“Recognizing You Need Treatment Is the Hardest Step”

An interview with Psychiatrist and Neurobiologist Alana Mendelsohn

Flexibility, emotional resilience, and the courage to seek help: for Creatives Care Co-founder Alana Mendelsohn, these attributes play a central role in one's mental well-being.

In this interview, the second in our series on the intersections between mental and physical health and the performing arts, Ariana Sidman, Kamala Schelling, and Catherine Hancock sit down with Dr. Mendelsohn to learn more about her work.

About our guest: Dr. Alana Mendelsohn, a co-founder of Creatives Care, is a Harvard- and Columbia- educated psychiatrist and neurobiologist based in New York City. In addition to seeing patients in her private practice in NYC, she is currently a research fellow at Columbia's Zuckerman Mind Brain Behavior Institute studying the organization of subcortical brain circuits that underlie many psychiatric and movement disorders.

Dr. Mendelsohn has won a number of awards as a clinician, researcher and educator, including the NIMH Outstanding Resident Award and the Gold Humanism and Excellence in Teaching Award. A lifelong music lover, Dr. Mendelsohn is a classically trained violinist and has performed with the Columbia University Medical Center Symphony Orchestra and the Weill Cornell Music and Medicine Orchestra.

Creatives Care: Dr. Mendelsohn, you're both a clinician and a scientist. Can you start by introducing yourself? What is the primary focus of your clinical practice?

Alana Mendelsohn: In my clinical practice, I’m a general psychiatrist who works with adults. My patients have a range of mood and anxiety disorders—including depression, anxiety, PTSD, OCD, and ADHD—which I treat through both medication and psychotherapy.

CC: If we have a physical injury, there's often an immediate and obvious sign: blood, pain, etc. By contrast, it can be  hard to accept (or even notice) that you’re struggling with mental health. How do you help an individual navigate signs of mental health challenges? What are behavioral changes that might indicate a need for professional help?  

AM: I think this is a great question. Part of what makes it hard (for both patients and providers) is that the warning signs differ from person to person. Some people who have a known mental health challenge may be able to recognize their own particular warning signs: a change in appetite, a change in sleep schedule, a change in the desire to see friends. Other people might not even know what to look for. So that's something we work on in therapy sessions: identifying your individual warning signs. 

I often have people tell me, “I know I don't have mental-health problems because I'm doing well, I’m doing everything I need to do, and I’m doing fine.” So the question I ask those people is: “How hard are you working to be fine?” You might be doing everything you're supposed to do—going to school, going to work, seeing friends—but if it's taking a huge toll on you just to be able to do it, that's a warning sign in and of itself. 

CC: How do you respond to the charge that mental-health challenges are all in your head? What if somebody comes to you and says, I think I'm battling depression, but everybody around me is telling me to just be happy? 

AM: I have this conversation with patients all the time. Let’s take depression as an example. What I often point out to patients is that the technical term for depression is “major depressive disorder.” It wouldn't be called a disorder if you were able to snap out of it yourself. We literally define mental-health conditions as something interfering with your ability to function, something you cannot simply overcome through sheer willpower. 

I think that there is a misconception that people with mental-health issues are lazy or self indulgent or self absorbed. But in my experience, they are some of the hardest-working people I've ever met. They work so hard to stay well, to stay in tune to what they need to do in order to function. Struggling isn’t a sign of laziness. It’s a sign that something is wrong.

CC: Do you find that artists are particularly inclined to try to “push through” adversity (mental-health challenges, physical injury, etc.) for the sake of their craft? And if so, why?

AM: It really depends on the person and on different communities within the arts. For example, being able to push through physical pain is something that trained dancers are expected to learn, so their relationship to physical pain may be different than other people's. But in any profession where there's an emphasis on performance, where you have to show up and really bring your A game, people have to learn to assure themselves that they're fine. This is also true for, say, a lawyer or a surgeon. But artists in particular have spent so many years training for a particular performance, there's a feeling of, “Well, I can't blow it. I've been working so hard for this moment, I can't afford to not be fine.”

