To anyone who wants an up-to-date modern introduction to what mental health/ mental illness really is, and is not, Losing Our Minds is the perfect book. Written by Lucy Foulkes, who herself is a psychologist, she has spent her time doing research mental health issues in adolescence. She also talks about the effects Covid-19 had on mental health, along with one chapter dedicated to adolescent and another dedicated to social media.
In short, Foulkes is asking us to rethink the mental health crisis. More importantly, she asks to reconsider the statistics and news we are given how mental health issues have blown up, when in reality she argues, mental health issues have been blown out of proportion.
There is a lot of useful information in this book, so I had decided to just write out my notes here instead of a review.
- What is it about this generation, about today’s society, we wonder, that could mean we’re suddenly in a collective psychiatric crisis?
- Examine why we seemed to have raised a generation of snowflakes; how today’s youth are less able to handle stress compared to previous generation, the alternate reality that today’s generation are growing up in a more stressed society, and the impact of social media.
- What is mental illness. what causes it and what can we do about it?
- We must also recognise what it isn’t.
- The book is about what’s been happening around me: in the research world and in society at large.
- 1 in 4 adults will experience a mental illness in any given year.
- Derealisaton: when you are present in one place but feel like you’ve never been there before
- The public understanding of mental illness is still limited. There’s still a lot of confusion of what mental illness is, what causes them and what the treatments are.
- Anyone who has mental illness, they need more than just professional help.
- OCD has two parts: intrusive repetitive thoughts (obsession) and ritualistic behaviours or thoughts (compulsion) carried out to try and manage distress caused by obsessions.
- We know mental illness exists, we it’s widespread, but few people really know what any of this means.
- Anxiety: one way people maintain anxiety is avoidance.
- Why adolescence don’t seek help: stigma, negative attitudes towards mental health services and professionals and poor mental health literacy.
Chapter 1: Rising Rates
- Context is always important when understanding mental health symptoms
- Reaserch is based around clinical interviews; considered superior to questionnaires.
- Such research only give an indication of a disorder
- Evidence: no significant changes in rates of mental illness in the time period up to 2007
- Self harm: we do it to avoid pain and keep ourselves safe.
- Why people self harm: they feel overwhelming negative emotions (sadness, guilt, shame) and pain is distracting so helps them shift focus away from distressing thoughts and feelings.
- Many people self harm because it’s painful, because of it’s power to distract.
- People cut themselves to replace overwhelming emotions with definable sensations.
- Other self harm because they feel they deserve to be in pain.
- Those who self harm are intensely distressed, and they need to be noticed; they need support and help.
- Globally, suicide rates have declined, especially in China and India.
- Reasons for drop in suicide rates: economic growth, urbanisation, better standards of living, improved access to medical care and restricted access to certain methods of suicide.
- However, in the West rates are increasing.
- 75% of suicides are men
- Psychological distress in repsonse to temporary stress is normal, and not necessarily an indicator of mental illness.
- Stressful events and socio-economic hardships are for everyone key factors that increase the risk of mental illness.
Chapter 2: On a Continuum
- Psychologists help us understand human experience by separating it into three broad categories: thoughts, feelings and behaviours.
- “Our mood affects the way we think, our thoughts affect the way we think, our actions affect out mood and so on.”
- When extreme patterns become uncontrollable and affect out ability to live the life we want, then we have moved into the realm of what many people might want to call ‘mental illness.’
- Many mental health professionals like psychologists and psychotherapists are not interested in identifying and diagnosing mental illnesses.
- There is no clear boundary for when any depressive symptom has moved from the realm of ‘normal experience’ to become a sure-fire sign of a disorder.
- Psychopathy: a personality disorder defined by a persistent lack of empathy and guilt, a flat emotional experience and manipulative and harmful behaviour toward others.
- Psychosis: loss of contact with reality; (i) delusions (believing things aren’t real) and (ii) hallucinations (experiencing things that aren’t real).
- Schizophrenia: often misunderstood as ‘split personality.’ Split personality can be described as dissociative identity disorder (Did)
- Schizophrenia: will experience either of the two: (i) auditory verbal hallucinations – inner voices, typically negative, and (ii) auditory verbal hallucinations, inner voices that can vary in loudness and frequency.
