In the last 7 years, the suicide rate under the age of 18 has increased by 50%. Mental health has surpassed cancer and cardiovascular disease in the US as the #1 contributor to morbidity and mortality. The number of casualties from military conflict in the last decade is less than the number of men that take their own lives in one year. The primary problem we face today is not physical; it's mental.
Why is that? Isn’t the world getting better? Aren’t we advancing as a society?
In some ways, but the challenges we face nowadays have changed.
Mental health is getting worse, and our society's response to that is psychiatric treatment. So if you have a mental illness then you should go see a psychiatrist or therapist and they will help you with that. But part of the problem is that somewhere along the way, mental stress became illness.
An illness is when your body or brain does what it is not supposed to. It is a malfunction of your mind or brain. Sometimes depression can be caused by a malfunction. Sometimes, when people feel lost, depressed, stuck, it is not actually a malfunction. It is not like their life is going wonderfully and something in their brain tells them that they are awful human beings. That is what real clinical illness looks like.
A person with schizophrenia might believe that the devil is possessing the people around them. There is not a whole lot of evidence for that, but that is what they believe. Their mind is not congruent with reality.
The challenge we face nowadays is that a lot of our depression is congruent with reality. Especially if you look at Gen Z and millennials — the world that we live in and the reality that we face is actually depressing. If you’re 23 years old and struggling to find a job and feel alone and don’t know what to do with yourself and don’t know where to go, how to put your life together, how to find motivation, then that’s not an illness. Your brain isn’t malfunctioning, that is just life.
Then you have a generation of people who get told, “Oh, you are mentally ill, so go see a psychiatrist or therapist.” So you do that, the psychiatrist or therapist diagnoses you with depression, they start you on a pill, and you go home and play video games all day, browse youtube, scroll through Reddit, etc. The pill doesn’t fix your life, because that is not what it does.
So the first issue is that mental health is getting worse and psychiatrists and therapists aren’t cutting it. The average age of a psychiatrist is older than 50 years old. If you talk to them about Twitch, social media, Reddit, etc, they are not going to understand what you are talking about.
The second thing is that sometimes it can take months to see a psychiatrist or therapist. It can also be quite expensive. Therapists will cost anywhere between $100-$400 per session. Psychiatrists will charge anywhere between $200 for a 30-minute appointment up to $400 or $500, at least in the United States.
So psychiatry is too old, too slow, and too ineffective. It doesn’t work well. This is why we started our coaching program. A lot of what we struggle with is not an illness but is actually congruent with reality.
Some studies published in very reputable journals show that antidepressants are not as effective as we think. A paper published in JAMA (The Journal of the American Medical Association) found that antidepressant medication had a small effect size (d = 0.2 on the Cohen Effect Size scale).
That means that antidepressants performed marginally better than placebo, and even this small difference could be due to sampling errors, biases, or chance. Moreover, antidepressants show a smaller effect size for depression rated as mild, moderate, or severe on the Hamilton Depression Rating Scale (HDRS). But if it gets rated as very severe, they show a higher efficacy. Another study reports similar results.
One reason for this is that when people see a psychiatrist, not all of them are mentally ill. The pill works if you have a neurochemistry imbalance, but many people have a depression that fits their lives. They are not mentally ill; they are sad because their life is going nowhere.
A paper published in the New England Journal of Medicine found that 94% of the trials published showed a positive outcome for the efficacy of antidepressants. However, if we include data from studies that were not published, only 51% of the published studies showed a positive outcome. A separate meta-analysis of the FDA and journal data sets showed that effect sizes ranged from 11 to 69%, with an average of 32% overall efficacy. That indicates a heavy publication bias as only studies with favorable outcomes were published. Another study backs up up the efficacy of antidepressants and publication bias for the same.
Going to a therapist is not about treating something, it’s about getting something checked out.
For example, if you have a lump, that does not necessarily mean that you have cancer. It means that you should get it checked out by someone who knows the difference so that they can tell you whether it is cancer or not.
If you feel sad or down every day, and you feel stuck in life, and you want to figure out whether you are feeling lazy or have clinical depression, then you can go to a therapist.
Additionally, if you are suffering or struggling, and feel like you are not able to do what you should be doing, then that is another reason to get an evaluation. Psychiatrists look at the impairment of function.
For example, one of the ways to identify whether someone is depressed or sad is to check whether their sadness impairs their ability to function. Are they able to go to work, or go to school? Is their work or school significantly impacted by their emotional state? Are they not able to maintain relationships?
