Mental health has become the first line among the young population, in social networks. Have any prejudices fallen or is it just an illusion?
Elena: Mental health is present on social networks, but because young people use social networks to talk about everything, they also give us a certain anonymity to talk about some things, which does not mean that tobacco does not exist. However, it's something we have to be careful about, because many times we show up too much, and a lot of things aren't for counting them on Twitter or on others like Twitter. It is necessary to talk about mental health and its consequences, break tobacco, but at the same time self-care is also fundamental and disseminate what happens to you can be dangerous, because by telling your reality gives legitimacy to other people to express their opinion about what you live, and what is important is not the opinion of others, which is what you do not need at that moment, but to point out that this reality exists. Breaking tobacco is OK, but on top of that is self-care, if you're not willing to tell what happens to you, don't tell.
Leire Pinedo: The taboo still exists, although it is true that the issue is opening up a little bit, on social networks, in the media ... and famous people have also appeared telling their experience. It's also a little fashionable, it seems that it's well-seen talking about mental health, but that also involves the dissemination of inappropriate information, and sometimes you blur what mental illness is, it's associated with violence, etc.
Idoia Agirre: Before they were not visualized, and now, on the contrary, the network effect is large: one says, the other repeats and expands ... Tobacco and totem are what we do with mental health, on the one hand, hide it. On the other hand, we say “this is so”, because we increasingly know more about these issues, but we do not know everything, and we are also children of our society and culture, in other cultures they respond differently to the same problem or situation, for example, because we understand love or death differently.
Elena: I know many young people with problems similar to those I had, anxiety, etc. Sometimes we deny that we have something and believe that we are unique, but by no means, the truth is that there is no talk about it. I threw it on Twitter telling me how I felt, and many people of my age wrote me, asking me how to seek help, what steps to take, how to go to the psychologist ... Because nobody gives us all this information.

The Wonderful messages, repeating that happiness and well-being are in our hands?
Aguirre: They're slogans taken from here and there. We know what they mean, but they're not right and they don't help what's going wrong. They're individualistic messages, and everyone's responsibility is fine, but they're responsible for what they can do, because not everything depends on each one.
Pinedo: Self-help messages don't help because life doesn't. In real life there's suffering, we have unpleasant emotions and situations, it's not true that you can get anything if you want to... and these kinds of messages make us more vulnerable because we don't get what we expect, and because it's more appropriate to recognize that we suffer and live undesirable situations. In addition, they increase the feeling of guilt, because they're telling you that if you're wrong it's because you haven't tried enough.
Elena: Suffering is a common and important component of our lives, and understanding and accepting that is a great advance, I've learned in my process. Of course, nobody wants to suffer, but understanding that you have to suffer when you adapt is not the usual, because we often do a constant rationalization to avoid that suffering, and on the contrary, we have to accept emotions, know how to live with what we feel, to start developing everything else from that point of view.
We have already mentioned social networks, what do we do in them? To imagine that everything is perfect, as if sadness doesn't exist, and making negative emotions invisible is a big problem.
Pinedo: Because everyday life is not extreme: not being very sad, not that joy and perfection in social networks. Having breakfast, going to work, taking the bus, getting bored -- and I can feel that my life isn't as good as social media imagery.
Elena: M. If Wonderful is a phrase that wants to oppose the messages, it gives me a lot of anger: “It’s OK that it’s wrong.” When I was wrong, I stopped going out in the street, learning, having relationships... and when I read “nothing happens because I was sad”, I thought “yes, a lot happens”. That is why we have to recognize sadness, yes, and we have the right to be sad, but at the same time we have to understand the consequences of that sadness, to the extent that in my case, for example, you do nothing, until we stop being people ... The consequences of their bad state are often difficult to digerir.La people think that being bad is being sad and that behind that sadness there is a great reason, that the
father has died or something like it, but in my case I lived more restlessness than sadness – I had tachycardia – and there was no main reason, there was no trauma that led me to depression, and people struggled to understand it. I didn't know what was happening to me, the only thing I knew was that at home I spent the day lying in bed lowering the blinds, and I started working with the psychologist that same thing, the illness itself, how to manage this situation, not the reason to get to it.
Pinedo: In each case it is different. Sometimes it's a punctual problem, like you've got a lot of pressure at work and it's led to anxiety, and if the rest of your life is fine, it's easier to get out of that situation. On other occasions there may be forms of relationship, thoughts or fears that we have been developing, even if we are not aware of it. For example, requiring us to be more productive than we can, because the message we get is that, because the life we live is very normalized. Look at what has happened in the pandemic: we have lived through something serious, and we have been asked to continue feeding the wheel of the system, which we would like when we needed, to think, to rest...

