Tara Thiagarajan is founder and chief scientist of Sapien Labs, a nonprofit organization that runs the Mental Health Million Project and its annual Mental State of the World Report, which uses an online survey to track mental wellbeing among internet-enabled populations around the world.
The 2021 report, just published, was the project’s second annual effort. Authored by Thiagarajan and lead scientist Jennifer Newson, it surveyed more than 233,000 internet users in 34 countries. The overall objective, write the authors, is to “provide an evolving global map of mental wellbeing and enable deep insights into its drivers.”
Its results have considerable implications regarding mental health and the factors that contribute to it.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Amy Biancolli: So, just to hop into the results, Venezuela actually topped out the list of 34 countries for its aggregate score of mental wellbeing. At the bottom were English speaking countries: 30% reported themselves as distressed and struggling. Could you speak to that a bit? What are the contributing factors and ramifications?
Tara Thiagarajan: Well first of all, thank you so much for the opportunity to be here and talk about this. So, when we saw Venezuela at the top of the list, we were extremely surprised, because it’s absolutely not what you would expect, and our first reaction was, “That can’t be right, let’s go back and make sure we analyzed everything correctly.”
Obviously Venezuela has gone through all kinds of challenges, and you would really think that it would be one of the countries closer to the bottom. So this was really the impetus to start looking at all these different global indicators and drivers to say, what could possibly explain this kind of ranking?
I think what really has come out of that is a few key insights. There were a number of different cultural indicators that we looked at that were developed by other groups, such as the Globe Project, there’s the Hofstede project, which looked at cultural indicators of different countries. This is where we really saw the biggest correlations, and obviously, a correlation doesn’t necessarily mean that that’s the absolute cause, but I think in this particular report, our goal was to demonstrate what kind of factors seemed to be related so that it could drive further investigation.
To give you an example, countries higher on individualism and performance orientation tended to have lower mental wellbeing metrics, and conversely, countries which had high in-group and family collectivism tended to have higher mental wellbeing.
One of the goals of this project is to really be able to look at mental wellbeing across the spectrum, from what we call distressed – which would be people who would have profiles of clinical disorders – to thriving. People move along the spectrum, I think, across their lifetimes in different ways. And it seems that culture has a lot to do with where people are on this.
So, the other side we looked at was economic factors. And obviously, when we looked at this list of countries, and where mental wellbeing was highest, it certainly is not a list that is economically ordered from highest – those with the highest economic growth or GDP – to those with the least.
In fact, it was somewhat the other way. So when we looked at the relationship of mental wellbeing to these economic factors and things like GDP, GDP growth, and Gross National Product, what we saw is that there was a negative correlation – maybe not as strong as the cultural factors, but still, a statistically significant negative correlation with mental wellbeing.
The question is really: How does the economic system drive culture? And how does culture end up influencing how people feel?
Biancolli: That really popped out at me. And what I found fascinating was the negative correlation between countries that prioritize individualism and achievement with mental wellbeing.
Thiagarajan: The mechanisms of economic growth hand-in-hand with certain cultural aspects of individualism. I think that’s the way it has evolved in the world today: that economic growth is associated with increased individualism, and this focus on individual performance, and so on.
What we realize is that there is a great human need for belonging to a social fabric, and I think that, as we’ve seen, even with the pandemic and the kind of impact that the pandemic has had, that the social isolation has had a very profound impact on the mental wellbeing of people. It points to this idea that the more we isolate ourselves, the worse we start to feel about a number of factors, and a lot of different aspects of our mental state start to fall apart.
Biancolli: Now, the social self – could you just define that generally, and speak a little bit to the role that it plays?
Thiagarajan: So, the social self is really a dimensional metric that we have compiled from the data that is acquired in the Mental Health Quotient assessment, which aggregates all the different aspects of how individuals see themselves in relation to others and how they are able to relate to other people.
So, just to back up and give you a sense for how this assessment is designed and structured: It captures a large number of mental attributes or aspects, and many of these are derived out of the types of symptoms that form part of the traditional DSM-based disorders. So it really covers and maps to all the 10 major disorders, but also looks at these aspects, not just on the negative side, but on the positive side as well.
Out of 47 elements that are captured, it aggregates a subset of those that relate specifically to how you see yourself and relate to others. So examples of some of the elements that would be in there are your self image, self worth and confidence, your ability to form relationships with others, your emotional resilience and interactions, and factors like that.
