Losing Our Minds

1. Awareness campaigns increased talk about mental health, but understanding lags behind.

For all this drive to start talking, no one knows how to listen; no one really knows what it is they’re supposed to say.

Talking has started. Campaigns like "Time to Change" successfully brought mental health into public conversation, featuring celebrities and highlighting statistics like "one in four adults will experience a mental illness." This shift made people feel less alone and more willing to discuss their struggles, a crucial first step after years of silence and stigma. The author's own experience in 2008 highlights this contrast, feeling isolated despite professionals saying her issues were common.

Understanding is limited. Despite increased awareness, public understanding of specific disorders and how to respond remains shallow. Terms like OCD are casually misused, trivializing severe conditions characterized by intrusive thoughts and debilitating compulsions. This lack of depth means that even when someone opens up, the listener may not grasp the reality of the problem, hindering effective support.

Support is needed. With psychological services underfunded and overstretched, informal support from friends, family, and colleagues is essential. However, without a deeper understanding of what mental illness truly involves, this informal network is ill-equipped to provide meaningful help. The conversation needs to move beyond statistics and hashtags to educate people on the realities of different disorders.

2. Mental illness symptoms exist on a continuum with normal human experience, making clear definitions difficult.

Delusions, in other words, are on a continuum.

Spectrum of experience. Symptoms of mental illness, such as low mood, worry, or even hallucinations and paranoia, are not entirely distinct from everyday thoughts, feelings, and behaviors. They lie on a smooth spectrum, making it challenging to define a precise cut-off point where normal experience ends and pathology begins. This is true even for seemingly clear-cut symptoms like hearing voices or holding irrational beliefs.

Defining thresholds. Despite the continuum, artificial cut-off points are necessary for practical reasons like diagnosis, treatment guidelines, insurance access, and research. Experts use criteria like severity, frequency, duration, and disruption to daily life to determine if symptoms reach a pathological level. However, these thresholds are inherently arbitrary and subject to debate among professionals.

Pragmatic judgment. Clinical judgment often supplements strict criteria, considering the distress and functional impairment caused by symptoms. This pragmatic approach acknowledges that the impact on a person's life is crucial, not just whether they tick a certain number of boxes on a questionnaire. Relying solely on self-report measures can overestimate prevalence by failing to capture this nuance.

3. Official definitions of mental illness are expanding, potentially medicalizing everyday distress.

Maybe we’re now labeling too many psychological experiences as disorders, applying the term “mental illness” to things that shouldn’t be called illnesses at all.

Expanding boundaries. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has significantly increased the number of recognized disorders since its first edition in 1952. This expansion occurs vertically (lowering thresholds for existing disorders) and horizontally (adding new disorders or broadening existing ones). Examples include the expansion of social anxiety disorder beyond public speaking and the addition of binge-eating disorder.

Concept creep. This phenomenon, termed "concept creep," means an increasing range of psychological experiences are now falling under the psychiatric domain. While some expansions are arguably beneficial (e.g., recognizing mental illness in children, including indirect trauma in PTSD), critics argue it risks medicalizing normal human suffering like grief or everyday anxiety.

Unintended consequences. The expanding definitions, combined with increased public awareness, can lead to people interpreting normal negative emotions through a psychiatric lens. This linguistic inflation can dilute the meaning of terms like "depression" or "trauma," making it harder to distinguish severe illness from transient distress and potentially leading to inappropriate self-labeling or skepticism about genuine disorders.

4. Mental illness arises from a complex interplay of biological vulnerability and environmental stress.

In essence, it is only when adverse environmental conditions are experienced that the genes ‘come online.’

Nature and nurture interact. Mental illness is not caused by genes or environment alone, but by their complex interaction. Genetic predispositions create vulnerability, but external stressors often act as triggers. Studies show that individuals with genetic susceptibility are more likely to develop disorders when exposed to difficult life circumstances.

