By In this interview, we delve into the current and future outlook for mental health in Spain, with the help of renowned psychologist and researcher, Eduardo Fonseca Pedrero.
Mental health has been receiving a lot of attention in recent years. Society seems to be increasingly aware of its importance and is transmitting this to those responsible for its management through events and street demonstrations.
The high incidence of mental disorders and the rise of medicalization require a calm and scientific reflection on this issue.
As a profession, psychology faces a dynamic, complex and multifactorial situation. The contexts are increasingly complex and we are not very cohesive. As a population, the situation could be described as “dramatic”, since the waiting lists in specialized and public centers are regrettably long, which produces a chronicity of suffering that is clearly unnecessary.
Furthermore, there are additional difficulties, since the cases of people with suicidal behaviour, as well as cases of completed suicide, are sadly on the rise. These reasons lead us to want to know, from the hand of the expert researcher Eduardo Fonseca Pedrero, his vision of the current panorama of psychology, as well as its future and the vision he has on suicide prevention.
“Suicidal behavior is a complex, multifaceted and multicausal phenomenon.”
-Eduardo Fonseca Pedrero-
Interview with Eduardo Fonseca Pedrero
Eduardo Fonseca Pedrero is one of the most prestigious Spanish psychologists and researchers. He is a Professor of Psychology at the University of La Rioja. He is currently Vice-Chancellor for Research and Internationalisation at the University of La Rioja. He is Principal Investigator of the PRISMA research team (Rioja Mental Health Research Programme) and member of the Biomedical Research Centre in Mental Health Network (CIBERSAM), in the Department of Psychiatry at the University of Oviedo.
He has published more than 200 research papers in high-impact scientific journals. He has published various books on psychological treatments and mental health, including the psychological treatment manuals published by Pirámide. He has participated in multiple book chapters in national and foreign publishers, as well as in national and international conferences. He has also received various scientific awards and recognitions.
Her lines of research focus on the promotion of emotional well-being and the study of mental health (e.g., suicidal behavior, psychosis), the prevention of psychological problems, the incorporation of new psychopathological models and the validation of psychological treatments.
Let’s see what he thinks about the current state of mental health right now.
Q. First of all, we would like to know: what motivated you to choose psychology as a profession?
First of all, I would like to sincerely thank you for considering me as a person worthy of being interviewed in your excellent digital magazine. I have been following you very closely for a long time (don’t tell anyone, sometimes I even use you as an example in my classes) as have many people from all over the world. Congratulations on this project that you are carrying out. I sincerely appreciate the invitation, I really do.
It’s a curious story, the one about my relationship with Psychology. I could say something that I’m sure of right away: psychology is my passion; it’s a love that I found along the way. I’m not going to lie to you, because I wasn’t one of those teenagers who had a clear idea of what they wanted to do, neither with their life nor with their studies. I almost forgot to sign up for the university entrance exam!
My (pre)occupations were other ones related to the typical ones of adolescence (sports, going out, etc.). I have to admit that I decided in a matter of minutes. Note that I selected physical education as my second option, and pedagogy and law as my third and fourth options.
Maybe because of naivety or maybe because it was unconscious, my Judo teacher, Joaquín Valdés (psychologist for Barcelona and the national football team with Luis Enrique) left his mark since I started with him at the age of 4 in a school in the city of Oviedo. It is one of those things in life where causality and chance are mixed.
Whatever the case, looking back, I feel fortunate for the path I have taken and the people I have met on the journey. But above all, I am excited about what the trip will bring me in the coming years or the new routes to take to places still unexplored.
Q. On the other hand, it seems that we are witnessing an increase in the prevalence of mental disorders such as depression or anxiety in our country: is this true? Why might this be happening?
It is an interesting question, no doubt. Here I have my own internal resistances that debate between a discourse more focused on the strengths of the human being and his capacity for resilience (because of the “antifragile” of the author Nassim Nicholas Taleb and how to obtain benefits from disorder and chaos) and another one more of psychopathologization of daily life (with its derivatives).
I would like to find a middle ground, without falling into insipid reductionisms. On the one hand, we know that human beings have a great capacity for adaptation; and at the same time, on the other, it seems that mental health problems have been increasing (I don’t know if it is due to the increase in DSM disorders, society and the cosmetics of happiness, the decrease in the levels of tolerance to discomfort and suffering, etc.).
In any case, it is a topic that is in the public arena and that we psychology professionals must respond to. However, there are many other issues that concern me and that are on the agenda, including suicidal behaviour.
Q. As a profession, what should we be able to do to meet today’s health challenges?
I could talk at length about the advances in psychology, the intricacies of the mind and the intricacies of mental health, but that’s what books are for. For my part, and I say this from the bottom of my heart, we have to be able to be a much more united and cohesive profession, working together, fighting for common, not partisan, interests that should not be negotiable.
