Are we making progress or just getting progressively lost?

In the wake of the Apalachee High School shooting, we do well to examine how we are, as a country, addressing mental health challenges within our communities. Something clearly failed in Barrow County, Georgia. We should want to figure out what went wrong and why.

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The easy part about the much needed conversation this country needs on mental health is to sound the call to alarm.

Why are we not, as a society, confronting these signs and symptoms? Why are we not, as a society, realizing that our friends and our neighbors are spiralling down into crisis, even as we watch it happen? Why do we continue to rationalize and excuse inaction when people are spiralling down into crisis, only to splutter with feigned rage when that crisis then explodes all over corporate media?

There is no getting around the sobering reality that, as more details about Colt Gray’s troubled young life emerge, there were too many people simply standing on the sidelines—aware, but either not engaged or not effectively engaged.

When there are indications that Colt Gray was bullied at school in addition to being alternately abused and neglected at home, it takes no great insight or analytical brilliance to deduce that not enough happened to arrest his downward spiral.

The father added: 'It went from one thing to another... I was trying to get him on the golf team... [they were like], "Oh, look, Colt's gay. He's dating that guy." 

'Just ridiculed him day after day after day.'

It is also troubling that the father was arrested for “knowingly” having facilitated Colt Gray’s violent act while others who also had knowledge of the boy’s deteriorating psychological state are not similarly being called to account.

One thing that seems absolutely certain in this entire tragedy is that such justice as it lies within the power of mere mortals to enact will be at best unevenly enacted.

It is also an inescapable reality that had there been effective mental health interventions in Colt Gray’s life as the troubles within his life mounted, this tragedy would not have occurred. That this tragedy happened at all is all by itself a damning indictment of how this country handles challenges of mental and emotional health.

However, if we are to have the much-needed conversation on mental and emotional health, we must also acknowledge the obvious reply from those who advocate for our country’s current mental health care systems: “look at all that we are doing! We’re not doing ‘nothing’!”

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Let us therefore consider some of the data regarding our mental health care systems.

It is surely significant that mental health care job growth in this country is expected to outpace overall job growth a few times over.

Even social worker jobs are projected to enjoy significant growth in the coming decade.

However, we must not draw the conclusion that there is particular focus even within healthcare on mental health professions. Both the current and projected employment levels even for health care occupations within the 20 fastest growing employment sectors moderates that perception with some perspective.

In terms of percentage growth, within those same fastest growing occupations, the mental health professions are not the one’s growing the fastest. Far from it.

As we can see from just the fact that the same data which projects 19% growth in mental health jobs over the next decade projects 40% growth in nurse practitioner jobs establishes that there is far from a concerted push for expanding mental health services in this country.

Health care overall is a growing employment area, but within health care mental health is growing relatively slowly.

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We can see that this is indeed the case when we read about schools in New York City losing funding for school psychologists and social workers—victims of the ending of COVID-related federal funding.

Unsurprisingly, this has been met with more than a little concern from a variety of advocacy groups.

“When children don’t get the services they need upstream, their needs become more intense and more complex, and then they end up in ERs and hospitals,” said Alice Bufkin, associate executive director for policy and advocacy at the nonprofit Citizens' Committee for Children of New York.

This latest school tragedy gives such words a starkly prophetic hue.

Nor is the perceived shortfall of mental health workers confined to New York City.

Colorado is facing similar challenges in fully addressing that state’s demand for mental health services.

A recent report by the University of Minnesota highlighted a perceived significant underserved need for mental health services within the state’s K-12 schools1.

With respect to student mental health:

• As described above, principals selected addressing student mental health challenges as the leadership activity posing the “single greatest challenge” to them more than any other activity in 2023.

• As described above, principals selected addressing student mental health challenges as the leadership activity posing the “single greatest challenge” to them more than any other activity in 2023.

• 45% somewhat agreed or agreed with the statement, My school or district is able to provide adequate support for students experiencing mental health challenges.

• The three most-selected perceived root causes of student mental health challenges were: trauma experienced firsthand (primary trauma) (74% of respondents selected this option), student engagement with social media (59%), and mental health challenges of caregivers (40%).

It is fair to say that, within schools especially, there is at least awareness that the need for mental and emotional health services is growing.

Research is confirming what a great many have long understood to be the case: loneliness and social isolation are not merely indicators of poor mental and emotional health, but have negative implications for physical health as well.

Even corporate media is starting to concede that our society’s younger generations especially are not doing all that well, emotionally and psychologically.

However, these realizations serve to highlight an uncomfortable truth: what we have been doing with respect to mental health and providing access to mental health services is not getting it done.

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How has our society come to a place of generally declining mental and emotional health in the same time span when there has been significant growth in health care and social assitance workers?

More importantly, how has this happened even as this country’s spending on mental and emotional health services has risen since 2001 as a percentage of real Gross Domestic Product?

Child care jobs in particular have since 2001 risen significantly relative to overall employment.

We are spending more. We are hiring more. We are focusing more….and yet we are getting worse outcomes?

We are spending more as a percentage of GDP—a greater and increasing portion of our economy is devoted to mental and emotional health services than before—and yet we are no happier, and certainly no healthier.

The mental health crisis in this country emerges not because we are doing nothing—but because what we are doing demonstrably is not working.

If all we do as a result of incidents such as Apalachee High School is double down on current mental health services and programs, there is an outsized risk we are merely doubling down on failure. Our current mental health services and programs undeniably failed with respect to Colt Gray—whatever interventions did happen did not achieve the desired outcome.

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The goal of all health care, whether physical or mental, is improving the individual person’s overall quality of life. While “quality of life” might not be easily quantified, it is fairly easy to determine if a person considers their quality of life to be good or bad, getting better or getting worse. One merely needs to ask them.

