Mental Health in Germany — Q&A with a German Psychiatrist | Easy German Podcast 610

Hello Cari.

Hello.

And hello Rieke.

Hello.

We have a wonderful guest today.

Rieke, welcome to our podcast.

Yes, thank you so much for having me.

Thanks for the invitation.

We got to know each other because you contacted us.

You actually have a medical education.

You are a doctor and lived in France for a year, learned French and discovered Easy French.

Some people don't even know that, but Easy German also exists in other languages.

And then you started watching Easy French and found Easy German through that?

Exactly, well, it was quite funny.

I did an Erasmus year in France, in Brittany, and I also worked in the hospital and studied at the same time, and then I saw videos on YouTube.

And even after I came back, I kept watching them from the Easy French colleagues in France.

Greetings to Hélène and Judith in Paris.

And the great thing is, you then went one step further and said, Easy German, cool, but you're missing a bit of medical topics.

And then suggested that we film a video at your hospital.

We are actually doing that.

And we also invited you to our podcast to talk about mental health today, because you work as a psychiatrist in Berlin.

Exactly, so I'm a doctor, a doctor in training and work in the department of psychiatry in a hospital here in Berlin.

And it was actually like a little spontaneous idea, I was sitting on the couch at home after work or lying on the couch, if we're being honest.

And then I saw a video of you on YouTube and went to your website.

And on your website there was this addition, hey, do you have any ideas? If you have any ideas, contact us, something like that.

And then I clicked on it because I had the idea that it would be kind of cool to somehow connect that again or to bring in the medical stuff or medical topics and to suggest that.

Easygerman.org slash youridea, that's what this page is called. You can take a look if you have an idea.

Yes.

And thanks to this page and thanks to your initiative, Rieke, we have a special...

Topic of the week.

Yes, our topic today is, as mentioned, mental health, and we actually asked you, our members were allowed to send questions. What is a member of Easy German?

What is a member? You can be a member of Easy German, easygerman.org slash membership, and part of this membership is a Discord group where we chat with each other, and there in our podcast channel, you asked what questions you have for Rieke.

Exactly, and we received a lot of questions about mental health. Before we start with the questions from our listeners, I wanted to ask in general, what actually is mental health?

So, mental health is first of all a super important question and a super important topic in today's time, and mental health, you would think, perhaps means that I am not mentally ill.

Not just that actually, but mental health actually means a balance or a well-being of emotional, psychological, and also social factors.

That means, it's not just about not having a mental illness or a psychological diagnosis, but also about having a well-being from several areas, and that's actually what mental health is.

Manuel, do you do anything for your mental health?

I am very lucky that I have always felt very happy. Can you say it like that? Is it luck if you are naturally happy? Can you have luck or bad luck in mental health?

Certainly. I mean, people are different. There are definitely those who perhaps wake up in a good mood every morning, and the others are grumpy in the morning.

Perhaps you can compare it a little bit. But it is also important, nobody can help it if they are affected by a mental illness. Nobody can help it if they feel mentally bad or can feel bad during their life.

I think you're right. So you can do things for your health. And yes, I meditate for example. That's certainly not bad. But I don't think anyone can help it if they feel bad. And conversely, I probably can't do much about the fact that I'm doing so well. So I might just have been lucky.

Let's get to our first set of questions. Because actually, this was a question that was often asked in different ways. What can you do yourself to be or stay mentally healthy? And some people asked questions about that.

For example, Maggi wrote, what should you definitely do to stay mentally healthy? Andrzej asked what role does nature play? I have read that hiking and walks really have a big impact on our quality of life. So should we people in modern civilization move more and have more contact with nature?

And Phil asked about the role of social media and also sent us a voice message about it.

Thank you, Phil, for the question. Phil addressed you formally. It wouldn't have been necessary. We use the informal 'du'. Yes, that's a huge complex. What can you do about it? Would you say, first of all, can you do something yourself?

So I think the question, no matter what specific question it was, is also about how do I deal with stress? How do I deal with stressors? And I think that's totally different for everyone. Everyone has different stressors. Everyone also has a different susceptibility to stress. Everyone has a different way of dealing with stress. And you mustn't forget that before you even come to a possible answer or solution. If there even is one solution, probably not.

