Do I need a therapist?
...or is our mental-health obsession driving us crazy?
The first time I saw a psychotherapist was when I was 20. I felt deeply ashamed and told no one except my parents.
I have an on-off relationship with therapy, but it’s only recently that I feel comfortable talking about it.
Seeing a therapist has become like getting a manicure or a massage. Everyone has one these days. And those who haven’t are thinking about getting one.
Mental health problems are common. 1 in every 8 people in the world live with a mental disorder, according to the WHO but the numbers are higher in the developed world. In the US, every year about 20% of working adults experience a mental health issue. A third of British people said they had turned to a counsellor in 2022. Couples therapy is also on the rise. Nearly 50% of married couples in the US have gone to counselling at one point in their relationship. Depression and anxiety are the most commonly diagnosed mental illnesses.
But people increasingly also see therapy as a lifestyle choice. When I signed up for the dating app The League it listed “Pop my therapy cherry” and “Restart therapy (this isn’t my first rodeo” as options for goals to put on your dating profile.
CEOs openly talk about their therapist and several of my friends see or have seen a therapist to cope with difficult childhoods, breakups and even “vague dissatisfaction with life”.
But it doesn’t stop there. Therapy-speak has infiltrated our everyday life. Everyone has a trauma (or at least a traumatic experience) and hurting someone by accident immediately gets you labelled as toxic. And we suddenly all need to “set boundaries” and avoid crossing our friends’ boundaries.
Is therapy culture harming us?
I am not convinced that all the focus on self-care and therapy is actually helping that much. On the contrary, it may be making things worse.
Sadness, pain, frustration and despair are part of the human experience. So are conflicts in relationships. It’s perfectly normal to feel sad when experiencing hardship in your life.
Avoiding uncomfortable feelings for fear of being “triggered” or shifting the blame on others because they are “toxic” or “narcissists” is causing all sorts of problems. People don’t take responsibility for their poor behaviour and it prevents people from forming and keeping relationships with others.
A few weeks ago, a 27-year-old Briton dying of cancer said his friends were ghosting him in his final days. Presumably dying from cancer was “crossing a boundary” for them or they needed to “protect their peace”.
Last year, a debate about Jonah Hill’s boundaries in his relationship, which appeared to be an attempt to control his girlfriend and which she called emotional abuse, went viral.
When I went through a gut-wrenching break-up in 2023 I was fobbed off by some friends along the lines of the infamous "I’m actually at my emotional capacity” template. I also found myself fighting random armchair diagnoses about my mental health when a few kind words and a hug would have been more appropriate.
We are getting some crucial things wrong here. A healthy relationship is a two-way street. There will likely be conflict and frustration on occasion. But the answer is not to retreat from relationships. Handling uncomfortable feelings and situations is a sign of maturity and is unavoidable if we want to lead meaningful lives and grow.
The problem with #inspirational
A lot of the so-called mental well-being, self-care and motivational content out there creates unnecessary pressure. It also manipulates people into spending money on expensive spa days or products in the name of self-care.
“It’s never too late!” posts rattling off random accomplishments and ages at which they were achieved imply people not reaching their goals are not trying hard enough.
The reality is that sometimes it is too late. We do not have unlimited resources, health, energy and career capital. Sometimes we need to accept that life didn’t go the way we hoped. There are times when we need to settle for what we ended up with and make it work.
Manifesting is another harmful self-help trend. It’s not materially different to wishful thinking or the law of attraction from the cult-self help book The Secret. Aside from the fact that there is no evidence whatsoever that we can create reality with our thoughts alone, it can set people’s expectations unnaturally high and set them up for failure and disappointment. It’s also an exercise in victim-blaming. If good things don’t happen to you, it must be your fault.
I also find the obsession with self-love disturbing. Women (not men for some reason) are told that wanting to rely on a partner is needy and that the solution is self-love. It’s important to have a sense of self-worth but you can’t truly love someone without being dependent and needing them to a certain degree. We were not designed to handle life’s challenges alone and it is a basic human need to want to belong.
Does therapy and medication even work?
There is nothing wrong with wanting to be more aware of our emotions or trying to live a happier, healthier and more fulfilling life.
But do we all need to see a therapist for this?
Research indicates that therapy may not be a good solution for everyone. According to studies only 50% to 75% of patients see a benefit from therapy and up to 10% say therapy has worsened their condition. In one study the worst-performing therapists failed to help a single patient within a three-year period.
Other studies found that a healthy diet and regular exercise might be as effective in treating depression than traditional psychotherapy. Last year a study indicated the dogma of clinical psychology that suppression of negative thoughts worsens mental health may be wrong.
In my experience with therapists, I found them not particularly helpful at least half of the time. Some of them lacked a sense of empathy (pretty concerning considering their line of work) and others just couldn’t offer any methods that worked.