Sometimes I have the feeling of fragmentation, of a lack of common goals or a lack of a sense of belonging. We have to take great care of the image of our profession, consciously and intentionally. It is curious that psychology professionals share the same biases, judgments, prejudices, etc., that we study and yet we cannot escape them.
Regarding the aforementioned defragmentation, and to use a simile, it is like there are millions of islands, small islands, islets, and islets. Call them Association A, Association B, Conference C, Congress D, Conference E, Foundation F, etc.
We must not lose sight of the saying that “unity is strength.” To get to this point, something that I see as complicated, although not impossible (due to the prevailing model of society, social networks, social values, etc.), is that we all “lose a little” to gain as a profession, as a guild. I bring up the saying: “no one is more than anyone else, no one is less than anyone else, and we are all someone.”
If I had to daydream… I hope that one day there will be a national or international congress of Spanish psychology that stirs passions and dreams, that is a real forum for change, a beacon to look to the horizon, a space where all the professionals of Spanish and Latin American psychology can meet, and where the frontiers of knowledge can be pushed. I like to call it (I stole this idea from my role as Vice President of the Dialnet Foundation) the Ibero-American space of psychological knowledge. As always, time will be the best judge.
Apart from this desire, there are millions of veins to work on and all are equally important. For example:
- Develop and validate psychological prevention programs based on empirical evidence.
- Determine which treatments are effective (their components) and for whom.
- Provide practical guidelines for educators, family members, and health and social professionals, etc.
- Disseminate truthful, scientific information, reducing the taboo and stigma associated with mental health.
- Improve the accessibility of psychological treatments and prevention programs for educational, social and clinical-care contexts.
- Improve the study and understanding of protective factors.
- Incorporate new methodologies, procedures and models (e.g., outpatient assessment, network models).
- Develop joint policies, plans and actions: coordination, cooperation and co-responsibility ( unus pro omnibus, omnes pro uno which in Spanish means ‘one for all and all for one’).
Currently, I think it is important that all Spanish Primary Care has psychology professionals, just as all Spanish educational centres also have their educational psychologist (in addition to the guidance counsellor). These actions represent a real quantitative and qualitative change.
Furthermore, to be direct and perhaps to tell an open secret, we have to occupy institutional positions. It is that simple and complex at the same time. Being in the place and at the time where decisions are made.
Q. Do you think we have enough resources to do so?
We already know that we are not buoyant in resources and it seems that this is how things will continue. A fact: in Spain suicide is the main cause of unnatural death, and we still do not have a national prevention plan.
My impression is that we cannot wait, we cannot be passive, but rather proactive; we have to create spaces through action. For example, if we want to work for the implementation of psychology professionals in primary care, then we have to develop a project (PSICAP) to show something that is obvious to us: “psychological intervention for emotional problems, compared to pharmacological treatment, is efficient, effective and effective.”
This creates new spaces, new horizons and new opportunities for psychology and our graduates (present and future). Although we already know this, we have to demonstrate that psychology is necessary to improve the quality of life and social well-being .
Obviously, there are many other actions, on a multi-level level, but we cannot lose sight of the goal; we have to separate the wheat from the chaff, to know which actions are most important and of priority not only for the profession, but for the whole of present and future society. We have an unavoidable social commitment, that must be our driving force to transform reality.
Q. In the Spanish public health system there is the figure of the Psychologist Specialised in Clinical Psychology. Do you think that other specialities should be created? Why?
Of course, there are many others such as clinical psychology of childhood and adolescence, neuropsychology, psycho-oncology, etc. But also educational psychology in educational centers.
Q. You are the author of such important manuals as Psychological Treatments for Psychosis , Psychological Treatments: Adults, Psychological Treatments: Childhood and Adolescence and the recently published Manual of Psychology of Suicidal Behavior with Susana Al-Halabí . What has it meant for you to coordinate, participate in and write these works?
Thank you very much for your question. For me it has been a personal challenge and a privilege and honour. Bear in mind that we are taking over from the great swords of Spanish psychology. I have been able to participate and collaborate with professionals whom I admire.
In this respect, and considering the group of authors who have signed these books, I believe that each of the contributors to the books could be classified in the world of wine as “gran reserva” authors. These are manuals that understand science as a collective enterprise.
It may seem like an illusion, but I would like to believe that these manuals will help people and society as a whole, towards an improvement in mental health that is more accessible, of higher quality and more inclusive.
As the Spanish Constitution states , it is necessary to “recognize the right to health protection, as well as to organize and protect public health through preventive measures and the necessary benefits and services . ” Without wanting to fall back into the cliché, we cannot affirm that “there is no health without mental health.”
