The Mental Health Foundations of Freedom

John Adams famously said, “Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other.” Perhaps he should have included “a mentally healthy people.” In recent years, Americans have become more willing to discuss mental health and seek professional help for anxiety, depression, and other maladies. But this commendable development has had side effects: self-fulfilling self-diagnoses, social media doom scrolling, and a decline in the feeling of agency. As a result, Americans increasingly believe improving their own lives is beyond their control and look to government for help.

Clay Routledge is a research psychologist and Executive Vice President of the Archbridge Institute. In this episode of Giving Ventures, he breaks down the latest mental health trends, charts a course for improved mental health, and explains the dangers a mentally unwell population poses for freedom.

Note: This transcript was generated and cleaned by AI.

Peter Lipsett: We have seen over the past few decades a major decrease in the stigma related to mental health, and that’s generally a good thing. More and more people are able to confront the issues that challenge them and get the help and support they need to stabilize their lives. But there is a growing… I’m just going to start that over. I’m not happy with that — plus there’s a fly in here that just flew at my face in the middle of that. I don’t know if you can see that. Anyway, at some point you’re going to hear me try to get that thing.

We’ve seen over the past several years, really the past several decades, a decline in the stigma related to people addressing issues of mental health, and that is generally a good thing. It means more and more people can get the help they need and live happier, more stable lives. But there is a downside to this growing interest and focus on mental health in this country: that inward focus weakens our democracy, our society, and our economy. That is the bold claim that got my attention a couple of months ago when I received an email from the Archbridge Institute. That email announced a new initiative called the Head Out Initiative, focused on mental health, but not in the way that I expected. For the first time that I can remember, it created a bridge between the discussion of mental health and the discussion of our health as a nation and as an economy.

So today we’re going to unpack that diagnosis with its author, Dr. Clay Routledge. Clay is a trained research psychologist and the COO at the Archbridge Institute, where he leads the Human Flourishing Lab and this new Head Out Initiative. So, Clay, welcome to my podcast couch, where we’ll unpack all of this. Let’s start with how things have changed. How have the discussions around mental health changed broadly over the past few decades?

Clay Routledge: I started my career in psychology working in outpatient mental health before I decided to pursue an academic career, which is what I did before joining the Archbridge Institute. I worked in an outpatient mental health facility, and we were working with severely ill people — people with schizophrenia, people with major bipolar disorder. This was very much thought of as an organic brain disease, affecting people who really had a difficult time functioning in society and needed a lot of intervention. At that time, which was over twenty-five years ago, we were definitely starting to see more general attention being paid to mental health as something that doesn’t just affect the severely ill, but everyone. But at that time there was still, I think, a real separation between people who are really, truly suffering deeply from mental illness in ways that disrupt their ability to function in society, and those who are just having more ordinary bouts of sadness, stress, or anxiety.

That perspective has started to change over the years, and now, more and more, we’re seeing our culture, our institutions, even psychologists, talking about mental illness in a more general way — conflating these more ordinary bouts of distress with more severe forms of illness. That has led to what’s sometimes referred to as concept creep, which is the broadening of our definitions of specific concepts. I think, for the most part, it’s been well intentioned, because the idea is that there are lots of people who are suffering unnecessarily and would benefit from some type of intervention, and I think that’s part of the story for sure. But another part of the story is unfortunate: unlike heart disease or cancer or other health conditions, where you generally think just bringing more attention to them is good — because it’s going to get people to seek out early detection tests or engage in preventative activities that might help them not develop a certain condition — mental illness is a strange category, in that it’s more centrally mediated through how we think and how we feel. You can’t really think your way into most physical health conditions, but you can actually think in certain patterns that make you more likely to develop depression.

So that’s the challenge: more awareness when it comes to mental health can be good, but it also has this potential to put people on a path toward a type of thinking and behavior that actually increases their risk of developing a mental illness they otherwise wouldn’t have had.

Peter Lipsett: People who have listened to this Giving Ventures podcast for a while might say, “Wait a minute, we’re talking about mental health — this is a podcast that usually talks about philanthropy, free markets, and liberty. What’s going on here?” So let’s build that bridge. I love — I was reading some things you’ve written in preparation for this, and one line that jumped out at me was, “Psychology is upstream of freedom, prosperity, and progress.” That’s a bold claim — that without figuring out the psychology piece, we don’t get the freedom, prosperity, and progress piece. You’ve connected these declines in mental health to declines in freedom and human progress. Build that bridge for us.

Clay Routledge: Ask yourself: where do the ideas that build the foundation of classical liberalism, free markets, and free societies come from? They come from people — from human brains. The institutions we build, the free markets we build, the entrepreneurial endeavors that lead to economic growth and prosperity, are driven by human beings, and human beings are psychological. So to me, the case is somewhat obvious, but you have to think through what that actually means. I work from a motivational, kind of a motivational-brain model of how humans engage with the world. The simplest way to think about it: there’s what I call defense motivation, which is when we feel threatened in the environment. That’s the time to become more vigilant, to narrow our focus, to pull back a little, because we want to protect what we have — we’re seeking security. Contrast that with growth motivation, which is when we want to go out and expand, to build. Both are important, because if you’re always just trying to grow, develop, try new things, explore, and innovate, then sometimes you’re not providing good security. And if you’re always focused on security, you’re never going to expand and grow. So both of these are important. But the problem is, when we feel threatened and the threat isn’t real, we end up in a defensive mindset that makes us see the world through a more hostile lens — one that doesn’t lend itself to the openness, creativity, and innovation that freedom requires.

That’s kind of what’s happening when you have more people reporting anxiety: you also have more people saying the world isn’t a safe place. To be more concrete, there’s a lot of research showing, for instance, that anxiety is a big predictor of social trust.

Social trust is generally good for entrepreneurship and for democratic stability. So if you have more people saying they’re anxious all the time, that leads to lower social trust, which tends to lead — though it can be more complicated than this — toward a disposition of “people can’t be trusted,” and so we need more government oversight, more government regulation.

There was research, for instance, on the COVID-19 pandemic in Europe, showing that the more people experienced anxiety and fear during that time — understandably, given what was going on — the more likely those same people were, subsequently, to support restrictions on civil liberties. So you can see this relationship between our own mental states and our general view of the world. If you see the world as a more threatening, unsafe, perilous place, then, speaking in generalities, you’re more likely to seek security over liberty.

Peter Lipsett: So is that to say this increase in anxiety diagnoses — are they wrong? Is it a bunch of people who have just been over-labeled and misdiagnosed, or is it true, but the therapeutic response has been wrong?

Clay Routledge: I think both are true, and in a self-reinforcing way. I should add — going back to the previous point — another big element we work on is hope. People who are more hopeful, who look to the future and see possibility, who believe we have the capacity to improve the world, are more likely to be entrepreneurs. They’re more likely to work with other people across differences to try to solve problems. So hope is a very progress-oriented, abundance-oriented mindset, and poor mental health is a big barrier to hope. In fact, poor mental health is a key driver of hopelessness — people who are severely depressed and anxious look to the future and see a dark future, and that’s not good for a free and flourishing society.

