Bummed Out: Should We Encourage Stoicism and Endurance?

Forthwith, my customary qualifiers (don’t I always have to insert these now?):  Depression and generalized anxiety disorder, along with other Axis I diagnoses including addictions are real, very real disease states.  I am neither dismissing, nor making fun of these potentially devastating psychiatric conditions.  Okay?

 I am however casting my usually querulous and increasingly baleful eye at the assertions made in “Lonely, burned out, and depressed: The state of millennials’ mental health in 2020.”  Points made are that the millennials are having a harder time going to work because of mental-health reasons, which are also encouraging them to quit work, many of them therefore being unable to afford the help that they are more likely to seek than previous generations.  That’s a lot to unpack.

“Here are 14 ways mental illness has plagued the millennial generation” 

1.     “Millennials are experiencing a health shock largely fueled by a decline in mental health” – According to Blue Cross, this could lead to a 40% increase in mortality.  They are comparing this to generational traumas like the Vietnam War, and AIDS.  Do you buy this?

2.      “Depression is on the rise among millennials” – The same study shows an increase from 3% to 4.4% in diagnosed depression in the 18-34-year-old group.  Why would this be?

3.     “Deaths of despair are also on the rise” – the rates of death due to substances or suicide are rising.

4.     “Suicide attempts have especially increased among black youths”- the reasons given are the usual veer-offs into sociology and platitudes.

5.     “It’s partly linked to money stress” – good thing previous generations were able to avoid that.

6.     Money stress isn’t just contributing to millennials’ mental health; it also means not everyone can afford to seek treatment” – Especially if you quit your job (see above).

7.     “Millennials are also lonely” – Hilarious, ironic, and sad, in a generation facing chronic neck problems from always staring at social media on their phones.

8.     “And they’re dealing with burnout in and out of the workplace …But millennials have reported they suffer from higher rates of burnout than other generations.”  At this point I have to ask how much conjuring bias is being delivered.  Ask the entry-level worker if he feels burned out, if burnout is a bad thing, and would she like a nap?  This begins to sound like recruitment.  

9.     “Many millennials dealing with mental-health problems at work say their office does not provide adequate support” – Why is that even considered to be a de facto employer responsibility?

10.  “Employees who work outside a traditional 9-5 are particularly vulnerable to depression, as are women, LGBTQ people, and racial minorities” – good to get a little more social justice cred in there.

11.  “Globally, workers say discrimination because of a mental illness is more prevalent than other forms of workplace bias.” – The supporting study is written so that if one surveyed feels discriminated against, then that is in fact proof of discrimination.  This is junk.

12.  “Nearly half of millennials” have left a job because of mental health reasons … ‘Mental health is becoming the next frontier of diversity and inclusion, and employees want their companies to address it,’ the authors wrote” – Insert your own comment.

13.   “For all their mental health issues, there is a bright side – millennials known as the “therapy generation,” are helping to destigmatize therapy” –  Is this actually a “bright” side???

14.  “If you’re struggling with depression, get help” – Absolutely, nice to wind this dirge up with a common-sense, irrefutable statement.

 I inflicted you all with this article, because Authentic Medicine ought to be about assisting patients to live healthier, happier lives.  There are real issues in this article, but they are wrapped in obvious agendas of funding, ego, recruitment, and politics.  On the front lines, we want to genuinely, compassionately connect with patients, and discern whether they have actual pathology, or are simply in a slump.  In a meta-article like this that would substitute for an AAFP weekend or ABFM MOC, I think we see a lot of presumptions.  It reminds me of the time almost twenty years ago when a 27-year old male came to my office for a Viagra prescription.  He was completely healthy, had no functional difficulties, and simply wanted some party pills for a big weekend road trip.  I told him he was perfectly fine, did not need any pharmacology, and simply needed to focus.

How often have we seen an angsty teen, or a bummed-out mid-twenty-something, and not gone through the specific diagnostic criteria, scheduled some follow up, or started with a simple psychologist referral, preferring rather to throw a quick SSRI prescription at them, brand them with a diagnosis, and confirm for them that they have an “illness”, rather than a condition from which they can learn, grow, and triumph.  I’m not saying that the old coach’s line about “rub some dirt on it and get back into the game” is always appropriate – certainly not! – but do we not have an obligation to encourage stoicism and endurance, in the right patients, as part of their treatment regimen? 

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