Mental Health

Barriers to Mental Health Treatment

Examining The Barriers People Encounter When Seeking Mental Health Treatment And The Issues That Keep Them From Getting Help

Table of Contents

Lack of Awareness and Education
Stigma and Shame
Financial and Logistical Barriers
Racial Barriers
There is Hope

When you sprain your ankle or can’t shake a nasty virus, making a trip to the emergency room, or your doctor’s office seems obvious, at least if you’re fortunate enough to have the health insurance or financial means to do so.

What about when you can’t get a decent night of sleep for weeks at a time? Or when you feel too depressed to successfully complete a day’s work? Who do you call when you fear alcohol is becoming too much of a crutch in your daily life?

One in 5 individuals faces a mental health illness or crisis each year. One in 25 faces serious mental illness (such as schizophrenia or bipolar disorder). And more than half of these individuals do not receive the necessary treatment. That leaves 27 million Americans per year going untreated for mental health issues. That is an astounding number and certainly cause for concern. (2)

Untreated mental health issues or illnesses can lead to further problems for the individual, their family and loved ones, and our society. Struggling with mental health makes everything more difficult. School, work, and interpersonal relationships will all start to suffer as a result of poor mental health.

When one person struggles, so do their immediate circle. Family, loved ones, co-workers, and acquaintances will all feel the effects sooner or later. It truly is in each of our best interests to prioritize mental health for ourselves and the world around us.

Untreated mental health conditions can and will lead to:

  • Increased risk of physical illnesses such as diabetes or cancer
  • Shorter life expectancy
  • Lost income
  • Higher rates of disability and unemployment
  • Lower overall life satisfaction
  • Higher risk of suicide (5)

Knowing what we know, how is mental health not a higher priority for our nation? What are some of the barriers to seeking out the mental health care that we so obviously need?

These are very good questions with complicated answers. Let us examine some of the biggest obstacles to seeking out mental health care as individuals and as a nation.

Lack of Awareness and Education

Mental health includes our psychological, emotional, and social well-being. Where we lie on the scale of mental health affects our thoughts, feelings, and actions. Poor mental health is not the same thing as having a mental illness, but untreated mental health problems can eventually lead to mental illness.

In school, we are taught basic health and hygiene. We are taught the rudimentary aspects of a nutritious diet. We learn about sex in terms of preventing STDs and unwanted pregnancies. There may be the occasional lesson in how “drugs and alcohol are bad” and why we should avoid them.

What we are not taught is that our physical and mental health go hand in hand – that what we eat affects our brains’ efficiency. We aren’t shown what a healthy relationship looks like in sex ed (how ironic!). We don’t discuss the emotional distress that sometimes leads to drug and alcohol misuse.

It’s tough being a kid or teenager; we have all these emotions and feelings that we don’t necessarily have the language to explain or describe – and no one is teaching us!

Talking about feelings needs to be normalized, and the younger we start, the better. Emotions are an everyday part of life, yet from a very young age, we are encouraged to “walk it off”, “let it go,” and “just ignore” the people who are giving us grief.

Stifling the expression of our emotions to make the people around us more comfortable is absolutely normalized, and therein lies a huge part of the problem.

How can we verbalize our struggles when we don’t even have the language to do so? How can we ask for help if we’re unaware that we need it?

It should be said that things are changing. People are speaking more openly about their mental health struggles, and slowly but surely, the stigma of mental health struggles is diminishing. We still have a long way to go through, and it begins with basic communication.

We need to start having tough conversations before there is a crisis. Parents and adults need to be role models by openly discussing feelings and emotions and how to deal with them.

Our children need to be taught the language of emotions; how to name them, when it’s ok to act on them and when it’s not. They need to be taught how to ask for help when they feel overwhelmed or out of control. The sooner we can address our mental health issues, the less likely they are to turn into a full-blown crises.

Stigma and Shame

Most people who live with mental illness have, at some point or another, been blamed for that illness, a thing they have no control over. They’ve been told it was “a phase” or something they could overcome if they just tried hard enough.

This attitude does not necessarily stem from cruelty, but rather a lack of understanding, education, and awareness.

Stigma creates shame in those who are suffering from something that is not in their control. Stigma and prejudice prevent countless numbers of people from reaching out for the help that they need in order to manage their mental health symptoms.

Here are some ways that you and your loved ones can combat the stigma that surrounds mental health struggles:

Speak Openly And Candidly

Speak openly and candidly about your own mental health. If you are a parent or teacher, be open with your kids about tough emotions. If you’re having a bad day and are feeling grouchy, explain that to them. Let them know that it’s ok to feel “sad,” “mad,” or “worried.” Normalize casual conversations about uncomfortable emotions. Teach them by example that sometimes, just talking about negative emotions can help to alleviate them.

Educate Yourself And Others

Educate yourself and others whenever you see an opportunity to do so. If you hear someone making a rude remark about someone’s mental health struggles, gently intervene and remind the speaker that mental illness is an illness – it doesn’t define a person, and it isn’t something that they can control. If you live with a mental illness and feel comfortable doing so, speak openly about your experiences. Do this in order to remind people that you’re just a regular human being who happens to live with challenges that are a little different than what they’ve seen before.

Use Concise Language

Words are incredibly powerful; they can be used to build someone up or tear them down. We tend to use mental health terms too colloquially in our culture. “I’m so OCD when I clean my closet,”; “I’m so depressed I could kill myself”, and “I drank like an alcoholic last night.” Casual use of serious mental health terms can be problematic. It diminishes the seriousness of the issues and may inhibit people from coming forth with their struggles.

Mental And Physical Illnesses Deserve Equal Compassion And Understanding

We don’t expect someone with heart disease to just “get on with it” the way we do when someone is too depressed to leave the house. Many mental illnesses are diseases, just like cancer and diabetes. We need to think about the comments we make and the preconceptions we have, and if in doubt, do some research and ask some questions to better understand the nature of various mental illnesses. Whether an illness is mental or physical, people deserve compassion.

Be Honest About Treatment

Be honest about treatment if you’re in therapy or counseling. We don’t feel embarrassed or ashamed about going to the dentist, or our primary care physician for a check-up, so let’s normalize “check-ups” or therapy for our mental health as well.

Be Aware Of Self-Stigma

Mental illness is nobody’s fault. Everyone’s body is different, and so are their minds. People handle challenges in different ways, including mental health challenges. You do what’s best for you and do it proudly and unapologetically. You don’t owe anyone an apology for struggling with your mental health, but you do owe yourself compassion, acceptance, and a pat on the back for proactively taking care of yourself.

Financial and Logistical Barriers

The Affordable Care Act requires medical insurers to provide behavioral and mental healthcare, but services can still be costly and difficult to find.

An ongoing mental illness, such as major depression, can cost upwards of 10 thousand dollars a year. A 60-minute therapy session can cost anywhere between 65$-250$. Sadly, a lack of financial resources prevents many people from ever seeking out the help they need.

Money isn’t the only barrier to mental healthcare. People must also contend with the following:

Long wait times

94 million Americans wait over a week for mental health services. This may not seem terrible, but for each day of wait time, 1% of patients give up on seeking treatment. And many people wait much longer than a week.

Shortage of providers

There is a rapidly increasing shortage of mental healthcare providers. Finding the right provider, who takes the right insurance, that is a good fit for the individual’s needs is becoming more challenging by the year. More providers are retiring than entering the field.

Language barriers

Mental healthcare relies quite heavily on verbal communication, and the U.S. doesn’t exactly prioritize multilingual learning. Non-English-speaking individuals seeking out healthcare (of any kind, really) are more likely to face treatment delays, misdiagnosis, and inadequate care.

Complex healthcare systems

Just navigating between insurance companies and care providers can feel like a full-time job. Many Americans have no idea when, where, or how to even begin the arduous process of seeking out mental healthcare. (7)

Racial Barriers

84% of U.S. Psychologists are white, 70% of social workers are white, and 88% of mental health counselors are white.

White adults are most likely to receive mental healthcare at 23%; 13.6% of Black people and 12.9% of Hispanic people are likely to receive treatment.

People aren’t as open to seeking out help when they suspect their doctors or other care providers can’t or won’t emphasize with their cultural differences and experiences.

This is particularly troubling since:

  • 15% of African Americans, 13% of Latinos, and 11% of Asian Americans report feeling that they would have received better mental healthcare if they were White.
  • 31% of White children vs. 13% of children from diverse racial and ethnic backgrounds receive mental health services.
  • 16% of White adults receive mental healthcare vs. 8.7% of Black adults.
  • 88% of Latino youths have unmet mental health needs, compared to 77% of Black youths and 76% of White youths. (8)

There is Hope

In June of this year, the U.S. House of Representatives passed the Restoring Hope for Mental Health and Well-Being Act. (10)

It is a welcome (if overdue) response to the nation’s ongoing and increasing mental health crisis. The act specifically addresses our record levels of overdose and suicide deaths, our increasing child and adolescent mental health crises, and the adverse psychological effects of the Pandemic on the mental health of Americans.

While it is reassuring to see our government take decisive action toward addressing the nation’s increasing mental health crises, it’s important to remember that significant change starts with each one of us as individuals.

It is up to each of us to educate ourselves, our children, our loved ones, and our neighbors with open minds and open hearts. Legislature is well and good (and very much needed), but compassion, empathy, and awareness from those close to us go much further to uplift and support the individual who is struggling. Feeling alone and misunderstood makes things worse. Feeling valued and accepted even at our lowest points makes it easier and more likely that we will reach out and gather the support and resources that we need.



Not Talking About Mental Health Is Literally Killing Men

Our editor explains why we have to fix this silent crisis now.

Our mission at has always been to help men build themselves into better men. Stronger men. Healthier men.

Rooted in science and expert opinion, our content translates dense topics into easily digestible, actionable health advice. Piecemeal, the concepts are sound and effective. But overall health must be viewed holistically.

One of the most integral components is your mind.

Your mental health is inseparable from your physical health. Not a revolutionary concept, but what is astounding is the stigmatization that still surrounds men who dare to talk about their mental struggles. As we move into Mental Health Awareness Month this May, we hope to change that.

Men who are vocal about any kind of mental issues can be dismissed as weak. As inferior. As flawed, broken guys who are more likely to be ostracized for their honesty, instead of rewarded for their bravery. Instead of affording a fellow man compassion, we mock, belittle, and turn a blind eye. We freely spit the phrase, “Man up,” as though your gender alone should suffice to guide you through your darkest times.

Or worse: we nonchalantly respond, “Well, that sucks,” then change the subject because talking about feelings is just too real.

What’s real is the fact that 9 percent of men experience depression on a daily basis. That’s more than 6 million men. Even if we understand what depression feels like, we rarely admit that’s the culprit. We lie and say we’re tired or just cranky. More than 3 million men struggle with anxiety daily. Of the 3.5 million people diagnosed as schizophrenic by the age of 30, more than 90 percent are men. An estimated 10 million men in the U.S. will suffer from an eating disorder in their lifetime. (Our own Style and Grooming Editor Louis Baragona eloquently and touchingly shared his battle with bulimia.) We retreat from friends and instead drown sorrows in numbing substances. One out of every five men will develop an alcohol dependency during his life.

Male suicide is rising at such an alarming rate that it’s been classified as a “silent epidemic.” It’s the seventh leading cause of death for males. That’s a staggering statistic. Drill down into the numbers and suicide is the second most common cause of death for every age group for men 10 through 39.

Our mental problems are literally killing us. And that has to stop.

This macho attitude of stuffing your feelings down, or ignoring them, is antiquated and downright dangerous.

It’s okay to not have your shit together. It’s okay to feel depressed. It’s okay to feel overwhelmed. It’s okay to be sad. It’s okay to be anxious. It’s okay to be scared. It’s okay to not have everything figured out, to feel a wave of uncertainty come crashing over you and not know which way is up, or when your next gulp of air will come. These are perfectly normal feelings that every man experiences. And it’s okay to talk about it.

What’s not okay is suffering in silence.

A few courageous men have led the charge, exposing their plights to the rest of us. Singer Zayn Malik openly discussed his struggle with anxiety and his battle with an eating disorder. The Cleveland Cavaliers’ Kevin Love penned an op-ed entitled “Everyone Is Going Through Something,” chronicling his panic attacks.

When Dwayne “The Rock” Johnson recently revealed his battle with depression after his mother attempted suicide when he was a teenager, his words struck a chord with us:

“[It] took me a long time to realize it but the key is to not be afraid to open up. Especially us dudes have a tendency to keep it in. You’re not alone.”

You’re not. This month, we’ll be bringing you a number of fantastic pieces and features that help shine light on all the aspects of men’s mental health, curated by our incredible Deputy Editor E.J. Dickson.

We’ll cover depression and anxiety, how to recognize the symptoms of each and what to do next. We’ll dive into the world of postpartum mood disorders for men, an issue that is more common than you think, but that no one ever speaks about. We’ll explore bipolar disorder, through the lens of Andy Irons, a surfer who fought his illness by self-medicating so much that it led to his untimely passing.

We’ll examine the link between gut health and mental health. Are there foods you can eat that are genuinely good for your mental wellbeing? We’ll talk about body dysmorphia, a condition our former cover star Dan Stein faced, as well as how to deal with that one part of your body that you simply hate and wish you could change. (You’re not alone there, either. Arnold Schwarzenegger said he could look in the mirror and “wanted to throw up.”)

We’ll look at the horrible trend of our policing agencies punishing cops for asking for mental help, and how good officers have to surreptitiously seek counseling outside of their insurance, paying for therapy and medications out of pocket, lest their badge and gun be removed. And we’ll discuss the science of male anger; why and how physiological and environmental elements can contribute to making men so violent and destructive.

Together, our voices can fight the stigma that real men don’t talk about their troubles. In doing so, we can usher in a positive conversation to replace the longstanding, detrimental silence. --- Sean Evans, Digital Director of Men’s Health

For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration Treatment Referral Helpline at 1-800-662-HELP (4357).

Our Mental Health Pandemic and My Audacious Plan to Treat It

My recent article, “How to Avoid a Mental Health Pandemic and What We Can Do to Help,” focused on the importance of addressing mental health issues during the Covid-19 Pandemic. This article describes a potential solution that communities might consider in addressing current mental health issues and those we are likely to face in the future.

There have been numerous virus outbreaks in the past. Michael Greger, M.D. offers an excellent overview Pandemics: History & Prevention. Yet, this is the first time in human history where a health pandemic has not only spread throughout the world, but with our modern media we can instantaneously receive information about what is going on everywhere, which can increase our anxiety and worry.

As I write this article on April 23, 2020 there were 2,670,536 cases of Covid-19 world-wide, 851,586 cases in the U.S., 37,707 cases in California, and 8 cases reported in Mendocino County where Carlin and I live. All these numbers are expected to increase and experts tell us that it will take many months, if not years, before we have preventive vaccines and treatments.

The pandemic itself, as well as the measures necessary to keep people safe, have created increased levels of anxiety, worry, irritability, anger, and frustration among millions of people everywhere. According to the National Alliance on Mental Illness (NAMI), 1 in 5 people in the U.S. suffer from mental illness, and 1 in 25 from severe mental illness. This was before Covid-19 hit us.

Physical distancing, which is now required in most regions across the country to slow the spread of the virus, can complicate and exacerbate some mental illnesses, including anxiety and depression. Dr. Ken Duckworth, medical director of NAMI, says,

“If you already have an anxiety disorder, or obsessive-compulsive disorder, or unstable housing, or you’re already isolated, this is going to compound your problems.”

Just as the physical aspects (sickness, deaths, testing, etc.) of the Covid-19 pandemic have touched everyone, so too, has it impacted everyone’s mental health. In an article in the April 13, 2020 issue of New England Journal of Medicine titled “Mental Health and the Covid-19 Pandemic,” Betty Pfefferbaum, M.D., J.D. and Carol S. North, M.D., M.P.E. offer this warning:

“Uncertain prognoses, looming severe shortages of resources for testing and treatment, imposition of unfamiliar public health measures that infringe on personal freedoms, large and growing financial losses, and conflicting messages from authorities are among the major stressors that undoubtedly will contribute to widespread emotional distress and increased risk for psychiatric illness associated with Covid-19.”

The doctors go on to say,

“Public health emergencies may affect the health, safety, and well-being of both individuals (causing, for example, insecurity, confusion, emotional isolation, and stigma) and communities (owing to economic loss, work and school closures, inadequate resources for medical response, and deficient distribution of necessities). These effects may translate into a range of emotional reactions (such as distress or psychiatric conditions), unhealthy behaviors (such as excessive substance use), and noncompliance with public health directives (such as home confinement and vaccination) in people who contract the disease and in the general population. Extensive research in disaster mental health has established that emotional distress is ubiquitous in affected populations — a finding certain to be echoed in populations affected by the Covid-19 pandemic.”

Because we are all impacted physically, mentally, emotionally, and economically by the Covid-19 Pandemic, in some ways we’re all honorary members of the National Alliance of Mental Illness (NAMI) whether we are aware of it or not. The way we will stop the virus from spreading is for everyone in the community to think of others, not just themselves. We wear cotton masks, primarily, to keep each of us from giving the virus to someone else, since few have been tested yet and infected people can spread the virus even when they don’t yet have symptoms. The masks should say, “I wear my mask to keep you safe.”

What would happen if communities took the same approach—coming together to help each other–in addressing the mental health pandemic? I have an audacious idea.

I’ll start with a few premises that are at the foundation of my plan.

Premise 1: We are in a new world now and have to think outside the box if we’re going to stop the virus pandemic and the mental health pandemic.

Premise 2: While the Federal and State governments can help, we must address these issues at a local level.

Premise 3: Those who survive and thrive will need to have “mental health skills” since we are likely to be facing other threats in the future.

No matter how much money we spend, or how many services we provide locally, there will never be enough mental health professionals to meet the demand.

The dictionary defines audacious as “showing a willingness to take surprisingly bold risks. Here’s my audacious plan:

  • Just as we need to test the population to see who has been infected by the Covid-19 virus, we need to assess the population to see whose mental health has been most impacted.
  • Train one-thousand people in our county whose mental health has been impacted by Covid-19 to become “Post-Covid Mental Health Practitioners.” These are the people who already have “skin in the game” and would be greatly motivated to help themselves and others.
  • These people would form the core of connected networks of practitioners who would join with those of us already working in the field to train the remaining people in the county.