To the current question: it’s both, and it’s self-reinforcing. What I mean is, it’s definitely true that if you go back to the early 1950s, when the first Diagnostic and Statistical Manual for mental illness was developed, there were somewhere around a hundred recognized disorders. Today it’s more like three hundred. So over time we’ve seen an expansion of what counts as a disorder, in both the number of disorders and the clinical threshold for something counting as a disorder. We’ve definitely expanded what something like anxiety is. That’s part of it. But at the same time, it’s true that with better treatments and more mental health awareness campaigns, there are people who were previously suffering without getting interventions who are now getting them. So some of it is that we’re actually capturing more people who are genuinely experiencing disorders.

But the problem with the first category — just expanding the definition — has become a real issue with social media, because a lot of people are getting their mental health information from social media, and it’s inaccurate. It’s not evidence-based; it’s more like vibes. So what happens is people get this information online, think, “A lot of people seem to have an anxiety disorder —

sometimes I actually feel pretty anxious, I’m pretty stressed out at work, sometimes I don’t know how to be, and everything feels overwhelming — maybe I have an anxiety disorder.” And when you start to integrate that idea into your sense of self, you start to behave like somebody with an anxiety disorder. One of the problems with anxiety disorders is that people who have them become avoidant of the things that make them productive in life, and avoidance is self-fulfilling: if something makes you anxious and you avoid it, you become more worried about encountering that experience, so you avoid it even more. Even just entertaining the idea that you might have an anxiety disorder can put you on the path to developing one — which would then actually increase the percentage of people who have anxiety disorders, but not for the typical reasons we used to think they developed them. It’s more a self-reinforcing loop, if that makes sense.

Peter Lipsett: Yeah, that does make sense. Whenever there’s a problem like this, we want to find somebody to blame — or “blame” may not be the right word. You have an article out this week in the New York Times that I thought was very good, called “Stop Pathologizing Ordinary Life,” which is a great title. But you talk about some of the different sources of how this came about — social media, which you just mentioned — where do we put the blame for this? I think we like “blame” because then we think maybe we can flip a switch and stop it — but maybe blame is the wrong way to think about it.

Clay Routledge: Well, first, thank the New York Times for the title — I didn’t come up with it, but it is a great title. On some level, and this might seem like an easy answer, we’re all to blame. What I mean is there isn’t just one thing that has contributed to this. I think a constructive way to think about blame is that we’re all to blame in the sense that most people want those who are suffering to not suffer mentally. Another way to more generally place blame is that part of this just seems to be a function of affluence and abundance. It’s a success story — America is a rich country, and people are now less worried about basic survival needs and basic physical safety. That’s allowed us to spend more time focusing on our inner lives and thinking about that type of mental suffering. It’s hard to get too worried about someone’s sadness or anxiety if you can’t put food on the table. So some of it is a story of success. Some of it is technological — not that I think we should blame social media for everything, but it is true that when you have cultural ideas that end up being counterproductive, they’re now much easier to spread through technology. That’s what we’re seeing on a lot of social media platforms: a lot of young people, in particular, are getting their information about mental health there, and there’s research showing that the more people get their information about mental illness from social media, the less accurate their knowledge about mental health is. There’s a lot of misinformation online, and I don’t think it’s necessarily the case that there are a bunch of bad actors here — it’s more that this has just kind of happened.

On top of that, other people, like Jonathan Haidt and Jean Twenge, have talked about the decline in free play in childhood. We might have kids who are becoming more vulnerable to psychological disorders because they’re not developing the resilience they might have in the past. Jean Twenge has also talked about how families are getting smaller — when you have fewer kids, you spend more focused attention on them. If you have just one child, you may be a bit more obsessive and worried about them, and that might reduce their resilience. So some of these are real issues in society that we’re grappling with, and no one person is to blame. The scholars who’ve done the most work on the idea of concept creep have proposed that it has something to do with —

a liberal society becoming more sensitive to harm. Again, they’ve said that very agnostically — they’re not saying liberalism is bad. The idea is that as we become more sensitive to harm, as we’ve already discussed, on one hand it means we have opportunities to potentially reduce suffering, but it also means we might unintentionally increase suffering by becoming too hypervigilant, too sensitive, too overly focused. So there are lots of potential sources of blame, but I think the constructive way to think about it is that there are also a lot of people who care about mental health. It’s not one of those issues where the problem is getting worse because we’re neglecting it. There’s an irony to it: the problem is getting worse because we’re almost —

saying we care too much isn’t quite right, but we’re almost focused on it in an unproductive way, which shows we’re well intentioned but maybe going about it the wrong way. That’s constructive to think about, because we already have people on board with the idea that this is an important issue. So what we need to do is bring together people who agree it’s important but recognize we’re going about it in a counterproductive way. We need to find a way to approach improving mental health without being so obsessed and preoccupied with it.

Peter Lipsett: So many of the things that lead to a degradation of freedom and individual liberty are often well-meaning — we just want to make sure people are safe, and so you get regulations, taxes, subsidies, and when those don’t work, it swings the other way. The more you tinker with it, the more it actually eats away at the prosperity you’re aiming for. It’s interesting that mental health could work the same way — the more you leave it alone — not that you entirely need to leave it alone. I want to get into some of the solutions, but one more question on the problem: the age demographic of this. We touched on this in the article too — how much of this is a product and problem of Gen Z or millennials, or is there an element of older generations involved as well? Where are we seeing it?

Clay Routledge: We’re definitely seeing it most with the younger generations. Even if you just look at surveys — and we’ve done a number of these at Archbridge, along with plenty of other surveys — when you ask people about the current state of their mental health, young people, Gen Z in particular, are much more likely to describe themselves as having poor mental health compared to older generations. Gen Z reports the highest levels of mental distress, then millennials, and it goes down from there, with older adults reporting much better mental health — maybe for a variety of reasons, but one does seem to be what we’ve talked about: this cultural transition to a more inward-focused, mental-health-preoccupied culture, which young adults are most likely to be involved in.

In addition, some of the other factors that might represent real vulnerabilities to mental health conditions — like overprotective parenting, which is a predictor of anxiety disorders — tie into this free-play-movement idea: kids need to develop resilience, they need to be out there doing things on their own, and that helps them build the psychological fortitude that protects them, or at least helps protect them, from developing psychopathology as they age. That’s something that’s happened in more recent decades. So both actual vulnerabilities to poor mental health and the preoccupation with mental health we’ve discussed make younger generations more vulnerable.

Peter Lipsett: So we live in a society where we’re more anxious, we recognize that as a clinical thing, and it becomes self-perpetuating — and another mental health diagnosis becomes self-perpetuating as well. But you’re not just sitting around identifying this problem — you’re actually working to create a solution, which is what we’re all about at DonorsTrust and with Giving Ventures; we like solutions. So talk to us about the Head Out Initiative. First, big picture — tell us what the Archbridge Institute is, since it’s still relatively new and people may not know as much about it, though it’s doing great work.

