Mental health is not a trend, it is a priority – interview with Dr. Gabriel Zanfir

Andrada: Hi! Welcome — or welcome back — to the Mental Health for Romania podcast! I’m Andrada, a volunteer with Mental Health for Romania, and I’m joined by Andrei Gabriel Zanfir, a resident physician at the Alexandru Obregia Clinical Hospital in Bucharest, who has joined us to, we hope, answer some questions our listeners may have. It’s great to have you here!

Dr. Gabriel Zanfir: It’s good to see you, too! I’m really happy to be here with you tonight!

Andrada: Thank you for being here today! I already know a little about you and your academic background — which I tried not to reveal entirely right from the start — but I’m not sure who’s joining us from home, so please tell them about yourself as well.

Dr. Gabriel Zanfir: Well , let’s put it this way: as for my job, I’ve been a psychiatrist since this year at the Alexandru Obregia Clinical Psychiatric Hospital in Bucharest. I’m a student in my final semester, less than 30 days away from earning my bachelor’s degree from the Faculty of Psychology at Babeș-Bolyai University (UBB) in Cluj. At the same time, I’m pursuing a master’s degree in Health Psychology at the University of Bucharest, and from time to time, I also find time to do a little research at the Cognitive Neuroscience and Mental Health Laboratory at the University of Bucharest.

Andrada: It’s truly incredible that you manage to do it all, that you still want to keep doing it all, and I think all these different paths you’re pursuing are very interesting, but the question I think we all have is, “Why?” It seems like a lot of work, so why would you choose to put so much effort into all of this?

Dr. Gabriel Zanfir: Well, my motivation for choosing the profession of psychiatrist, so to speak, stemmed from a combination of both personal experiences and a passion for understanding and treating mental disorders. It’s funny that even from a young age I was, so to speak, fascinated by the complexity of the human mind and by how our thoughts, emotions, and behaviours can be influenced by our quality of life. Whenever my mom was upset or a friend was having a hard time, I’d always think, “What can I do to help?” “What can I do to get them out of this state?” and apparently that evolved into a career in mental health.

As I mentioned, I have had my own experiences — as, I suppose, each of us has at some point in life — related to mental health, which led me to understand and become involved in this field. This personal experience made me realise how important it is to provide support and appropriate specialised treatment to people dealing with mental health conditions. Moreover, why did I choose to study psychology? Well, I believe that studying psychology has played an essential role in my education. Why? Because understanding the psychological foundations, mental processes, and — so to speak — psychological theories helps me better understand mental disorders and approach patients in the most holistic way possible. Studying psychology has also provided me with knowledge about the normal development and functioning of the human psyche, as well as about factors that can contribute to the onset of — or, more accurately, the etiopathogenesis of — mental disorders. In addition, the reason I believe I made a good choice in pursuing both psychology and medicine is that it has developed my communication skills and, in a way, strengthened my capacity for empathy, which is essential when interacting with my patients. Understanding these psychological processes and the dynamics of therapeutic relationships helps me, I believe, to create a safe environment and establish an empathetic connection with my patients, which facilitates a treatment and healing process that is much more — let’s say — smooth. Furthermore, the skills I’ve developed from my education in psychology have enabled me to understand and adapt to the cultural diversity and individual perspectives that each of my patients brings. We must never forget that every person has a unique life experience, and understanding their individual context is crucial to providing personalised and effective treatment.

To sum it up, I can say that my motivation to become a mental health professional stems first and foremost from my passion and, secondly, from my personal experiences. That’s what led me to choose a career in mental health, especially in Romania. Why do I say this? Because, unfortunately, I’ve seen in the clinical setting how patients are still viewed in a negative light and how they struggle with a very strong stigma — something that, sadly, is deeply ingrained in our society.

