- Business Insider asked three clinical psychologists to debunk 25 of the most common myths about mental health and therapy.
- They explain that schizophrenia is not having multiple personalities, but experiencing a break with reality, and that obsessive-compulsive disorder is not just about being neat.
- They also talk about therapy, explaining that it's not like having a paid friend — and that it doesn't last forever.
- Visit Business Insider's homepage for more stories.
Following is the transcript of the video.
Laura Goorin: So, the myth that all neat freaks have OCD is a common one. Most people who are clean just actually care about being clean, and that's totally different than having OCD. Also, there are no five stages of loss. It's just a myth.
Narrator: That's Laura Goorin, one of three psychologists we brought into our studios to debunk some of the most common mental-health myths.
Goorin: So, the myth that most people with schizophrenia have multiple personalities, that was a very old way that it was understood, and it's been proven to not be true. So, with schizophrenia, it's not another personality. What it is, though, is a break with reality and a part of ourselves, maybe, for instance, that believes that someone is out to get them. OK, so that's a really common one with schizophrenia. So the myth that all "neat freaks" have OCD is a common one. It seems like it's almost a popular cultural thing that people say to each other, "You have OCD," when somebody is, like, organizing their bag. And, in reality, OCD itself, the illness has different components. And one of the subsets is the keeping things organized and clean. But it has to be at an obsessive level, where people are thinking about it all the time. And so that itself is really uncommon. Most people who are clean just actually care about being clean. And that's totally different than having OCD.
Jillian Stile: Bipolar disorder is not simply mood swings. It's a very high elevation of maybe a positive mood and a very low, negative mood. Everybody has mood swings. But with bipolar disorder, it's not just that. It's severe forms of elevated mood or depressed mood, and they cycle through that. And so sometimes it could be shown as symptoms of, like, a manic episode, might be somebody, like, hypersexuality or not sleeping at all and things like that. It's not simply feeling good. Goorin: This is a common myth, and I hear people throw this one around a lot too. Anxiety itself is thinking, thinking, thinking. And just imagine yourself going into the worry thoughts of "what if." What if, what if this happens, what if that happens. And it's unremitting, and it goes on for hours for some people. Sometimes it's more passing for others. But being stressed out about something, as humans, we're wired to handle stressors, and we've been dealing with an onslaught of stressors since the beginning of time. You know, going to work, taking the subway, coming in contact with other people. You know, that can be stressful. That can be stress-inducing. Unless you have an actual, like, panic attack while you're taking the subway, that would be more of an anxiety reaction, whereas the stress of taking the subway is more stress-based.
Stile: You know, everybody feels anxious, let's say, before a presentation or before an exam. But an anxiety disorder is the extreme form of that where it becomes, you know, it interferes with somebody's daily functioning.
Goorin: This is actually a really important myth. Sadness is an ephemeral reaction to something. It's an emotion and, by definition, lasts a few seconds. It can last, like, 10 minutes, but on average, we have an emotion, it passes, and then we have another emotion. The thing that tends to bring us from sadness to depression is rumination, which means thinking and thinking and thinking about the thing over and over and over again. And that's how we then go from sadness to depression, but it's not an immediate thing. We all have moments of sadness, and we just allow them and let them pass. We tend to be OK. But if we get caught up in getting ruminating and thinking about all the reasons why we're sad, that's when we tend to go into depression. So, to the myth that depression is not a real illness, it is a real illness, and, in fact, it can be incredibly debilitating. In order to classify as having depression, we have to have some kind of a lethargic kind of behavior where we have trouble getting out of bed. I mean, there are different ways of depression, but one of the primary ones has this, what they're called neurovegetative symptoms, like, where we can't sleep, where we can't eat. There's also a kind of depression which is dysthymia, which has an anhedonia component into it, which means less pleasure in things that we used to enjoy, which is another kind of depression. And a lot of people will describe, like, "Oh, I used to love pottery, and now I can't even look at pots." You know? Like, something just totally changes for them when they're deeply in this state of depression.
Neil Altman: Talking about painful things that you've learned how to sort cover over can initially be more painful but in the interest of working out things that if not dealt with straightforwardly are gonna come back to bite them. I'll say another thing about that is that sometimes patients wonder, "What's the therapist gonna feel if I say thus and so?" Like, "Can the therapist handle the level of despair that I sometimes feel?" And on those occasions, when the patient has the strength to put it out there and see how the therapist responds, the fact that the therapist can handle it is a big step toward the patient then being able to handle it. There are reasons, and they may change over time. But I think the thing that I would want to debunk in that respect is the idea that there's a single reason. So that if you handle that, then you're gonna be freed of that. And there's not. In most cases, there's not. You've got to discover the reasons, in the plural, that you're depressed and what you can do something about. And what you can't.