Clay Routledge: Thank you. The Archbridge Institute is a nonpartisan think tank focused on three pillars of human flourishing: economics, psychology, and culture. A lot of people are probably familiar with the economic side, which is focused on removing barriers to flourishing — things like occupational licensing, social mobility, economic freedom — what you’d expect in the classical-liberal space of economics. But we also take a more holistic approach, because life is more than that, and especially when you think about barriers, there are real regulatory barriers to people flourishing, but sometimes the barrier is inside us — the barrier isn’t the government. You could imagine an ideal regulatory situation in which people have all the opportunity and freedom to pursue their ambitions but lack the motivation or the ideas to do so. So adding the psychology piece is about recognizing that there are external, regulatory barriers, but also internal, psychological barriers. That connects to our third pillar, culture, because a lot of the time those internal barriers — and some of the external ones too — are shaped by our broader cultural narratives and attitudes. So we wanted to focus on all three, and critically, to see them not as independent but as highly interrelated, and I think this goes in both directions. Regulatory barriers can be demoralizing and demotivating at the psychological level. But psychology and culture also shape the regulatory environment: if you have a culture of high trust, a culture that celebrates entrepreneurial success stories, that energizes people psychologically and promotes hope, and it also encourages people to vote for the candidates and policies that —

will support an environment of aspiration and growth. So we see all of these things as connected. I’m a psychologist by training — I was a psychology professor and business professor for many years before joining the Archbridge Institute, and I joined to help expand our thinking around psychology and culture. We’ve done a lot of work in that space on topics like meaning in life, hope, and agency — psychological ingredients we think are critical to a free and flourishing society. But more recently we wanted to focus specifically on the mental health issue, because over the past several decades, as we noted earlier, there’s been a dramatic increase in the percentage of Americans who report being in poor mental health. Poor mental health is very much connected to the agentic, hopeful mindset that’s critical not just for freedom to be sustained and promoted, but for freedom to turn into flourishing. You can have a free society where no one is particularly motivated to do anything, and that undermines freedom, because eventually, if people aren’t doing anything, they’ll start looking to the government to solve their problems. So we said: here’s a specific, growing concern for our country — mental health — let’s focus on it. And as you pointed out —

and I’m glad you did — it’s one thing to say, “Here’s the problem: we have a culture that’s become obsessed, or overly preoccupied, with mental health, and in a way we’re talking ourselves into being less mentally healthy.” That’s a challenge. But then what do you do about it? We call this project Head Out because — and this isn’t something we made up, it’s not a marketing pitch — there’s a ton of empirical evidence that some of the best ways to improve your mental health are to spend less time thinking about it and get out in the world and do things. So that’s the idea: head out, get out of your head, and head out into the world. As one example, physical exercise: we now have large volumes of empirical evidence indicating that physical exercise is as effective, if not more effective —

than traditional psychotherapy and pharmacological interventions for treating depression and anxiety. It’s not that no one needs those types of interventions — it’s that for most people, most of the time, they’ll get as much value, recovery, and positive mental health from engaging in physical exercise as they would from seeing a clinician or taking antidepressants.

Peter Lipsett: So the Head Out Initiative has five different categories, and physical exercise is one of them. Can we go through the others quickly, just to help people ground themselves in what these solutions actually are?

Clay Routledge: Yeah. So the first one, which we just talked about, we call Move — whether you’re running, lifting weights, in a fitness class, anything that really gets you moving. There are a lot of physiological mediators of that mechanism, but I think a lot of it is that exercise helps break the cycle of rumination and anxiety — it gets you out of your head. These activities have shown that you don’t have to be a gym rat or train for a marathon; even relatively low levels of physical exercise are really beneficial for psychological health. Move is one; Work is another. There’s research showing, for instance, that losing a job is a source of psychological distress, unsurprisingly. So for people experiencing work-related depression or anxiety, one of the best interventions to get them back to baseline is to find another job — productive work. The third is what we call Create — hobbies, or even businesses and entrepreneurial activities, forms of self-expression that direct your attention toward something creative; there are lots of different ways to do that. Connect is the fourth, which is about social relationships.

Just a quick note on social relationships, because I think this is sometimes misunderstood: relationships aren’t just about being around people, and connection isn’t just about people being nice or kind to you. What really fulfills that deep sense of connection is the sense that you matter — that you have an important role to play in a relationship. You can be surrounded by people and still feel quite lonely; loneliness isn’t just about your social environment, it’s about the role you play in it. So connection is a very agentic thing. And finally, the last category is Transcend, which is the more spiritual or religious dimension of flourishing. Again, to help prove the point that this is really about getting out of your head —

it’s not just about holding a religious or spiritual belief. It’s the people who are actively participating in religious communities, or who channel their spiritual beliefs into productive action, who get the most benefit from their faith.

Of course, we’re separating these things out, but they’re all interrelated. A lot of times your work environment provides the social relationships that are useful, or gives you opportunities to engage in creative work. Exercise is often more enjoyable, or particularly rewarding, when we’re doing it with other people. So you can imagine all these things as interconnected. But the point is, across these five domains of human activity, what really helps people flourish mentally is getting out of your head and focusing your attention on a project, a task, a relationship, a job, a faith tradition — something other than worrying about yourself, but actively involved in making a difference in the world and being a significant member of a family, a community, and a workplace.

Peter Lipsett: So none of these are a pill — I can’t just pop one and fix it overnight. It’s not a miracle drug. These things take work: finding fulfilling work, for instance — I may hate my job, so I have to redirect it, and that takes work. Getting off the couch and starting to move, if you haven’t been doing that, takes work. It all takes work. And some people just don’t like work. So what is the prescription, Doctor? You’ve written this out — this is what we should do. What should Archbridge, or other groups, or donors, or someone, be doing to help people actually swallow this non-pill?

Clay Routledge: Yeah. So the first thing — and this is something we launched with the Head Out Initiative — the first step is really getting the word out, because, as you said, this requires work. A lot of people think there’s a simple solution: if they’re feeling down or stressed, they should just go see a therapist or pop a pill. I think a lot of younger people, in particular, are being told that mental health isn’t something you have to work at — that life being difficult and challenging, which is actually a good thing, isn’t the frame. It’s not the default that you’re just going to be a well-adjusted human; you have to work at this.

So part of this is just getting the word out and increasing awareness. That’s part of what the New York Times article I wrote is meant to do — a lot of people read the New York Times, so they can see this perspective and think, “Maybe we should rethink how we approach mental health.” You’re seeing this in schools too. There’s now been a fair amount of research that I hope is getting schools to rethink how they approach mental health. This research has found that a number of schools, particularly in places like the UK and Australia, decided to give all students what’s called universal treatment — mental health interventions for the whole class, not just students identified as needing them.