If current approaches to mental health care have not prevented the mental health crisis that has been repeatedly reported even by corporate media, we need to consider the very real probability that current approaches to mental health care are not working.

We need to think long and hard not just about how much of our society’s resources should be devoted to treating mental health issues, but how our society goes about treating mental health issues.

We must not forget that Apalachee High School was not just another school shooting tragedy. It was also yet another warning that our systems of mental health care are failing us. Even as our spending on these systems has increased, even as we have hired more and more people to work within these systems, our systems of mental health are still failing us.

It makes no sense to devote increasing resources to systems that are not working as they should. It makes no sense to devote more and more spending—taxpayer-funded and otherwise—to our current systems of mental health care if we are not seeing the improved results we want to see.

We absolutely do need to have an ongoing dialogue in this country about mental health, but the baseline stipulation that needs to be understood in order for us to have that ongoing dialogue is that much of what we’ve done thus far has not worked as it should.

The baseline stipulation needs to be that we need to rethink how we are delivering mental health services in this country. We need to step completely outside the bureaucratic box and craft new proposals, new programs, and new thinking on mental health overall. If we’re not willing to not merely entertain but focus on thinking outside that bureaucratic box, we are not having the serious discussion on mental health this country needs to be having.

What we have been doing with regards to mental health did not prevent Apalachee High School from becoming the latest in a far too long list of school tragedies. That means whate we have been doing with regards to mental health has failed us in the worst possible way.

Whatever else we do with regards to mental health in response to Apalachee High School, let’s not double down on failure. Let’s not continue repeating the same mistake of doing that which is not working.

We can do better. We just need to figure out how.

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Yet more lives lost.

Yet more proof that these shooters do not emerge fully formed out of the ether. They are months and years in the making, while people stand by and watch them deteriorate. While nothing gets done. While another child, another human being, somehow falls through the cracks.

No matter what else emerges in the days and weeks to follow after yesterday’s shooting at Apalachee High School in Barrow County, Georgia, we already know that much.

Now it has emerged that the FBI and the police had interviewed Gray and his father in May 2023 over “online threats to commit a school shooting,” which contained photographs of guns, the FBI’s Atlanta office said in a statement.

After receiving several anonymous tips, the FBI confirmed the online threats originated from Georgia and referred the information to the Jackson County Sheriffs’ Office.

More than one year ago, “several” people noticed that Colt Gray was is crisis. The FBI has already confirmed this to be the case.

Yet here we are. People dead. Lives shattered.

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Let me be clear: I do not know what mental or emotional health struggles Colt Gray has. I do not consider any of them to excuse or mitigate what he is accused of doing. Whatever demons lurk inside of him, killing others is not a means for handling them. Violence is not a solution to mental health.

Taking a weapon into his school was an evil act, and he must now answer for that evil act. That is what should happen, and that appears to be what will happen.

However, we already know that Colt Gray is not unique in the world. We already know that there are troubled youths out there. Will we stand by and let those troubled youths also deteriorate to the point where violence seems permissible, where killing somehow becomes a solution?

Can we now admit to ourselves that the warning signs have been there that Colt Gray was a young man headed for a troubled ending? That those warning signs, if heeded, could have changed that ending?

Let me clear again: We know Colt Gray was a troubled youth. We know he was expressing some very intense rage one year ago. An intervention at that time to remediate that rage would have absolutely prevented this tragedy. The lives that were lost could have been saved.

Nor was it simply a case of a single FBI incident. Even his own classmates concede they were aware he was a troubled youth.

Student Lyela Sayarath told CNN that she wasn’t surprised when she heard Gray was the suspected gunman because he fitted the description of a shooter.

“He wasn’t there most times,” Sayarath said. “He either wouldn’t be there or skip class. But even when he would’ve talked, it was one-word answers and short statements.”

How does any high school student become so cynical and so callous as to simply shrug off another human being as “fitting the description of a shooter”? How can it be that obvious that someone is in crisis and yet things continue on their tragic course?

To be sure, the reporting does indicate that Gray’s family was in contact with the family services agencies for their community.

It was also revealed that Gray and his family had contact with the department of family and children’s services in the area, which authorities are pursuing as another a line of inquiry.

Gray has been described by a classmate as “quiet” student who would often “skip class”.

Take a moment to consider these observations made off the cuff by those around Apalachee High School: Colt Gray was “quiet”. Colt Gray skipped class often. Colt Gray was minimally engaged with his classes and apparently with his classmates as well.

The term to be applied here is “social isolation”. Whatever else was going on in Colt Gray’s life, what the witnesses to this tragedy have already said is that Colt Gray was a socially isolated youth.

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We do not need to speculate if social isolation is a mental health problem. That question has been answered in abundance.

Social isolation is not merely a mental health problem. Studies show that social isolation in children has lifelong consequences1.

Socially isolated children had higher levels of C-reactive protein in mid-life (standardized coefficient=0.05, p≤0.001). In addition, children who were socially isolated tended to have lower subsequent educational attainment, be in a less advantaged social class in adulthood, were more likely to be psychologically distressed across adulthood and were more likely to be obese and to smoke. All of these factors partially explained the association between childhood social isolation and CRP. However, this association remained statistically significant after considering all mediators simultaneously.

Studies have shown that even among adults, social isolation can have neurological consequences2.

Research also shows that even teens recognize that social isolation is frequently a response to life stressors—and not a good response, either3:

Taking the perspective of one student, he described the stress experience in the following way:

So, me, personally, when I see my stress, I'd talk to you in a different way. I'm usually an energetic, annoying person sometimes. But if I'm really stressed, I won't talk to you at all. I really won't talk to you, or I'd be wanting to leave school early, something like that.

