Saving Lives or Cementing Stigma? A Review of “Just Like You…”

I’ve been Mad in America’s Family Resources Editor for more than three years now, but except for a brief mention in my bio, I haven’t shared much about my lived experience with psychiatry. I wanted to maintain a proper journalistic distance from the content I manage and focus on amplifying others’ voices. But I have a story, too, so that’s about to change.

This blog will be the first in a regular series of “Editor’s Corner” columns for the Family Resources page, in which I’ll write about relevant trends from my perspective not just as a journalist but also as a mental health consumer/survivor/ex-patient. I hope they will stimulate discussion and, where appropriate, spur organizing around shared experiences and goals.

Here, I take a look at a new short film in the growing “mental health awareness” genre from my perspective as someone who’s experienced the very “disorders” it portrays.

Just Like Me?

I receive a fair number of press releases about new research, books, and multimedia initiatives designed to address the perceived youth mental health crisis.  These efforts are designed to encourage kids to normalize talking about emotional distress, help them feel less alone, urge help-seeking, and above all “end the stigma!” One from a few weeks ago piqued my interest:

 “In ‘Just Like You: Anxiety and Depression,’ 10 brave kids, 2 Emmy-award-winning journalists, 1 determined parent and 1 clinical psychologist at Columbia University take on the fear and stigma plaguing the mental health community by immersing us in life with an anxiety disorder and depression in a way that leaves us enlightened, empowered and equipped to … support people living with an anxiety disorder and depression and prevent death by suicide….”

I was interested in screening JLY because, well, I’ve lived it. In my junior year of high school in 1975, I entered psychotherapy for what would now be labeled panic disorder and generalized anxiety disorder. Despite often paralyzing emotional pain and scary symptoms, I pretty much hid my struggles except for telling my few friends  that I was “seeing a shrink.” Then, in my sophomore year of college, the end of my first romance and a transfer to a new school flipped me back into panic mode, accompanied by inconsolable sadness and insomnia diagnosed as “reactive depression.”

I got better, though. And though I’ve had a few of what some would call relapses, I’ve never let them define me (despite the best efforts of some prescription-pad-wielding psychiatrists). So I hoped the film would characterize the experience accurately and provide wisdom I and those around me could have benefited from along the way. However, after screening it I fear that despite its good intentions, it may stoke the very stigma it seeks to stop.

Grand Goals

Just Like You: Anxiety and Depression (now available for rent or purchase on iTunes) is the latest and longest in the Just Like You series of short educational videos, an anti-bullying effort started by a Kansas documentary filmmaker for an audience of youth, their families, and teachers, among others. They feature portraits of real kids with various differences and disabilities such as autism, diabetes, Down Syndrome, food allergies, and more. The videos follow a template in which the youth, their best friends, and some of the caring adults in their lives take turns explaining their condition, what it’s like to live with it, and how others can best support them. The take-home: We have challenges others might not, but we are more similar to than different from our peers.

But the feature-length JLY:A&D has a grander goal behind its didactic mission: to “save lives.”  Less documentary than info-mercial, the tightly scripted film is built around specific messages delivered in phrases recited and reiterated by endearing kids and relatable adults with lived experience of anxiety and depression.

What are those messages? The usual outdated, pathologizing myths from the APA/NAMI playbook, dressed up in new, kid-friendly metaphors with a few welcome nods to more humanistic and holistic concepts such as peer support and self-care.  Let’s take a look.

Stigma and Suicide

The first message is as grim as it is familiar: Anxiety and depression among youth are at crisis level, leading kids (and adults) to suffer in silence and even die by suicide. But stigma, it’s said, prevents them from getting help. Families and peers thus have a responsibility to “know better” so they can “do better,” say the parents of Pierson, a 15-year-old mental health activist who died by suicide. We then meet those “10 brave kids” from Kansas—Morgan, Allie, Jana, Roshaun, and Dylan and each of their best friends or close family members—learning a bit about their different talents and passions. We also meet the two adult journalists (Fox network broadcasters Abby Eden and Ryan LeFebvre). All of them have one thing in common:  “I live with depression and an anxiety disorder.” “So do I.” “Me, too.”

