The following is an interview conducted by Archbridge Vice President of Research and Director of the Human Flourishing Lab Clay Routledge with Lucy Foulkes, an academic psychologist at the University of Oxford. We discuss her research on the possible negative consequences of increased public mental health awareness.
Clay Routledge: In recent years, we have seen a proliferation of mental health awareness campaigns. Although these campaigns have helped remove the stigma surrounding mental illness, you have proposed that they may also have some unintended consequences. Can you talk a little bit about your proposal and evidence that supports it?
Lucy Foulkes: I’m concerned that these campaigns have led to a tendency to use psychiatric language too readily, that we are now over-pathologizing common emotional experiences. This is unhelpful for a number of reasons. It makes those emotional experiences more frightening, because it adds the additional burden of the person believing there’s something wrong with them, or that they have a mental disorder, when perhaps they don’t. But there are also unintended consequences for people who are most seriously unwell. There is no language left for them to describe their experiences, and they continue to feel unseen and unheard. But they were the people that these campaigns were designed to help.
This is mainly a hypothesis at the moment. There are a few limited bits of evidence, like some studies showing that people’s understanding of terms like ‘trauma’ has expanded in recent years, especially in young people. Over the next few years, with a team at Oxford and with collaborators, I’m going to work on experimentally testing this hypothesis in more detail.
Clay: Can you provide some examples of the ways in which mental health awareness campaigns are encouraging people to view mild or temporarily unpleasant mental states as serious psychological problems that require a diagnosis and treatment?
Lucy: Anxiety is a good example. It’s an emotion that we all feel to different degrees. But people are being encouraged now to view any experience of anxiety as that meaning they ‘have anxiety’, that it’s part of their identity. This means they change the way they understand themselves and the way they behave in a way that could ultimately be self-fulfilling. For example, anxiety is now commonly being used as a reason not to do things in schools and universities, such as sitting exams or handing in work on time. But it’s very well established that avoidance maintains and exacerbates anxiety in the long run. We are effectively now encouraging avoidance in a lot of settings. This can be helpful sometimes, on a temporary basis, but not as a blanket approach to dealing with difficult emotions.
Clay: There are a number of social trends that may be making children, teens, and young adults more vulnerable to mental distress and less psychologically resilient, such as overprotective parenting practices, decreased time spent socializing in person with peers, increased social media consumption, and so on. Do you think these trends are contributing to mental health problems? Do you see any connection between these trends and mental health awareness campaigns?
Lucy: I don’t study parenting, and I don’t necessarily buy the idea that less in-person socializing means worse mental health by default. Social media is still socializing, and we don’t yet understand well how the different format of connecting with peers might impact mental health (if it does). But, I do think that parents and social media are relevant in that they are both routes by which young people are being sent a repetitive message: your generation is in a mental health crisis, and you personally are likely to be unwell. Teenagers today are getting this message from everywhere and everyone. Of course, it’s often well-intended, and some teenagers really are seriously unwell. But the collateral damage is that all teenagers get the message that they’re vulnerable, and that is wrong and unhelpful.
Clay: What role, if any, do you think schools and universities are playing in the rise of reported mental health problems?
Lucy: I think schools and universities are in an extremely difficult position. They are under pressure from the government, charities, parents, and young people themselves to do ‘something’ about mental health. And they see with their own eyes examples of very distressed young people. But they are not mental health professionals, and they are limited in terms of time, money, and resources in terms of help they can provide. Yet they feel they have to do that something, and they have to be seen to be doing something – so that means generally low-budget solutions (like whole-class lessons) by people with minimal training. Maybe that’s helpful for some young people, but the evidence isn’t very encouraging, and I’m worried that it leads to practices like avoidance that ultimately contribute to the problem.
Clay: If efforts to increase mental health awareness are helping some people better recognize and address their mental health problems but leading others to overpathologize normal psychological experiences, how can we retain the benefits of increased mental health awareness while reducing the negative consequences?
Lucy: This is the big question: how do we get the right info to the people who really need it, without the collateral damage? And I honestly don’t know at the moment. It may be about focusing on providing better health services rather than interventions in schools. It may be about improving other aspects of school (such as reducing academic pressure or increasing a sense of school safety and belonging) rather than running mental health awareness campaigns. In a few years’ time I hope to have a better answer to all this. But, right now, I think we need to be brave enough to ask whether we’ve got it wrong so far and brave enough to consider pressing pause on all these campaigns. It feels unpalatable to say maybe we shouldn’t be widely sharing generic information about mental health, but that’s the way my thinking is now going.