Andrada: Yes, I’ve heard you speak before — I mean, there is a reason I invited you here, right? Especially about this holistic approach to mental health and, in a way, your passion for local patients and the fact that you’re not afraid to address problems here, but maybe we’ll get to that a little later. And even though we’ve discussed these kinds of issues before, I’ve never heard your full “speech,” if I can call it that, and I find it really interesting when you put it all together and I hear the whole story, it all makes sense to me. But, yes, honestly, I do know other words besides “interesting,” but it’s somehow the only one that comes to mind when I hear you speak.

Anyway, I know I’m always asked what the difference is between psychology and psychiatry, and what each one does, why we need both, all sorts of questions like that, so I was wondering if you’d be willing to explain the difference to us as a specialist: “What is psychotherapy?”, “What are clinical psychology and psychiatry?”, “What do they involve, and why are they important?” Especially from your perspective, let’s take a multidisciplinary approach to mental health.

Dr. Gabriel Zanfir: Okay , I’ll definitely try. I’ll have to go through them one by one, and I hope I don’t forget anything, but please feel free to jump in at any time.

Andrada: Yes, I’ll follow up with some guiding questions if needed.

Dr. Gabriel Zanfir: Please do. Okay, well, I’ll try to clarify the differences and describe the fields of psychology — that is, clinical psychology, psychiatry, and psychotherapy. I hope to do so in the simplest and most accessible way possible. Well, first of all, psychology, in general, is the science that studies human behavior and the mental processes underlying it. We must keep in mind that psychologists always use scientific methods to investigate various aspects of the mind — including cognitive processes, emotions, social behavior, psychological development, human development, and so on. Psychology encompasses a wide range of fields, such as clinical psychology, experimental psychology, and so on.

Well, clinical psychology focuses on the assessment and treatment of mental disorders. Clinical psychologists are mental health professionals who are trained to conduct psychological assessments, make clinical diagnoses, and provide short-term treatment using various methods such as counseling, group therapy, and others. They primarily work with clients who are dealing with issues such as anxiety, depression and eating disorders, among many others. Clinical psychology also plays an important role in hospital settings. We, as psychiatrists, are in a constant state of interdependence with clinical psychologists, precisely because only their diagnostic methods can help us gain a comprehensive understanding of our patients and, at the same time, determine an effective treatment plan that is as beneficial as possible for the patient.

On the other hand, psychotherapy is a form of treatment in which a therapist — a trained psychologist — works with a client to resolve, so to speak, their emotional, behavioral, and relational problems, and so on. In psychotherapy, the therapist uses various therapeutic approaches, including cognitive-behavioral therapy — probably the best known, which many of our listeners have undergone — psychodynamic therapy, interpersonal therapy, and we can also mention group therapy, but we must not forget what the goal of psychotherapy is—what the goal of a psychotherapist is. It is to support personal development and behavioural change. At the same time, a psychotherapist must, among many other things, help develop stress management strategies and improve not only the mental health but also the overall well-being of the client in front of them.

Moving on and shifting slightly to a different area, psychiatry is a branch of medicine that focuses on the diagnosis, treatment and prevention of mental disorders, as well as preventing their exacerbation. Psychiatrists are doctors who specialise in mental health, and they are the only professionals qualified to prescribe medication for the treatment of mental disorders. We, as psychiatrists, take a medical approach and can combine — or recommend combining — psychopharmacological treatment with psychotherapy. Most often in psychiatric practice, we treat patients with various mental disorders, particularly more acute ones. These include anxiety disorders, sleep disorders, severe mood disorders such as depression and bipolar disorder, and, last but not least, psychotic disorders such as schizophrenia, which, according to current guidelines, currently respond best to a multidisciplinary approach, especially through the initiation of psychopharmacological treatment.

Why is it important to take a multidisciplinary approach? Well, as I explained earlier, because each field brings a unique set of knowledge, and it’s very difficult for one person to have an in-depth understanding of every field — even though there are still people who do it, like me, for example. Okay, I went to college for psychology, I went to medical school, but I still don’t have all the necessary knowledge; I haven’t specialised in a particular type of psychotherapy, and maybe I haven’t yet undergone — or won’t undergo — a specific form of supervision in clinical psychology, so the multidisciplinary approach brings to the table a unique set of knowledge from each of these mental health specialists. I believe that only by combining clinical psychology, psychotherapy, and psychiatry can we achieve the most comprehensive assessment of mental health issues and offer individualised and effective treatment options for each of our patients. I believe that collaboration among mental health professionals, especially in these fields, can improve therapeutic outcomes and ensure a holistic and integrated approach to the care of patients suffering from psychopathologies. I hope I’ve managed to answer your questions to some extent, and if not, please feel free to ask me another one.