Here and throughout the film, they tell us what their suffering feels like, from spiraling worries to inconsolable tears, and the pressure to remain stoic and silent, along with the desperation that sometimes leads to hospitalization or a plan for self-harm. Their stories, and later medical information, are sometimes illustrated with cartoons and offset by the stories of those who love them but sometimes labor to understand their moods. I strongly identified when, about halfway through, Ryan recalls, “So many times, I wanted to sleep, but my anxious mind wouldn’t let me. And I wanted to do something, but my depressed mind wouldn’t let me.”

Pushing the Medical Model

Ryan also delivers the second and overarching message, repeated multiple times from many mouths: “Anxiety and depression are real medical conditions….” And so begins the promotion of the biological model of “mental illness,” which research has shown actually increases stigma. The medical myth is further muddied by a novel analogy I’d never heard before. According to JLY, anxiety disorders and depression are not exactly “chemical imbalances” but malfunctions in how our body reacts to emotions, “no different from being attacked by a virus or an allergen.”

The film’s chipper Columbia psychologist, Dr. Ali Mattu, explains that the “right,” or “normal” amounts of fear and sadness are natural reflexes, reactions to stress akin to coughing or hunger pangs. But “too much” fear or sadness constitutes a disorder that can harm us, he claims. “Just like asthma or flu,” says Abby, they can become “extremely severe, even life-threatening.” In this telling, emotional distress is not only a problem innate to the individual, but also somehow an outside invader like a virus.

Fatalism and Helplessness

Worse, we’re told the prognosis is poor. JLY’s third message is that anxiety and depression aren’t just a dangerous “real medical condition” but an incurable one. These kids and adults tell us that not only can’t they “just get over it,” but are also helpless to control it. Ryan recommends “surrendering” to this fact and recognizing that “we need other people to help us.” After this fatalistic take, we learn we’re not to blame them nor make a big deal of it. (Jana: “It’s not my fault, just like it’s not my fault if my stomach growls.” Dylan: “It’s just how my body works.”)  Dr. Mattu explains that this horrible disease can be managed with cognitive behavioral therapy, medication (likened inaccurately to an asthma rescue inhaler), and self-care including diet and exercise.

You Can (Must) Help

This leads to the fourth message, which may be the best aspect of the film: Peer support really helps. The emphasis is on what friends can—and, it’s implied, have a duty to—do on a daily basis to engage and support their fellow youth.

To its credit, the film emphasizes that talking about suicide won’t make it happen and shows through often touching scenes how, say, songwriter Allie’s best friend, Michael, has learned how to read when she is in the throes and finds ways to just be with her, listening and responding to what she says helps her feel better. At one point, Roshaun (whose champion is big brother Breydon and who uses journaling as an outlet for his struggles) shares his vision for ending mental health stigma. But it sounds like a recipe for healing human pain: “[…Come] together as a community and help people…to feel loved and heard.”

Other recommendations also sound sensible but have risky downsides. For example, teens are encouraged to steer overanxious or depressed friends and family members toward professional help. (We’re reassured that that won’t lead to being locked away or ruin one’s future job prospects, but as MIA has documented, both of these outcomes happen too often.) The film even urges teens to report friends to the authorities if they have a hunch the person might be suicidal. But that can lead to further trauma when one is hauled away in handcuffs.

Besides being paternalistic, taking it upon oneself to monitor others and potentially save their lives is a lot of responsibility to put on youth. I worry that adolescents, who can sometimes be self-absorbed, may want to steer clear of rather than befriend peers portrayed as fragile or “high maintenance.”

Inaccuracies and Omissions

The film ends by reassuring viewers that kids with anxiety and depression are, in the end, “just like you.” This seems to conflict with the medical model of mental illness, which is othering by definition. Mixed messages aside, I’m concerned about the inaccuracies and omissions that reveal the filmmakers’ lack of awareness of recent research and social movements.

For example, the film uses this statistic: “Depression and anxiety disorders are one of the leading factors for death by suicide.” Yet according to the U.S. Department of Health and Human Services, while about 60% of people who died by suicide had a diagnosed “mood disorder,” only 2% of those ever treated for depression will die of suicide. A recent meta-analysis on the link between anxiety disorders and suicide (estimated in one 2010 review to be as high as 70%) found that “anxiety is a statistically significant, yet weak predictor of suicide ideation…and attempts.”  This suggests we need to focus less on someone’s diagnosis and more on what’s going on in their lives—not just if they’re suicidal but if they’re depressed or anxious in the first place.