And I would say, first of all, it is important to know, A, what is stressing me right now? To consider, what is my strength right now? How can I divide it up? Do I even have enough strength right now for what is challenging me so much? That means, being so mindful with yourself, also going inside yourself and listening to how I am doing, is actually the first step.

So being aware of your feelings and the influencing factors?

Yes, exactly. So you don't always have to have understood everything or thought it through in detail, but just to look, okay, what am I feeling right now? Do I feel some kind of restlessness right now? Do I feel a tiredness right now? Do I feel an extreme fatigue, something like that first?

So mindfulness, that's actually what you train with meditation, that you don't just do your things on autopilot in everyday life, but you do check-ins with yourself.

Yes exactly, that makes total sense, right, to actually do regular check-ins. You shouldn't spend the whole day somehow listening to yourself, that's not productive, I think, but at least giving yourself the opportunity from time to time is, I think, totally useful.

Yes, what kind of routines can you do there? So Manuel, do you meditate every morning?

Not every morning unfortunately, but occasionally and I always find it difficult to say that you meditate to achieve a specific goal. It is simply an exercise that helps to be more mindful in everyday life in the long term.

So first of all, become aware of how you are doing, that's the first step. I started writing a diary two years ago or so, Manuel always recommended that to me and that's for me also, I notice immediately, there are days when I have so much to do that I hardly get to reflect and I have that now as a fixed to-do item.

So it's on my list every day, I have to write something and I have to write how I'm doing and I notice that that really helps me, especially when it gets stressful, to just take out this moment, this stress and just acknowledge, so I've already learned that, acknowledging how I'm doing is usually the first step to insight.

What about external factors now? So would you say, okay, some people can handle stress well, they feel good if they spend ten hours a day on TikTok and never go into nature, or are there any rules there? Now Phil asked about social media and Andrzej about the role of nature. Or would you already say, okay, there are a few tips that you could give to everyone that would be good?

So I think, especially when it comes to social media, it's I think, no question, if you would scroll for 16 hours somehow, it would probably make you feel very bad in the long run and at the same time it is totally difficult to escape social media in today's time. It is not only a negative aspect, what social media concerns, it is also a totally great further development of technology, you mustn't forget that, not all media or new media are bad per se, I think you have to know how to use them

use them well, in what frequency, in what intensity you use them.

Only Easy German episodes and Easy French.

Yes, exactly, and then I think it's also a question of what the balance is, and that's where nature might come into play. I think there was even a group at the Max Planck Institute two years ago who actually did a study, and they had subjects walk in the city and in nature, in the forest, somewhere in the Grunewald, and then they did MRIs of their heads afterwards.

And in the region that's responsible for stress response and emotions, the activity in those who walked in nature had decreased, so it went down.

And from that, one would conclude, yes, it's absolutely good to be in nature.

It's a bit, well, I'm happy that this study took place, but it's also a bit Captain Obvious, you could have guessed that.

Maybe you could have guessed it.

But you, as a psychiatrist with a professional background, do you make rules for yourself?

Do you say, okay, I only use Instagram for half an hour a day and I go into nature twice a week?

I wish I were that disciplined.

Sure, I would absolutely recommend it, I recommend it to myself too.

How you then actually go through with it is the next question.

That's the difficult part about it.

I think we all know that nature is good for us, that spending time in nature is good for us.

Nevertheless, it's also true that we can't all spend six hours a day in nature.

We also have our everyday lives, our lives, and we live in the big city.

And you might not get to spend six hours a day in nature, nor should you, right?

No, it depends on what you do.

But I think balance is important and that you find things that are good for you,

that you find things that are individually a balance for yourself.

And that doesn't have to be nature.

It can also be, I meet up with friends and play cards or I meet up with friends and eat something or watch TV or whatever.

It can also be a balance.

I think everyone really has to find that out and try it out for themselves individually.

So very important.

We've now talked about some things that might be obvious.

As Manuel already said with Captain Obvious, a member of Easy German with the great name Schwolf asks,

what non-obvious things influence our mental health?

Yes, that's an interesting question too.

I've, well, I'm wondering what obvious things are.

Sure, nature, sleep probably, nutrition, I would say now.

Stress at work.

But stress isn't really that obvious, is it?

Some people perceive different things as stressful than others do.

Yes, although there are also different forms of stress.

Not all stress is negative.

There's also this distinction between good and bad stress.

What is good stress?

Well, good stress, in professional terms, would be called eustress, and bad stress is distress.

