Josef Witt-Doerring on Gen Z Mental Health, Isolation, and Psychiatric Prescribing

Shabbos Kestenbaum opens with what he describes as alarming findings from the Walton Family Foundation: 42% of Gen Z Americans have received a mental-health diagnosis, twice the rate among older adults. He also cites high reported rates of anxiety, depression, and ADHD. He asks psychiatrist Josef Witt-Doerring what could account for such widespread distress.

Witt-Doerring says he considers the problem a real medical and psychiatric crisis. His central explanation is that many people are living out of alignment with the conditions under which they function well. He points to extensive social-media use and a broader pattern of poor physical health, limited movement, and daily routines organized around technology.

He cites widespread overweight and obesity and an average of roughly 4,000 steps a day as examples of that pattern. In his account, young people may wake up, stay indoors, and spend the day on screens without sunlight or much physical activity. He sees physical and mental well-being as connected rather than separate problems.

Kestenbaum then contrasts the growth in treatment with continuing distress. He cites a 62% increase in suicide deaths since the early 2000s and a rise of more than 500% in antidepressant use, asking why billions of additional dollars have not produced better mental-health outcomes. These figures frame the interview’s question about what the treatment system is delivering.

Witt-Doerring argues that money is being spent in the wrong ways. He describes a mental-health industry approaching $400 billion annually and compares that with defense spending to emphasize its scale. His criticism is that the dominant model readily supplies medication while giving too little attention to understanding the person who is asking for help.

He describes the familiar path of a patient seeing a doctor, completing a checklist, and receiving a depression or anxiety diagnosis. In his account, many psychiatric prescriptions come from family physicians with around seven minutes of face time available. He attributes that constraint to commercial insurance and the number of appointments required to keep a practice financially viable.

When clinicians have little time to understand patients, Witt-Doerring says, care can become a sequence of checklists and algorithms: identify depression and choose an antidepressant. He argues that patients may receive limited help with the circumstances underlying their distress. His concern is that medication can blunt symptoms while problems in a person’s life remain unresolved.

Kestenbaum asks whether the criticism of overprescribing associated with Robert F. Kennedy Jr. and the Make America Healthy Again movement describes the problem accurately. Witt-Doerring agrees with the concern. He argues that pharmaceutical companies benefit from interpreting difficulties through a medical lens, and that doctors also work within a system that encourages people to seek medical solutions.

Witt-Doerring objects to treating food, exercise, sleep, relationships, meaning, and purpose as merely mild or alternative interventions. In his view, these are central to sustained well-being rather than peripheral additions reserved for minor depression. He challenges the assumption that a problem described as serious or genetic must therefore be addressed primarily with drugs.

Kestenbaum shifts to GLP-1 drugs, naming Zepbound and Ozempic, and asks about the psychiatrist’s concerns regarding mental health and adverse effects. Witt-Doerring first steps back to emotional eating. He describes highly processed foods as products people use to calm themselves when they feel irritable or unwell, rather than simply to satisfy nutritional needs.

He says children obtain a large share of their calories from ultra-processed foods, which he characterizes as convenient and pacifying. His argument is that suppressing appetite does not necessarily address the reasons people eat for emotional relief. He returns to his larger theme: changing a symptom is different from examining the routine or circumstances contributing to it.

Witt-Doerring then presents his concern that reducing hunger can also reduce motivation for some people. He refers to reports described as an “Ozempic personality,” in which people feel indifferent or unmotivated. He characterizes GLP-1 drugs as a bandage for a larger lifestyle problem; this is his interpretation within the interview, rather than an individualized assessment of any viewer’s treatment.

Kestenbaum introduces a different proposal from NYU marketing professor Scott Galloway: young men might benefit from more social drinking because it gets them together in person. He stresses that the point is not getting drunk but reducing isolation and breaking through digital screens. An excerpt of Galloway argues that isolation can outweigh the risks he associates with a young adult having a drink.

Witt-Doerring agrees with Galloway’s emphasis on in-person life. He describes young people spending roughly five hours daily on social media and asks what that time could otherwise contain: sports, walking, visiting shops, talking with friends, gathering socially, or sleeping. He contrasts those activities with remaining indoors, looking at a screen, and absorbing online ragebait.

The conversation moves from friendship to intimacy. Kestenbaum cites reporting about young adults who have never had sex and an increase in those who report no sex in the past year. He asks whether romantic attraction and relationships have a constructive place in responding to loneliness, presenting the question as part of the broader loss of human connection.

Witt-Doerring says intimate, loving relationships are a core component of happiness, and he associates having children with meaning and purpose. He argues that pornography and online conversation can become substitutes for relationships rather than ways of reaching them. His concern is that people may shut themselves off from an important dimension of life while remaining digitally occupied.