I believe there are numerous benefits to the plan including the following:

  • The plan brings our communities together at a time when many people’s fear causes them to disconnect in an attempt to protect themselves.
  • More and more people are using on-line platforms like Zoom to learn new skills. We could begin training on Zoom now and later add live face-to-face training.
  • In our community, we are already planning to train law enforcement personnel and other first responders. We could expand the training to begin working with groups from the community.
  • Trained people not only can help themselves and their families deal with the present mental health consequences of Covid-19, but will prepare them to deal with other stressors that will likely come in the future.
  • The world is going to need more and more people with mental health training. This training could position people for new jobs and provide economic growth for our local communities.
  • Once we’ve shown this model is successful, we could share best practices with other communities throughout the world who could build on our success.
  • We could draw from the best teachers in our communities, and beyond, to teach the skills most needed for addressing mental health issues in this new world we all find ourselves living in.

I look forward to your comments and suggestions. You can contact me by emailing me at to (be sure to respond to my spamarrest filter when writing for the first time).

Men’s Mental Health Challenges in the Covid-19 Era 4/3/20

I’m guessing that few people in the world had ever heard about Covid-19 until a few months ago. Now everyone has heard and most of us are scared. We ask ourselves, “Will I get it? Will someone I love get it? Will one of us die? When will it end?”

There really are two pandemics we’re dealing with. First, is the spread of the virus and its impact on our physical health. Second, is the spread of the fear and panic and its impact on our mental health. For me, both of these fears are up close and personal. I’m in the high-risk group for getting the virus, getting sick, and dying:

  • I’m older (age 76).
  • I’ve had chronic lung problems most of my life.
  • I’m a man.

I’m also in the high-risk group for having mental and emotional problems associated with Covid-19.

  • I’ve suffered from depression all my life.
  • I worry a lot and suffer from anxiety.
  • When I get stressed, I get angry, which often pushes away those I need for emotional support.

Let me say at the outset that we can’t separate physical health from mental health. When I’m down with the flu, I’m also often sad and depressed. When I’m dealing with anxiety, anger, and depression, my physical health suffers as well.

In addressing the risks associated with Covid-19, most people are aware that older people and those with other health problems are more likely to become sicker and die if they contract the virus. However, fewer people seem to be aware that being male seems to put us at higher risk.

White House coronavirus coordinator Dr. Deborah Birx recently pointed out this “concerning trend” after looking at statistics in Italy, where footage of hospital intensive care units showed bed after bed of older men breathing with the help of ventilators. “The mortality in males seems to be twice that of females in every age group,” said Dr. Birx.

When Italy recently offered statistics on deaths, they noted that 28% of the deaths were female, while 72% of those who had died were men, according to a report by the BBC. One study put the number even higher, with men making up 80% of people who had died of Covid-19 in Italy.

I’ve been helping men improve their mental health for fifty years now. Well, even longer when I remember my father who took an overdose of sleeping pills when I was five years old when his depression intensified because he was unable to make a living supporting this family. Here were the words he wrote in his journal just days prior to overdosing and being committed to Camarillo State Mental Hospital, north of our home in Los Angeles.

“October 30th: Faster, faster, faster, I walk. I plug away looking for work, anything to support my family. I try, try, try, try, try. I always try and never stop.

“November 2nd: A hundred failures, an endless number of failures, until now, my confidence, my hope, my belief in myself, has run completely out. Middle aged, I stand and gaze ahead, numb, confused, and desperately worried. All around me I see the young in spirit, the young in heart, with ten times my confidence, twice my youth, ten times my fervor, twice my education.

“I see them all, a whole army of them, battering at the same doors I’m battering, trying in the same field I’m trying. Yes, on a Sunday morning in early November, my hope and my life stream are both running desperately low, so low, so stagnant, that I hold my breath in fear, believing that the dark, blank curtain is about to descend.”

In addition to being depressed, my father was also angry. His anger pushed my mother away emotionally and he kept his pain bottled up inside. He survived the suicide attempt, but our lives were never the same. I went with my uncle every week to visit my father, but he got worse and worse. I’m sure my decision to dedicate my life to helping men and their families deal with these issues began during the months I visited my father and was unable to help him.

We know now that the suicide rate for men is 3 to 18 times higher than it is for women and it increases with age. The current crisis not only impacts men’s physical and emotional health but it interferes with men’s ability to work and to love, the two cornerstones, I believe, of men’s physical and emotional health.

There is hope on the horizon. The bad news is that the Covid-19 virus has spread throughout the world. The good news is that there are millions of men and women that are working to develop a vaccine and find treatments that can help those who get sick. There are also more and more programs dedicated to helping men and the families who love them.

Here are some things I’ve found to be important in addressing men’s mental health.

1. Men have an aversion anything “mental.”

I grew up with all the stereotypes of people who had “mental problems:”

  • Nuts
  • Psycho
  • Looney tunes
  • Weird
  • Freak

Although the stereotypes impact women and men, men are particularly sensitive to anything that implies they are “less than a man” or have a problem they can’t control.

Solution: I’ve learned that “mental problems” are as common and treatable as physical problems. Its manly to acknowledge what’s going on inside me. I felt free when I began talking about my own depression and anxiety. And so have millions of other men including Dwayne “the rock” Johnson, Trevor Noah, Brad Pitt, Bruce Springsteen, and Terry Bradshaw, to name a few. Talk about your feelings. The truth will set you free.

2. Men are taught we must be tough and never show weakness.

This is part of the “man-box” culture so many of us grew up in and I discuss in my new book, 12 Rules for Good Men. We are taught that real men don’t acknowledge pain, physical or mental. I remember a cartoon. A man and woman are sitting across from each other. The woman sticks a fork into the bridge of the man’s nose. He sits impassively as though nothing has happened. The caption reads, “That’s what I like about you Louie, you’re tough.”

Solution: Denying our pain and being unfeeling when we are hurt or afraid is not a sign of manly strength. It’s a kind of masochism where strength is measured by how much pain we can carry without acknowledging it. Pain is a signal that something is wrong. Let it out. Tell the truth. Be kind to ourselves.

3. When men are depressed, we often cover our unhappiness with irritability and anger.

There’s a quote by comedian Elayne Boosler who captures a truth about men’s health. “When women are depressed, they eat or go shopping,” she says. “Men invade another country.” I might add, or they yell at their wives and children or engage in risky and harmful behaviors that hurt themselves.

Don’t let anger harm yourself and your family. I realized I was angry all my life and a lot of the anger came out when I was really stressed, depressed, and unhappy. I finally learned to deal with my anger more effectively, learned to help others, and wrote a best-selling book, The Irritable Male Syndrome: Understanding and Managing the 4 Key Causes of Depression and Aggression. If this is an issue for you or a family member, check it out.

The Meaning of the Covid-19: How to Survive and Thrive in the New Partnership Culture 3/27/20

With the sudden reality of Covid-19 and the world-wide pandemic, people are understandably frightened. It’s like we went to bed one night in a world that was familiar and a life that made sense, and we woke up in a totally different world where everything was different. This is the fourth in a series of articles that I hope will help you make sense of this new world and how you can both survive and thrive.

I first posted “When We’re Sick: What We Can Learn About Love, Life, and Meaning.” Second, “How to Stay Safe and Not Panic: 6 Things You Can Do to Protect Your Health and Well Being.” Third, “Disconnection Syndrome: Why We Are Stressed, Depressed, and Afraid and How We Can Reconnect and Heal.”

Seth Godin’s recent blog, “Calm also has a coefficient,” offers some helpful advice. “Panic loves company,” he says, “And yet calm is our practical, efficient, rational alternative… If panic is helpful, of course, you should bring it on. But it rarely is. Instead: Curate your incoming.

Stay off Twitter. Do the work instead. Whatever needs doing most is better than panic. Being up-to-date on the news is a trap and a scam. Five minutes a day is all you need.”

I’ll admit, I go in and out of panic. It’s difficult not to get caught up checking the latest media reports. It helps if you have time to prepare. I’ve been seeing this coming for twenty-five years now and I have a clearer picture of what we’re facing, what it means, and how we can get through this together.

The reality of this massive shift in the world was first brought home to me during a sweat lodge ceremony at a men’s conference in 1995. The sweat lodge is an ancient ceremony present in cultures throughout the world and is often used as a time for cleansing, prayer, and for asking for guidance or visions about the future. In the fourth round of the sweat lodge ceremony, the lodge became so hot that many of the men were forced to crawl out. I was sitting at the very back in the hottest spot. I wasn’t aware of the heat because I was transported by a vision:

We are all on a huge ocean liner. It is the Ship of Civilization. Everything that we know and have ever known is on the ship. People are born and die. Goods and services are created, wars are fought, and elections are held. Species come into being and face extinction. The Ship steams on and on and there is no doubt that it will continue on its present course forever.

There are many decks on the ship starting way down in the boiler room where the poorest and grimiest toil to keep the ship going. As you ascend the decks things get lighter and easier. The people who run the ship have suites on the very top deck. Their job, as they see it, is to keep the ship going and keep those on the lower decks in their proper places. Since they are at the top, they are sure that they deserve to have the best that the ship has to offer.

Everyone on the lower decks aspires to get up to the next deck and hungers to get to the very top. That’s the way it is. That’s the way it has always been. That’s the way it will always be.

However, there are a few people who realize that something very strange is happening. What they come to know is that the Ship of Civilization is sinking. At first, like everyone else, they can’t believe it. The Ship has been afloat since time before time. It is the best of the best. That it could sink is unthinkable. Nonetheless, they are sure the Ship is sinking.

They try and warn the people, but no one believes them. The Ship cannot be sinking and anyone who thinks so must be out of their mind. When they persist in trying to warn the people of what they are facing, those in charge of the Ship silence them and lock them up. The Ship’s media keeps grinding out news stories describing how wonderful the future will be.

The captains of the Ship smile and wave, and promise prosperity for all. But water is beginning to seep in from below. The higher the water rises, the more frightened the people become and the more frantic they scramble to get to the upper decks. Some believe it is the end of the world and actually welcome the prospect of the destruction of life as we know it. They believe it is the fulfillment of religious prophesies. Others become more and more irritable, angry, and depressed and use alcohol, drugs, and other forms of self-medication to escape the pain.

But as the water rises, those who have been issuing the warnings can no longer be silenced. More and more escape confinement and lead the people towards the lifeboats. Though there are boats enough for all, many people are reluctant to leave the Ship of Civilization. “Things may look bad now, but surely they will get better soon,” they say to each other.

Nevertheless, the Ship is sinking. Many people go over the side and are lowered down to the boats. As they descend, they are puzzled to see lettering on the side of the ship, T-I-T-A-N

-I-C. When they reach the lifeboats, many are frightened and look for someone who looks like they know what to do. They’d like to ride with those people.

However, they find that each person must get in their own boat and row away from the Ship in their own direction. If they don’t get away from the Ship as soon as possible they will be pulled under with it. Though each person must row their own boat, they must stay connected to others. When everyone, each in their own boats rowing in their own direction, reaches a certain spot a new kind of network will emerge… It will be the basis for a new way of life that will replace the life that was lived on the old Ship of Civilization.

I slowly came back to the present and found myself alone at the back of the Sweat Lodge. I wasn’t quite sure what had happened, but the vision was clear in my mind and has remained so ever since. As a scientist, I don’t usually put much store in “visions.” Yet, over the years I have come to trust the intuitive glimpses into the future that many people see. In the years since the vision, a number of people from different backgrounds have validated the essentials of what I experienced.

What’s the Meaning of the Vision as We Deal with the Covid-19 Crisis?

1. In the vision I saw two systems—The Ship of Civilization and The Connected Lifeboats.

Although the Ship of Civilization is been here for a long-time it has some fatal flaws. It is hierarchical and separates people by class. Those at the top have a lot of the good things in life. Those who are not at the top work hard, but get less and less. The primary problem with the Ship of Civilization is that it wasn’t built to last. It is slowly sinking.

Those who recognize the danger try and warn others, but are not believed. Those who see the danger, get off the sinking Ship into lifeboats. As each person rows away, they create a new way of life that is more egalitarian, where people are linked rather than ranked.

This fits with what Riane Eisler, author of the Chalice and the Blade and with Douglas Fry, Nurturing Our Humanity: How Domination and Partnership Shape Our Brains, Lives, and Future, calls the Domination system (the sinking ship) and the Partnership system (boats of life).

2. The Partnership system is our basic human heritage. The Domination system is relatively recent.

Anthropologists tell us that our evolutionary history of humans goes back at least a million years. What we have come to call civilization goes back around 10,000 years, when we began to domesticate plants and animals. So, our Partnership past lasted for 990,000 years. The Dominator period lasted about 10,000 years (1% of our human history) and now we have a chance to get back to our Partnership roots.

Biologist Jared Diamond, in a 1987 article in Discover magazine, called Civilization “the worst mistake in the history of the human race.” Diamond says, “The adoption of agriculture, supposedly our most decisive step toward a better life, was in many ways a catastrophe from which we have never recovered. With agriculture came the gross social and sexual inequality, the disease and despotism, that curse our existence.”

I would add that it isn’t agriculture, per se, that is catastrophic, but the dominator system that holds the belief that humans are entitled to take whatever they want from the earth and all other life on the planet must serve human needs or die.

3. COVID-19 is our final wake-up call to change our ways or it is the human species that will die.

According to paleontologist and evolutionary biologist, Nick Longrich, “Nine species of humans once walked the earth. Now there is just one.” As frightening as this Coronavirus is, we will recover. Biologist, Bruce Lipton, PhD., was asked recently “will the COVID-19 epidemic go on and on?” He answered, unequivocally. “The answer is clearly NO!” says Lipton. “As is evidenced by the almost complete cessation of new COVID-19 cases in China and South Korea, the epidemic will come to an end.”

The question is, will humans see this as another inconvenience and once it’s over go back to business as usual? Or will we change our ways? The truth is that the Dominator system is not sustainable. We can no longer continue to heat up our planet, use more and more of the Earth’s resources, and see ourselves as a separate species that can ignore the rules of nature.

Thomas Berry was a priest, a “geologian,” and a historian of religions. He spoke eloquently to our connection to the Earth and the consequences of our failure to remember we are one member in the community of life. “We never knew enough. Nor were we sufficiently intimate with all our cousins in the great family of the earth. Nor could we listen to the various creatures of the earth, each telling its own story. The time has now come, however, when we will listen or we will die.

4. We have a unique opportunity to return to our partnership roots.

This is a transformative time for those who are ready change and embrace a positive future. In their book, Spontaneous Evolution: Our Positive Future (and a way to get there from here), Bruce Lipton and Steve Bhaerman say we are ready for “A Whole New Story.”

They continue, “If you find it hard to imagine that we can ever get from the crises that we are facing now to a more loving and functional world, consider the tale of another world in transition. Imagine you are a single cell among millions that comprise a growing caterpillar. The structure around you have been operating like a well-oiled machine, and the larva world has been creeping along predictably.

“Then one day, the machine begins to shudder and shake. The system begins to fail. Cells begin to commit suicide. There is a sense of darkness and impending doom.

From within the dying population, a new breed of cells begins to emerge, called imaginal cells. Clustering in community, they devise a plan to create something entirely new from the wreckage. Out of the decay arises a great flying machine—a butterfly—that enables the survivor cells to escape from the ashes and experience a beautiful world, far beyond imagination.

Here is the amazing thing: the caterpillar and the butterfly have the exact same DNA. They are the same organism but are receiving and responding to a different organizing signal.”

So, my friends, the choice is ours. This is the time where we can stick with the Ship, which is familiar but is sinking. Or we can take the risk to become one of the imaginal cells who get into the boats of life and create the new Partnership Culture. I hope you join us.

How to Avoid a Mental Health Pandemic And What You Can Do to Help 4/17/20

I’ve been working as a mental health professional since I graduated from U.C. Berkeley in 1968, but my interest began much earlier. When I was five years old my father had “a nervous breakdown,” which is what they called a mental health crisis back in 1949. He had become increasingly depressed because he couldn’t find work to support his family. In desperation he took an overdose of sleeping pills and was committed to Camarillo State Mental Hospital. Though he survived physically, our lives were never the same. I grew up wondering what happened to my father, whether it would happen to me, and what I could do to help other families avoid the devastation that his absence had on our lives.

I went on to college and later medical school. I had planned to be a psychiatrist, but found the medical training I was getting left out the social and community aspects of mental health. I dropped out and later went back to school getting a Master’s degree in Social Work and a PhD in International Health. My doctoral level training helped me better understand the risks of infectious diseases like influenza, the modern diseases such as heart disease, cancer, and diabetes, and how both were connected to diseases of the mind including anxiety, post-traumatic stress disorders, and depression. My dissertation examined the different ways men and women experience depression. My finding were published as a book, Male vs. Female Depression: Why Men Act Out and Women Act In.

Now we are in the midst of a world-wide pandemic and millions of people all over the world are dealing with Covid-19. As I write this today (April 17, 2020) there are 2,172,031 confirmed cases world-wide and 671,425 cases in the United States according to Johns Hopkins University Corona Virus Resource Center ( All experts agree that these numbers will continue to rise and these simple words, from doctors on the front line, remind us of our responsibilities:

As challenging as the Covid-19 medical challenge is, there may an even bigger challenge we will soon face unless we take action now. “We are in the midst of an epidemic and possibly pandemic of anxiety and distress,” says Robert T. London, M.D.

If you, like me, have suffered from anxiety and depression in your life, the Covid-19 pandemic is likely making these problems worse. You’re not alone. Andrew Solomon is a professor of medical clinical psychology at Columbia University Medical Center. Here’s what he says in a recent opinion article in the New York Times: “For nearly 30 years — most of my adult life — I have struggled with depression and anxiety. While I’ve never felt alone in such commonplace afflictions — the family secret everyone shares — I now find I have more fellow sufferers than I could have ever imagined. Within weeks, the familiar symptoms of mental illness have become universal reality.”

It certainly makes sense to mobilize our medical health professionals to deal with the Covid-19 crisis. Though the statistics of illness and death are grim, most health-care professional believe that one country, one city, one community after another will reach its peak, assuming we continue to practice physical distancing, and things will get better. Eventually, there will be a vaccine to prevent future outbreaks.

But how do we deal with the immediate and long-term effects of anxiety, depression, and post-traumatic stress disorders? We’re rightly focused on getting protective masks and other gear for doctors and nurses on the front lines, but what are we doing to help them deal with the crippling emotional challenges they must face every day?

Mental health has often been seen as a less important than physical health. Yet, from my years of experience, I don’t believe we can separate the two. When I’ve been physically sick, as I was recently, with pneumonia, I was also anxious and depressed. And when I’ve been anxious, depressed, and stressed, it impacts my physical health.

In the midst of the crisis New York’s Governor Andrew Cuomo talked about the importance of mental health services. “No one’s really talking about this. We’re all concerned about the immediate critical need, the life and death of the immediate situation, but don’t underestimate the emotional trauma that people are feeling and the emotional health issues.”