CC: Do you think individuals are more likely to confront a physical injury or a mental-health challenge, and why?

AM: If you break your leg and you're wearing a cast, it's pretty hard to avoid saying “I had a physical injury.” Whereas a lot of people don't even necessarily think of mental-health challenges as injuries.

But with our patients, we do often describe depression or anxiety as having an injury: “Look, if you broke your leg, you'd go to physical therapy to get stronger. If you had a depressive episode, you probably need to go to therapy for a period of time in order to strengthen your skills for regulating your emotional state and your behaviors in order to pull yourself out of the depression.” 

CC: When do you see patients trying to mask their feelings of discomfort, and what are some possible reasons they would do so?

AM: The people that I see in my practice have already taken what is likely the hardest step toward recovery, which is recognizing that they need treatment. By the time someone shows up to my office, they're already on their journey towards healing and recovery. 

But stigma around and access to mental health care remain a huge public-health issue. So making it easier for people to clear the first hurdle—going to that first appointment—is a really important step we as a medical field and as a society can take.

CC: What would you say to someone that hasn't taken that first step to reach out?

AM: I think that requires a great deal of cultural competency. Different communities may have their own particular reasons for having ambivalence toward or stigmas about mental health. As a provider and as a representative of the medical community, I think the first thing that we need to do is just listen, so we can meet people where they are and respond appropriately to their particular needs.

CC: With some exceptions, it seems that mental health care is often a one-on-one experience. But do you think there's a way to build a team of providers and a support network to help people get through these challenges? 

AM: We already do that in many settings. For example, in the child-psychiatry world, family members are always involved in a child's treatment. For people with serious mental illness, family members are often involved from the very beginning. Eating disorders are an example where family-based therapy is, according to the evidence, one of the best treatments for the disorder. Additionally, there are wonderful organizations like NAMI, the National Alliance for Mental illness, that have groups and resources specifically for family members. 

Some patients ask if we would be willing to speak to a spouse, family member, sibling, etc. That's something we are very, very happy to do. But it has to be in the service of the patient. We always want to figure out what's going to be most helpful for them.

CC: What are some ways that we as a community can support our colleagues, peers, and friends who are battling mental health challenges? 

AM: That's a great question. And I think that one of the best things that we can do is educate ourselves. It's hard enough to be battling a mental-health challenge; it's even more difficult to be educating those around you while you struggle. So I suggest that people be proactive. Try to understand, for example, “What is therapy? What are medications and their purposes? What does it mean to be in treatment?” Having a solid foundation of knowledge about mental health is one of the best ways to support those around us. 

CC: The International Association for the Study of Pain recently altered their definition of pain to include an emotional element. Could you speak to how physical pain can impact your emotions and some of the other ways pain and emotions are related? 

AM: Physical pain is a huge precipitating risk factor for depression, suicidal thinking, and other serious mental-health issues. Suffering from physical injury can lead to social isolation. It can undermine your sense of purpose. It can make you feel like a burden. All of these are contributing factors to depression. 

Additionally,  emotional pain and physical pain can activate similar areas in the brain. In fact, if you're a researcher, it can be hard to tell the difference between them!

CC: What about if a patient comes to you with an injury (either physical or mental) that could mean the end of their career? How do you navigate that journey?

AM: This gets to the core of two things that people have been talking about a lot lately: resilience and flexibility. Injuries happen to all of us. And when I say injury, I don't just mean a physical injury: I mean emotional injury, trauma, things that happen in life that hurt or are not what we wanted. When people are too rigidly stuck in one way of thinking—”this is the only way my life can be”—then when you have an injury that might end a career, it can be devastating. Flexibility and resilience mean the ability to adapt to a new reality for our lives and move forward. 

This can be really hard for artists, because they've been so focused on one thing for so much of their lives. It's not that they are rigid: It's that they have been trained to imagine only one path for themselves. So one thing we can do as mental-health providers is to help people see that there are many ways to have a life as an artist. If we can foster that sense of flexibility, it can allow people to move forward.