What is mental health?

A week after the deadly December 2012 shooting at a Newtown, Connecticut, elementary school, DePaul University student Erica Jellerson shut down her computer in frustration. She was upset by newspaper readers' online comments about the shooter, which included such phrases as "crazy," "psychotic" and "go to hell."

"I remember thinking that unless you're dealing with a mental illness yourself, or are extremely close to someone dealing with one, you just don't get it," says Jellerson.

That's when Jellerson began her blog, To My Brother, With Love, which chronicles her 11-year-old brother Christopher's struggle with mental illness and aggression. She seeks to help people understand the warning signs of mental illness and the fact that often people try to get care and don't have access to it.

Jellerson is one of many who blog to process their grief about mentally ill loved ones or to help themselves cope with mental illness by writing about painful periods of depression or anxiety, discussing day-to-day challenges or simply venting. Many bloggers also use these online forums to provide resources for those who are newly diagnosed and to exchange support with others who may be facing similar challenges.

As mental health experts, psychologists have also become avid bloggers, writing to educate people about mental health conditions and occasionally working through their own mental health challenges. Blogging can help chip away at the stigma of mental illness, says Ali Mattu, PhD, a clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders. He writes about the psychology of science fiction at Brain Knows Better, but also uses the blog to share personal stories. Last year, Mattu's post — written as part of APA's 2013 Mental Health Month Blog Day — about dealing with the aftermath of his brother's suicide won the 2013 Brass Crescent Award for Best Blog Post.

"As psychologists, it's our job to model how to handle these things, and if we're not willing to talk about some of our own difficulties and how we've sought help, how do we expect our patients to do it?" Mattu says.

Good for your health

Long before the ubiquity of blogs and other social media, psychologists touted the benefits of writing about thoughts and emotions that arise from traumatic or stressful experiences. Since the 1980s, research by University of Texas at Austin psychology professor James Pennebaker, PhD, and others has found that short-term focused writing about emotions can enhance immune function, lower blood pressure, decrease heart rate, reduce asthma and arthritis symptoms, and lessen sleep disturbances in patients with metastatic cancers. Research has also documented such psychological benefits as lowered anxiety, less rumination and fewer depressive symptoms.

"There's a lot of science grounding expressive language writing and journaling as being an extremely helpful piece for maintaining mental wellness," says Deborah Serani, PsyD, a New York-based psychotherapist who blogs about mental health. That's one reason she encourages her clients to engage in expressive arts, be it blogging, journaling or taking an art, music or dance class.

"You don't want patients just to use their 50-minute session to process what's going on in their lives," says Serani, author of the 2011 book "Living with Depression," which chronicles her own struggle with the illness. "Instead, we should be helping them create a toolbox of ways to express themselves that they can use not only outside of therapy but in place of therapy at some point."

Blogging adds a more public element to the writing process, and some research suggests that such communal communication offers additional psychological perks. In a 2013 study of 161 high school students, researchers at the University of Haifa found that writing a blog was more effective than writing in a private diary in improving troubled students' self-esteem and lessening their social anxiety and emotional distress (Psychological Services). Opening the blog to public comment intensified these effects.

Jellerson has seen this firsthand. "I've gotten so many messages from people who are so supportive — both people we know and people I've never met before," she says. "It's been helpful in some ways to hear that you're not the only one."

The anonymity of blogging can also be helpful for some people, allowing them to express themselves more freely without being concerned about family and friends knowing their thoughts, Serani points out. One New Yorker who has a compulsive skin-picking disorder known as dermatillomania writes anonymously at Diary of a Skin Picker, a blog he began four years ago to document his therapy journey and spread awareness about this little-known disorder.

"It's a really tight community," he says. "We share resources, post pictures and provide encouragement — things I really wasn't finding online when I was first diagnosed."

He says the support he has given and received through the blog, coupled with a year of cognitive behavioral therapy, have helped him improve his self-care, identify alternative strategies for dealing with his skin-picking urges and prompted him to join a local support group. He's now also pursuing a master's degree in social work to help others who suffer from skin picking and to do clinical work and much needed research about new therapies for skin picking.

Social media pitfalls

Of course, blogging isn't a cure-all. Many psychologists remind clients who blog that whatever they write about should also be discussed in the therapy room.

"Social media can be a good adjunct to treatment, but not necessarily a replacement," says Colorado clinical psychologist Stephanie Smith, PsyD, who blogs about the importance of psychology and good mental health. That said, Smith recognizes that many people can't afford treatment, don't have access to therapy or just don't believe in it. "If online support and resources are all that some folks can manage, then I think it's important we support them in that," she says.

Another consideration for social media users is the comment section in blogs and other posts, since some comments can be extremely negative and hurtful. Serani recommends clients and other psychologists use "comment moderation" tools on their blogs, which allow you to review comments before they are published, or to create settings where no comments are allowed.

"Negative comments are inevitable when blogging, and in fact, there are people who troll blogs just to find something to argue, berate or taunt," Serani says. "Resist talking back, arguing or trying to prove your point to the negative commenter. Instead, delete his or her existence once you discover it."

Psychologists should also be aware that some blogs and websites promote harmful behaviors, such as pro-anorexia and pro-bulimia blogs, or sites that detail ways to commit suicide. If a patient discloses that he or she chats with others online about problems, the therapist can investigate the kinds of communications that the client is having to determine whether they are supportive or destructive ones, says Smith.

Overall, it is critical for psychologists to adhere to the APA Ethics Code if they blog or recommend blogging to their clients. Smith, for example, underscores that psychologists should never Google a client or visit a client's blog unless he or she requests it.

"I also tell folks they are welcome to follow me on Twitter or subscribe to my blog or like my professional Facebook page, but that I'm not going to follow them back since that can breach their confidentiality," Smith says.

Such ethical considerations are important to keep at the forefront since blogging and other social media are here to stay, Mattu says. "There's a lot of value in sharing and writing about experiences, so it's important for psychologists to understand how the technology can be used in the best way."


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