From his perspective, he is able to identify a physiological marker of when stress is present by noting that his disposition changed. He is normally an outgoing student but notices he becomes more guarded and closed off when stressed. He also did not identify any adaptive ability he used to manage stress other than to withdraw from his peers, which is a primitive response to stress akin to the “flight” response from “flight or fight” theory. When asked to describe what stress looks like when it happens to his peers, he again named observed behaviors:

When I see my other friends who are stressed, I can tell because of their body language. So, I have a friend who's... he's cool and he's funny, stuff like that. But whenever he has stress, he doesn't talk, or he'll just give you a one-word answer if you ask him a question. So, that's how I could tell he's stressed.

Students are aware of behavioral changes in their peers. As other students shared their experiences with stress, the theme of observed mood changes and a desire to isolate continued to be a common talking point:

I pretty much just put on my headphones. I try and block people out when I'm stressed because everything just sends me over the edge. My moods are different. I'm just irritated with everything and everyone for no reason. Obviously, there's a reason. But just body language you can tell when people, when they're stressed, they're just different. Most cases, what I've noticed with my friends, they try to isolate themselves, to be themselves and deal with it, and they're not actually dealing with it.

This student recognizes stress occurring and shares that she and her friends often prefer to isolate when dealing with stress but there is recognition by this student that withdrawing and isolating may not be the best method for managing stress.

For decades, research has shown that loneliness and social isolation correlate to depression among adolescents4. Research has also shown that, not infrequently, loneliness is a cause of major depression among adolescents5.

Our results suggest that enduring peer-related loneliness during childhood constitutes an interpersonal stressor that predisposes children to adolescent depressive symptoms.

While it might seem extravagant to extrapolate major depressive illness from a handful of ad hoc observations, bear in mind these observations come from people who experienced Colt Gray daily. These were the casual observations of those who had casually observed Colt Gray for at least the past year.

Those casual observations are all consistent with signs and predictors of major depressive illness. They should have been red flags to everyone around Colt Gray that “something” was wrong, that he wasn’t doing well, and that he was heading into crisis if not already in crisis.

Those casual observations, along with the FBI notice and the investigation last year by the Jackson County Sheriff’s Office, all lead to the same inescapable conclusion:

THE PEOPLE AROUND COLT GRAY KNEW HE WAS A TROUBLED TEEN!

People knew, and still he slipped through the cracks, his issues either not noticed or insufficiently noticed.

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Unsurprisingly, we do not hear about mental health from political leaders in response to this tragedy. All we get is more pious pontifications about gun control.

We get useless finger pointing at other political leaders.

These are worse than useless statements to make. They are stupid statements to make—government does not have the Constitutional authority to disarm people and render everyone helpless.

Even if one wishes to argue that the right to keep and bear arms is not an unlimited right, nowhere in the Constitution does it empower any level of government to decide what those limits should be—which means government does not get to decide what those limits should be. Until such time as the Constitution is amended to give government that authority, gun control talk is simply not rational. Until the Second Amendment is itself amended, there is no “common sense” regulation of the right to keep and bear arms.

There is, however, much that can be said about loneliness. I’ve said some of it here on this Substack.

Others are commenting about it as well. Unfortunately, the discussion that gets had revolves around deciding who is more troubled—a perverse olympiad of mental health crisis, which teens appear to be losing.

Of course, being a teen isn’t easy either. Depression and anxiety are increasing among adolescents. But in high school, you’re more likely to have people keeping an eye on you, who’ll notice if you’re upset at home or if you don’t show up to school. Adults know that they should protect you, and they have some power to do it, Weissbourd said.

We can say just on what few facts we have that the adults around Colt Gray failed to protect those whom he is accused of killing—which means the adults around Colt Gray failed to protect Colt Gray as well.

We know this because the witness statements are already showing that those around Colt Gray knew he was troubled. They knew, and yet still allowed this situation to develop.

Some might say I am trying to excuse what Colt Gray did. That is true. Colt Gray stands accused of murder, he will be tried as an adult, and, at this juncture, that is what needs to happen. No matter what brought him to make the evil choice he did, it was an evil choice and he must receive the full measure of consequence for that choice.

Some might also say that I am being too harsh on the teachers at his school, or his parents. No, I am not. Even if they claim “they didn’t know”, the reality of public schools and parenting is that it is their obligation to know. If even his classmates can be casually aware of the signs and symptoms of a teen in crisis, it is not credible in the slightest for the teachers and the parents to be blissfully unaware of those same signs and symptoms.

The reality of today’s youth is that they are as a generation in mental health crisis. The data shows that unambiguously, and that younger generations in this country are progressively less able to cope with life’s challenges than older generations.

While I do not know and will not speculate if Colt Gray suffers from any form of Post Traumatic Stress Disorder, it surely is an important perspective on the emotional and mental health challenges facing today’s youth to realize that this country has as many children grappling with PTSD as it does soldiers returning from combat with PTSD.

Whatever “solutions” we think we’re putting forward on adolescent and teen mental health, or just on people’s mental health in general, they are not proving to be up to the challenge. Whatever solution one wishes to highlight as being something being done about these issues—it’s not enough. Either more is needed, or a different approach is needed. Either way, the status quo should not be deemed acceptable, not even for a second.

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It is too late to intervene to assist Colt Gray. That train has tragically left the station.

It is not too late to learn the lesson that each and every one of these tragic events arguably has been trying to teach us for years: The kids are not alright.

Our children are not doing well.

Our children are not thriving.

We see the signs of mental health crisis. We see the symptoms of mental health crisis. Even as teens we casually concede that we know the signs and symptoms of mental health crisis are, in fact, signs and symtpoms of mental health crisis.

