Insane mag in 2020 and the state of society as regards to mental health: an interview with Lucie, the founder of Insane magazine

An interview done by Noé Michalon, translated into English by Aurélie Hoarau-Michel and Jessica Dutse. Many thanks to them all!

Lucie, you're the founder of Insane. Can you remind me again why you decided to create a magazine that is dedicated to mental health?

If I got the idea to launch it, it’s because I experienced a major depression during the first year of my Master's degree at Sciences Po [an elite university in France]. So much so that I had to take a gap year to breathe (during which I did an internship at madmoiZelle.com, a webmagazine) , and I was hospitalized in a psychiatric hospital three times.

But each time I came out, I found myself powerless and without resources: I didn't know what to read on the Internet, I didn't even know what to look for, except maybe typing "getting out of depression" on Google... and obviously there are a lot of things that show up there but they are not necessarily reliable.

Doctissimo forums, etc.?

That’s it, or other websites that clinically explained what depression is. Which was fine, but when I got out of the hospital, I had to deal with Sciences Po asking me to hand in written or group works, I was flat sharing and I couldn't afford to do any kind of household chores... The question was, how do I cope? That's really what I missed: practical things, tips, advice, things to know that could help me get through the day.

Also, the problem in France is that when you go to see a psychiatrist or when you are being treated in a hospital, this is what happens: they make you see a psychiatrist to see if you need medication, and then afterwards you may be assigned a psychologist so that you can talk. And that's really limited to psychoanalysis. So there you are, in front of your psychoanalyst, who asks you, "How are you today?" and then asks you to talk about your childhood. Which is interesting, but in reality, when you get out of there, you still don't know how to cope with your day-to-day issues.

When I was in hospital, I was lucky to have a Master's director who was wonderful: a petite lady (smaller than me!) full of energy, she was the one who handled everything for me while I was in the hospital, and until I came back to Sciences Po.

To put it in simpler terms, what actually happened was that, on a Wednesday like any other, I went to class as usual, and in the evening I decided to go to the psychiatric emergency room, because I had to wait two weeks before my next appointment with my psychiatrist (I had only had one appointment at that time), and I couldn't hold on. I was reaching a breaking point.

So I ended up in the hospital, it was the middle of the university semester, I had some work to do, so I wrote to my Master's director saying "Hello, this is where I am right now, I'm in a psychiatric hospital, I don't know when I'll get out, I don't know if I should stop Sciences Po, in short, I don't know anything." From that moment on, she took care of me: she asked me to contact each of my professors individually by email and send her a copy, asking them to extend the deadlines for assignments, or to adjust some of their marking schemes, or change group works that I obviously couldn't do to individual work. She really helped me out, I think that without her, I simply would have given up on my studies at Sciences Po. I was lucky I met her, because there were others around me who weren't doing so well - they didn't go to hospital but they were depressed - and whose Master's Directors simply didn't care. So, these were important and very real issues that complicated things.

My Master's director then sent me to the Disability Department at Sciences Po, where I got help dealing with these issues, which further enabled me to continue my studies. Here is a silly example: when you are depressed, you tend to have no energy at all. So, for me, climbing the stairs to go to class could take about 10 minutes. Sounds silly, but it's complicated, or even impossible to explain! You are not walking on crutches, you're not in a wheelchair, so you can't say "I have a physical problem", and yet...

I remember the elevators were exclusively reserved for the disabled...

Exactly. So the Disability Department gave me an elevator access badge so I could get to class!

So that's exactly what Insane's is about: giving people access to this information, to these tips. For example, who to contact if you are a student, how to find a shrink when you don't know anything about the mental healthcare system, etc. I had searched for a psychiatrist or psychologist myself. Well, my roommate did so for me because I was too exhausted to do it myself, and she actually just typed "psy" in Google. She found a list of resources that provided the addresses of teenage centres, help centres and care facilities etc., but I had to call them myself to book an appointment. And out of the 20 calls I made, I was systematically rejected: either because I was too old (over 18), or because I was too young (under 25) or because I didn't live in the right district...

It's unbelievable how an already serious problem becomes even more problematic!

Yes. It did become problematic, and I wasn't given any other number to call nor any other information. Actually, that's how I ended up in the hospital. This knowledge is or will eventually be shared on Insane: what to do when you're not well, from point zero. Do you talk to your medical doctor or not? What the system looks like once you get into it, etc., very specific issues.

Are there sections which, in addition to providing news, articles, etc., on the website that will now serve as a sort of user manual, or like frequently asked questions, things like that?