Kestenbaum adds figures attributed to the American Enterprise Institute about men’s shrinking friendship networks. He contrasts an earlier majority reporting at least six close friends with much lower numbers today, and cites increases in men reporting no friends at all. He asks what is happening beyond the medical categories of depression, anxiety, or suicidality.

Witt-Doerring answers partly from his own experience as a millennial. He says work has dominated his life and describes how leaving friends behind can lead to isolation. He also believes political polarization and the possibility of online cancellation can make people afraid to open up. He asks Kestenbaum what the problem looks like from inside Gen Z.

Kestenbaum names social media first, suggesting that pornography and online substitutes reduce the pressure to pursue relationships in person. He also attributes some young men’s hesitation to fear of social or professional consequences and to cultural messages about masculinity and race. He argues that the response must include cultural and political questions, not only medical or scientific ones.

Witt-Doerring agrees with Kestenbaum’s interpretation that messages about privilege, racism, and possible punishment for perceived wrongdoing have made some men guarded. This exchange presents the speakers’ cultural explanation for isolation. It leads back to a clinical question: how to criticize excessive prescribing without implying that nobody should receive medication.

Kestenbaum lists concerns such as sexual dysfunction, emotional blunting, dependence, and longer-term complications, then asks where Witt-Doerring draws the line. How should a clinician distinguish someone who needs more movement and stronger relationships from someone for whom medication has a place? He asks the psychiatrist to answer viewers who might interpret his argument as opposition to all psychiatric drugs.

Witt-Doerring describes drugs as tools in a toolkit rather than inherently bad things. He asks whether prescribing Prozac is good care if the clinician has not understood a patient’s life. His example is someone who barely moves, stays indoors, works immediately after waking, eats poorly, and uses caffeine, nicotine, and evening alcohol within an unhealthy routine.

In that example, he argues that meeting criteria for depression does not eliminate the need to investigate daily living. He wants care to examine movement, food, exercise, time outdoors, and the sleep-wake rhythm. His objection is to using a prescription to cover over these circumstances while leaving the person without support to address them.

He then offers a contrasting case: a patient has worked seriously on health, has supportive relationships and a sense of purpose, and still feels unwell. In that situation, he says he would discuss a drug such as Lexapro or Prozac, including its risks and benefits. His criticism is that the earlier investigation and non-drug work often do not happen before prescribing.

Kestenbaum relates the argument to his own experience after October 7. He says he was diagnosed with anxiety and depression, received what he considered a heavy medication dosage, gained considerable weight, and did not feel substantially better. He recalls walking, making friends, and reinforcing existing relationships as helpful, while explicitly acknowledging that individuals differ.

He asks why well-intentioned doctors would provide the kind of care Witt-Doerring criticizes. People often know and trust their own physicians, so the explanation cannot simply be that individual doctors are bad people. He asks how much responsibility belongs to pharmaceutical companies, public policy, or the economics of the system.

Witt-Doerring identifies pharmaceutical marketing as one influence. He describes antidepressants as commercially successful products supported by substantial marketing budgets. In his view, one especially effective message was the idea that depression should be understood primarily as a genetic medical problem requiring a drug. He argues instead for a broader understanding of depression and its possible causes.

The second influence he identifies is reimbursement. He says insurer consolidation and negotiated payment levels pushed doctors toward very short visits. A clinician seeing several people an hour and caring for a panel of thousands cannot easily understand every patient’s life. He portrays good people trying to work with one hand tied behind their backs.

Within those constraints, he says, a questionnaire and an FDA-approved prescription can become the most practical action a doctor can take. He emphasizes again that his account is not a claim that these physicians are malicious. His argument is that they lack the time needed to do the more comprehensive work he believes patients require.

For the final topic, Kestenbaum asks about looksmaxxing, stimulant use, and an online personality known as Clavicular. He describes a reported overdose and seizure on a livestream, then asks why an appearance-centered movement can become dangerous. Witt-Doerring responds by focusing on the values and incentives of social media rather than treating this as an isolated individual story.

Witt-Doerring describes an online culture preoccupied with attractiveness, money, and conspicuous success. He says impressionable viewers can come to believe these are the standards they must meet, especially when recommendation algorithms repeatedly feed them the same material. He does not place all the blame on the people drawn into that environment.

He argues that pursuing appearance and wealth does not reliably produce lasting happiness. In his account, prolonged exposure to such messages can encourage dissatisfaction with one’s body, cosmetic interventions, and unhealthy attempts to stay lean. He contrasts that preoccupation with charity, service to others, relationships, and values previously conveyed by churches or older generations.

Witt-Doerring closes by expressing concern about the physical and psychological direction of the lifestyle they have discussed. Kestenbaum calls the conversation difficult but important and identifies his guest’s psychiatric and former FDA roles. The episode presents Witt-Doerring’s professional opinions and experiences; its description emphasizes individualized treatment and consulting a clinician before changing or stopping prescribed medication.