Why are we not, as a society, confronting these signs and symptoms? Why are we not, as a society, realizing that our friends and our neighbors are spiralling down into crisis, even as we watch it happen? Why do we continue to rationalize and excuse inaction when people are spiralling down into crisis, only to splutter with feigned rage when that crisis then explodes all over corporate media?

I know we are capable of better than this.

I want to believe we want to better than this.

We absolutely have got to become better than this. If we want these tragedies to stop for good, the challenge is on us to become a whole lot better than this.

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Except it’s not a radical thought. It is a blunt way of looking at the evidence surrounding antidepressant use and the difficulties that arise in discontinuing that use, which recent studies make clear.

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However, about half of people taking antidepressants have been using them for longer than 12 months. People can experience unpleasant withdrawal symptoms when they attempt to stop antidepressants, which leads to them restarting or continuing antidepressants.

According to a recent study1 published in The Lancet, as many as one in six people experience severe withdrawal symptoms when they attempt to discontinue antidepressant usage. We should note that the study itself acknowledges that people often refer to the symptoms experienced when discontinuing antidepressants as “withdrawal”, even as researchers shy away from that language (for reasons which are intuitively obvious).

Experiences occurring after antidepressant discontinuation have been called withdrawal symptoms, phenomena, or events, or antidepressant discontinuation symptoms, syndromes, or symptomatology.

Moreover, the study confirmed that a third of people who discontinue antidepressants experience at least some withdrawal symptoms.

While the psychiatric community might blanche at the use of the language of addiction with respect to antidepressants, the study itself stands as a confirmation that the human body does become acclimated and even physiologically dependent upon antidepressant medication when taken for a long period of time.

Our study yielded four main results. First, across all studies and antidepressants, we found that approximately every third patient discontinuing antidepressants will have antidepressant discontinuation symptoms of any kind (event rate 0·31). Second, even in studies of people receiving a placebo, discontinuation symptoms (which could be called discontinuation-like symptoms) occurred in approximately one in six patients (event rate 0·17). Third, severe discontinuation symptoms occurred in around one in 30 patients discontinuing antidepressants (event rate 0·03). Fourth, the incidence of antidepressant discontinuation symptoms is modified by specific antidepressants, the use of instruments for detecting antidepressant discontinuation symptoms, and by study rigour, but substantial statistical heterogeneity remains.

That symptoms occur even in patients being given a placebo rather than the actual medication before discontinuing said “treatment” suggests that there is a psychological dimension to the phenomenon as well.

Small wonder antidepressants become a lifelong commitment: at least some portion of the patient population is arguably addicted (or at least physiologically dependent on them).

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While doctors insist that antidepressants are an effective treatment for depression, the reality that antidepressant therapy is easier to start than to stop is a great unresolved issue within psychiatric medicine.

The researchers emphasize that there is strong evidence supporting the effectiveness of antidepressants for many individuals with depressive disorders, either alone or in combination with other treatments like psychotherapy.

However, these medications do not work for everyone and can cause unpleasant side effects for some patients.

For those who have recovered with the aid of antidepressants, doctors and patients may decide to discontinue their use over time. Therefore, it is important for both doctors and patients to have a clear, evidence-based understanding of what might occur when antidepressants are stopped.

We should be clear about one thing regarding antidepressants and indeed all psychotropic medication: some people will consider themselves to be well-treated by antidepressants, and will not want to discontinue them. This analysis is not an argument for taking antidepressants away from people who feel they are highly effective. People who feel they are helped by using such medications should by no means stop using them just because some random Substack author said so.

What gets left barely acknowledged, however, is the existence of research suggesting that psychotherapy is at least as effective at treating depression than antidepressants. That was the clear conclusion of a 2005 study2 comparing antidepressant medication efficacy against cognitive therapy (psychotherapy).

Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise.

Even though antidepressants do work for some patients, across broad patient demographics cognitive therapies are shown to work better for more people, and should be promoted over antidepressants.

Another study, this one from 20213, found that treating depression with cognitive therapy to remission was more likely than medication to prevent relapse after treatment was ended (emphasis mine).

In the 50 years since it was first introduced, cognitive therapy has been shown to be as efficacious as antidepressant medications (on average) in the acute treatment of nonpsychotic depression, although some patients will do better on one than on the other. Moreover, patients treated to remission with cognitive therapy are less than half as likely to relapse following treatment termination as patients treated to remission with medications. However, a recent study suggests that adding medications interferes with any such enduring effect and medications themselves may have an iatrogenic effect that suppresses symptoms at the expense of prolonging the underlying episode.

Think on that emphasized portion for a moment. Mixing antidepressants with cognitive therapy could be hindering actual treatment and actually prolong the antidepressant episode.

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Why are antidepressants still the “go to” for treating depression, despite evidence suggesting they are more of a problem than a solution? In a word, cost. Corporate media and the medical establishment freely acknowledge this:

Yet pills are often easier and cheaper: It can be hard for people to access therapy because there aren’t enough providers, and mental health treatments often aren’t fully covered by insurance.

Is the problem that we do not have enough therapists? Or is it possible we do not have enough friends? There is already good evidence that loneliness—itself both symptom and cause of depression—is on the rise and is taking a toll on people’s physical health. This despite the reality that loneliness should be the easiest of problems to resolve: quite literally people just need to be friendlier and to enlarge their circle of friends.

Yet we should also be mindful that social support systems and interpersonal relationships are not the province of counsellors and therapists, but of ordinary individuals. Not only is talking the best treatment for most mental health challenges, but talking among friends—in having the reassurance and support of committed friendships—goes a long way towards improving everyone’s mental and emotional health.

It is important to understand that the best therapies for resolving PTSD involve talking. While friends and other members of a person’s support network are not clinically trained therapists, and cannot provide the structured talk therapies available in the clinical setting, everyone has the capacity to listen, everyone has the capacity to create a safe and nurturing space where people can discuss their inner turmoil, and people grappling with trauma especially need that safe and nurturing space in which to talk.

