Dear Therapist:

I am a teacher in a high school and am writing regarding a girl in one of my 11th grade classes. Some of the other staff think she should be sent for therapy because "she doesn't seem happy." She is a girl who is shy and introverted. I know her mother and she is also quite shy.  She has friends but is quiet in big groups. She does well in groups of 2 or 3. She isn't very happy in school because learning is a struggle, but she is doing well enough academically to get by overall and she is happy at home. Not 'jumping for joy' kind of happy but content. The staff got worried because she missed the school production. I don't really see an issue. To me it seems like she just has more of an introverted personality and the world, certainly school, is just geared more towards an extroverted personality. Do you see a real issue here? Can you please provide some recommendations that might be helpful to understanding a personality like this? Thank you.  



Obviously, I cannot diagnose (or rule out a diagnosis) sight unseen. I have no way of knowing whether this girl is depressed or has another mental health issue.

Generally speaking, I think that you are touching on a problem that seems to be affecting our society in general. Today everything needs a label. People can no longer simply be themselves; they need to be classified, codified, and categorized.

If someone is more animated than me, I decide that they have ADHD. If a friend is reacting more emotionally than what I am used to, I assume that they are depressed. People who seem a bit different from the “norm” may be “on the spectrum.”

In addition to our obsession with labelling (are we all obsessive-compulsive?), most of us have no baseline for “normal” other than that gleaned from our own feelings and experiences. Thus, our labels are based on what normal means for us. Of course, normal can mean very different things for one person/family/community/culture than for another.

Over the last generation or so, we have become much better versed in the verbiage of mental health. This is due to the proliferation of mental health literature, and the popularized use of mental health terminology. This means that most of us have a simplex sense of many mental health conditions. This has helped to minimize the taboos associated with mental health conditions, allowing many to obtain help.

However, as Alexander Pope wrote, a little knowledge is a dangerous thing. I have heard of many instances of laypeople “diagnosing” and attempting to “treat” themselves and others. I have heard of school teachers and principals telling parents that their children “have ADHD,” or “are depressed” and need medication.

The question that I would ask about the girl in your class is: Does she have a problem with her personality or her shyness or introversion? Or do the school staff have a problem with these things? Certainly shyness and introversion can be indicative of an emotional issue, and school staff should be commended for their interest and concern. However, it seems that your perspective with regard to this girl’s happiness is quite different from that of some of your colleagues (an example of different people’s baselines leading them to very different conclusions).

Depending on the situation, there may be no detriment to encouraging someone to see a therapist to help determine whether there is an issue that can be worked on. The concern may be that the person can take the suggestion as a determination of something being wrong with them (especially when presented by an authority figure). This can become a self-fulfilling prophecy, whereby they blame themselves for being introverted. This can easily turn into a vicious cycle in which the person feels progressively worse based on their assumption that their introversion is abnormal, leading to the sense that others are judging them, in turn leading to further self-flagellation.

If I were seeing this girl in my practice, one of my first questions would be whether she is happy, and whether she feels that she has a problem. If she could be approached in a way that is nonjudgmental and is purely inquisitive (“Is something bothering you” rather than “There is something bothering you”), that might be an option. Perhaps a better idea—rather than singling her out—would be for the school to have open discussions with students about the importance of seeking help when people are having emotional difficulties. This can help to both deemphasize the use of labels and encourage those who could use some help to obtain it.  

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer / 516-218-4200