Empowering Women in Mental Health

Debra Maldonado  02:36

And the protocols to decide. Let’s just touch on that quickly. The difference in a nutshell, between therapy and coaching is that therapy is a medical model. It’s designed in the industry to look at a dysfunction in the mind, illness. The goal of therapy is to get them from that dysfunction to typical functioning. We all know, no one is normal, so we don’t use the word “normal” but typical functioning where they’re able to live their life, cope with life, get to work, pay their own bills, have relationships, they have a typical life. Coaching doesn’t meet the client in that dysfunction, coaching meets the client assuming they’re at typical functioning already, they’re high functioning, they’re helping them reach their potential. When someone’s below the line of functioning, you can’t tell them to change your life, reach your goals, think positive, they’re still not at that level. We need to bring them up. That’s the benefit and the gift of therapy because they work with clinical depression, PTSD, disorders, bipolar, helping with serious diagnoses in mental health. In coaching, we have our own market which is the high-functioning people that are ready to now create with their life because you can’t go from the deficit to rocket ship overnight, there needs to be a stage. There are people that actually go to therapy for years, they get to that typical level, maybe they had a tough experience in their life and have PTSD from war or event. They get to that typical functioning, then they have the coach who can take it from there. It’s just an easy way to think about it. One is potential-based, and one is more diagnosis and treatment. It’s called a patient with a therapist, the coach calls them clients, not patients. Outside of the medical model.

Robert Maldonado  04:45

There’re gray areas because there’s overlap in those categories. But that’s the general consensus and the best way to approach is to give as much information as they need to make an informed decision.

Debra Maldonado  05:05

There’s also therapists that do feel like they do more coaching because they have high-functioning clients. There is that gray area, it’s not just the therapists only does therapy, there are therapists that work with a different population. But the reason why we’re bringing this up for mental health, which I found not surprising, is that the prevalence — I don’t know if it’s because people admit it — in women is much higher than men, women are more likely to seek treatment than men, more likely to read self-help books. When I had my book published, they said 96% of the population that read self-help books are women, which is interesting enough. The mental health field does focus a lot on women. But there were some interesting things as well that came up when we were doing the research.

Robert Maldonado  06:06

Let’s start with the risk factors for mental health problems in women. One of the biggest risk factor is that women earn less than men, women who are full-time workers earn about 1/4 less than their male counterparts in a given year. That puts them at disadvantage, it causes stress. It’s unfair, this unfairness itself is stressful.

Debra Maldonado  06:40

They have to work twice as hard to get half the pay and compete. When it comes to childbearing, they have to take maternity leave, they lose out sometimes on promotions. They have extra responsibilities, they become a mom, their attention is split.

Robert Maldonado  07:05

The poverty rate for women ages 18 to 64 is 14.2%, compared to 10.5% for men. Women are more likely to live in poverty than men.

Debra Maldonado  07:22

Stress about money. One in three women have experienced sexual violence, physical violence, or stalking by an intimate partner in their lifetime, one in three, that is pretty huge. You’re in the room with a group of friends. If there’s more than three, at least one of you has had that. I know from working with people over these past 20 years, it’s so prevalent, I was so shocked of how much it was affecting women. It creates trauma, traumatizing situations, it makes them feel less, they blame themselves and feel the stress, anxiety, panic from those experiences. A lot of the people I’ve worked with tell me that I’m the first person they told about it, they don’t tell people, they don’t get treatment about it, they push it under the rug and don’t really address the issue.

Robert Maldonado  08:23

Then an estimated 65% of caregivers are women. These are people that have taken care of elderly parents or other family members. Family caregivers may spend as much as 50% more time providing care than male caregivers.

Debra Maldonado  08:45

You see that with families, oftentimes the oldest sister is the one who ends up being the caretaker. I worked with a lot of single women, a lot of them, as a single sibling, were the ones who had to take care because the other siblings were like “We have a family, we have kids, you’re single, you don’t have any responsibility.” Even though you’re the CEO of a financial company and work 60 hours a week, but you don’t have children, so you don’t know what stress is. A lot of them would say it’s left on their hands to take care of the parent after work. That can cause a lot of stress too because you don’t want to say no, because you care about them. As women, we’re caregivers, we that’s a natural for us. Because of a lot of that caregiving, we put ourselves last, that creates stress, anxiety, sometimes depression.