And there is that distinction.

And good stress is, so to speak, a stress reaction on a biological level with the release of stress hormones,

which, however, encourages us to improve performance or leads to improved performance.

For example, I don't know, during a marathon or when I have a deadline and I'm two days before the deadline for a paper,

then I'll really buckle down again and get it done.

And the difference is that with eustress, with good stress, there are always phases of recovery.

And with distress, it's stress where we feel overwhelmed by it.

We can't withstand it.

That doesn't lead to improved performance or a good form of stress,

but to exhaustion, overwork, and in the long run, that makes you sick.

And that's the difference.

There's not only bad stress, but also good stress.

You just have to make sure you incorporate balance, and that's important.

And how do you know what's good and what's bad stress?

Because the transition is probably fluid.

We just had a major deadline.

For months we worked towards the launch of our membership platform.

And we all noticed that in the last two weeks, and especially in the last few days, we had really positive stress.

We were excited and we worked a lot harder and we were all happy.

But at the same time, if we had had that stressful phase for longer than two weeks, it wouldn't have been healthy anymore.

Where is the transition then? How do you distinguish between them?

Well, I don't think you can define it that clearly, because stress and stressors are individual for everyone.

What stresses me out doesn't have to stress out the other person.

And that's why it's totally worth considering what my personal stressors actually are.

What might there be in my environment? What might there be at work that stresses me out?

Maybe also in social contacts, what stresses me out? Are there any conflicts?

And that's totally different for everyone.

We've now established that every person is different, and every person may also have a different way of coping.

I always find the question of when one should actually seek help very difficult.

So when do I cope with something myself, and when maybe not?

Maggie also asked that. When do you have to look for a psychologist, and when for a psychiatrist?

Those are first of all still the distinctions, psychologist and psychiatrist, that we should perhaps explain.

But let's start with seeking help first. What would you say, when do I need help?

Because with mental health, it's sometimes not as clear as with physical health, right?

Yes, totally. So if I somehow have a stomach ache and I'm doubled over in pain, then I know, okay, I need to go to the doctor.

That's usually not so crystal clear with mental illnesses.

What is clear is, if I have a phase where I'm not doing well mentally, where I'm no longer able to cope with my everyday life,

where I'm no longer able to take care of myself, in the worst case.

So no longer showering, no longer washing myself, these basic abilities that one actually has in everyday life.

If all that no longer works, then I definitely need help. But it doesn't always have to get to that point.

I can also gladly seek help before I can no longer feed myself or wash myself. So, for God's sake, very, very important.

That's for example a topic that has often occupied me. I said at the beginning that I'm a very happy person.

Nevertheless, I have of course had phases in my life where I wasn't doing so well.

And then I struggled a lot with myself as to whether I should now seek professional help, because that somehow didn't really fit my self-image perhaps.

Or I also think, well, other people need help much more urgently.

And especially in a city like Berlin, there are simply only limited offers, therapy places. What would you recommend there?

Totally difficult topic. So it is absolutely clear that contact points are there.

I also don't find it easy to answer, in the sense that one also knows it oneself, when one is not doing badly.

Well, one somehow has a bad conscience. And those are then usually the people who then really also wait until they are doing very, very badly.

And that's why we would actually rather motivate people to seek help early on, if you notice that it's not going away on its own.

Yes, if I notice, okay, I don't have anyone in my circle who can support me right now.

Of course, you can first try to get it under control yourself.

So if I notice that I'm not doing well now, I'm down, my mood is bad.

What can I do to feel better?

That's what I can ask myself first. Can I perhaps activate my circle of friends, my acquaintances, call someone, and somehow seek support there?

And if all that doesn't help, there are also outpatient services you can make use of.

So, the first step doesn't always have to be going to the emergency room, but there are plenty of outpatient networks where you can reach out.

Whether it's counseling centers, psychiatric day clinics, or outpatient therapists, that's very important.

I know this from my circle of friends. There are many points of contact, but you really have to work your way through it.

So, there's also a lot of bureaucracy in the moment when you say, I'm looking for help.

Yes, there are offers, but you also have to stick with it.

We actually want to make a whole separate episode on this topic of how to find help, because it's such a big topic and you've really had a lot of questions about it.

So, how do I find help, where can I go, what does the health insurance pay for?

Let's come back to Magi's question, who wrote, what is it, when should you go to a psychologist and when to a psychiatrist?