Actually yes, the frequently asked questions is a good idea. However, there aren't any yet.

The sections are not yet visible on the website, but they will be in the second upcoming version of 2020. Among these sections, there will be a News section (for example, an article like the one on the Yellow Vests (gilets jaunes) and the emergency crisis), a section on different psychiatric illnesses based on personal experiences, or their human representation rather than their clinical explanation (in the same style as the interview with Dévi and his schizophrenia), an SOS/How-to-do section, which will include very practical tips and advice on how to handle specific situations (just like in the article on how to find a psychiatrist, or advice on how to help relatives)... Also, there will be a section entirely dedicated to testimonials, both from affected people, from their relatives and from health professionals, which will be in a separate section of its own. This is because there are people who are solely looking for testimonies, and people who are looking for everything but that. We will therefore try to satisfy both.

The idea is that there are already a lot of websites that explain the clinical approach to mental disorders, so it wouldn't be very interesting to replicate that. On the contrary, the idea is to present someone's illness, from their point of view and/or their loved ones’, in a realistic way, and then provide helpful tips and solutions. These will be solutions that already exist, resources that may even be mentioned elsewhere, in official brochures, but are scattered all over the Internet. This means Insane brings clarity, readability, and reliability in terms of recommending these resources. You have to remember that when you're not doing well, doing all this research to find out how to get better is exhausting. So Insane does it for you.

Above all, what Insane will host is a mapping of these resources, as exhaustive as possible: associations, a maximum of therapists (psychiatrists, psychologists, sophrologists...), reception facilities, hotlines soon, so that you can do your research based on where you live, your specific needs, and your preferences (in terms of gender, language spoken, etc.).

And among the media that talk about mental health, have you found that they sometimes talk about it inappropriately? Has the handling of mental health news so far been up to expectations?

Frankly no, it is not so good. On one hand, there is clearly a vacuum when it comes to finding actual information, and on the other, there is the issue of mainstream media painting a negative picture about mental illness: I'm not the first one to complain about that! I don't know if you remember that terrible fire in the 16th district of Paris...

Yes, I remember, a story about a psychopathic old woman...

Exactly! It was an old lady with a psychiatric history, who had set fire to a trash can because she'd had a fight with her neighbor. And the problem is that her psychiatric history was all we knew about her or at least all that was said about her in the media. "She's crazy, she set a trash can on fire, she's dangerous." And so, how do you expect us to have a less warped, or more accurate idea of mental health after that?! That's the problem with the issue of mental health, there is a very strong stigmatisation related to it that kills. It doesn't encourage people to go to counselling. In the case of a very small minority of dangerous persons, there is a stigma against them, that doesn't encourage them to go see a doctor in the first place, where they could have been treated, and that kind of drama could have been avoided. It is that stupid!

I feel this psychiatrisation of news report is quite recurrent. So the general public inevitably associates the two.

Exactly. And above all, there's no solution for it. Let's imagine someone reading it, of course it would frighten them, which is understandable. Let's say then that this person goes on the Internet to look up what the disease really is -- now we're already talking about a very meticulous person who really wants to look for information -- and what do they come across? This person already has a bias from previously watching the news, and the danger of mentally ill people, and on top of that they potentially find only articles that clinically describe the disease, and not in a human way. Then, they envision someone with the disease. This is what is different about Insane: if by chance this person is lucky enough to come across testimonials of directly affected people, they will essentially explain how difficult this life is, and how painful it is (which is perfectly justified). If there are testimonials from close relatives, they will generally explain how complicated their everyday life is, and how finding care is not easy, how it took a while for their child to be correctly diagnosed. This is about only the negative things.

Yes, the impression I get from Insane is that it has a rather positive and benevolent outlook.

Absolutely, it's hope, it’s optimism. Despite these illnesses it's possible to live a satisfying life, and happily. Of course it is not simple, when parents say that it takes 10 years to get a diagnosis, it is true. But being diagnosed with schizophrenia, for example, doesn't mean you're destined to be either crazy or insane, or totally unhappy and socially isolated. That's not true, it's possible to be fine. It's called recovery.