Anyone can make a difference in someone else’s life simply by reaching out a hand of friendship. Simply by being a friend, each of us has it within his or her power to directly confront the loneliness and social isolation that is complicating everyone’s overall health outlook.

Nor is there much scientific dispute about the need for strong social support networks and good interpersonal communication for people grappling with the debilitating challenges of PTSD.

When we listen to people, when we make them feel safe about opening up regarding their inner turmoil, we give them space to address their trauma history and move that much closer to healing. When we validate that their traumas are real, that their inner pain is real, and that they are not “broken” or made less because of their experiences, we give them hope that real healing can be had.

Moreover, we should not forget that the evidence also suggests that one reason such mental health challenges are getting worse is because there is less “talking” and social interaction, particuarly from one generation to the next.

The growing body of evidence suggests that older generations have the tools, the life skills and life lessons, younger generations need to be better able to adapt and avoid being damaged or destroyed by their experiences of adversity—and those tools, life skills, and life lessons are not being transmitted to the younger generations.

People’s mental health is steadily declining generation to generation because the younger generations are simply not being taught the coping skills needed to buffer life’s many adversities.

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The data is telling us that this societal lack of talking and human interaction is not merely making younger people more susceptible to mental health concerns, but it is also impeding the treatment of mental health concerns in every generation.

As June is PTSD Awareness Month, I am focusing my reading and writing for this Substack on issues of mental health specifically. This is a bandwagon worth getting on, to bring greater awareness to these issues, and also to bring awareness to the larger societal issues which the research data reveals.

We cannot eliminate all depression and mental health problems simply by spending more time talking to each other, and we should not pretend that we can. We can, however, go a long way towards mitigating and even preventing a good many mental health challenges simply by spending more time talking to one another. We can make mental health challenges less rather than more common, just by listening. Without spending a single dime on therapists or antidepressants, we can directly tackle the most common mental health issues confronting our communities.

Ordinary people are not therapists, and we should not require them to be therapists. However, even ordinary people can be a friend to someone, can listen to and be present for someone. There is no disputing the scientific and medical reality that lay people doing just that much for their fellow man would improve mental health outcomes across the board, but particularly form the common and escalating conditions such as depression.

There is also no disputing the reality that loneliness and social isolation—the polar opposites of what communities should be doing for their members—are negatively impacting people’s physical and mental health.

What the data is telling us, if we are but willing to listen, is that antidepressants are yet another class of medication that is overprescribed and even misprescribed.

What the data is telling us, if we are but willing to listen, is that we ourselves—ordinary people living ordinary lives—are an essential but largely neglected element of any effective treatment for depression.

Regardless of how simplistic it sounds, what the data is telling us is that we need to be more intentional about cultivating friends, and cultivating the social institutions—churches, civic clubs, hobby groups, et cetera—which help us to cultivate friends.

We can spend a little time cultivating friends and making our communities friendlier, or we can spend a lot of money on ineffective antidepressants because we do not have enough friends and we have not made our communities friendly.

A little time vs a lot of money: which expenditure do you choose to make?

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The data leaves little room for an alternate interpretation, with one in three experiencing feelings of loneliness at least once a week, and one in ten feeling lonely every day of the week. So says the latest polling by the American Psychiatric Association.

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What make this data concerning is research showing that a lonely heart is very often a diseased heart, based on a recently published meta-analysis in Nature Scientific Reports.

The review, published in Nature Scientific Reports, comes from a team of Saudi Arabian public health researchers who combined the data from six studies involving nearly 105,000 participants into a meta-analysis. They found that having poor social relationships (regular connections with family members, friends, neighbors, and co-workers) was associated with a 16 percent increase in cardiovascular disease. Their analysis also found that older adults and retired people were more likely to experience social isolation and more likely to develop heart disease.

To be clear, the study1 did not find that loneliness and social isolation caused cardiovascular disease per se. Rather, it identified loneliness and social isolation as an aggrevating factor—it makes underlying cardiac conditions worse.

Poor social health increases the risk of and worsens outcomes in incident cardiovascular diseases. However, the observed effect estimate is small, and this may be attributable to residual confounding from the incomplete measurement of potentially confounding or mediating factors.

While loneliness may not cause heart disease, the correlation is definite between loneliness and increased incidence of heart disease.

One study examined whether loneliness predicts cardiovascular and all-cause mortality in older men and women and reported that cardiovascular disease accounted for 59.2% of all deaths in the selected cohort. Across the remaining studies, 5,073 CVD events were reported, and the Hazard Ratio (HR) of new CVD when comparing high versus low loneliness or social isolation was 1.16 (95% CI 1.10 to 1.22; see Fig. 4). In another words the poor social relationships were associated with a 16% increase in risk of incident CVD (P < 0.0001). The large P-value for heterogeneity of 0.16 (> 0.05) and the l² of 36% both indicate that heterogeneity was not present. So we didn’t need to perform subgroup analyses according to risk of confounding and risk of bias due to outcome measurement error.

Heart disease is but the latest health problem correlated to social isolation and feelings of loneliness. Social isolation has been found to be positively correlated with increases in dementia2 as well as compulsive/addictive internet usage among young people3.

As a direct consequence of these correlations, loneliness, while a mental health condition, is one that actually has physical symptoms even on a day-to-day basis. The research4 establishes that strong of a link between loneliness, social isolation, and physical ailments.

Loneliness is associated with physical health symptoms on a day-to-day basis, especially for people who are highly variable in loneliness. Considerations of multiple sources of variation in daily loneliness may be necessary to adequately address loneliness and promote health. Public health interventions addressing loneliness may be most effective if they support social connectedness in people's everyday lives in ways that promote stable, low levels of loneliness.

