The Paradox of External Confidence and Internal Misery

Carrie Fisher's suggestion that "they should issue medals along with the steady stream of medication," encapsulates the complex, often unseen struggles of those living with mental illness. Her sentiment points to the fact that people who navigate life with psychological challenges deserve recognition for their resilience amid a harsh and demanding environment. While modern medicine has made some strides in understanding and treating mental illness, and societal awareness is increasing, these advances have not fully alleviated the daily struggles of millions. The high-paced, high-pressure demands of modern society create a paradox: People are expected to exude confidence, assertiveness, and wealth, yet often carry an internal burden of misery, anxiety, and self-doubt (Gibson, 2020). Social norms and expectations reward external displays of success and confidence, leaving little space for vulnerability or the nuanced realities of mental health struggles.

Rising Mental Health Issues

Mental illness now finds a voice in art, film, and literature because it reflects the lived experiences of millions worldwide. Recent statistics highlight a staggering 400% increase in antidepressant usage in the U.S., with roughly 10% of the population now depending on these medications and Europe mirrors this pattern closely (Twenge, 2017). However, less than a third of individuals on antidepressants have seen a mental health professional within the past year (NIMH, 2022), which seems to indicate serious gaps in comprehensive mental health care provision. This trend unfortunately reflects not only an overreliance on medication but also a broader societal struggle to address mental illness effectively and holistically.

Stark Disparities

Women in Their 40s and 50s

Antidepressant usage peaks at 23% for women in this demographic, far exceeding any other age group (Pratt et al., 2011). This high prevalence suggests unique pressures faced by middle-aged women, possibly linked to caregiving responsibilities, career pressures, and hormonal changes.

Gender Disparity

Women are 2.5 times more likely than men to be prescribed antidepressants, revealing potential differences in help-seeking behaviours and societal expectations around emotional expression (Pratt et al., 2011).

Racial Disparity

White Americans are significantly more likely to be on antidepressants (14%) compared to their Black (4%) or Mexican American (3%) counterparts (Pratt et al., 2011). This disparity may reflect variations in cultural attitudes towards mental health, accessibility of care, or systemic healthcare inequalities.

In her book Generation Me, Jean Twenge suggests that the contemporary social environment exacerbates mental health issues and I believe this to be true. Although young people are increasingly confident, assertive, and may seem entitled, they paradoxically seem to experience heightened anxiety, relationship problems, poor sleep, and concentration issues. Societal pressures such as academic performance, overwork, social media stress, and inadequate access to mental health services amplify feelings of fragility and dissatisfaction among younger generations and some older populations too. The pursuit of outward success leaves many struggling internally, as cultural norms also seem to discourage vulnerability while pushing individuals to maintain a facade of control and competence, based primarily on the desire to avoid feeling shame or guilt for feeling so inadequate (Twenge, 2017).

Social Changes and the Self-Centered Society

Our increasingly self-centred, digitally connected yet emotionally isolated world has exacerbated mental health challenges and some key societal changes have contributed to this trend:

Changing Family Structures

Fragmented families, high divorce rates, and longer working hours for parents leave some children without the stability of close-knit families (Twenge & Campbell, 2009).

Lifestyle Shifts

Increased mobility, coupled with a pursuit of personal gratification, has eroded rooted communities and meaningful relationships (Gibson, 2020).

Technology Overload

The prevalence of computers, smartphones, and social media fosters virtual connections at the expense of physical, supportive relationships (Gibson, 2024).

Commercialisation

Aggressive marketing tactics, especially toward children, fuel consumerism and unrealistic expectations.

Education Changes

A focus on grades over growth fosters unhealthy competition (Timimi, 2009).

Contradictory Solutions

An abundance of conflicting mental health solutions leads to confusion and ineffective treatment.

Individualism

A relentless focus on self-improvement creates a sense of inadequacy and comparison (Gibson, 2024).

Overreliance on Medication

Overprescribing psychiatric medications often overlooks the root causes of distress (National Institute of Mental Health, 2022).

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The all-too-common heroic narrative depicted in the media—where people transform from depressed and failing to cured and successful—oversimplifies reality. Although antidepressants like Prozac provide relief for some, their effectiveness remains inconsistent (Fisher, 2008) and the rise in prescriptions, especially for children, is concerning (National Institute on Drug Abuse, 2011). Mental health stories are also becoming increasingly commodified, leading to unrealistic expectations and stigmatizing attitudes. The "medical model," which attributes mental illness to biology alone, also exacerbates stigma and hopelessness with most problems. Patients, sadly, internalize these narratives, feeling isolated and helpless and develop an increasingly poor self-concept and image of their capabilities, which can create a self-fulfilling effect (Angermeyer & Matschinger, 2005).

The Impact of Parenting

Parenting seems to be another contributor to mental health struggles with young people. Overprotective parents tend to shield their children from challenges, creating a double-edged sword. The contradictory message to the young person seems less clear and often conveyed unconsciously by the parents in which they appear to state clearly and openly that "you can be anything you want to be," but then the behaviour the parents demonstrate involves them stepping in to solve problems for their children, thus contradicting them, selves, thus undermining the young persons’ self-confidence and competence, leading to an increasing sense of fragility (Portelli, Papantuono and Gibson, 2016).

Detrimental effects may include that:

• Children receive rewards regardless of effort, making them feel special without accountability.
• They believe rewards are their right, often resulting in entitlement and unrealistic expectations.
• Overparenting reinforces dependency, making them feel incapable of overcoming challenges on their own.

Mental Health Paradox

In an increasingly self-centred society, individuals face a psychological vacuum. An emphasis on self-gratification and consumption has made it harder to find meaningful connections. The resulting rise in behavioural issues, substance misuse, eating disorders, and self-harm reveals a deeper societal problem. To improve mental health, we must move away from a culture of individualism, narcissism and consumerism and we must work to foster connections, promote emotional security, and encourage resilience in young people that will help break the cycle of fragility and entitlement they sat times seem caught in. By understanding the personal and societal forces shaping our mental health, we can begin to forge a new path—one that values genuine connections, self-worth, and community over materialism and superficial validation.