I would guess my journey with therapy looks similar to many other middle-ish class women who’ve been able to access and afford healthcare as an adult. It’s been bumpy and inconsistent and paved with a lot of lines like “...but I don’t, like, need therapy.” I first started therapy in early 2016 then took a break just before the presidential election. (Good timing, me.) I began antidepressants in 2018 and went back to therapy at the beginning of 2019. My depression, of course, did not take a break in 2017. It didn’t begin the same time I decided to start therapy. It didn’t subside entirely when I took my first dose of Lexapro. The thing that changed the most during my own mental health journey over the decade was how I thought about treatment. And I'm not alone. In the cultural discussion around therapy, awareness is perhaps one of the areas in which we've made the biggest strides in the last 10 years.
According to the World Health Organization (WHO), one in four people will experience a mental health disorder in any given year globally. By 2020, according to the WHO, depressive disorders are expected to be the second leading cause of disease and disability; the leading cause is heart disease. However, heart health carries much less of a social stigma than mental health.
Per the National Alliance on Mental Illness (NAMI), just 43% of people experiencing any form of mental illness will get treatment in any given year. Additionally, NAMI reports that, on average, there is a delay between onset of symptoms and treatment of 11 years. In other words, a majority of people experiencing mental illness will not get treatment and, even if they do, it will often take more than a decade for them to get the help they need.
If we are what we search, the consistent uptick in searches for “mental health” over the past decade, per Google Trends, shows that we are talking more about mental health. It’s worth noting that in recent years, searches for “mental health” spiked in January 2017, February 2018, and October 2018 — when Donald Trump’s presidential inauguration, the shooting at Marjory Stoneman Douglas High School, and Brett Kavanaugh’s Supreme Court confirmation each took place respectively.
Researchers believe there is a link between our political climate, news exhaustion, and mental health, one that has been dubbed “headline stress disorder.” This is perhaps no surprise to those whose identities have always been politicized, whose existence has been disproportionately governed, legislated, and policed. In the same way the 2016 presidential election felt like an awakening in certain communities — those communities likely being whiter and wealthier —it felt like an inevitable reckoning among those who have never had the option to “opt out” of politics. The 2010s were the same decade that birthed the #BlackLivesMatter movement, saw the U.S. Supreme Court’s ruling on marriage equality, and gave rise to the #MeToo movement. (While the latter was originally founded in 2006, the #BlackLivesMatter movement was founded in 2013 and the U.S. didn’t rule same-sex marriage bans unconstitutional until 2015.)
Perhaps the decade made us more comfortable with therapy because it was necessary in order to get through it. When confronted with things like gun violence, global warming, misogyny, sexual abuse, biogtry, racism, and transphobia everywhere from our communities to the highest office in the country in seemingly rampant succession, how could we not talk about how it impacted us?
Making Light From Darkness
Whether art imitates life or vice versa, the 2010s weren’t the first decade in which TV shows depicted therapy. (I’d be remiss to ignore psychiatrist Dr. Frasier Crane’s reign over the 90s.) But there was a notable shift from the Hoarders and My Strange Addictions of the late ‘00s/early ‘10s to the most popular shows that discuss mental health today. (While My Strange Addiction aired its last episode on TLC in 2015, Hoarders spin-offs including Hoarders: Where Are They Now? and Hoarders: Overload have released new episodes as recently as 2019.) We are unfortunately not entirely rid of media that makes light of therapy, sensationalized mental illness, or treats mental health as a spectator sport, but we are certainly more critical of its depiction as a whole.
Take, for example, Netflix’s 13 Reasons Why based off the best-selling YA novel. Casual viewers and mental health professionals alike were critical of the 2017 show’s choice to show its main character’s suicide with some studies linking the show to an increase in suicide among teens. The critique prompted campaigns like #ZeroReasonsWhy, a mental health awareness organization driven by teens in the greater Kansas City area. Even if you didn’t watch the series, it was hard to ignore the growing conversation surrounding it.