The New York governor has taken the lead in this area and mental health professionals have responded. The governor said that anyone currently struggling with their mental health can call the hotline and schedule a free appointment with a professional. “Again, God bless the 6,000 mental health professionals, who are doing this 100% free, on top of whatever they have to do in their normal practice,” Cuomo said. “I am sure in their normal practice they’re busy, this is really an extraordinary step by them.”

According to the National Alliance on Mental Illness (NAMI), 1 in 5 people in the U.S. suffer from mental illness, and 1 in 25 from severe mental illness. Social distancing, which is now required in many regions across the country to slow the spread of the virus, can complicate and exacerbate some mental illnesses, including anxiety and depression. Dr. Ken Duckworth, medical director of NAMI, says. “So, if you already have an anxiety disorder, or obsessive-compulsive disorder, or unstable housing, or you’re already isolated, this is going to compound your problems.

Every community should be addressing mental health issues now. Those that get ahead of the curve will find it will help everyone now and in years to come. In my own community, I’m seeing an increase of people coming to me with irritability and anger issues. There seems to also be an increase in relationship stresses which can lead to domestic violence. Too much togetherness can be stressful.

The opposite is true as well. Social isolation generates at least as much escalation of mental illness as does fear of the virus itself. Julianne Holt-Lunstad, a psychologist, found that social isolation is twice as harmful to a person’s physical health as obesity. Researchers have determined that “a lonely person’s immune system responds differently to fighting viruses, making them more likely to develop an illness.”

“You might feel more on edge than usual, angry, helpless or sad. You might notice that you are more frustrated with others or want to completely avoid any reminders of what is happening,” said the American Foundation for Suicide Prevention (AFSP). “It’s important to note that we are not helpless in light of current news events.”

We may be physically distancing, but we don’t have to be socially distancing. Reach out to someone. If you’re feeling stressed and depressed, or having any difficulties, reach out. If you’re feeling OK, reach out to others who may be having a more difficult time. We’re all in this together and we need to stay connected.

I’m starting a new program to train health care workers who want to help stem the tide of this coming crisis. If you’re interested drop me a note to (be sure to respond to my spamarrest filter when writing for the first time) and put “training program” in the subject line.

If you found this article helpful, you can read more on my blog,

Myths About Suicide

Content Warning: Suicide, self-harm, trauma, psychiatric hospitalization

Two important things to know: Mental health is treatable. Suicide is preventable. When we all have the facts about mental health, we can better support the loved ones in our lives in getting the help they need. Unfortunately, while suicide remains the second leading cause of death for young adults, there is still so much confusion about this important issue. So, below, we have debunked 13 common myths about suicide to help you have open and honest conversations about mental health.

If you or someone you know is struggling, don’t be afraid to reach out for help 24/7. Text “SOS” to 741-741 or call 1-800-273-8255 to speak to a trained crisis counselor.

Myth: It's dangerous to ask someone if they are suicidal

Asking someone directly about suicide will not give them thoughts they did not already have. People who battle with suicidal thoughts often want to be heard and validated but may struggle with figuring out how to share. Initiating this conversation with someone who is struggling may help them talk about what they are going through and connect them with important resources. Regardless of how they may respond in that moment, starting the conversation will let them know that you are there for them and that you care about their safety. It takes courage to ask the question: “Are you considering suicide?” For more information, check out Active Minds’ Offering Help page.

Myth: Someone who "has their life together" (has a job, family and friends) is not at risk of suicide

Suicidal thoughts and actions can affect people of all ages, races, genders, life experiences, and more. Even though someone’s life might look “picture perfect” from the outside, they may be struggling on the inside. No one is immune to mental health challenges. This is why it’s so important to check up on your friends, even those who appear to be okay. Learn Active Minds’ V-A-R tool for active listening in the everyday.

Myth: People who die by suicide are selfish

People who are considering suicide often mistakenly believe themselves to be a burden on others. Instead of stopping a conversation with the belief that suicide is selfish, keep the conversation open by understanding and alleviating the veil of silence that too often surrounds the topic of suicide. Keep in mind that suicide itself is not the problem when someone is struggling – it is a solution to a perceived insolvable problem. Supporting people in their time of need and talking openly about what they are going through is how we can help prevent suicide.

Myth: There is typically a singular cause (bullying, a break-up, rejection) that leans to someone ending their life

Suicide is rarely, if ever, caused by a single factor, even if that factor is mental illness. Mental health professional Stan Collins compares factors that contribute to suicide to the game Jenga: while one block may ultimately be the tipping point, the structure of the tower was compromised by many misplaced blocks, which is what actually led to the tower toppling.

Suicide is complex and should not be oversimplified. Risk factors for suicide include previous suicide attempts, access to firearms, family history of suicide, trauma, relationship problems, substance use, financial stress, and more.

Myth: All people who experience suicidal thoughts have been admitted to a psychiatric hospital

While hospitalization is most likely the safest option for someone who is experiencing thoughts of suicide, others may be able to manage their suicidal thoughts with different levels of care, such as mental health professionals or support from loved ones. Everyone’s struggle is real and valid, and they are deserving of the support that is right for them.

Myth: All people who have thoughts of suicide will act on them eventually

Passive suicidal ideation is a phenomenon that ranges from fleeting thoughts of indifference towards life to contemplating a suicide attempt. Some people who struggle with thoughts of suicide are not necessarily in immediate danger. People who experience passive suicidal ideation may need to manage these difficult thoughts on a daily basis with the help of their support systems and trained professionals. Chronic suicidal ideation takes on many forms, and passive ideation can turn into active ideation; so crisis safety plans and open communication with treatment providers, friends, and family are important protective factors of maintaining wellbeing.

Myth: If you limit someone's access to lethal means to suicide, they will find another way to end their life.

Most suicidal crises are short-lived. Reducing access to fatal means, particularly firearms, when someone is struggling with thoughts of suicide can substantially reduce the risk of suicide. Check out the Active Minds Transform Your Campus Guide on Means Reduction for guidance on how to reduce access to lethal means on college campuses.

Myth: People take their own life "out of the blue"

Although it often feels sudden for friends and loved ones, people who die by suicide have likely fought a long and extremely difficult battle. Common warning signs to be mindful of include giving away possessions, saying they want their life to end, behaving in extreme ways, experiencing mood swings, withdrawing socially, and abusing substances. Refer to the Active Minds’ Signs and Symptoms page for further information on warning signs.

Myth: Suicide and suicidal ideation only happen to people who already have depession or another diagnosed mental illness

Suicide can affect anyone, regardless of whether or not they have a diagnosed mental health condition. Suicide is complex and many circumstances may contribute to suicides among persons with or without known mental health conditions, including relationship problems/loss, crisis or trauma, substance use, or financial, housing, or legal issues.

Myth: Someone who made an attempt and "recovered" will not be suicidal again

While some people who attempt suicide and receive the treatment they need may never experience suicidal thoughts again, some will, and it is important and valuable to engage with ongoing treatment and support options.

Myth: Everyone who experiences suicidal throughts has depression.

Many people who have depression do not experience any suicidal ideation, and many people who are affected by suicidal thoughts are not diagnosed with depression.

Myth: People who self-harm wan to end their life

There are two types of self-harm: 1) self-harm with intent to end one’s life, and 2) self-harm with no intention to end one’s life. Some individuals self-harm as a perceived coping mechanism for a variety of reasons: to process their negative feelings, to feel something physical when they feel numb, or to punish themselves for something they perceive to have done wrong. Self-harm is dangerous and should be taken very seriously; however, it does not necessarily mean someone is suicidal.

Myth: No one can stop a suicide

When we can recognize and act upon the warning signs that may indicate someone is considering suicide, we may be able to get them the help they need and reduce or even remove the risk of suicide altogether.

Please speak up when you hear these myths being perpetuated, as one common misconception could prevent a friend or loved one from seeking the help they deserve. Learn more ways you can help change the conversation about mental health by visiting some of our mental health resources: V-A-R®, Offering Help, Referral Resources, and Crisis Information.

What REALLY Happens When You Reach Out to Crisis Lines?

As someone interested in mental health, you may know the numbers to the Crisis Text Line (text SOS to 741741) and the National Suicide Prevention Lifeline (1-800-273-8255) by heart. What you may not know is what happens — and what doesn’t happen — once you pick up your phone to reach out in a crisis. We partnered with our friends at the Crisis Text Line to dispel myths surrounding these services, so you can know what to expect when you place a call or send a text to help yourself or a loved one get through a difficult time.

Myth #1: I must be experiencing thoughts of suicide to reach out to a crisis line.

The trained counselors at the Crisis Text Line and National Suicide Prevention Lifeline are available 24/7 for anyone who is experiencing any crisis, such as sexual abuse, domestic violence, LGBTQ issues, bereavement, self-harm, suicidal thoughts, or mental illness-related concerns. (Check out the topic trends from past text conversations here.) Although what is considered a ‘crisis’ is defined loosely to encourage anyone in need to reach out for help, callers and texters should recognize that crisis lines are neither short- nor long-term substitutes for therapy, emergency care, or professional health care.

Myth #2: If I mention that I’m suicidal, they’ll send the police to my location.

The Crisis Text Line engages in an “active rescue” (i.e., emergency services) in less than 1% of crises. The goal of the Crisis Text Line is to de-escalate the situation and work with the texter to identify the best options for seeking help locally. Emergency services are only alerted when there is imminent risk of harm to the texter and when the texter is unable or unwilling to create a safety plan (for example, unable or unwilling to separate themselves from their means for suicide or self-harm). Similarly, the National Suicide Prevention Lifeline’s website emphasizes that its crisis counselors strive to empower the caller and help them problem-solve to identify the best course of action, meaning emergency services are only involved in situations where the caller is in immediate danger.

Myth #3: Since crisis lines have the potential to send emergency services to my location, my call/text is not confidential.

Anonymity is of utmost important to the Crisis Text Line and National Suicide Prevention Lifeline. When you call or text a crisis line, your location and phone number are encrypted or otherwise anonymized, making it impossible for them to trace you. In some situations, counselors at these crisis lines may ask you to provide personally identifiable information (your name and home address) to better assist you, but you are under no obligation to share this information over text or on the phone.

Myth #4: I can only reach out to crisis lines via text or phone call.

You can also connect with the Crisis Textline and National Suicide Prevention Lifeline over Facebook Messenger. You can reach out to the Crisis Text Line by hitting “Send Message” on their Facebook page. Facebook communication with the National Suicide Prevention Lifeline is a little different: if a post of yours is flagged for suicidal content, Facebook reviews it and gives you the option to call and/or enter a Facebook chat with a counselor from the National Suicide Prevention Lifeline.

The best part about communication with either of these crisis lines over Facebook is that your information is encrypted and anonymized, so you can rest assured that even your Facebook conversations with these services are confidential and secure. They won’t have access to your profile or other identifying information, so they’ll only know what you tell them – nothing more!

So, what does happen when you call/text a crisis line?

After you text SOS to the Crisis Text Line at 741741, a trained crisis counselor will receive it and respond within minutes. Then, the crisis counselor will help you de-escalate your situation and connect you to help locally.

When you call the National Suicide Prevention Lifeline (1-800-273-8255), you’ll hear an automated message with additional information and options while your call is routed to your local Lifeline network crisis center and hear some cool elevator music while you wait to be connected to a crisis counselor. Once you’re connected, you’ll have someone to listen to you, provide support, and connect you with help.

Sounds simple, huh? Don’t be intimidated or frightened by these free and confidential national resources. On the other end of your text or call is a trained, caring individual who is volunteering their time to help you work through rough patches and access local resources. Reaching out when you need help is brave, no matter how big or small you think your issues are. Above all, your safety and privacy are paramount to the Crisis Text Line and the National Suicide Prevention Lifeline, so you’ll be in great hands.

Still have questions or concerns about crisis lines? Check out the websites for the Crisis Text Line and the National Suicide Prevention Lifeline for more information.

Permission to be Human

Pediatricians say the mental health crisis among kids has become a national emergency

This story includes the topic of suicide.

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting SOS to 741741.

A coalition of the nation's leading experts in pediatric health has issued an urgent warning declaring the mental health crisis among children so dire that it has become a national emergency.

The declaration was penned by the American Academy of Pediatrics, the Children's Hospital Association and the American Academy of Child and Adolescent Psychiatry, which together represent more than 77,000 physicians and 200 children's hospitals.

In a letter released Tuesday, the groups say that rates of childhood mental health concerns were already steadily rising over the past decade. But the coronavirus pandemic, as well as the issue of racial inequality, they write, has exacerbated the challenges.

"This worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by COVID-19 and the ongoing struggle for racial justice and represents an acceleration of trends observed prior to 2020," the declaration from the pediatric groups says.

When it comes to suicide in particular, the groups point to data showing that by 2018, suicide was the second-leading cause of death for people between the ages of 10 and 24.

Teenage girls have emerged particularly at risk.(not of dying by suicide but of attempting suicide.) From February to March of this year, emergency department visits for suspected suicide attempts were up 51% for girls ages 12 to 17, compared with the same period in 2019, according to data from the Centers for Disease Control and Prevention.

Overall, the data shows that in 2020, the percentage of emergency department visits for mental health emergencies rose by 24% for children between the ages of 5 and 11 and 31% for those 12 to 17, compared with 2019.

"Young people have endured so much throughout this pandemic and while much of the attention is often placed on its physical health consequences, we cannot overlook the escalating mental health crisis facing our patients," the American Academy of Pediatrics' president, Dr. Lee Savio Beers, said in a statement.

The crisis affects children of color even more

The declaration from the pediatric groups notes that the disruptions children and families have experienced during the pandemic have disproportionately affected children of color.

A recent study in the journal Pediatrics showed that 140,000 children have lost a parent or grandparent caregiver to COVID-19. A majority of those children were kids of color.

The study showed that, compared with white children, Native American children were 4.5 times more likely to have lost a primary caregiver. Black children were 2.4 times more likely, and Hispanic children nearly twice as likely. (Ignores the gender disparity, with young black males dying by suicide at greater rates than girls of color and girls in general. Is an actual suicide not considered a mental health issue?)

"We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and suicidality that will have lasting impacts on them, their families, their communities, and all of our futures," said Dr. Gabrielle Carlson, president of the American Academy of Child and Adolescent Psychiatry.

Pediatric leaders are urging policymakers to invest in telemedicine and mental health in schools

The declaration calls for policymakers on the local and federal levels to fund and improve mental health care for children when it comes to screening, diagnosing and treatment. Access to telemedicine and mental health care in schools should be a priority, the letter says. The groups also want to address the challenge of children experiencing a shortage of beds in emergency care.

The Biden administration announced in August plans to invest nearly $85 million in funding for mental health awareness, training and treatment for children.

6 Symptoms Of Mental Illnesses - 6 Signs of Mental Illnesses

Mental disorder symptoms

In order to meet the criteria for mental illness, your symptoms must cause significant distress or interfere with your social, occupational, or educational functioning and last for a defined period of time.

Symptoms vary widely and may affect mood, thinking, and the ability to interact with others.

Most Common Types

Discover these 6 physical symptoms that may be attached to a mental illness

Clinical depression

The persistent feeling of sadness or loss of interest that characterizes major depression can lead to a range of behavioral and physical symptoms. These may include changes in sleep, appetite, energy level, concentration, daily behavior, or self-esteem. Depression can also be associated with thoughts of suicide.

Anxiety disorder

Symptoms include stress that's out of proportion to the impact of the event, inability to set aside a worry, and restlessness.

Bipolar disorder

Manic episodes may include symptoms such as high energy, reduced need for sleep, and loss of touch with reality. Depressive episodes may include symptoms such as low energy, low motivation, and loss of interest in daily activities. Mood episodes last days to months at a time and may also be associated with suicidal thoughts.


Symptoms include forgetfulness, limited social skills, and thinking abilities so impaired that it interferes with daily functioning.

Attention-deficit/hyperactivity disorder

Symptoms include limited attention and hyperactivity.


Schizophrenia is characterized by thoughts or experiences that seem out of touch with reality, disorganized speech or behavior, and decreased participation in daily activities. Difficulty with concentration and memory may also be present.

Obsessive compulsive disorder

OCD often centers on themes such as a fear of germs or the need to arrange objects in a specific manner. Symptoms usually begin gradually and vary throughout life.


The range and severity of symptoms can vary widely. Common symptoms include difficulty with communication, difficulty with social interactions, obsessive interests, and repetitive behaviors.

Post traumatic stress disorder

Symptoms may include nightmares or unwanted memories of the trauma, avoidance of situations that bring back memories of the trauma, heightened reactions, anxiety, or depressed mood.

For informational purposes only. Consult your local medical authority for advice.

Sources: Mayo Clinic and others. Learn more

Physical Symptoms of Mental Illnesses

They say when the mind suffers the body cries out, and there’s truth based in medical science. Problems with mental health can affect your physical health in adverse ways, and in some cases a chronic health condition can cause mental problems such as depression.

Studies have shown that mental illnesses can manifest themselves in a variety of ways physically, as well as changing behavior (risk-taking and improper diet) that can impact overall health and lead to complications or a shortened lifespan. Here are 15 physical symptoms that may be attached to a mental illness…


A post on the U.S. National Library of Medicine website explains that those with severe mental illness (SMI) such as bipolar disorder and schizophrenia may be at higher risk for attaining unhealthy body mass, reading as 30 or higher on a body mass index (BMI).

It adds that those with schizophrenia are up to 3.5-times more likely to become obese, while those with major depression or bipolar disorder are at 1.5-times increased risk for obesity. The weight gain is traced to lifestyle factors such as less exercise, although medications (such as antipsychotics) to treat these illnesses can also be a contributor, notes the post.


The Mayo Clinic says mental illness can be more than just feelings of sadness or distress. They may cause you to feel “significant tiredness, low energy or problems sleeping” according to the source.

Of course, insomnia will likely only lead to feeling more tired. Depression and chronic fatigue syndrome are often mistaken for each other, but can also exist at the same time, points out other sources. It’s important to let a doctor make that call to properly treat it.

Chronic Pain

Those little aches or pains (or worse) can actually be tied to a mental health condition. While pain can cause depression, the feelings of sadness can intensify this pain. As Harvard Medical School points out, “Hurting bodies and suffering minds often require the same treatment.”

The school also notes that those with chronic pain are at 3-times higher risk for developing psychiatric problems, while those with depression are 3-times more likely to develop associated chronic pain.

Tics and Twitches

Tics are said to be a controllable response to an urge to contract muscles, while twitches are generally involuntary spasms. CalmClinic points to the connection between mental suffering and twitches from anxiety affecting “something as small as a finger or as large as your entire leg.”

The clinic also points out that in many cases, muscle twitches can lead a person to believe there’s a bigger problem, which in turn creates more anxiety. While muscle twitching “is absolutely a sign of anxiety,” in some cases it can suggest MS or nerve damage. If it persists, have it checked out by a medical professional.