Andrada: No, I think you answered all the questions, yes, and it was a very comprehensive answer. Before, I thought I knew what everyone does and who does what, but now I feel like I have a better understanding — maybe it’s a little clearer, or maybe I actually understand some details that I hadn’t quite grasped before. I just hope this information sticks with people for a while, and I hope this “imaginary tour” through the fields of mental health has helped at least someone — and that now our listeners will know who to turn to when they need a specialist. After all, that’s what this is all about, to a certain extent.

What I really liked is that, from what I understand, you’re not just working in any of these fields, but you want to become a mental health specialist. Honestly, I haven’t heard many people talk about it this way, and I find it, again, very interesting, which makes me wonder: What are some of the challenges you face, specifically as a mental health specialist who combines several fields of practice?

Dr. Gabriel Zanfir: If I may interject briefly before answering your question directly. You were asking who we should turn to when we have problems — something I’m not sure I’ve emphasised clearly enough. In our current healthcare system, I think it’s important to emphasise that when we face mental health issues — just as with any other health problem — we should always turn to our family doctor, and I encourage our listeners to do the same. You should know that your family doctor has all the expertise needed to support you in deciding where to go next, and this is the first step toward ensuring effective treatment. It’s important not to seek psychotherapy or clinical psychology on our own, or to show up at the emergency room of a psychiatric hospital. First, we should ask our family doctor for advice, and then, based on that, seek the specialised help that’s best suited for us.

Another thing I think I need to clarify is what it means to be a mental health specialist. Well, even though my job is as a psychiatrist, that already makes me a mental health specialist — and so are all my colleagues. Mental health specialists include all psychologists who work in clinical settings, all psychotherapists who help us resolve our problems using the techniques they propose, and all psychiatrists. But it’s true that the more familiar a mental health specialist is with as many of these specialisations — so to speak — the better it will be for the patient. And even if not, they can confidently turn to any of their colleagues.

Andrada: Yes, oh, I didn’t mean to imply that any of these specialisations isn’t equally well-equipped to address mental health issues. It’s good that you pointed out that it could be interpreted that way. I think what you’re doing is a valuable approach, and that it gives you this multifaceted perspective on how mental health issues manifest — and that it’s important to have, I don’t even know how to put it, different kinds of specialists, if you will, in mental health.

Dr. Gabriel Zanfir: Yes , absolutely not, don’t worry, I understand what you’re trying to say, but I felt the need to mention it precisely to avoid any confusion for our listeners. Indeed, the more familiar you are with the subject and the more knowledge you have, the clearer it is that the service you can provide to the patient and the person in front of you is all the greater, but, as mental health professionals, each of us mentioned above specialises in our respective fields.

Andrada: That’s right, very well put. Now that we’ve clarified everything that needed to be clarified, let’s get back to the original question: What challenges do mental health professionals face?

Dr. Gabriel Zanfir: That’s a pretty complicated question, and I need to take a moment to gather my thoughts so I can try to keep it simple, if possible. Well, there are several challenges that mental health professionals face. One important aspect is the complexity of human beings. People are complex beings, and mental health, in turn, involves a complex interplay of biological, psychological, social, and cultural factors. The assessment and treatment of mental disorders require a thorough understanding of each patient within their unique context, and these complex factors must always be taken into account.

Another challenge that I face quite often, I would say, is the stigma and prejudice that still exist in Romanian society regarding mental health. The stigma associated with mental health can create a barrier for people who need help. Specialists of all kinds in this broad field of mental health face an additional challenge: combating prejudice and promoting understanding and acceptance of mental health conditions in society, something I hope I, too, will be able to achieve in some way today.