Robert Maldonado  09:40

These factors have a cumulative effect, if you have one or more of the stressors, it piles on. Then you are more likely to fall into depression, anxiety, other kinds of mental health problems. That’s one factor, then gender differences in seeking and receiving mental health services. There’s some interesting data here. Women are more likely to be prescribed psychotropic medications than men. Most of these phenomena have what’s called a multifactorial cause. There’s more than one cause that’s creating this situation. But in general, I think women are more open to talking to their primary care physician and saying, “I’m feeling anxious and depressed. Can you prescribe any medication for this?” Because they are busy, they’re taking care of kids, they’re taking care of parents, they’re working at same time, medication is just a simple solution.

Debra Maldonado  11:12

They asked women the three things that have helped them with depression and anxiety. 60% said medication helped them, it was the number one thing. A little under 40% said therapy. The third one is family and friends, just having a good relationship has helped. I find it interesting that they all were just prescribed medication. I’m not saying right or wrong, but it seems there are other natural ways to deal with it that can be healthier than medication. Do you feel it’s overprescribed in some ways to people?

Robert Maldonado  11:59

It’s both over-prescribed and underprescribed, which is weird. But what I mean is that some doctors are overprescribing psychotropic medications like antidepressants. They give it to anybody who’s having a little bit of trouble. Maybe they had a loss in their family or some stress at work. Then there’s others that aren’t educated in mental health services or medications, so they never prescribe medications when their patients might need it.

Debra Maldonado  12:45

Some people instead of taking medication will use wine or street drugs, like marijuana, to treat the depression, or food. They don’t want the stigma of taking the medication, so they find other ways but it’s still causing problems in their life.

Robert Maldonado  13:07

It’s also controversial. Still, there’s some contradictory data as to whether psychotropic drugs do what they report to do.

Debra Maldonado  13:22

And what the long-term side effects from them are that we don’t know yet. In 20 or 30 years from now, we’ll know what these impacts are.

Robert Maldonado  13:34

Women are more likely to seek help or disclose mental health problems to their primary care physician.

Debra Maldonado  13:52

Women are less likely than men to disclose problems with alcohol use with their healthcare provider. Women are more ashamed of that. Where a guy would say, “I’ve been drinking a lot, I want to cut back” where it’s almost shameful for a woman, maybe it’s a different social stigma. Women are reluctant to disclose history of violent victimization unless a physician asks, that’s exactly what I experienced. They told me, “You’re the first person I told,” and they came to me to lose weight or quit smoking. I worked as a hypnotherapist. They didn’t come to me to talk about deep issues, it would be confessional. I was like, “You held this in your whole life, you’re in your 50s and you never told another soul about this.” If you’re not addressing it, it has an effect on your mental health, anxiety, mood swings, working with your emotions, suppressing emotions.

Robert Maldonado  16:00

This is an interesting one. Physicians are more likely to diagnose depression in women compared with men, even when both genders have identical symptoms or similar scores on standardized measures of depression. It’s hard to say, but there are unconscious biases in the way we interact with each other and the way we relate to men and women. It is part of the culture, it’s ingrained in the culture, the way we think about men and women’s needs is different.

Debra Maldonado  16:45

Imagining a man depressed is a blind concept for a lot of physician men. I know it’s changing.

Robert Maldonado  16:57

The cultural norms are absorbed by both men and women. Even if a physician is a woman, she might still overprescribe for women and underprescribe for men.

Debra Maldonado  17:14

Truly, women are seeking more mental health treatment, whether it’s going to a shaman, or healer, or a therapist, or their doctor, their friends, they’re more likely to do that. But there’s also a huge population of women that are hiding in their suffering. They are maybe caregivers and don’t have time to look at themselves and what’s going on with themselves. You hear stories of family members, why is that person so cruel, so emotionally unbalanced. They never went to a therapist, they have issues they haven’t worked with. There’s a huge need to normalize that we all have problems, we all have emotional challenges, we all have stress. It’s okay to talk about it.