The research leaves little room for doubt or even debate on this point. To be lonely is to be sick, or at the very least less healthy.

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Loneliness and social isolation are emerging in a variety of ways in people, underscoring that this is no small mental health concern. A recent poll by the APA shows Americans to be more anxious, feeling more stress, and getting less sleep.

When asked about a list of lifestyle factors potentially impacting mental health, adults most commonly say stress (53%) and sleep (40%) have the biggest impact on their mental health. Younger adults (18-34 years old) are more likely than older adults (50+) to say social connection has the biggest impact on their mental health. Despite the increasing anxiety, most adults have not sought professional mental health support. In 2024, just one in four (24%) adults say they talked with a mental health care professional in the past year. Notably, younger adults (18-34) are more than twice as likely as older adults (50+) to have done so.

These latest research findings are grimly very much in line with other studies showing confirming a steady decline in mental health in this country, and even in generational mental health.

What this data does reiterate is the role social support systems and strong interpersonal relationships play in sustaining one’s mental and emotional health. If people’s mental and emotional health is suffering, there is good reason to look to the state of their social interactions (or lack thereof) when looking for ways to mitigate the problems.

This data also underscores the need to continue to elevate conversations about mental health issues, and to constantly strive to destigmatize mental health concerns. It is a perverse and brutal irony if feelings of loneliness and social isolation become a recursive cause for continued loneliness and social isolation.

Given that the incidence of Childhood PTSD is on par with that of Combat PTSD in this country, it is clear that we absolutely must not be indifferent to people’s mental and emotional health challenges.

It takes no great leap of logic to surmise that challenges such as PTSD are a contributing factor to people experiencing loneliness and social isolation, and having not just their mental health but also their physical health suffering as direct consequence.

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There are numerous mental health resources, free and otherwise, available in most metropolitan regions. My own city of San Antonio has an abundance of support groups as well as therapists. People who need professional care for their mental health have, in many regions, resources to assist them in getting that care.

Yet we should also be mindful that social support systems and interpersonal relationships are not the province of counsellors and therapists, but of ordinary individuals. Not only is talking the best treatment for most mental health challenges, but talking among friends—in having the reassurance and support of committed friendships—goes a long way towards improving everyone’s mental and emotional health.

It is important to understand that the best therapies for resolving PTSD involve talking. While friends and other members of a person’s support network are not clinically trained therapists, and cannot provide the structured talk therapies available in the clinical setting, everyone has the capacity to listen, everyone has the capacity to create a safe and nurturing space where people can discuss their inner turmoil, and people grappling with trauma especially need that safe and nurturing space in which to talk.

Anyone can make a difference in someone else’s life simply by reaching out a hand of friendship. Simply by being a friend, each of us has it within his or her power to directly confront the loneliness and social isolation that is complicating everyone’s overall health outlook.

These latest research findings reiterate what we truthfully have always known, and of which we should be constantly mindful: our communities and our society will do best if we focus on reaching out to those around us. We have the power to make people’s lives better, and to therefore make our communities better, just by reaching out a hand of friendship to someone who is in need.

Loneliness is on the rise in this country. That means mental health is on the decline—and that means that physical health is likewise on the decline. These latest research findings do not admit of any other conclusions.

Loneliness means people are suffering from a lack of friends. We have the power to change that. The data is telling us that we need to change that. We need to change that now.

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While most people somewhat naturally associate PTSD with soldiers who have been in combat, combat PTSD is but one type. Trauma can occur anywhere and impact literally anyone.

One particularly vulnerable demographic for trauma and incidence of PTSD is children. According to the National Center for PTSD, nearly half (43%) of all boys and girls will experience at least one trauma during childhood or adolescence. Of those experiencing at least one childhood trauma, up to 15% of girls and 6% of boys will develop symptoms of Post Traumatic Stress Disorder. For comparison, nearly 7% of veterans will develop symptoms of PTSD, with 13% of female veterans showing signs and 6-7% of male veterans developing symptoms.

In other words, roughly as many children develop symptoms of PTSD in this country as do soldiers who have been in combat.

Let that thought sink in: in this country, roughly the same numbers of children develop signs of PTSD as do soldiers in combat.

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What causes PTSD in children? Obviously, exposure to traumatic events, and frequently to multiple or ongoing traumatic events:

• Physical, sexual, or emotional maltreatment

• Being a victim or witness to violence or crime

• Serious illness or death of a close family member or friend

• Natural or manmade disasters

• Severe car accidents

What makes childhood PTSD particularly troubling is that many of the involved traumatic events involve the family or take place within the family setting. Physical and sexual abuse often occurs in the home, and even when the physical abuse comes in the form of bullying outside of the home, ineffective responses from parents—which can often equate to emotional neglect and maltreatment—can compound and exacerbate the trauma.

Childhood PTSD is made even more tricky to assess and to treat because many of the symptoms particularly in boys can overlap those for Attention Deficit Hyperactivity Disorder (ADHD).

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One aspect of Childhood PTSD that makes it qualitatively different from other forms of trauma is that, because the traumatic events occur during the developmental years, the impacts are unavoidably life-altering. A great many maladaptive behaviors which occur during the adult years can be traced back to traumatic events during childhood and adolescence, even if the individual is not aware of the connection.

Sadly, many people fail to see the connection between their childhood trauma and their adult-life thoughts and actions. Due to such lack of understanding and association, they sometimes think of themselves and their adult-life symptoms as crazy. They simply don’t understand that their upbringing was lacking and left them without a positive sense of self or needed life skills, and their emotionally escapist behaviors are an adaptive response to what they experienced. In other words, they don’t understand that their problematic adult-life choices are a coping mechanism, typically started early in life, that is now being (maladaptively) used to deal with emotional discomfort.

