Transcriber: Jude Armstrong
Reviewer: Robert Tucker Who here has heard about
the mental health crisis? Yes, everyone. We all either are or know someone who is struggling
with significant psychological distress which negatively impacts our lives. But the actual problem is that we’ve generated
no real solutions to addressing it. This is not to say that no solutions
are being proposed. In December, Mayor Eric Adams,
concerned about crime in New York City, announced that members of the New York
police and fire departments would be permitted to take
unhoused individuals to psychiatric inpatient hospitals
against their will. Financial judgments
against pharmaceutical companies have been pledged
to address the opioid epidemic. But solutions like these. although I honestly believe
that they are well intended, and they come from a place
of genuine desire to help other people, are pretty poorly informed
and lacking in substance. The reason is that we've
failed to understand why so many of us are
struggling with mental illness. That's where I come in. I'm a licensed clinical psychologist who has treated clients
in diverse settings nationwide. And the things that I've learned
behind my closed therapy office door are things that we all
need to better understand if we're going to see the systemic failure to promote the psychological
well-being of our fellow humans. Today, I'm going to pull back the curtain, so that you can see these systemic causes and become agents of change. These are extremely
complicated problems to solve, and there is no one therapeutic strategy
that works for everyone. I'm here, today, to shine a light
on an often unacknowledged aspect that contributes
to our psychological distress. We don't have all of the answers, and there is significant resistance to acknowledging
all of these different factors that contribute to this problem. What you can do, though, is you can internalize
what I'm telling you today. You can reflect on the ways
in which these ideas impact your day-to-day feelings,
thoughts, and behaviors. And you can talk about these things
with everyone you know, so that we can change the conversations
that we are having about mental health. The most common explanation
well-meaning people give about why so many people
struggle with mental illness is that it's a combination of genes
or biological factors and stressors. Now, it's not inaccurate to say that genes and stressors
result in psychological distress, but it is an incomplete explanation, meaning that we will fail to really generate
good, adequate solutions to address the mental health crisis. So, what’s missing
in our conceptualization? Well, here’s the answer. It’s ... it’s not simple, but it’s short, at least for this context. The simple, or the short, answer is that we have built our society
around three core beliefs that, when taken to their extreme, are a recipe for psychological distress. These factors are: the myth of the self-made man, the celebration of independence, and the demonization of emotions. So, why are these so problematic? The myth of the self-made man
became prominent in the 1800s in the stories by Horatio Alger, in which a young man - it was always a man- was born into less
than ideal circumstances, then pulled himself up by his bootstraps
to achieve socioeconomic success. This sounds like
the American dream, right? Work hard, and you’ll succeed. The problem is that it is
the exception and not the rule that hard work leads
to socioeconomic mobility, which is our current
societal definition of worth. So, if it were that simple, would it make the news
whenever someone was discovered who pulled themselves up
by their bootstraps out of impoverished circumstances
to achieve socioeconomic success? Do we make movies about students
studying hard for an exam, and getting a good grade? Why not? Simply because it doesn't
defy the odds for it to happen. Even before we are born, some of us have circumstances
that were created by other people that facilitate success, that facilitate a successful path in life. Now, to be clear, I am not saying that having
a secure start in life guarantees success. But what I am saying is that it is that much harder to learn, or to even be exposed to opportunities to develop our skills,
talents, and interests, if your basic needs aren’t met. It's possible, but it's not probable. And we are telling people that it is an individual failure that they are not successful, and that is not a way
to promote psychological wellness. We are telling people that they are lazy, or they aren't trying hard enough, when really, from day one, they haven't had
the opportunity to achieve what they might have otherwise
had the opportunity to achieve, had their basic needs been met. I've seen this endlessly discounted
over the course of my career, people who, if you knew their life story, you would recognize, had tried over and over again to pull themselves up by their bootstraps, and become self-made humans, only to find that they encountered
endless, insurmountable obstacles. They don't come to me
because they're outraged by the systemic inequities
that created this; they come to me because they have
internalized the belief that it is their fault that they have not been able to achieve whatever it is that they've
been trying to achieve. I can't sit behind my locked
therapy office door and act as if this is some shameful topic,
unable to be brought into the light of day when behind my closed doors, people are actually honest
about their struggles. The myth of the self-made man is a fantasy, and until we acknowledge that, we are not going to be able
to find any viable solutions to address the mental health crisis. Even the process by which
we treat mental illness is an example of this problem in action. In order to get treatment, you need to have
both resources and providers. Assuming you can get these things, you are then instructed
to take medication, and/or go to see a therapist, and figure out ways to cope with
whatever's going on in your life. The problem is that
this leads to this idea that psychological wellness
is under your individual control, meaning that if you work hard enough,
you'll be able to fix it. But this isn't possible because our society is constructed
in a way that makes that impossible to do. This is a nice segue
into the celebration of independence, which is related to this idea
of pulling yourself up by your bootstraps. How often do you hear about
how important it is to be independent, and to not rely on others
for your happiness? This type of messaging creates
so much shame and despair for the vast majority of us who desperately want to have emotional closeness
and connection with people. This comes up all the time
in couples therapy, which is one of my areas of expertise. One or both partners comes to my office, and they tell me that they don’t want the other person
to be dependent or codependent on them. This is when I introduced
the idea of interdependence, which is a reliance on another person in ways that both people find to be