Although the topic is more present, it can be a generalized feeling, “It will not happen to me, I am psychologically strong.” On the contrary, the data indicates that many of us suffer from mental illness throughout our lives. Is there any profile that might be more predisposed? Are there psychologically more “weak” people and “stronger” people?
Aguirre: The psychiatrist Jorge Tizón says this: “Health is a positive and general concept, and above all it is not that there is no health”. That is, health is not opposed to disease, health is the balance a person has achieved at a given moment, and it can be healthy to get sick at a moment, if that helps you progress. If something has happened to you, you can't follow at the same pace, you have to stop and look for a place of care... We all have the right to get sick and to supplement at a given time.
Pinedo: Many of us say that we are going to have some mental illness and we are surprised by the amount, surely because when we talk about mental illness very serious diseases come to mind, but most of the cases I see in the daily consultation are not serious, they are more situations that at a given time are not well managed, or something has happened and there is a reaction, like the death of someone you want. It asks for more prone profiles, there are no weaker profiles, but those that have characteristics associated with neuroticism: with many changing emotions, with a tendency to live things with a lot of tension or guilt, with very high physical symptoms, or stiff and with greater difficulties to adapt to changes... The truth is that, beyond individualizing these characteristics or thinking that it is genetic, sometimes the environments and situations experienced have been able to develop in us these kinds of tendencies and insecurities.
Elena: I would add that sensitivity can also be related. What happens is what matters so much that you will surely be less likely to suffer from anxiety...
Pinedo: Yes, but at the same time, what you might care about is not anxiety, but problems controlling violence. Mental illnesses are very varied, although it is true that the two most frequent are depression and anxiety.
Elena: And the adjectives “strong” and “weak” are not appropriate. I am very psychologically strong, I face very well mentally the pressure, for example, the physical pain, and look, I've had depression.
Pinedo: We all have our weak and strong points, and when we touch those points we can fall, one will fall when the father dies and another with something else ...

What are the most common prejudices?
Elena: You've suddenly gone crazy, you've become a weird person...
Aguirre: What we have just mentioned relates it to the weakness of mental illness.
Pinedo: And associating mental problems with very serious illnesses, but most of them are mild psychological problems and can have an easy solution.

Research suggests that low-income people have more mental problems. Is mental health a classicist?
Pinedo: If you live in poverty and precariousness, you don't have security in your life, if you're worried about having to eat or your children's future -- it's easier to fall into anxiety or depression.
Aguirre: I would highlight the accessibility of surveillance zones. I mean, when you're sick, do you get to those care zones, enough and enough?

Research also says that women have more mental illness. Does mental health have gender?
Pinedo: On the one hand, we women have more pressure, because in employment we have to add care tasks. On the other hand, culturally, women demand more psychological help, so they are more diagnosed. This does not mean that men have better mental health, but that they face difficulties in a different way; we should look at alcohol and/or drug use.
Aguirre: It is interesting, since in adulthood women talk more easily about these issues by the models we have internalized, but if we look at the statistics of children and adolescents, the majority that is diagnosed is the boy, and the hypotheses indicate that there may be a cultural sense behind, how they express the incapacity of each other, autonomy, development, expressiveness of aggressiveness...

