A few months back, I reviewed a small, independent film called “Just Like You: Anxiety and Depression.” It was designed to educate youth, teachers, and families about teen mental health in hopes of busting stigma, stirring compassion, and “saving lives.” But it mostly served to reinforce biomedical-model myths and misinformation that encourage teens to view themselves as incurably ill.
Now, with the debut this summer of the Ken Burns-produced “Hiding in Plain Sight: Youth Mental Illness,” a four-hour PBS documentary with similar goals and a better pedigree, I was hoping for more accurate representation. What I saw instead was a glossy patchwork of mixed messages.
Storms and Survival
“Hiding…” is the capstone of the Well Beings Youth Mental Health Project, a collaboration among PBS and other major media launched in 2020 and funded by Otsuka America Pharmaceuticals, Kaiser Permanente, the American Psychiatric Association Foundation, and others. It is divided into two parts.
Part 1, “The Storm,” offers an unvarnished look at the lived experience of more than 20 diverse, articulate young people aged 11 to 30-something. Through interview clips shot in the intimacy of their own homes, the youth (and sometimes family members) talk candidly about their emotional distress, self-destructive behaviors, and extreme states. It isn’t pretty: They face bullying, racism, and homo- and trans-phobia; parents who are divorced, addicted, ill, absent or in jail; being adopted or in foster care; and physical and sexual abuse. They feel unbearable sadness or crippling fear, starve or cut themselves, abuse drugs and alcohol, have “manic episodes,” and battle voices and visions only they can perceive. Yet they’ve felt they must mask their misery, fighting alone as best they can.
This section, and the rest of the film, also tell us how to interpret these stories. It presents an “Adolescent Psych 101” survey of mental health topics from anxiety to suicidality, complete with definitions on PowerPoint slides and commentary from adult experts: a kindly therapist, a pragmatic child psychiatrist, a neuroscientist, peer and school counselors, and mental health advocates.
The trailer for “ Hiding…” captures its form and content well (it begins at 1:40, after Burns’ introduction).
Part 2, “Resilience,” is about reaching one’s breaking point, seeking help, and coming out the other side with the tools and relationships to “manage” one’s condition. Here, we’re shown and told about the process of diagnosis via the DSM (“a glossary”), the purpose and types of psych medication, and the experience of undergoing inpatient “treatment” in hospital psych wards and youth residential centers. Later, the film delves into society-wide issues that don’t seem to fit elsewhere (the criminal justice system, “double stigma,” and the rise of youth suicide).
Pros and Cons
At its best, the film conveys vividly how hard it is to be a young person today, building its narrative around the interviewees’ personal arcs, which culminate in hard-won recovery. Intentionally or not, it makes clear that, given the limits of our current mental health system and its treatments, finding what works for one person versus another is mostly about trial, error, and finding those key, supportive adults to confide in. But when you do, it says, thriving is possible: You, too can pursue school and a career and feel more confident in being your unique self.
At worst, the film restates the trite and potentially disempowering advice we always hear: Recognize mental illness “symptoms,” tell someone about them, and get vectored into the mental health system. Don’t choose suicide, because you matter. If we vocalize our struggles, stigma will end. If you need help, contact the National Suicide Prevention Hotline or NAMI. These recommendations reinforce the problem of youth “mental illness” as a pathology within individuals.
Given these conflicting perspectives, we’re left with a patchwork of mixed messages. Here are two important examples.
Sources of Distress
“Hiding…” starts off with a not-what’s-wrong-with-you-what-happened-to-you? overview of the types of stressors that can lead to overwhelm. It’s not nature versus nurture that “set the stage for mental illness,” we’re told, it’s their interplay. Adverse childhood experiences, the pandemic, toxic social media, and social oppression can trigger psychosocial dysfunction in vulnerable individuals, especially those in unstable family situations. It’s also insightful on how severe stress shows up in young people (anxiety can manifest as school avoidance; depression as rage; coping as self-harm or substance use, etc.). As child and family counselor Kee Dunning puts it, we adults need to engage kids in facing their demons; then, “It can be worked out.”
On the other hand, such perspectives are bracketed by other, more dire statements: According to the faceless, baritone narrator, “mental illness” shows up for different reasons and looks different in each person, but “it is, in fact, a DISEASE: …the place where sadness leaves off and depression begins….where nervousness becomes anxiety…where excitement becomes mania…and habit becomes addiction.”
Similarly, advocate Patrick Kennedy talks about being “highjacked by a brain disorder,” and two young women who self-identify as bipolar talk about their “chemical imbalance.” Throughout, we’re bombarded with gloomy stock photos, clips of stormy seas, and ominous mood music that creates a sense of fear. (Still, the narrator reassures us, “Help is available, and with the right treatment, you can feel better.”)
The “right treatment” for just about all of the youth profiled seems to include a drug prescription (even if, like Maclayn, a sad boy who’s just come out of the closet, you’re only 11 years old). “We do need medication,” says creative and quirky Amethyst, 15: “…the symptoms are too intense.”
And yet, some of the “meds’” biggest adult boosters are quite frank about their limitations and potential harms. After lauding the variety of drugs out there, brain scientist Thomas Insel states, “None of the medicines we have are curative. None of them are perfectly matched to the problem at hand. All of them have side effects.” Parent and advocate Pete Earley even talks about how those on antipsychotics die years earlier than their peers. Some of the youths are ambivalent about their pills: Samantha (diagnosed with agoraphobia and GAD) shares that some antidepressants made her feel suicidal, but no one listened. Kevin (Pete’s son, diagnosed with schizoaffective disorder) believes that while he must stay medicated to function, antipsychotics can leave you “a shell of the person you were.”
While “Hiding…” is about shining a light on today’s youth and speaking openly about mental health, the film stays mum about the full identity and potential conflicts of interest among some of its celebrity adults. They include:
- Thomas Insel, who admits that he didn’t realize his own daughter had an eating disorder, is not just any psychiatrist but the former longtime head of the National Institute of Mental Health. He famously left the agency for Silicon Valley, frustrated by the lack of progress made in the biomedical research he funded. “I should have been able to help us bend the curves for death and disability,” he wrote recently. “But I didn’t.”
- Patrick Kennedy has a diagnosis of bipolar disorder and a history of Oxycontin addiction. This lived experience isn’t mentioned, though. Moreover, he is a member of a political family associated with both psychiatric abuse and a vision of community-based mental health care that never materialized. (His aunt, Rosemary Kennedy, was involuntarily lobotomized, and his uncle was President John F. Kennedy.)
- Pete Earley, the journalist, is presented as Kevin’s loving dad, bemoaning how psychiatrists treated his son like a number and offered doom-laden prognoses for his future. Hiding in plain sight are Earley’s controversial books and blogs, which advocate for forced treatment of those with “serious mental illness” and belittle the belief that their civil rights matter. (We do get a hint of this when he tells the camera that he tried to hide Kevin’s medication in his cereal.)
“Hiding” also lets us think that none of these youth know each other, but as we learn toward the film’s end, six of them go to the same Rhode Island high school and started a support group after a mutual friend died by suicide.
So, can Hiding In Plain Sight help “save lives”? Maybe, but only if those who identify with the youth and their families decide now is the time to address the personal and societal issues that are causing them so much distress. And to explore solutions beyond drugs and therapy (which the cast agree can be useless if you see the wrong practitioner). I like the message offered by Alexis, a 21-year-old Chippewa tribe member who adopts Indigenous healing practices like immersion in nature. “Not only is trauma embedded in my DNA,” she says, “but so is resilience.”
You can watch the whole thing here. I’d love to hear your thoughts.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.