What a Psychiatrist Says About Mental Health in Germany

Mental health is more than illness

Rieke began with a definition that was broader than the usual shorthand. Mental health, she said, is not simply whether someone has a psychiatric diagnosis, but whether emotional, psychological, and social factors are in balance.

Mental health is not just the absence of a psychological illness. It is a balance, or well-being, of emotional, psychological, and social factors.

That framing set up one of the conversation’s first themes, which was that people are often too quick to sort themselves into healthy or unwell. Rieke argued that mood, stress, and resilience vary from person to person, and that luck also plays a role in how life unfolds.

People are different. There are surely those who wake up cheerful in the morning, and others are morning grumps. Nobody is at fault if a mental illness catches them.

The point was less that people should stop thinking about diagnosis than that they should stop using diagnosis as the only measure. In Rieke’s account, a person can lack a formal disorder and still be struggling, and can also have a diagnosis while still functioning well in parts of life.

Stress needs a balance

When the discussion turned to habits, Rieke resisted any fantasy of a universal wellness formula. She said the first question is not what everyone should do, but what specifically is stressing the person in front of you and how much capacity they actually have left.

It is important first to know what is stressing me right now. How do I divide up my energy? Do I even have enough strength for what is demanding me right now?

You do not have to sit there all day and listen inwardly. That is not useful either. But from time to time, giving yourself the chance to do that is really sensible.

Meditation and journaling came up as tools, but not as magic fixes. Manuel described writing every day as a way to catch himself before stress turns into blur, and Rieke agreed that small check-ins can stop a person from running on autopilot.

She also drew a distinction between two kinds of stress. In her account, Eustress is the kind that can sharpen performance, like a marathon or a looming paper deadline, while Distress is the kind that overwhelms and eventually makes people ill.^*

At the level of stress hormones, it leads more to performance increase. But with distress, we feel overloaded. We cannot withstand it.

Nature, exercise, friends, cards, food, television, Rieke listed all of them as possible counterweights. Her argument was that balance matters more than the exact method, and that people need to find what actually restores them rather than copy someone else’s routine.

Help before collapse

The most consequential part of the conversation was about when ordinary strain becomes something that needs professional help. Rieke said the clearest warning sign is when a person can no longer manage basic daily life, but she stressed that nobody has to wait that long.

If I am in a phase where I am doing badly psychologically, where I am no longer able to manage my everyday life, then I definitely need help.

I may also look for help before I can no longer feed myself or wash myself. For heaven’s sake, that is very important.

She described a common trap, which is that people feel guilty about needing support and then wait until they are in much worse shape. Her advice was to start by asking whether anything in one’s circle can help, then move to ambulatory options such as counselling centres, day clinics, or therapists.

It does not have to be the first step to go to the emergency room. There are enough outpatient networks too, where you can get in touch.

She also acknowledged the bureaucracy. There are many places to turn, she said, but people still have to push through forms and referral paths, which can be exhausting exactly when they are least able to do so.

Psychiatry and psychology

A large chunk of the exchange was devoted to a basic confusion: what is the difference between a psychiatrist and a psychologist? Rieke answered plainly that the two professions come from different training paths, and that only psychiatrists can prescribe medication.

Psychologists studied psychology, and psychiatrists studied medicine. Psychiatrists are doctors, and psychologists are psychologists who studied psychology.

Both professional groups can offer psychotherapy. The difference is that psychiatrists are allowed to prescribe medication.

She then corrected a common assumption, which was that psychiatry is only about diagnosis and psychology is only about treatment. In her account, either profession can take a therapeutic route, though some clinicians focus more on medication and others more on talk therapy.

That confusion, she implied, is part of why mental health care feels opaque from the outside. The system is not just a medical question, but a navigation problem.

Taboo is loosening slowly

When listeners asked about the social climate around mental health in Germany, Rieke said the taboo is weaker than it once was, especially in big cities like Berlin, Hamburg, and Munich. Even so, she argued, the stigma has not disappeared.

In Berlin I have the feeling that people speak very openly about this topic. I think the taboo is declining, but it is still present.

There are still situations, certain social bubbles, certain professions, maybe jobs and companies, where it is not always self-evident.

Listeners from the United States and elsewhere pushed the conversation toward culture and generation. Rieke said she would not call Germany uniquely taboo compared with the rest of Europe, though she suggested the United States may be somewhat more open and Japan clearly more closed.

She also said younger people often seem more willing to seek help, while older generations may have had little exposure to psychotherapy at all. Social media, in her view, can help normalise those conversations, even if it also carries obvious risks.

There are people who maybe are older and have never had psychotherapy in their lives and have also never heard of it. There is a difference between generations.

Another listener asked about transgenerational trauma, after describing a family marked by war and silence. Rieke did not claim to diagnose that from afar, but she accepted that inherited patterns and unspoken histories can shape how families relate to mental illness.

Neurodiversity and self-diagnosis

The last major topic was neurodiversity, a term that is increasingly used to describe autism, ADHD, and related differences in cognition and behaviour. Rieke said the subject is only now becoming more openly discussed in Germany, both among patients and in the professional field.

People are just beginning to talk about it more openly. More people are dealing with whether they might be neurodivergent themselves or are getting diagnosed and then speaking about it.

There is much more research on this than there was years or decades ago. That is absolutely positive, that there is more openness on both sides.

She was careful, though, about the internet’s role in all this. YouTube and social media can raise awareness, but they can also produce a wave of self-diagnosis that is not always reliable.

If you watch videos on social media, then everyone thinks, at some point, that they have ADHD. Of course I think that too.

Her bottom line was not that people should avoid those videos, but that real diagnosis belongs in the right place. Social media may open the door, she said, but it cannot replace clinical evaluation.