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Success pressure takes a toll, psychologist says

Original post made on May 11, 2009

A "deep drive for perfection" in Palo Alto is taking a toll on the community's children, according to a psychologist who runs counseling programs in middle and high schools.

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Comments (30)

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Posted by anonymous
a resident of Duveneck/St. Francis
on May 11, 2009 at 2:09 pm

For perspective, it helps if you have lived elsewhere or have an international family, etc. I got news for ya: the world does not revolve around Palo Alto. Some here sure think it does, though.

In our experience, people are generally not modest here. For those who ARE modest and use good taste (don't brag about their grades, money, keep personal things whether favorable or not to themselves)it can be tough to be constantly barraged by the braggarts who are constantly trying to demoralize you. I speak of both children and parents. I speak of important things: honesty, kindness as well as unimportant but strong symbols/visuals: I'll never forget the Paly kid who drove a luxury convertible sportscar a few years ago.

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Posted by Sharon
a resident of Midtown
on May 11, 2009 at 2:24 pm

Philippe Rey has already lost credibility by the thoughtless and misleading comments he made last week in the Daily Post.

If you want valid information go to Stanford School of Medicine Health Library Web site hereWeb Link

And the Stanford Childrens Hospital Web Page on Teen Suicide hereWeb Link

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Posted by Avid Reader
a resident of Downtown North
on May 11, 2009 at 4:06 pm

Why would you assume Philippe was quoted correctly in the Post?

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Posted by adding stress?
a resident of Another Palo Alto neighborhood
on May 11, 2009 at 5:10 pm

If you think you are not adding stress to your children or their friends just stop and think how many of you have asked someone what their SAT scores are; then stop and think how many of you (adults)have asked a freshman or sophomore what college they are thinking of applying to.

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 11, 2009 at 6:09 pm

I didn't see anything unreasonable about what Rey said. It tracks with what's been said by some of the current students and recent grads in the threads.

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Posted by Sharon
a resident of Midtown
on May 11, 2009 at 8:17 pm

So you are suggesting that we should listen to someone who reflects the opinions of HS students rather than someone with an MD after their name?
We will take the MD and evidence based opinion and treatment for our kids if needed, but good luck with the HS advice, it is a free country.
Good luck with that.

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Posted by jack mehoff
a resident of Green Acres
on May 11, 2009 at 10:12 pm

sharon while an doctoral degree might make someone think they have the knowledge to control another persons life, hs students may have some valid points as to how they should be treated, maybe you shouldnt be so quick to dismiss their opinions

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Posted by Outside Observer
a resident of another community
on May 11, 2009 at 10:59 pm

Sorry Palo Alto, no sympathy at all.

Scholastic competition is now global, and for every privileged Palo Alto kid, there are millions more throughout the world achieving much more, and with none of the "perks" of Palo Alto.

Take a look around you, in the economy of our area. Spoiled white kids are not the technical backbone of silicon valley.

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 11, 2009 at 11:21 pm


I've known far too many MDs to assume that a medical degree confers automatic wisdom. Psychiatrists tend to specialize in giving medication not in psychotherapy. Someone who's clinically depressed with decent insurance will see a therapist (such as a psychologist)once or twice a week and a psychiatrist once a month. The psychologist is the one most likely to know about the causes of the depression.

Neither sort of doctor would assume that no one else has insight into the issue.

Outside Observer,

Wanna discuss the extremely high suicide rates of young people in Asia? Stupid and tragic to have a situation where kids jump out of windows over test scores every year.

The irony is that the tests aren't great predictors of future performance in life.

That said, I don't get your obsession with race in this instance. Any student could tell you that the extreme pressures affect non-white students as well--just look at the stats of depression among teens.

I see plenty of white guys, by the way, running plenty of Silicon Valley companies. Google, Facebook, H-P, Oracle, Sun--maybe you've heard of them?

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Posted by Sharon
a resident of Midtown
on May 12, 2009 at 6:58 am

Serious depression, Anorexia, addiction or other serious mental illness requires qualified medical and psychiatric experts to evaluate and treat.

Often there are neurological and/ or biochemical factors involved.

The double blind research on talk therapy shows its utility is marginal a best, there may be gains from expert cognitive/behavioral interventions in controlled settings, but it is limited.

Anti depressant, anti psychotic medication, withdrawal protocols etc have been tested and proved to work in multiple double blind studies across multiple populations in multiple countries.

The evidence is clear, evaluation and treatment by a qualified physician, an MD is the gold standard for the treatment of mental illness.

