Mental Health Awareness

We are assured, on the best scientific authority, that we can best deal with the nation’s mental health crisis by increasing public awareness of our mental health crisis.

One needs always to take such nostrums with some considerable doubt. After all, we still remember our post from 2011, inspired by a book by one Ethan Watters to the effect that when a girl suddenly died of starvation in Hong Kong the local authorities launched a campaign to increase public awareness of anorexia. And not only of anorexia. The campaign sought to increase awareness of adolescent distress.

The result, in a place where anorexia had been unknown, was an epidemic of anorexia.

Somehow or other, enhanced awareness of mental illness produces more mental illness.

Psychologist Clay Routledge makes the same point in today’s Wall Street Journal. We have reported said points in the past, so this might sound slightly familiar.

We hear a lot about America’s mental-health crisis, and the crisis is real. But part of the problem is that we talk about it too much.

In an attempt to bring more attention to the issue, we’re becoming a nation that increasingly defines itself as mentally fragile and unwell. Instead of asking Americans to turn inward, fixating on their own thoughts and feelings, it’d be better to encourage them to turn outward and engage with the world.

Introspection is the problem, not the solution. Instead of turning inward, we do better to turn outward. Rather than ruminate, we should engage actively with other people.

But dwelling on mental health too much can exacerbate psychological distress. Psychologists Lucy Foulkes and Jack Andrews explain in a recent article in New Ideas in Psychology that mental-health awareness campaigns may be encouraging people to interpret mild forms of distress as being severe, which in turn can make distress worse. Everyone worries, but if someone who experiences mild anxiety begins to view himself as struggling with a serious mental illness, he is likely to become more fixated on what worries him and more avoidant of anxiety-provoking experiences. This reinforces the anxious voice in his mind that says such things should be feared, which will make his anxiety worse, not better.

Someone who is mildly anxious should not see himself as mentally ill. If he considers himself to be seriously ill he will act accordingly, and will become fixated on his worries, to the exclusion of all other prosocial activities.

Consider the current mania over trigger warnings. Children, in particular, are being warned that certain material, certain images, certain conversations are likely to retraumatize them. The principle tells us something like: forewarned is forewarned.

And yet, everyone knows by now, and as we have reported, these warnings do not work:

Research finds that trigger warnings are ineffective at reducing anxiety in the moment and might harm mental health in the long run in a similar way to awareness campaigns. They encourage avoidance, which worsens symptoms over time, and can reinforce to trauma survivors that their traumatic experiences play a central role in their personal identity. Trigger warnings can send the message that traumatic experiences cause permanent psychological change, when the reality is that humans are naturally resilient. Most people who experience trauma aren’t permanently altered as a result—unless they come to view it as a central part of who they are.

As we have noted extensively, new studies on human resilience have shown that most people get over trauma, without any therapeutic intervention. If you tell people that their traumas have damaged them, they are more likely to start functioning like victims, thereby ruining their engagements with other people.

As I have occasionally recommended, get out of your mind and into your life. You might not think that it is therapeutic-- and it is one reason why I no longer practice therapy-- but it is better than therapy.

Engaging in acts of kindness toward other people is better than ruminating about how other people are threats. Of course, exercise is notably effective as a treatment for depression. 

So, the recent research, reported on here, has shown that the traditional forms of therapy have not been effective as treatments of mental illness. And now we know-- we should have known sooner-- that introspection and rumination are the wrong way to go. Stop looking for answers within and start looking to engage with the outside world.