Mental Health: Separating Myth from Fact

Americans are learning more about and accepting mental health issues every day. According to a 2019 American Psychological Association (APA) survey, 87% of Americans saw no shame in having a mental illness, and 86% believed that those afflicted by mental illnesses could recover or improve. Despite what stereotypes may lead you to believe, the younger the participants were, the more stigma they harbored about mental illnesses.1

While one can chalk these attitudes up to being young and not having as many experiences, other factors, such as social media, could be at play. Mental health conditions, such as anxiety and depression, are reduced more and more often to hyperbolic expressions or buzzwords that limit our understanding. To help raise awareness and reduce the spread of misinformation, we’ve compiled a list of common mental health myths and the facts to counter them.

Fact: Children are at risk for developing mental health illnesses.

Although hormones, growth spurts, and brain chemistry have much to do with how children and adolescents behave, we must take their mental health seriously. 50% of long-term mental health illnesses start before age 14.2 Depression, anxiety, and ADHD are three of the most common mental health problems that children and teenagers face. For example, depression is seen more often in older children and teens but can be present in children as young as three.3

The number of youth diagnosed with anxiety and depression increases each year, although one likely cause of this increase is that providers screen for these conditions more than they ever did in the past. A Pew Research Center analysis of the National Survey on Drug Use and Health found that 3.2 million adolescents aged 12-17 reported having a major depressive episode in 2017, compared to 2 million in 2007. With suicide as the second leading cause of death in kids aged 10-14, it has never been more important to prioritize mental health education and awareness in schools and at home.4

Recognizing which behaviors are normal and which aren’t is an important tool in a caregiver’s arsenal, but symptoms can vary from child to child. In addition, some children conceal how they feel or downplay the severity of their symptoms. If you’re unsure whether your child is exhibiting poor mental health or undergoing normal hormonal fluctuations, take the time to talk to them openly and free of judgment. If you’re noticing unusual behavior in your child or are worried, be their advocate and reach out to a mental health professional. Keep in mind that a child might feel more comfortable talking to someone else than you right now — try not to take this personally. This may happen if they worry about upsetting you or being judged.

Fact: People with schizophrenia pose more danger to themselves than to others.

While some people with schizophrenia can become more violent, this violence probably isn’t solely because of their mental illness. According to a study conducted in 2019, most people with schizophrenia are not violent at all. Instead, increased violence and aggression in those with schizophrenia typically coincides with substance abuse. Unfortunately, the myth that people with schizophrenia are violent may stem from the fact that they are five times more likely to struggle with substance abuse and dependence than the rest of the population.5

One theory for this phenomenon is that some antipsychotic medications given to patients block the dopamine receptor D2, which prevents them from feeling pleasure. Patients taking these medications are more likely to turn to drug and alcohol abuse to try and override this feeling of numbness.5

More often, their vulnerable states often make them victims of violent crime rather than perpetrators. A 2001 study found that people with schizophrenia were 14 times more likely to be victims of violent crimes than commit them.6 A more recent study conducted in Australia discovered that those with schizophrenia are significantly more likely to be victims of nonviolent, violent, and sexual crimes than the general population. To make matters more complicated, their risk of being victims increased if substance abuse was involved.7 Individuals with schizophrenia often pose more of a threat to themselves than someone else; their risk of suicide is 20 times higher than the rest of the population.8

Fact: Schizophrenia is a separate disorder with very different symptoms, causes, and treatment.

Schizophrenia is one of several psychotic disorders. Symptoms of schizophrenia last for at least six months; patients with schizophrenia commonly experience visual and auditory hallucinations or delusions, meaning they may see, hear, or believe things that have no basis in reality.8 Milder symptoms of schizophrenia may be the inability to remain motivated, problems focusing, and even the tendency to forget things. Being paranoid, having inappropriate emotional reactions and outbursts, and being catatonic are also symptoms of schizophrenia.8

Other psychotic disorders include:9

• Schizoaffective disorder, in which symptoms are similar to schizophrenia, but mood disorder symptoms are also present. Because psychosis from mania looks similar to longer-term psychosis, it’s one of the most commonly misdiagnosed mental illnesses.10
• Schizophreniform disorder, in which symptoms of schizophrenia last between one and six months.
• Brief psychotic disorder, which is a short-term psychotic episode induced by heightened stress, lasting between one and 30 days.
• Medication or substance-induced psychotic disorder.
• Psychotic disorder due to other factors, such as brain injury.