We would not risks our childrens lives and future with anything less than the gold standard of evaluations and treatments that can only be provided by an MD.

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Posted by palo alto mom
a resident of Crescent Park
on May 12, 2009 at 9:01 am

There is much we could do as a community to lessen the stress on our students.

Academics - math and science are not the only subjects of value, support your student in all their efforts

Teaching staff - act and teach as if you want and expect the students to succeed. Provide timely feedback, be accessible, be a facilitator not a roadblock. Remember you are really important to your students.

Sports - provide a place where kids can play sports in a less competitive way, except for AYSO soccer, most sport are all or nothing by 4-5th grade. You must commit to playing a sport, 5 days a week.

Parents - support and applaud effort. Allow your kids to fail and make mistakes in middle school. It will serve them well in high school.

Pay attention - too often as parents, teachers, etc. we get distracted. Pay attention to your kids. Be there, physically and mentally on a regular basis.

Access to other adults - kids should have an adult to talk to, preferably in addition to their parents. Never underestimate how important you may be to your child's friend.

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Posted by Dave
a resident of Professorville
on May 12, 2009 at 10:46 am

The headline of this article is inaccurate. I started to read "Success pressure takes a toll" expecting it to be about the pressure created by being a success. The headline should have been, "Pressure to succeed takes a toll."

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 12, 2009 at 1:39 pm


What double-blind tests? And under what kind of situation? For how long? Depression is often chronic occurring intermittantly for decades.

Links please?

Antidepressants work, but they don't treat the situational or underlying causes of the problem.

And the research is hardly unanimous. Here for example is a study that showed talk therapy to be as efficaceous as drugs (and without side effects)

Web Link

Here's an earlier summary on the effectiveness of psychotherapy.

Web Link

It's a nice compact summary of the major findings--i.e. depression is best treated with a combination of psychotherapy and pharmaceuticals. (As I pointed out earlier.) Borderline Personality Disorder responds best to a specific type of psychotherapy. (Since those with BPD have a high rate of suicide and an even higher rate of suicide attempts--this disorder is pertinent to any discussion of suicide.)

One of the problems with research in the area is that there's a hell of a lot of money to be made from prescribing drugs to treat mental illness. In some types of illness, they're absolutely the right thing--bipolar illness--no question. However, there's a great deal that we don't know about drug interactions.

Antidepressants are a relatively cheap fix compared to talk therapy. Insurance companies like that--so there's a lot of push to use them. But there are some pretty serious drugs with side effects.

And, of course, the big pharmaceutical companies are funding much of the research into the efficacy of treatments.

Even with the most successful drug treatments, by the way, the recurrence of depression is about the same as it is in an uncontrolled group of depression. In that sense, while drugs may alleviate the symptoms of depression they're not great at doing much to prevent the onset of depression--and this is true in the case of depressions caused by a biochemical imbalance.

The 1992 Hollan study showed that the relapse rate for patients treated with both drugs and cognitive therapy was half that of those treated with just drugs.

Basically, talk therapy doesn't reset the mood the way drugs do, but it does teaching ways of coping and drugs don't.

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Posted by Martha
a resident of Downtown North
on May 12, 2009 at 2:09 pm

I don't have children, so I don't know what's going on with kids today. However, I'm relatively young and went through three of the best universities in the US including Stanford and Ivy Leagues; and I can tell you that I never cared about grades. But my passion for learning and understanding got me through and into all the schools. 90% of all the students that I went to school with didn't give a hoot about what they were learning. They only cared that they were on top of the curve.

Well, I certainly got some bad grades when I didn't care about a class; but all my teachers saw the passion I had for all of the subjects I did care about and would give me high glorified recommendations for anything I asked; not because I got good grades but because I truly wanted to know and understand whey were teaching.

My parents never saw my grades beyond junior high school and never once commented on my performance. They knew that I was doing the best I could and that I loved going to school because each and every and every day I would learn something new and came home excited. I would sit on my report cards, unopened for long periods of time, because I knew they were not a result of what I learned but what the teachers thought was important for me to learn. These were not always the same thing.

I continue to lead through my passions. I got three degrees in engineering and business and used little of them, but I've made a lot of money by doing what my heart told me. I employ some Palo Alto employees now, and the younger ones don't know how to think on their own because their parents seem to have always driven their lives. They don't know how to choose or make decisions. I hate to be the bearer of bad news, but it is more the Asian kids that have this issue. Asians were also the great majority who care a lot about grades at the universities I went to.