Take JLY’s Morgan, an equestrian, who couldn’t get out of bed when her favorite horse died. This event prompted her diagnosis. But grief isn’t a pathology. Similarly, Roshaun (whose mother, featured in the film, mistook his meltdowns for misbehavior) tells of being repeatedly called the N-word in school. Racism—a cultural and structural problem—has repeatedly been linked to poor mental health in youth of color and exists outside the individual. So has discrimination against LGBT+ youth of all races. As MIA Science News reported recently, suicide is inherently cultural and political, yet activism around righting social injustices isn’t mentioned as an intervention.

More important, in its desire to “teach” viewers about anxiety and depression as simply as possible, the film’s adherence to standard DSM definitions, explanations, and treatments overlooks newer, empirically validated, and more optimistic approaches to the feelings and behaviors labeled mental illness. These include everything from trauma-informed care (which focuses on adverse childhood experiences such as abuse), the recovery model, and the Power-Threat-Meaning framework to neuroplasticity, Acceptance and Commitment Therapy, and even the Mad Movement. Perhaps that’s too much to ask of a film like this. (Information on all of these ideas can be found in MIA’s Family Resources pages and elsewhere on this site.)

Hope and Empowerment

So what should parents, loved ones, and friends of kids who are struggling with debilitating worry, fear, sadness, and/or hopelessness do? I’d like to offer some alternative messages.

In my experience, episodes of anxiety and depression dwindle in the face of hope and empowerment. Let’s loop back to adolescent Miranda, plagued with insecurity and dread. When I first came into my therapist Marilynn’s office, I was convinced that I was physically ill due to frequent symptoms such as rapid heartbeat, de-realization, sweating, and trembling – and I wanted medication, stat!

Marilynn never told me I was “mentally ill.” She explained that my physical sensations were psychological in origin and not dangerous per se. She eschewed drugs, viewing them as a cop-out from dealing with underlying issues. And she reassured me that if I worked hard to change, I could recover. This framing saw me as anything but helpless against a supposedly permanent disease, helping me envision a future I could look forward to.

And we did that work, getting to the root of my emotional problems, which back then were viewed as primarily environmentally driven and person-specific. She helped me to get in touch with conflicting and often unconscious emotions, identify better ways to cope with my current situation, and understand and undo some toxic family dynamics—of which my admittedly loving family had plenty. “You,” she told 16-year-old me, “are being born.”

If anyone had told me that there was something fundamentally wrong inside of me that could never be healed, only managed—and just might kill me unless I let others steer me from its clutches—it would have tipped me into deeper despair. So I worry that JLY: A&D may do the same for today’s kids and their families. Indeed, research confirms that the disease model of conceptualizing distress not only increases stigma, but also leads to more prescriptions for antidepressants, which science has linked to suicidality in children and youth. This link led the U.S. FDA to include a “black box” warning on the drugs.

So if we want to be a supportive friend, teacher, or parent (rather than a savior), then we need to help the kid that’s hurting to discover the underlying driver(s) of the intense fear and sadness that manifest as a “disorder.” To quote trauma-informed child psychiatrist Dr. Bruce Perry, we want to help them articulate “Not what’s wrong with you; what happened to you?” If, as the film says, fear and sadness help keep us alive, what threats or unfulfilled needs are the anxiety and depression screaming at us to address? No doubt some of these concerns are very real, and global: the climate crisis, the pandemic, and possibly nuclear war.

As for suicidality, former therapist and hotline worker Steve McCrea wrote recently that youth “considering suicide almost always see ending their life as a solution to a problem they are experiencing” because they are often “trapped by the actions of adults who have power over them.” Sometimes we need to hold space for these taboo feelings so we can help them figure out a different solution. Not blame a broken brain.

. . .

Resources

“Rethinking Suicide Prevention: An Interview on Critical Suicide Studies with Jennifer White”

“Jodi Amen: Anxiety, I Am So Done with You!”

“Emotional CPR: Heart-Centered Peer Support”

 

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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