Multiple personality disorder, now known as Dissociative Identity Disorder (DID), is a dissociative disorder, not a psychotic disorder. When someone has DID, they experience two or more distinct identities, or personalities, within themselves. While it may sound like a delusion or hallucination based on that description alone, it’s essential to realize that DID isn’t a split from reality but within that person’s sense of self. DID often occurs due to trauma, where the mind feels it’s unsafe to be fully present in the world.

Symptoms of DID also differ significantly from schizophrenia:11

• Dissociative amnesia
• Depersonalization
• Memories of experiences you don’t recall having
• Speech, personality, and behavior changes
• Lapses in memory
• Not feeling in control of your body, emotions, and thoughts

The stigma surrounding DID has sensationalized the disorder to the point where many people question its existence. It is a real condition that affects 1.5% of people worldwide.11 Understanding mental health conditions like schizophrenia and DID reduces the stigma surrounding them, giving people with mental illnesses back their dignity. No one chooses to have a mental illness, but we can choose how we talk about them.

Fact: While parenting is a critical contributor to mental health problems, it is not the only factor.

It can be easy to blame mental health problems on a person’s upbringing, particularly if they were mistreated, abused, or neglected. A 2017 study found that varying levels of care shown by parents have a profound impact on the child’s psyche. Low maternal care and high maternal control were linked to children’s depression, eating disorders, and behavior disorders; low paternal care and high control were associated with future alcohol abuse and phobias.12

However, the study failed to account for things like unemployment, socioeconomic status, and the mental and physical health of the parents. Not having a job, poverty, and poor health can increase stress levels, triggering depression or other mood disorders. This environment can make the home a stressful place for all family members. In this case, a mental health disorder is not a reflection of parenting but diminished resources and the struggle to survive. When it comes to mental health, both nature and nurture make a big difference.

While parenting styles can impact a person’s mental health, we can’t ignore other factors. A person might have loving and supportive parents but may experience trauma early on in life that triggers a mental health condition. The World Health Organization (WHO) lists many determinants of mental health besides parenting:13

• Interpersonal conflict with peers
• Media influence
• Chronic illness
• Being an orphan
• Adversity or oppression
• Peer pressure
• Identity exploration
• Gender norms
• Quality of life
• War
• Bullying
• Sexual assault
• Physical violence

Fact: Your risk for developing depression increases if an immediate family member has depression or depressive episodes.

In the same way we can’t exclusively look at parenting styles to determine rates of mental illness, we can’t rely on your environment to determine your risk of depression. Depression is the leading cause of disability in the United States, with nearly one in 10 Americans aged 12 and up reporting at least one major depressive episode in 2020 alone.14 The COVID-19 pandemic triggered a 25% increase in the prevalence of depression worldwide. Of course, increasing rates of depression have not been lost on researchers and health professionals, who have long suspected that depression may have a genetic component.

Research has found that the risk of depression in the general population is 10%, while the risk in those whose immediate family members have depression is 30%. This risk triples if the family member has had two or more major depressive episodes in their lifetime. Research studying depression in sets of identical twins found that major depression is 40% to 50% likely to be inherited, with severe depression carrying an even higher chance of inheritability.15 The severity of inherited depression can also vary depending on whether the mother or father has depression.16

Scientists searched for and analyzed more than 100 candidate genes to find one responsible for depression but were unsuccessful. However, the theory that depression is a complex illness involving the interaction of many genes and environmental factors proved true. In 2021, a genome-wide associations study (GWAS) analyzing the health records of 1.2 million people found 178 gene variants linked to major depression, a landmark discovery that will aid in identifying at-risk individuals and the most effective medications.

Fact: Depression is a condition that affects millions of people indiscriminately.