I think that children need to be allowed to listen to their hearts and follow their dreams. Life is too short to live out someone else's dreams.

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Posted by Sharon
a resident of Midtown
on May 12, 2009 at 2:33 pm

Belief in talk therapy is based on faith,anecdote and marketing not evidence.

Psychopharmacology is based on evidence and science.

So a discussion is like that between creationists and evolutionary biologists, ships passing in the night.

This is the state of psychotherapy research--

"As early as 1952, in one of the earliest studies of psychotherapy treatment, Hans Eysenck reported that two thirds of therapy patients improved significantly or recovered on their own within two years, whether or not they received psychotherapy

Virtually no comparisons of different psychotherapies with long follow-up times have been carried out.

There is considerable controversy over which form of psychotherapy is most effective, and more specifically, which types of therapy are optimal for treating which sorts of problems.

The dropout level is quite high; one meta-analysis of 125 studies concluded that the mean dropout rate was 46.86%.
The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy."

This is the state of Psychopharmacology research

Evidence-based guidelines for treating depressive disorders with antidepressants Web Link

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Posted by palo alto mom
a resident of Embarcadero Oaks/Leland
on May 12, 2009 at 2:39 pm

Martha - thank you for sharing your experience, I agree that it is both difficult and very important to let our children dream their own dreams and follow their own hearts. In my years in the business world, the out-of-the-box thinkers have been the most successful and often the most happy. While tech skills are important, creativity and a willingness to take risks are much more important. There is definitely a need for the very competent line workers, someone called them the technical backbone, but competence is different from being a star.

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Posted by Wellness
a resident of another community
on May 12, 2009 at 4:44 pm

Sharon: "Belief in talk therapy is based on faith,anecdote and marketing not evidence.

Psychopharmacology is based on evidence and science."

Sharon, it so happens that there is excellent clinical (i.e. scientific) evidence, derived from many well-controlled studies that a combination of drugs AND therapy (with some therapies proving better than others, like short-term cognitive therapy), that a COMBINATION of drugs and therapy are most effective. Of course, every case is different, as the etiology of depression is complex, and can involve many environmental and genetic components. There is no "gold standard" for treating depression, yet. A good friend (now deceased) carried out many of the studies I'm talking about, at the Stanford School of Medicine.

btw, it's also been shown that a certain population of depressed persons can obtain very fast relief through well-conducted courses of cognitive therapy alone, provided they are willing to invest small amount of time every day in completing exercises that give them insight into new coping skills. Some studies indicate that in certain populations, positive changes in brain chemistry and relief from suffering (up to and including suicidal impulses) are as dramatic, or more dramatic, than with drugs alone.

When people go spouting about things they know little about, based on pure belief, there is always the possibility that some poor soul will take them at their word. When it comes to depression, this can have tragic outcomes. Please be more careful about spouting opinion that is based on shallow knowledge, especially within the domain of mental illness. Lives can depend on getting facts straight.

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Posted by Wellness
a resident of another community
on May 12, 2009 at 4:49 pm

There are many cognitive distortions extant as triggers to depressive illness. Perfectionism is but one of those distortions. The problem is that we have poor knowledge of which kids are saddled by a genetic (hastened by environmental) disposition to depression. What is needed is more early intervention, so that those who have a propensity for depression (as well as those who don't) get more good information about how they can make their lives better, through the self-identification of cognitive distortion, and the application of very simple techniques to neutralize those distortions.

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Posted by Sharon
a resident of Midtown
on May 12, 2009 at 8:03 pm

In 1995, less than half of people getting mental health treatment -- 40% -- got drug therapy.
Now 68% get drug treatment, and 80% of those treated for depression or anxiety get drug treatment.

We now have a whole new range of effective medicines to treat depression, and other mental health problems, quickly and effectively.

Psychotherapy has changed little since the 19 century, the era of the buggy whip.

Martin Seligman, the past president of the APA, has shown that the whole focus of psychotherapy is outdated. He launched a new model--Positive Psychology-- that emphasizes resilience, it has not been tested in controlled clinical trials yet and, given the recent Elizabeth Edwards weird contamination of that brand, it may never get off the ground.
As it is psychotherapy, in the words of Harry Stack Sullivan, is bought friendship.
It does not have a scientific or evidence base.
It is a matter of "Caveat Emptor" with a built in conflict of interest for the MFCC etc, they make money by finding new issues to bill their time for. Kaiser does have a different incentive structure so they are a better bet if you choose the talk route, and they always have an MD monitoring and supervising the psychotherapy.
In contrast medication is audited and monitored by the FDA, it has to be both safe and effective.
No such controls apply to talk therapy.
We will go with the science, quality control and oversight that MD ensures, if the issues arises in our family-- better safe than sorry.