The manuals represent a journey to Ithaca. There were some issues that were not protected by Spanish psychology and that inevitably marked the direction to take. On the one hand, the lack of updated books, in Spanish, on empirically supported psychological treatments. On the other, the absence of a reference work on interventions in psychosis or the psychology of suicidal behaviour (also in Spanish). As you can see, it was not an easy task.
These works also respond to some of the paths that (clinical) psychology was (and is) taking due to the lack of epistemological vigilance of certain insipid reductionisms that are rampant in this vast ocean of the world (lest people end up believing that a psychological problem is due to a neurotransmitter or a brain disorder or that the genetic code explains more than the postal code).
We were also concerned about the lack of current works on key topics for Spanish psychology that would not only allow us to educate present and future generations, but also help our profession respond to a social challenge and health problem of such magnitude as psychological problems or suicidal behavior.
In short, this work of many excellent professionals is the fruit of a commitment, a commitment to our profession, a commitment to excellence and science, a commitment to families, a social commitment. Psychology will not look the other way.
Q. On the other hand, last year we broke a sad record in Spain: 4,003 suicides. It is the first cause of unnatural death in Spain. What do you think is behind this increase?
It is clear that suicide is the most silent and most silenced drama of life. We know that every year it takes the lives of more than a million people in the world, leaving hundreds of thousands of other families broken by pain. Deaths that, in many cases, could have been prevented.
You already know that suicidal behavior is a complex, multifaceted and multi-causal phenomenon. There is no single reason why a person decides to end his or her life. Suicidal behavior is part of human life.
We maintain that suicidal behavior encompasses different manifestations ranging from ideation and planning, through suicidal communication to suicide attempts and death by suicide. It is a polyhedral concept whose manifestations, of different nature and severity, can vary along a phenotypic continuum .
For us, therefore, a new approach to the phenomenon of suicide is needed , one that is in harmony with the human condition and existential vulnerability, and which can show that suicidal behaviour is precisely that: behaviour anchored to a biographical context that limits a person’s life. It is not a symptom or a disorder, nor is it a consequence, complication or “natural” evolution of mental disorders.
Thinking about suicide beyond psychopathology and the “diagnostic-centric” model is a scientific and moral imperative, and a pending task for all social agents. It is argued that suicidal behavior is neither the consequence of a “supposed mental illness”, as fever is of an infection, nor is it caused by a supposed brain problem, neurochemical deficit, genetic alterations or other typical ones. Nor does the so-called “suicidal brain” exist, nor is it expected.
It is understood, from a contextual-existential approach, that in the study and understanding of suicidal behavior, the vital-biographical context of people and their dealings with life problems, extreme situations and existential concerns must be considered (see chapter 1 of the Manual of Psychology of Suicidal Behavior ).
This approach tries to situate the understanding of suicide in the biography of the person and their circumstances. That is, to understand the reasons rather than the causes, to “put more head and less brain.”
Q. Regarding suicide, can it be prevented?
Yes, without a doubt. It must be said as loudly as possible. The reader must remember that:
- Suicidal behavior can be prevented with timely, evidence-based, and often low-cost interventions.
- The response must be comprehensive, inclusive, holistic, multisectoral, multidisciplinary and person-based.
- The solution lies in co-responsibility. The involvement of all agents in society is essential.
For us, it is essential to train, inform, sensitize and raise awareness among psychology professionals and those in any other field about suicidal behavior (it is essential to “know in order to act”). Obviously, there is no easy solution. Many questions remain unanswered, the most pressing being, perhaps, the lack of a national plan for the prevention of suicidal behavior in Spain.
Essentially, suicide can be prevented. All that is needed is prevention policies and programmes; of course, they must be implemented. For example, our group has been working in recent years on the prevention programme called Positividad and this year we will publish the effectiveness of the 6-month programme, which has had benefits for girls. We are now working on a second, shorter version (5 sessions) for implementation as a universal prevention programme in secondary schools.
Q. On the other hand, do you think that enough is being invested in the development of new psychological treatments for them to be effective and efficient?
Clearly not. If you want, I’ll ask you a couple of questions: how many empirically validated psychological treatments are there for treating suicidal behaviour in the Spanish National Health System? How many programmes are there for preventing suicidal behaviour or emotional problems in educational contexts? The answer is probably close to zero in both cases.
Q. In this sense, what do you think will be the future of psychotherapy?
Rivers of ink have been written on the subject. I have little to add to this matter here. One wish, going beyond the innovations in ICT, AVATAR and related aspects… To stop and think and reflect, what do we want, as a profession, in the field of psychotherapy? What are our knowledge gaps ? What are the weaknesses, threats and opportunities (SWOT) in this area?
I would like to see a group of experts (or a consortium, whatever you want to call it) who would say which issues are priorities, duly justified, and which actions should be designed and implemented in a certain time period. Then everyone can do what they want, but at least we would have a kind of strategic plan.