While this is not the same as saying that the discrete symptoms of Childhood PTSD last a lifetime, there is no denying that childhood traumas, particularly repeated or extended traumas (e.g., physical and sexual abuse), almost unavoidably alters the trajectory of a person’s life and psycho-social development. Difficulties with interpersonal relationships, and even heightened risk for alcohol and substance abuse, are not uncommon consequences of repeated exposures to childhood traumas. The shattering of the ability to trust in childhood can have lasting impacts on the ability to form healthy relationships going forward.

When an individual experiences traumatic events as children, it can shatter our sense of safety and trust in the world. You may learn that relationships are sources of pain rather than comfort. This can lead to a fear of vulnerability and a tendency to keep others at arm’s length. You may struggle to open up, communicate our needs, or allow ourselves to depend on others. Research has shown that childhood emotional abuse is linked to insecure attachment styles in adulthood, particularly anxious or avoidant patterns. You may cling to partners out of fear of abandonment or push them away to avoid getting hurt.

To the extent these unhealthy attachment styles persist into adulthood, there is also an increased risk of being re-traumatized in adulthood, as the individual may subconsciously be drawn into dysfunctional relationships which are a replay of the earlier childhood traumas.

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Are childhood traumas a contributing factor to the generational decline in mental health that has taken place in this country over the past several decades? Quite possibly. Certainly the extent that any prevalence of childhood trauma or abuse is increasing is going to contribute to an overall decline in mental and emotional health within any generational cohort.

At a minimum we may safely conclude that any individual coming out of an abusive family environment while growing up is also less likely to have mastered many of the essential life skills or learned the essential life lessons necessary to buffer their adult lives even without the added complications of PTSD and exposure to childhood traumas.

Regardless of when a person experiences trauma, however, a key determinant in their ability to move past the trauma and move back towards healthy and productive living is the presence of a strong social support network.

One of the most powerful protective factors for adult survivors is a strong support system. Surrounding oneself with caring, understanding people can provide a buffer against the long-term effects of trauma. Building a chosen family of supportive friends and mentors can be instrumental in the healing process. Having people who validate experiences, offer compassion, and provide encouragement makes a significant difference. 

While there is a great deal of benefit to the support offered by other PTSD survivors, it is important also to understand that validation, compassion, and encouragement can be offered by anyone willing to meet other people where they are, and to be present in the moment with other people.

It is important to understand that the best therapies for resolving PTSD involve talking. While friends and other members of a person’s support network are not clinically trained therapists, and cannot provide the structured talk therapies available in the clinical setting, everyone has the capacity to listen, everyone has the capacity to create a safe and nurturing space where people can discuss their inner turmoil, and people grappling with trauma especially need that safe and nurturing space in which to talk.

When we listen to people, when we make them feel safe about opening up regarding their inner turmoil, we give them space to address their trauma history and move that much closer to healing. When we validate that their traumas are real, that their inner pain is real, and that they are not “broken” or made less because of their experiences, we give them hope that real healing can be had.

People may not have the same shared experiences of trauma, but to the extent that life has its share of traumas and adversity, nearly anyone has a foundation for connecting with others over their experiences of suffering.

We may not share similar experiences with others, but it is certain that we all suffer in some way, and that we are all tempted in some way. Perhaps by seeking to understand our own suffering and our own temptations we will find the wisdom to offer meaningful aid and comfort to others who are suffering and who are tempted.

We do well to remember that social support networks are networks of friends, of co-workers, and even of family members. Social support networks are not dependent upon clinics and therapists with degrees and licenses to tack on after their name. Anyone can be a part of a person’s social support network—just make the commitment to be a good friend and an active listener with that person.

The more we listen to people grappling with PTSD, the more we encourage them to talk about their traumas, and make them feel safe revealing their traumas, the closer they will come to achieving lasting inner peace and true healing.

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June is PTSD Awareness Month. This is the month when many organizations—including The Houses Of Refuge Project—will be making extra effort to promote dialog and discussion about PTSD and other mental health challenges.

Yet the most important dialog and discussion about PTSD, or indeed about any mental health challenge, is the one any of us can have with someone struggling with PTSD, as well as any other mental health challenge. The best thing any of us can do to assist someone in recoverying from trauma, childhood or otherwise, is to talk to them, and especially to listen to them.

By talking, by listening, and by meeting people where they are, each of us has the capacity to build up the support networks we need to buffer the slings and arrows of outrageous fortune called “life.”

The more we can meet people with respect, with care, and with compassion, the more we can aid those who struggle. A little time and a whole lot of listening can make all the difference to those in pain.

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What if the old dogs aren’t the ones who need to learn the tricks? And what if the tricks that need to be learned aren’t new?

When it comes to the average mental health state of our younger generations, we absolutely need to think about these two questions. A growing body of data suggests that it’s not the “old dogs” who need to learn the “tricks” of mental health maintenance, but the “new dogs”—and it’s the “old dogs” who have the “tricks” the “new dogs” need to learn.

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A Gallup poll from September of last year showed that “Generation Z”—those born from the mid-1990s through the early 2000’s—are experiencing significantly lower levels of self-assessed mental health than earlier generations:

A smaller share of Gen Z is thriving compared to millennials at the same age, and members of Gen Z are far less likely to describe their mental health as “excellent,” according to a new study.

“Less than half (47%) of Gen Z Americans are thriving in their lives — among the lowest across all generations in the U.S. today and a much lower rate than millennials at the same age,” a report from Gallup and the Walton Family Foundation said.

What often gets overlooked about this study data is that, just as millennials are doing better than Gen Z Americans, Gen X Americans are doing better than millenials, and Baby Boomers are doing better than Gen X Americans, if we look at the percentages self-reporting poor mental health.