The idea that depression is a sign of weakness or failure to adapt is ignorant and diminishes the experience of the millions of people who suffer from it. The shame and stigma of depression have undoubtedly played a role in why such a low percentage of people seek treatment despite its strong prevalence in American society.14 Depression can debilitate the person suffering from it, potentially costing their livelihood, relationships, and even their life.

Those with depression sometimes have difficulty coming to terms with the diagnosis or experience barriers to care. Some reasons for these difficulties and obstacles include the following:

• In men, the belief that a depression diagnosis is emasculating can make them ashamed to admit they have depression and prevent them from seeking care.16
• Some cultures do not acknowledge depression for the same reasons. For example, sub-Saharan immigrants reported being raised to equate mental illness with instability and weakness.16
• Affordability and availability of care can also affect whether or not a person with depression seeks treatment. The potential lack of mental health monitoring in these communities further demonstrates that we still don’t know the full weight of depression on American society, especially in marginalized communities. Rates of depression and suicide from depression could be much higher than we currently estimate.16

Even the rich and famous are susceptible to mental health problems. Celebrities like Dwayne “The Rock” Johnson, Lady Gaga, and Demi Lovato have spoken about their experiences with depression and other mental illnesses, such as bipolar disorder and PTSD. If depression were a sign of weakness and failure to adapt, our history, arts, and sciences would look much different. Historical figures who reportedly suffered from depression include Abraham Lincoln, Sigmund Freud, Ludwig van Beethoven, Vincent van Gogh, and Charles Dickens. Their mental illnesses were not hidden by their talent, fame, and legacy, but they changed the world regardless.

Fact: Anxiety is a diagnosable mental illness.

Anxiety disorders are the most common mental illness in the United States, with 40 million adults experiencing some form each year. The global burden is also high, with 1 in 13 people suffering from anxiety disorder worldwide.18 Anxiety is best described as a state of constant irrational stress and debilitating worry, causing avoidance or fear that interferes with daily life. The symptoms of anxiety disorders vary, depending on which type of anxiety disorder a person has. Shared symptoms between these disorders often include:19

• Elevated heart rate
• Problems focusing
• Sleep problems, such as losing sleep due to stress or worry
• Feeling tightness in the chest
• Fear of dying or not being in control

Much like other mental illnesses, anxiety becomes a diagnosable disorder once two or more symptoms last longer than six months, according to the Diagnostic and Statistical Manual for Mental Health, fifth edition (DSM-5).19 Anxiety can manifest in different ways, and there are many types of anxiety disorders, which include:18

• Post-Traumatic Stress Disorder (PTSD) is brought on by trauma or life-threatening experience. It can occur in anyone at any age and is twice as likely in women than men. Currently, eight million people live with PTSD in the U.S.
• Social Anxiety Disorder can be described as anxiety or fear of rejection or judgment from peers and can lead to avoidance or isolation. Social Anxiety Disorder affects 15 million adults and is the second most common anxiety disorder.
• Panic Disorder is diagnosed when individuals experience frequent or sudden panic attacks that don’t have a clear trigger. 2-3% of adults in the U.S. experience panic disorders, which is more common in women than men.
• Agoraphobia is regarded as the fear of being unable to escape from somewhere. People with agoraphobia fear places where an escape route is unclear, such as a mall, school campus, or large, open places such as a parking lot. This may manifest as being unable to leave your home.
• Phobias are extreme, irrational fears of something. Specific phobia is the most common anxiety disorder. Agoraphobia is a type of phobia, but other phobias include a fear of heights, enclosed spaces, blood, and needles.
• Generalized Anxiety Disorder (GAD) is defined by relentless worry about many things. GAD affects 6.8 million adults in the U.S.
• Obsessive-Compulsive Disorder (OCD) involves intrusive thoughts and ritualistic behavior that the person is compelled to do to lessen their anxiety. In the U.S., OCD affects 1 in 40 adults and 1 in 100 children. OCD was once considered an anxiety disorder, but the DSM-5 reclassified it into its own category.

