We’re Basically All Struggling With Mental Health Right Now—Let’s Normalize It

originally posted at: https://www.self.com/story/normalize-mental-health-conversations by By Jessica A. Gold, M.D., M.S.

If you look around right now, it feels like conversations about mental health are everywhere. It’s pretty much impossible to think about the impact of the coronavirus pandemic on our day-to-day lives, or that of systemic racism against Black people in the United States, without touching on mental health. (To say nothing of the many other factors that can affect how we’re doing mentally.) We don’t need to pretend like everything is normal, because it’s not. We don’t need to act like everything is okay, because it’s not. Our conversations in the workplace, with our friends and family, and on social media seem to have shifted to be more real, and perhaps more open and vulnerable, at least based on what I’m seeing. As a psychiatrist, this makes me hopeful that we can finally normalize what it means to struggle with our mental health, because really, most of us are in some way or another.

“The world—and the U.S. in particular, for a variety of reasons—is currently going through a major trauma,” Anne Giedinghagen, M.D., assistant professor of psychiatry at Washington University in St. Louis, tells SELF. “The pandemic is upending our lives and senses of safety. People are losing jobs, people are getting sick, people are dying. Our routines—from how we eat to how we socialize to how we sleep—are disrupted.” Kelechi Loynd, M.D., a child, adolescent, and adult psychiatrist adds, “With the COVID-19 pandemic, as well as the unrest due to social injustice and issues related to systemic racism, a lot more people are experiencing an increased level of anxiety and even some hopelessness related to an uncertain future. It is important to recognize these struggles as part of our common human condition to some degree.”

A nationally representative survey published in JAMA: The Journal of the American Medical Association in June of this year found a marked increase in how many U.S. adults reported feeling symptoms of “serious psychological distress” in April 2020 versus in 2018—13.6% vs. 3.9%, respectively. And while 13.6% may not sound like a lot, keep in mind that the survey was only measuring “serious” psychological distress using a specific scale—when even psychological distress that wouldn’t technically count as “serious” in this survey can absolutely have an impact on your life—and the numbers vary based on factors like age. For example, 24% of 18- to 29-year-olds reported serious psychological distress, and 19.3% of people with an annual household income under $35,000 said the same. But you probably don’t need a study to tell you that the past few months have been hard on so many people’s relationships, work, finances, sleep, productivity, and ultimately, mental health.

“People feel disconnected and anxious,” Danielle Hairston, M.D., a psychiatrist at Howard University, tells SELF. “They are worried about their family members, jobs, and children going to school. My patients are struggling from not having the same access to care, and many feel angry and exhausted by the shift from their norm.” My patients are exhausted too. So are my friends and family members. In fact, so am I.

This feeling has only been getting worse as the pandemic has gone on. That’s probably because of the constantly changing and seemingly never-ending timeline we’re dealing with. “The lack of certainty about so many things during this time, and the stress associated with it, can really exacerbate underlying mental health concerns and/or be a catalyst for the onset of mental health conditions,” Amalia Londono Tobon, M.D., adult and child psychiatrist and perinatal psychiatry postdoctoral research fellow at Brown University, tells SELF. Dr. Giedinghagen adds, “Running a marathon is always hard, but it’s even harder when you can’t even visualize the finish line.

It is also harder if you’re trying to do it without enough support. Stigma and shame are huge reasons for people not getting mental health help when they need it. In many ways, therapy has become more normalized, for which I’m grateful. We’ve gotten to a point where, as a psychiatrist myself, I can talk about struggling with teletherapy during the pandemic. Major shows like Grey’s Anatomy have even spotlighted lesser-known types of therapy. But in my experience, medication is still quite stigmatized, usually much more so than therapy. It’s such a shame because medication can be so crucial for many people’s mental health. “There’s a sense that you’re ‘cheating’ if you take medication,” Pooja Lakshmin, M.D., clinical assistant professor of psychiatry at George Washington University School of Medicine, tells SELF. “But I ask my patients, ‘If you broke your leg and your surgeon said, “We need to operate,” would you call that cheating?’” As long as so many people view mental health conditions as somehow more shameful and lesser than physical health conditions, the stigma will remain.

“Stigma stops people from accessing the help they need,” Jack Turban, M.D., child and adolescent psychiatry fellow at Stanford University School of Medicine, tells SELF. “Luckily, we’ve had more folks speaking out publicly, from celebrities like Selena Gomez to doctors. I’m hopeful that we’re making progress.”

While not everyone with some measure of psychological distress during this time needs mental health treatment, having open conversations about the nuances of mental well-being is always critical. “When you normalize problems that people are having individually in secret, you lower the threshold for them to be able to talk about them,” Kali Cyrus, M.D., assistant professor of psychiatry at Johns Hopkins Medicine, tells SELF.

But what does normalizing mental health concerns look like in practice? It can definitely mean that we talk about our own mental health or difficult emotions really openly and honestly. Maybe you curate your social media posts less and instead make them more realistic, showing when you’re stressed, tired, angry, sad, or any other number of emotions. But you might not be ready to be that open about how you’re doing, and that’s completely okay. (Of course, it is important to try to talk with someone if you’re having a hard time, even a friend, just to make sure you aren’t keeping it all inside.)

Normalizing mental health discussions can also mean that if it seems like your roommate or a friend is really going through it, you say something like, “This pandemic has been such a hard time emotionally, so I just wanted you to know I’m here to talk if you need me.” Then actually follow through and be ready to talk to them, judgment-free, and maybe even solution-free. Sometimes people just want someone to listen, not try to fix their problems. 

Normalizing mental health concerns can also mean that, if you’re a boss or in a position of leadership at your job, you create a culture where vulnerability is acceptable by talking about your own feelings and life stressors. You should also normalize things like going to therapy appointments, even by using that as an example for a completely valid reason to be out of the office for a bit. On that note, taking time off for mental health needs (such as via a mental health day) should not only be the norm, but encouraged.

You can also normalize mental health discussions when you and your friends talk about a celebrity who’s in the news for, say, a bipolar disorder diagnosis—you can commend the celebrity for sharing that information and refrain from laughing at their actions or using words like crazy or insane to describe their behaviors. Even holding back from incorrectly using words like schizophrenic or bipolar can go a long way, as can stopping yourself from dismissively calling someone an addict or saying someone committed suicide (because that makes it sound like a crime).

These are just some of the ways we can normalize mental health. We change the culture around it, and it becomes part of our day-to-day life instead of a separate, shameful area of it. There’s nothing more normal than having a hard time when trying to process multiple national crises while dealing with the details of your own life too (and how your life intersects with said crises). There is no abnormal emotional reaction to a pandemic, and what’s more, none of us is immune from having a hard time right now. Your boss might be dealing with it. Your friends might be dealing with it. Your family members might be dealing with it. You might be dealing with it. Even your therapist might be dealing with it. (Did I mention I see a therapist regularly, and she’s the reason I’m getting through the pandemic at all?)

It is completely normal to struggle with our mental health, to ask for help, and to get treatment when we need it. It’s about time we all say so out loud.