Note how the distributions from “Poor” to “Excellent” mental health and emotional wellbeing shift from Baby Boomers down to Gen Z: 14% of Baby Boomers rated their mental health as “Poor” or “Only Fair”, but 36% of Gen Z members gave one of those two assessments, and each generation reported noticeably worse levels of mental health.

The older generations are reporting higher levels of mental health and emotional well being than the younger generations. Why is this?

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Nor is this a new finding. A 2018 study by the American Psychological Association titled “Stress In America: Generation Z”, showed a similar trend.

Our 2018 survey results show that high-profile issues, such as sexual harassment and gun violence, are significant stressors for Gen Z. America’s youngest adults are most likely of all generations to report poor mental health, and Gen Z is also significantly more likely to seek professional help for mental health issues.

Even before 2020 and the COVID “Pandemic” completely fractured daily life for just about everyone, younger generations were showing themselves increasingly less resilient than older generations. Why was this? Why is this continuing?

Pre-pandemic, even millennials were faring noticeably worse than Generation X and the Baby Boomers, as a 2019 Business Insider examination of the mental health state of millennials reported.

A recent Blue Cross Blue Shield report found that millennials are seeing their physical and mental health decline at a faster rate than Gen X as they age. Without proper management or treatment, millennials could see a 40% uptick in mortality compared with Gen Xers of the same age, the report found.

This report is from 2019—before the pandemic and most importantly before the mRNA inoculations began skewing mortality statistics in the US—and Blue Cross Blue Shield was reporting then that millennials might show a 40% uptick in mortality relative to Gen X.

Millennials in 2019 were demonstrably more fragile and less reslient than Generation X. Why was this? Why is this continuing?

Broad generalizations are always inherently dangerous, but one reported possible cause for Generation Z especially was identified by the Cleveland Clinic in 2019: changes in parenting styles and techniques—changes which were themselves triggered by significant events which impacted the parents of Generation Z members, according to Psychologist Scott Bea, PsyD:

“This is a group whose parents were experiencing 9/11 when they were young ― 6 years of age or younger. Our world really changed and we became more sensitive to threat,” Dr. Bea says. “During this time, the news media exploded as more and more people wanted news and we started engaging in more safety behaviors.”

As parents became more protective, children had fewer developmental opportunites in which to build out their repertoire of coping skills.

If we’re not allowing young folks to solve problems … to develop active coping strategies, we’re robbing them of those opportunities. And while we’re doing that, in a benevolent way and for a good cause, we may be inadvertently handicapping them at the same time.

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What this data shows is not just that younger generations’ mental health has been steadily deteriorating literally for years and even decades, but also that at least a portion of that deteriotion may be fairly attributed to a lack of “generational wisdom” being transmitted from the Baby Boomers and Generation X to their millennial and Gen Z offspring. Whether as parents, teachers, or mentors, the older generations have not transmitted their life lessons (and the skills which accompany them) to younger generations.

While each era and even each day presents challenges which are unique unto themselves, the one constant in every era and on every day is that there are challenges. People face adversity at work, at home, in school, and in the community nearly all the time—and always have.

Adversity happens. People must either adapt and grow through that adversity or be damaged and even destroyed by it.

The growing body of evidence suggests that younger generations are not adapting and are more likely to be damaged or even destroyed by their experiences of adversity.

The growing body of evidence suggests that older generations have the tools, the life skills and life lessons, younger generations need to be better able to adapt and avoid being damaged or destroyed by their experiences of adversity—and those tools, life skills, and life lessons are not being transmitted to the younger generations.

We can change this. We must change this. A major reason I made the decision to shift my focus with All Facts Matter, as well as to start The Houses Of Refuge Project, has been to address this lack of “generational wisdom” transfer.

How do we transmit life experience and life lessons from one generation to the next?

Ideally through parenting. The very process which has in large measure helped create these challenges is the very process which is best suited to reverse the trend. What has not been done, or at least has not been broadly done well, needs to be done better in the future.

Yet it need not all be on the parents. Those who have lived a life—especially those who have gone through a time of darkness and tribulation, and come out the other side—have powerful stories those who are just starting their lives need to hear. We need to tell those stories.

Nor is it merely a question of telling powerful stories. Whenever people face adversity, the community around them intrinsically has the capacity to offer caring, compassion, and respectful assistance. I also believe the community has the calling to do exactly that.

We do not need to have fancy credentials, or extensive education. We but need to have a generous heart. We but need to choose to extend the helping hand, and to stand between the one needing the safe space and whatever violence threatens to come down upon him from the world. We but need to show tenderness and compassion. We but need to have mercy.

What the ever-expanding body of evidence tells us about the mental health state of our younger generations especially is that the need for caring, compassion, and respectful assistance is growing in just about every dimension.

What the ever-expanding body of evidence tells us about what our communities are doing to address the adversity confronting younger generations especially, but truly all generations, is that not nearly enough is being done, and absolutely more needs to be done.

Everyone has their own prescription of what that “more” is. My prescription is to focus on the simple solutions first and foremost. A pair of shoes, or a new suit of clothes, or even a monthly bus pass can easily be the difference between a person getting and holding a job, or losing that job. Taking the time to mentor and tutor people in both technical and life skills—which is nothing more than people who know sharing their knowledge with people who do not—increases everyone’s potential to contribute both in the workplace and in the community.

In the process of doing these simple things, a simple message is communicated to younger generations especially: there is always hope because there are always people around who care enough to help.

The data shows that this is a message younger generations desperately need to hear.

Fortunately, the data also shows that the older generations have the wherewithal to send that message to the younger generations.

The data is telling us that it is past time for the older generations to make a renewed effort to send a message of hope to younger generations. The data is telling us that it is past time for the old dogs to start teaching the new dogs some old tricks.

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