Treating Mental Illness as a Society

From a lecture series presented by The Great Courses

When it comes to treating mental illness, people have many options, including medication and talk therapy. Unfortunately, though, due to the stigmatization of mental illness, many individuals do not seek out treatment. Discover what it would take to address mental illness not just on an individual level, but on a societal one.

One more picture of sad girls where two of them are trying to mentally support their crying friend.

Increased Awareness of Mental Illness

Largely, the media has been to blame for the stigmatization of mental illness. Stigmatization can be seen in films, TV shows, and news headlines that depict the mentally ill as violent criminals.

Fortunately, though, high-profile celebrities have started talking frankly about their mental health struggles and how they decided to seek help. The Boston Globe, in an article titled “Could Celebrities Stories Destigmatize Mental Illness for the Masses?” discussed some big-name stars, including Kanye West and Adele.

Singer Selena Gomez openly discussed her struggles with anxiety and depression at the American Music Awards, saying, “I was absolutely broken inside.” She implored her fans to seek treatment if needed. In her own words, she said, “If you are broken, you don’t have to stay broken.”

This is a transcript from the video series The Skeptic’s Guide to Health, Medicine, and the Media. Watch it now, on The Great Courses Plus.

On Twitter and other social media channels, the response to these stories has been mostly positive and supportive. That response fits with a possible generational change in attitudes about mental illness—a positive change. The Boston Globe story cites a Harris poll from 2016 indicating that younger adults, from ages 18 to 25, report a more accepting view on mental health care than older adults.

Mental Illness and Social Media

But there’s a dark side to social media, too. Intensive use of social media can be seen among people recovering from mental illness, but may also be contributing to mental illness in some cases.

Sites and apps like Facebook, Twitter, Instagram, and Pinterest encourage posting and interactions among online friends, which sometimes are people who you don’t even know in real life.

Silhouette of a girl using her tablet computer

There is a correlation between social media use and depression, based on observations from multiple studies that have documented higher rates of depression among heavy social media users. These kinds of studies, though, don’t always make it clear that one thing causes the other.

Perhaps, people who are socially isolated are both prone to turn to social media and are at elevated risk for depression. One doesn’t necessarily directly cause the other, even if they are related.

Similar observations have been made for increased social media use perhaps promoting or being associated with a more-distorted body self-image, which is a component of eating disorders.

On the other hand, some web-based interactive services have been shown to be effective in helping to treat certain mental illnesses, especially anxiety disorders. Social media, like other kinds of media, is neither always good nor always bad, when it comes to its effect on mental health.

Learn more about the media’s take on mental health

Are Antidepressant Medications Effective?

Sometimes, media reporting on mental health can be downright confusing. In 2010, the Journal of the American Medical Association published a large meta-analysis, a study combining the results of many previous studies, on the effectiveness of antidepressant medications.

The study found that medication was much more effective for severe depression than for mild depression. This makes sense, and fits current medical guidelines—the first line of therapy suggested for mild depression doesn’t necessarily include the use of medication.

But compare how the headlines from some big media outlets reported this story.

Time magazine reported it this way: “Antidepressants Do Little for Mild Depression, Study Finds.” NPR took a slightly different tack, “Meds May Help Only Those with Severe Depression,” while HealthDay spun it this way: “Severely Depressed Gain Most from Antidepressants.”

These headlines were all pertaining to the same study. In fact, the stories often included quotes from the same interviews and snippets of the same statistics. But each of the three headlines frames the story differently, and paints a very different picture about the role of medication in the treatment of depression.

Additionally, a 2016 study looked at healthy, adult volunteers—these were people without mental illness—given antidepressant medications to monitor for potential side effects. And there were side effects, certainly, including nightmares, feeling jittery, anxiety, and restlessness.

Prescription medicines and pill bottles.

These side effects occurred at about twice the rate in medicine-taking volunteers than in volunteers taking placebos. The authors lumped these and other side effects together, labeling them as “activating events,” and contending that if these side effects were to occur, it would increase the risk of people committing suicide.

Note that none of the volunteers committed suicide, or even reported suicidal thoughts, but the authors’ conclusion was that “Antidepressants double the occurrence of events in adult volunteers that can lead to suicide and violence.”

Again, this study didn’t actually show any increased risk of suicide, suicidal thoughts, or violence, and it was a study done involving healthy volunteers. We know that suicide and suicidal thoughts are symptoms of depression and can be treated with these medicines. But at least some of the headlines about this study missed these nuances.

In the UK, The Sun reported “Happy Pills Suicide Risk: Antidepressants Can Make Depressed People Twice as Likely to Think about Killing Themselves.” This study was not done in depressed people and no one with journalistic integrity calls them “happy pills.”

To its credit, The Daily Telegraph, in London published the article, “Rows over Study Which Claims Antidepressants Double Suicide Risks,” and walked through the study’s shortcomings, pointing out that the headline-grabbing conclusion wasn’t entirely justified.

Learn more about how to recognize articles based on solid scientific evidence

Mental Illness and Prisons

While looking at the big picture in the United States regarding mental health, an essay published by CNN, and co-written by Republican Speaker Newt Gingrich and Democratic commentator Van Jones, posed this rhetorical question: “Name the largest provider of mental health care in America.”

If you guessed “our prisons and jails,” you’d be right.

The essay, titled “Mental Illness Is No Crime,” quotes a U.S. Department of Justice study with some chilling statistics: two out of three people in jail, including three out of four incarcerated women, have symptoms or a history of a mental disorder.

The statistics are similar if you look at federal or state prisons and jails. The estimated number of mental patients incarcerated in criminal institutions outstrips the number of patients in state mental hospitals by a factor of 10 to 1.

When looking at these numbers, Gingrich and Jones concluded that the approach used when the mentally ill commit nonviolent crimes—and that accounts for the vast majority of these prisoners—is “A solution straight out of the 1800s. We’re locking them up instead of addressing the problem.”

Even if we were to think that a large amount of violent crime is committed by the mentally ill—and that’s not actually true—you’d think that we’d then be even more invested in mental health outreach and treatment.

We’d want to identify the risk factors that contribute to mental illness, including things we already know about, like growing up in poverty or experiencing traumatic or abusive events in childhood. We’d be looking for other influences, too, trying to identify genetic markers that could lead to new therapies or environmental influences that could be addressed.

Long-Term Solutions for Mental Illness

Early identification and treatment, finding people at risk, intervening before a tragedy occurs and before substance abuse becomes an added disaster for someone and their family—these are all goals that really ought to be at the top of the list in searching for long-term solutions.

But in many ways, we’re just not quite comfortable with this approach. People with mental illness don’t feel comfortable stepping forward for help, and their families and coworkers aren’t always eager to encourage people to seek treatment.

The media, by and large, still seems to treat people with mental illness very differently from people with physical illnesses. If you knew someone with a kidney stone or a bleeding ulcer, or someone who could barely stand because of a backache, you’d be right there to drive them to the hospital.

But what if you noticed a coworker who’s isolated and alone, and maybe starting to drink too much? He’s hurting, I bet you, just as much as that guy with the backache.

But who are you more likely to try to help?

From the lecture series The Skeptic’s Guide to Health, Medicine, and the Media, taught by Professor Roy Benaroch, M.D.

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