× Expand Keith Tsuji/Sipa via AP Images Hong Kong riot police fire tear gas at protesters during pro-democracy demonstration, October 2019.

Throughout most of Hong Kong’s summer of dissent, “Catrina Ko” felt like a coward. A professional in her mid-20s, she’s older than many of her fellow dissidents in black. Some were half her age. When the mass rallies took off, Ko (who uses a pseudonym to protect her identity) provided food and medical aid to protesters on the front lines. As police in riot gear deployed increasingly lethal weapons against her peers—from batons to tear gas, and later live bullets—she began to feel inadequate, not fast or strong enough to defend them. “I felt like if I’m not bleeding, I’m not contributing,” she says.

Away from the streets, Ko obsessively tracked updates and live streams of the protests on social media. She struggled to sleep and slipped into what she called a “depressive dip,” pulled down by the gravity of guilt. Nevertheless, she decided to join the Citizens’ Press Conference, a group of activists and citizen journalists, and work to analyze statements from public officials and translate breaking news into English. She describes the gig as both empowering and demoralizing.

Now she’s found her own way of contributing to the movement, but her mood has darkened as she debunks disinformation from pro-China officials and churns out reports on civilian suicides and police brutality. In September, Ko traveled to Capitol Hill with a delegation of Hong Kong activists to advocate for the passage of the Hong Kong Human Rights and Democracy Act, a bill that would allow the U.S. to impose sanctions “to block and prohibit all transactions [involving U.S.] properties and interests of a foreign person” found to be “suppressing basic freedoms in Hong Kong.”

Already rail thin, she’s lost weight and sleeps barely five hours a night. Still concerned about protecting her identity during her U.S. trip, Ko wore a black face mask and sunglasses when we met. “I’ve never known that I could work at this level of intensity,” she tells me. “But I do worry that I could just drop dead over my laptop one day because I practically take no break.”

The adrenaline rush of organizing and recovering from protests, combined with exposure to beatings and arrest by police, makes young people susceptible to acute psychological distress. This can be particularly true for activists who spend long hours on social networks planning and tracking movements, according to Bart Andrews, a clinical psychologist with Behavioral Health Response, a Missouri-based nonprofit that provides around-the-clock support to both activists and police. “The threshold to get enmeshed in a social protest is lower for [people with] fewer social obligations,” he says. Without stable jobs or families to care for, students and recent college graduates are more likely to pour their energy into one cause, protesting day and night.

Globally, a growing portion of young adults are struggling with some form of mental illness. The number of young Americans experiencing psychological distress increased by 71 percent in the past decade. Reports of major depression and suicidal thoughts are also trending upward. The concurrent rise in social media use among youth is partially responsible, according to a 2015 British Psychological Society study. Watching violent videos, for instance, can trigger symptoms associated with PTSD, even in people who haven’t previously experienced trauma.

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The threat of arrest and catastrophic injury at the hands of security forces hasn’t dampened youth enthusiasm for protest. The number of Americans aged 18 to 25 who have participated in a march has tripled since 2016. But research on the psychological impacts of activism on the group is still in its infancy; there’s little data on the exact figures of people suffering from chronic stress or mental illnesses.

EPOCH-DEFINING YOUTH MOVEMENTS are familiar components of modern history. From the campus green spaces of Kent State and Columbia University during the Vietnam War to the scrappy tents inside Tiananmen Square, young people have launched protests against wars, racial discrimination, and authoritarianism—and those demonstrations that turn violent affect participants in profoundly different ways. In the five years since Hong Kong’s Umbrella Revolution erupted, pro-democracy rallies have become bigger and bloodier as relations between police and civilians have deteriorated. In Hong Kong this year, more than 1,000 tear gas canisters have been fired, and more than 2,300 people arrested. Earlier in October, a high school student was shot in the chest at close range and remains in critical condition.

Before the police began using tear gas during the Umbrella Revolution, they were widely respected for their fair handling of mass protests. According to a 2011 University of Hong Kong Public Opinion Program poll, a majority of Hong Kongers, nearly 60 percent, held positive views of the department’s performance. Researchers concluded that while other locales might find that figure “respectable,” it was a significant drop from a poll the group conducted in 1997, when 80 percent of those surveyed had positive views. In September, Citizens’ Press Conference released the results of a citywide poll on police conduct. Nearly 90 percent of more than 130,000 respondents gave the police an approval rating of zero.