Robert Maldonado  18:07

We’ll be talking about stigma on our next episode but it’s definitely a big part of the problem that mental health issues are not openly discussed. They’re not taught in schools or in work settings, when they should be a part of the conversation, just like physical illnesses. If somebody has diabetes, or breaks a leg, or has anything physical going on, there’s accommodations for them, there’s respect for that because we understand you need assistance, you need help. The mind, because it’s invisible, is often ignored. It’s not seen but behind the scenes, there’s all these issues going on.

Debra Maldonado  19:03

We just watched on Apple TV, Selena Gomez talked about her bipolar diagnosis. I thought that was brilliant to raise awareness of mental health. Oprah has a series on mental health too. It’s really important for us to talk about it openly, not put a stigma on it. It was very moving to watch Selena. She says she’s reached every goal she’s ever had. She’s wildly successful, beautiful, and she has these mood swings and challenges of her inner world. Just because on the outside someone’s famous and rich, it feels like they have it all together, it’s actually something to look for too. People around you, you may think they have it together, they don’t have any problem. But there’s the subtle signs that maybe they’re not so happy. How do we open up those conversations, especially friends, or people that we care about, family members and check in with them to see what’s going on? The barriers to mental health are the reasons why people aren’t getting the help or even understanding it.

Robert Maldonado  20:13

Let’s turn it around and talk about solutions we can start to implement as a culture, as societies. We know there’re economic barriers, for example, lack of insurance and costs to some of these treatments. How can we bring down the cost? How can we help or insist that insurance companies cover a lot of these services, so that people can get them? In a lot of countries, especially developed countries, no one is out in the street because they have mental health issues. We only get this in the US. It’s the only developed country where you see people with mental health issues living on the street. That’s ridiculous. There’s no need for that. But it’s because people tolerate it, because we never say, “What’s going on here, let’s do something about this, let’s insist that these people are cared for properly.”

Debra Maldonado  21:21

If you think about it, not only the homeless, but the inner cities, the gangs and the gang violence, those communities are traumatized every day, these little kids are around these violent experiences. We need to bring that in schools and education for the young ones too. Then the parents who lose their children, we should have services to help those people in tough situations to have access to all the wonderful information we have, in ways we can treat people for trauma and depression. That’s where coaching can come in. We should really push to have coaching, some insurance companies are doing this now, wellness coaches are now being covered by insurance more and more, because the hospitals, doctors, treatment centers are seeing that a health coach can be an intermediary between a physician giving orders, helping the client, but then the mental health, the well being of the client is not taken care of in between those visits. Wellness is such a huge part. Coaching in between can help people feel inspired, help be able to work with their emotions, be able to ask for what they want, keep boundaries. All those things can reduce stress, even practicing breath work, mindfulness, meditation, those easy, no-cost ways to help a person work with those issues.

Robert Maldonado  23:01

Certainly, coaching can play a big role in prevention, in helping people improve their lifestyles, not get to those critical points needing mental health services. Increasing awareness about mental health issues, treatment options, and available services is part of the work we’re doing. Having a conversation and providing information so that people can use it, so that people can learn to talk about it and feel more comfortable talking about these things. Hopefully, they can find those resources they need.

Debra Maldonado  23:43

What would you recommend if you knew a family member was depressed or anxious and they weren’t seeking treatment? Or a good friend. What would you recommend as the first step for them to do, as a layperson, to raise awareness and encourage them to get help? Would it be to look for a therapist? Or would it be to look for a coach? Or just ask, “Do you need to talk to someone?”

Robert Maldonado  24:12

A good place to start is with your family physician. Just asking them, “What do you recommend?” They know you better than most other professionals, so they’re able to guide you, give you a referral to a clinical psychologist, psychiatrist, maybe even just a counselor, or maybe even a coach, somebody who can help you change your lifestyle, if those issues are important.