The downsides are devastating so we would have low risk tolerance.
Stick with science, evidence and oversight.

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 12, 2009 at 8:16 pm


Thank you for your comments. I know, right now, we've got a lot of younger readers on the Forum who are having a hard time after what happened last week. I hope they talk to people as they need to.


Wow, so you cherrypicked sentences of a wikipedia article--no *wonder* you didn't give a link since you took the sentences out of context.

Whereas I gave you links to discussions of particular studies. No *wonder* you didn't comment on them.

And no wonder you haven't been able to process what I said--which is that the preferred treatment for serious depression combines drugs and psychotherapy.

As Wellness points out, depression isn't a simple condition. The causes can be many and people have different ways of responding to treatment. Because of the situation with insurance, the research focus has been on short-term treatments--such as cognitive therapy techniques--that have relatively quick results. *That's* why the studies are of short-term techniques--that's what insurance companies are willing to pay for.

I realize you like to try to be an expert on things, but you are out of your depth here. This isn't an area about which you learn everything overnight.

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Posted by Sharon
a resident of Midtown
on May 12, 2009 at 8:48 pm

Actually, before I changed to law, I was a behavioral scientist with the NIMH Center for the Study of Schizophrenia in Bethesda.
We reviewed and did meta analysis of all the major studies of psychotherapy and drugs.
Sorry about that---
Psychotherapy is "bought friendship" with an inherent conflict of interest, unless you go to a HMO like Kaiser which has MD oversight and a financial incentive to get you back on track fast.

At NIMH we also did studies of psychotherapists personality--, they have a drive for controlled intimacy and are typically "non swimmers attempting to be life guards"--- as we summarized in our meta report.

Stick with science, evidence and oversight.Otherwise you are in Caveat Emptor land.
If it were just a matter of lonely, wealthy crones thats ok to buy friendship, I guess.

When it comes to our children welfare parents need to be alert and look at the compelling evidence about what works.
That is not trivial.

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 12, 2009 at 9:03 pm


And you really think that 80 percent receiving drugs is doing so without seeing a therapist?

Now that I think of it, I think you've gotten upset about counselors before--I sense a personal agenda here.

Anyone, you've had enough attention for now.


I'm glad to know that it's still possible to get through the system and care about learning more than grades. I've seen something similar--people who did all the right things, pleased their parents, went to the "right" schools and then just sort of flounder as adults. I feel like a lot of them either don't really know what they want or don't know how to pursue a dream without being told how to do so. A lack of independence, I suppose. And, yes, it doesn't make for a future leader.

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 12, 2009 at 9:22 pm


Oh, yeah, right you're a lawyer and a behavioral scientist.

Problem is, Sharon, is that you're not a reliable narrator. You don't think like a lawyer--basic logic eludes you consistently. You don't know how to put together an argument and support it with evidence.

You don't think like a scientist either. A real scientist would acknowledge my links and then say why or why not they were valid.

A real scientist at NIMH would *know* that the therapist/psychiatrist combination is standard practice.

A real NIMH scientist would know about the more recent research done on cognitive therapy.

A real NIMH scientist wouldn't be cutting up bits of Wikipedia and distorting it. A real scientist would have much better information at her fingertips and know the weaknesses and strengths of the studies.

She'd also know the limits of her expertise.

She'd also have access to the professional databases.

Some of us have been around long enough to have seen you morph before the Forum came down on the use of multiple user names in a single thread.

I've yet to see you display any knowledge that's beyond basic Googling.

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Posted by Outside Observer
a resident of another community
on May 12, 2009 at 9:42 pm


We had the discussion about college requirements weeks ago in the thread on UC admission changes - no need to re-hash that.

Re: teen suicide in Asia, yes Japan has a particularly high rate, and it's a function of their culture, not an indication of greater/lesser stress in academic achievement. To their credit, the Japanese government is taking action to deal with it.

I said "Spoiled white kids are not the technical backbone of silicon valley". The managers and owners will come along in the next generation.

I will give you points for one thing in your post. Something that shows that although you are a liberal, you have the capacity for independent thought.

You inferred I have some racism against whites in your response. While not true, the lock-step lib line is that whites are responsible for all suffering in the world, so any possible discrimination is more than justified. i.e., in the liberal world racism against whites is impossible.

