Doctor Mom is a physician who lives in Ontario
Earlier this year I took my 13 year old son out to lunch to talk about mental health. It just happened that Son #2 and my husband were out for the day and I had a rare opportunity to be alone with Son #1. I didn’t say ‘I’m going to take you out to lunch so that we can talk about mental health.’ I just reckoned that the odds of him listening to me would be higher if a) we were somewhere removed from the all-consuming ‘call of the PS4’, and b) there was a favorite food to both fill his mouth and free his hands from electronic device. So out to eat we went.
I had no idea how to have the conversation I wanted to have. I can tell you that figuring out how to talk him through the gaps left by school sex ed was easy by comparison.
My desire to have a talk with him about mental health wasn’t prompted by any particular worry. It wasn’t that he’d seemed depressed, anxious, unmotivated, unusually moody or to be losing interest in life. Yet he had recently sat a high school entry test and done an important music audition and I’d seen in him some familiar reactions to self-imposed high expectations and pressures of competition. Little alarm bells had rung in my head. Memories had surfaced: of me as the seemingly self-confident, talented pre-teen…. who then turned self-doubting, self-loathing, eating-disordered, depressed, socially-withdrawn and obsessive-compulsive young adult who dragged herself through two decades of life. Nobody ever had a talk with me when I was a kid about the importance of paying attention to and building strong mental health (and why would they? – no one knew how to talk about it back then). But I really could have used one. Not that I’m naïve enough to think it would have conferred some kind of immunity against mental illness, but perhaps then I wouldn’t have had to go through it so utterly in the dark and feeling so completely alone in my muddled-up ‘wrongness’.
2017 isn’t 1987 when it comes to awareness of both the existence and the burdens of mental illness, thankfully. We had Canadian Mental Illness Awareness Week last week and it is the WHO’s World Mental Health Day today. #BellLetsTalk has become a Canadian tradition that has helped to raise awareness of mental illness and reduce associated stigma. Many celebrities have talked openly about their struggles with mental illness and addiction. All this is good. There’s easily-accessible, easily-digestible evidence showing that if you have mental illness you are part of a big crowd not a small bunch of wierdos best ignored lest they ruin the party for everyone else.
And that’s where I started the mental health conversation with Son #1. At the place I’ve begun many reflective talks about health topics with my boys: evidence (with a little personal experience thrown in because stories stick).
“When you’re taught Health at school, do your teachers ever talk to you about mental health?” I began, “Because mental illness is really common, you know? And especially in young people.”
“No,” he replied, shoveling noodles into his mouth.
“So, what…they only teach you about stuff like exercise and what you eat and sex ed and say don’t do drugs?”
“That’s interesting because there’s some new research out that says that 10 to 20% of young people in Canada have a mental disorder, like depression or anxiety or an eating disorder. Which is A LOT. I’d have thought that teaching you to recognize signs of mental illness would be helpful. Wouldn’t you?”
Silence. More noodle-shoveling. Then, through a mouthful of food, a muffled,“Why?”
“Why? Because mental illness is scary if you don’t know anything about what it feels like. It can just happen to you out of nowhere. You often don’t feel sick so much as it messes up your thinking. You just feel like you are a bad person or that you have a bad life. Or you stop enjoying things that you once really liked doing and you feel numb. And if you don’t recognize it you might not get treatment until it’s become quite overwhelming, and that’s a bad thing just as it would be if you had pneumonia or diabetes.”
If this was a movie script I could write my teen asking the right questions that allowed me to share perfect tweet-length advice that he could carry with him through life.
But this isn’t a movie script and it wasn’t like that. He didn’t ask me questions. Except he asked if he could have dessert. And it wasn’t my purpose to dispense advice. I wanted to show him a door of communication that he could choose to open – or not – some other time.
Still, he seemed happy enough to listen for a little while, and perhaps he gave it some attention from the part of his brain that wasn’t enjoying pecan pie or thinking about online gaming.
“I had mental health problems that started in high school,” I said. “I just wanted you to know that in case you ever want to ask me about it. It started with depression but back then there was much less awareness of mental illness and I had no idea that’s what I had until many years later. It really made my late teens and early 20s awful for me because I didn’t get any help.
“You know how you get migraine headaches and I was able to tell you how to avoid triggers because I get them too? Well, I’ve also learned over time what makes me more likely to feel depressed and what helps my mood be better. Sorry to tell you this but the fact I’ve had depression makes you more at risk of getting it than someone whose parents have never had a mental illness. I just want you to know, if you ever feel low or empty or like you aren’t enjoying anything, you can talk to me about it or I can help you find someone to talk to.”
That was all I managed to say on that day. I’m not sure what he took away from it.
In my public-health-at-the-family-level practice I try to teach my sons self-awareness and I try to parent using an emotion-coaching approach (within the limitations of my ability).
Son #1 frequently points out that the two of us are very similar in personality. He seems to quite like it. I like to tell him how I’ve learned that character-traits may be beneficial or not, depending on how you develop them. And so I’ve woven the mental health awareness agenda into other conversations. For example, we’re both pretty introverted. We’ve talked about the fine line between, on the one hand, liking being on our own to recharge and, on the other, neglecting human connection a little too much and creating loneliness. We’ve talked about being driven, which he is… and I’ve shared how, on the one hand, it has helped me to achieve goals and yet, on the other hand, it’s contributed to burnout and low mood because I have pushed myself too far. I've told him that I felt that pushing myself ‘beyond’ was expected of me and that I don’t expect it of him.
Nobody has the mental illness prevention recipe figured out, although epidemiological research has given us an idea of the ingredient list. Enough physical activity, enough sleep, healthy eating, positive relationships, hobbies, purpose …. But even if there were a recipe, many people would be missing some ingredients by virtue of birth and circumstance. We can't eradicate mental illness, but taking action to destigmatize it, helping to raise awareness (both in others and in self) and working/voting/lobbying for better access to treatment for mental disorders will go a long way to reducing the substantial individual and societal burden these conditions deliver.