WHEN was growing up, young people didn鈥檛 discuss their mental health. Today, things are very different. There are numerous mental health awareness days, the language of psychiatry has become integrated into the vernacular and, in some countries, schools have become the front line in dealing with the mental health issues of young people.
Even so, Foulkes doesn鈥檛 believe things have necessarily changed for the better. As a psychologist at the University of Oxford, she argues that this societal push to talk about our mental health might not be helping everyone. In fact, it could be making things worse. She talks to New Scientist about how 鈥渃oncept creep鈥� and 鈥渢herapy speak鈥� are doing people a disservice when it comes to mental health.
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Catherine de Lange: It feels like there is a mental health awareness campaign almost every week. Surely that is a good thing?
Lucy Foulkes: It seems like it is, but I think there are all sorts of reasons why it might not be. These campaigns are often designed for social media, posters, billboards or whatever, so they are necessarily very shallow when, actually, mental health is an incredibly complex topic. They tell people to go and get help, and the help often isn鈥檛 there. A lot of campaigns are encouraging people to talk and not enough are teaching people to listen.
The big thing that I鈥檓 really interested in is whether they encourage people to interpret essentially all negative thoughts and feelings as symptomatic of a disorder or a problem. That has big consequences in terms of making people feel unnecessarily vulnerable and viewing themselves as having a disorder when they don鈥檛. Partly tied up with this, I think when everyone uses this language, it means the people who really do have the most serious mental health problems are even less acknowledged than they were before. The language is being taken away from them.
What sort of language are people using inappropriately?
I saw a TikTok video the other day, and it said: 鈥淚f you鈥檙e wondering if you鈥檝e had trauma, here is the test: are you hurting? If you鈥檙e hurting, then you鈥檙e experiencing trauma.鈥� That is just so far removed from what trauma was originally supposed to mean.
There has been a general trend in the past 10, 20 or 30 years to view our experience through the psychiatric lens. We鈥檙e looking for everything to have a psychological name. But there has also been a more recent discussion about 鈥渢herapy speak鈥� 鈥� that everything is being seen through the lens of language that was once reserved for the therapy room.
[at the University of Melbourne, Australia] talks about concept creep and he argues that, over the past 30 years or so, terms relating to harm 鈥� like 鈥渂ullying鈥�, 鈥渢rauma鈥�, 鈥渕ental illness鈥� 鈥� have become expanded and expanded, so that more and more mild experiences fall under this language. He argues that we are increasingly seeing harm everywhere 鈥� and seeing ourselves as being vulnerable to harm. In some respects that鈥檚 a good thing as plenty of people have been abused and bullied and experienced trauma, and that hasn鈥檛 been recognised. But there鈥檚 a side that is now being misapplied. The end result is that you feel weak and vulnerable in a way that isn鈥檛 useful.
Is therapy speak also having a detrimental effect on society? For example, the actor for using the concept of 鈥減ersonal boundaries鈥� as a way to control someone else鈥檚 behaviour.
I guess it鈥檚 a problem when it鈥檚 used the way Jonah Hill was said to have used it 鈥� under the guise of self-care to manipulate and control someone else in an inappropriate way. You could argue that this whole thing is just neutral 鈥� observe it as a kind of cultural shift. But I think it鈥檚 a problem when it makes everyone feel more vulnerable, because a lot of this language is the language of vulnerability and victimhood and harm.
Surely for some people it is useful to put a label on things?
Definitely. It鈥檚 very validating. It helps you understand yourself. It helps you communicate your distress to other people and it might potentially be a ticket to getting help, particularly in schools. So, in some respects, these labels are very helpful. But in other respects they can make people believe they have a problem that they don鈥檛 really have.
There have been several studies in schools showing that teaching young people about mental health can make them feel worse. They end up reporting more symptoms than people who never had these lessons. I鈥檓 trying to bring together all this research, and also conduct more of this work myself. It鈥檚 actually not a new idea. For a long time, people have mused over how the way you label things can affect how you experience something. This is the concept of the 鈥渟ick role鈥�: how you change once you鈥檝e adopted a diagnosis.
What research are you doing to explore this?