Thankfully, researchers decided to study the efficacy of this, and what they found is that it wasn’t just ineffective — it actually made kids’ mental health worse. You took a group of students, most of whom didn’t have a mental illness, and instead of targeting the few who did, you gave everyone the intervention. It seemed like the easy approach, but it made all the other students start thinking in unproductive ways, focusing more on things like —

“I did feel sad today; my feelings were hurt today; maybe I have this problem.” It’s unfortunate that this was done in the first place, but at least there’s now good evidence documenting it, and you’re starting to see more people say, “That was well intentioned, but it’s a bad approach.” So I think that’s the first thing that needs to happen: we need to change the cultural attitude around mental health and mental health awareness — and in a way that doesn’t look backward. That’s one of the challenges: it’s easy for people to misunderstand what I’m saying, to assume I think everyone’s fine and that we should go back to mental illness being stigmatized, with no one talking about their feelings. That’s not what I’m saying. What we’re saying is that it’s good we’ve made progress — improved accessibility to interventions and improved the quality of those interventions — but we’re also doing something unhealthy that’s making the problem worse, and nobody wants that. We need to figure out how to thread the needle between having a supportive environment where people who are really suffering can get the treatment they need — because there are a lot of people who die by suicide, for instance, who never received any mental health treatment — and it’s still the case that there are people who aren’t getting the help they need, people grappling with very severe brain disorders. But for most people, thankfully, that’s not their situation, and we need to think about this more productively. That’s why I like this Head Out approach — it’s almost like preventative medicine. There are a lot of things people can do for themselves that don’t require seeking out a therapist or a pharmacological intervention. In addition to getting that message out, once people realize these are things they can do for themselves, the prescription becomes pretty accessible — you have to have the motivation to do it, but these aren’t things that are difficult for people to access. Anyone can work out; it doesn’t require a fancy gym membership or equipment. It’s something that’s very accessible to anyone.

Peter Lipsett: How different is this from cognitive behavioral therapy? That may just be my own ignorance showing, but isn’t that the point of something like CBT — to connect you to reality?

Clay Routledge: Yes, for the most part, I’d say yes. One of the most successful aspects of CBT is what’s called behavioral activation, which is basically the idea behind Head Out: part of the problem with issues like anxiety is that people get stuck in a feedback loop of negative thinking, and a good therapist will say, “Over the next twenty-four weeks, or whatever, we’re going to have a specific treatment plan that helps you get out of your head and go do the activities that are fulfilling.” Some people do need that intervention. If you go to our website, headoutworld.org, we have a toolkit that helps people decide whether they need a therapist, when they should seek one out, and how — because, unfortunately, there’s a lot of therapy out there that isn’t evidence-based. Not all therapists are the same. Some use empirically validated methods that really are about getting people back to good mental health so they can function on their own, and someone shouldn’t necessarily be in therapy forever — these are interventions with specific timelines.

But they require work, to your earlier point — this isn’t just something that happens when you see a therapist once a week; you have to go out and do difficult things. So yes, there are aspects of CBT and other therapeutic interventions that are very much about this, and that’s great — some people need that. But most people don’t. In our toolkit, on our website, people can go through different steps: “If this is me, then here’s where I am, and here are the things I can do for myself.” Sometimes it’s actually a wait-and-see approach, because you might be experiencing symptoms that seem like a mental illness, but in reality they’ll go away in a couple of weeks —

especially if you engage in these types of activities. I think one thing that should be unifying about this Head Out approach is that it’s something anyone can do — it’s agency. Sometimes you’ll see people on the political left saying we have all these mental health problems and we’re not spending enough money on it. Where we can meet people halfway is by saying there’s a lot that doesn’t cost much money — in fact, doesn’t cost any money — that people can do for themselves. I think that’s a very empowering message, especially for young people, who I think increasingly feel like they have to go through some type of intervention to feel good.

about life. And it’s like, no — you actually have a lot more power than you realize. This doesn’t just apply to mental health; it applies to a lot of aspects of their lives.

Peter Lipsett: Are you hearing from folks? You had that New York Times article, and it’s read by a lot of people — I can imagine a pile of hate mail coming in from people saying, “It’s not that easy, Clay.” Have you heard things, positive or negative?

Clay Routledge: You know what’s been interesting about that? The article came out on Sunday, so it’s only been less than a week. I’ve received dozens of emails from clinicians and psychologists — a very positive response. They’re saying this is an issue they actually deal with themselves: they have a lot of people seeking mental health services who don’t really need them. I also think one of the challenges for psychologists who are sensitive to this issue is that there’s just a lot of misinformation online. Just as most doctors wouldn’t want their patients to be sicker, psychologists don’t want a society full of more mentally unhealthy people. So I think they’re genuinely worried about misinformation and about a culture in which mental illness is almost becoming trendy —

promoted almost as a trendy thing. As one example, there’s research showing that when people look at social media influencers sharing their mental health concerns — what’s called normalizing — if an influencer says something like, “I have an anxiety disorder, and it turns out a lot of people have anxiety disorders,” that normalizing increases

the likelihood that one of their followers will identify with that person and think, “Maybe I have a mental health disorder.” So psychologists are concerned about that. The response has been overwhelmingly positive — not just from psychologists, but I’ve also received a lot of emails from teachers and employers who are dealing with these issues too. I’m sure there are negative comments — there always are — but among the people who took the extra step of not just commenting online but reaching out to me directly, they’ve all been really positive. So again, I think it’s encouraging that a lot of people are starting to realize this has become an issue, and it’s also a concern for those who are deeply worried about people suffering with mental illness.

They’re also worried about this because it directs resources away from those who are most in need. As I noted earlier, there are people who engage in self-harm, or who die by suicide, who never sought out or received any mental health treatment. The more people who see themselves as mentally ill,

the less attention, I think, the people who are most severely suffering receive. So that’s a unifying concern too: we want mental illness to be taken seriously, and if we pathologize ordinary life, that trivializes it, in a way — people become more dismissive of it, and that ends up harming the people who are most vulnerable. So I think there are a lot of people, with very different beliefs and politics, who can find some common ground on this issue. We’re connecting this to free markets and other economic issues we care about, but even for people with no interest in that, I think most are interested, generally, in Americans being mentally healthy — so I think it’s an area where we can find common ground.

Peter Lipsett: A more stable society — one with the kind of social trust where people feel agency, which leads to better communities, people working together, solving problems together, less demand for government, and more ability to go out and do good things. Like I said at the top, it’s a fascinating bridge — a connection I’d never really thought about, but so much of our attention and conversation gets taken up by these mental health issues, and if we can correct them and help people — as you’ve reiterated here, this isn’t because nobody’s suffering, it’s because we’re sometimes over-pathologizing real issues some people do have, to the detriment of our own society. It’s fascinating stuff. I think it’s right for the Archbridge Institute to take this on, and it’s great that you were pulled out of the clinical world to come work in this space and help people understand it. I hope the response continues to be very positive. Clay Routledge, thank you so much.

Clay Routledge: Thank you, Peter — I appreciate it, and thank you for giving me the time to talk about this project.