Biancolli: The DSM, of course, is closely associated with the framework around mental health, especially in English-speaking countries. It also offers a very mechanistic, biomedical view, and you are using this survey, this MHQ, to really shape a different portrait of the factors involved in mental health. Is that the case? Do you feel like this sends a different message?
Thiagarajan: It’s a different lens, let’s say. It provides a different lens to some of the same things. So I wouldn’t say it’s totally different. It’s certainly overlapping, because we’ve derived it out of all the things that people have considered as something that can go wrong, right? Something that is negative in our lives and those are considered – from a diagnostic perspective and psychiatry – as a symptom.
How do we extend it from just being, “Are you having a serious problem?” to “Where are you on the spectrum? And where do you stand on this larger picture of mental wellbeing, from distressed to thriving” – as opposed to just carving out the negative end of it. So that’s one part. I think the second aspect is that we’ve also brought into play other factors that go beyond, “What are the symptoms in the DSM?” For example, there’s certain elements that were put forth as the research domain criteria (by) the NIMH. There are some other factors from psychology that have been included. The idea was, how do we get the most, you know, well-rounded, 360 view of an individual’s mental makeup?
Biancolli: So you’re using it as a tool?
Thiagarajan: Yeah. So, how do you get the 360-degree view in a short assessment-time window? And it has a lot of flexibility in that, because it derives out of all of these symptoms. The symptoms can map back to diagnostic criteria if you want to do that, but also gives you this ability to look more dimensionally at things. We have different dimensions that we assess – like your mood and outlook overall, the social self drive and motivation, resilience – and these are subsets where some of the elements certainly overlap. But it just gives you a different perspective on what that mental makeup of the person is or mental challenges the person is facing.
To go back to your question on what is the social self, it really is the dimension that seems to have declined most substantially, relative to all others, though followed very closely by mood and outlook. If we think about this from the perspective of different challenges to our social behavior and ability to integrate into the social fabric, it gives us a different way of thinking about solutions as well. And, you know, one of the challenges has been that a lot of the documentation – or the research around this declining mental wellbeing, or the crisis in young people – has focused on just the depression and anxiety symptoms. But it doesn’t give you the sense for what’s really driving it, and what’s really going wrong. So I think the social self really provides a different perspective.
This is an opinion – because it’s really sort of a synthesis, I would say, of the research we have, but certainly would need some more rigorous validation. But it seems to me that what has happened over the last decade – that’s when these changes have started to arise – really has a lot to do with the internet, which has changed the way social interaction takes place.
Compared to 10 years ago, when studies showed that young people had the greatest or highest psychological wellbeing, today what we’re seeing is that each younger generation is successively worse and worse. So it’s not the case that young people are worse off and then as you get older, your mental wellbeing improves. It’s more that when you look at these snapshots, in the past young people were always at the top of psychological well being, and now they’re way at the bottom. I think there are two factors that really are driving this. One is that, you know, with the advent of the Internet and Smartphones in everybody’s hands, what we’re seeing now is people are spending 7 to 10 hours a day online. And when you do that, you don’t have time left really to do other things that really enable the social self. And so we’re not building the social self or developing the social self in young people.
So if we can look at what’s really driving this, or what are the factors that are really compromised in these younger generations now, it’s both the mood and outlook – but even more so, the social self. And if I were to make my best sort of hypothesis about why this is happening, the timing is very much associated with the increase in internet usage and Smartphone usage in the world, because prior to 2010, before the whole Smartphone really came into being in the ubiquitous way it is now, the trend was the opposite – where young people always had the best psychological wellbeing.
The Mental Health Million project essentially surveys only adults 18 and above, but those 18-to-24-year-olds are the first generation that actually grew up on Smartphones and the internet. So there’s a clear potential developmental aspect to all of this.
And by my estimation — and sort of a back-of-the-envelope calculation — if you look at generations that grew up before the internet, when you weren’t spending 7 to 10 hours online, you had a lot of time to go out and hang out with friends and just do silly things. Even for my generation, we always thought of it as, you’re out there just wasting time with your friends, and you’re not doing something productive. But really what we’re realizing is that, first of all, by the time we got to adulthood at 18 years old, if we grew up without the internet: We probably would have spent, by then, at least 10,000 and up to even 25,000-30,000 hours just engaging with other people.
Now, when you’re online 7 to 10 hours a day, it’s probably more like 5,000 — so up to one-fifth of what people probably did prior to the internet, and maybe even lower than that. And if you think about social development, like the capacity for prosocial behavior, it may be an innate capacity of humans in the same way that language is an innate capacity for humans.