It's about showing that these are normal people, and that it's possible to be okay. It also encourages people to seek care, and stick to it. In psychiatry, as with many illnesses, the problem is also that after a while patients stop getting treatment, or stop seeing their shrink, particularly because it's often viewed negatively... You have to know that when you have a psychiatric illness, everyone around you is waiting for when you will stop taking the medication. The problem is, for many illnesses, you may never stop taking the medication, because these are lifelong disorders, which cannot really be cured: it's not a cold, it's not even cancer. So people are even more tempted not to take their medication properly, or to stop against medical advice.... Or they just don't go for the cure: they tell themselves that it's useless, that they'll be unhappy all their lives anyway, or that no one will love them.

Basically, there's a certain sense of doom.

That's what it is. But care is a bit like placebos: it works better if you believe it works. That's Insane's idea.

Alright. And Insane mainly aims to reach young people, especially from 18-30 years old, who have trouble accessing support services, like you did. So how do you plan to make Insane accessible ?

Insane isn't limited to 18-30 years old, but those are its core target, because three-quarters of mental health problems occur between the ages of 15 and 25 (with puberty or the end of puberty, which plays a significant role). My audience is also a bit biased, because my social circle today is 18-30 years old. However, they are the ones less likely to be aware of the resources available to them, simply because they will discover those resources as time goes by, and also because they are at the turning point of their lives: either you are a student or you are starting out in the job market. You also tend to get around and move, leaving your well-established social circle and your bearings... All of this makes things more difficult, making stress more pronounced, and mental disorders more likely to appear.

Actually, what makes Insane accessible to this audience (and to others) is our presence on social networks (Facebook, Twitter, LinkedIn, Instagram and Medium), which is virtually compulsory. Then, financial accessibility: today Insane is 100% free, and if one day we set up a premium subscription for example, it will remain accessible, something like 5€/month. That's also why Insane is a completely online media: it reduces production costs and keeps it accessible, especially for people who are not in continental France, who don't speak the language of their host country, who live in a country where care is minimal... and who therefore need the practical information that Insane provides.

The magazine is available in French and English, isn't it?

Yes, it is. Eventually, the goal is to make it available in as many languages as possible: Arabic, German, Spanish, Chinese... Even if not immediately.

I'm thinking about it: the idea of having articles in written format, essentially, also plays a role in terms of accessibility, because once the article is loaded, it's good, there's no need for an Internet connection. It is something worth taking into account, because it is almost impossible or complicated for people with limited internet connection to watch videos, or even listen to podcasts. It's something I think of, because that was the case for me when I was in Damascus in Syria, and at my grandmother's in the countryside, in France. But in the long run we'll still have subtitled videos and transcribed podcasts.

I've experienced that with the very limited Internet connection as well... And two languages is good enough! I was wondering if you have a precise periodicity though?

We publish articles as often as possible! The publication rhythm today is relatively uneven, because I write articles, and I also manage every other thing on the side. 2020 looks good though: in addition to Jérémie, my husband and our web developer who has been with me since the beginning, I've recruited Natacha, community manager; Camille, editor; Jessica, French to English translator; and Aurélie, English to French translator. And more will be coming soon!

And will there be any "real" appointments, beyond the written magazine?

Yes, there will! I've started to set up workshops, the first one has been carried out in partnership with the association Change MakHERs, on the theme of self-esteem and self-confidence: there will be others in 2020. Insane also regularly participates in events related to mental health, such as Disability Month which was organized in the 14th arrondissement in Paris in June 2019. To find out more, follow us on social networks or suscribe to our newsletter! Also, I offer awareness and prevention services for companies and schools, feel free to contact me by email ([email protected]).

Since the launch of the media, how has its reception by different actors in the field of mental health been like?

I published our first articles in October 2018, and I officially launched Insane in February 2019, so it's been almost a year!

So overall it's really very positive, I didn't expect it to be this way! Strangely, I had more positive reactions from general practitioners, or specialists outside psychiatry, than from psychiatrists. I've talked to a lot of professionals, physiotherapists, hairdressers, etc. who come across a lot of people, especially people who are likely to show they are in difficulty. And these professionals told me that they are often helpless in the face of the distress of their patients and clients. Since they are not mental health professionals, they were happy to have a resource like Insane to advise them if they need help.

On the other hand, I was once at a purely "psychiatric" event, with many psychiatrists and directors of institutions, where I came up against something I consider to be very French: fear of novelty, of change, a certain rigidity. In fact, when talking with them, I realized that their patients did have the problems I had identified, namely a lack of concrete resources, but these directors obviously felt that this could be treated with medication, or at least with the help of a psychiatrist, and nothing else, certainly not an online media. These are people who clearly despised me, especially because I'm young, and maybe because I'm a woman. Another thing is the Internet aspect... it was obviously a complicated concept for many of them, even though it's something essential in the lives of their patients.

