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We sit down with Marissa Caudill, a psychiatrist specializing in child, adolescent, and adult mental health, to explore the findings from the U.S. Surgeon General’s advisory “Parents Under Pressure.” We discuss the skyrocketing levels of stress among parents, the balancing act of caregiving, financial struggles, and the mental health toll on both parents and children. Marissa shares her insights on how physicians can support parents, foster gratitude, and advocate for systemic changes that benefit caregivers.
Marissa Caudill is a psychiatrist specializing in child, adolescent, and adult mental health, dedicated to empowering parents to navigate the teen mental health crisis. As CEO and founder of The Parent Doctor, she offers education, guidance, and inspiration to parents worldwide, with a focus on supporting those most in need. Follow her on Facebook and Instagram, listen to The Parent Doctor podcast, or join her free monthly book club for practical insights.
She discusses the KevinMD article, “Parents in crisis: How physicians can help.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Marissa Caudill. She’s a psychiatrist specializing in child, adolescent, and adult mental health. Today’s KevinMD article is “Parents in Crisis: How Physicians Can Help.” Marissa Caudill, welcome to the show.
Marissa Caudill: Hi, thank you, Kevin.
Kevin Pho: Thanks for having me. So, let’s start by briefly sharing your story and journey.
Marissa Caudill: Sure. So, I am a psychiatrist. I trained at UCLA and did medical school at the University of Connecticut. I am born in New England, so for me, coming out here for residency was a bit of a leap of faith, but that was way back in 2007, and I never left.
So, it worked out all right. I met my husband during training. He’s also a psychiatrist, and we have two kids and live in Santa Monica.
Kevin Pho: All right, so your KevinMD article, “Parents in Crisis: How Physicians Can Help.” So, this certainly has been in the news because the Surgeon General has highlighted this. Tell us what led you to write this article in the first place and then talk about the article itself.
Marissa Caudill: Sure. So, I was led to read or to write the article because I actually saw a colleague of mine had written an article and realized, “Oh, I could do that too.” And when the Surgeon General advisory came out back in September, I was really excited because I actually left my full-time clinical job with Kaiser Permanente in 2022 in order to start The Parent Doctor.
And that’s basically a business where I am working to educate, on a larger scale, parents and support them to reverse the teen mental health crisis that our nation is facing. So that’s obviously gotten a lot of press. We all know that kids are not doing well, especially during and right after the pandemic, but those numbers have generally been trending in a downward, you know, worse direction for many years now.
So, I was excited to see that the Surgeon General is drawing attention to parents because, as a clinician working with families, I’ve seen this. I’ve seen it in my office, where parents are really stressed and spread thin. And I thought that this 36-page advisory was really well written, and delivering some really important things that we as a whole society really need to be thinking about, but physicians are in a position to really be helpful to parents.
Kevin Pho: So, for those who aren’t familiar with the Surgeon General’s report, what are some of the main take-home messages that they can come away with?
Marissa Caudill: Yeah, sure. So, in this 36-page document, Vivek Murthy cited a study that was done by the American Psychological Association about stress. And that study looked at thousands of American adults. And what was really interesting was when they parsed that out and looked at the outcomes and responses for parents versus non-parents, what they saw was that the parents were almost twice as likely to report feeling extremely overwhelmed most of the time, to the point that they couldn’t even function.
And so then he kind of dives into, well, why is this happening? Why are parents so much more overwhelmed? Why is it so hard? Why is it so much harder to parent in 2024 than it was 40 years ago? And there’s many factors at play. I mean, obviously we who are parents know that there’s a lot of things on our plates.
We are paying more for child care than our parents were. Both moms and dads are working longer hours outside the home in addition to spending more hours directly caring for our kids. So, that means we’re just spending more of ourselves both at work and at home and having less time for our own hobbies and interests and friendships.
And that’s really what’s taking the toll, I think, on parents, that we are lonelier than ever, we feel less of a sense of community, and then you add on top of that the fact that many parents are now stuck in this sandwich generation where they’re both caring for aging parents and their children, and that means there’s even less time for ourselves.