But it has to be developed, right? You don’t have language unless you learn it, unless you practice it, and you get greater and greater ease with it as you do more and more and more. In the same way, I think that social behavior — it’s a very complex activity, right? You have to read facial expressions, you are reading body language, there’s tone, you have to understand all of these different social norms, and then you have to learn how to regulate your own response, your emotional response, what you say. And you learn how to resolve conflicts, you learn how to cooperate, you learn how to do lots of things. Some of it might seem like you’re wasting time, but it’s not. You are actually learning a lot of this ability to really integrate and relate to others.
Obviously, the second aspect is, then, what you do online — and I think what you’re doing online is creating this very distorted perception of your social reality. And that obviously has ramifications, I think. Lots of people have studied the impact to body image of people seeing these filtered faces, or photoshopped faces, on social media and so on. The virtual environment is more asynchronous. So it doesn’t give you the opportunity for that kind of social development and the kind of embedding in social fabric. And I think what we’re seeing is the consequences of that. But we’re not able to cope with that social environment in the same way.
Biancolli: I was born in ’63, so I grew up long before the advent of the Internet. Yes, you’d hang out in person with friends, and sometimes you would find yourself spending time with people you didn’t particularly like. But you’d learn how to navigate that. And you’d also learn how to be bored. I’ve often wondered whether that could be one of the downsides of the Internet age that we’re – that, as a rule, we don’t know what to do when we’re not online. And maybe that’s part of what we need to relearn or learn how to navigate.
Thiagarajan: Yeah, I mean, I think that’s the thing, right? If you grow up on the internet — or the more time you’re spending with that – then I guess it takes time to reorient and say, “Well, I could do all of these other things, too.” Because what comes to your mind is what you’ve been familiar with and are doing every day.
There are two challenges. One is that, how do you create a balance in the world – like, to be able to provide and facilitate the ability to develop the social self – but also get the benefits of the internet?
Then the other factor is that social media, and all of this, happened so fast. And unlike our integration into the physical social world, where there’s so much instruction around it – you know, “Look your aunt in the eye when you say hello to her,” “Sit like this at the table,” “Don’t say that to someone,” “That’s not a nice thing to say,” “Apologize to your brother” – nobody tells anybody what to do online, right?
There’s no guidance for young people coming in online. And so the environment has become, in lots of parts of the internet and social media, very negative. And part of it is that perhaps we have to say, okay, first of all, we have to develop our in-person social skills and environment – because that’s fundamentally and profoundly important for the human psyche. But we also have this new medium, which offers a lot of great things, but we need to have some kind of guardrails and instruction for children on how to navigate. So that when you get on, it’s not a free-for-all – kids who grow up with no one telling them ever what to do or how to behave.
Biancolli: That’s interesting – the lack of a finger-wagging aunty saying, “Don’t do that. That’s mean. That’s mean. Don’t do that.”
Thiagarajan: Exactly. “That’s mean, do you know there’s a person at the other end of it? How would they feel?” And you know, there is none of that. Nobody is instructed before they are let loose in these environments.
Biancolli: So, the data: You spoke a little bit at the beginning about being really surprised by the link between higher income countries and lower wellbeing. But if you could just expand on that, were there any particular ramifications, takeaways, insights that really startled you a little bit?
Thiagarajan: Well, I think it is startling when you think that there’s probably a balance between material prosperity and some of these other, very intangible factors of your social embeddedness, and so on. I guess the surprise, to me, was how much they seem to be in somewhat opposition to each other in the current environment of the world – the current economic state of the world. It’s just that our narrative has always been so contrary to what we’ve always thought: that material prosperity and wellbeing are one and the same. Of course, people have always said money can’t buy happiness. But here, it’s not just happiness that we’re looking at, but the whole host of mental attributes and functioning.
I think the surprising thing is that maybe these are actually much more important – and partly, measuring it in this way starts giving us the opportunity to quantify how much more important, or how important, is this? How important is that? And where’s the balance between two factors? And I think that’s the real power of having large data like this.
Biancolli: I know there are all sorts of other factors. There are also elements such as political instability, environmental toxins. You talked about unemployment, education. To what extent should policy be addressed? Did you have feelings about how policy should change in response to these insights?
Thiagarajan: We’re in just year two of this project, and as we progress, we’re going to have much larger data each year – and the idea is that we would sample at least a million people each year around the world. We should get there in the next couple of years or so. And when you get to large scale, you have the opportunity then to understand how all these various complex factors kind of come into play to impact mental wellbeing.