In the past decade, there seems to have been an increase in television depictions of therapy, treating mental health with both weight and levity, addressing it as something that is simply a part of many people’s lives. “The common belief about who goes to therapy has changed in the past 10 years,” Dr. Marsha D. Brown, licensed psychologist, tells Bustle. Dr. Brown mentions the Freudian image of a person lying down on a couch, therapist sitting cross-legged with a clipboard in a chair next to them, and how it is no longer relevant. It is not the sort of therapy people experience or the picture they want to see.
Shows like Crazy Ex-Girlfriend and Bojack Horseman have made light from darkness, showing therapy and mental health in a more realistic way despite their fantastical, fictional settings. You’re The Worst and This Is Us gave us more a holistic look at depression and anxiety. Hollywood is giving us better depictions of therapy and mental health because audiences expect it.
Social media’s continued growth throughout the 2010s played no small part in our cultural conversation on therapy. From trending hashtags like #ItsOkNotToBeOk to Twitter bots dedicated to self-care, we felt compelled to check in on each other. In late Nov. 2019, writer Caroline Moss asked Twitter the best thing they learned in therapy as a means of giving users “free therapy,” as reported by UpWorthy. From messages like “thoughts aren’t facts” to changing negative ideations to positive ones, the common thread was that we could all use a little help understanding our mental health.
Social media has also helped bring a necessary spotlight to problems that have persisted among black and brown people for generations. “I have seen more cultural conversation regarding the negative mental health consequences of discrimination, particularly transphobia and racism,” Dr. Kale Edmiston, assistant professor of Psychiatry, University of Pittsburgh School of Medicine, tells Bustle, noting movements like #BlackLivesMatter. “I hope this results in more mental health resources and better healthcare access for underserved communities.”
Accessibility & Inclusivity
For better or worse or some combination of both, technology and our mental health are becoming inextricable from one another. A 2018 survey on mental health from the National Council for Behavioral Health found that 42% of Americans cite cost and lack of insurance coverage as issues when it comes to accessing mental health care, making them two of the top barriers for accessibility. In many ways, technology has made therapy more accessible for a large population of people. There are therapy podcasts by professionals, like “Where Should We Begin” by renowned psychotherapist Esther Perel, and licensed therapists on YouTube, like Kati Morton, offering free advice sortable by episode title or playlist heading. There are sites like Talkspace and BetterHelp dedicated to helping people get connected to mental health professionals they can afford. There’s the growing prevalence of resources like Therapy for Black Girls, Trans Lifeline, and The Trevor Project, creating dedicated space for the underserved communities Dr. Edminston alluded to.
In 2015, among adults with any mental illness, 48% of white people received mental health services compared to 31% of black and Hispanic people and 22% of Asian people, per a mental health survey from the American Psychiatric Association. In a 2019 article for Vice, writer Rajul Punjabi talked about the cultural barriers black and brown people face when seeking therapy and how mental health stigma affects these communities uniquely. This paired with racial bias still prevalent in medicine and medical research makes it all-too-difficult for many black and brown people to get the mental health services they need.
Dr. Edmiston also credits the visibility of campaigns like #BlackLivesMatter with bringing “the community trauma caused by police violence to the attention of many white Americans.”
“Struggles are shared,” Amy Cirbus, a New York-based Talkspace therapist, tells Bustle, “and as we identify with one another it allows us to speak a common language.” Though the disparity in therapy and mental health access persists, people are finding ways to be heard and, more importantly, people are starting to listen.
The celebrity social media break and the influencer documenting and posting about their emotional health are both mental health-centric phenomena that have come out of the 2010s. Kristen Bell has opened up about her experience with depression and going to therapy. Chrissy Teigen wrote an essay about postpartum depression. Kid Cudi posted to Facebook about seeking treatment for depression and suicidal thoughts. Social media has made celebrities more accessible and, in turn, we expect a level of transparency about who and how they are. Of course, that accessibility and our cultural demand for constant access may feed into those celebrities’ needs for “mental health breaks.” Perhaps that is something the 2020s can address.
The National Council for Behavioral Health’s 2018 survey on mental health found that nearly one in three Americans (31%) report still worrying about others judging them for going to therapy. Celebrities’ transparency with their mental health opens an opportunity for a greater cultural conversation on things like therapy. As clinical mental health therapist Dominique Apollon, M.Ed, LPC, tells Bustle, hearing celebrities talk about mental health “allows people to realize no matter who you are, we are all human at the end of the day.”
