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In this video, Jeremy Faust, MD, editor-in-chief of 木瓜直播, sits down with , an assistant professor in the department of psychiatry at Washington University School of Medicine in St. Louis, and , a psychiatry resident at the Yale Child Study Center in New Haven, Connecticut, to discuss the pros and cons of celebrities discussing mental health on social media.

The following is a transcript of their remarks:

Faust: I'm interested to hear both of your perspectives on how celebrities can help and hurt.

I'll frame it like this: I know there's a lot of data to show when a prominent famous person completes suicide, there's been in some countries like a copycat effect -- increased attempts and completions.

On the other hand, you have, I think for the first time that I can remember, people being very open about their mental health struggles. And instead of saying, "Oh, I'm a celebrity, I'm perfect, I have no problems," [they say], "I don't feel safe, I'm going to withdraw from the Olympics, because I don't feel I can do that," or, "I'm a senator, I'm going to go into Walter Reed and get mental health treatment." I feel those are the extremes.

Does every celebrity need a primer on how to be a force for good in social media for kids?

Calhoun: So Dr. Gold and I have written about this. I think that some celebrities do it really, really well. I don't know if they have an advisor or what, but I am very pro-celebrities disclosing their mental health struggles. I think it could be very effective. It has been very effective.

And I actually think, and I know Dr. Gold thinks this too, that we as psychiatrists really need to partner with celebrities more. We stay in these sort of ivory towers with this siloed research. The everyday person is not reading that. But if you were to partner with someone, like say Lizzo -- I would love to partner with Lizzo about mental health --

Gold: Shout out, Lizzo.

Calhoun: Right? There are so many people who would be able to relate to that.

I actually just saw her in concert, and she had a lot in her concert about mental health. She talks a lot about body positivity. It was very, very moving to me, and I think that it resonated with a lot of people. I know it did.

And so I think celebrities very much have a big role to play, because people follow them, people look up to them, people relate to them, they think that [celebrities] are perfect like you said. So if they see that this person who they've always looked up to actually struggles with substance use or they struggle with depression -- we've definitely seen in the data that it does lead to increased help-seeking behavior.

So yeah, I would love it if we would partner with celebrities more, psychiatrists. I think it would be actually quite life-changing.

Gold: It's complicated too, right? I think we often hear about the extremes and not the spectrum of mental health. So we should not only be talking about mental health as it relates to suicide, and it should not be only when it is a negative outcome that is then publicized incorrectly -- because there are lots of rules about talking about suicide in the media that no one follows.

It shouldn't have to be us repeatedly saying, "Stop that. Don't do that. That's dangerous." It should be like these self-disclosures like people like Simone Biles have done, [which] are wonderful and helpful. There are people that maybe would've never thought mental health applied to them in any capacity who sees the symptoms look different in a person that looks like them.

That's really important, which is why we need multiple stories and not just an ambassador for all mental illness in celebrities, right? But we talk a lot more about the negative effects and people talking poorly about their experience with so-and-so.

I do think it's important to think about what coaching looks like to tell your story, because if you talk about something, you have to be sure that it's your experience, not everyone's experience. And that if you didn't like medication, that's valid, but it doesn't mean someone else might not. So I think it's really important that those stories are told with facts and also couched in "this is my personal experience."

Also when you tell stories, people self disclose to you. [Celebrities] are not doctors, and that's really hard. As someone who has been open about my own mental health, I don't even like to hold that for people and I'm not their doctor, even though I could be, right?

Self-disclosure breeds self-disclosure, which is part of the best thing about it. But if you're not prepared to handle a bunch of people being like, "Well, when I was suicidal this happened," "when I had that much anxiety and couldn't do something, this is what happened." That's a lot for someone to hold who might be in an acute stage of recovery and had to make a comment.

Because celebrities often get found out because they do something bad, right? Like something is seen in the newspapers, and they don't know what to do with that behavior. And so the behavior gets found out and they have to say, "Oh, by the way, it was anxiety," or, "I was not nice to that reporter because I don't like reporters and they make me anxious." It comes up in those settings.

So we really need to be aware that somebody is in an acute state most of the time when that is happening and they're probably not even ready to tell their story. I think that's really hard too. Ideally you'd be ready for it, prepared for it, and supported through it, right?

Faust: Yeah. I mean, I'm actually thinking of a medical thing. I wrote about this in Slate a few years ago.

There was this moment where John McCain had this weird moment when he was not really making sense in the Senate and his PR team said, "He's fine, he just was up late watching a baseball game." And we learned down the road that he had a really serious problem that was life-threatening and ultimately was fatal.

I think the honest thing would've been to say, "Gosh, that was a little weird. I feel fine right now, but I'm going to go to my doctor and get it checked out just because I don't know what's going on. I've never had that happen to me, so we'll update you." Instead, there was an immediate spin to, "The senator's fine. I'm fine, there's no possible way I could be ill."

Gold: Yeah, I mean that's been the role of celebrity publicists for generations.

I wrote this piece about Taylor Swift for the Washington Post, but it was really about Judy Garland. It started with the history of Judy Garland's mental health, and it was weaponized against her, really. The way publicists and studios were back then, that was the point of them. You only had one studio, and you did all films with one studio. It's long been this weapon from various angles, and it shouldn't be. It should be someone's choice, but sometimes you can't make a choice if you do something super public.

So you shouldn't just say, "I'm fine." There should be a way to tell that story without having to tell your whole story, I think. And I don't know that we do very well in the nuance.

Calhoun: Yeah, I would agree with that for sure.

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