The Mental Health Foundations of Freedom

John Adams famously said, “Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other.” Perhaps he should have included “a mentally healthy people.” In recent years, Americans have become more willing to discuss mental health and seek professional help for anxiety, depression, and other maladies. But this commendable development has had side effects: self-fulfilling self-diagnoses, social media doom scrolling, and a decline in the feeling of agency. As a result, Americans increasingly believe improving their own lives is beyond their control and look to government for help.

Clay Routledge is a research psychologist and Executive Vice President of the Archbridge Institute. In this episode of Giving Ventures, he breaks down the latest mental health trends, charts a course for improved mental health, and explains the dangers a mentally unwell population poses for freedom.

Note: This transcript was generated and cleaned by AI.

Peter Lipsett: We have seen over the past few decades a major decrease in the stigma related to mental health, and that’s generally a good thing. More and more people are able to confront the issues that challenge them and get the help and support they need to stabilize their lives. But there is a growing… I’m just going to start that over. I’m not happy with that — plus there’s a fly in here that just flew at my face in the middle of that. I don’t know if you can see that. Anyway, at some point you’re going to hear me try to get that thing.

We’ve seen over the past several years, really the past several decades, a decline in the stigma related to people addressing issues of mental health, and that is generally a good thing. It means more and more people can get the help they need and live happier, more stable lives. But there is a downside to this growing interest and focus on mental health in this country: that inward focus weakens our democracy, our society, and our economy. That is the bold claim that got my attention a couple of months ago when I received an email from the Archbridge Institute. That email announced a new initiative called the Head Out Initiative, focused on mental health, but not in the way that I expected. For the first time that I can remember, it created a bridge between the discussion of mental health and the discussion of our health as a nation and as an economy.

So today we’re going to unpack that diagnosis with its author, Dr. Clay Routledge. Clay is a trained research psychologist and the COO at the Archbridge Institute, where he leads the Human Flourishing Lab and this new Head Out Initiative. So, Clay, welcome to my podcast couch, where we’ll unpack all of this. Let’s start with how things have changed. How have the discussions around mental health changed broadly over the past few decades?

Clay Routledge: I started my career in psychology working in outpatient mental health before I decided to pursue an academic career, which is what I did before joining the Archbridge Institute. I worked in an outpatient mental health facility, and we were working with severely ill people — people with schizophrenia, people with major bipolar disorder. This was very much thought of as an organic brain disease, affecting people who really had a difficult time functioning in society and needed a lot of intervention. At that time, which was over twenty-five years ago, we were definitely starting to see more general attention being paid to mental health as something that doesn’t just affect the severely ill, but everyone. But at that time there was still, I think, a real separation between people who are really, truly suffering deeply from mental illness in ways that disrupt their ability to function in society, and those who are just having more ordinary bouts of sadness, stress, or anxiety.

That perspective has started to change over the years, and now, more and more, we’re seeing our culture, our institutions, even psychologists, talking about mental illness in a more general way — conflating these more ordinary bouts of distress with more severe forms of illness. That has led to what’s sometimes referred to as concept creep, which is the broadening of our definitions of specific concepts. I think, for the most part, it’s been well intentioned, because the idea is that there are lots of people who are suffering unnecessarily and would benefit from some type of intervention, and I think that’s part of the story for sure. But another part of the story is unfortunate: unlike heart disease or cancer or other health conditions, where you generally think just bringing more attention to them is good — because it’s going to get people to seek out early detection tests or engage in preventative activities that might help them not develop a certain condition — mental illness is a strange category, in that it’s more centrally mediated through how we think and how we feel. You can’t really think your way into most physical health conditions, but you can actually think in certain patterns that make you more likely to develop depression.

So that’s the challenge: more awareness when it comes to mental health can be good, but it also has this potential to put people on a path toward a type of thinking and behavior that actually increases their risk of developing a mental illness they otherwise wouldn’t have had.

Peter Lipsett: People who have listened to this Giving Ventures podcast for a while might say, “Wait a minute, we’re talking about mental health — this is a podcast that usually talks about philanthropy, free markets, and liberty. What’s going on here?” So let’s build that bridge. I love — I was reading some things you’ve written in preparation for this, and one line that jumped out at me was, “Psychology is upstream of freedom, prosperity, and progress.” That’s a bold claim — that without figuring out the psychology piece, we don’t get the freedom, prosperity, and progress piece. You’ve connected these declines in mental health to declines in freedom and human progress. Build that bridge for us.

Clay Routledge: Ask yourself: where do the ideas that build the foundation of classical liberalism, free markets, and free societies come from? They come from people — from human brains. The institutions we build, the free markets we build, the entrepreneurial endeavors that lead to economic growth and prosperity, are driven by human beings, and human beings are psychological. So to me, the case is somewhat obvious, but you have to think through what that actually means. I work from a motivational, kind of a motivational-brain model of how humans engage with the world. The simplest way to think about it: there’s what I call defense motivation, which is when we feel threatened in the environment. That’s the time to become more vigilant, to narrow our focus, to pull back a little, because we want to protect what we have — we’re seeking security. Contrast that with growth motivation, which is when we want to go out and expand, to build. Both are important, because if you’re always just trying to grow, develop, try new things, explore, and innovate, then sometimes you’re not providing good security. And if you’re always focused on security, you’re never going to expand and grow. So both of these are important. But the problem is, when we feel threatened and the threat isn’t real, we end up in a defensive mindset that makes us see the world through a more hostile lens — one that doesn’t lend itself to the openness, creativity, and innovation that freedom requires.

That’s kind of what’s happening when you have more people reporting anxiety: you also have more people saying the world isn’t a safe place. To be more concrete, there’s a lot of research showing, for instance, that anxiety is a big predictor of social trust.

Social trust is generally good for entrepreneurship and for democratic stability. So if you have more people saying they’re anxious all the time, that leads to lower social trust, which tends to lead — though it can be more complicated than this — toward a disposition of “people can’t be trusted,” and so we need more government oversight, more government regulation.

There was research, for instance, on the COVID-19 pandemic in Europe, showing that the more people experienced anxiety and fear during that time — understandably, given what was going on — the more likely those same people were, subsequently, to support restrictions on civil liberties. So you can see this relationship between our own mental states and our general view of the world. If you see the world as a more threatening, unsafe, perilous place, then, speaking in generalities, you’re more likely to seek security over liberty.

Peter Lipsett: So is that to say this increase in anxiety diagnoses — are they wrong? Is it a bunch of people who have just been over-labeled and misdiagnosed, or is it true, but the therapeutic response has been wrong?

Clay Routledge: I think both are true, and in a self-reinforcing way. I should add — going back to the previous point — another big element we work on is hope. People who are more hopeful, who look to the future and see possibility, who believe we have the capacity to improve the world, are more likely to be entrepreneurs. They’re more likely to work with other people across differences to try to solve problems. So hope is a very progress-oriented, abundance-oriented mindset, and poor mental health is a big barrier to hope. In fact, poor mental health is a key driver of hopelessness — people who are severely depressed and anxious look to the future and see a dark future, and that’s not good for a free and flourishing society.