At least I didn’t find them harmful. American actress Anna Kendrick said her couple’s therapist repeatedly sided with her ex and prevented her from identifying his abusive behaviour. Earlier this year a woman in the UK won more than €200,000 in damages after her therapist sexually abused her. It is estimated that about 600 people are sexually abused by their therapist in Germany alone (most victims are women).
Medication may be less effective than previously thought. Recent research has shown that anti-depressants, the most prescribed medication in the United States, help very little or not at all in mild depression. Even in severe and chronic cases, the effect is only modest when compared with placebo.
Medication for psychiatric conditions only treats symptoms. It cannot heal depression or anxiety, meaning the symptoms are likely to come back as soon as the pills are stopped.
There is often not enough data to fully understand the risks and benefits of more experimental forms of treatment such as hypnosis apps, EMDR, brainspotting as well as psychedelic-assisted therapy.
Mental health apps are sprouting everywhere and the market for them is valued at more than $6 billion but there is very little hard evidence that they actually help. A 2022 study with 50,000 patients didn’t find convincing evidence that any mobile app improved mental well-being. There are growing concerns about privacy violations and cybersecurity risks of mental health apps as well.
Can we treat mental health conditions ourselves?
Suffering from mental health conditions is pretty normal and affects people from all walks of life. Most of them manage to have families and careers and have fulfilling lives. Thankfully the stigma and fears about being labelled crazy or mentally unstable are fading. Plenty of high-achieving individuals have opened up about their struggles.
Singers Adele, Lady Gaga and Miley Cyrus suffered from depression. British journalist and communication strategist Alastair Campbell and author J.K. Rowling openly talked about being depressed. Business people are also affected: Elon Musk (bipolar), Arianna Huffington and Jeff Bezos (both burnout), Richard Branson (dyslexia and ADHD). Some experts even speculate that high-powered business executives and entrepreneurs may be more susceptible to depression than others.
There are cases where seeking treatment (with a reputable therapist or doctor) is necessary. Admittedly it is hard to know at what point and personally, I find the bar to be diagnosed with depression (“low or sad mood that persists for 2 weeks or longer”) too low. However, I would recommend seeking professional help when you are struggling to complete daily tasks such as work, eating regular meals and maintaining a social life. Severe depression is a deadly disease causing about 700,000 suicides annually. If in doubt, it is potentially life-saving to see a doctor or intervene if you think someone is at risk.
But there is also a lot we can do to treat milder forms of mental health conditions (or prevent them) ourselves.
Science-based ways to improve mental well-being and help with mental health conditions are:
Exercise (walking or jogging, yoga and strength training are thought to be the most effective forms of exercise to treat depression)
Spending time in nature
A healthy diet
Socialising with other people (preferably in person)
Acts of giving and kindness
Meditation and breathing exercises can help reduce anxiety and depression (but don’t overdo it. There have been reports of extreme meditation triggering psychosis)
It’s advisable to avoid tech and social media overuse as well as drinking alcohol and taking drugs. Research has shown a strong link between cannabis and mental illnesses and social media and alcohol have various negative effects on our mental health.
Personally, I find reading books and articles about psychology and mental health helpful. I also often find solace in fiction and poetry. Art has been helping people cope with tough times for centuries, so why wouldn’t it work for millennials? Practising mindfulness by trying to live in the moment and focusing on enjoying small things like a cup of coffee or appreciating the colour of autumn leaves also improves my mood.
Some people find journaling (keeping a diary) or writing down things they are grateful for (gratitude diary) helpful but it makes me more depressed and anxious.
But looking at the science, social connection appears to be the key variable for greater health, happiness, and a longer life, according to the famous 85-year Harvard study. So, the best thing you can do for your mental health is to invest time and effort in relationships with friends, family, colleagues and your partner.
Recommended Reading:
Psychotherapie: Woran merke ich, ob meine Therapie wirkt? | ZEIT ONLINE
Cafe Depresso Mental Health Podcast
Is Therapy-Speak Making Us Selfish? by Rebecca Fishbein
The Age of Abandonment by Freya India GIRLS
Bei leichten Depressionen gibt es Besseres als Antidepressiva - Wissen - SZ.de
What You Really Need to Know About Antidepressants
‘It was devastating’: what happens when therapy makes things worse by Amelia Tait
How diet can affect your mental wellbeing BBC
Dramatic growth in mental-health apps has created a risky industry
Man's Search For Meaning: The classic tribute to hope from the Holocaust
Important disclaimer:
I am not a psychiatrist or psychotherapist. This is not medical advice. I have researched this article to the best of my ability and linked to relevant sources. However, it is important to do your own research and/or ask a mental health professional for advice.