Yes, it must be a complicated area, I guess, in terms of legitimacy?

I clearly feel that for these people, an Internet media is just too easy. And that's true, there's no check behind it, anyone can actually decide to create a website, and talk about mental health. But in the end, when someone publishes a book, it's the same problem!

I had read an article that spoke in a very concrete way about the problem with current psychiatrists, and that explains the difficulties that I had with them: the article said quite simply that 70% of the psychiatrists that we can consult today will be retired in less than 10 years, and even within 5-6 years. This means that the psychiatrists to whom we have access today are really old school, less open to the Internet, etc., but in addition, we will soon be faced with a major shortage of psychiatrists: Insane will therefore be even more useful. Insane is not necessarily a cure, but it is certainly a relief: a sort of relief to help endure until the next day, until the next appointment with a psychologist, while you change psychiatrists, etc.

Also, Insane isn't alone, fortunately: there are equally a lot of support groups, Facebook groups in particular, though it's often quite exhausting to spend time on them, because people talk about their difficulties and distress. The problem is that on these groups there is no reliability check, so very often there is a lot of nonsense going around.

We're talking about old school psychiatrists who remain very sceptical, but do you see any new initiatives emerging?

Yes, but above all, what I find remarkable is self-care, taking care of oneself, which is becoming more widespread: people are becoming aware that they need time for themselves, time for leisure, a non-toxic work environment, and at the same time, people often have a tendency to say to themselves "I take care of myself, it's normal and it's good, but at least I'm not crazy, I don't go to a shrink. I go to the sophrologist and do yoga." This makes people realise more or less that they have a mental health even though they often can't name it, and they continue to completely stigmatize mental disorders. But it's heading in the right direction, anxiety and depression are more common and accepted... which is not the case for other illnesses such as Attention Deficit Disorder (ADHD) or schizophrenia.

It is always said that France is among the leading countries in antidepressant consumption, how do you explain this particularity?

Today, the problem with this in France is that it involves consulting a psychiatrist, getting antidepressants (sometimes even when it is not necessary), simply because the national health system (Sécurité Sociale) reimburses them, whereas going to see a psychologist and following a psychotherapy is not! In Anglo-Saxon countries, drugs are only one possibility among others, in France they are key. There are known therapies (CBT, Cognitive and Behavioral Therapies) that can help patients calm down on a daily basis, or change one's way of thinking etc., rather than psychoanalysis, for example, which lasts for years, and may be completely unsuitable. This is because there is no point in trying to make someone think about their past if that person is totally depressed, or very anxious, and is already unable to manage his or her daily life.

In this regard, which countries are well ahead?

First, there is Canada, clearly. Many of the articles I have read that are really interesting, with some thought behind them, are English Canadian articles. We are also especially lucky to have Quebec, which is practically the only place on the Internet to produce good articles on the subject in French. When it comes to research, or the general subject of mental health, France produces nothing or almost nothing. Which is why I'm launching Insane, with a lot of articles in French. Australia is not bad either, and of course the United States as well.

Are you considering partnerships with other media?

Insane already has a partnership with a newspaper in Lille, La Manufacture, which re-publishes our articles in its health section.

Also, I plan to offer awareness-raising services, workshops, to train mainstream media journalists (including medical journalists) to properly talk about mental health.

For me, the idea in the long term is also to employ journalists who also have mental disorders. I will therefore start by approaching journalism schools since I offer internships (2 at the same time, all year round).

What will be Insane's next priorities?

We're going to increase the number of articles related to the news, to show that psychiatry and mental health is evolving. Today, psychiatry is seen as something very "old school", which nobody talks about because it's too specific, but they are vital issues, and they concern everyone!

There would be more articles of course, thanks to Camille particularly, our newly recruited editor.

Furthermore, we are in the process of creating the new website, it's coming in 2020! Users or visitors can post comments once they have an account on the site.

Question from someone who isn't familiar with the subject at all: can a person's situation, or the state of the society they live in, really have a major influence on their mental health?

Yes, it can. In fact, I really hope that more and more people who come to read Insane will not necessarily be diagnosed with a mental disorder themselves, but that they will come here because they are aware that it is a health issue for everyone, and that it's something that is part of our everyday life. Many people experience an episode of poor mental health in the course of their lives! It is not necessarily a chronic illness: it is quite possible to experience a single depressive episode, as a result of a period of unemployment, or discrimination, for instance. 1 in 4 people suffer from at least one mental health problem in their lives; depression is becoming the world's leading cause of disability in the world, and it's getting worse.