And is mental health old? Data indicate that the number of people with mental illness has increased considerably among young people. To what extent does the pandemic influence all this, to what extent does the lack of perspective that many have for the future influence?
Pinedo: Everything has influenced. In Pandemia, for example, the importance of social relations in youth has been highlighted.
Aguirre: Some have made crak in the pandemic, that's obvious.
Elena: And the insecurity that young people have is also enormous. We finished the studies but we have no work and if we have work the conditions are very precarious, until the age of 35 we have to live in the parents' house...
Pinedo: We are not fair to young people, it seems that the problems of young people are not so important, we hear that the university era is the best time of life, but what Elena has said is to be very young. As with adolescence: it is a very delicate and hard stage, it changes the relationship with the parents we had as references, with friends, with emotions beyond control... and for adults the problems are others, linked to work, etc., but we must understand that young people can feel marginalized, that nobody understands them, and that besides the individual problem is always important.
Aguirre: There's a bias, like childhood and youth were happy times without conflict, and I think it's the trap that we adults do, as if we adults suffer alone. There is also the construction of human psyche, because we leave many things in the unconscious, we silence them, we forget them... Because we want or need to get away from them. Denial is a great necessary defence, but it does not mean that this reality has not been realized.
Elena: They call us glass generation because adults look at us with the needs they had when they were young, and the situation is not the same. For them, we are crystal clear and weak, because we accept as a generation that we are not well, because we denounce how we feel. It seems to me that we are doing a very good job, denouncing all this, because not having been denounced by the generation of our parents does not mean that it did not exist. We are able to say “look, this happens to me, this is a reality and it is a problem, the system is not willing to face it”.
Pinedo: Every generation has their own struggles. I also see that young people are easier to go to the consultations, to talk about emotions in the consultations, and that is good. In the first consultation, adults often come with many fears, what others will think, if they are crazy... and young people naturally accept to go to the psychologist. That's important.
Aguirre: When I hear the crystal generation, it gives me something to think about, because it suggests fragility, but also transparency. We'd like to be transparent, easy to understand, because in these times we want to know everything and we think we have everything at hand, but we're not transparent and easy to understand, we're complex, contradictory, subjective beings -- and with mental ills, we don't understand them. That disturbs us.

In the news reports, we have been bombarded by the images of the young righteous. Is it not precisely a juerga and a young man hiding in the fortress of the house, who has to worry us? Has the tendency to isolation favored the pandemic?
Elena: I believe that the issue of street rigors has been an invention for political purposes, which is not enough for the debates it has aroused. And on the isolation at home, in the case of some you would have had what you say, for others it may have been the opportunity to stop, to stop at a frenetic pace. I was well in lockdown, precisely because I had just come out of the depression and I had the opportunity to be calm without any pressure and without having to explain.
Aguirre: Isolation I associate with forced isolation, pribation, and that generates frustration. Another thing is voluntary retirement, because often only the young man is in the room, but he's not alone, he's playing or talking to his friends by computer. To see if that young man has something, we'd need more data.

Data indicate that the increase in suicides is also remarkable. Is suicide the clearest sign that mental illness has not had a response, or a satisfactory response?
Pinedo: The association of suicide only with mental illnesses is not correct, it is related to suffering, but not always with the disease, and the majority of patients with mental illness do not commit suicide. If mental illness is a risk factor, it is not the only one, and if we only focus suicide on mental illness, we will not focus on other areas, such as the inability to lead a dignified life or the precariousness of life are risk factors.
Aguirre: And I would add that our society is in crisis, Freud talked about how we also experience the Society's discomfort, and that we have to reflect as a society, if our young people prefer to die, than to live in this world. After all, this world is much larger, adults we send and regulate, and young people can feel frustrated with our organization. Precariousness, lack of illusion... has already been mentioned by Elena.

Do we address suicide from a proper perspective?
Pinedo: I have to give guidelines, what to do when I'm wrong, where to go... How resources are reported when dealing with male violence. But if not, making suicide visible is fine, I think it's good to talk about it, about errors, because we already know that talking about it doesn't have the effect of mimicking it. They also help the experiences of famous people who tell how they've come out of their suicide attempt and how they've come out of it.
Aguirre: That is, the key is to give useful information.
Elena: If we talk about communication, in the same way that public money has been invested to prevent other deaths, for example in car accident reduction campaigns, I believe that greater investment should also be made.

The way to care for mental health is to go to the psychologist?
Pinedo: Do we all have to go to the psychologist? If you don't need it, you don't have to go. Being nervous about a change and sleeping less that night is normal, but not lengthen insomnia one more month. When to go to the psychologist? Because when you can't live your life as you want (you can't go to work or school, you have difficulties in your relationships because of this, in the basics you don't get the body and for example you don't get hungry...).
Aguirre: There are many ways of caring, each one has to make its own way, but in that path the public health option must be easy and accessible: it is the government's responsibility to ensure a good health service, to articulate properly the relationship between specialists and family doctors, to integrate well the social services and the health... And when there's good health care, people do it easily, like when we have physical pain, we do it easily to the doctor.
Elena: From my experience, even being OK, I would recommend going to the psychologist. What I see among my friends is that they perceive who we have gone to the psychologist and who we have not, because after three or four years of therapy I know what to do when something happens to me, how to act with that emotion, I have it very systematized and learned. And I see that many friends who haven't gone to the psychologist, the problems are growing like a snowball. That's why it's important to work emotions in education.