- Healthy people an also hear inner voices, doesn’t mean they are schizophrenic.
- Delusion: the point at which a belief usefully becomes a delusion is subtle, a matter of degree. Delusion are on a continuum.
- Paranoia: sense that others are talking about you or out to harm you, one of the most common form of delusion.
- No diagnosis for a mental disorder is made based on one symptom alone.
- Anxiety takes two forms: panic and worry.
- Panic is physical side, the physiological way that your body reacts when you are afraid
- Worry is the cognitive process of thinking negative thoughts, typically about the future; it’s the process of holding on to these thoughts, going over and over them.
- Every therapist will tell you that we need some level of anxiety; an entire absence of anxiety will lead us into trouble.
- When panic reaches its extreme state, we get panic attack
- Panic Attack: a person becomes so overwhelmed with physical experience of of anxiety that they start to feel they can’t breathe, which sets off a series of events: they take short quick breaths, and begin to hyperventilate. This results in increased exhalation which causes carbon dioxide to drop causing more symptoms of panic like dizziness, nausea and chest pains.
- Will last up to 20 minutes.
- Is not a mental illness.
- It can be diagnosed as mental illness if the attacks are recurrent, one of them must have been followed by at least a month of worry about the attacks, only then it’s considered a panic disorder.
- Chronicity: how long has this person been worrying for?
- Severity: have the worries been mild or difficulty or overwhelming?
- Disruption: has the worry stopped the person being able to function normally in daily life.
- General Anxiety Disorder (GAD): people experience frequent stream of exaggerated concerns about various difference scenarios.
- (i) You need to have worried ‘excessively’ for more days than not each week, for at least six months, about many different things. (ii) you must find it difficult to control the worry. (iii) you must be showing at least three of the physical symptoms: feeling restless or on edge, being easily fatigued, having difficulty concentrating, irritability, muscle tension, sleep disturbance.
- 9 possible symptoms
- (i) depressed mood most of the day, nearly every day
- (ii) diminished interest or pleasure in all, or almost all, activities more of the day, nearly every day.
- (iii) significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- (iv) insomnia (not sleeping) or hypersomnia (sleeping too much)
- (v) slowing down of thoughts and reduction of physical movements.
- (vi) fatigue, loss of energy every day
- (vii) feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- (viii) diminished ability to think or concentrate, indecisiveness.
- (ix) recurrent thoughts of death suicidal ideation, or suicide attempt.
Chapter 3: Moving Goalposts
- Today, we are labelling too many pshcologocal experiences as disorders, applying the term ‘mental illness’s things that shouldn’t be called illnesses at all.
Social Anxiety Disorder (SAD)
- Characterised by intense, persistent worry or pain related to situations with other people, especially in which the individual will be judged or evaluated in some way.
- Criteria: social situations would almost provoke anxiety; anxiety is put of proportion to the threat; person starts to avoid situations; anxiety must cause significant distress. All of this should last at least six months to be diagnosed as SAD.
- Pattern of uncontrollable binging and purging
- Type of mood disorder in which people cycle through episodes of depression and mania. Mania is a period of elated mood and associated symptoms. Hypomania is the milder version of mania and is often described as Bipolar Disorder II.
- Repeated intrusive memories of an event (like nightmares of flashbacks); a tendency to avoid triggers of the memories; and negative emotions like depression or irritability.
- What sets PTSD apart from other disorder is that there is a specific triggering event: the trauma.
- Hard to defend because there ar Eno crisp boundaries demarcating ordinary stressors from traumatic stressors.
- Includes Indirect Exposure, where on learns about the trauma.
- Symptoms only become a disorder if you experience a lot of them, at an intense level, for a long time. Otherwise they are just negative emotions, thoughts and behaviours.
- As long as someone has experienced symptoms for two weeks, they can be diagnosed as depression.
- Homosexuality was removed as an “disorder” in 1987.
- (i) Lots of people with mental disorders have more than one disorder
- (ii) Different disorders often have similar causes
- (iii) A lot of symptoms appear in more than one disorder
- (iv) Same treatments are effective for many disorders
- Cultural Symdromes- where specific disorders crop up at certain places.
Chapter 4: Biology
- Genes are the individual recipes: they contain instructions for every aspect of how you function.