Does it have to do with the increasing insecurity, the inequalities...?

Yes, absolutely, it has a lot to do with that. I mean, today, buying a house, for our generation, is a dream, absolutely not something ordinary or given. You check all the boxes: you work well in school, you get your high school diploma, you get to Master 2, you do internships... and there is still no grarantee that you will get a job after your studies. Also, having the generations before you who don't understand why you're struggling, why you're depressed, why you're anxious, obviously doesn't help.

Climate change is also a major cause of distress: for us in the North, it's okay, but for millions of people, life is hard. Farmers are losing their jobs, there are famines, entire families displaced because their homes have been devastated...

Watching news that is always negative, especially on television, can ultimately have a very negative impact on people's mood, too. Besides, these are programs and news that typically focus on the tree and ignore the forest behind it.

For the elderly, who get a lot of information via television, and often find themselves isolated, it must be particularly terrible, isn't it?

Exactly. Besides, depression among the elderly is a subject that is not talked about much, not enough anyway. We are talking about depression that could lead to suicide! We tend to think that it's normal for an elderly person to think about death. It's not, not under these conditions. There is a huge difference between knowing that you are old, that you are going to die in a relatively near future, and having remorse or regret... and wanting to die because your life is no longer worth living. These elderly people in distress are often ignored; because they are elderly so they "have already lived their lives", but also because they are easier to ignore because they are often disabled in one way or another, and may therefore have difficulty expressing themselves.

Not to mention the fact that, in their time, there was even more stigma, I imagine?

Absolutely, it also has a lot to do with whether or not they want to talk about it. Their isolation and loneliness is terrible, indeed. In a way, the elderly people are among those who need Insane the most: nowadays, they visit the Internet more to look for answers to their questions, especially often when they see that their children or grandchildren are not well. Not having grown up with the Internet, they absolutely need reliable websites, and easily accessible solutions. This is because it is harder for them to do further research, or to determine which sites are reliable or not. It's not necessarily easy enough for us...

What do you think would be the top five most urgent coverages to do?

There would be, not necessarily in that order: how to prepare for a stay in a psychiatric hospital; a complementary testimony on how the psychiatric hospital has impacted the person's health (today most of the rarest testimonials that exist concern people who have been re-traumatized or those who have been hospitalized without their consent), because the purpose of the hospital is still to treat; how to detect dark thoughts in the elderly; what to do, from A to Z when you're not well, but don't have money to get help; a report on the implementation of the "Housing First" principle for people with mental health problems who live on the streets; and an article on what actually constitutes a mental disability (using the complicated and controversial example of autism, among others).

Do you have any publications, websites, books, in short, references to recommend for someone who doesn't know much about mental health but would like to learn more?

I would recommend The Mighty, a website in English that includes testimonials from people with mental health problems, but also with disabilities of all kinds. The site allows you to choose subjects you are interested in, so there is a whole section dedicated to mental health. What I find unfortunate is that the vast majority of these testimonials are negative, explaining why it is hard to live with these disabilities, but completely ignoring the fact that, in reality, it is possible to live happily despite having these disabilities. For a start, it's not bad at all, there are a lot of very short testimonials. Otherwise, I would rather advise going to Medium (follow the Insane publication!), a site that allows you to filter by tags, thus accessing many articles related to mental health. It also gives you a slightly more diversified, more reflective, or maybe even more philosophical view of the subject.

Finally, there's madmoiZelle.com and Rockie (in French), which I have to quote because through their articles on very diverse subjects, these two magazines deal with different subjects related to mental health: knowing how to say no, knowing how to take care of yourself...

For films and novels, I make lists and (will) talk about them on Insane: there's already the article on Insatiable!

I'll also add that there's a pop-rock band, Icon For Hire, whose singer has mental health problems herself, who's doing a great job. I'll write about it!

And then there's the wonderful work of Destiny Blue, another artist affected by depression, which we wrote about on Insane.

One last piece of advice for people who would like to help loved ones in distress?

Speak to them, and speak to them clearly, with kindness, because you may be up to your neck in it, and without even knowing it. Then, you should try to take note of what is becoming issues in everyday life (taking public transport, cooking...), and help them to do so, but above all help them to find the resources, such as making an appointment with a psychiatrist or psychologist, and accompanying them to these appointments... Anything that can be done so they are not left alone and deprived, and to remind them that they are loved and valued.