So, it sounds all very hopeless. I know, but it’s not. I mean, I really want people to think about the things that they can do. And this was my, you know, advocacy for us as physicians to step up and really start asking our patients who are parents, you know, what can they do differently? How can they prioritize themselves—not to be selfish, but to be selfish to kind of take care of themselves.
And I think there’s so many things that we can do, whether it be, you know, making sure that we get enough sleep, making sure that we get some exercise, go for walks, making sure that we schedule time with friends. Those things are important for us. We do it for our children, but we need to do it for ourselves too.
Kevin Pho: So, before talking about some of the solutions, I want to focus more on that impact of parental stress. And certainly, there’s obvious health repercussions from that, but how about the repercussions on the children that the parents are parenting? How does that stress affect the parenting of the kids?
Marissa Caudill: Yeah, so the article goes into that a lot, the advisory, that when parents’ mental health is suffering, kids’ mental health and overall well-being also suffers, which makes sense. We know this, right? I mean, if you as a parent are depressed and not able to function and be fully present, then your kids aren’t getting all that they need from you.
So, definitely, severe mental illness we know is negative for a child of a parent who has severe mental illness, but even mild or moderate mental illness or just unwellness can have a negative impact on kids. The best thing we can do for our kids is to prioritize our own physical and mental health, and we need to lead by example for them and not put them so much ahead of—put their needs so much ahead of our own that we end up experiencing a cost for ourselves or resentment towards them because we’ve let their priorities be greater than our own.
Kevin Pho: So, how are these parents presenting to you as a psychiatrist? Are they coming to you and saying, “I am suffering from parental stress?” Like, how are they presenting to you?
Marissa Caudill: No, that almost never happens. I think there’s, like, no awareness that we are so stressed. What far more commonly happens, especially when kids hit adolescence, they become the identified patient, you know, and the parents focus on them as the problem. But this is why I started to do my work as The Parent Doctor, because what I would see is that the problems and patterns that had led to this crisis, which usually was happening in adolescence, had actually been in place for years before.
And if a parent isn’t taking care of themselves first, they can’t be there for their kid in the way the kid needs. And so really what I do is I support parents through education, using neuroscience, psychology, and spirituality, to help them be the best parent they can be, both for their own well-being, but also for their child to be a healthy young adult and adult in the future.
Kevin Pho: So, in the exam room, if I’m talking to a parent, tell me the types of questions I should be asking. What are some ways that I can help these parents?
Marissa Caudill: Yeah, sure. I think physicians who are interacting with adults who are parents should be asking them, “How are you doing?” Just checking in on the fact and noticing that it is hard to be a parent. I think just having that rapport would be a very good, you know, connection between you and a patient who’s a parent. And then asking them, “What do you do for you? Like, how do you fill your cup? What do you have planned this week that you’re looking forward to?” Maybe the person’s going to say nothing.
And you say like, “Well, when’s the last time you did something that you enjoyed or that was fun for you?” And if they say it’s been weeks or months, or “I don’t remember,” that can stimulate a conversation to ask this person, “What do you think of that? Do you want to change that?” Again, a little bit of motivational interviewing to let the person know you have a choice here. Every day, we have a choice in how we spend our time, who we spend our time with, and encouraging people to be a little bit more aware of that, I think, would be for their betterment and therefore the betterment of their families and kids.
Kevin Pho: In terms of child care, so that’s one of the biggest stresses that you mentioned that parents face and that was mentioned in the advisory. So, as physicians, what are some ways that we can advocate to address this issue?
Marissa Caudill: That’s a great question. And I honestly wish I was a better advocate myself on, like, a governmental level, but I think many other countries do a much better job than the United States does in recognizing that if you’re a parent and you need to go to work, your child needs someplace to go that’s safe and supportive while you’re at work. If you want to be focused at your job, that’s such a no-brainer. And I don’t know why more people aren’t recognizing this and why it isn’t on the government to really provide this for us.