If your function is impacted, then you should definitely go see a mental health professional.
What makes you hesitant to go to therapy?
If you can find the answers to these questions, then you can start to learn more about yourself, and put yourself on the path to get the help that you need.
That is a reasonable choice, but you should still get an evaluation from a mental health professional. Mental health is not just about mental illness that requires treatment. There are lots of stories of people who changed their mental health through practices that were not mental health treatment.
The question is whether you can afford to take the time to DIY, and what are the consequences if you fail.
For example, if you are a sophomore in college and you are struggling with depression, it is important for you to be in treatment fast. If you experiment on your own for a year and your depression causes you to fail classes, that could alter your trajectory for the rest of your life. It can affect chances to get into graduate school, as well as job prospects.
It is worthwhile to get evaluated and see if you have a clinical issue and let the psychiatrist or therapist weigh in about whether treatment is necessary or not. The other benefit of getting an evaluation is to see whether it is safe for you to delay treatment for some amount of time.
The biggest source of overcoming stigma is experience. Be a critical thinker about your own beliefs. Ask yourself why you have those perceptions of therapy or psychiatry. Then try it.
For example, if you have never had sushi before, the thought of having raw fish might be repulsive to you. However, a lot of people who try it realize that the experience of having sushi is very different from the thought of having it. They often end up liking it as well.
Question your belief and think about whether there is any harm in trying it before you make a judgment. The best way to overcome stigma is to actually gain experience.
If you have any kind of doctor (general practitioner or primary care physician), you can ask them for mental health support, evaluation, or referral. Start with your doctor because it is their job to connect you with appropriate care.
If you have insurance, you can contact your insurance company and ask them for a list of mental health providers in your area. Nowadays, you might even be able to log into your online insurance account and search for mental health providers in your area that are covered by insurance.
If you find a provider who takes your insurance, then they will cover most of it. Your insurance company will pay them anywhere between $100-$300 per visit, whereas you will only have to pay $15-$50. Those are the two simplest ways.
Nowadays you can also search for mental health providers using websites such as PsychologyToday and Zencare. You can see their profiles and see what they specialize in. You can also search based on whether they take insurance or not.
If you don’t have insurance, you can google for “community mental health centers”. These provide services for people who otherwise cannot afford them. They get federal or state funding to provide a necessary service. They can get compensated for seeing you, despite you not having insurance. They can also walk you through the process of getting some kind of insurance that may not cost you anything, such as state Medicaid, etc.
Additionally, if you don’t have insurance, you can simply reach out to providers directly and ask them if they have any free-care slots available. Thankfully, a lot of providers are in it to help people, so they are sometimes okay with taking on people if they cannot afford therapy otherwise, and if the provider thinks that they can help that person. Most providers will have a few slots open for people at reduced fees or no fees.
Organizations like Rise Above the Disorder are committed to delivering mental health services to our community despite people’s inability to pay. They are a non-profit — they get funded by the industry.
If you are a student, oftentimes, there are student mental health clinics or university mental health services that you can avail of, such as a school counselor. Additionally, Community Mental Health Centers will provide free services to people.
On therapy websites, some providers have the option to be paid on a sliding scale. You can make use of that if you cannot afford therapy at their full rates. You can also email a provider if you like their profile and ask if they can give you therapy for free. It can be humiliating, but generally, mental health providers are in the business to help people, so sometimes they will be willing to take you.
If you have the resources or the availability, you should schedule three appointments with three different people about two weeks apart. If you don’t like the first person, you can see the second one, and if you don’t like the second one, you can see the third one, and at the end, you can pick your favourite.
But if you like the first person and you like the fit, you can cancel the rest of the appointments. A lot of the time, people will judge therapy as a whole based on an individual provider. However, like other things, it can take a few tries to find a therapist who fits with you.
The best way to find a therapist who fits with you is to see if they understand you. Additionally, do you have a good talking relationship with them? Do you feel like you can come back and talk to this person for the next couple of months, once a week?
It’s not about their background, their degree, or where they trained — it’s about whether you can sit with this person in a room for one hour a week for 3-6 months (minimum).
You should try a couple of things. Some kinds of therapy are very different.
There’s a branch of therapy that is called Cognitive Behavioral Therapy (CBT), which is quite rigorous. CBT tries to help you understand the relationship between your thoughts, your emotions, and your behaviors. Cognitive Behavioral Therapists will give you exercises and things to think about and do. It is quite active and is more than just talking about your feelings.
The other branch of therapy is Psychodynamic Psychotherapy, which is more of talking about your feelings. It is a little bit more free-form and can take a bit longer to get to the problem.