Sinus Problems

Psychology Today explains in a 2014 article that chronic sinus issues have been linked to depression. It notes that up to 1-quarter of people with chronic sinusitis–inflammation of the sinuses–also are affected by depression.

Sinusitis itself can be troublesome, as it causes feelings of always being “stuffed up” or causing pressure in the facial area. This is another case where depression can trigger a physical ailment, which in turn intensifies your feelings of sadness, making the ailment tougher to cope with.


Feeling sick to your stomach often may be a sign that your mind is not doing its best, according to a .ScienceDaily release. The post, which is now more than a decade old, explains that people who are susceptible to nausea should get checked out for anxiety or depression before aggressive treatments for gastric problems are used.

The findings were based on a study in Norway involving 62,000 subjects. Forty-eight percent of respondents noted they had some gastrointestinal complaints, and nearly 13-percent had nausea during the first year. ScienceDaily writes, “Those who reported symptoms of nausea were more than three times as likely to also have an anxiety disorder, and nearly one-and-a-half times more likely to suffer from depression.”

Weight Loss

In contrast to obesity, it is not uncommon for individuals with mental illnesses such as depression and anxiety to lose weight without even trying. Individuals with anxiety and depression disorders often lose the desire they once had for things they find enjoyable – even food.

Psychiatrist Keith Humphreys, MD at Stanford Health Care states that disorders like depression often disrupt our hormones that tell us when we are hungry and when we are full. Some individuals may not receive signals of hunger when suffering from depression.


A study done by General Hospital Psychiatry found that migraines and mental illnesses such as depression and anxiety disorder are highly related. The study found that both migrainesand mental disorders show low activity of enzymes that are responsible for deactivating certain chemical messages to the brain.

Frederick Taylor, MD, found that depression and anxiety affect 83 percent of individuals who suffer from migraines and .severe headaches.

Irritated Skin

A study done in Norway in the Department of Adult Psychiatry at the Aalesund Hospital, found that low levels of omega-3 fatty acids in females are associated with both depression and eczema.

However, the reason that depression or anxiety may cause conditions like eczema or acne to worsen is actually due to the fact that mental illnesses increase stress which releases the stress hormone cortisol. WebMD states that Cortisol will result in the skin producing more oil which in turn will produce more acne. Stress may also produce hives, skin rashes or worsen conditions like psoriasis.


This next condition is more of a side effect rather than a symptom, but there is a link between depression and cavities. The reason this is a side effect is because individuals suffering from mental illnesses such as depression often find everyday tasks like brushing their teeth rather difficult and potentially skip them altogether.

Also, a study done by the Academy of General Dentistry found that medications used for depression and anxiety may cause dry mouth, cavities and .gum disease Doctors stress the extra importance of oral hygiene for patients taking.

Adrenaline Rush

If you’ve ever had an anxiety attack, you know they are absolutely awful! anxiety attaks are often triggered mentally but felt physically. An article written by, states that, “when the body is very anxious, the nervous system gives a signal to release adrenaline…the body activates the fight or flight response to get us ready to face danger, to run or fight.”

During this surge of adrenaline, individuals will feel their heart rate increase and feel heart palpitations, take shorter and faster breaths, and experience dizziness, chest pains, chills or hot flashes and muscle tenseness to name a few.antidepressants.

Jaw Pain

While you may be experiencing those mysterious aches and pains throughout your body as a result of depression or anxiety, you might also develop a condition called temporomandiibular joint (TMJ) disorders . explains this disorder has been linked to these mental conditions through a study by German researchers. The study found that among 4,000-patients, depressive symptoms “were more strongly related to TMJ pain than to muscle pain, while anxiety symptoms were linked with muscle pain.” Mental health conditions can lead to more jaw activity (including teeth grinding) that can cause inflammation and pain, it adds.

Strep Throat

MedicalXPress notes people with streptocoecal throat infection, which results in a very sore throat that requires antibiotics to clear up, may be at higher risk of having a mental disorder.

The source cites a study out of Denmark that included data for more than one million children – of that number, 638,265 had received a streptococcal test, and 349,982 who had one or more positive test results. The source says the incidence of mental disorders was higher for those who tested positive, especially for OCD and tic disorders.

Unexplained Sweating

Huffington Post says excessive sweating has been linked to mental health, and refers to research from Anhui Medical University in China and the University of British Columbia that shows that people with hyperhidrosis (the medical term for excessive sweating) are more likely to have anxiety or depression than their counterparts without hyperhidrosis.

However, the source is quick to point out that it’s not clear whether the sweating is a result of underlying mental health issues, or if the physical symptoms are triggering the anxiety or depression. Controlling hyperhidrosis won’t necessarily mean you’ll suddenly overcome your mental health challenges, it adds.

Swelling confirms a possible physical symptom of mental health disorders is swelling, but it’s not that simple. “Many people with anxiety complain of swelling, but the actual issue is not what you may think,” it adds.

The real issue is “hypersensitivity,” it adds, explaining that anxiety can cause you to become hyper-aware of any changes in your body. “Hypersensitivity can also cause normal things in your body to feel bigger or larger,” it adds. However, it is possible for anxiety to actually cause swelling, including a swollen liver and mild swelling of joints, it adds.

Mental Illness Types, Symptoms, and Diagnosis

What Is Mental Illness?

Mental health conditions are disturbances in a person's thinking, feeling, or behavior (or a combination of these) that reflect a problem in mental function. They cause distress or disability in social, work, or family activities. Just as the phrase “physical illness” is used to describe a range of physical health problems, the term "mental illness" encompasses a variety of mental health conditions.

What Is Mental Illness?

The American Psychiatric Association defines mental illness as a health condition that involves “changes in emotion, thinking, or behavior—or a combination of these.”1 If left untreated, mental illnesses can have a huge impact on daily living, including your ability to work, care for family, and relate and interact with others. Similar to having other medical conditions like diabetes or heart disease, there is no shame in having a mental illness, and support and treatment are available.


Mental illnesses are incredibly common in the United States. Each year:2

  • 1 in 5 U.S. adults experience mental illness
  • 1 in 25 U.S. adults live with serious mental illness
  • 1 in 6 U.S. youth aged 6 to 17 years experience a mental health illness

Serious mental illness (SMI) is a term used by health professionals to describe the most severe mental health conditions. These illnesses significantly interfere with or limit one or more major life activities. Two of the most common SMIs are bipolar disorder and schizophrenia.


There are hundreds of mental illnesses listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association’s diagnostic manual. The DSM-5 puts illnesses into categories based on their diagnostic criteria.3??

Anxiety Disorders

This group of mental illnesses is characterized by significant feelings of anxiety or fear, accompanied by physical symptoms such as shortness of breath, rapid heartbeat, and dizziness.

Three major anxiety disorders are:

  • Generalized anxiety disorder (GAD)
  • Panic disorder
  • Social anxiety disorder (SAD)

Bipolar and Related Disorders

Formerly known as manic depression, bipolar disorders are characterized by alternating episodes of mania, hypomania, and major depression

There are three broad types of bipolar disorder:

  • Bipolar I
  • Bipolar II
  • Cyclothymia

Depressive Disorders

The common feature of all depressive disorders is the presence of sad, empty, or irritable mood, accompanied by physical symptoms and cognitive changes that significantly affect a person's capacity to function.

Examples include major depressive disorder and premenstrual dysphoric disorder (PMDD).

Disruptive, Impulse-Control, and Conduct Disorders

A group of psychiatric conditions that involve problems with the self-control of emotions and behaviors.

Disorders in this group include:

  • Intermittent explosive disorder
  • Kleptomania
  • Oppositional defiant disorder (ODD)
  • Pyromania

Dissociative Disorders

This group of psychiatric syndromes is characterized by an involuntary disconnection between consciousness, memories, emotions, perceptions, and behaviors—even one's own identity or sense of self.

Elimination Disorders

Children with elimination disorders repeatedly void urine or feces at inappropriate times and in inappropriate places, whether the action is involuntary or not.

Feeding and Eating Disorders

Eating disturbances are characterized by a persistent disturbance of eating patterns that leads to poor physical and psychological health.

Three major eating disorders include:

  • Anorexia nervosa
  • Binge-eating disorder
  • Bulimia nervosa

Gender Dysphoria

Formerly known as gender identity disorder, gender dysphoria occurs when a person feels extreme discomfort or distress because their gender identity is at odds with the gender they were assigned at birth.

Neurocognitive Disorders

These disorders are characterized by a decrease in a person's previous level of cognitive function. In addition to Alzheimer's disease, other conditions in this category include:

  • Huntington's disease
  • Neurocognitive issues due to HIV infection
  • Traumatic brain injury (TBI)

Neurodevelopmental Disorders

These disorders typically manifest early in development, often before a child enters grade school. They are characterized by impairments of personal, social, academic, or occupational functioning.

Examples of neurodevelopmental disorders include:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Autism
  • Learning and intellectual disabilities

Obsessive-Compulsive and Related Disorders

As the name suggests, these disorders are characterized by the presence of obsessions and/or compulsions.

Examples obsessive-compulsive and related disorders include:

  • Body dysmorphic disorder
  • Hoarding disorder
  • Obsessive-compulsive disorder (OCD)

Paraphilic Disorders

Describes intense or persistent sexual interests that cause distress or impairment. These may involve recurrent fantasies, urges, or behaviors involving atypical sexual interests.

Personality Disorders

These disorders are characterized by an enduring inflexible pattern of experience and behavior that causes distress or impairment. There are currently 10 recognized personality disorders.

Schizophrenia Spectrum and Other Psychotic Disorders

These disorders are defined by abnormalities in one or more of the following areas:

  • Delusions
  • Disorganized thinking
  • Disorganized or abnormal motor behavior
  • Hallucinations
  • Negative symptoms

Sexual Dysfunctions

This heterogeneous group of disorders is characterized by a person's inability to fully engage in or experience sexual pleasure.

Some of the most common sexual dysfunctions include:

  • Delayed ejaculation
  • Erectile disorder
  • Female orgasmic disorder
  • Female sexual interest/arousal disorder

Sleep-Wake Disorders

There are several different types of sleep-wake disorders, and all involve problems falling asleep or staying awake at desired or socially appropriate times.

These disorders are characterized by misalignment of circadian rhythms with the surrounding environment or abnormalities of the circadian system itself. Common sleep-wake disorders include insomnia and narcolepsy.

Somatic Symptom and Related Disorders

People with these disorders feel extreme, exaggerated anxiety about physical symptoms—such as pain, weakness, or shortness of breath. This preoccupation is so intense that it disrupts the person's daily life.

Substance-Related and Addictive Disorders

All substance-related disorders are characterized by a cluster of behavioral and physical symptoms, which can include withdrawal, tolerance, and craving. Substance-related disorders can result from the use of 10 separate classes of drugs.

Trauma and Stressor-Related Disorders

This group includes disorders that were related to exposure to a traumatic or stressful event. The most common is post-traumatic stress disorder (PTSD).

Signs and Symptoms

Everyone experiences peaks and valleys in their mental health. A stressful experience, such as the loss of a loved one, might temporarily diminish your psychological well-being. In general, in order to meet the criteria for mental illness, your symptoms must cause significant distress or interfere with your social, occupational, or educational functioning and last for a defined period of time.

Each disorder has its own set of symptoms that can vary greatly in severity, but common signs of mental illness in adults and adolescents can include:4

Excessive fear or uneasiness: Feeling afraid, anxious, nervous, or panicked

Mood changes: Deep sadness, inability to express joy, indifference to situations, feelings of hopelessness, laughter at inappropriate times for no apparent reason, or thoughts of suicide

Problems thinking: Inability to concentrate or problems with memory, thoughts, or speech that are hard to explain

Sleep or appetite changes: Sleeping and eating dramatically more or less than usual; noticeable and rapid weight gain or loss

Withdrawal: Sitting and doing nothing for long periods of time or dropping out of previously enjoyed activities

It's important to note that the presence of one or two of these signs alone doesn't mean that you have a mental illness. But it does indicate that you may need further evaluation.

If you're experiencing several of these symptoms at one time and they're preventing you from going about your daily life, you should contact a physician or mental health professional.


There is no single cause of mental illness. Instead, it’s thought that they stem from a wide range of factors (sometimes in combination). The following are some factors that may influence whether someone develops a mental illness:5

  • Biology: Brain chemistry plays a major role in mental illnesses. Changes and imbalance in neurotransmitters, the chemical messengers within the brain, are often associated with mental disorders.
  • Environmental exposures: Children exposed to certain substances in utero may be at higher risk of developing mental illness. For example, if your mother drank alcohol, used drugs, or was exposed to harmful chemicals or toxins when she was pregnant with you, you may be at increased risk.
  • Genetics: Experts have long recognized that many mental illnesses tend to run in families, suggesting a genetic component. People who have a relative with a mental illness—such as autism, bipolar disorder, major depression, and schizophrenia—may be at a higher risk of developing it, for example.
  • Life experiences: The stressful life events you’ve experienced may contribute to the development of mental illness. For example, enduring traumatic events might cause a condition like PTSD, while repeated changes in primary caregivers in childhood may influence the development of an attachment disorder.


Diagnosis of a mental illness is a multi-step process that may include more than one healthcare provider, often starting with your primary care physician.

Physical Exam

Before a diagnosis is made, you may need to undergo a physical exam to rule out a physical condition. Some mental illnesses, such as depression and anxiety, can have physical causes. Thyroid problems and other physical diseases can also sometimes be misdiagnosed as mental health disorders due to overlapping or similar symptoms; this is why a thorough physical exam is essential.

Your doctor will take a lengthy history and may order lab tests to rule out physical issues that could be causing your symptoms. If your doctor doesn't find a physical cause for your symptoms, you'll likely be referred to a mental health professional so you can be evaluated for mental illness.

Is There a Blood Test for Depression?

Psychological Evaluation

A mental health professional, such as a psychiatrist or psychologist, will ask you a series of questions related to your symptoms and family history. They may even ask one of your family members to participate in the interview so they can describe the symptoms they see.

Sometimes, the mental health professional will administer tests and other psychological evaluation tools to pinpoint your exact diagnosis or help determine the severity of your illness. Most psychiatrists and psychologists use the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental health illnesses.

This manual contains descriptions and symptoms for all of the different mental illnesses. It also lists criteria like what symptoms must be present, how many, and for how long (along with conditions that should not be present) in order to qualify for a particular diagnosis. This is known as the diagnostic criteria.

It's not uncommon to be diagnosed with more than one mental illness. Some conditions increase the risk of other disorders. For instance, sometimes an anxiety disorder can develop into a depressive disorder.

The Difference Between Provisional and Differential Diagnoses


Most mental illnesses aren’t considered "curable," but they are definitely treatable. Treatment for mental health disorders varies greatly depending on your individual diagnosis and the severity of your symptoms, and results can vary greatly on the individual level.

Some mental illnesses respond well to medications. Other conditions respond best to talk therapy. Some research also supports the use of complementary and alternative therapies for certain conditions. Often, treatment plans will include a combination of treatment options and will require some trial and error before finding what works best for you.

Finding the Right Approach to Therapy with Same-Sex Partners

Choosing which theory to utilize when working with couples not only needs to reflect the personality and competence of the clinician, but it also needs to be of value and serve the needs of the client. They deserve to know their clinician vetted the theory. They want to trust that the chosen interventions reflect the stressors, societal expectations, and internal pressures experienced in their lives.

The most popular theories of couples therapy were developed with opposite-sex partners who hoped to avoid divorce. Because a large portion of the clients I see identify as being lesbian or gay, I was aware these clients didn’t have the right to marry, or therefore divorce, until the Supreme Court hearing of Obergefell v Hodges in 2015 (Obergefell V. Hodges, 2019). Thus, a clinician who works with gay and lesbian couples must make sure the theories that they ask their clients to incorporate into their relationship are appropriate for the goals and presenting issues that often differ from heterosexual couples.

Differences in same-sex couples therapy

In my search for the right theory for my same-sex clients, my first goal was to consider whether the factors driving couples to therapy were the same for both same-sex and opposite-sex partners. Research showed that both same-sex and heterosexual couples share common goals of desiring better communication, wanting shared values, needing to navigate personal differences to make them complementary, and desiring to feel supported and committed to their partners (Riggle et al., 2016).

However, competent couples therapists should be aware of the common differences in regard to the issues that get layered into the relationship experiences due to their sexual identity. Because of the way society has historically treated gays and lesbians, same-sex partners may be more vulnerable to relationship distress. They face the challenges of dealing with developmental stages of acceptance around their gender identity, societal discrimination, and worries of concealing relationships from friends and family (Macapagal, Greene, Rivera, & Mustanski, 2015). Additionally, issues commonly occurring in gay and lesbian relationships arise around issues of commitment stages, norms regarding monogamy, and differing levels of HIV risks that are not generally present for heterosexual couples (Macapagel et al., 2015).

Emotional intimacy is a goal for all couples regardless of gender orientation. However, internalized shame and guilt as a result of sexual orientation concealment tends to negatively impact many same-sex partners in their comfort level of expressing emotional intimacy (Guschlbauer, Smith, DeStefano, & Soltis, 2019). For too many same-sex partners, the strain of living with uncertainty and inconsistent messages about societal acceptance about their right to marry has taken a toll both socially and psychologically. These messages from society have often led to confusion amongst gay and lesbian partners and struggles with whether to embrace the typical symbols of heteronormative commitment (Holley, 2017).

The Gottman Method and working with same-sex couples

The Gottman Method identifies itself as a multidimensional therapeutic approach to working with couples counseling that moves partners from conflict to comfortable exchanges by enhancing basic social skills. The method also sets out to develop an awareness of the interpersonal pitfalls associated with the relationship behaviors of criticism, contempt, defensiveness, and stonewalling. Some of the goals of the Gottman Method are to replace those identified negative behaviors, which are shown to undermine relationships, with more civil ways of expressing disapproval, building a culture of appreciation, acceptance, mutual responsibility for problems, and self-soothing (Lopez, Pedrotti, & Snyder, 2019).

An uncontrolled study by The Gottman Institute published in 2017 collected and measured relationship satisfaction at five separate time points using the Gottman Method of Couples Therapy with gay and lesbian couples. The data showed significant improvement following 11 sessions of therapy for both gay male and lesbian female couples. The study suggests the Gottman Method was highly effective for same-sex couples. Gay and lesbian couples improved more than twice as much as most heterosexual couples did in nearly half as many sessions as was typical for heterosexual couples using the Gottman Method (Garanzini et al., 2017).

Some of the reasons were based on the belief that same-sex couples generally function better than heterosexual couples because of smaller gender-role and inequality. For same-sex couples, they are often socialized similarly concerning gender roles and may share more similar communication styles than opposite-sex couples. Variables such as the distribution of household chores, division of finances, a sense of play, equality of support, and communication play a more important role in relationships of same-sex partners than heterosexual relationships (Garanzini et al., 2017).