But it really, for all of us, it’s like this piecemeal system where there’s probably the preferred daycare or whatever in your community, and you got to get on that spot the minute you turn your pregnancy test blue if you want your child to get in there. It’s a lot of pressure. And then even within families, especially like dual-physician families, it’s a lot of tension between the couple, because when a kid is sick, who’s going to take the day off, you know? As physicians, we have busy schedules, our jobs are important, people are counting on us. And when we have to cancel our day for child care, it’s really stressful. And that’s true for many people too.
So, I think I don’t know what organizations advocate for these kinds of things in terms of lobbying our government, but I do think that we as physicians are in a unique position. That said, when I was working a full-time clinical job at Kaiser, if someone was on a podcast telling me that it was my job to advocate for these things, I’d probably be kind of upset about it because we’re busy. We’re so busy. So I think it’s on, like, the AMA and big organizations to do a better job recognizing that these are things that impact people’s overall health.
And there’s millions of parents in the U.S. I think the statistics in the document were like 63 million people who are directly caring for their own parents and then millions more adults who are the guardians or caregivers of kids, whether it’s grandparents or aunts and uncles or other caregivers. So, this is a huge chunk of our society that’s impacted by these stressors. And if we could have some kind of steady, reliable, affordable child care, think of how that would impact our productivity, our employment rates, all of these things I think would be better.
Kevin Pho: So, can you tell us a case study or story? Maybe take us into your exam room or into one of your coaching sessions where a parent came to you with the issues that we’re discussing, and you gave them some interventions that appreciably moved the needle. Tell us a case study or story that was successful.
Marissa Caudill: So, in my most intimate coaching program, I right now have about five women, all of whom are very successful. Many of them are physicians. And we’ve been talking about, you know, how do you manage all of these things? And one thing is just having that community, I think, is extremely helpful for them because we come together each week. We talk about what we’re going through. So, you don’t feel like you’re alone. You know, that other people are going through the same thing. So, I would say that’s step number one, is find a group of like-minded people that you can meet with regularly, even if it’s going out for coffee or going for a walk, who can support you.
Then it’s about holding yourself accountable to make some kind of change and then measure and see if that helps. So, if you’re someone who hasn’t been getting enough sleep, maybe you’re going to commit to this group that you’re going to try to get at least seven hours of sleep every night this week and see how you feel, and then write it down and have those people hold you accountable. So again, it’s kind of like having an accountability group.
So, I think finding yourself a community of people who are like-minded and can hold you gently but firmly accountable to the things that you might put in place, whether it’s prioritizing your sleep, prioritizing your nutrition, prioritizing the time that you want to spend with friends or with loved ones.
Prioritizing time one-on-one with your kids without expectations. No, often we’re just go, go, going. I think there’s some statistic that the average couple spends fewer than four minutes every day talking with each other about things that aren’t just logistical, like who’s picking up the kid and who’s doing this and what are we having for dinner? So, even if it’s just spending an intentional 15 minutes a day with your partner, that’s going to go a long way in building your mental health and resilience and ability to function, both as a parent, as an employee, as you know, in every aspect of your life.
Kevin Pho: One of the things that you wrote in your article was the concept of the gap and the gain where parents shift their focus from stressors to successes. So, tell us more about that concept.
Marissa Caudill: Well, if you haven’t read that book, I love that book. My kids are so sick of me talking about the gap and the gain. But it’s by Benjamin Hardy and Dan Sullivan. Benjamin Hardy is a psychologist. He’s a parent, and he coupled with Dan Sullivan, who’s a coach, like a business coach, kind of like a Tony Robbins guy, but much more calm.
And so, they’ve written a bunch of books together, but this one, it’s a very simple concept. You know, it’s kind of like the glass half-full versus half-empty, with the idea being that our natural inclination is to focus on what is not there—to focus on the glass as half-empty—but with practice, we can get better at focusing on the gains, on what we have accomplished, and as a result, we’ll be so much happier. And I think this is something that parents can really take and teach their kids as well through regular daily practices.