Let’s not forget about resource-related issues. The availability of adequate resources — such as specialised staff, treatment facilities, and funding — poses a challenge to the provision of quality care. Resources can affect access to services and the quality of care. Although one might think there are plenty of psychologists on the market, and many doctors, unfortunately, the reality is quite grim: there are fewer and fewer specialists in every field — not just mental health — who are available to patients today.

Another interesting challenge is, so to speak, the evolution of mental health and the new disorders that are being discovered. The field of mental health is constantly undergoing research and development — whether we’re talking about the medical field, psychometrics, or psychology — new discoveries are constantly being made, new insights are emerging, and… insights into mental disorders emerge constantly. I mentioned new disorders. Well, here I’d like to highlight two that I’m currently a bit more familiar with: cyberchondria, which is an obsession with a disease based on obsessively searching for symptoms online, as well as orthorexia, which is an obsession with healthy eating — an obsession that, unfortunately, borders on psychopathology and, regrettably, has had some quite devastating consequences for patients over the past 10 years. Within these two psychopathologies, as well as in others, research in the field of mental health is constantly evolving. There is a need for new assessment tools, as well as for new therapeutic approaches. Since these are such new disorders, they are not yet included in international diagnostic guidelines, but that does not mean the conditions themselves do not exist. That is one of the major challenges. There are patients who, unfortunately, do not meet the criteria outlined in the manual or do not meet them 100 percent.

Andrada: Yes, sorry to interrupt, but I’m curious about something you just said. Until now, I hadn’t heard of these new pathologies, and when I hear that someone is suffering from depression or anxiety or, I don’t know, something more “common” (in quotation marks), I can imagine some symptoms or figure out how they might be diagnosed. Still, how do you tell if someone is suffering from something like that, or how do you start to suspect that someone has one of these new pathologies? Should I be worried if I say I’m going to eat nothing but salad starting tomorrow? At what point do any of these symptoms become a disorder?

Dr. Gabriel Zanfir: Okay, that’s a very good question. I think that before answering your question per se —”How do we diagnose?” or “When does it become a problem?” — I think it would be good to go into a little more detail about these two psychopathologies and explain a bit more thoroughly to our listeners what the exact definition is and what the current diagnostic criteria are, if you don’t mind, and then we’ll talk a bit about the current psychometrics of these conditions, as well as the psychometrics of mental disorders in general, if that’s okay.

Andrada: Yes, of course it’s okay! We don’t necessarily have a specific destination in mind; we’re just trying to answer some questions, and I see we keep adding more questions here. I honestly think it’s worth mentioning what psychometrics is — a term I learned from you — and I don’t think it’s widely used or easily understood by listeners. Look, I keep interrupting you, please go on.

Dr. Gabriel Zanfir: Okay , well, we’ll come back to psychometrics later; for now, let’s continue talking about orthorexia. Orthorexia is a term used to describe an excessive obsession, as I mentioned, with healthy eating. People with orthorexia are overly concerned with the quality and composition of the foods they consume. They can become so obsessed with strictly controlling their diet that they gradually eliminate entire food groups and develop severe restrictions regarding what and how they eat — a pattern that is also common in the clinical presentation of anorexia nervosa. Over time, this obsession with food can negatively affect mental and emotional health and lead to anxiety and social isolation, but it can also have certain — let’s call them — somatic consequences, namely unhealthy weight loss and nutritional deficiencies, which in turn can exacerbate mental health symptoms.

On the other hand, cyberchondria — or, as it has been called in some local articles, “online health anxiety” — is an excessive and obsessive preoccupation with one’s health based on excessive online research into symptoms and medical conditions. People suffering from cyberchondria constantly search for information about symptoms and illnesses, and this obsessive searching leads to an exaggerated and misinterpretation of symptoms, fueling unfounded anxiety and fears of having a serious illness. Naturally, this can lead to increased stress or constant anxiety, but more than that, it can also lead to situations where it affects those around us—both our family and society as a whole — when you’re so preoccupied with your health and get scared by the slightest symptom — whether you actually have it or not — then we can realise, so to speak, what the implications are and why it’s important to bring this up for discussion.

