending on what's happening.

Action: If you've been putting off getting help, think about one specific thing you'd want support with first.

Outcome: Asking for help feels more manageable and focused.

Lesson 3: Resilience is flexibility, not a brick wall

Insight: This was the part that set off light bulbs for me. On social media, resilience often sounds like being a brick wall: unbreakable, repelling everything. Kosmas sees it differently.

He says the idea of resilience originally came from engineering, where materials that stretch without breaking are resilient. For people, he sees it as a dynamic capability made up of several skills. It's the ability to bounce back, to adapt and be flexible, to scan your environment, and to spot the opportunities, consequences and risks of your actions. Putting all of that together is what makes someone resilient.

He also talked about variety in a child's life. He's concerned that keeping young people in institutions with rigid routines for long periods can lead to dependency, and he believes the family, or another caring person, is usually the best place for care when it's safe. Diversity and change are what build resilience.

Action: Think of a recent setback, and ask how you could adapt to it rather than just push through.

Outcome: You build the kind of resilience that bends without breaking.

Lesson 4: Get kids into the land of the living

Insight: Growing up, I had about 10 to 15 years before social media. Kids now are born into it. I asked Kosmas how teenagers can quiet the noise and find who they are.

He said the peer group becomes more important than parents in the teenage years. In his time, kids spent a lot of time in groups and team sport. His advice is to encourage young people to be "in the land of the living, not in the land of the virtual". The virtual world is a distorted snapshot. Scouts, girl guides, footy and other team activities build camaraderie and help young people develop their own values.

He also says that when teenagers push back against their parents, it's easy to see it as negative. Often it's part of them developing their own identity.

Action: If you're a parent, help your teenager find one regular activity with peers that doesn't involve a screen.

Outcome: They build real connections and a stronger sense of who they are.

Lesson 5: Labels can help or hinder

Insight: We spoke about the rise in diagnoses, and people self-diagnosing after watching reels online. Kosmas said diagnostic criteria have broadened since the 1980s. He doesn't see that as good or bad. A diagnosis can give people insight, access to support and an "aha" moment. For others, it might feel like a negative label.

I mentioned that a guest from South Sudan told me her language doesn't have a word for depression. Kosmas believes emotions are universal. People express and identify them differently, but whether you call it depression or feeling down in the dumps, you're still having that feeling.

He also doesn't think emotions should be split into good and bad. They sit on a continuum. He referred to Freud's idea of "common everyday unhappiness". We're not meant to be happy all the time. Feeling content and okay, so you can function and enjoy life, is a great place to be.

Action: Next time you feel low, describe the feeling in your own words instead of judging it.

Outcome: You relate to your emotions with more curiosity and less fear.

Lesson 6: Learn to pause

Insight: I told Kosmas about an upcoming guest who's written a book on pausing before you eat. I've been trying to pause before sending emails and making business decisions too.

Kosmas loved it. He pointed out that when people were more religious, many said grace before eating, which was a pause. Very few people do that now. His advice: when you go out to dinner, pause the phone and give the food priority. Give your bedtime priority as well.

He's also used pairing to learn things he didn't enjoy. He hated statistics, so he'd go surfing and camping and then read his statistics books. Pairing something you dislike with something you love is a behavioural technique, and he ended up teaching the subject.

Action: Before your next meal, put your phone away and take a breath before you start eating.

Outcome: You make more intentional choices across your day.

Lesson 7: Respect and forgive yourself

Insight: My final question was the one thing Kosmas would get every Australian to do every day. His answer was to respect yourself, which can spill over into respecting others. Alongside that, forgive yourself, and forgive others.

To get there, he says you first need awareness. When do you hold back forgiveness? How often? What's the barrier? He shared that he recently went up to a neighbour he'd had a run-in with and talked about burying the hatchet. He said it was a relief. We all carry a backpack of history, and forgiveness lets you throw an item out.

He also recommends journaling, whether that's in a notebook or an app. His wife, a clinical psychologist, developed a technique of journaling in your mother tongue. If you speak more than one language, you may find your thinking changes depending on the language you write in.

Action: Write down one thing you're still holding against yourself, and one small step towards letting it go.

Outcome: Your world becomes a little lighter.

Quick wins

• Notice the thought behind the fear.
• Treat resilience as adapting, not resisting.
• Get your kids into team activities.
• Pause your phone at meals and before bed.
• Practise forgiving yourself first.

Closing insight

Kosmas came back to one word all the way through: multidetermined. Our motivation, our struggles and our children's wellbeing come from many causes, not one. That's why there's no single fix. But it also means there are many ways in. Being flexible, staying connected to real people, pausing and forgiving ourselves are all good places to start.

Listen to the full episode

The full conversation is on Spotify, Apple Podcasts and YouTube, or press play at the top of this page.

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