In fact, it is emphasized that emotional education is fundamental. How should we educate ourselves to learn how to manage emotions?
Elena: To start with, emotional education is prevention: if we were taught from a young age to manage sadness, in youth we wouldn't be so hard, we wouldn't have that feeling, "What now?" What should I do with this feeling?” But my psychologist hates the word “manage” he mentioned, I said “I don’t know how to manage these emotions” and he answered me: “You don’t have to manage sadness, you have to take that sadness, accept it, mourn, move forward.” I did a thousand things, until I understood how I did it, and I developed my process, very useful to me, but I think everyone has to look for their own, because it's not worth the same to everyone.
Pinedo: We must accept and understand emotions, why we have them, how they relate to our behaviors and our thoughts. All emotions have their meaning and we have to pay attention to them, because sometimes we go very fast and we don't realize that the body is screaming at us. Emotions are useful, anger helps us to set limits, fear of certain risks, sadness to mourn and connect with others... but sometimes they assume and control our lives, they don't allow us to walk our way. The other sensations don't chain us to that level, I'm hungry, but I can decide to eat later, I don't live as something that I have to change that feeling of hunger, like we do with emotions. Let's act the same with emotions: if I'm angry, maybe in some relationships I don't put the limits right. Mr. above. Wonderful messages don't help: “You have to be happy.” Not always: you're angry and maybe it's the best thing at the time, or something bad has happened to you and you have to be sad, and the more you try to deny and avoid that emotion, the more it will intensify. We can balance emotions: if I'm overwhelmed at work, I'm going to run or listen to music, if that relaxes me. We can't avoid negative emotions, but we can add the positive ones to balance them.
Aguirre: I would say that in recent years there is a tendency to reconcile reason with emotions, at least in children I see how they are increasingly taking care of the world of emotions. But it's complicated, because everyone can understand emotions in a different way, and because every culture and even every generation has their own emotional education.

How can the people around you help? Starting with prevention, do we know how to identify someone who is not in good health when it's a head?
Elena: My parents saw that it wasn't OK, but they didn't know what to do to help me. My mother saw me lying in bed and told me that “I feel like I’ve made you wrong as my mother.” People didn't understand and I learned that I couldn't ask others to understand what happens to me, it's so complex and incomprehensible. They ask you, "Why don't you go out into the street?" and you don't know what answer, because you don't know why you can't go out into the street, but you can't go out. So what can people do to help her? If it doesn't judge you, it's no small thing.
Aguirre: Respect and not impose on the patient.
Pinedo: Think about it, sometimes you don't even know what you need, how you're going to ask someone else for help. It's not always easy for others to identify the disease, because we're very good.
Elena: Until the disease goes into the physical field, until it has some physical or physiological consequence, I think it does not identify itself.

Is reality beyond dichotomy psychological vs pill?
Elena: Depending on the case. At first I had a very pessimistic attitude towards medication, I didn't want to take anything, but then the pills have been very important and necessary to me, they have helped me to keep normality in a situation that was not normal. I have conjugated the medication with the therapy and when it came time to leave the pills, although they leave little by little, I was afraid, I would return to the first. But it's not, by the time you're told you can leave them, you're willing to move forward without them.
Aguirre: In my practice, the two pills and therapies can be supplemented at a given time. Sometimes, to be able to perform the same therapy it is necessary to decrease the level of agitation, fear or anxiety of the patient, provide a stability, and the pill helps to do so, is another resource. To carry out the mentalization process, in order to communicate correctly, self-regulation is necessary and, sometimes, the medication helps self-regulation. In addition, the drug is temporary, has a process and then is eliminated when it is not necessary. What doesn't have to become pills is a tool to worry about, like continuing to live in parents' homes, so parents can do everything.
Pinedo: The pills do, but when necessary. First, the patient should be informed about the available options. In public health, for example, sometimes the pills are prescribed more than they should, because it depends on the resources we have, that is, if there is not enough psychologist, or if the psychologist sees you within a month, the pill is used as a substitute and risks enquiring the problem. On other occasions, the covering reaction to certain events is used, a normal reaction but we do not want to live, such as duels. It's a message that the pill gives: what you feel is not right and I'm going to take it away; and it's a message from therapy: what you feel is normal in your situation, and what we have to change is your relationship with that situation or situation.

