Madeline Levine has been a practicing psychologist for twenty–five years, but it was only recently that she began to observe a new breed of unhappy teenager. When a bright, personable fifteen–year–old girl, from a loving and financially comfortable family, came into her office with the word empty carved into her left forearm, Levine was startled. This girl and her message seemed to embody a disturbing pattern Levine had been observing. Her teenage patients were bright, socially skilled, and loved by their affluent parents. But behind a veneer of achievement and charm, many of these teens suffered severe emotional problems. What was going on?

Conversations with educators and clinicians across the country as well as meticulous research confirmed Levine's suspicions that something was terribly amiss. Numerous studies show that privileged adolescents are experiencing epidemic rates of depression, anxiety disorders, and substance abuse — rates that are higher than those of any other socioeconomic group of young people in this country. The various elements of a perfect storm — materialism, pressure to achieve, perfectionism, disconnection — are combining to create a crisis in America's culture of affluence. This culture is as unmanageable for parents — mothers in particular — as it is for their children. While many privileged kids project confidence and know how to make a good impression, alarming numbers lack the basic foundation of psychological development: an authentic sense of self. Even parents often miss the signs of significant emotional problems in their "star" children.

In this controversial look at privileged families, Levine offers thoughtful, practical advice as she explodes one child–rearing myth after another. With empathy and candor, she identifies parenting practices that are toxic to healthy self–development and that have contributed to epidemic levels of depression, anxiety, and substance abuse in the most unlikely place — the affluent family.

It was 6:15 P.M. Friday when I closed the door behind my last unhappy teenage patient of the week. I slumped into my well-worn chair feeling depleted and surprisingly close to tears. The fifteen-year-old girl who had just left my office was bright, personable, highly pressured by her adoring, but frequently preoccupied, affluent parents, and very angry. She had used a razor to incise the word empty on her left forearm, showing it to me when I commented on her typical cutter disguise -- a long-sleeve T-shirt pulled halfway over her hand, with an opening torn in the cuff for her thumb. Such T-shirts are almost always worn to camouflage an array of self-mutilating behaviors: cutting with sharp instruments, piercing with safety pins, or burning with matches. I tried to imagine how intensely unhappy my young patient must have felt to cut her distress into her flesh.

As a psychologist who has been treating unhappy teens for over twenty-five years, I wondered why this particular child left me feeling so ragged. I live and work in an upper-middle-class suburban community with concerned, educated, and involved parents who have exceedingly high expectations for their children. In spite of parental concern and economic advantage, many of my adolescent patients suffer from readily apparent emotional disorders: addictions, anxiety disorders, depression, eating disorders, and assorted self-destructive behaviors. Others are perplexingly and persistently unhappy in ways that are more difficult to quantify easily. The fact that many of these teens are highly proficient in some areas of their lives helps mask significant impairments in others -- the straight-A student who feels too socially awkward to attend a single school dance, the captain of the basketball team who is abusive toward his mother, the svelte homecoming queen who consistently sees a "fat ugly duckling" in the mirror. While I love my work, it is also quite demanding and I usually greet the end of the day on Friday with a mixture of relief and anticipation, not sadness. Sinking further into my chair, I flipped through my appointment book, searching for clues to my emotional weariness.

I was not surprised by the seriousness of many of my cases. After two decades of treating unhappy kids, and the publication of a couple of books on how the media influence child development, I had become a "senior" psychologist and am often referred difficult cases. I enjoy working with troubled adolescents and seem to have a knack for developing an easy rapport with them. The eating-disordered girls who are enraged by their mother's submissiveness and yet mimic it in their own self-defeating behavior. The junior high school girls with pitiable self-esteem who regularly give oral sex to boys behind the school gymnasium, while insisting that they are not sexually active -- an astonishing redefinition of sexual activity shared by most of their generation. The substance-abusing boys who attempt to ward off depression with drug use but ultimately end up in out-of-the-way places for a year or two of rehab. Many of these teenagers suffer from obvious emotional illnesses: depression, anxiety disorders, eating disorders, and substance abuse. Often there is a family history of depression or bipolar illness or alcoholism. These teens "look" troubled. Their grades are usually poor, their relationships volatile, and their behavior floridly risky. Their parents are terrified when they haul them in for treatment.

But I was puzzled by the fact that an increasingly large number of my hours were filled with cases that initially seem to be rather garden-variety adolescent problems. When parents make calls to my office for these kids, there is often...

Madeline Levine, Ph.D., has been a practicing clinical psychologist in Marin County for the past twenty-five years. She is the author of Viewing Violence and See No Evil: A Guide to Protecting Our Children from Media Violence. A frequent lecturer on child and adolescent issues, she lives in California with her husband and three sons.