It鈥檚 basically about trying to test the hypothesis that mental health awareness efforts are contributing to the that we鈥檙e seeing. Part of that is theoretical work and bringing together the evidence. Then a new strand that I鈥檓 setting up is trying to see whether you can experimentally manipulate the information you show people or tell them and see whether you can temporarily induce more or less reporting of anxiety, for example. There鈥檚 some evidence you can do that with blood pressure: if you tell people they鈥檙e above average, it affects what they subsequently report. If you can show that鈥檚 happening with mental health in a lab setting, that would be quite a powerful argument that it鈥檚 potentially happening on a bigger scale in society.
You have also been working in schools in the UK. What is the situation there?
In the past, schools didn鈥檛 consider people鈥檚 psychological well-being or mental health, or the impact that education might have on it. But in recent years, there鈥檚 been a shift and school is seen as a place where these things should be spotted and managed. Unfortunately, a lot of this falls on teachers, who aren鈥檛 necessarily trained to do it or want to do it.
I worked on a big mindfulness trial that was about training school teachers to be mindfulness teachers and teaching children either eight or 10 weeks of mindfulness lessons 鈥� and whether that would improve their mental health. . For that and for various other projects, I have spoken to a lot of schools and they鈥檙e desperate for mental health support. They want to know what their role should be. There鈥檚 such a climate of fear around it that they are tending to treat everything as a mental health problem that they can鈥檛 touch, when actually, old-fashioned social support might be really powerful. But I don鈥檛 blame them. I think they鈥檙e in a really difficult position because they鈥檙e receiving all these messages about a mental health crisis, like everyone else.
How might this kind of over-psychiatrising in schools lead to further problems?
Anxiety is a really good example. An increasing number of young people are saying that they don鈥檛 want to do something on the grounds of anxiety. I get a lot of emails from teachers about this 鈥� and the same thing is happening in universities with undergraduate students. Sometimes the most appropriate response is to make an adjustment for that person. They shouldn鈥檛 be asked questions in class or they shouldn鈥檛 have to sit exams in a big hall, for example. But this genuine, useful principle has been blown out of proportion. It seems like in some cases in schools, people are automatically being given an adjustment 鈥� they are told they don鈥檛 need to do something 鈥� with no intention to ever review it.
The trouble is that the worst thing you can do in terms of maintaining anxiety in the long run is allowing people to not do the thing that scares them. Actually, the most useful therapeutic thing is to support them, step by step, to do what they are scared of. If, with support, you gradually do the things that make you anxious, you learn two things. One is that it isn鈥檛 as bad as you thought it would be, and the other is that, even if it is bad, you cope. If you avoid things, you never get the opportunity to discover this so you just remain perpetually anxious.
It sounds like what鈥檚 going on in schools isn鈥檛 working. What should we do differently?
Something needs to change. I don鈥檛 yet know what the answer is. I feel like I鈥檓 at the very beginning of trying to press pause on what鈥檚 happening and understanding what might be going wrong. There鈥檚 so much fear at the moment. No one wants to miss something, so everyone is being treated as a sort of potential risk. There鈥檚 also a kind of risk of liability on the individual teacher and on the school. So I think there needs to be better understanding of who are the young people who really do need one-to-one support and who can be supported just by teachers being helpful, trusted adults. But both of those things cost money and might involve training.
The reason teachers are often in such a bind is that there鈥檚 a big chunk of children who aren鈥檛 unwell enough for a referral to [Child and Adolescent Mental 91色情片 Services, provided by the National 91色情片 Service (NHS)] but that do need more help than teachers have been trained to offer. There are various initiatives trying to tackle that 鈥� including something called that are being set up in schools in England [in conjunction with the NHS] 鈥� but they all seem to be doing something slightly different. They are currently being rolled out across the country. But it鈥檚 early days and we鈥檝e not yet got data on how much they鈥檙e improving things.
I鈥檝e heard you jokingly compare some of your views to those of the controversial commentator Piers Morgan. How have people responded to your work?
I disagree with Piers鈥檚 approach 鈥� I鈥檓 definitely not calling all young people snowflakes. I think multiple things can be true at once, so I think talking about mental health is really good for some people and possibly problematic for others. I also always try to take the approach that this isn鈥檛 young people鈥檚 fault.
I鈥檝e generally had a lot of support, a lot of people saying they agree but they didn鈥檛 want to say this themselves. So I think there is an appetite for this argument to be made 鈥� just not many people actually want to be the one that鈥檚 making it.
Catherine de Lange is magazine editor at New Scientist