Stile: The myth that only women get depressed couldn't be further from the truth. However, women are twice as likely to experience depression. So, the reason why oftentimes people think women have a higher rate of depression than men is because of maybe hormonal changes, life circumstances, and stress. The other thing that I like to think about is that women might express their feelings in a different way than men do. So, sometimes men might, you know, act out behaviorally, whereas women might focus on their internal experience. And so they might be more likely to see a therapist if that's the case.
Goorin: When people have gone down the road of eventually deciding to go on medications for antidepressants, they don't change your personality; they change the symptoms of depression. They can also work for anxiety. So, typically, if you have just typical symptoms of depression and anxiety, we'll be given an antidepressant is what it's called, an SSRI. And that will help us regulate the symptoms of our, just, up and down of moods. And the way I describe it to people is it's like going back to your baseline you when it's the right medication. But it doesn't change your personality. Your personality, you're you. So, in terms of the myth that we'll always be cured from depression by antidepressants, the research shows that the most effective thing right now for depression is actually therapy. And then for people who need antidepressants, therapy and antidepressants together are another effective form. And not everybody has to take it. So even with people who are taking antidepressants, it's important to still be in therapy.
Altman: The myth that bad parenting causes mental illness I think is a trap. Because parents are all too ready to take responsibility and to feel guilty about all sorts of problems that their children have. So there's no point in reinforcing that and harming and damaging the mental health of parents. If you think that your parents caused your mental illness, you're gonna end up endlessly complaining about your parent. What can you do about the way you were raised? You can do something about what it's left you with in the present.
Goorin: Around LGBT adults and youth, there's so many myths associated with mental health. And a big part of it I think is, unfortunately, because the profession that I'm in had a really dirty history along these lines in the DSM, which is our Diagnostic Statistic Manual, until 1973, homosexuality was actually listed as a disorder. And after a lot of pushback and studies and LGBTQ rights being integrated into theory, we realized that that was really outdated. And since then, in DSM-3, it stopped being, unless somebody has specific anxiety related to being gay, then they're not diagnosed ever with a mental-health-related disorder associated with it. The same is true for being trans, actually. That it's only if somebody has what's called dysphoria, where they don't like their body, that they then have a diagnosis. But just being trans in and of itself isn't a disorder anymore.
Goorin: You know, to the question about what role mental health plays in the attacks of gun violence, unfortunately, that's been a mischaracterization of people who have severe mental illness, is that they're more likely to commit crimes and with guns. It's not that people with mental illness are more likely to be aggressive. It's the people who commit these crimes have access to guns, and they tend to be really self-loathing. Like, that's kind of the primary thing that makes people have a lack of empathy. That seems to be the things that make them be more violent and aggressive. Those are better predictors than any type of a mental health disorder.
Goorin: People talk about a whole town, like, on the news, "A whole town was traumatized by the shooting," for instance. Right? And it doesn't work that way, and that's actually one of the most common mental-health disorders that I've seen mischaracterized in that particular way, is PTSD. People seem to think that by virtue of having the experience to a potentially traumatic event, that you'll have these particular realm of symptoms that include hypervigilance, there's impulsivity. There's so many different realms of what comes up for people after trauma, and I've heard people say, you know, "Because I was traumatized, because I was there at 9/11," for instance. Well, a whole city was there, and we have really good numbers about the number of people who ended up having PTSD, and they're actually really small. When something like this happens, a major tragedy like a gun shooting or a 9/11 or any other type of tragedy like that, people tend to be resilient.
Goorin: There's a big myth, actually, even within the mental-health field saying that there are prototypical ways to respond to grief and loss. And that's in pop culture as well, that people have these ideas that there's one way to grieve and if we're not devastated and deeply traumatized that somehow we're in denial or unfeeling. And that's not true. In fact, since the beginning of time, we've been dealing with death. We have different ways of dealing with it. And sometimes we're relieved that the person dies because we didn't have a very good relationship with them. Or even if the person, if we love them and we feel really connected to them but they were sick, we're relieved that they're dead because we don't want them to suffer anymore. People tend to feel really guilty about being relieved after a death, which is a very common reaction to death. There are no five stages of loss; it's just a myth. And it's one of the most popular myths out there. And it's one of those things where people who aren't very psychologically minded will come in and say, "Oh, my gosh, I must be in the denial phase of loss," or, "I must be in this phase because I'm not dealing with it yet." In reality, I just think it's one of those things that makes us feel safe. Like, if we can imagine these stages are ahead of us, then we can feel better about where we are, and so I think that's why it's so popular. However, I've seen the flip side, which is why it can be damaging, when people have losses and they're judging themselves for not having this prototypical series of stages, and they're not based on reality or evidence or anything.