On the other hand, I have the feeling that we are on a transatlantic ship at full speed, with a very rigid rudder (which is very difficult to move a few degrees); an aspect that does not allow us to reflect deeply (I have already mentioned that not all winds are favourable nor are all sea currents). In addition, new therapies, models, etc. appear every second, without prior evidence having been established.
And, as I have said, I am concerned that relevant topics are being left out of the scope of Spanish psychology (without disparaging any of them), such as the lack of empirically supported interventions for psychosis, bipolar disorder, etc., in the absence of programs for suicide prevention or the implementation of a true national mental health strategy in educational and socio-health contexts. We cannot afford to leave flagships such as those I have mentioned off our radar.
Q. In the circles of students who are preparing to access PIR (Resident Psychologist Intern) training, it is said that you are the successor of the prestigious psychologist Marino Pérez Álvarez in terms of the great reference manuals in clinical psychology: what do you think and how do you feel about this?
[Laughs out loud] Marino is unrepeatable, unique; in my humble opinion, I don’t think that such an important and relevant figure for Spanish psychology, in its broadest sense, can be repeated for a long time. Knowing Marino’s passion for football, for me he is comparable to Messi, Pelé, Maradona. What he says, how he says it, why he says it, how he validates it when you talk to him, etc., is simply fascinating.
As you can see, I admire Marino, and being compared to him is quite a compliment, but Marino plays in a different league. I’m not going to lie to you, a lot of my passion for psychology comes from him, and also from my dear mentors José Muñiz and Serafín Lemos. And many others.
The fact that these manuals you mention have been developed is because they, long ago, allowed me to dream of unwritten worlds or opened horizons for me that are now realities. Although it sounds like a typical phrase, in line with what I am commenting on, it is true when it is said that “we walk on the shoulders of giants.”
I have already mentioned this elsewhere, I have been fortunate to have the teachers I have had in my undergraduate studies and then in my doctorate and in my clinical and academic career. Getting to this point, much of the variance explained, depends on them. I perfectly remember Marino talking about the psychopathology of Don Quixote, Muñiz talking about reliability with the metaphor of the grain and the chaff (true punctuation and error) or Serafín talking about people who experience hallucinations.
For me, these are all experiences that have marked me forever and that determine much of who I am now, and that clearly outline who I want to be, and who I will be. Along the way, I have also been accompanied by many other wonderful people who must be mentioned, such as my dear Alicia Pérez de Albéniz and Susana Al Halabí. You know, “it is well-born to be grateful.”
As for the books, I have little to say, I would only like them to serve to educate the present and future generations, hoping to displace borders, open horizons, break molds, move the emotional weather vane, or whatever you want to say, that they help to improve Spanish psychology. I have no doubt that the manuals, on which many professionals collaborated, will fulfill their purpose.
Q. Finally, what advice can you give us to have better mental health?
This is an excellent question. Years ago we developed a decalogue of emotional well-being and a guide that I believe contains a series of guidelines for promoting emotional well-being. I will briefly discuss them below:
- Learn to talk about yourself to others. Try to identify and express your feelings. It is a way of getting to know yourself and being known.
- Know yourself. Recognize your faults and limitations, but also be aware of your strengths and potential. Nobody is perfect.
- Regulate your emotions. Channel your anger and aggression. Don’t get carried away by the moment or hold a grudge; be respectful and put yourself in someone else’s shoes. Don’t let stress block you.
- Love yourself. Evaluate your achievements and positive aspects daily. Develop a positive self-image. Be optimistic as much as possible.
- Find activities that you enjoy. Play sports, listen to music, help others or participate in NGOs. Be open-minded and eager to learn.
- Set goals in life. Set realistic goals and try to achieve them, it will make you feel good.
- Connect. Stay connected. Don’t isolate yourself. Make new friends. Protect yourself from people you think are harmful to you.
- Have a healthy lifestyle. Take care of your physical health. Exercise, eat well, get enough sleep and avoid damaging your health by consuming toxic substances.
- Accept life’s setbacks. Suffering is part of the human condition. Correct and learn from your mistakes or life’s lessons, that will make you stronger. Be flexible with setbacks and changes that arise. Look for alternatives and gain perspective. Problems do not have a single solution.
- If the situation is overwhelming you and you feel overwhelmed: ask for help! From a family member, friend, counselor, psychologist, doctor or from an association.
We would like to thank Eduardo for the fantastic opportunity he has given us to conduct this interview. Readers will have been able to see that the world of psychology is vast and complex, as well as intensely beautiful.
We would certainly like to recommend the Decalogue that Eduardo has given us, since, as is well known, “there is no health without mental health” and the latter can be greatly favored by this extraordinary advice.