To the current question: it’s both, and it’s self-reinforcing. What I mean is, it’s definitely true that if you go back to the early 1950s, when the first Diagnostic and Statistical Manual for mental illness was developed, there were somewhere around a hundred recognized disorders. Today it’s more like three hundred. So over time we’ve seen an expansion of what counts as a disorder, in both the number of disorders and the clinical threshold for something counting as a disorder. We’ve definitely expanded what something like anxiety is. That’s part of it. But at the same time, it’s true that with better treatments and more mental health awareness campaigns, there are people who were previously suffering without getting interventions who are now getting them. So some of it is that we’re actually capturing more people who are genuinely experiencing disorders.

But the problem with the first category — just expanding the definition — has become a real issue with social media, because a lot of people are getting their mental health information from social media, and it’s inaccurate. It’s not evidence-based; it’s more like vibes. So what happens is people get this information online, think, “A lot of people seem to have an anxiety disorder —

sometimes I actually feel pretty anxious, I’m pretty stressed out at work, sometimes I don’t know how to be, and everything feels overwhelming — maybe I have an anxiety disorder.” And when you start to integrate that idea into your sense of self, you start to behave like somebody with an anxiety disorder. One of the problems with anxiety disorders is that people who have them become avoidant of the things that make them productive in life, and avoidance is self-fulfilling: if something makes you anxious and you avoid it, you become more worried about encountering that experience, so you avoid it even more. Even just entertaining the idea that you might have an anxiety disorder can put you on the path to developing one — which would then actually increase the percentage of people who have anxiety disorders, but not for the typical reasons we used to think they developed them. It’s more a self-reinforcing loop, if that makes sense.

Peter Lipsett: Yeah, that does make sense. Whenever there’s a problem like this, we want to find somebody to blame — or “blame” may not be the right word. You have an article out this week in the New York Times that I thought was very good, called “Stop Pathologizing Ordinary Life,” which is a great title. But you talk about some of the different sources of how this came about — social media, which you just mentioned — where do we put the blame for this? I think we like “blame” because then we think maybe we can flip a switch and stop it — but maybe blame is the wrong way to think about it.

Clay Routledge: Well, first, thank the New York Times for the title — I didn’t come up with it, but it is a great title. On some level, and this might seem like an easy answer, we’re all to blame. What I mean is there isn’t just one thing that has contributed to this. I think a constructive way to think about blame is that we’re all to blame in the sense that most people want those who are suffering to not suffer mentally. Another way to more generally place blame is that part of this just seems to be a function of affluence and abundance. It’s a success story — America is a rich country, and people are now less worried about basic survival needs and basic physical safety. That’s allowed us to spend more time focusing on our inner lives and thinking about that type of mental suffering. It’s hard to get too worried about someone’s sadness or anxiety if you can’t put food on the table. So some of it is a story of success. Some of it is technological — not that I think we should blame social media for everything, but it is true that when you have cultural ideas that end up being counterproductive, they’re now much easier to spread through technology. That’s what we’re seeing on a lot of social media platforms: a lot of young people, in particular, are getting their information about mental health there, and there’s research showing that the more people get their information about mental illness from social media, the less accurate their knowledge about mental health is. There’s a lot of misinformation online, and I don’t think it’s necessarily the case that there are a bunch of bad actors here — it’s more that this has just kind of happened.

On top of that, other people, like Jonathan Haidt and Jean Twenge, have talked about the decline in free play in childhood. We might have kids who are becoming more vulnerable to psychological disorders because they’re not developing the resilience they might have in the past. Jean Twenge has also talked about how families are getting smaller — when you have fewer kids, you spend more focused attention on them. If you have just one child, you may be a bit more obsessive and worried about them, and that might reduce their resilience. So some of these are real issues in society that we’re grappling with, and no one person is to blame. The scholars who’ve done the most work on the idea of concept creep have proposed that it has something to do with —

a liberal society becoming more sensitive to harm. Again, they’ve said that very agnostically — they’re not saying liberalism is bad. The idea is that as we become more sensitive to harm, as we’ve already discussed, on one hand it means we have opportunities to potentially reduce suffering, but it also means we might unintentionally increase suffering by becoming too hypervigilant, too sensitive, too overly focused. So there are lots of potential sources of blame, but I think the constructive way to think about it is that there are also a lot of people who care about mental health. It’s not one of those issues where the problem is getting worse because we’re neglecting it. There’s an irony to it: the problem is getting worse because we’re almost —

saying we care too much isn’t quite right, but we’re almost focused on it in an unproductive way, which shows we’re well intentioned but maybe going about it the wrong way. That’s constructive to think about, because we already have people on board with the idea that this is an important issue. So what we need to do is bring together people who agree it’s important but recognize we’re going about it in a counterproductive way. We need to find a way to approach improving mental health without being so obsessed and preoccupied with it.

Peter Lipsett: So many of the things that lead to a degradation of freedom and individual liberty are often well-meaning — we just want to make sure people are safe, and so you get regulations, taxes, subsidies, and when those don’t work, it swings the other way. The more you tinker with it, the more it actually eats away at the prosperity you’re aiming for. It’s interesting that mental health could work the same way — the more you leave it alone — not that you entirely need to leave it alone. I want to get into some of the solutions, but one more question on the problem: the age demographic of this. We touched on this in the article too — how much of this is a product and problem of Gen Z or millennials, or is there an element of older generations involved as well? Where are we seeing it?

Clay Routledge: We’re definitely seeing it most with the younger generations. Even if you just look at surveys — and we’ve done a number of these at Archbridge, along with plenty of other surveys — when you ask people about the current state of their mental health, young people, Gen Z in particular, are much more likely to describe themselves as having poor mental health compared to older generations. Gen Z reports the highest levels of mental distress, then millennials, and it goes down from there, with older adults reporting much better mental health — maybe for a variety of reasons, but one does seem to be what we’ve talked about: this cultural transition to a more inward-focused, mental-health-preoccupied culture, which young adults are most likely to be involved in.

In addition, some of the other factors that might represent real vulnerabilities to mental health conditions — like overprotective parenting, which is a predictor of anxiety disorders — tie into this free-play-movement idea: kids need to develop resilience, they need to be out there doing things on their own, and that helps them build the psychological fortitude that protects them, or at least helps protect them, from developing psychopathology as they age. That’s something that’s happened in more recent decades. So both actual vulnerabilities to poor mental health and the preoccupation with mental health we’ve discussed make younger generations more vulnerable.

Peter Lipsett: So we live in a society where we’re more anxious, we recognize that as a clinical thing, and it becomes self-perpetuating — and another mental health diagnosis becomes self-perpetuating as well. But you’re not just sitting around identifying this problem — you’re actually working to create a solution, which is what we’re all about at DonorsTrust and with Giving Ventures; we like solutions. So talk to us about the Head Out Initiative. First, big picture — tell us what the Archbridge Institute is, since it’s still relatively new and people may not know as much about it, though it’s doing great work.