Goorin: OK, so, people are gonna hate me for saying this, but, and this is so common in the dating world. Like, if you ever look on people's profiles on dating profiles, they always say, like, "I am an NYFB," or, I don't even know what they say. But it's always about how they're these certain, you know, Myers-Briggs score. And it's really popular these days, Myers-Briggs. And, in fact, a lot of organizations use it and really base a lot of their testing on it. Again, there's no validation around any of these studies. And so while it might resonate for people, and that is something that, you know, just like when we talk about, you know, "I'm a Gemini because I do this," you know, it resonates for you, the idea of being a Gemini, and you might act in ways that remind you of this description of what it is to be a Gemini, but there are no empirical tests to say that you are such this thing. There are personality tests, but Myers-Briggs isn't one of them.
Altman: The myth that therapy is gonna be exclusively about the past or predominantly about the past and not help you in your current life or not give you a form for talking about what's happening today and yesterday, there's a reason why people hold on to that myth. And the reason is that there was an early version of psychoanalysis that held to the idea that people's personalities were formed in their first five years and that the past was strongly formative of the present. It sometimes can be helpful to say that there was a pattern that was established in relation to people in the past. And that can give you some perspective on what's happening in the present. So making reference to the past is not necessarily a bad thing, but it should never be because this happened, therefore you're having this problem now. It's not an explanation. It's only a way of getting perspective on the present.
Stile: I think oftentimes people might say, "Oh, why not go speak with a friend who's a good friend, and they can keep things confidential?" But therapists are trained to work in a particular way to help people deal with specific problems they're facing. Therapists are different than friends because even though your friends might be willing to, for example, hold a secret, therapists really treat things in a very confidential manner. And they're willing to explore things that maybe a friend would be uncomfortable exploring.
Altman: Actually, the fact is that most people who come to therapy are among the stronger people. And the reason is because they have the courage and the strength to look at themselves, which is not an easy thing to do in various ways. I think it's because the people who come to me are people who've already decided to work on themselves. Good therapists don't force their patients to talk about something they don't want to talk about. To the contrary, I think that even encouraging a person to talk about something that they're not ready to talk about is counterproductive. The problem with hitting pain points right on the head is privacy, for one thing. People are entitled to their privacy. Therapy isn't just an opportunity to spill. So I think having people's privacy, when their privacy is respected, that makes them more confident to open up, actually. But the other problem for that is that the therapist needs to be thinking that there's a limit to the tolerance of everybody, including the therapist, for how much pain they can tolerate at any given time. And so respect for people's anxiety about getting into some of the more difficult things in their lives is also part of the process.
Goorin: Psychiatrists are the only ones who are able in this country to prescribe medication. They do what's called a psychopharmacological consult, where they will go through all of your history. And that's something they do if you want that. And I say if you want that because it's really important. As a psychologist, for instance, we always try therapy first. It's the treatment of preference for all clinicians. In fact, they've done all these studies that have shown that therapy first for several months before you then even think about a medication is the best course of treatment for people. Because that way you can really see what is what. And if you then still want to do medications, it's certainly something you can talk about. But you don't have to do medications. It's up to you and your therapist if it feels like that would be beneficial to you.
Altman: I would not say that most therapists consider that therapy has to go on forever. But I think when you're interviewing somebody and considering them to be your therapist, that's one thing to ask about. How do you think about how long this should go on, and when do you start to think that maybe it's time to end it? How do you break up with your therapist? Do not break up with your therapist in an email or a text or a phone message. You've got to be direct. You've got to say, "I've been thinking that maybe it's time for us to stop." But then that can't be the end of it. If you haven't already said it, hopefully you have already said it in one way or another in the preceding sessions. "What I've been looking for is this, and I see how it's been happening in my life." And maybe give an example or two. But it's not like you feel you have to convince the therapist. I want to be sure to let people know that there are lots of ways of getting good psychotherapy at a reduced fee. So, there are institutes where people get advanced training beyond their doctorate. And all those institutes have training clinics where people are treated at a low fee. And some people might think that the higher the fee, the more skilled the practitioner, which is not necessarily the case. But certainly in that case it's not true.
EDITOR'S NOTE: This video was originally published in November 2019.
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