Debra Maldonado  24:47

Another thing is what I’ve seen for myself, I’m open book, I share my personal development journey with my friends or my family, and inspire them to read this book, or I went to this workshop, I hired this coach, it’s been really helpful for me. I think being that person, sharing and being transparent about it versus hiding it, thinking no one’s going to understand. By opening up and sharing your journey, you’re gonna inspire the people around you to get help as well.

Robert Maldonado  25:23

Reducing the stigma associated with mental illness. That’s a tough one but we need to, with these conversations, the more open as a society we are about that, the less stigma there will be. Stigma is a false idea that you’re weak, you’re broken, there’s something wrong with you if you seek assistance.

Debra Maldonado  25:50

The last one is, well, there’s two, the lack of time-related support. Take time off work. People are like, “I’m too busy”, they’re in that cycle of “Go! Go! Go!” They don’t have time to even read a book, or to sit with themselves, or meditate, or reach out for help, because life gets too busy.

Robert Maldonado  26:18

It would be insisting. When people come together, incredible things happen. It’s remarkable how a small group of people can change society. It’s really about getting together with like-minded people and saying, “Here’s a possible solution to these problems. Why don’t we give women maternity leave? Why don’t we help them have time off? Instead of stressing people out, let’s create environments where people can take time out. If they’re stressed, they can go into a relaxation room.”

Debra Maldonado  27:06

Even at corporate wellness programs, helping them get coaches, that’s actually popping up more and more, where the companies are helping their employees, pushing more of those benefits to people.

Robert Maldonado  27:22

Help moms with child care services, transportation, those very simple things.

Debra Maldonado  27:31

How do you even drive to the therapist or a doctor if you need to, providing ways for people to get to the help they need or getting to the support group they need. Then the last one is lack of appropriate intervention strategies, including integration of mental health and primary care services. The primary care services isn’t really married into the mental health system, as integrated as it could be.

Robert Maldonado  28:02

I have seen some clinics that are starting to do that. Some doctors groups did start to incorporate mental health services along with their practices. Again, the solutions are there, it’s implementing them and making them accessible to people.

Debra Maldonado  28:23

Making it more available, making people understand more about mental health, personal growth, psychology. The main thing, the stigma is that we’re not broken. We all have had tough knocks in life. There’s not one person on this planet that did not have some tough experience in life, and many had multiple. No one teaches us how to do that. No one teaches us how to deal with it. Except our parents, and they’re coping with it as their parents dealt with it, and their parents dealt with it. Hundred years ago mental health wasn’t even discussed. It was only for those people they lock up in the institutions, everyone else has this idea of normal. Carl Jung says that to aspire to be normal is an insanity because he didn’t think he’s ever met a normal person, because we all have a unique set of challenges and problems. Why can’t we normalize it versus make it that there’s a subset of society that’s damaged, that needs to be handled with kid gloves? We’re also resilient and have the potential for change.

Robert Maldonado  29:42

It’s a complex issue, obviously, but it plays on both sides. What I saw when I started my career in psychology was the mental health hospitals, these huge institutions that housed a lot of patients, where most of them were heavily medicated. As new developments in pharmaceuticals came about, they were able to leave those hospitals, they were able to go off into the community and try to live normal lives or semi-normal. Medication is not bad, it gave people a lot of opportunity to leave those institutions.

Debra Maldonado  30:32

If someone’s clinically depressed, medication can help them from going deeper into it, give them a little lift. We’re not anti-medication, but there are other ways to prevent you from going down a darker path because the mind is resilient. We can go deeper or it can rise above, it has that resilient factor.

Robert Maldonado  30:55

On the other hand, the medical model took over the mental health field to where now the mind was pathologized. Everything was about you having some trauma, some disorder. If you’re sad, you must need medication, you’re depressed. It’s finding that balance. Not everything in life is pathology. We all face challenges, we all have some hard knocks. It’s just part of life. That’s where coaching can come in, it can act as a buffer, a barrier to help people deal with the everyday issues and stresses of life in a more preventative way, instead of pathologizing them and going straight to diagnosis and medication. Why don’t we help everyone be the best they can be and have that support system?