Both of the conditions I mentioned — orthorexia and cyberchondria — highlight the complex interaction between mental health and the digital environment, so to speak. With increasingly easy access to online information and social media platforms, it’s important to be aware of the negative effects these sources can have on mental health. It is essential, so to speak, to adopt a balanced and healthy approach to the information we seek, and we must always remain aware of the impact of information overload and the social comparison we encounter in the online environment.

For people struggling with orthorexia or cyberchondria, it is important to seek specialized help in order to address these issues and develop healthy coping strategies. Well, precisely because it is so important to address these symptoms — which, at first glance, might not seem dysfunctional — it is crucial to seek specialised help because, as I mentioned, these are new conditions that can only be diagnosed by a specialist. Why? Because, for most mental disorders — and even more so for these new disorders — a diagnosis requires a multidimensional assessment that may include various aspects.

Just as with depression, it is helpful to talk with a patient during a clinical interview. A clinical interview is a conversation with the patient, which is often the first step in a mental health assessment. Through this process, we as specialists can explore the patient’s symptoms, medical and psychological history, as well as stressors, context, and so on. Another important aspect that highlights the importance of a multidisciplinary approach is questionnaires and assessment scales. There are various questionnaires available today, as well as assessment scales developed to evaluate specific symptoms, their severity, and their impact on daily functioning. These tools are typically used by clinical psychologists, not by psychiatrists. They can be used to obtain additional information, and more than that, they are used to quantify the severity of a mental disorder. These questionnaires and assessment scales represent the psychometric aspect — that is, the quantification or mathematics behind our minds.

In my clinical practice, I have often needed the help of psychometrics. Here, too, we’re talking about scales that help me quantify a patient’s level of depression. We can speak specifically, for example, about the Beck Depression Inventory, which is currently still one of the most widely used tools for quantifying depression. Perhaps many people are wondering, “Okay, but as a psychiatrist, can’t you just tell when you see someone who’s depressed?” Well, theoretically, yes. You can tell, but one characteristic of psychiatric patients — and, more broadly, of patients in general in the 21st century — is concealment. So, whenever we have doubts about the severity or even the existence of symptoms in a particular patient, we consult a clinical psychologist, who will help us use valid assessment scales — validated for the Romanian population or other local populations — to make a diagnosis. This is where the multidisciplinary aspect comes into play.

Another important aspect to keep in mind when diagnosing mental disorders is behavioural observation and monitoring. This can be done both by the clinical psychologist during sessions and by the psychotherapist, especially since the relationship between the client and the psychotherapist is usually longer-lasting than that with a clinical psychologist or even a psychiatrist, and this observation can provide information about severity and progression. For example, I can observe changes in my patient’s behavior, I can observe their emotions, and, more than that, I can assess their daily functioning. Of course, observation is a much more effective diagnostic tool than a phone conversation because I interpret things differently when I see the patient in person than when I merely hear their voice.

In closing, it is important to emphasise that assessing severity, quantifying symptoms, and so on, in the field of mental health is not a simple process — and above all, it is by no means an automatic one. It requires a holistic approach that takes into account multiple aspects of the disorders and the patient’s individual context. It is important to follow clinical guidelines and recommended diagnostic criteria to establish an accurate diagnosis and assess the severity of mental disorders. Only a mental health professional can help a patient with mental health issues, and it is important to emphasise this point.

When we have problems, we need to turn to specialists — not get our information from the internet, not listen to what our neighbor says, and not listen to what our coworker says — because a mental health specialist draws on their professional experience and up-to-date knowledge to assess the severity of a diagnosis as accurately and comprehensively as possible — something you probably can’t do in your apartment building or out on the street — so please come see the specialists.

Andrada: First, see your family doctor so you can be referred to specialists.

Dr. Gabriel Zanfir: Exactly, that should be the first step. At least you have… I can already see that some information has stuck.