- Over 99% of our genes is the same across all humans, but in less than 1% of our genes, there are subtle differences.
- Genes affect how quickly and readily electrochemical signals are sent and where they are sent.
- 1000s of Twin Studies have shown that all psychiatric disorders are genetic to some extent.
- The child of a parent with a mental illness remains at heightened risk for that disorder themselves, even when they are adopted.
- Problem is that we know genes are involved, but we can’t figure out which specific gene is responsible for a particular disorder.
- At times, the same gene is responsible for a variety of disorders.
- DNA can account only one’s vulnerability to a disorder, not to the disorder itself.
- In order for the vulnerability to become a disorder, a trigger needs to set it off.
- We can’t do a brain scan or a blood test to diagnose a disorder because we don’t have any biomarkers for most common mental disorders.
Chapter 5: Environment
- Our parents, whether they intend to or not, can have a negative influence on us,
- Subtle parenting habits that can affect us: Rejection; Control; Overprotection; and Lack of Warmth and Affection.
- There is clear evidence that the environment affects your risk of mental illness.
- Children ‘model’ their parents’ behaviours- modelling can be both positive and negative.
- If you have a history of mental illness, you can pass this onto your child in part because of your genes, and in part because of your own psychological tendency of how you parent.
- Physical abuse- any non-accidental injury; includes beating, kicking or anything that causes physical harm
- Sexual abuse- any sexual activity with a child
- Emotional or psychological abuse- giving an inappropriate response to a child’s emotional needs
- Neglect– absence of appropriate caring of a child
- Children who are abused at home are likely to abused at school
- Simply speaking, if something stressful happens to you, either a one-off or as a chronic problem, you have a greater risk of mental illness, self-harm and suicide.
- If you are exposed to stress for a prolonged period of time, you will become immune to it.
- Stressful life events can trigger our mental illness and will affect the way we view ourselves, the world and other people.
- Events that involve Loss can lead to depression or GAD
- Events that involve Humiliation can lead to predicted depression.
- Events that involve Danger or Entrapment can lead to depression or GAD.
- Borderline Personality Disorder can be seen as someone who has a chaotic and mistrustful social behaviour- and usually these people have had a earlier experience of abuse.
- For a mental illness to be activate, we need the predisposition to that particular mental illness and a trigger to set it off. (trigger can be both external or internal).
- Active– includes strategies that include looking for solutions, seeking social support and talking about difficult issues with trusted people.
- Passive– includes mainly avoiding dealing with difficult things, along with rumination, suppressing emotions, self medication.
- You can assess how you are dealing with stress- you can give yourself a “positive appraisal’ or a ‘negative appraisal.’
- If someone is stressed, better to ask “what has happened to you?” instead of “what’s wrong with you?”
- Bottom line: stressful life events affects s the way we think about ourselves, the world, the way we regulate ourselves emotionally, our memory, the way we process new information.
Chapter 6: Adolescence
- If you are even going to develop a mental illness, it will start in your adolescence years.
- 75% of adults reported first experiencing mental illness at the age of 24, and 50% by the age of 14.
- If you make it to the age of 25 without a mental illness, chances are very minimal for a mental illness to develop later on in adult life.
- Adolescence: defined as the period of physical psychological development between childhood and adulthood.
- Average of puberty for boys is 12 and girls is 11.
- Goal of adolescence: develop from vulnerable, dependent child into a mature, independent adult capable of sexual reproduction.
- Pubertal hormones helps the body physically develop as well helping child develop psychologically.
- Physical changes will include eating disorders: Anorexia and Bulimia
- We need to remember that mental illness is not set off in everyone– it can be a trigger for those who have already have had some underlying genetic or environment vulnerability.
- To become independent, an individual must find emotional support beyond the family, find and keep a sexual partner, and develop nuanced social skills.
- Self-concept is very important
- Adolescents start incorporating what other people think about them.
- Social Emotions: emotions that are specifically dependent on other people
- Can develop Paranoia- where someone worries excessively that others are hostile around them.
- Adolescents care about who likes them, whether their actions and tastes and appearance are accepted by their peers, and what their social standing is.
- Adolescents shift towards the night-owl end of the sleep spectrum.
Chapter 7: Social Media
- Excessive digital screen use can lead to depression and anxiety.