So, the idea of the gap and the gain is really that if we have a goal—so, for example, if you have a goal with your child, you know, you want them to, you’re aspiring that they’re going to go to some great college someday—that’s your, your goal, your ultimate goal. Any little challenge that they have on the day-to-day, even when they’re like five or 10 or 12, is going to feel like, “Oh no, we’re off path. We’re off course.” And they emphasize in the book it’s true that you’re almost always off course. I mean, if you look at airline pilots, they’re constantly course-correcting. That’s normal.
And so, if instead you can just focus on the fact that you still have traveled this much farther towards your ultimate goal and be focused on the little gains and the steps along the way, you’re going to be feeling more positive, your family’s going to be more connected to each other, you’re going to be more likely to support each other through hard times rather than criticizing each other in a panic that things aren’t going well.
And really, I think that we can apply those principles in that book to so many things, both in our parenting, you know, directly in our contact with our kids, in our co-parenting, and in our functionality as adults who are parents, and the progress that we hope to make in our own lives in various areas.
Kevin Pho: So, going forward, I guess, you mentioned that, you know, it all sounded hopeless, like, you know, what do you foresee in the next, you know, coming year in terms of the trends regarding that stress of parenting? Do you see that turning around? Do you see some of what you’re doing making a difference, kind of more on a macro scale? So, tell us what you expect in the next year or so.
Marissa Caudill: Well, I certainly hope so. I am doing everything I can to kind of get out there and get the message to parents that really, in many ways, I think less is more. And I do see signs that there is sort of a pendulum shift, both in terms of kids’ use of social media, and I think sometimes kids now are getting a little wise to the fact that maybe I shouldn’t be on TikTok six hours a day. You know, I think there is going to be some increasing awareness for their mental health, that that gets better.
And I hope, I really hope that as parents, we also wake up and realize that, you know, you just get this one life and we get this one period of time with our children, and we really need to be present for it as much as possible and less focused on the future. And if we can enjoy the small moments that we have, we’re going to be happier than if we’re constantly thinking about what isn’t happening that should be happening because we want to get to whatever we think we want to get to.
So yeah, I mean, in next year on a global scale, are we going to see massive improvements? Maybe not. I mean, I hope so. I certainly hope that for kids’ mental health, we start to see things shifting and I don’t think the answer is more Prozac or more psychiatry appointments. I think the answer is really going to be parents shifting our approach with our kids because we know parents are the most important people in kids’ lives. You may not feel that way, especially if you have a teenager, you may be feeling like they don’t care about you or they don’t want to listen to you, but you are still, even if you don’t feel like it, the most important person in your kid’s life, how you see them, how you appreciate them, how you notice them, does make a difference.
And so I think if we can start waking up to that fact because so many parents I know are so anxious I think increasingly we feel like we’re living in this competitive world. We’re worried about our kids being on top, staying ahead, you know, being successful. And we have this mentality that it’s like Yale or jail, you know, if they don’t get into this top college, they’re going to end up living under the freeway in a box. And there’s so many wonderful ways that you can succeed at life that don’t have to be scripted in the way that you might imagine.
So I think we can give our kids that flexibility and really embrace it in our own hearts. Then that shift is going to really happen.
Kevin Pho: We’re talking to Marissa Caudill. She’s a psychiatrist specializing in child, adolescent, and adult mental health. Today’s KevinMD article is “Parents in Crisis: How Physicians Can Help.” Marissa Caudill, we’ll end with some of your take-home messages to the KevinMD audience.
Marissa Caudill: Sure. So, if you are a parent, my take-home message to you is think about this week, three things that you can do for yourself that are going to help refill your cup so that you can then be there for your co-parent, if you have one, and for your kids. And then see and observe how you feel after doing those three things for yourself. And if you feel better, make it a regular habit.
Kevin Pho: Marissa Caudill, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Marissa Caudill: Thank you. Thanks, Kevin, for having me.