Andrada: Yes, it was very interesting because I didn’t know that from the start — I mean, it surprised me a little. I kept noticing that you said something that caught my attention, and that I’ve overused the words “interesting” and “fascinating” in this interview, but it is interesting, and you keep saying that these are local issues — that diagnosis should be tailored to the Romanian population — and it seems to me that this is something I don’t hear discussed very often. I see a lot of discussions about mental health online, but I can’t say I see anything that says, “Young people in Romania suffer from this”. Generally, it’s young people, and we don’t know if they’re from Romania, we don’t know if they’re from the United States — we know nothing about them — and perhaps it’s worth mentioning a little more about what the local issues are, whether Romanian patients differ from other patients, or how you, as a specialist, view these — again, local — issues?

Dr. Gabriel Zanfir: To start off in an organized manner, it’s important to highlight the prevalence of mental disorders. Unfortunately, as far as I’m aware, there are currently no statistics available for Romania, but depression ranks in the top 5 in the European Union in terms of prevalence, according to data from two or three years ago. However, why is Romania — or rather, let’s not just say Romania, but Eastern Europe — different, since I’ve also seen literature indicating that, unfortunately, this part of the continent faces more or less the same problems?

First of all — as I mentioned earlier, and I’ll just briefly reiterate — we’re talking about stigma and discrimination. We must keep in mind that patients, first and foremost, may have difficulty acknowledging their issues or seeking help because they fear ostracism and discrimination. Everyone is afraid to see a psychiatrist, everyone is afraid to see a psychologist; we think, “And then what am I supposed to tell people? How could I possibly have ended up at Obregia Hospital?” — something that doesn’t happen in a civilised country or in the rest of Europe, a new finding revealed by studies on the statistics regarding the number of visits to psychiatric services.

Another issue is limited access to mental health services. There is a significant gap between the population’s mental health needs and the availability of adequate services. The number of specialists, such as psychiatrists or clinical psychologists, is relatively small compared to the existing demand, especially given our country’s population. We are also seeing an uneven distribution of these services between urban and rural areas, which can limit access to treatment for people in certain regions. I’ve noticed that in Bucharest and, most likely, in Cluj — large cities — not only is the community more open-minded, but there are also more options when it comes to mental health specialists.

Unfortunately, for people in rural areas, things aren’t so good, and let’s delve a little deeper into this issue. What I find troubling — and what I still see as a local problem — is the lack of information and education, as well as limited knowledge among the general public about mental disorders and the importance of mental health care, which can lead to delays in seeking help and result in delayed treatment that may not be as effective. Proper education and information could help reduce stigma, promote prevention, and encourage early self-care. Let’s not forget, when discussing domestic issues, that Romania is one of the few EU member states that does not include health education classes in its public school curriculum, a fact that also affects knowledge about mental health.

Another issue that I can say I have encountered with my patients as well is socioeconomic problems, such as poverty, unemployment, and social inequality, which, unfortunately, can be both the cause but they can also be factors that exacerbate mental health problems. People facing such difficulties may have more limited access to mental health services and may be at greater risk of developing disorders because they are uninsured, cannot benefit from services covered by the national health insurance, and, moreover, we must not forget that at present, psychotherapy covered by the national health insurance is very difficult for patients to access. First, you must see your primary care physician and obtain a referral to a psychiatrist, who, if they wish or deem it appropriate, may recommend up to four psychotherapy sessions per month but unfortunately, not all psychotherapy specialists work with the national health insurance. And unfortunately, the cost of a psychotherapy session is quite high, but it’s justifiably high because training and supervision in the fields of clinical psychology and psychotherapy are very expensive for us as well. So, unfortunately, I think another local issue is the way our healthcare system operates — so to speak — and it should be improved as soon as possible, precisely to help our patients as much as possible.

There are other issues as well, especially in Romania — we’re talking about emigration and family separation, factors that have a significant impact on mental health, particularly among children, but it’s important to continue our efforts to raise awareness, develop appropriate services, and reduce stigma so that we can ensure proper care and support everyone who needs it. There are indeed some challenges, but we hope we’ll be able to overcome them as soon as possible.