The reality is that you need look no farther than the tax code to see that there is government sponsored, systematic racism against rich whites.

I hope I'm correct in my take that you are an independent thinker in regards to anti-white racism.

The more your opinions are outside of lock-step liberalism, the more I will consider their validity.

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Posted by Sharon
a resident of Midtown
on May 12, 2009 at 9:49 pm


[Portion removed by Palo Alto Online staff.]

Actually at Stanford they developed an artificial intelligence model of psychotherapy ELIZAWeb Link

OP I did not respond to your links because they are outdated, partisan and do not meet the test of academic credibility for a scientific vs "constructivist" point of view,

Anyway, the important thing is that our childrens lives are at stake.
Psychotherapy is fine for old lonely chrones who want to buy friendship, I guess, such services are not regulated in this state.

For parents who want peace of mind and probability of good outcome, go with the MD and medication, follow the evidence.

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 12, 2009 at 10:11 pm

Outside Observer,

Look up South Korea--the suicides there come in direct response to test results--every Spring they have a couple hundred of them.

You can't separate academic pressures from culture. How pressure is experienced and how "failure" is assessed ties directly into cultural expectations.

The owners and managers will come in the next generation? No, I don't think so--and I'll tell you why. We've already had a large number of Asian engineers and programmers for more than 20 years. (Remember Wang Labs?). We have East Asian engineers and programmers with the training and the connections--and they do work in Silicon Valley, but, when it comes to running the show, they're under-represented.

In contrast, Indian entrepreneurs were everywhere during the dot-com boom--a smaller and more recent immigrant group. I remember one figure during the peak had an Indian founder involved with 40 percent of the dot-com start-ups.

I don't think it's lack of East Asian talent or training. I do think there are cultural reasons that, Jerry Yang being a notable exception, that that 23-year-old hot start-up CEO was named Zuckerman instead of Wong. (And, no, I'm not Jewish.) I think the pressure to conform and meet parental expectations is an issue; I think there's a tendency to care more about the external markers (i.e. grades) than the internal (what's actually learned)can be an issue and I think the idea that only a fairly narrow range of careers are acceptable is an issue.

Successful people need to know how to fail and live with it. There's something about Chinese and American culture that doesn't always mix well. The American/immigrant drive to succeed gets in, but not so much that American tolerance for quirkiness . . . or there's something about trying to combine conforming to parental expectations that works badly with the American focus on individuality.

I haven't hashed it all out, but having had American-Asian friends all my life I've observed it--as well as having observed how large the generational differences--being zero-gen is way different than 4th-gen.

And yes I'm a liberal and no, I'm not particularly PC.

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 12, 2009 at 10:22 pm


In other words, you can't admit that standard treatment of depression combines psychotherapy AND drugs. Nor can you deny it.

Given that my links were to studies more recent than yours, your "outdated" claim doesn't wash.

Of course, a real scientist would be able to say why a study was outdated--and what the more recent research was. You didn't. But, then, you don't have that sort of information.

And, of course, I linked to a peer-reviewed journals and a reference to a peer-reviewed journal. In fact, one is a link to the American Journal of Psychiatry.

You know, one of those MD journals.

But maybe you forgot during your post-9/11 trauma.

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Posted by Sharon
a resident of Midtown
on May 12, 2009 at 10:56 pm

My main concern at this point is kids health.

The objective research shows that talk therapy is no better than placebo,
In fact exercise is more effective for mild depression than anything.

Apart from that medication and MD supervised time limited cognitive/behavioral therapy is effective.

Interesting you brought up 911.
A whole cottage industry grew up to make money from PTSD, actually the research shows that the vast majority of the talk and group therapy re that issue does more harm than good.
I remember being approached by under employed family therapist and members of scientology in NY, they were like vultures.
In fact, family, church and brief medication, to enable sleep, proved to be the best approach, according to the research by CDC.
Again the best thing short of medication is working out, sleep and learned optimism.
It is simple, cheap and effective.
Avoid the vultures who want to profit from your pain.
Of course, those who lost family and friends and witnessed 911 will never forget and never forgive, but they can forgive themselves for surviving and direct their anger to where it belongs.

Since we have moved to the West Coast we do not see that anger, you see it elsewhere and a strong drive for revenge.
It is what it is

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Posted by OhlonePar
a resident of Duveneck/St. Francis
on May 13, 2009 at 1:38 am

[Post removed by Palo Alto Online staff.]

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Posted by parent
a resident of Community Center
on May 13, 2009 at 10:06 am

[Post removed by Palo Alto Online staff.]

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