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Perspectives on mental health can vary across generations, sometimes dramatically so, and these differences are not always transparent. For help decoding the different ways that generations perceive mental health issues, we reached out to FHE Health’s director of dialectical behavior therapy, Arielle Kanitz, LCSW, DBT-Linehan Board of Certification, Certified Clinician™. Kanitz has experience working with patients representing a wide range of generations, from the very young to the very old. She shared her insights below, starting with how attitudes towards mental health, including stigma, have evolved across generations.
The Evolution of Stigma and Attitudes Towards Mental Health
What generational differences has Kanitz observed in terms of attitudes towards mental health?
“With generations such as the Boomers and the Silent Generation (parents of boomers), there’s a real stigma around mental health,” Kanitz said. “They come from a period when we just didn’t have these types of conversations.”
“If you were getting mental health treatment,” Kanitz elaborated further, “it was because you were crazy and were getting medicated—there was no in-between. You weren’t treated on an outpatient basis.” She added as further context that it was not until the 1970s that insane asylums disbanded.
Gen X’ers in that 40s age group carried some of that same stigma, according to Kanitz. She said their approach to mental health was largely “‘suck it up and deal with it.’”
What about Millennials? (They and Gen Zers have made headlines lately because of reportedly higher rates of anxiety and depression.) Kanitz said Millennials as a group are more anxious. She made an educated guess as to why: Millennials grew up in the 1990s, a period characterized by “crisis after crisis.” That was when the U.S. saw a rise in school shootings, Kanitz said, noting how 9/11 happened soon after. Millennials were “quite young” during this period, “so their brain development may have been more affected,” Kanitz added.
As compared to earlier generations, Gen Z’ers are the “most vocal about mental health struggles” and “embracing of mental health issues to stop that stigma,” according to Kanitz. She noted that Gen Z is “the only generation that has from the beginning had internet, social media, and a broader pool to get info from,” and “this can make mental health seem more prevalent than it really is.”
Unique Challenges Younger Generations Face When Seeking Mental Health Treatment
If less stigmatization of mental health issues among the younger generations makes seeking treatment easier, there are other challenges unique to this demographic that can complicate mental health treatment. An “overabundance of information,” was one example. “In previous generations, you’d start with a doctor or psychiatrist who then referred you to a therapist,” Kanitz explained. “Now, because of an open market, you become the one who makes the choice. People may go to a lot of therapists and not be able to find the right one—they’re not necessarily getting the right fit.”
Another consequence of too much information everywhere is that people are “coming into therapy with too much knowledge about mental health and self-diagnose themselves,” Kanitz said. She cautioned that “going on the internet and getting a diagnosis is not the way to do it; there may be tons of info but that can also be overwhelming, and there is a lot of misinformation.”
How Older Generations View Therapy and Medication Compared to Younger Generations?
Older generations can be more inclined to certain stereotypes about therapy and medication. Kanitz remembered a client in her 80s who, based on largely outdated, Freudian-inspired concepts of psychoanalysis, was under the impression that Kanitz was not supposed to say anything to her during their therapy session.
With medication, “a lot of people who think about psychiatric meds picture One Flew Over the Cuckoo’s Nest, and a lot of people who have never taken psych meds will ask if it ‘will make me a zombie.’”
Cultural Differences in Patients’ Approaches to Treatment
There can be cultural differences in patients’ approaches to treatment, thanks to a good deal of racial, ethnic, and religious variation, Kanitz said. One difference is the tendency in certain cultures to lean on the family and community for mental health before consulting a stranger. Kanitz also noted that “in certain religions, if a person seeks help outside their religion, that can be shunned upon.”
Kanitz was also quick to point out that there is “disparity in the treatment of mental health based on race,” noting how “people of color receive subpar care” and that “bias is built into the system.”
Technology’s Impact on How Patients Seek and Receive Care Across Generations
In a bewildering revolution over the course of several years, telehealth and telemedicine have transformed therapy from an in-person service to a largely virtual one. That has its limits. Kanitz observed that “most older generations don’t even attempt telemedicine,” and that telehealth also “doesn’t work well with adolescents.” As a provider, Kanitz has also noticed a “difference between telehealth versus in-person”: “It’s harder to know the vibe of someone via a screen.”
Changes in the Frequency of Mental Health Diagnoses Across Different Generations?
Anxiety was the recurring theme when we talked about the frequency of mental health diagnoses among the younger generations. “Kids in high school have a unique sense of pressure,” Kanitz said. Factors like the “pressure to perform, the state of the world, and a fear-driven culture with catastrophe unfolding somewhere all the time” are driving the anxiety.
In contrast, the late-life period is “marked by loss”: the loss of a career and one’s identity; the loss of freedom with new physical limitations; and the loss of loved ones, “so for this age group there’s a lot of depression.” Kanitz pointed out that “the Silent Generation is one of the most ignored populations in mental health.”
Differences in How Patients of Different Generations Respond to Treatment
Are there any differences in the way patients of different generations respond to treatment approaches? The main difference, according to Kanitz, is that there tends to be “more of an openness in hearing treatment options” among the older generations, whereas “some of the younger generation with Dr. Google on their side will give more pushback about treatment approaches.” Members of the younger generations may come in knowing what they want, but older generations don’t typically know.
Addressing the Stigma of Mental Health for Future Generations
We ended our conversation by asking Kanitz what she believed needed to change to reduce the stigma surrounding mental health for future generations.
“A lot of work is being done,” she said. “The biggest piece is normalizing these experiences. Most people in their life will have some mental health struggle. That doesn’t mean it will be a diagnosable issue, but normalizing is important and validating ‘me too.’”