Clay Routledge: Thank you. The Archbridge Institute is a nonpartisan think tank focused on three pillars of human flourishing: economics, psychology, and culture. A lot of people are probably familiar with the economic side, which is focused on removing barriers to flourishing — things like occupational licensing, social mobility, economic freedom — what you’d expect in the classical-liberal space of economics. But we also take a more holistic approach, because life is more than that, and especially when you think about barriers, there are real regulatory barriers to people flourishing, but sometimes the barrier is inside us — the barrier isn’t the government. You could imagine an ideal regulatory situation in which people have all the opportunity and freedom to pursue their ambitions but lack the motivation or the ideas to do so. So adding the psychology piece is about recognizing that there are external, regulatory barriers, but also internal, psychological barriers. That connects to our third pillar, culture, because a lot of the time those internal barriers — and some of the external ones too — are shaped by our broader cultural narratives and attitudes. So we wanted to focus on all three, and critically, to see them not as independent but as highly interrelated, and I think this goes in both directions. Regulatory barriers can be demoralizing and demotivating at the psychological level. But psychology and culture also shape the regulatory environment: if you have a culture of high trust, a culture that celebrates entrepreneurial success stories, that energizes people psychologically and promotes hope, and it also encourages people to vote for the candidates and policies that —

will support an environment of aspiration and growth. So we see all of these things as connected. I’m a psychologist by training — I was a psychology professor and business professor for many years before joining the Archbridge Institute, and I joined to help expand our thinking around psychology and culture. We’ve done a lot of work in that space on topics like meaning in life, hope, and agency — psychological ingredients we think are critical to a free and flourishing society. But more recently we wanted to focus specifically on the mental health issue, because over the past several decades, as we noted earlier, there’s been a dramatic increase in the percentage of Americans who report being in poor mental health. Poor mental health is very much connected to the agentic, hopeful mindset that’s critical not just for freedom to be sustained and promoted, but for freedom to turn into flourishing. You can have a free society where no one is particularly motivated to do anything, and that undermines freedom, because eventually, if people aren’t doing anything, they’ll start looking to the government to solve their problems. So we said: here’s a specific, growing concern for our country — mental health — let’s focus on it. And as you pointed out —

and I’m glad you did — it’s one thing to say, “Here’s the problem: we have a culture that’s become obsessed, or overly preoccupied, with mental health, and in a way we’re talking ourselves into being less mentally healthy.” That’s a challenge. But then what do you do about it? We call this project Head Out because — and this isn’t something we made up, it’s not a marketing pitch — there’s a ton of empirical evidence that some of the best ways to improve your mental health are to spend less time thinking about it and get out in the world and do things. So that’s the idea: head out, get out of your head, and head out into the world. As one example, physical exercise: we now have large volumes of empirical evidence indicating that physical exercise is as effective, if not more effective —

than traditional psychotherapy and pharmacological interventions for treating depression and anxiety. It’s not that no one needs those types of interventions — it’s that for most people, most of the time, they’ll get as much value, recovery, and positive mental health from engaging in physical exercise as they would from seeing a clinician or taking antidepressants.

Peter Lipsett: So the Head Out Initiative has five different categories, and physical exercise is one of them. Can we go through the others quickly, just to help people ground themselves in what these solutions actually are?

Clay Routledge: Yeah. So the first one, which we just talked about, we call Move — whether you’re running, lifting weights, in a fitness class, anything that really gets you moving. There are a lot of physiological mediators of that mechanism, but I think a lot of it is that exercise helps break the cycle of rumination and anxiety — it gets you out of your head. These activities have shown that you don’t have to be a gym rat or train for a marathon; even relatively low levels of physical exercise are really beneficial for psychological health. Move is one; Work is another. There’s research showing, for instance, that losing a job is a source of psychological distress, unsurprisingly. So for people experiencing work-related depression or anxiety, one of the best interventions to get them back to baseline is to find another job — productive work. The third is what we call Create — hobbies, or even businesses and entrepreneurial activities, forms of self-expression that direct your attention toward something creative; there are lots of different ways to do that. Connect is the fourth, which is about social relationships.

Just a quick note on social relationships, because I think this is sometimes misunderstood: relationships aren’t just about being around people, and connection isn’t just about people being nice or kind to you. What really fulfills that deep sense of connection is the sense that you matter — that you have an important role to play in a relationship. You can be surrounded by people and still feel quite lonely; loneliness isn’t just about your social environment, it’s about the role you play in it. So connection is a very agentic thing. And finally, the last category is Transcend, which is the more spiritual or religious dimension of flourishing. Again, to help prove the point that this is really about getting out of your head —

it’s not just about holding a religious or spiritual belief. It’s the people who are actively participating in religious communities, or who channel their spiritual beliefs into productive action, who get the most benefit from their faith.

Of course, we’re separating these things out, but they’re all interrelated. A lot of times your work environment provides the social relationships that are useful, or gives you opportunities to engage in creative work. Exercise is often more enjoyable, or particularly rewarding, when we’re doing it with other people. So you can imagine all these things as interconnected. But the point is, across these five domains of human activity, what really helps people flourish mentally is getting out of your head and focusing your attention on a project, a task, a relationship, a job, a faith tradition — something other than worrying about yourself, but actively involved in making a difference in the world and being a significant member of a family, a community, and a workplace.

Peter Lipsett: So none of these are a pill — I can’t just pop one and fix it overnight. It’s not a miracle drug. These things take work: finding fulfilling work, for instance — I may hate my job, so I have to redirect it, and that takes work. Getting off the couch and starting to move, if you haven’t been doing that, takes work. It all takes work. And some people just don’t like work. So what is the prescription, Doctor? You’ve written this out — this is what we should do. What should Archbridge, or other groups, or donors, or someone, be doing to help people actually swallow this non-pill?

Clay Routledge: Yeah. So the first thing — and this is something we launched with the Head Out Initiative — the first step is really getting the word out, because, as you said, this requires work. A lot of people think there’s a simple solution: if they’re feeling down or stressed, they should just go see a therapist or pop a pill. I think a lot of younger people, in particular, are being told that mental health isn’t something you have to work at — that life being difficult and challenging, which is actually a good thing, isn’t the frame. It’s not the default that you’re just going to be a well-adjusted human; you have to work at this.

So part of this is just getting the word out and increasing awareness. That’s part of what the New York Times article I wrote is meant to do — a lot of people read the New York Times, so they can see this perspective and think, “Maybe we should rethink how we approach mental health.” You’re seeing this in schools too. There’s now been a fair amount of research that I hope is getting schools to rethink how they approach mental health. This research has found that a number of schools, particularly in places like the UK and Australia, decided to give all students what’s called universal treatment — mental health interventions for the whole class, not just students identified as needing them.