Research shows that medication and therapy can be highly effective in treating anxiety. The perception that anxiety is a feeling that can be easily squashed or gotten over contributes to the misinformation and stigma surrounding the illness.19 Only a third of people with anxiety disorders receive treatment, and increasing treatment rates means reducing barriers to care. Similar to depression, these barriers to care can be misinformation, affordability, availability of care, and cultural perceptions of anxiety.18

Fact: Therapy can be highly effective, and there are options for affordable care.

Therapy is an effective treatment for many kinds of issues, ranging from short-term life stresses, like a difficult divorce or breakup, to chronic mental illnesses, like bipolar disorder. Since the 1970s, studies have shown that therapy has a 75-80% success rate in treating depression.20 In 2019, responses from the National Health Interview Survey found that 9.5% of people in the United States received therapy for their mental health in the past year; women were more likely to receive treatment than men. It was also found that older adults were less likely to seek therapy than younger adults, but were more likely to choose medication. Conversely, younger adults were less likely to opt for medication and more likely to choose therapy.21

Different types of mental health therapies fall under the terms therapy or psychotherapy. Counseling is a form of therapy with various subtypes and can sometimes be more helpful for specific problems or stressors, such as a death in the family or a career mishap. Counseling tends to focus on a specific issue for a limited time, while other types of therapy often delve deeper with an aim to promote greater exploration of self over a longer period. Your counselor will walk you through the situation by giving advice or coping strategies and try to adjust your perception or behavior. It can be used in conjunction with other forms of therapies, such as:

• Animal-assisted therapy (AAT), in which the patient interacts with animals such as cats, dogs, and horses to relieve stress and anxiety.
• Art therapy encourages self-expression and healing through writing, painting, music, and dance.
• Play therapy, which is directed mostly at children, encourages communication through play.

Therapy creates a profile for your life, and your counselor or therapist could refer you to a medical professional if you may be suffering from a medical, rather than a mental, health problem. Traditional therapy typically lasts between 30 and 50 sessions over several months, either in a private or group session.22

Psychotherapy is a primary process that navigates long-term issues, analyzing past events or illnesses that continue to impact the patient daily. People with chronic mental illnesses such as depression, PTSD, phobias, and anxiety often seek psychotherapy and take medication. You may be in sessions for one or more years, depending on the severity of the problem. Psychotherapists will employ different techniques or specialties, including:23

• Cognitive behavior therapy (CBT) analyzes and seeks to improve or change behavior and thought patterns. CBT is the gold standard for treating depression and anxiety disorders and involves replacing negative thought patterns and behaviors with positive ones.
• Dialectical behavior therapy (DBT) focuses primarily on emotional regulation. It is helpful for people struggling with suicidal ideation, personality disorders, PTSD, and eating disorders. Both CBT and DBT are conducted in either private or group sessions.
• Supportive therapy teaches the patient to be self-reliant by establishing stronger coping mechanisms and building self-esteem. Supportive therapy is useful for patients with anxiety and depression.
• Interpersonal therapy (IPT) is useful in treating depression and navigating specific problems, as it relies on improving your connections with others to heal. IPT is often time-limited to 12-16 weeks.

While federal law requires that health insurance covers most mental health treatments and services, they can still be prohibitively expensive.23 And even if you can afford therapy, wait lists can sometimes span months. Cost and care availability play big roles in whether a person chooses to seek treatment. Unfortunately, it’s often the case that the people who need it the most experience the largest number of barriers. To combat this, teletherapy and telepsychiatry have become popular alternatives to in-person sessions.

Telepsychiatry has been around since 1959 when the Nebraska Psychiatric Institute used videoconferencing to provide group therapy, long-term therapy, and even medical school training.24 The advent of new technologies, such as personal computers, tablets, and smartphones, has propelled telepsychiatry into the modern age. The most important catalyst for telepsychiatry’s popularity, however, was the COVID-19 pandemic. Depression rates increased by 25% worldwide. With lockdowns preventing people from leaving their homes, they turned to online therapy for relief.25

Today, there are many websites offering therapy at a variety of different costs, and some even provide financial assistance. However, it can be challenging to determine which one is right for you. We’ve put together a guide to help you find the best online therapy, with independent resources for marginalized communities like BIPOC and LGBTQ+ populations. No matter who you are or what your situation looks like, therapists are always ready to help you heal.