The difference in choice depends on whether you want something more structured or free-form.
Are you someone who approaches therapy with the mindset of “In 16 weeks, I want my social anxiety to be manageable to the point where I can go out and engage with people without being overwhelmed”? Then CBT might be the choice for you.
If you are want to understand the roots of your problems and are willing to invest more time, then psychodynamic psychotherapy might be the right one for you.
Moreover, some therapists specialize in particular things, and it is reasonable to find one for a different kind of issue. At the same time, have a conversation with your therapist before switching.
Ask “Hey, I’d like to work on this particular issue. Do you think we can work on this, or do you think I should find a different therapist for this issue?”
Remember that you can tell your therapist anything. It is the one space that you get to share things that you do not normally share or say.
For example, you can go into your therapists office for the first time, sit down, and say, “Hey, I really don’t want to be here. I don’t think this is going to work. I think this is a waste of time. I want to be able to do it myself. I think your profession sucks, and I don’t want to be here.”
That could be the best thing that you say to your therapist. They will be overjoyed, because it demonstrates honesty, which is a strong indicator of some of the best outcomes in therapy.
The biggest limitation of therapy is that it is not guaranteed to fix you.
A healer is just going to heal you. They are NOT going to beat the raid boss for you. You still have to deal the damage. You still have to do the work.
A lot of people go to therapy thinking that if they show up to therapy for one hour every week for the next six months, their problems will be solved. However, that is a misconception. The patients that benefit the most from therapy are the ones that do the work between sessions. The difference like night and day.
The biggest limitation of therapy is that it is not like any other medical treatment, where you go in, get a procedure done, and then you leave and are fixed. Therapy is not like that — it requires active work on the patient’s end.
If you have been in therapy for a while and it does not feel like it is working or helping you, then consider looking for a different therapist.
Additionally, consider that sometimes it is hard to see change. Change in therapy happens slowly and you don’t really notice it.
For example, if you wake up and look at yourself in the mirror in the morning, you look the same as you did before. But if you wake up and look at a picture of yourself five years ago, then you look like a completely different person.
Therapy is the same way. It can feel like you are not making any progress, even though you are.
When you feel better, or you feel that you are ready to move on, then that is usually a good time to end therapy. Trust yourself.
| Psychiatrist | Psychologist | Mental Therapist | ||
|---|---|---|---|---|
| Schooling | Medical School specializing in the mind | Science or research degree that studies the mind exclusively | ||
| Duration of Training | 4 years of medical school 4 years of psychiatry training | 5-7 years of school 1 year post-doctorate | 2 years of social worker training | |
| Other | Can prescribe medication | Usually cannot prescribe medication | Can be a social worker, psychiatrist, or psychology |
As a friend, you are not responsible for someone else’s mental health. You are not a therapist. Support from friends is not a substitute for therapy and medication from a therapist. Be supportive by being a good friend but do not think that you can replace professional help.
The most common reason that prevents suicidal people from killing themselves is having people in their life that matter to them. The therapist should not the one to be telling their patient that they love them. Therapy does not give you a sense of love. You should be the one that should be telling your friend that you love them.
When helping people, you have to be patient with yourself and other people. Meet people where they are at. It is easy to be upset, but being upset is not what needs to be done. Whether you are at your best or your worst, don’t give up.
Do not expect people to be what they are not when you are helping them. Help is not conditional on whether the person is who you expect them to be. You can be productive if you stick with it and accept them for who they are.
It is not about never giving up or being perseverant. It is about being patient, especially with yourself.
When you are not at your best, you tend to treat yourself badly, give up on yourself, you call yourself names, and you beat yourself up. Do not do this. Helping yourself can be productive if you give yourself a chance and you stick things through.
People have certain internal beliefs and when the external world sends them a message relating to that belief, it affects them deeply. If your depression worsens from hearing that someone has died, then you might have a belief that the world is a hopeless place.
Depression is like PTSD — certain things can trigger it to come out, or worsen. If you are running to use the restroom and you have to wait for the stalls, then your desire to go becomes stronger. You might have a view about the world which shapes your attitudes toward events that occur in the world.
There are promising studies that use psychedelic drugs to treat depression and addiction. However, there is a difference between drug use and psychedelic-assisted psychotherapy.
Psychoactive substances used correctly under the guidance and supervision of a trained professional can have promising results, but some people just get high off of them and they do not get better. Moreover, unsupervised and non-therapeutic psychedelic use can often lead to the development of PTSD.