That's what the psychologist is working on...
Pinedo: We often aren't very clear about what it means to go to the psychologist, we think we're going to tell our problems and period. And it's not that, or it's not just that.
Elena: The first time I went to the psychologist I didn't know what I was going to do, it's not like going to the doctor, you talk, but it sends you to the next session... And it's very important to have a good feel with the psychologist. Imagine, I had three psychologists, until I found the best for me.
Pinedo: And that's a big problem, because it's not easy to find a psychologist good for you. The way each psychologist works is good for some patients and for others not, or it is not convenient to work with people, because things happen to psychologists too, and for example if I am a victim of male violence and a man comes to me who has these behaviors as a patient, it can be difficult conectar.Por another part, public health makes you a psychologist, but the frequency is very scarce, if you are lucky you will have a monthly session with the psychologist.
Who can turn to the private...
Elena: And there are very good professionals in public health, but the problem is that frequency, there's no continuity. Once every two weeks or once a month, if you're in an extreme situation, it's not enough.
Pinedo: There are many patients, we have the agendas full... More resources are needed.

Should the Administration strengthen mental health resources?
Elena: Yes, because health care must be comprehensive, physical and mental.
Pinedo: And being aware that strengthening therapies is a long-term investment, prevention for the coming years.
Aguirre: We need and need to demand more resources, improve and stabilise working conditions for workers, but I am a few years old, and the resources that have been created in these years are many, it must also be said. The child and youth network has been completed in the last 50 years in public health. At the same time, child and juvenile psychiatry was approved last year as a specialization, until now it did not exist, and the specialty of psychologist of children and young people is not recognized. We already have a way to go. And, I insist, accessibility is important, but in both directions it is important, on the one hand, to make available resources, and on the other hand, that the presence of the user is not kept waiting, because it is the responsibility of everyone to care for and improve public health. But there are often fears, prejudices ...

If mental health services are not strengthened, will they affect us in the future?
Elena: We are already suffering the consequences and they will only increase.
Aguirre: Or we would be naive or ambitious, if we didn't get that conclusion. We must be aware that we are vulnerable and we need care.
Pinedo: The World Health Organization has warned that it is a growing problem that must be tackled seriously, not only by investing in health services, but also in services that guarantee dignified lifestyles, because that is also prevention in mental illnesses.

CURRICULUMS:

Leire Pinedo Rodríguez. Inner Egoistic Psychologist in Osakidetza

Born in Bilbao in 1990, he graduated in Psychology from the University of Salamanca. In Osakidetza, the second year of Specialized Health Education is being developed to obtain the title of Psychologist Specialist in Clinical Psychology and to be able to practice as a clinical psychologist in the Public Administration. In addition to claiming his status as “advocate for the improvement of mental health care in public health”, he is interested in the dissemination of psychology and mental health to “break taboos and enhance prevention”.

Idoia Agirre Lasarte. psychoanalyst psychiatrist for adults and children

Born in San Sebastian in 1959, he holds a degree in Medicine and Surgery from the University of the Basque Country. He is a double graduate in Psychiatry and Psychotherapy for Adults, Youth and Children, in Lausanne, Switzerland. He currently combines private consultation with the work of Osakidetza's collaborator. She has worked as a communicator in various media and has lectured on child and youth mental health in children's schools, day care centers and schools.

Elena. depression and anxiety disorder

Born in a town of Bizkaia in 1999, he combines studies and work. For almost two years she had been diagnosed with depression and anxiety disorder. Both to put your mental health on the table and to help someone, you have left us a testimony of your experience, how you have lived it, what you have done and where you have gone. It is clear that as important as making the theme visible is taking care of oneself and not putting oneself under the spotlight, and that is why he asks for anonymity to participate in this colloquium.