Some activists feel such a strong sense of betrayal by the Hong Kong government that they’re even refusing medical treatment.

This jarring shift in police conduct has produced widespread anger and fear—and driven some young people to despair. At least eight Hong Kongers, one as young as 21, have committed suicide since June. In July, after the first suicides in the city began to alarm residents, the social-services group Reclaiming Social Work Movement formed a suicide response unit. Irving Alfred Baleros, a social worker, says that the team scours social media for photos featuring seascapes or rooftops, which are often accompanied by grim captions. Once social workers locate the poster, they will head to the scene and try to dissuade the individual from jumping. In the past three months, the group has handled more than 150 of these types of cases.

These ad hoc rescue missions put a lot of strain on social workers. On October 1, the 70th anniversary of Communist Party rule in China, Baleros received more than 30 calls from distressed callers; he usually gets about ten on an average day. Children as young as 12 years old sought help with PTSD symptoms: insomnia, panic attacks, flashbacks. Some say they break down when they hear gunshot-like noises or walk past protest spots where they’ve witnessed bloodshed.

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Some activists feel such a strong sense of betrayal by the Hong Kong government that they’re even refusing medical treatment. “Whatever services [are] subsidized by the government will not be trusted by the youth,” says Joey Siu, a 20-year-old spokesperson for Hong Kong Higher Education International Affairs Delegation, which represents a dozen university student unions. Siu, who was among the protesters teargassed during a mid-June demonstration, says that police violence is the “root cause” of all the anxiety and hopelessness, so addressing it is a better way of handling the mental-health epidemic than providing consultation services to the injured. Yet, rather than address the police-induced anxiety that’s engulfed the city, Chief Executive Carrie Lam, who heads Hong Kong’s governing body, continues to berate protesters for destroying infrastructure.

“It shows they care more about vending machines than human lives,” Baleros says.

Numerous academic studies have found that youths generally hold more negative opinions of law enforcement than adults. In the U.S., race, as always, plays a key role. Relations between minorities and police are historically fraught: Black and Latino high school students reported being less satisfied with police than their white counterparts, according to a 2015 Justice Quarterly study.

But the 2014 shooting of Michael Brown, an unarmed black man, in Ferguson, Missouri, marked yet another new low in race relations that produced a generation of dedicated activists. The inability of white public officials to process the community’s grief and anger—the police left Brown’s body in the street for hours and later set up loudspeakers to chastise protesters for looting and burning buildings—helped escalate the riots that launched the Black Lives Matter movement.

× Expand Charlie Riedel/AP File Photo Police arrest a man as they disperse a protest in Ferguson, Missouri, following the shooting of unarmed 18-year-old Michael Brown, August 2014.

Some young people who came of age in the Ferguson era are pushing themselves to the brink in the fight against police brutality. Nupol Kiazolu, 19, is the president of Black Lives Matter New York. She organizes rallies, recruits new members, and travels nearly every weekend to speak at conferences and meet heads of state. She’s also a college freshman who already has plans to run for president in 2036. Completing all her obligations often requires doing homework on trains, sleeping an average of four hours a night, and often falling ill.

When we spoke, she was fighting a cold. “Sometimes I just want to feel normal again,” she says. “But I can’t afford to right now, with the goals I have.” In the past year and a half, she’s been hospitalized several times for still-undiagnosed kidney complications. “It takes a lot to get up every single day and do the work,” she admits. “But I don’t want people to pity me.”

People will turn to more disruptive and destructive means of protest when they feel disempowered.

Hawk Newsome, 42, is the chairman and co-founder of the New York chapter and sees Kiazolu as a daughter. He worries about possible encounters she may have with law enforcement. Since launching the chapter in 2016, he’s been arrested twice at protest sites, sustaining a spinal injury in the process. “These things can kill you,” says Newsome. “It’s scary to know they’re willing to hurt you for doing nothing more than protesting. It makes you think that you’re a political prisoner.”

According to April Foreman, a psychologist on the board of directors of the American Association of Suicidology, the prominence of conflict in youth-led movements today has created what she calls an “ambient feeling of betrayal” in society at large. “We have ways of protesting right now that’s setting people up to be traumatized,” she says. “People will turn to more disruptive and destructive means of protest when they feel disempowered."