Andrada: Yes, this glimmer of hope as we’re nearing the end is exactly what I needed, especially after you’ve brought up so many issues. It’s interesting to think specifically about the issues facing Eastern Europe, and Romania in particular, when it comes to mental health. Unfortunately, the situation isn’t very rosy right now, but we hope that by the time of our next interview, things will be different.

Maybe this is the second-to-last question, or maybe it’s actually the last one — who knows? It really depends on whether you say interesting things and we keep dragging it out to have more to talk about. As I’ve already mentioned, a lot of the information most of us find about mental health comes from social media. On the one hand, as you said, we live in a reality where most mental health issues are stigmatised, and on the other hand, there’s also what I’d call an excessive popularisation of mental health issues. You open TikTok and see a list of “5 symptoms that clearly indicate you’re suffering from I don’t know what”; you go on Instagram and see that everyone has anxiety and depression. I think it’s good that people are talking about this, but there are almost certainly negative aspects to it as well. What’s your opinion on this excessive — I’d say uncontrolled, though maybe that’s not the best term — popularisation? I think getting your information from TikTok is often, as you said, like getting your information from the stairwell of your apartment building. What are the risks of this excessive popularisation?

Dr. Gabriel Zanfir: First of all, I’m glad I sparked a little interest with what I said earlier, and indeed, I hope that by the next interview we’ll already see the first steps toward change. And now, to answer your question — well, initiatives to raise awareness about mental health issues, such as Mental Health for Romania, are very important because they bring numerous significant benefits, and that’s exactly why I’ll start by talking about the good things, then move on to the bad things, and explain why we need to be a little careful about the information we get from online sources.

Well, first of all, these initiatives help eliminate the stigma and prejudice associated with mental health conditions — an issue we frequently face as mental health professionals, as I mentioned earlier. I firmly believe that only by promoting open discussions and being honest about our mental distress can we create an environment where people will feel more comfortable seeking help and talking about their experiences. Another important aspect of these initiatives — which, I emphasise, are guided and supported by specialists in the field — is raising awareness among the general public about mental health disorders and their impact on daily life. I believe we all agree that once people become better informed and better able to correctly recognise the signs and symptoms of mental health disorders, diagnosis and interventions will be earlier and more effective. However, as you mentioned, it’s important to acknowledge that there are also challenges — specifically regarding mental health information and campaigns on social media — particularly in terms of self-diagnosis and misperceptions. I’ve encountered — and not just once — unverified, distorted, and non-expert information being promoted on social media not only by local users but also by certain so-called influencers, and this can create confusion or even panic among the general public.

It is important that we, as mental health professionals, consistently encourage a rational and balanced approach to information about mental health, but also that we fight to counteract these phenomena in order to ensure a responsible approach to mental health. One thing I like to say often is that we need to be careful. Mental health isn’t a trend — it’s a priority. In addition to the issues I’ve mentioned, this phenomenon of self-diagnosis can have a negative impact not only on you as an individual, as I said, but it can also have negative effects on society as a whole. I’ve worked a few shifts in recent months where the number of patients was very high; most of them weren’t patients who would normally have needed to come to the psychiatric emergency department, but, nevertheless, after watching TikTok videos, browsing online content, or talking to neighbors, they said, “I should go to a psychiatric hospital, this is serious.” This just makes our job much harder, and at the same time, it has a negative impact on access for patients who really need care, even though we don’t realise it. Although it’s good to talk about feelings, it would be best to do so in a controlled way, and the problem of misdiagnosis as long as everyone — I’m exaggerating, not everyone — young people and influencers start talking about depression, anxiety, and bipolar disorder, problems begin to arise in the realm of diagnosis; and once a person repeatedly receives information about a certain mental disorder, there’s a fairly high chance that a psychiatric patient will mask their symptoms or adopt certain symptoms they hear about around them, and this can have negative effects.