Debra Maldonado  31:58

In our previous episode, we talked about the gifted children and the troubled children, how the teacher assumed the gifted children were troubled, and then their scores went down. It’s the same thing with mental health. If you’re projecting onto people: you’re depressed, you must be weaker, you must have less potential, you are broken in some way, or you had this trauma happen to you, you must be broken, you have a limitation to a normal functioning life. That kind of projection can be very limiting for someone. We want to see people as becoming always, even if they’ve had the toughest of life, to see them becoming. It reminds me this story, probably five years ago, when the girls from the school in Boko Haram in Africa. They captured the girls, abused them, the army kept them for a while, then finally gave them back. The matriarch got on TV, she was like, “These girls are not broken.” She said it so clear. She said they are resilient, they’re smart, nothing that happened to them is going to define them for the rest of their life. I thought that was so brilliant, because yes, they do need care, they do need attention, they do need support, maybe more than some people, but it doesn’t mean they’re always going to be operating from that because of that past experience. In mental health, sometimes you’re stigmatized or labeled with this thing that happened, you’re always the survivor of that thing, something you always have to carry within you, in your mind, this label is a part of yourself. We teach in Eastern philosophy that your true self can never be harmed, can never be damaged. When you’re working with the personality, you’re only working on the ego level. All these things that happen to us in our life, our limitations and our setbacks in these events that may be traumatizing, only happened on the ego level. On the deep level, there’s this pure potential that’s within all of us. We all have the same potential. If we could speak to mental health in that way, a lot of people, especially women who look for mental health services more than men, will see the changes, will feel more resilience, will see more transformation in their life coming from that place instead of coming from a deficit.

Robert Maldonado  34:34

Some people have asked us, “Is your work an alternative to therapy?” That’s a tough one to answer. There are times and situations where therapy is appropriate and the right way to go. But for many people, I would say the majority of people, they’re not really damaged, they’re not really traumatized. The problem is that the only language they have to talk about their issues is the language of trauma, of PTSD, of depression and anxiety. Therefore they use that language and those labels to speak of their emotional life that way.

Debra Maldonado  35:27

Even saying, “I am depressed,” like you’re identifying with the depression as something of who you are versus “I’m experiencing this state they call depression, but that’s not who I am. I’m just having the state right now.” Then it’s not a permanent label.

Robert Maldonado  35:44

Ultimately, we’re developing a coaching model that in the future, as we develop it and educate people in it, could serve as an alternative to psychotherapy and medication. To begin with, it’d be more of a preventative type of measure that would give people that are already high functioning, a way to go to higher functioning.

Debra Maldonado  36:23

They don’t fall when they lose their job, or lose a mate, or can’t find a partner. They’re not sinking down into more serious anxiety, depression, hiding and exacerbating the subtle, maybe it was like a seed, now it’s grown into this big, heavy emotional challenge they feel like it’s taken over them.

Robert Maldonado  36:47

Then also work in collaboration with psychotherapy, perhaps, to augment the power the client receives from psychotherapy in the social setting, because often therapy is confined to the mental health office or to the clinic. Patients don’t live in the clinic, they live in the real world where they have to face these challenges on an everyday basis. Coaches could certainly serve in that function as well. But of course, it requires training in both areas to understand the mind, what the challenges of the client are, how coaching can serve in those environments.

Debra Maldonado  37:47

Filling the gap in. When I was single and struggling, doing self-help books and workshops, I didn’t think to go to a therapist, I went to healers. If I had known there were coaches, I think it’d have been such a change for me. I think I’d have moved faster because I needed someone to help me to think about my life, think about my emotions, ask me the right questions, instead of me trying to self-treat and manage my own emotional life, trying to read these books on psychology and apply it on myself, which is what a lot of people do. You can get help. Even if you don’t have a one-to-one coach, there’s a lot of group programs that are highly affordable, you can at least have access to a coach and a group that will help you get out of the funk that you’re in or help you reach your potential. For the next episode, we talked about women, we’re going to talk about men and what stops men from getting the help they need and how we can change that in the world.

Robert Maldonado  39:01

Believe it or not, men have a mind as well, we have emotions also. We’ll be talking about that next time.

Debra Maldonado  39:10

Take care, everyone. Hope you have a great week, and we’ll see you next time.