Foreman’s concerns are well founded. In 2016, Black Lives Matter activist MarShawn McCarrel, 23, left a Facebook message hours before taking his life: “My demons won today.” Nearly two years later, Erica Garner, who became a prominent face for the movement after her father was killed in a police chokehold, died from a heart attack at the age of 27. She spoke publicly and privately about the mounting pressures of protesting full-time and finding a steady job to support her two children.

THE PSYCHOLOGICAL INJURIES activists sustain in their youth can remain dormant for years and surface much later in life. Rose Tang was 20 when she joined the Tiananmen Square protests in 1989. A student leader, she’d been prepared to “die for democracy,” but was still blindsided when the state turned on its own people. Battered, with her glasses smashed, she had to crawl over a tank to escape the carnage. “Nobody thought authorities would send troops to shoot at us and tanks to crush us,” says Tang, now 50 and living in Brooklyn.

For decades, Tang struggled with survivor’s guilt, which she calls a “martyrdom complex.” She had migraines, and often found it difficult to complete routine tasks without thinking about Tiananmen. Due to the lack of dialogue about mental illness, she didn’t realize she suffered from depression and PTSD until 2014, when she finally began seeing a therapist. She cried when she described for the first time how the massacre unfolded, how her joints ached as she scaled the tank. “I realized that I could still feel the pain in my body,” she says. “I could still feel the cold, hard, steel parts of the tank.”

Thirty years later, Tang says she’s grown weary of the romantic narrative that the media has promulgated about protest and sacrifice, as well as the idea that confrontation is an effective way to score political victories. From hosting fundraising concerts to penning letters to international lawmakers, she has, in her adult life, made quiet but sizable contributions to pro-democracy movements in Tibet and Hong Kong. “My lesson from Tiananmen is that we’re so defenseless we cannot just use our bodies to fight this monster,” she says, referring to the state. “It’s important to stay alive. Don’t be a martyr.”

In recent years, a growing contingent of young activists have shifted tactics from on-the-streets protests to more diplomatic and less psychologically taxing efforts. Black Lives Matter activists are taking their causes into K-12 classrooms, with a curriculum that aims to make schools the “sites of resistance to white supremacy and anti-blackness.” Gun control activists are lobbying elected officials and launching “get out to vote” campaigns. The Hong Kong activists who came to Washington last month have had success in Congress, with the House passing the pro-democracy measure on October 15. (The Senate is considering a similar bill.) And Siu, the spokesperson for student unions, recently met with German lawmaker Reinhard Bütikofer to discuss asylum applications in Europe for dissidents.

Some prefer an approach that mixes protest and politics. Trevon Bosley, 21, became a gun control activist at age 8, one year after his brother was killed. Last summer, he and other anti-violence protesters rallied thousands of people to block a busy expressway in Chicago, drawing the wrath of local politicians and law enforcement. The incident attracted enough public attention that lawmakers, including candidates for the 2019 mayoral race, developed new measures to address gun violence. Though he realizes that achieving concrete reform requires conversation and compromise, Bosley still sees the value in confrontation. “Because we disrupted people’s daily lives, we had an impact on the city that we wanted to have,” he says.

The young activists I interviewed for this story told me that the intense pressure they feel now is a small price to pay for a future they can be proud of, one where the youth of tomorrow can feel safer than they do today. Although the psychological toll of sustained social and political activism can be overwhelming, many young people are no longer carrying these burdens alone. In Hong Kong, groups like Reclaiming Social Work Movement and Samaritans Befrienders direct distressed citizens to appropriate mental-health services. “Protect the Children,” a collective of senior citizens and volunteers, attends rallies on weekends to mediate testy confrontations between youths and police.

Young Hong Kongers understand that the cost of continuing their fight—in lives, livelihoods, and financial damage—is sweeping and substantial. To win just one concession from Lam’s pro-China legislature—the withdrawal of the hated extradition bill—thousands of people have suffered severe, in some cases irreparable, physical and psychological harm. “We’ve stopped one evil bill with a huge cost to be paid,” says Bonnie Leung, former vice convener of the Civil Human Rights Front, an umbrella organization that coordinated some of the biggest marches this summer. “What if the government dreams up another? Do we risk everything all over again?” she asks. “We can’t.”

But for protesters like Ko of the Citizens’ Press Conference, this “endgame” mentality is intertwined with a sense of optimism. Even through the current lens of destruction, they can conjure up hopeful visions of a world rebuilt. “I hope that I will be able to say to my children and my children’s children that, when I had the chance to fight, I gave it my best go,” she says.