Speaking of anxiety, we can take as an example something I’ve encountered in my clinical practice: depression and anxiety — people who would come in and say they were very anxious and had panic attacks, who didn’t know what a panic attack actually was; in fact, they were suffering from depression. And based on information they found online, these two conditions — depression and anxiety — which share common symptoms such as persistent sadness, anhedonia (that is, a loss of interest and pleasure), difficulty concentrating, and sleep problems — led the patient to seek help for an anxiety issue. Indeed, it was fortunate that they saw a specialist, who was able to distinguish between the conditions, make a correct differential diagnosis, and initiate appropriate treatment for them, because the treatment for depression and anxiety is different. Whether we’re talking about psychopharmacological treatment or psychotherapy methods, once a specialist has made a diagnosis, there are only certain treatment methods that can be effective.

Another example that surprised me is that everyone suffers from a personality disorder to one degree or another; it’s impossible for anyone to be perfect and have no personality disorder at all. The prevalence of borderline personality disorder is quite high compared to other types, but borderline personality disorder is one thing, and bipolar disorder is another—and we often hear people say, “Oh, I’m so bipolar.” This isn’t okay because, while both disorders can indeed involve intense mood swings, emotional instability, and impulsivity, that’s pretty much where the similarities end, so to speak. Again, treatment is very different, and the patient may suffer if it’s initiated incorrectly. The difference between bipolar disorder and borderline personality disorder once again highlights the importance of a multidisciplinary approach, because the clinical psychologist plays a very important role in diagnosing these personality disorders.

What I wanted to emphasise here is that we need to be careful about where we get our information, and some errors can be more “costly” — if I may say so, in quotes — than we realise. Although awareness initiatives offer many advantages — such as information campaigns in hospitals and on reputable social media platforms — it’s important to recognise, as we conclude this discussion, that only a specialist has the expertise needed to make a correct diagnosis and provide appropriate treatment.

Andrada: Thank you for highlighting all these points so well! It’s clear you’re an expert, and while it’s good to destigmatise mental health issues, yes, only a specialist can make an accurate diagnosis, and it’s very important to remember that. When we gather information from the internet — especially social media — we don’t become experts ourselves, and we need to be careful about how we use that information. I think you’ve given us enough information to get us thinking for a while and to make us want to learn more about mental health — and to explore it from multiple angles so we can get a broader perspective. You’ve really given us a lot of information, and I have to admit that you’re going to make it hard for us when it comes time to come up with a title for this episode — maybe it’ll be something like “Everything with Gabi Zanfir.” And now that we’re approaching the end, do you have one final thought you’d like to share with our listeners? And, if anyone has questions after listening to the episode or is curious, can they contact you for clarification? We’ll obviously try to answer all the questions, but you’re the real expert here — if they want to contact you, what’s the best way for them to do so?

Dr. Gabriel Zanfir: Certainly, one key takeaway is what informed support is — support that’s designed to help you feel your best. Seek out specialists in the right order so they can guide you toward solving your problems, and I feel the need to repeat that mental health isn’t a trend — it’s a priority, especially these days — and I’d be more than happy to share my contact information with you. You can also email me; I’ll send them to you so you can add them to the episode’s description, and please don’t hesitate — whether it’s just a piece of advice, some guidance, or information — I’m here for you. I’m a little sorry that I probably wasn’t as concise as I could have been and maybe didn’t go into enough detail in certain areas, but it seems to me that the discussion about mental health is so broad, and I hope I’ve managed to highlight a few things that will give you something to think about and some takeaways. Thank you so much for the invitation, and I’m glad I got to be here with you!

Andrada: We also want to thank you for joining us today, and please don’t worry that you touched on so many different topics — I think that was actually the best part, especially since you brought up some things I wouldn’t have thought to ask about. I wouldn’t have thought to ask someone to come talk about orthorexia for the simple reason that I didn’t even know it existed until now. I’d say this episode is a real gem, so I hope everyone can take something away from it. Thank you for listening — especially if you’ve stuck with us this far — and until next time, take care of yourselves and your mental health. See you soon!