Thankfully, researchers decided to study the efficacy of this, and what they found is that it wasn’t just ineffective — it actually made kids’ mental health worse. You took a group of students, most of whom didn’t have a mental illness, and instead of targeting the few who did, you gave everyone the intervention. It seemed like the easy approach, but it made all the other students start thinking in unproductive ways, focusing more on things like —

“I did feel sad today; my feelings were hurt today; maybe I have this problem.” It’s unfortunate that this was done in the first place, but at least there’s now good evidence documenting it, and you’re starting to see more people say, “That was well intentioned, but it’s a bad approach.” So I think that’s the first thing that needs to happen: we need to change the cultural attitude around mental health and mental health awareness — and in a way that doesn’t look backward. That’s one of the challenges: it’s easy for people to misunderstand what I’m saying, to assume I think everyone’s fine and that we should go back to mental illness being stigmatized, with no one talking about their feelings. That’s not what I’m saying. What we’re saying is that it’s good we’ve made progress — improved accessibility to interventions and improved the quality of those interventions — but we’re also doing something unhealthy that’s making the problem worse, and nobody wants that. We need to figure out how to thread the needle between having a supportive environment where people who are really suffering can get the treatment they need — because there are a lot of people who die by suicide, for instance, who never received any mental health treatment — and it’s still the case that there are people who aren’t getting the help they need, people grappling with very severe brain disorders. But for most people, thankfully, that’s not their situation, and we need to think about this more productively. That’s why I like this Head Out approach — it’s almost like preventative medicine. There are a lot of things people can do for themselves that don’t require seeking out a therapist or a pharmacological intervention. In addition to getting that message out, once people realize these are things they can do for themselves, the prescription becomes pretty accessible — you have to have the motivation to do it, but these aren’t things that are difficult for people to access. Anyone can work out; it doesn’t require a fancy gym membership or equipment. It’s something that’s very accessible to anyone.

Peter Lipsett: How different is this from cognitive behavioral therapy? That may just be my own ignorance showing, but isn’t that the point of something like CBT — to connect you to reality?

Clay Routledge: Yes, for the most part, I’d say yes. One of the most successful aspects of CBT is what’s called behavioral activation, which is basically the idea behind Head Out: part of the problem with issues like anxiety is that people get stuck in a feedback loop of negative thinking, and a good therapist will say, “Over the next twenty-four weeks, or whatever, we’re going to have a specific treatment plan that helps you get out of your head and go do the activities that are fulfilling.” Some people do need that intervention. If you go to our website, headoutworld.org, we have a toolkit that helps people decide whether they need a therapist, when they should seek one out, and how — because, unfortunately, there’s a lot of therapy out there that isn’t evidence-based. Not all therapists are the same. Some use empirically validated methods that really are about getting people back to good mental health so they can function on their own, and someone shouldn’t necessarily be in therapy forever — these are interventions with specific timelines.

But they require work, to your earlier point — this isn’t just something that happens when you see a therapist once a week; you have to go out and do difficult things. So yes, there are aspects of CBT and other therapeutic interventions that are very much about this, and that’s great — some people need that. But most people don’t. In our toolkit, on our website, people can go through different steps: “If this is me, then here’s where I am, and here are the things I can do for myself.” Sometimes it’s actually a wait-and-see approach, because you might be experiencing symptoms that seem like a mental illness, but in reality they’ll go away in a couple of weeks —

especially if you engage in these types of activities. I think one thing that should be unifying about this Head Out approach is that it’s something anyone can do — it’s agency. Sometimes you’ll see people on the political left saying we have all these mental health problems and we’re not spending enough money on it. Where we can meet people halfway is by saying there’s a lot that doesn’t cost much money — in fact, doesn’t cost any money — that people can do for themselves. I think that’s a very empowering message, especially for young people, who I think increasingly feel like they have to go through some type of intervention to feel good.

about life. And it’s like, no — you actually have a lot more power than you realize. This doesn’t just apply to mental health; it applies to a lot of aspects of their lives.

Peter Lipsett: Are you hearing from folks? You had that New York Times article, and it’s read by a lot of people — I can imagine a pile of hate mail coming in from people saying, “It’s not that easy, Clay.” Have you heard things, positive or negative?

Clay Routledge: You know what’s been interesting about that? The article came out on Sunday, so it’s only been less than a week. I’ve received dozens of emails from clinicians and psychologists — a very positive response. They’re saying this is an issue they actually deal with themselves: they have a lot of people seeking mental health services who don’t really need them. I also think one of the challenges for psychologists who are sensitive to this issue is that there’s just a lot of misinformation online. Just as most doctors wouldn’t want their patients to be sicker, psychologists don’t want a society full of more mentally unhealthy people. So I think they’re genuinely worried about misinformation and about a culture in which mental illness is almost becoming trendy —

promoted almost as a trendy thing. As one example, there’s research showing that when people look at social media influencers sharing their mental health concerns — what’s called normalizing — if an influencer says something like, “I have an anxiety disorder, and it turns out a lot of people have anxiety disorders,” that normalizing increases

the likelihood that one of their followers will identify with that person and think, “Maybe I have a mental health disorder.” So psychologists are concerned about that. The response has been overwhelmingly positive — not just from psychologists, but I’ve also received a lot of emails from teachers and employers who are dealing with these issues too. I’m sure there are negative comments — there always are — but among the people who took the extra step of not just commenting online but reaching out to me directly, they’ve all been really positive. So again, I think it’s encouraging that a lot of people are starting to realize this has become an issue, and it’s also a concern for those who are deeply worried about people suffering with mental illness.

They’re also worried about this because it directs resources away from those who are most in need. As I noted earlier, there are people who engage in self-harm, or who die by suicide, who never sought out or received any mental health treatment. The more people who see themselves as mentally ill,

the less attention, I think, the people who are most severely suffering receive. So that’s a unifying concern too: we want mental illness to be taken seriously, and if we pathologize ordinary life, that trivializes it, in a way — people become more dismissive of it, and that ends up harming the people who are most vulnerable. So I think there are a lot of people, with very different beliefs and politics, who can find some common ground on this issue. We’re connecting this to free markets and other economic issues we care about, but even for people with no interest in that, I think most are interested, generally, in Americans being mentally healthy — so I think it’s an area where we can find common ground.

Peter Lipsett: A more stable society — one with the kind of social trust where people feel agency, which leads to better communities, people working together, solving problems together, less demand for government, and more ability to go out and do good things. Like I said at the top, it’s a fascinating bridge — a connection I’d never really thought about, but so much of our attention and conversation gets taken up by these mental health issues, and if we can correct them and help people — as you’ve reiterated here, this isn’t because nobody’s suffering, it’s because we’re sometimes over-pathologizing real issues some people do have, to the detriment of our own society. It’s fascinating stuff. I think it’s right for the Archbridge Institute to take this on, and it’s great that you were pulled out of the clinical world to come work in this space and help people understand it. I hope the response continues to be very positive. Clay Routledge, thank you so much.

Clay Routledge: Thank you, Peter — I appreciate it, and thank you for giving me the time to talk about this project.

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