Biological factors. Genes influence brain structure and function, affecting psychological processes like emotion regulation, impulse control, and threat processing. While no single gene causes a disorder, hundreds or thousands contribute small risks. Brain network dysfunctions are associated with many disorders, but the relationship is complex, with symptoms also affecting brain function.

Environmental factors. Stressful life events, from major trauma like abuse or war to chronic hardship like poverty or bullying, significantly increase risk. Parenting styles can also contribute, sometimes linked to parents' own genetic vulnerabilities (gene-environment correlation). However, most people exposed to stress do not develop disorders, highlighting the importance of individual vulnerability and coping mechanisms.

5. Adolescence is a critical period for mental illness onset due to rapid biological and social changes.

If you make it to the age of twenty-five without experiencing a mental illness, the chances that you’ll get one beyond that age—while it certainly does happen—are reduced considerably.

Peak risk period. Research indicates that the majority of mental illnesses begin by the age of 24, with 50% starting by age 14. Adolescence, roughly ages 10-24, is a time of heightened vulnerability. This isn't just about age, but the profound physical and psychological changes driven by puberty and brain development.

Pubertal and brain changes. Hormonal shifts during puberty trigger physical development and significant changes in brain structure and connectivity, continuing into the twenties. These changes underpin the development of complex cognitive and emotional skills needed for adulthood, but can also go awry in vulnerable individuals. Early puberty, particularly in girls, is linked to increased risk for several disorders.

Social reorientation. Adolescence involves a crucial shift towards peer relationships and developing sophisticated social skills like "theory of mind." Increased sensitivity to peer judgment and social exclusion, combined with new independence and exposure to risky behaviors (substance use, sexual activity), create potential stressors that can trigger disorders in those with underlying vulnerabilities. Sleep patterns also change, often leading to chronic disruption that exacerbates psychological difficulties.

6. Social media is a "double-edged sword," offering both connection and potential harm depending on the user and context.

This phrase—a double-edged sword—could be used to summarize the relationship of social media with mental health as a whole.

Complex impact. Social media's effect on mental health is not simple or universally negative, despite alarming headlines. Research findings are often conflicting, partly due to methodological issues like relying on cross-sectional data. While some studies show small correlations between screen time and distress, others find no link.

Beyond screen time. The way social media is used matters more than just the hours spent. Behaviors like curating online images and seeking "likes" can interact with and potentially amplify existing vulnerabilities related to self-worth and appearance, particularly in adolescents. However, social media often reflects and magnifies real-life issues rather than creating entirely new ones.

Benefits and harms. Social media provides opportunities for connection, validation, self-disclosure, and companionship, mirroring aspects of offline friendships. It can reduce isolation and offer support, especially for those struggling with mental health. Conversely, it facilitates cyberbullying and exposure to harmful content (self-harm, suicide), which can exacerbate distress in vulnerable individuals. Its impact depends heavily on the user's pre-existing state and offline context.

7. Reported increases in mental illness may partly reflect greater openness and changing definitions, not just rising prevalence.

The upshot is that a person filling out a questionnaire about their mood in 2020, for example, will have a totally different cultural framework in which to understand what the questions mean.

More people seeking help. Increased antidepressant prescriptions and people seeking treatment suggest rising rates, but this could be due to reduced stigma and greater willingness to admit problems. This is a positive outcome of awareness campaigns, but it complicates interpreting prevalence data based on clinical samples.

Changing interpretations. Even in community studies using questionnaires, responses are influenced by cultural context. As mental health language becomes more common and definitions expand (looping effects), people may interpret their normal negative feelings as symptoms of a disorder, leading to higher self-reported rates without a true increase in underlying distress levels.

Multiple contributing factors. While increased openness and changing definitions play a role, other factors likely contribute to observed increases, particularly in self-harm and suicide among young people. These include potential increases in stress, changes in coping mechanisms (like social contagion of self-harm), difficulties accessing treatment, and other societal issues. The full picture is complex and multifaceted.

8. Overusing psychiatric labels for normal suffering can devalue the experience of severe illness.

To conflate normality and pathology devalues the currency of true illness.