The study also suggested that, while the issues happening for same-sex partners were not necessarily easier to manage than those of their opposite counterparts, the Gottman Method platform created a way for couples to discuss their unique preferences for equality in the relationship (Garanzini et al., 2017). Use of the Gottman Method interventions offered same-sex couples ways to improve their relationships in the themes that were identified as contributing to relationship longevity and taught ways of communicating antidotes to criticism and defensiveness that could be applied to their unique relationship challenges. Same-sex couples also reported that as a result of the new communication techniques taught in the Gottman Method, they experienced support in building their friendship connection and were able to rekindle sexual sparks in their relationships. (Garanzini et al., 2017).

Takeaways and recommended research

The challenge presented to all clinicians who work with couples is to set aside their own assumptions or judgments about what is best for their clients and meet them where they are at in achieving their desired relationship goals. Some of the roadblocks couples therapists encounter working with same sex-partners may require clinicians to evaluate if the “tried-and-true” theories they have been using with their opposite-sex partners is valid for all of the populations they serve.

Ideally, research needs to address if it is warranted to develop separate couples theories that address the unique needs of gay versus lesbian partners. Much of the research that is currently available seems to clump FAAB and MAAB individuals together as one category and the methods developed from those findings tend to often, also be "one size fits all.". The idea that “one size fits all” does not apply to FAAB and MAAB individuals, whether they are BIPOC or LGBTQ or cis gender. Gender differences produce different life experiences and the communication pattern styles attached to being male or female..This creates a need to address the gender differenes in order to obtain intervention and prevention methods that effectively reach and speak to boys and men who might become at risk for a suicidal outcome.. Clients have gender differences, life experiences, and the communication pattern styles attached to being male or female. This creates a need to be addressed individually.

Are you currently looking for a Certified Gottman Couples Therapist to use research-based approaches to help your relationship? The Gottman Institute is seeking couples to participate in an international outcome study on Gottman Method Couples Therapy. Learn more here.


Garanzini, S., Yee, A., Gottman, J., Gottman, J., Cole, C., Preciado, M., & Jasculca, C. (2017). Results of Gottman method couples therapy with gay and lesbian couples. Journal of Marital and Family Therapy, 43(4), 674-684. doi:

Guschlbauer, A., Smith, N. G., DeStefano, J., & Soltis, D. E. (2019). Minority stress and emotional intimacy among individuals in lesbian and gay couples: Implications for relationship satisfaction and health. Journal of Social and Personal Relationships, 36(3), 855-878. doi:

Holley, S. R. (2017). Perspectives on contemporary lesbian relationships. Journal of Lesbian Studies, 21(1), 1-6. doi:

Lopez, S. J., Pedrotti, J. T., & Snyder, C. R. (2019). Positive psychology (Fourth ed.). Thousand Oaks, CA: SAGE Publications, Inc.

Macapagal, K., Greene, G. J., Rivera, Z., & Mustanski, B. (2015). “The best is always yet to come”: Relationship stages and processes among young LGBT couples. Journal of Family Psychology, 29(3), 309-320. doi:

Obergefell V. Hodges. (2019). Oyez. Retrieved from

Riggle, E. D. B., Rothblum, E. D., Rostosky, S. S., Clark, J. B., & Balsam, K. F. (2016). “The secret of our success”: Long-term same-sex couples’ perceptions of their relationship longevity. Journal of GLBT Family Studies, 12(4), 319-334. doi:

Why Men Usually End Up With Female Therapists - 2/2/18

Men seek help from female therapists as a result of economic factors they're not entirely aware of.

Men are far less likely to go to therapy than women, and, when they do, they often end up talking about their problems with therapists who happen to be women. But the reasons men end up with female therapists are less about their desire to unload on someone who reminds them of their mothers, or someone they’re sexually attracted to. Instead, most men see female therapists because there aren’t enough male therapists to choose from.

Guys tend to prefer male therapists if given the choice. “A lot of men don’t want a nurturing mother to be their therapist and tend to be more practical problem solvers, and they want a guy that’s going to match him in that approach,” psychotherapist Fran Walfish, Psy.D., told Fatherly. But male psychotherapists are hard to come by. “It’s slim pickings when it comes to quality, standout male therapists. There are more females to choose from,” she says.

Fortunately, there’s nothing wrong with men seeing female therapists. But there are a few potential complications that can come up. One concern is transference, a common phenomenon in which a patient projects feelings about another person onto their therapist. When that person from the past is your mother, spouse, or ex-partner, projecting her onto your therapist can get in the way.

But at the same time, transference also happens to men seeing male therapists, and mental health professionals are trained at recognizing this and addressing it head-on before it gets out of hand. It’s not unusual to get some signals crossed, Walfish says. It’s nothing to be ashamed of.

When transference is not an issue, there are other specific factors that may make a male therapist the best fit. “If the man has not had warm, positive, well-attuned relationships with a strong father figure, he needs a male therapist for a corrective experience,” Walfish says.

But for men who’ve had abusive relationships with father figures in the past, their traumatic history may make it more difficult to trust a man in this role initially. In these cases, it’s important for a female therapist to be sensitive to this and help male patients work up to and perhaps recommend a male mental health provider when they’re ready for it. Conversely, if a man has grown up with a complicated relationship with his mother, having a female therapist may be helpful for the same reasons.

Ultimately, finding a therapist you’re comfortable being open and honest with is far more significant than mulling over their gender. And, heck, even if you do mull it over, odds are your therapist will be a woman.

What to Expect From Couples Counseling

The idea of couples counseling seems pretty straightforward, right? A married couple is having problems, so they go to a therapist to fix them. They sit on either side of a sofa and explain to the marriage counselor what they don’t like about their partner. The counselor listens patiently and then provides sage advice. And voila! They have the answer to their relationship issues, and they walk off, hand in hand, into the sunset to live happily married ever after.

Unfortunately, there are several things wrong with this scenario. Marriage is hard work, and couples therapy requires participation, willingness, and commitment from both partners to achieve optimum results.

Will couples counseling really work?

Today’s couples therapy looks a little different than it did even 30 years ago. Back then, most marital counseling approaches had less than a 50% success rate. Therapists helped couples improve their friendship and romantic relationship, but the improvements tended to be short-lived.

New approaches to marriage counseling, including Emotion-Focused Therapy, or EFT, and the Gottman Approach, are achieving much better results. EFT, for example, has a 75% success rate. The American Association of Marriage and Family Therapists reports an overall success rate of 98%. The success of couples therapy and other factors contributes to a decreasing divorce rate in the United States. Today, counseling can indeed save and strengthen a marriage.

Your first step: Find the right counselor.

You’re more likely to find success in counseling, including relationship therapy, if you’re comfortable with your therapist. Finding one who is a good fit for you and your partner is essential. Of course, you’ll want to find a counselor who practices couples therapy.

The terms “therapist” and “counselor” are often used as umbrella terms for psychologists, psychiatrists, licensed professional counselors (LPC), licensed clinical social workers (LCSW), and licensed marriage and family therapists (LMFT). While there are differences in the educational and credentialing requirements of each type of therapist, most are well-versed in today’s most successful relationship counseling approaches. Some even specialize in particular marital problems like intimacy issues.

You might consider other criteria when selecting a marriage counselor, including gender, sexual orientation, ethnicity, race, religious beliefs, or years of experience. Websites like offer tools for helping you narrow down your options. You also might consider asking for recommendations from family members, friends, or trusted coworkers. It’s perfectly acceptable to interview a therapist by phone or in person, too, just to be sure they’re the best fit for you and your partner.

Your First Session

Once you’ve made an appointment with the couples counselor of your choice, you and your partner should prepare for your first therapy session. Your counselor may provide paperwork or have a conversation with you about their policies and the legalities and ethics of your therapist/patient relationship. After those necessities are out of the way, the remainder of your first session will usually be spent talking about what brought you to couples counseling in the first place.

There are several different reasons couples decide to see a couples counselor. For some couples, therapy begins before marriage with premarital counseling. Premarital counseling helps couples strengthen the foundations of their relationship, improve their communication skills, and learn how to handle disagreements healthily.

Other couples seek counseling after serious issues have threatened their marriage. Infidelity, a feeling that you’re growing apart, unhealthy communication, or no communication at all, frequent arguments, money disagreements, or problems in your sex life are common reasons to consider therapy. However, some couples in healthy relationships attend counseling regularly to continue to improve their bond and interactions with one another.

Getting to Know You

In the first few sessions of couples counseling, a couples counselor will conduct an intake where they learn about your reasons for seeking counseling and get to know you individually and as a couple. Your therapist will ask you and your partner questions about your childhoods, how you met, the early years of your marriage, your family, or other areas of your personal lives. It’s important to understand that this part of the therapeutic process is necessary. Hearing your whole story will help your therapist make an assessment of your relationship and create an appropriate treatment plan. Plus, sometimes recalling the past helps you to put your current relationship problems into perspective.

Sharing intimate details of your relationship with a third party may be uncomfortable at first, but rest assured that your therapist’s office is a safe space. You can — and should — be open and honest, even if that means you raise your voice, yell, or cry. Your therapist is there to keep you on track, but also let you be yourself. As both members speak, the relationship counselor listens to what they’re saying and observes body language and how the partners react to and communicate with one another.

Setting Goals and a Timeline

During these initial sessions, you will also set goals for your time in couples counseling. Again, this discussion requires honesty and thoughtfulness. Perhaps you want your partner to show more affection, while your partner wants you to show empathy. Maybe you want to learn how to deal with the resentment and anger you feel after your partner’s affair. It could be all of the above. Whatever your specific personal goals, sharing them with your partner and relationship counselor is one of the first steps to achieving them. Keep in mind that your goals may change or evolve as you and your partner progress through therapy.

There’s no set number of sessions for couples counseling. You may find improvement after three visits with your therapist, or you might meet for months. Therapy is highly personalized, and although you can certainly call it quits at any time, for the best outcome, you should continue to see your counselor as long as you benefit from it.

Expect individual, couples, and family therapy sessions

Not all of your marriage counseling sessions will be spent with you, your partner, and your therapist. Most marital therapy includes individual therapy sessions as well, especially at the beginning of treatment. These one-on-one sessions allow you to share things with your counselor that you might have been reluctant to share in your partner’s presence. They also give your counselor the chance to help you work on your weaknesses and build on your strengths.

You may decide to participate in family therapy sessions if you have children or other family members who may be affected by your relationship problems. When there’s tension between two parents, it can affect everyone in the household. Often stress in a family system can manifest as behavioral or emotional symptoms in younger family members. An example of this may include an adolescent who has developed an eating disorder or substance abuse problem. Family therapy works to improve connections and communication patterns among family members to create a more functional and secure family unit.

What You’ll Learn in Therapy

You’ll learn a lot of new skills during couples therapy, from communication skills to better ways to manage your stress. Everyone can learn from couples counseling — even a couples counselor. Licensed marriage and family therapist Moshe Ratson and his wife sought therapy after just a year of marriage, with great success.

“A professional outlook on our marriage helped us in getting the spark back in our relationship,” Mr. Ratson writes in HuffPost. “It assisted us in dealing with our fears, expectations, anger, and passive-aggressive behaviors that arise when the going gets tough.”

Specifically, Mr. Ratson learned to recognize his and his wife’s specific triggers or things that brought up negative emotions or distressing memories. He learned to replace blame with compassion and to be proactive instead of reactive.

“It is normal for a collision to occur when two people with different personality traits and mindset are put together to spend the rest of their life together,” says Mr. Ratson. “But what comes out of that makes the marriage just right.”

Types of Couples Therapy

Emotionally focused therapy (EFT) seeks to work with couples more constructively. It focuses on emotions as the key to a person’s relationship needs and helps to develop emotional awareness, compassion between partners, and acceptance. In couples therapy, EFT can lend strength to the emotional bond between partners and create a more secure attachment.

The Gottman Method is based on many years of extensive research. It is based on a thorough assessment at the beginning of treatment, which is used to informed the course of couples therapy. Chiefly, the Gottman Method emphasizes addressing three elements of a couple’s relationship: their friendship, how they manage conflicts, and the creation of shared meaning.

Some Potential Barriers to Success

Even with the encouraging success rate of marital therapy, some couples might not improve their relationship after working with a marriage counselor. Counseling may finally reveal to both members of the couple that the relationship is irreconcilable, and in some cases, that is a good thing, albeit a harrowing realization. Even in that situation, though, therapy can help you part ways amicably and in a manner that lessens the negative impact on other members of the family.

Another barrier to success in couples therapy is one partner’s unwillingness to attend or participate in therapy sessions. If your partner is reluctant to embrace couples counseling, here are a few tips from Psychology Today to convince them to try at least one session. Ask them:

To talk about their pros and cons of attending therapy.

What kind of mental health professional they’d prefer to see (someone in private practice or a community-based option, a person of a particular gender or ethnicity, a social worker or an LMFT)

When and where they’d like to attend a therapy session so that it’s convenient for them

If they’d be willing to look at a few therapy websites or read a book about couples therapy

Be honest with your partner about your belief in relationship therapy as a way to improve your marriage. Explain in a respectful way that you want your relationship to change and grow, and treatment will help you achieve that goal. Unfortunately, even though individual therapy is an essential component of couples counseling, there is no evidence that individual treatment alone will help solve marital problems.

Make an Appointment Today

Statistics show that most couples wait an average of six years before seeking relationship therapy. Some believe that if they ignore the problem, it will go away on its own, while others worry that suggesting counseling means admitting that the relationship is in trouble. The best advice is to seek therapy as soon as you recognize you have relationship issues, or before, so you can prevent them or learn to work through them healthily.

The mental health professionals at the Therapy Group of NYC offer a wide range of therapy specialties, including couples counseling. Don’t wait to reach out. Make a teletherapy appointment today.

Guns and Domestic Violence: The Scary Statistics 10/2/22

Put a gun in the hands of an abuser, and the chance that their partner will be killed increases by 1,000%. Here, survivors tell their stories — and advocates explain why the "boyfriend loophole" is still a problem.

This story contains descriptions of physical and emotional abuse. If you or a loved one is a victim of abuse, call the National Domestic Violence Hotline at 800-799-7233, or log on to for help, or call 911 if physical abuse is happening or imminent. For more about the warning signs of domestic abuse, visit the National Network to End Domestic Violence (NNEDV) website at

In just one state, in one year — Iowa, 2021 — the murders added up. Different ages, relationships, but the same ending. Margaret Jensen, 54, was shot to death by her husband, who then shot and killed himself. Wilanna Bibbs, 20, had hoped to start a singing career. Her boyfriend of several months was charged with first-degree murder after she was shot and has entered a not-guilty plea. Tanniaah Spates, 43, had an order of protection after a domestic assault charge against the father of her children. But that didn't stop him from murdering her with a gun, then killing himself. (I think it is important to note that, at this point, this is a totally bias story so may not offer much knowledge for boys and men who are in an abusive relationship. Note in the next paragraph, 20% of the victims of domestic violence are male, not to mention how many suffer from emotional abuse from their partners - Editor)

These deaths were just a few of the 365 domestic violence-related homicides in Iowa from 1995 to 2022 compiled by the Iowa Attorney General's Office's Domestic Violence Fatality Chronicle. Among those, 249 were women, 47 men, and 69 bystanders, which included children.

Spouses, former spouses, dating partners, and cohabitors killed 249 Iowa women. One woman was killed by a hitman hired by her husband. A gun was used in 54% of the deaths (in Iowa).

That’s just one state — but these Iowa deaths were a reflection of a national trend. Here is the stark truth: When men who have committed intimate-partner violence have access to a gun, it increases the risk of a woman being killed by more than 1?000%, according to 2020 meta-analysis of 17 studies. One thousand percent.

The numbers tell a harrowing story:

  • According to the FBI's most recent statistics, 10,153 girlfriends, wives, ex-wives, and common-law wives were murdered by their partners between 2010 and 2020. While the murder weapon isn't named for those deaths, at least 71% of all homicides nationally were committed with firearms, says research by the Centers for Disease Control and Prevention (CDC).
  • And actually, the number is greater than those stats show, because only 62% of law enforcement agencies submitted data to the FBI — and ex-girlfriends and stalking victims aren't included.
  • Over half of all homicides of non-Hispanic Black and American Indian/Alaska Native women (who experience the highest overall rates of homicide) were related to intimate partner violence, according to a CDC data analysis. Again, the murder weapons aren’t named, but firearms were used in almost 54% of female homicides overall.

And when you consider the connection between domestic violence and mass shootings (defined as four or more people killed by gunfire), it’s clear that the impact goes beyond the home, too. A 2021 study in the journal Injury Epidemiology found that in around 68% of mass shootings, the perpetrator either shot or killed at least one partner or family member. Or the perpetrator had a history of domestic violence, either against an intimate partner, family members, or someone they cohabitated or shared a child with.

The recent, tragic Uvalde school shooting — which allegedly began when the shooter’s grandmother was shot in the face — led Congress to pass the Bipartisan Safer Communities Act in June. The first major federal gun safety law to pass Congress in over a quarter century, the Act — among various changes it made to federal firearm law — addressed what’s been called the Boyfriend Loophole: Previous to this law, boyfriends who had been convicted of misdemeanor domestic violence charges weren't prohibited from owning guns— only spouses were. Now the law would apply to boyfriends as well.

The Act may help protect those at risk of intimate partner gun violence—but some advocates point out that it may not go far enough.

The Boyfriend Loophole

When Woodson Bradley was in her 20s, her boyfriend gradually became more controlling and physically violent. One night during a fight, he dragged her by the hair to the garage and handed her a gun, she says. He held another gun to her head and told her to shoot her beloved border collie, Amos. In her rural neighborhood, no one could hear her screams and pleading.

Bradley considered her options — if she turned the gun on her boyfriend, she had no idea if the gun was loaded. He got closer to her, so loud and close that she could feel his spit and hot breath on her face, his rage ringing in her ears.

"I begged God to forgive me," Bradley said. She pulled the trigger, shaking. Click. Empty. Her boyfriend slapped her face with a backhanded blow, punching and kicking her, calling her vile words for being willing to kill her dog, she says.

"I ran away from him like an animal, grabbing everything I could," Bradley says. Later, she discovered the situation is a common abuser's technique — creating horrific conditions where no matter what you choose, it's the wrong choice. She fled the state.