empowering and supportive, but which doesn't require
either person to lose their authenticity, or behave in ways that violate
their deeply held values, in order to maintain the relationship. Forming these types of connections, and valuing these types of connections, is a path to psychological wellness. How do I know this? Because having a strong
social support system is a protective factor for suicide, and it protects against
the exacerbation of severe mental illness. Having robust social networks contributes
to our longevity and to our happiness. Couples therapy is
an evidence-based intervention that is indicated for some women
who are struggling with depression. So, we can't revere independence and also claim that we want to find
solutions to the mental health crisis when some of those solutions point directly to the importance
of closeness and connection. We can't have it both ways. This brings the last factor
out of the shadows: the demonization of emotions. I cannot tell you how often
people tell me how logical they are. Like it's some kind of virtue. This is not to say there's not
a time and a place for logic, but failing to understand how imperative both emotions and logic
are to our survival is another recipe
for psychological distress. It also leads many people to feel shame
when they even experience emotions because they feel like they shouldn’t. They feel they shouldn’t
have any emotional reaction at all. So, here's how this fits
into today's general theme. We've constructed a society in which we've conferred
huge advantages to some, and left others without
even their basic needs met. We encourage people to be
independent islands who rely on no one, and we expect people to go through life
without feeling emotion, even though I think we can all agree
that this life is really very stressful. And when people do dare
to experience emotion, they are instructed to regulate them. So, people have what is
a very reasonable emotional reaction to something that happens, and they experience shame and loneliness because they feel they're
burdening the people around them if they dare to share it, and they think they shouldn't be having
an emotional reaction anyway. These are some of the more subtle ways
in which these ideas show up in our lives. I want you to think about how deeply you have
internalized these as truths, rather than as simply societal constructs that we've created to establish our socioeconomic hierarchy. Recognize that these factors are factors in how we’ve
constructed our healthcare system, our education system. They impact how we approach
our romantic relationships, parenting, friendships, and the expectations, or lack thereof,
that we have for community. They are everywhere,
and they are harming us. You may have been surprised - well, I don’t think you were surprised - when I mentioned that these factors contributed to the construction
of our healthcare and education systems. But what may have surprised you was
when I mentioned romantic relationships, because you may not realize just how deeply you have
internalized these values, and how they show up in your life. A romantic relationship,
or a primary partnership, is one of the only
acceptable ways in our society to not be independent. In fact, we are permitted
to rely on a romantic partner, sort of, and in very specific ways, like making sure
the household runs smoothly. But how often have you found yourself
asking yourself something like: If I snap my person,
will they think I’m too needy? Am I being the dreaded codependent? Am I expecting too much time
with my partner, or expecting too much
communication about emotion? Think about what happens
when you first meet a potential partner, and the types of topics
that you talk about. When we first meet someone, we think we're supposed
to hang out with them, and engage in enjoyable activities. But we are not supposed
to talk about controversial topics like finances, religion, or politics. Why? Because these topics elicit emotion, and we are socialized to believe that it is unacceptable to talk about things that people may feel
uncomfortable emotions about. I directly challenge this by saying that in order to have emotional
closeness and connection, we need to have conversations
about challenging topics. So, you can see from this example, just how subtly and pervasively these ideas have kind of, like, extended
their little fingers into our lives. Let's wrap up by talking about what needs to happen to address
the mental health crisis. We need to challenge
any surface level solutions, and we need to insist
that our elected officials listen to experts so that they can truly change
these dysfunctional, constructed systems. Unfortunately, as I've discovered
in my own political activism, people in power are socialized
with these same values. And so they have likely internalized this belief that the individuals
should help themselves. So, they question: "Why do we need policy change?" They've also benefited from these systems, and they are loathe to disrupt systems
that are working for them. This is the ultimate irony. Appropriately constructed systems
are possible to achieve if policymakers facilitate
individuals being able to help themselves. So, again, we can see
that change is necessary. And change is possible if we recognize all
of these insidious ways in which these factors
and ideas and values have permeated our lives. One thing we know from acceptance
and commitment therapy, or ACT, is that we often lose sight
of our deeply held values, and we engage in strategies
of emotional avoidance, even when experiencing emotional distress
would be in the service of these values. But when you're clear about your values, and you stop prioritizing
not feeling badly, it turns out that the behaviors and actions that are consistent
with your overarching values become pretty clear. The same is true for reconstructing
our harmful systems. We know that our systems
are built on the systemic inequities that are a natural consequence
of the myth of the self-made man, the celebration of independence, and the demonization of emotions. Recognizing that means that we can
actually reconstruct systems that work to benefit all of us, not just a few. This may seem overwhelming, but we can and should do this because without such efforts, we will continue to spin our wheels and wonder why we have not
adequately addressed People suffer when we do not
acknowledge these flaws, and pledge to address them, as is consistent
with the theme of today's talk. This is not something
that we can do on an individual basis. We must change the conversations
that we are having ... as a society, before we can even hope
to generate adequate solutions to address this problem. That's where you all come in. You can help me to challenge this incomplete understanding
of mental illness, by talking about these ideas
with everyone you know. This is it. We must acknowledge what we have built, in order to move forward and make the necessary changes
to protect each other. Thank you. (Applause)