Diluting meaning. Applying terms like "depression," "anxiety disorder," or "trauma" to mild or transient distress, or normal reactions to difficult life events (like grief), dilutes the meaning of these terms. This linguistic inflation makes it harder to distinguish between significant, disabling mental illness and everyday unhappiness or stress.

Harm to the severely ill. When everyone claims to have "depression" or "anxiety," those with severe, debilitating forms of these disorders may feel their suffering is not taken seriously or is misunderstood. This can lead to feelings of isolation and frustration, as their profound struggles are equated with experiences far less severe. It hinders effective communication about the reality of severe mental illness.

Skepticism and misdirection. The casual use of psychiatric language can lead to public skepticism, fueling dismissive attitudes like the "snowflake" narrative. It also risks misdirecting resources and attention away from those most in need of intensive support and treatment, as the focus shifts to a broader population experiencing milder, non-clinical distress.

9. Professional help is vital but often inaccessible, and recovery is frequently about managing symptoms long-term.

For some people, mental illness is not something they “recover” from, it is a long-term challenge and disability.

Treatment options. Professional help typically involves medication (like SSRIs) and/or talk therapy (like CBT). While medication effectiveness has been debated, recent large studies confirm they offer significant benefits over placebo for many. Therapy provides tools to manage thoughts, feelings, and behaviors, and the therapeutic relationship itself is a key factor in positive outcomes.

Access barriers. Despite the need, accessing professional mental health care is often difficult due to underfunding, long waiting lists, and insurance limitations. This gap between the call to seek help and the availability of services is a significant problem, potentially worsening outcomes for those in crisis.

Recovery is complex. The popular narrative of "recovery" as a complete cure is often unrealistic. For many, mental illness is a chronic condition requiring ongoing management. Treatment often focuses on coping with symptoms, preventing relapse, and achieving personal goals, rather than complete symptom eradication. Acknowledging this reality is crucial for managing expectations and reducing pressure on individuals.

10. Supporting others through active listening and promoting self-help strategies are crucial for collective well-being.

It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.

Everyone can help. Supporting those struggling with mental health is a shared responsibility. Making it easier for people to talk by asking "How are you really?" and practicing active listening are simple yet powerful ways to provide support. Active listening involves demonstrating attention, understanding, and empathy through verbal and non-verbal cues.

Talking about suicide. Fear often prevents people from asking directly about suicidal thoughts, but research shows this is unhelpful and potentially harmful. Asking openly about suicide does not plant the idea; it provides an opportunity for the person to share their distress and access help. Support organizations offer guidance on how to have these difficult conversations safely and effectively.

Self-help is valuable. For milder distress or alongside professional treatment, individuals can employ self-help strategies. Focusing on physical well-being through exercise, relaxation techniques, and improving sleep habits can significantly impact mental health. These body-focused approaches address the physical manifestations of distress and can be more intuitive for some than purely cognitive methods.

11. Some stress is normal and necessary for building resilience; time is a powerful, often overlooked, healer.

Time is the thing that is bigger than depression and anxiety, and can disprove their lies.

Stress inoculation. Avoiding all stress is neither possible nor beneficial. Experiencing manageable stress and challenges, particularly during development, can build coping skills and resilience, preparing individuals for future hardships. This "stress inoculation" suggests that a certain level of exposure is protective, analogous to building physical fitness.

Enduring suffering. Some psychological pain is an unavoidable part of the human experience and cannot always be fixed or eliminated. Learning to live alongside or through distress, rather than viewing it as a sign of pathology, is a crucial aspect of mental well-being. The public conversation needs to make space for this reality, acknowledging that feeling bad is sometimes just part of being human.

The healing power of time. Time is an essential element in recovery and managing distress. It allows perspective, disproves the permanence felt during difficult periods, and facilitates natural healing processes. Recovery is often non-linear, with setbacks, but building a personal history of getting through tough times provides evidence that improvement is possible, reinforcing hope. Sometimes, simply enduring and waiting is necessary.

Last updated: May 1, 2025