Listening Through Language
Representation, in news, entertainment, and ad campaigns, is often an indicator of our cultural temperature on a subject. In 2013, the AP Stylebook expanded their entry on mental illness adding and amending the language used in journalism and academia when discussing mental health. Merriam-Webster added “self-care” to the dictionary in 2018, a small nod to how the word has become integrated in conversations about health and well-being.
A study on newspaper coverage of mental illness in England found measurable differences when it came to how language is used to discuss mental health in reporting. Overall, when looking at articles from 27 newspapers published between 2008 and 2014, researchers found a decrease in articles linking mental illness to dangerousness, using less language like “danger to others” or the suggestion that mental illness is self‐inflicted. However, the study noted an increase in language that portrayed people experiencing mental illness as a “hopeless victim” or otherwise incapable.
In the past decade, mental health has become marketable with self-care becoming a $10 billion industry, per the LA Times. Though, some brands are still flailing between co-opting a movement and showing compassion.
How we talk about mental health — from ad campaigns to news to with each other — matters. This is especially true when so many people are either actively going to therapy or wondering whether they should get help in the first place. The 2018 survey from the National Council for Behavioral Health found that 56% of Americans have sought out mental health services like therapy for either themselves or a loved one. These individuals skew younger, are more likely to have lower income and a military background. The conversation on mental health doesn’t have some hypothetical audience. It includes people of every age, race, gender, class, and ability.
Where Do We Go From Here?
When I asked a handful of mental health experts how they hoped the conversation surrounding mental health and therapy, in particular, would be improved in the coming decade, there was a resounding chorus: therapy is not only necessary in extreme cases.
Talkspace therapist Cirbus notes that many still think that “therapy is only for serious problems” and what we deem as “serious” likely ties into mental health stigma.
“Therapy is for everyone, whether life is good or not,” Apollon, clinical mental health therapist, tells Bustle. “Everyone can benefit from therapy because it teaches us life tools to better manage our expectations of what we believe life should look like. It allows us to find balance and accept all of the unthinkable challenges that life will throw at us while allowing ourselves to live intuitively.”
Dr. Brown says “changing the belief about what therapy actually is” will be the next big step in our conversation about mental health. It isn’t a one-time cure-all, she says. “It is a mutual process.” It’s gradual and requires work on the part of both parties. Dr. Brown also mentions “awareness, education, and inclusion” will be key parts of changing misconceptions about therapy.
“Mental health as an issue that affects everyone,” Dr. Brown says noting a statistic from the CDC that says more than 50% of people will be diagnosed with a mental illness or mental disorder at some point in their lifetime. Chances are good you or someone you know is affected by mental illness. With that in mind, Dr. Brown notes that it’s something “that everyone should have invested interest in.”
2019 marks the end of the first time I have seen a therapist for a full year. Like our larger discussions on mental health, my own personal conversation still needs perfecting. I still need help with my words, the ones I tell myself and the ones I use to discuss therapy as a whole. But at the very least, we’re talking.
Smith, J. (2019) Relationship barriers examined among millennial-age couples. The Journal of Relationships, http://www.exampleurl.com/study
American Psychiatric Association. (2017) Mental Health Disparities: Diverse Populations. https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts
Cohen Veterans Network and National Council for Behavioral Health (2018) America’s Mental Health 2018. https://www.cohenveteransnetwork.org/AmericasMentalHealth/
Rhydderch, D. et al. (2016) Changes in newspaper coverage of mental illness from 2008 to 2014 in England. Acta Psychiatrica Scandinavica, https://onlinelibrary.wiley.com/doi/full/10.1111/acps.12606
World Health Organization (2001) Mental Health: New Understanding, New Hope. https://www.who.int/whr/2001/media_centre/press_release/en/
Dominique Apollon, M.Ed, LPC, Clinical mental health therapist
Dr. Marsha D. Brown, PH.D., P.A. Licensed Psychologist
Amy Cirbus, New York-based Talkspace therapist