You're a psychiatrist, what is that exactly?

So, the difference between psychologists or psychiatrists is that psychologists have studied psychology and psychiatrists have studied medicine.

That means psychiatrists are doctors and psychologists are, well, psychologists who have studied psychology. Those are completely two different courses of study to begin with.

The difference is that psychiatrists are allowed to prescribe medication, and both psychologists and psychiatrists then do the therapist training when they are in clinical training.

That means both professional groups can offer psychotherapy.

Okay, I actually didn't understand that myself. I always thought, okay, the psychiatrists, they studied medicine, they make the diagnosis, and then you go to the psychologist for treatment. But that's not necessarily the case?

No, it doesn't have to be that way. So, there is the possibility to decide, am I working more as a doctor or as a therapist? For example, in outpatient care, if I now open a practice or am active as an outpatient, I would consider whether I want to work therapeutically or medically?

What's the difference then? So, therapy is not a medical activity?

Yes, in this case it is, because I am a medical psychotherapist, for example. But there are colleagues who are then therapeutically active in their practice, using talk therapy or behavioral therapy, and don't necessarily do the medical part by prescribing medication at the same time.

There are certainly colleagues who somehow offer both, I'm not sure about that, but that's one difference. So you can kind of set the focus differently.

That's an exciting topic, so we'll maybe talk about it again in the second episode. What is it, what do you even need? When do you need therapy and when do you need medication? I find that interesting too.

I would like to come back to a set of topics for which we have also received many questions, and that is the social handling of the topic of mental health. Manuel, would you like to read Elli's question?

Hello Cari and Manuel, thank you very much for your podcast. I am recovering from anorexia and for me the podcast is a positive and important distraction when my thoughts are too loud.

I am finally healthy enough to travel. Tomorrow I'm flying to Munich. Based on my experiences, I would like to hear your opinions on the psychiatric health system in Germany. What is the attitude of the German population towards mental health?

Big question.

Yes, big question.

Can you answer that in two sentences, Rieke?

I almost don't think so. That's difficult in two sentences.

The attitude of the German population.

So, it's a little bit about the topic of taboo. Is it a taboo topic? And at least in the big cities, at least in Berlin, Hamburg, Munich, I have the feeling that it's not a taboo anymore. That it certainly used to be, but in Berlin, I feel that this topic is discussed very openly.

Well, I think it depends on what circle you're probably in.

In Manuel's bubble.

In which bubble, exactly.

That could be, yes.

I also think that the taboo is decreasing, that's for sure. But I also think that it is at least still present. So in certain situations, in certain social bubbles, in certain, yes.

Occupational groups perhaps.

Maybe that too, yes.

Jobs, companies.

Yes, totally. A good example, for example. The integration of employees who, for example, are somehow out of work. Or how do I deal with it in the company, at work. I think that's still an issue that's not so self-evident, still. And which the patients then also feel. So in the sense of taboo or stigma as well.

Yes, I would definitely say that it's a huge taboo. I think we both now live in such a Berlin bubble, let's say, in our circle of friends, in our age group, in our group of origin.

Maybe it's slowly getting a little better, but I would also say, even with us, the topic is not de-tabooed, and in other groups even less so.

Antje sent us a very interesting voice message. And there she brings in two aspects. Namely, cultures in different countries are also different and also in generations.

Hello everyone at the Easy German Team. Antje here from Portland, Oregon.

My experience is that mental health is unfortunately still a taboo in Germany.

Personally, I have lived with depression since the birth of my children.

And so far through therapy and medication, I live relatively well with it, but it is a lifelong process.

My parents come from Germany and both sides suffer from depression, anxiety disorders, although almost all of my relatives don't want to talk about it or seek help and it can make relationships difficult.

As a mom, it is very important for me to be honest with my children about my experiences, to speak openly and to teach mental health.

My relatives survived two world wars and subsequently raised their children, how often does generational trauma come into treatment.

Do Germans who suffer from mental illnesses realize that it can be a component of their suffering?

I thank you for bringing such an important topic to the forefront.

Greetings and Manuel, please give Tofu a kiss from me.

Bye.

So Antje has a very specific question, this generational trauma, but perhaps we can zoom out a bit again.

I found her observation interesting, she says in Germany it is a taboo, you yourself have lived in France at least, have been in other countries perhaps.

