Mental health in Spain is getting worse every day. There are more and more suicides, more cases of depression, and anxiety affects 6.7% of the population, more than 3 million people. Numerous causes have been attributed to this crisis: social networks, covid-19, climate crisis, economic crisis, changes in the family structure. But what if part of the problem is that, precisely, there is too much talk about mental health?
Right now, in Spain, more than 12 million people – 26.2% of the population – go to psychologists, according to the Mutua Madrileña report from last year. This figure is substantially higher than the 5.4% of Spaniards who attended consultations five years ago. Furthermore, the consumption of anxiolytics has increased by 18.9%, which represents an increase of 13% in the last five years, according to data from the Ministry of Health. This situation also occurs in much of the rest of the world. In 2004, 13% of Americans were receiving mental health treatment; in 2021, the percentage had risen to almost 22%.
Experts and the media have been wondering for some time why mental health problems are increasing, despite the fact that it is increasingly common to go to the psychologist, more medications are prescribed and there is greater awareness: since the establishment of a World Mental Health Day, Mental Health to public figures such as Prince Harry, the athlete Simone Biles or the singer Selena Gómez publicly sharing their struggles, to advance destigmatization.
“Overinterpreting” symptoms
Beginnings of May, The New York Times put the following hypothesis on the table: what if psychological therapy and awareness campaigns, especially those aimed at adolescents, are, paradoxically, aggravating the problem of mental health? The article admits that some awareness campaigns help adolescents identify disorders that urgently need treatment, but warns that, in others, this type of action can lead to “overinterpreting symptoms,” and “seeing themselves as more problematic than they are.” That is, young people who, upon learning more about the symptoms of mental disorders through campaigns, begin to think that their common experiences of stress, sadness or anxiety are indicative of a larger problem.
Where does this hypothesis come from? Mainly from an article published last year by two psychologists from the University of Oxford: Lucy Foulkes and Jack Andrews. EL PAÍS has contacted Andrews, who clarifies that the article does not present concrete findings, but rather is a theoretical piece that raises the “prevalence inflation hypothesis.” “On the one hand, we know that awareness efforts have led to more accurate recognition of mental health symptoms that were previously unrecognized or underreported. This increase in accuracy is a positive result, as it allows more people to seek the help they need,” he explains by email.
What is the negative part? “These efforts lead some people to interpret mild, transient forms of distress as serious mental health problems that require treatment,” she says. That is, overinterpretation. Andrews emphasizes the need to undertake more research to test this theory, although he assures that right now there is enough evidence to believe that treatments without a scientific basis are being carried out in many schools in various countries around the world. “Several large-scale trials in schools have found iatrogenic (negative or unintended) effects when applying interventions based on mindfulness, Cognitive Behavioral Therapy and Dialectical Behavioral Therapy.”
It is not the first time that someone defends this thesis. This year, journalist Abigail Shrier published a book titled Bad Therapy: Why the Kids Aren’t Growing Up (Bad therapy: Why aren’t children growing?). This essay considers whether Generation Z (born since the mid-to-late 1990s) suffers from more mental problems than previous generations, precisely because of a pedagogy that has placed significant emphasis on their feelings and emotional well-being, and in parenting practices focused on emotional validation and psychological support. “How is it possible that children raised delicately have come to believe that they have suffered disabling childhood trauma? How have children who have received so much more psychotherapy than any other generation sunk into a bottomless pit of despair?” the book asks.
Ana, a 26-year-old artist from Madrid, assures that, from her experience, increased awareness and emphasis on mental health can lead to an overinterpretation of symptoms and excessive self-absorption in emotional problems. She defines herself as a person with “delicate underlying mental health,” “with a chronic addiction to life.” on-line”, “the type of person who, at 15 years old, could lock himself in his room for a week listening to Lana del Rey.”
He has gone to psychological therapy at three different times in his life. The last one was a little over a year ago. She helped him resolve a love conflict, “if you can call the process of getting out of a toxic relationship that way.” She stopped going before she had been discharged. The reason was that she felt “saturated with herself”, she couldn’t stop thinking about how she was feeling at all times, about whether or not it was in her best interest to do anything. “Added to that was the fact that almost all of my friends started going to the psychologist, and we spent hours talking about our feelings, as if in a loop. It almost became impossible to enjoy life,” she says.
Controversial approach
The thesis defended by all these authors has an undeniably controversial dimension. The visibility of mental health problems is considered a significant advance in the achievement of social rights, “a fundamental human right,” according to the WHO. Furthermore, this thesis has some weaknesses. “On the one hand, it could be argued that it confuses correlation with causality,” defends the psychologist specialized in child therapy Manuel Pozuelo. “The fact that more people are seeking treatment and that there are more reports of mental health problems does not necessarily imply that visibility is the cause of the increase in these problems. Rather, it could indicate a greater willingness to recognize and treat these problems, which is a positive development.”
The expert points out that currently in Spain there are only six psychologists per 100,000 inhabitants in the National Health System, three times less than the European average, a situation that is repeated in much of the world. Pozuelo argues that, in the absence of adequate resources to address mental health problems effectively, prevention campaigns can be crucial. “Early detection and treatment of mental health problems are essential. Delaying or minimizing these problems on the grounds that they might be ‘overinterpretations’ could lead to more serious long-term consequences. Visibility allows people to identify and address these problems before they worsen,” he defends.
In summary, there is a position that excessive focus on oneself and self-perception as patients with mental illness contributes to the increase in mental health problems; and another that argues that increased awareness and treatment are positive developments, allowing more people to recognize and address their problems before they worsen. The philosopher Søren Kierkegaard would not particularly agree with either position. in his book The concept of anguish, defends the idea that this feeling is an essential part of the human condition and can be seen as a sign of potential growth and self-discovery. As he himself wrote: “Anxiety is the reality of freedom as possibility in the face of possibility.”