What is it that humanity is trying to accomplish, right? I mean, we’ve talked for decades now just about economic growth – and GDP has been sort of the North Star for countries. But it’s because there has been this conflation of economic growth and material wealth with the prosperity of human beings.
And when I say “prosperity,” there is only, to me, one metric of prosperity, which is the prosperity of the human mind. Because there is only one arbiter of reality, and that is the human mind. Without that there really is nothing. Ultimately, that’s what serves humanity. It’s not something else that may be at cross purposes to humanity’s prosperity of mind. So from a policy perspective, what really can come out of this data as we move forward is an understanding of what factors and policies – and what elements – are really going to drive that. And therefore, where should we put our efforts from a policy perspective?
Biancolli: Listening to all that you’re saying, I keep thinking this is almost an existential crisis you’re describing. You’re saying this is about the mind. This is about our perception of who we are and how we move through the world, right? Is this a turning point? An existential kind of grappling that we’re going through? How to be well, how to be connected?
Thiagarajan: I believe so. And I think, here’s the thing when you’re talking about a population-wide issue: We’re saying, in terms of mental wellbeing and the decline across generations, we’ve gone from – in people 65 and over – only about 6% to 7% having what you would think of as clinical-level distress to 50%. I mean, this is not trivial.
So what we’re looking at, with this, is a situation where we’re going from maybe 6% of people having challenges to now half the population. And as these younger people become the older generations – that is, if this number stays the same or even gets worse – that half the population has mental health challenges.
When we look at it from the perspective of the MHQ, we’re talking about mental wellbeing on a functional life-impact scale, which means that when we look at these scores, what we’re able to see is that it has a strong relationship basically to functional productivity in life, right? The lower the MHQ scores, the more number of days people are unable to work or function.
And so if half the population is unable to work or function, it’s not a problem any medical system is going to be able to solve – because who’s going to solve it? Like, you need some population to be able to do the work, keep the water running and the electricity on, and all of that, and then treating half of the population.
But that’s from a medical perspective. I think when you think about it more existentially, our ability as human beings to sort of engage with one another – and socially connect with one another – is really what allows us to build and create the world that we’ve created so far. And if we start to see that crumble, what does that mean for civil society, and the ability to come together to actually build the kind of institutions and global cooperation that we would need for our survival?
Biancolli: I mean, even from an evolutionary biological standpoint, we’ve evolved this way because we’re social. One of the things I wanted to ask you about was this quote:
Perhaps it is not material hardship itself that breaks us, but the lack of belonging and being in it together. Even as we must understand these relationships more fully, these data make clear that to nurture the human spirit we need a new paradigm.
The existing paradigm says, “Okay, when we talk about mental health, you over there are disordered. The rest of us don’t have to think about it.” But you used the word “spectrum” before. How we navigate our lives in the world is all on a spectrum of engagement and the spectrum of mental wellbeing. Is that kind of what you’re talking about, and is that the new paradigm?
Thiagarajan: Where we really need to start thinking about new paradigms is: What will serve us? You know, a system where only 10% can thrive is not an effective system – and so I think that’s the paradigm that we need to start thinking about. How do we move toward a system where more people are thriving rather than more and more people falling off this cliff of mental wellbeing, where you are in a zone of negative functioning or inability to function effectively? Which is sort of how our scale is constructed. So when we construct these metrics, those who end up on the negative end are folks who are suffering, are struggling to such a degree, that it’s having a severe impact on their ability to function in the world.
Biancolli: I have to ask: What gives you hope? Moving forward, what are your aims and goals – and is there anything in particular that gives you hope for the future?
Thiagarajan: Human beings have been resilient through history. Human history is full of dark times that have ultimately resolved in some way, and so I think, just from that perspective, we should all have hope in that. But that doesn’t mean necessarily that you sit back and hope that it will just happen by itself. I think all of us have to be active participants in it. And what we hope to provide to enable that journey is this sort of large-data perspective that really allows us to see how we’re changing in real time – and what kind of things are actually driving those changes, and allow that dialogue and debate to happen?
So our data is available to all research, nonprofit, and academic researchers to really look at all these relationships. And I think if we start to think about understanding what’s really the most important driver, and what kind of things will really move the needle the most – and have this as a way of measuring it and tracking – if we are moving the needle, I think that can be really helpful.
Biancolli: Well, thank you. Thank you so much for taking the time to speak with me today. This has been terrific.
Thiagarajan: Thank you so much.