Organizations such as the National Coalition Against Domestic Violence (NCADV) had long asked that dating partners be included in the definition ?of a "misdemeanor crime of domestic violence" in the federal firearms code. But until the new Act was passed, that code didn't cover boyfriends or ex-boyfriends. If someone was convicted of this crime against a current or former spouse or cohabitant, or a person with whom they shared a child, the code prohibited them from owning a gun. But if the crime was against their girlfriend or former girlfriend? They could own a gun. And more than a half of women killed by partners were murdered by people they were simply dating — not married to — according to historical data.

Now, the “boyfriend loophole” has been narrowed by the Bipartisan Safer Communities Act: Gun possession is prohibited for five years for current or recent dating partners who have been convicted of? a domestic violence misdemeanor.

"There's finally an acknowledgment that people who don't have kids in common, aren't married or don't cohabitate are also at risk," says Gretta Gordy Gardner, general counsel at Ujima Inc: The National Center on Violence Against Women in the Black Community, who has spent two decades in the field, including as a prosecutor in the Domestic Violence Unit at the Baltimore City State’s Attorney’s Office.

The gun legislation is promising and a great step forward for protecting victims of domestic violence, says Ruth Glenn, CEO and president of NCADV. She's worked in the domestic violence field for over 27 years and is a survivor of domestic violence. Yet some serious issues went unaddressed, one of which involves protective orders.

The limits of protective order

The federal firearms code also prohibits abusers from possessing firearms if they are subject to permanent ?(final) protective orders. However, one of these orders is issued only after a hearing at which the abuser has the opportunity to appear, make their case, and present evidence. (It’s easy to imagine why a victim of domestic violence wouldn’t want to put herself through that process.) And "permanent" restraining orders often expire within six months to two years, depending on the state, according to the NCADV.

NCADV's wish list for the firearms code would include blocking abusers from possessing firearms if they’re under temporary domestic violence protective orders as well, not just permanent ones. In addition, they'd like to see dating partners added to the protective order prohibitor, which is currently only the case in some states. Another reason why this is important: More protective orders are issued annually than misdemeanor domestic violence convictions.

Another change that the NCADV would like to see is for misdemeanor stalking to be added to the list of disqualifying crimes, because not only can that happen during abusive relationships — it can take place after a relationship ends: An abuser may take a break and then pick up stalking months or years later. "You have to consider the history of the relationship to understand. The stalking may not be continuous, and that's a tactic some abusers use," Gardner says. Some states, such as Oregon, have stalking protection orders prohibiting gun ownership, but there's no equivalent at the federal level.

The organization also hopes to encourage states to adopt effective protocols for firearm surrender and removal in domestic violence cases; as it stands now, surrender protocols aren't consistent across states. Evidence by the Boston University School of Public Health shows that these protocols work: In states that require abusers who are subject to protective orders to surrender their firearms, there are lower rates of intimate-partner homicide.

Intimidation by gun

When Jeanne Muhammad tried to leave a boyfriend in her thirties, he held a gun to her head while her young children played in the other room. "The most dangerous time is when you try to leave someone," she says. Even when he wasn't handling the gun, he'd point his fingers at her and say bam bam.

A gun in the home can produce this type of coercive effect. "An abuser could be sitting on the sofa with a gun next to him, and the message his partner’s getting is, she's not going anywhere, and he didn't have to utter a word," Gardner says. According to a study in the journal Trauma, Violence & Abuse, about 4.5 million U.S. women have had an intimate partner threaten them with a gun, and nearly 1 million have been shot or shot at by an intimate partner.

Guns become leverage, a form of power, Woodson Bradley says: "It doesn't have to be flashed in your face or used to get you to concede." An abuser just needs to glance at it. Abusers may also threaten to kill themselves, the children, or parents, Glenn says: "Anything they can say to maintain and gain control, they'll do. The gun just makes threats more immediate."

Learning self-defense

Even as people who've escaped abuse move to different states, or await state or federal policy changes and other interventions, they must choose how to survive and thrive. In Atlanta, Marchelle Davis is a domestic abuse and sexual assault survivor who bought a gun for self-defense and now trains other women, many of them women of color, in firearms and self-defense. About half of her students are survivors of domestic or intimate partner violence, she says. Davis teaches a variety of self-defense techniques, including situational awareness, getting fit, and non-lethal or less-than-lethal forms of defense. She says that a person’s mind is her first and best weapon — a firearm is a last resort. Learning self-defense often brings about a transformation and empowerment among the women, Davis says. "I say that we're survivors, not victims, and we're here to take safety back. We're here, and so many sisters haven’t made it."

Davis agrees that statistically, women with firearms are more likely to have the guns used against them. Training is critical, she says. "You must train with a firearm and be mentally, emotionally and spiritually prepared to use one. If you're not prepared to use one as legally intended, don't buy it. But a firearm is a last resort."

In addition, advocates are concerned that when women defend themselves, they may be prosecuted as the offender; some violent perpetrators have convinced judicial systems that they're the victims. "It's often arrest first, ask questions later," says Gardner. States are offering varying solutions to this issue. In New York, for example, the Domestic Violence Survivors Justice Act allows alternative sentences for defendants who show they were domestic violence victims, and resentencing for those already sentenced.

Although Muhammad purchased a gun for self-protection and was trained to use it, she now feels firearms can increase the danger in volatile situations. "Depending on that person's situation, owning a gun might be what they feel they have to do at that time — it's about survival. But when tempers are flaring and out of whack, the last thing you need, in my opinion, is a gun."

Last year in Arizona, Vanessa Martinez was returning home with a cake for her youngest daughter's birthday party when her ex-boyfriend surprised her outside her home. She heard him say, "If I can't have you, no one can," and she heard a bang. A bullet entered the right side of her head, just below her temple and exited at the back of her head.

Her ex-boyfriend pled guilty to various charges related to this incident and was sentenced to 15.5 years. Just a year after the shooting, during which she had brain surgery, her mental health is improving but she still struggles immensely from the single shot. Brain and nerve damage persist, along with vision and hearing impairment, and a balloon's pop still startles her. The shattered skull fragments affected her memory and hearing. Martinez briefly considered getting a firearm for her peace of mind, but decided against it.

Woodson Bradley got a concealed weapons permit and owns a gun. She supports measures like Congress's Bipartisan Act, as well as universal background checks and restrictions on ownership of certain types of weapons or by age. Says Bradley, "The Second Amendment mentions arming a well-regulated militia — not a disgruntled boyfriend or husband having a bad day."

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The association between playing professional American football and longevity -10/30/23


Professional American football—a major cultural, institutional, and economic force in American society in recent decades—has been publicly criticized for its negative impacts on the cardiovascular and brain health of players participating in the sport. Perhaps surprisingly, however, recent evidence suggests that the benefits of playing professional American football may outweigh the costs such that players live longer than other men. We conclude that this counterintuitive finding is due to flawed methodological designs of many prior studies. Using two stronger research strategies, we find no evidence of a positive association between playing football and longevity; indeed, linemen’s lives are shorter.


Recent research concludes that professional American football players (hereafter, “football players”) live longer than American men in general, despite experiencing higher rates of chronic traumatic encephalopathy (CTE) and cardiovascular disease (CVD). This suggests that the longevity-enhancing benefits of playing football (e.g., physical fitness, money) outweigh the costs associated with CTE, CVD, and other longevity detriments of playing football. However, these surprising results may be the consequence of flawed research design. To investigate, we conducted two analyses. In analysis 1, we compared a) all professional American football players whose first season was 1986 or between 1988 and 1995 to b) a random sample of same-age American men observed as part of the National Health Interview Surveys in those same years selected on good health, at least 3 y of college, and not being poor. The exposure consists of playing one or more games of professional football; the outcome is risk of death within 25 y. In analysis 2, we use data on 1,365 men drafted to play in the (American) National Football League in the 1950s—906 of whom ultimately played professional football, and 459 of whom never played a game in any professional league. We estimate the association between playing football and survival through early 2023. In both analyses, we investigate differences between linemen and other position players. In contrast to most prior research, in both analyses, we find that linemen died earlier than otherwise similar men; men who played other positions died no earlier (or later).

A robust body of research finds that professional American football players (hereafter, “football players”) live longer than men in the United States in general (1 2 3 4 5 6 7). On the surface, this finding might seem surprising given publicity and research about high rates of cardiovascular (8 9 10 11 12) and neuropsychological problems (many resulting from traumatic brain injuries) (13 14 15 16 17 18) among football players. On the other hand, football players are elite athletes, often earn very high salaries, and almost always have at least 3 y of college education—all factors that have strong positive influences on health and longevity. With only a handful of exceptions (19), the current body of evidence suggests that the longevity benefits of playing professional American football may outweigh the longevity costs of playing the game—resulting in longer lives for players.

Nearly all this evidence about the longevity consequences of playing football comes from research designs that contrast the mortality outcomes of football players with those of men who may not be comparable in important respects. In most cases, football players are compared to “American men in general” (4, 6, 7, 13, 20) or to elite athletes who played different sports (19, 21). In both cases, we are concerned about the validity of the comparison group.

Research that compares football players to men in the United States in general may be conflating “healthy worker effects” (6, 22 23 24)—a form of selection bias—with the actual benefits and harms of playing football. Men who—like football players—are healthy, relatively well educated, and able to hold jobs for extended periods of time are, on average, likely to live longer than men in general even when their actual jobs may have substantial negative effects on their health (25, 26). Football players may thus live longer than men in the United States in general because of selection factors (e.g., good health, education) that allow them to play football in the first place and to continue to play football (or to hold any job) at a professional level. At the same time, this research also implicitly ignores another important difference between football players and men in the United States in general: In recent decades, football players are disproportionately racialized as Black. Given racial disparities in early mortality (27, 28), previous research that compares football players to American men in general may understate the mortality advantages of playing football.

On the other hand, prior studies that compare football players to elite athletes who play other sports may suffer from a different form of selection bias: This research implicitly assumes that the social, economic, regional, racial, and cultural processes that influence who plays football (29, 30) are the same as the processes that influence who plays basketball, baseball, soccer, or other sports; this may or may not be true. As a result, it is not entirely clear whether differences in mortality outcomes between football players and other athletes are because of the sport itself or because of differences in the selectivity of who plays which sports. To properly assess the association between longevity and playing professional American football, we must compare football players to men who are as similar as possible with respect to racial, socioeconomic, health, and other factors that impact the timing of men’s death.

The balance between the harms and benefits of playing football for longevity may also depend on what position men play in the sport. For example, there is growing evidence that offensive and defensive linemen (hereafter, linemen) are especially likely to suffer health complications related to cardiovascular disease (CVD) (8 9 10, 31 32 33)—mainly due to rapid weight gain (beginning in college) and strength training (throughout their careers) in the absence of sufficient cardiovascular conditioning. There is also evidence that linemen are at elevated risk of experiencing concussions and chronic traumatic encephalopathy (CTE) compared to other players (34, 35). For this reason, we follow prior research (4, 31, 36, 37) in distinguishing linemen from other players in assessing the impact of playing football on longevity.

Is playing professional American football associated with men’s longevity? Does that association depend on playing position? We expect that we will—like a great deal of prior research—initially observe that football players live longer as compared to men in the United States in general. However, we hypothesize that this association will be greatly reduced or eliminated when football players are compared to American men who are similarly selective with respect to education, health, racial group membership, and other factors. Further, we hypothesize that our results will vary by playing position, such that linemen will fare worse than other position players with respect to longevity.


To test these hypotheses, we conducted two complementary sets of analyses. In analysis 1, we begin—like much prior research—by comparing the longevity of football players to the longevity of American men in general; we observe the latter group in the U.S. National Health Interview Survey (NHIS). We then repeat that comparison after restricting the NHIS sample to men who are comparable to football players with respect to education, health, race/ethnicity, and other factors. In analysis 2, we compare football players to men who were highly at risk of playing professional football but who never actually played. Here, we compare men who were drafted to play professional American football and who did play to men who were drafted to play football but who never played a single professional game. The “Methods and Materials” section describes how we constructed the requisite data for both analyses, as well as how we conducted both sets of analyses.

Analysis 1.

Analysis 1 includes 21- to 25-y-old male NHIS respondents and first-year American professional football players observed in 1986 or between 1988 and 1995; 1987 is excluded because of a players’ strike. Table 1 reports descriptive statistics for key measures, separately for the sample of men in the NHIS (the first column) and for all football players (the third column). Comparing the two groups with respect to risk of death within 25 y of initial observation, Table 1 shows that 3.1% of football players died within 25 y as compared to 4.9% of same-age men in the United States in general. This replicates prior research; this is also where much prior research stops.

However, professional American football players have almost always completed three or more years of college; are generally in very good health and lack serious illnesses or disabilities; are (by definition) employed; and (at least between 1986 and 1995) earned moderately high incomes. Only about 1 in 7 men in the United States were like football players in all these respects in these years. Thus, we restrict the NHIS sample to the subset of 4,342 same-age American men who completed at least 3 y of college; were in good health; were not confined to bed for more than 2 d in the preceding year with illness or injury; were employed; and earned family incomes of at least $25,000. When we compare this subset of NHIS men to football players, the differences in risk of early death are eliminated completely: As shown in Table 1, whereas 3.1% of football players died within 25 y, only 2.3% of comparable men in the United States did so.

However, as shown in the fourth and fifth columns of Table 1, football players’ risk of early death varies by position. Offensive and defensive linemen—perhaps because of an elevated risk of CVDs and CTE—have a relatively higher risk of early death than other football players. On the other hand, all other players have a relatively lower risk of early death.

Figs. 1 and 2 depict results from logistic regression and event history models, respectively. Fig. 1 reports results of models predicting death within 25 y of first observation; the figure depicts predicted probabilities of death within 25 y, along with 95% CIs. Fig. 2 reports results of models of timing of death between first observation and 2019; the figure depicts hazard ratios and 95% CIs.

ootball players were at substantially lower risk of early death as compared to same-age men in the United States in general. Adjusting for age and year, football players’ odds of surviving for 25 y beyond initial observation were 82% higher (OR = 1.82; 95% CI = 0.73 to 1.77; P < 0.001). In the event history models, football players’ hazard of death was markedly lower than that for same-age men in the United States in general (Hazard = 0.53; CI = 0.43 to 0.66; P < 0.001).

However, results are markedly different when we compare football players to the restricted subset of same-age men in the United States who were more like football players with respect to educational attainment, health, disability, employment status, family income, and racial composition. As shown in Figs. 1 and 2, the key associations are greatly reduced in magnitude and are no longer statistically significant. Net of age and year, football players’ odds of surviving for 25 y beyond initial observation were not significantly different than those of otherwise comparable men (OR = 1.14; 95% CI = 0.73 to 1.77; P = 0.559). In the event history models, football players’ hazard of death was not significantly different than for otherwise comparable men (Hazard = 0.81; CI = 0.63 to 1.04; P = 0.094).

As shown in the right-hand sides of Figs. 1 and 2, results differ markedly when we distinguish linemen from other position players. Comparing football players to same-age men in the United States in general, we see that nonlinemen are substantially less likely than men in the United States in general to experience early death. For them, and net of age and year, the odds of surviving for 25 y beyond initial observation were more than double those of men in the United States in general (OR = 2.59; 95% CI, 1.88 to 3.58; P < 0.001). In contrast, linemen appear no less (or more) likely to die within 25 y as compared to same-age men in the United States in general (OR = 1.03; 95% CI = 0.74 to 1.43; P = 0.869). Results from hazard models depicted in Fig. 2 are similar.

When we compare football players by position to the subset of men in the United States who more closely resemble football players—see the right-most set of results in Figs. 1 and 2—we see no significant differences between linemen or nonlinemen and otherwise similar men in their risk of death within 25 y (For linemen, OR = 0.63; CI, 0.38 to 1.05; P = 0.078; For other players, OR = 1.63; CI = 0.99 to 2.67; P = 0.05). However, results from the event history models (Fig. 2) show that—as compared to otherwise similar men—linemen have a higher hazard of death (Hazard = 1.49; CI = 1.09 to 2.05; P = 0.013), whereas other players have a lower hazard of death (Hazard = 0.55; CI, 0.74 to 0.89; P < 0.001). Note that nonlinemen’s advantage with respect to hazard of death is substantially smaller than in the model that compared them to men in general.

Analysis 2.

As described in the “Methods and Materials” section, for analysis 2, we begin with all 1,463 men who were selected in the first 12 rounds of the National Football League (NFL) draft between 1950 and 1959. Our analytic file consists of the 1,365 of these men for whom we have measures of a) birthdate and b) number of professional games played. Of the 1,365 men, 906 played at least one professional game; 459 never played a single game in any professional league (in the United States or Canada); 497 were linemen (on offense or defense); and 868 played other positions.

Our key treatment measure is a binary indicator of whether men ever played one or more games of professional American football (regardless of which league they played in). We also consider both the intensity of the treatment (i.e., how many games men played) and heterogeneity in the effects of the treatment across playing positions. Our outcome measure is longevity, expressed as the number of days from a man’s being drafted into the NFL until his death.

Our analyses consist of descriptive analytic procedures and event history models of time to death. Because we are studying the entire population of men drafted in the first 12 rounds of the NFL drafts between 1950 and 1959, we do not employ inferential statistics (e.g., CIs, SEs, P values) in our analyses; assuming our model is correct, our point estimates represent true population parameters for men drafted in the first 12 rounds in this era.

In Table 2, we provide descriptive statistics for all measures, separately by playing position (linemen vs. all other positions) and by whether drafted men ever played in any professional football league. About 87% of men drafted to play in the NFL in the 1950s were deceased by February 1, 2023; this figure was somewhat higher for linemen and somewhat lower for other position players. Among deceased men, average age at death was lower for linemen as compared to other position players and lower for men who played one or more games as compared to men who never played. A key result in Table 2 is that among men drafted to be linemen, those who eventually played professionally died about 1.6 y earlier than those who never played.

When we compare football players by position to the subset of men in the United States who more closely resemble football players—see the right-most set of results in Figs. 1 and 2—we see no significant differences between linemen or nonlinemen and otherwise similar men in their risk of death within 25 y (For linemen, OR = 0.63; CI, 0.38 to 1.05; P = 0.078; For other players, OR = 1.63; CI = 0.99 to 2.67; P = 0.05). However, results from the event history models (Fig. 2) show that—as compared to otherwise similar men—linemen have a higher hazard of death (Hazard = 1.49; CI = 1.09 to 2.05; P = 0.013), whereas other players have a lower hazard of death (Hazard = 0.55; CI, 0.74 to 0.89; P < 0.001). Note that nonlinemen’s advantage with respect to hazard of death is substantially smaller than in the model that compared them to men in general.

Analysis 2.

As described in the “Methods and Materials” section, for analysis 2, we begin with all 1,463 men who were selected in the first 12 rounds of the National Football League (NFL) draft between 1950 and 1959. Our analytic file consists of the 1,365 of these men for whom we have measures of a) birthdate and b) number of professional games played. Of the 1,365 men, 906 played at least one professional game; 459 never played a single game in any professional league (in the United States or Canada); 497 were linemen (on offense or defense); and 868 played other positions.