- If you want to understand how social media affects adolescents, its important to look into not how many hours they are spending online, but what apps are they spending it on.
- Self-concept: adolescents care about their appearances and so manage their online presence and impression.
- Those who spend a lot of time objectifying themselves only, spend a lot of time in taking selfies and editing them, can fall into anxiety and depression.
- We receive feedback in the form of likes and hearts
- This is problematic because (i) it becomes quantifiable, (ii) it’s public and not getting enough likes or hearts makes people feel unhappy and anxious.
Benefits of Social Media
- The reduction of social isolation for people who are self-harming
- Encouragement of recovery
- The opportunity to disclose or share difficult feelings
- The ability of all of the above to reduce the urge to self-harm
- Validation – people get this from other friends online
- Self-disclosure- allows us to share difficult feelings with friends online
- Prove instrumental support
- Vast majority of those who are bullied online, are also bullied in real life.
- How social media affects a person depends on a lot of things: a person’s personality, their level of self-worth, their social or professional status, the apps they use, how they use them, the people they follow, the feedback they receive on their post, whether they post at all and so on.
Chapter 8: Rethinking the Crisis
- When trying to understand mental illness increase in today’s time, one plausible explanation is that people today are living in more stressful times.
- If a person reacts badly to stress, it is not the fault of the person but of the adults and institutions around them.
- Overparenting can be detrimental to children’s healthy development.
- Helicopter Parenting (always hovering around children) and Lawnmower Parenting (always trying to solve children’s issues for them and paving a smooth way ahead).
- People in distress today are more likely to self harm
- If you have a friend who self-harms, chances are you may also self-harm.
- Studies and research has shown that young people today are indeed living in more stressful times that previous generation.
- Rates of mental illness may be getting worse due to lack access to proper medical care.
- The more people who talk about their mental illness to their doctors, the more it will seem like rates are increasing.
Chapter 9: Language Matters
- We do need to try, in the language we use to maintain the distinction between health and illness.
- Calling everything depression and anxiety serves no one.
- First step is to allow space for the person to respond emotionally to difficult events without labelling it as a disorder.
- Second step is to be more aware of what we are reading online and in the media about mental health.
Chapter 10: Expert Help
- Talk Therapy
- CBT is very popular and commonly used; Idea is to understand how you thoughts affect your behaviour and the way you think- and it’s best to scrutinise these thoughts and eventually you will come to realise how skewed and irrational the thoughts are.
- One of the best CBT method is asking three questions: what’s the worst that could happen what’s the best that could happen, and what’s the most likely thing to happen?
- Short Term Therapy
- Light Touch therapy
- More intense therapy with medication
- Specialist or psychiatrist
- A study was done with a large group pf people, where half of them were given actual antidepressants and the other half were given a placebo drug. First group said they felt better, while most of the people from the second group said they also felt better. So antidepressants may not always be the best treatment for everyone.
- Research has shown that what type of therapy doesn’t really matter, because the outcome for the individual will almost always be the same.
- One thing that helps a person in therapy is the “therapeutic alliance” they have with their therapist.
- Therapists who are flexible, honest, warm and open are more likely to have a decent therapeutic alliance with their clients.
- Therapist who can accurately interpret and reflect feelings back to clients are also likely to help clients
- It’s rare to be fully listened to which is therapy is helpful.
- What is special and rare about a therapist, relative to other relationships, is that they help you figure out what the problem is. They don’t tell you what they think, or what you should think. Instead, they very gently help you work it all out for yourself.
Chapter 11: Helping Each Other and Ourselves
- Active listening is important
- Verbal and Non-Verbal components are equally important.
- Asking someone about their suicidal thoughts is beneficial instead of not asking.
- Asking someone who is feeling suicidal will show you truly value and care for them.
- We store anxiety in our bodies, so it’s a good idea to get exercise done.
- Mental Illness is not just in our minds, it’s also in our bodies.
- Muscle relaxation exercises are extremely beneficial.
- Meditation is also very helpful.
- Sleep is very important.
- Some degree of distress is actually good for us.
- Time teaches recovery is not linear.
- It’s ok and normal to have setbacks.
- Time can change everything and sometimes the best thing you can do is just find a way to hold on.