Not Everyone Needs to Go to Therapy

Everyone should be in therapy.

This phrase becoming embedded in our lexicon is a mark of how much American culture has shifted.

The destigmatization of mental-health problems—and the normalization that many people do struggle with severe mental illnesses—has been one of the great cultural transformations of the 21st century. And with this shift have come concerns about unintended consequences.

After all, what if therapy is less like exercise—something everyone should do to be healthy—and more like prescription medication—something you should only really use if you need it? On today’s episode of Good on Paper, I’m joined by Dr. Lucy Foulkes, a researcher at the University of Oxford who has become increasingly concerned that raising awareness is not unambiguously good. Rather, she worries, it could encourage people to pathologize mild forms of distress.

Foulkes’s questions about inadvertent harms are focused on untailored mental-health awareness campaigns, particularly ones targeted to school-age children and by schools themselves, a practice that has become commonplace in the U.K.

“How on earth do we ask this question without undermining, firstly, the people who are most unwell, who are still not getting help, but also the people who might not have a mental disorder, but they have distress and difficulty that needs to be taken seriously?” Foulkes asked. “But I think, actually, the more we allow the conversation publicly to proliferate and go unchecked, a risk of all of that is this en masse skepticism that you’re now seeing towards almost anyone who stands up and says, I have a mental-health problem.”

Listen to the conversation here:

Subscribe here: Apple Podcasts | Spotify | YouTube | Overcast | Pocket Casts

The following is a transcript of the episode:

[Music]

Jerusalem Demsas: Just go to therapy. It’s the kind of thing that’s become very common to say, regardless of the circumstances. For many, therapy—or mental-health treatment—has become less like health care and more like exercise or eating healthy foods: prescribed to everyone broadly, regardless of their individual circumstances.

In my opinion, destigmatizing mental illnesses and making people comfortable with asking for help is one of the great cultural innovations of the 21st century.

But there have been increasing worries that this cultural shift and the policy and behavioral changes that have accompanied it, particularly in schools, are having some unintended consequences.

In a provocatively titled psychology article, our guest today, Dr. Lucy Foulkes, asked the academic community, “Are mental health awareness efforts contributing to the rise in reported mental health problems?”

She and her co-author theorize that mental-health awareness efforts are leading to more accurate reporting of often-ignored mental-health issues but also that awareness efforts are “leading some individuals to interpret and report milder forms of distress as mental-health problems.”

This is Good on Paper. It’s a policy show that questions what we really know about popular narratives. I’m your host, Jerusalem Demsas. And today’s show is about whether the effort to destigmatize mental health and encourage people to get therapy when they need it has not been tailored enough. Not everyone needs to be in therapy. For some people it may even be harmful.

[Music]

Lucy Foulkes is a really thoughtful guest, and I wanted to have her on the show because, unlike many people in this space, she doesn’t see this issue as black and white but rather as a variety of tradeoffs we need to weigh against one another.

Questioning the growing orthodoxy that therapy is always good or asking if frequent discussions of mental health may have some serious drawbacks doesn’t mean dismissing mental illness as a serious concern. But it does open us up to many difficult questions—ones I explore with Lucy in today’s episode.

Demsas: Dr. Lucy Foulkes, welcome to the show.

Lucy Foulkes: Hi. Thanks for having me.

Demsas: I want to start with a paper you published last year that I feel like set off a real firestorm, and it was called, “Are Mental Health Awareness Efforts Contributing to the Rise in Reported Mental Health Problems?” Tell me about this paper. Why was it so controversial?

Foulkes: Well, I’ve been interested for a long time in the possibility that some really well-intended efforts to get people to talk more about mental-health problems—and to label them and to seek help for them—might have had some unintended consequences. And that paper was the culmination at that point of my thinking about it, along with my colleague Jack Andrews.

And really in that paper, we posed it as a question that needs to be investigated and tested and explored. And the question was: Is it the case that the more we encourage people to think and notice and talk about mental health, the more they end up reporting mental-health