Our key treatment measure is a binary indicator of whether men ever played one or more games of professional American football (regardless of which league they played in). We also consider both the intensity of the treatment (i.e., how many games men played) and heterogeneity in the effects of the treatment across playing positions. Our outcome measure is longevity, expressed as the number of days from a man’s being drafted into the NFL until his death.

Our analyses consist of descriptive analytic procedures and event history models of time to death. Because we are studying the entire population of men drafted in the first 12 rounds of the NFL drafts between 1950 and 1959, we do not employ inferential statistics (e.g., CIs, SEs, P values) in our analyses; assuming our model is correct, our point estimates represent true population parameters for men drafted in the first 12 rounds in this era.

In Table 2, we provide descriptive statistics for all measures, separately by playing position (linemen vs. all other positions) and by whether drafted men ever played in any professional football league. About 87% of men drafted to play in the NFL in the 1950s were deceased by February 1, 2023; this figure was somewhat higher for linemen and somewhat lower for other position players. Among deceased men, average age at death was lower for linemen as compared to other position players and lower for men who played one or more games as compared to men who never played. A key result in Table 2 is that among men drafted to be linemen, those who eventually played professionally died about 1.6 y earlier than those who never played.

Fig. 3 depicts age-specific survival rates since the date on which men were drafted into the NFL, separately by playing position (linemen vs. other players) and number of professional games played in any league (zero vs. one or more). Whereas 100% of men were alive on their draft day, only about one-fourth of them were alive 64 y later. There are no meaningful differences between the survival curves of drafted nonlinemen who played vs. drafted nonlinemen who never played. In contrast, Fig. 3 shows that men drafted to be linemen died sooner if they played one or more professional games. For example, as reported in the figure, the median number of years from NFL draft to death was 57.1 for linemen who never played a single game but nearly 2 y lower (55.2) for linemen who played one or more games.

To account for the possibility that our descriptive results above are misleading because of systematic differences between groups of drafted men with respect to how old they were when they were drafted, the year in which they were drafted, and/or the round in which they were drafted, we estimate a series of multivariate Cox proportional hazard models. Drafted men who played one or more games may have been older on draft day (thus reducing their rate of survival after draft day) or they may have tended to be drafted earlier in the 1950s (such that secular increases in life expectancy may account for our descriptive results). Our models express the impact of playing American professional football on timing of death net of age at draft, year of draft, and draft round.

As shown in Table 3, we continue to see that among men drafted to play nonlinemen positions, playing professional football had little relationship with their longevity. This is true when we distinguish players from nonplayers (panel A on Table 3) and when we differentiate players according to how many games they played in their careers (panel B). In contrast, results from the multivariate event history models continue to indicate that among men drafted to be linemen, those who eventually played one or more games were at increased risk of death. Panel B of Table 3 indicates that the greatest risk was among linemen who played a moderate number of games (i.e., who were in the middle two quartiles of number of games played). As we elaborate in the Discussion below, we suspect that this is a variant of the “healthy worker effect.”


Previous research has typically concluded that playing professional American football is associated with longer life expectancy; this is perhaps a surprising finding given relatively higher rates of cardiovascular problems and CTE among former players. We wonder whether this counterintuitive conclusion may be due to weaknesses in the designs of prior research. Professional football players are not a random or representative subset of all American men, and so it is inappropriate to compare them to American men in general. Professional football players are highly athletic, they have nearly always attended at least some college, and they are (at least initially) healthy enough for paid work. Even absent any longevity effects of playing, these systematic differences between professional football players and other men should lead to higher life expectancy among players than among American men in general.

Like prior research, we ask whether playing professional American football is associated with longevity. Unlike most previous investigations, we find that playing American professional football is associated with shorter the life expectancy among linemen and has little relationship with life expectancy among other players. In analysis 2, for example, we find that men drafted to be linemen died about 2 y earlier if they played one or more games as compared to drafted linemen who never played. Is this difference in life expectancy small or large? For context, this 2-y difference in longevity is about two-thirds the size of the effect of getting a bachelor’s degree (38) and about two-fifths the size of the effect of being female (39).

One basic methodological point for this field of research is that it is imperative to employ proper comparison groups to account for the selectivity of men who are at risk of playing professional American football. “American men in general” is not a proper comparison group; nor (we suspect) are men who played other sports professionally. Men at risk of playing professional football are selective with respect to education, health, race/ethnicity, and other factors that are consequential for mortality.

Although our designs are, we argue, methodologically stronger than in prior studies, our research is still limited in several ways. First, like prior research, our results only speak to the effects of playing professional football; collectively, we know very little—but not quite nothing (6)—about the longevity consequences of playing recreational, high school, or college football. Second, our results say nothing about the quality of life experienced by men who formerly played professional football. Although we find no longevity effects of playing football among nonlinemen, for example, there may still be sizable effects on later-life functional limitations, pain, cognitive impairments, and other outcomes among these men. Third, our research—like all prior research—uses observational designs. Although we argue that our estimates—especially from analysis 2—come closer to causal estimates, caution is warranted in making causal claims. Fourth, our results say nothing about heterogeneity in effects by race/ethnicity. Racism in postcareer health care, financial institutions, or other settings may mean that white players are better able to avoid longevity penalties associated with having played professional football. We hope that future research will improve on our knowledge in all these ways.

Analysis 1.

Analysis 1 compares the mortality outcomes of two groups of men in the United States. The first group includes 21- to 25-y-old men who were first-year (“rookie”) players in the NFL in 1986 or in any year between 1988 and 1995; we exclude 1987 because a players’ strike caused the league to use replacement players who may not be typical of all players. The second group includes 21- to 25-y-old men who were respondents to the cross-sectional NHIS (40) in 1986 or in any year between 1988 and 1995; the NHIS includes a randomly selected, nationally representative sample of community-dwelling individuals in the United States in each year. To replicate prior research, we begin by comparing the risk of early death of a) football players to b) same-age men in the United States in general. We then compare the risk of early death of a) football players to b) same-age men in the United States who are like football players with respect to educational attainment, current employment status, income, health, disability status, and racial/ethnic composition. We argue that the latter comparison better represents the association between playing football and risk of early death. In other words, we assume that football players were employed, college educated, healthy, not disabled, and earning at least moderate salaries at the outset of their playing careers, and we construct a control sample that has those characteristics at the same young ages; we also equate the two groups with respect to racial/ethnic composition. Finally, we make these same comparisons after distinguishing linemen from other players.

Information about football players is derived from the website Pro Football Archives (41). The site includes comprehensive information about every person who ever played in the NFL, including date of birth, date of death, years played in the NFL, number of games played in the NFL, and position played. Our analyses include all 2,525 players who played at least one game in the NFL, whose initial season was 1986 or between 1988 and 1995, and who were between the ages of 21 and 25 in that season. From information about initial year played in the NFL and year of death, we construct measures indicating whether players survived for 25 y beyond their initial NFL season. Event history analyses model risk of death between the year of players’ initial NFL seasons and 2019.

Information about men in the United States in general is derived from 1986 and 1988 through 1995 NHIS interviews. Our analyses include the 31,836 men who were between ages 21 and 25 in any of those NHIS years. Records include information about men’s age; education attainment (0 = completed 2 y of college or less; 1 = completed 3 y of college or more); current employment status (0 = not employed; 1 = employed); family income (0 = less than $25,000; 1 = $25,000 or more); self-assessed overall health (0 = good, fair, or poor health; 1 = excellent or very good health); and disability status (0 = spent 2 or fewer days in bed in the preceding year due to illness or injury; 1 = spent 3 or more days in bed). Records for NHIS respondents to the 1986 and 1988 through 1995 surveys have been linked by the National Center for Health Statistics to the National Death Index (42), which includes date of death; deaths are observed through 2019. From information about survey year and date of death, we construct a measure indicating whether men survived for 25 y beyond their NHIS survey. Event history analyses model risk of death between the year of men’s NHIS survey and 2019. To adjust for racial/ethnic composition, we reweight the NHIS data to cause it to reflect the approximate racial/ethnic distribution of football players in this era (43). All analyses use the NHIS sampling weight MORTWT, which accounts for survey nonresponse and selective eligibility for linkages to the National Death Index.

For clarity, Fig. 4 depicts the possible ages at death of men who were first observed in 1986 or between 1988 and 1995. As shown in the figure, for all men we observe risk of death for at least 25 y after initial observation.

Our analyses of risk of death within 25 y from first observation—that is, from initial NFL season or NHIS survey—use rare event logistic regression models (44). Analyses of time to death between initial observation and 2019 use Cox proportional hazard (event history) models. All models include an indicator of whether men played professional American football; they also adjust for age (which ranges from 21 to 25) and calendar year of first observation. Our focus is on the magnitude, direction, and statistical significance of the coefficient for the indicator of whether men played football. We use 2-sided hypothesis tests and an a priori level of significance of a = 0.05. All analyses are executed using Stata (version 14.2, StataCorp).

Analysis 2.

Our analytic sample for analysis 2 begins with all 1,463 men who were drafted to play in the NFL in the first 12 rounds of the 1950 and 1959 drafts; in most of these 10 y, there were 12 NFL teams, although in some years, there were 13 teams, and, in some years, there was a bonus first-round pick for a randomly selected team. We only considered the first 12 draft rounds for reasons of cost; as described below, determining birth and death dates for drafted men who never played took a great deal of time and effort.

We obtained information about each drafted man’s name, playing position, college football career, draft year/position/team, and number of NFL games eventually played from the sports information website For men who ultimately played at least one game in the NFL, we merged records from the sports information website to obtain exact date of birth and (when applicable) exact date of death; note that because we initially linked records to in early 2022, no player deaths were recorded in after January 2022.

To obtain information about exact dates of birth and death for men who were drafted but who never played a single game in any professional league and information about deaths occurring after January of 2022 among men who did play one or more professional games, we used a team of trained undergraduate research assistants to conduct archival research.

Our team of undergraduate research assistants was trained to use various online resources to obtain a) exact dates of birth and death for men who were drafted between 1950 and 1959 to play in the NFL but who never played in a single professional game and b) information about deaths occurring after January of 2022 among men who did play one or more professional games. These online resources included (among others) obituaries, newspaper articles, genealogical websites like and, Social Security claims files, and state birth and death records.

Our research assistants began with known information about men—including their name, approximate birth year (i.e., a man drafted in 1950 who played 4 y of football in college would typically have been born in about 1928); position played; and college attended. They did not conclude that they had obtained exact birth or death dates from online archival sources unless they could confidently conclude that the information pertained to exactly the man who was drafted. For example, an online obituary would need to mention that the deceased man was drafted to play in the NFL in the year listed on for the research assistant to use the birth and death dates included in that obituary. In some cases, this required careful triangulation: For example, a college football team’s website might identify the man’s exact birthdate and the year he was drafted; a genealogical source for a man with the same name and exact birthdate might then provide an exact death date; and an obituary for a man with those same birth and death dates might mention the college he attended. Only when research assistants were highly confident that they had identified information for the same man they were researching were they permitted to stop searching and record birth and/or death dates.

About 8% of men who were drafted to play in the NFL in this era never ultimately played in even one NFL game but did go on to play in the Canadian Football League (CFL); a very small number played in other professional football leagues. Men who played in Canadian or other professional leagues were treated as having played professional American football. For drafted men who never played in the NFL, research assistants thus also used online resources to determine whether the men ever played one or more games in the CFL or other professional leagues and (if they did) how many games they played.

All research assistants went through training in the responsible conduct of research (even though all the data are from public records), and all were required to complete training sessions, conducted by the authors, about how to rigorously and reliably search for drafted men in online archives. All research assistants then searched for information about the same set of 25 men as a training exercise; the authors had already obtained information for those 25 men. Only research assistants who demonstrated very high levels of accuracy in researching those 25 men were permitted to continue with the project.

Of the 1,463 drafted men, 794 were determined to have played one or more professional American football games in the NFL; 133 were determined to have played one or more games in another professional football league (most in the CFL); and 536 were determined to have never played even one professional football game. Of the 927 men who played American professional football in any league, we obtained birth dates for all but seven; of the 920 professional players with birth dates, we obtained death dates for 800 (87%) and the other 120 (17%) are presumed to have still been alive as of late February 1, 2023. Of the 536 men who never played a single game in any professional league, we obtained birth dates for all but 77; of the 460 such men with birth dates, we obtained death dates for 401 (87%) and the other 59 (17%) are presumed to have still been alive as of late February 1, 2023. This means that we lack birth dates for 84 men: 0 NFL players, seven men who played in other professional leagues, and 77 drafted men who never played professional football; these men are excluded from our analyses because we cannot confirm that we obtained valid outcome measures for them. We also exclude 14 cases in which we are not able to determine how many games players played. Note that in the small number of cases in which we obtained only birth year (but not month or day), we assumed that men were born on July 1 of that year; this assumption had no meaningful impact on our substantive findings. In the end, we are left with 1,365 cases in our analysis file.

Our key treatment measure is a binary indicator of whether men ever played one or more games of American professional football. As noted above, we also consider both the intensity of the treatment (i.e., how many games men played) and heterogeneity in the treatment effect across playing positions. Our outcome measure is longevity, expressed as number of days from players’ NFL draft until their death; the small number of men who had not died by February 1, 2023, are thus censored on the outcome measure but are still included in our event history models. Besides the treatment, the only other covariates included in our models are age (in days) on draft day, year of draft, and draft round.

In analysis 2, we rely primarily on descriptive statistics. However, to estimate the impact of playing professional American football on longevity, we estimate a series of Cox proportional (event history) models using the streg suite of commands in Stata 14.2.

Because we are studying the entire population of men drafted in the first 12 rounds to play in the NFL between 1950 and 1959, we do not employ inferential statistics (e.g., CIs, SEs, P values) in our analyses; our point estimates represent true population parameters for men drafted in this era.

Data, Materials, and Software Availability

Data from the National Health Interview Survey (NHIS) are publicly available (45). Data (birth and death dates, playing dates, and positions) for football players have been deposited in (46).


Generous support for this project has been provided by 1) the Minnesota Population Center, which receives core funding from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (P2C HD041023), and 2) the University of Minnesota’s Life Course Center, which receives core funding from the National Institute on Aging (P30 AG066613). We are also very grateful to Isabella Stade, Erynne Kringstad, Karl Vachuska, and a stellar team of undergraduate students for helpful research assistance and to Andrew Halpern-Manners, Douglas Hartmann, Elaine Hernandez, Michael Hout, Mark Lee, Elizabeth Wrigley-Field, and anonymous reviewers for comments on early drafts of the article. However, errors and omissions are entirely the responsibility of the authors.


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Students nationally continue to struggle with mental health. Here’s what support looks like at one Oregon high school 3/26/24

Addressing student mental health is now a part of the many services schools offer. A look at what’s available at David Douglas, the school several students in the Class of 2025 attend.

Soft lighting, comfy seats, a closed-off room away from the hard desks and fluorescent lights of the classroom.

This is where a handful of David Douglas High School students come for therapy. They might talk to Clarke Miller.

“In some ways, it’s like I’m a friend … I guess a real supporter, both emotionally and physically, just someone who’s there for them that they can rely on and talk to.”

Or Michael Cortez.

“This is a space where they can come in, they can relax, they can be vulnerable and open up,” he said.

Or Kai Hostetler.

“If you walk through this door, I’d like you to be able to go, ‘oh,’ and feel a little bit less heavy by the time you walk out.”

These three in-school therapists are contracted through Trillium Family Services to be at David Douglas, providing both therapy and more informal help to students who need it.

Recent research and stories tell of deteriorating mental health for students. According to the most recent Oregon student health survey, 70% of 11th graders reported feeling nervous, anxious, or on edge several days in a 30-day period. Almost a quarter of students felt those things nearly every day. One national study found child and adolescent mental health outcomes are declining even as other indicators are improving. A 2023 Washington Post story warned that teen girls are in crisis, and in 2021, a group of national organizations including the American Academy of Pediatrics declared a national emergency in child and adolescent mental health.

David Douglas High School junior Ali is one of 27 students OPB has been following since first grade in the long-term reporting project, Class of 2025. She said she’s been affected by depression and anxiety in recent years.

“It was really hard because it didn’t allow me to do my best in school,” she said. “But I’m trying to overcome that and do better.”

Anna, another student in the Class of 2025, has also dealt with anxiety and heightened stress in high school

“I’ve taken a lot of advanced classes, so there’s a lot of homework, a lot to worry about on tests,” she said.

Ali, Anna, and several of the other students in OPB’s Class of 2025 attend David Douglas High School, one the largest high schools in the state. Like other schools across Oregon and nationwide, David Douglas has placed an emphasis on supporting students’ mental health by providing a network of adults throughout campus whose job it is to help students succeed.

Schools across Oregon provide critical mental health resources at no or low cost to students and their families. But funding challenges and staff turnover due to burnout and other factors threaten the future of these services, even as students continue to struggle.

Hostetler, Miller and Cortez hear from David Douglas students on a range of topics — from anxiety and depression to parent and peer relationships. Sometimes that depression is rooted in childhood trauma, or anxiety is tied to a student’s post-pandemic struggle to pass classes or turn in assignments on time.

Miller wasn’t initially expecting students to talk about serious issues.

“I went into it thinking that there would probably be a lot of petty drama, ‘Beverly Hills 90210' kind of stuff, and I don’t really get any of that,” Miller said.

Instead, he said students are intelligent, insightful, and interested in grown-up conversations.

“The issues that we work on, I think, would be very similar to if they were 40 years old, maybe even more so, because their minds are so malleable and they’re growing so much, and they want to grow so much and they’re so motivated to learn and be better.”

Physical health connected to mental health

High school for many students means traveling in groups — to the bathroom, to the cafeteria, and at David Douglas, sometimes to the student health center, an on-campus medical clinic.

This isn’t a typical doctor’s office.

“You can’t walk into a primary care center with five girls,” said Kristin Case, a nurse practitioner at the David Douglas student health center.

But at the student health center, a small gray building on the high school campus, you can.

They’ll stand outside, or at the front desk, Case says.

“There’s sometimes a group of kids that are just standing at the door,” she said. The door stays locked for safety reasons, but sometimes students need that extra push before coming in.

“We might just open the door and say, ‘can we help you?’”

When a group comes in, Case or someone working at the front desk might try and figure out who the spokesperson of the group is, or who needs to make an appointment.

“I think sometimes there’s safety in numbers,” Case said.

There’s also a written form in English or Spanish at the front desk so students can privately explain what they’re looking for.