And she spoke of the generations, what would you say, is it more or less taboo in Germany than in other countries?

I wouldn't say that it's necessarily less of a taboo, I would argue, without having hard numbers or any studies,

that it's probably relatively similar in the European area, at least that's my experience from France.

But then Germany, USA, Antje comes from the USA, could I imagine that that is a difference, or? You've lived in the USA, are people more open about mental health there?

I also think it depends a bit on the bubble you're in. Yes, I know that in Japan, for example, it's a classic example of being very, very tabooed,

that it's a completely different societal thing there than it is here. In the US, I think it's already tending to be more open, but these are all generalizations in the end, probably.

Okay, and this generational conflict, perhaps even existing, is that something you see in your daily life, that perhaps people in certain age groups are less open to diagnosis and treatment in general?

Well, it does happen that we have the impression, or that you yourself somehow get the impression from practice, that especially with younger people, the barrier to seeking help is lower, and there is an openness to learning things or towards therapies of any kind.

Whereas there are also people who may be older, who have perhaps never done psychotherapy in their lives and have never even heard of it, and you could definitely think that there's a generational difference there that will hopefully dissolve a bit or continue to improve, also with the keyword of social media.

I think it's definitely an opportunity to exchange information about mental health topics, maybe even to learn, and I think that's at least a positive aspect of the media, because we had the topic earlier. But yes, of course, the differences in generation can certainly be present, yes.

And then we got a message from Yi Zhao. Yi Zhao writes, a friend of mine recently told me that she was recently diagnosed with autism. I've known her for a long time, yet I was quite surprised when she revealed her diagnosis to me.

On the one hand, I'm happy that she gives me this great trust to share her diagnosis with me. On the other hand, I didn't even know how I could support her as her trusted friend. So here's the question, what can you do if a friend, a friend, someone in your own family says, hey, I might not be doing so well or I have a diagnosis for a mental illness or a personality,

disorder or whatever. How do you deal with that?

I think the most important thing at the beginning is just to be there, to listen. I don't think you have to present a solution. I think it's first and foremost about having a place and conveying to the other person or the person you're talking to, okay, I'm here and I see you, and I see you in your suffering perhaps, and tell me what you need. And to offer that openly.

Yichao also asked later, what about the topic of neurodiversity in Germany? Is it even discussed? Do friends talk about which different diagnoses or neuro, what do you call it when you're neurodiverse? It's not necessarily a disease, but you have a different structure.

A different way of being.

A different way of being, yes.

That's how I would put it.

From my feeling, people haven't been talking about it so openly for very long, but it's still something that's in the process of being de-stigmatized. So more people are dealing with whether they might be neurodiverse themselves or getting diagnosed and then talking about it. It's still in transition a little bit, isn't it?

Totally. Especially the topic of neurodiversity, i.e. ADHD, autism, these are all spectrum disorders or such a different way of being, which are totally in transition. And there is much, much more research on this in the professional world than there was years or decades ago.

So I think compared to, let's say, 40 years ago, there's no comparison. Especially with these clinical pictures or with these disorders. I don't really want to say clinical pictures. I call it more a different way of being. And it is absolutely positive that there is more of this openness on both sides, on the patient side and also on the professional side.

So, there is more awareness of it and therefore more demand and therefore more diagnosis? Or how would you describe this connection?

So I think there's more awareness of it. There is also more demand. Of course, there are also diagnoses that are not confirmed. You have to say that very clearly too. Especially with regard to any YouTube diagnostic videos. So I warn against that, very dangerous.

So there are people who quasi self-diagnose because they watch YouTube videos?

Yes, it's not dangerous now, but it's just difficult. Any tests that you see somewhere in social media, if you watch the videos, then every second person thinks they have ADHD. Of course, I think that too then. But it is always important to contact the right places. It doesn't hurt at all to watch these videos, but I think then seeking help and going into diagnostics, that must then run in the right place.

Exciting. So many topics. I feel like we have so many tabs open right now. And we want to talk to you further, Rieke. We're going to record a second episode. It won't be released directly this week, but probably in two to three weeks.

And there we will talk about how can you specifically seek help in Germany? And how does the health system actually work? Does the health insurance pay if I do therapy? How do I even find a therapy place? I'm looking forward to it.

I'm looking forward to it too.

See you soon, Rieke.

See you soon.

Ciao.

Bye.