The health center serves young people districtwide, from kindergarten all the way to 12th grade. It’s part of a system that operates eight other student health centers in other Multnomah County school districts, including Portland and Reynolds. The David Douglas health center has an onsite behavioral health provider and therapist, in addition to Case.

These facilities, sometimes called school-based health centers, have been around in Oregon since 1986. Some are operated through partnerships between counties and school districts, while others are supported by local health systems or the Oregon Health Authority.

At David Douglas, the center served a little over 1,000 clients last school year, almost half of them ages 15-18. Most often, students show up for routine well-check visits and sports physicals. The second biggest reason? Anxiety and depression.

“The numbers have significantly gone up from what I can see,” Case said, " … Has our detection gone up? Have kids felt safer coming here? Probably all of the above.”

Over her 13 years at David Douglas, Case said she’s seen an increase in students seeking behavioral and mental health help. The rise was so significant she obtained an extra certification in pediatric mental health. She attributes some of the rise to students being more open to seeking support, as well as assessments that staff will do at every well visit and sports physical to screen students for anxiety, depression, substance abuse, and suicide.

Case said what might start out as a physical health visit often turns into a mental or behavioral health visit, but sometimes it takes time to build a relationship and build trust with a student.

“I might see a kid and they’re coming in for headaches, but really it’s sleep,” Case explained, noting the possible connections between physical symptoms like headaches and sleep problems, and behavioral or mental health.

Removing the barriers to getting help — starting in the counselor’s office

Not every student will have a reason to go to the health center. But they will at some point see a school counselor. That’s often the first person who hears a student mention a problem with mental health.

At David Douglas, eight counselors work with the whole student body. They meet with students a couple of times a year to discuss schedules and planning for the future. But sometimes, other things come up.

“School counselors are trained in mental health,” counselor Sarah Hunt said.

But time constraints make it difficult to have in-depth conversations with students.

“We certainly will sit and talk with a student that is going through, you know, ordinary teenage crises,” Hunt explained. “We have, ‘my best friend is moving’ or ‘we’re fighting,’ or ‘my boyfriend, my girlfriend,’ certainly all of those things are still things for teenagers and we still talk with them about that.”

But for things that are more serious, a student might get referred to one of the school’s two social workers. One of them is Caty Buckley.

“Last year I had a lot more kids who were feeling suicidal,” Buckley said. “Thankfully this year, I’m not hearing that quite as much, but right now … especially after the pandemic, we had a lot of kids with eating disorders.”

“And I think we continue to see drugs and alcohol increase with our students … I think that I’m also hearing a lot more trauma stories and I’m not sure if that’s because that’s being normalized in social media, but I think students are feeling more comfortable talking about what’s happened to them.”

But for all of these services that are offered, they’re only reaching a small number of students. Buckley has a caseload of about 40 students, less than 2% of the students that attend David Douglas.

While she’s happy she can help those students, Buckley is overwhelmed thinking about the many others who are not speaking to a counselor or other adult about what’s going on in their lives.

“Sometimes it can be like a little bit of a tsunami,” she said.

The limitations of in-school services

Even when fully staffed, working as a mental health provider can take a toll.

And sometimes, there’s not much a therapist can provide for students when there are bigger issues families are facing — like paying the bills.

“You can’t cope your way out of poverty,” Hostetler said.

“I feel like sometimes people do look to us to fix the problem, and the problem is the rest of the environment … That’s kind of where I hit a brick wall and I’ve noticed that a lot of other clinicians, that’s where they start to hit their burnout point too.”

Therapists say they can also have difficulty getting students to come to appointments, or engaging parents or family members in a student’s mental health journey.

“A lot of the things that our kids struggle with is their relationship with their parents. And it can be really tough for me sometimes to sit there and just to realize that like, they just don’t have a lot of options if their parents aren’t gonna be involved or supportive about these things and are not willing to make any changes,” Hostetler said.

Hostetler and Cortez, the Trillium therapists, are new to David Douglas this year, filling positions that were vacant at the beginning of the school year.

Waitlists of students seeking help filled up faster than usual. Counselors stepped in, playing a triage role helping students who might not need the level of support Buckley, school therapists, or a behavioral health professional can provide.

Not every school has all of the resources David Douglas has, and it is costly for Multnomah County to provide services to students. Despite a strong desire to support student health, sometimes staff turnover has prevented the student health center from fully being able to serve students.

But when it comes to mental health services, not a lot of Oregon students seek out formal help. According to the statewide student survey, only 4.1% of students go to a school-based health center when they have a physical or mental health problem or feel anxious during the school day.

Only 5.3% of students seek out a mental health therapist at school, while 18.7% go to their counselor. 33.2% talk to a parent, step parent, or guardian.

The vast majority of 11th graders surveyed, 62.2%, go to their friends.

Sometimes it just takes a group of your peers

Teenagers talking to their friends about the problems they’re having isn’t a bad thing. Improving mental health is not just about going to therapy. Spending time with friends, exercising, or getting enough sleep are all ways that have been proven to help teens and their mental health.

Class of 2025 student Ali said there haven’t been any adults at school who directly helped her when she’s struggled, other than a math teacher who helped her pass a class. She says her friends have played a big role.

“They make me want to come to school and they help me learn and when I need help, I know I can ask them and they’ll help me,” she said.

Also a big help? Her dog and her sister.

“I like to go out and spend time with everyone that I love and that helps me a lot,” she said.

In Oregon, grant funds have been doled out to school districts to help support youth-led projects that relate to mental health. From 2021 to 2023, youth-led projects included hosting movie nights and organizing mental health awareness weeks at schools. Additionally, there are regular groups where students can hang out with their peers, doing the things they enjoy, like Lane County Behavioral Health’s Dungeons & Dragons groups

Sometimes dealing with anxiety or other mental health challenges might just come down to the individual finding their own coping strategies

When Class of 2025 student Anna is stressed, she likes to break down the different things she’s stressed about into smaller, more manageable pieces.

“It doesn’t feel as worrying as this one big thing instead of a few small things,” she said.

This article was originally published by Oregon Public Broadcasting. It was republished with permission.

How the U.S. Is Addressing the Youth Mental Health Crisis - 3/21/24

COVID, social media, gun violence all contributing factors, says Rachel Levine, MD, of HHS

In part two of this exclusive video interview, MedPage Today editor-in-chief Jeremy Faust, MD, talks with Admiral Rachel Levine, MD, the assistant secretary for health at the Department of Health and Human Services (HHS), about how HHS is addressing mental health issues among U.S. kids and adolescents.

Watch part one of the interview here.

Faust: Let's turn to a discussion of mental health. It's an area that you've spent a lot of time and expertise on -- it was your fellowship training, so long before your government service.

The teen mental health crisis in this country is not new. The pandemic made it worse. I feel like maybe social media is not helping. If you were just to give me the napkin pitch on what is the root cause of this is? What would you say?

Levine: Well, there's no simplistic answers to that, in terms of root causes. Again, there are many different factors.

Youth mental health was challenged before the pandemic, you're right. I'm an adolescent medicine specialist and a pediatrician, and my whole career has been treating children, adolescents, and young adults, particularly with that intersection between physical health and mental health. That was in academic medicine, primarily at Penn State College of Medicine, and then as the physician general and the secretary of health of Pennsylvania. Of course, I've been very active in that role in my current position. I'm co-chair of the Behavioral Health Coordinating Council for Secretary Becerra -- with my friend and colleague Assistant Secretary Delphin-Rittmon of SAMHSA [Substance Abuse and Mental Health Services Administration] -- and we have a specific subcommittee looking at child and adolescent mental health.

I think that there are many different causes of this. The social determinants of health, of course, are involved. I think social media plays a role, and the surgeon general, [Vice] Admiral Murthy, has been very vocal in terms of impacts of social media. All of this has been exacerbated during the COVID-19 pandemic, and we're left with significant mental health challenges. So we are looking at depression and anxiety, suicidality, we're looking at eating disorders, we're looking at the risk of substance use and the full range of mental health challenges that youth face.

Many different activities are going on with our subcommittees. We're looking at further integration of physical and mental health, which means having mental health providers in our community health centers sponsored by HRSA [Health Resources and Services Administration]. We're looking at availability of psychiatric and psychological consultations for pediatricians through our HRSA hotline. We're looking at working on the workforce capacity for mental health professionals, and HRSA has many different activities with that. CMS is looking at in terms of reimbursement. We're always looking for new treatments and protocols from NIH and the NIMH [National Institute of Mental Health].

So many different activities across the range of divisions looking at youth mental health, looking at prevention, looking at access, and looking at treatment.

Faust: Do you think that the COVID-19 pandemic operated on this in a way that had more to do with isolation or the virus itself? Because I think there's an easy out to say, "Oh, people, their mental health was hit because of all the isolation." But a lot of times you look at kids and you say, "Look, how many thousands of kids lost a parent or a grandparent," and that is the downstream effect of our failure to control this virus or take it seriously. So it's not a yes either/or, but do you think that that gets lost in the conversation when people talk about this?

Levine: I think it does get lost, and certainly the isolation experience was really challenging. But this was a global pandemic the likes of which we haven't seen in 100 years. It was, of course, going to have a serious impact on the health and mental health of our nation and the world.

The same mental health challenges we're seeing in the United States we are seeing globally. And you're right, many, many youth were impacted either by illness or illness of their parents or loved ones. Significant impacts all around from the COVID-19 pandemic in its acute phase, and we're doing everything we can to help challenged youth and families in our nation.

Faust: But I think sometimes even the CDC -- again, that's not you -- the messaging was, "Suicide attempts in teenage girls went up during the pandemic." But then when you looked at it, it coincided with the re-opening of schools. And I wonder if we're missing a bigger problem, which is: is school really a safe place for our kids these days? I mean, yes, they have to be -- but are we missing the picture there that school is where a lot of good things happen, but it's also where a lot of toxic things happen?

Levine: Well, I think schools are absolutely necessary for the education of young people. And it is our job in the federal government working with the states and communities to make school as safe and nurturing a place as possible. I'm sure that's what the Department of Education is doing, and [what] we are working on in terms of, for example, school-based health professionals and school-based mental health professionals.

But there are other challenges in schools, and one of the challenges that the president has spoken a lot about is the issue in terms of gun violence. The president has called for numerous common sense gun control efforts, and so we call upon the legislature to follow the president's recommendations.

Children Should Not Have to Be Resilient - NAMI - 2/24/23

You’ve likely heard someone say that “children are resilient.” Historically, parenting and child psychology books have touted that young people have the ability to overcome and “bounce back” from hardship and trauma. However, as someone who experienced childhood trauma, I believe that those working with children often fall back on the concept of resilience without fully understanding the scope of the battles some young people are facing on their own.

As a society, we may assume that children facing trauma is a rare occurrence; however, 61% of children before age 18 have experienced adverse childhood experiences (ACEs), such as violence, abuse, neglect, substance use or mental health problems within the family unit. We may not always hear stories like mine due to the shame or stigma of attempting to conceal the deep pain and trauma. There is a vital need for trauma to be addressed with the utmost sensitivity and compassion.

Mentioning that children are resilient is often well-intentioned, but I believe that this idea, and its accompanying rhetoric, can be detrimental to a child's growth and development; in fact, it can invalidate their realities. Offering this “compliment” to compensate for a child's traumatic environment is something we must reevaluate. With the notable prevalence of ACEs, it matters for adults to know how to support children best.

I believe parents, counselors, educators, coaches, etc. can work collaboratively to meet children’s needs. What this can look like is ensuring the child is in a safe environment, offering emotional support while being mindful of any triggers and vulnerabilities and allowing time for children to heal.

My Experience As A “Resilient Child”

I’ve noticed that the adults in a child’s immediate life typically describe children as resilient when they learn of the battles we have faced — abuse, unsafe home environments, loss of loved ones and more. Having grown up in dysfunction and unpredictability, I have shared my trauma with teachers and counselors in the past — and, as a result, been on the receiving end of the “You are resilient” and “You are so brave” observations.

I initially glowed with joy as I was called “brave” and “resilient.” I relished the positive attention, as most of the attention I received at the time were words and actions fueled by anger and blame. In those rare moments of affirmation from others, I felt comforted — until I returned home and nothing else had changed about my trauma. I was not rescued; I was trapped. Without tangible support, I felt helpless — and my mental health deteriorated over time.

I felt a heavy pressure to continue being “the brave, resilient one” in moments I deserved to rest, recuperate and simply be a child. I would force myself to be strong. I spent years of my life tucking my pain into neat little boxes of resilience that inevitably tore open, with intense emotions spilling out in a great storm of needing to be seen.

Prioritizing Safety

While it is nice to commend children for “bouncing back” from an unsafe situation, children simply should not have to “bounce back.” They should always be given safety and stability. American psychologist Abraham Maslow famously developed a “Hierarchy of Needs” which lists safety as a key component to ensure one’s proper growth and development. Safety is comparable to water, food and shelter to us; we depend on these necessities to live.

A flotation device helps us not drown in the ocean for the time being, but we will not have a chance at survival without a lifeboat then pulling us in and returning us to shore. Sometimes I felt I was given floatation devices so I could keep my head above water, but then stranded in the deepest waters. The first step in helping children who are struggling is getting them out of the deepest waters and into safety.

Giving Emotional Support

Additionally, children need emotional support and validation for what they are experiencing. Some of my trauma involved life-altering issues being swept under the rug in my family unit. I spiraled because my dark reality was not acknowledged in the home — or outside of it.

My response is consistent with research on the topic; a 2018 study by Washington State University, found that, “Kids are good at picking up subtle cues from emotions. If they feel something negative has happened, and the parents are acting normal and not addressing it, that's confusing for them. Those are two conflicting messages being sent."

Changing Our Language

It is more fitting for someone to recognize how I effectively coped with the after-effects of trauma rather than being called brave and resilient for surviving it; the language and implications matter significantly. Support that serves me better as an adult now is when my supports recognize my strengths and triumphs that I actively work hard on addressing every day — like when I have a “recovery win,” such as being able to sit with my discomfort and find clarity before reacting to an upsetting situation. I am strong in how I choose to heal, manage and grow. I grow leaps and bounds when my supports recognize the hard work I put in today.

As a child, I was not always willing to embrace change, so perhaps finding smaller goals to recognize along my path to recovery would have better served me, rather than facing the implication that survival is admirable — or even that I need to be grateful for my trauma. The truth is that some children face unjust and highly traumatic experiences — and not everything “happens for a reason.”

Allowing Time To Heal

I do not want to be validated for withstanding or surviving; I fell behind my peers and severely struggled growing up because I had no choice but to survive. Rather than being called brave, I want to be able to make mistakes and recover in my own time.

Through my recovery from trauma and mental illness, I have learned that I never had to be resilient; I do not owe anyone else resilience. If anything, I owe myself rest, self-love, compassion and understanding. I thrive when I receive compassion and understanding from others.

Meeting children who are struggling with the correct actions and the intention to resolve the issues at hand is imperative in getting them on a path toward healing. Many trauma survivors face punishment and silence when what they need is the follow-through of rescue and resolve.

Trauma survivors are more than what we survived. I am brave for overcoming, redefining and living life beyond my darkest moments.

Emotional suppression has negative outcomes on children - 11/26/18

New research shows it's better to express negative emotions in a healthy way than to tamp them down


'Not in front of the kids' is an age-old plea for parents to avoid showing conflict and strong negative emotions around their children. But scientists now disagree, showing that it's better to express negative emotions in a healthy way than to tamp them down.

"Not in front of the kids." It's an age-old plea for parents to avoid showing conflict and strong negative emotions around their children.

But new research from a Washington State University scientist disagrees, showing that it's better to express negative emotions in a healthy way than to tamp them down.

Sara Waters, an assistant professor in the Department of Human Development on the WSU Vancouver campus, and co-authors from the University of California, Berkley and the University of California, San Francisco, write about their findings in the journal Emotion.

"We wanted to look at how we suppress emotions and how that changes the way parents and kids interact," Waters said. "Kids pick up on suppression, but it's something a lot of parents think is a good thing to do."

The study was conducted on 109 mothers or fathers with their children in San Francisco. The sample was split almost evenly between mothers and fathers, as the scientists wanted to see if any differences existed in the results between genders.

First, the researchers gave the parent a stressful task: public speaking with negative feedback provided by the audience. Then, the parents were given an activity to complete with their children, with some randomly told to suppress their emotions. The others were told to act naturally.

The activity was the same for all pairs, working together to assemble a Lego project. However, the kids, ages 7-11, received the paper instructions, but weren't allowed to touch the Legos. The parents had to assemble the project, but couldn't look at the instructions. This forced them to work together closely to succeed.

"We were interested in behaviors," Waters said. "We looked at the responsiveness, warmth, quality of the interactions, how the parent provided guidance for the child."

Waters and her co-authors had a team of undergraduate research assistants from WSU Vancouver watch all 109 videos of the interactions to mark every instance of warmth, guidance, and other emotions.

Both the parent and the child were also hooked up to a variety of sensors, to measure heart rate, stress levels, etc. The study authors combined that data with the coding done by the assistants to get their results.

"The act of trying to suppress their stress made parents less positive partners during the Lego task," Waters said. "They offered less guidance, but it wasn't just the parents who responded. Those kids were less responsive and positive to their parents. It's almost like the parents were transmitting those emotions."

Gender differences (gender or sex differences?

Since the team made such an effort to get an equal mother/father split, they were able to make further discoveries. It turns out that emotional suppression made kids more sensitive to their mothers. The children showed less change in their responses when a father was suppressing his emotions, Waters said.

For now, there isn't enough data on fathers and their children in emotion studies to say why that is.

"We just don't have much research on dads because it's really hard to get dads to participate in research projects," Waters said. "It took a LOT of work to get enough dads in this study."

In previous research, it has been found that, in general, men are more likely to suppress their emotions. Waters suspects that it's possible a father suppressing his emotions isn't unusual, so it didn't have as much impact on the kids in this study.

Kids pick up emotional residue

Waters said there are dozens of studies that show kids are good at picking up "emotional residue" from their parents.

"Kids are good at picking up subtle cues from emotions," she said. "If they feel something negative has happened, and the parents are acting normal and not addressing it, that's confusing for them. Those are two conflicting messages being sent."

Rather than suppressing emotions in front of your children, Waters suggests the best course of action is to let kids see a healthy conflict, from start to resolution.

"Let them see the whole trajectory," she said. "That helps kids learn to regulate their own emotions and solve problems. They see that problems can get resolved. It’s best to let the kids know you feel angry, and tell them what you’re going to do about it to make the situation better."

Journal Reference:

1. Helena Rose Karnilowicz, Sara F. Waters, Wendy Berry Mendes. Not in front of the kids: Effects of parental suppression on socialization behaviors during cooperative parent–child interactions.. Emotion, 2018; DOI: 10.1037/emo0000527