With July 4^th approaching, I’ve been reflecting about culture in our country. In particular, the values, attitudes, and beliefs that we have about mental health have given me pause. It’s been nearly 20 years since I graduated from medical school and decided to become a psychiatrist. I also happened to be asked this question on a recent appearance I made on a recent episode of the Carrigan and Company podcast. So milestones like this makes me wonder: does stigma about mental health persist?

Stigma refers to the markers of shame or disapproval attached to specific attributes that result in prejudices, stereotypes, and discrimination. The topic of stigma often arises in public discourse when a well-known figure or celebrity reveals to the media that they’ve struggled with a psychiatric disorder – for instance, a substance use disorder, postpartum depression, or anxiety. I would argue that this marks a major step in destigmatizing mental health conditions because such public disclosures normalize seeking help. Similarly, as someone who is active on social media, I consistently see people posting about mental health conditions. On TikTok, entire communities are formed around the discussion of specific psychiatric disorders. This shows me that there is a generation of individuals who feel empowered to talk about their personal experiences with mental health to broad audiences.

But despite apparent progress, I do wonder whether mental health remains fundamentally stigmatized. Why? Because of the day-to-day conversations, statements, and remarks I either hear or read about mental health. My first example of this are attitudes toward treatments for psychiatric disorders. As with all medical specialties, psychiatric treatments don’t work for everyone. Yet, I tend to see individual narratives about mental health decry psychiatric care more than any other medical treatment. Second, while I’ve spent the last 8 years of my career investigating ways to mitigate workplace burnout, I recognize how common it is for people to prefer the label of burnout to depression when they often co-exist. This is especially relevant in healthcare where burnout becomes a social acceptable way to discuss symptoms that tread into the territory of mood or trauma-based disorders. Third, I find that many people will disclose their stress but rarely their anxiety disorder. While all medical conditions are often considered a private matter, people still have a higher level of comfort discussing their diabetes, for instance, more than their depression.

Social neuroscience explains how stigma develops. Brain regions involved in emotion and threat (the amygdala) overwhelm brain regions involved in perspective taking, emotional regulation, and expression of empathy (the prefrontal cortex). What’s counterintuitive in the medical research about stigma is that biological explanations for psychiatric disorders reduce blame but perpetuate stigma by reinforcing an “us” versus “them” explanation. So then, how do we diminish stigma effectively?

Combining neurobiological understanding with lived experience on the efficacy of treatment and stories of recovery is critical. Psychiatric disorders are common AND treatable. Now, more than ever, I can offer people novel treatments that simply weren’t accessible a decade ago. That’s what I find uniquely energizing about being a psychiatrist: the recognition that the field is constantly evolving and identifying more effective options. And as I celebrate July 4^th this year, I feel hopeful about the possibility that there will be a day when seeking psychiatric care is viewed no differently than seeking treatment for any other medical condition. I believe THAT is is the milestone we will reach that shows me what a culture free of stigma would look like.

As a psychiatrist, I consistently see the difference between what it means to have insight while lacking self-awareness or empathize while also missing critical social cues. That difference lies in whether someone possesses a threshold level of emotional intelligence. If someone came to me and asked me, how do I find what I’m looking for – in love, work, and life? My answer would be the same every time: cultivate emotional intelligence.

Since my focus here is to delve into the neuroscience and psychology behind modern life, first, let’s define emotional intelligence. In my own experience, this consists of 5 domains:

1) Empathy – for yourself and others

2) Self-regulation – the ability to manage your mood, especially when it feels hardest to do so

3) Social awareness and relationship management – how well you can understand the people around you to maintain mutual support and trust

4) Self-awareness – the extent to which you know your strengths and weaknesses, not just based on self-reflection, but on feedback from others around you

5) Strategic thinking – this about putting it all together. How well do you understand yourself, the people around you, and your environment to anticipate what happens when you make a decision AND THEN change your behavior to elicit the outcome you’re seeking?

Next, let’s understand why emotional intelligence is so hard to build, even among people who are bright, capable, and ambitious. My observation is that such people master #1, #2, but #3, #4, and #5 get harder as they advance, either in their careers, or the depth of their romantic relationships.

In general, people tend to focus on themselves. Their feelings, their thoughts, and their behavior. The structure of our brain that drives this self-focus is the default mode network (DMN). This is by evolutionary design. The DMN enabled us to learn from the past and plan for the future. However, stress, anxiety and depression (often encountered in love, work, and life) tend to increase self-referential thinking. As a result, people cycle in rigid rumination loops. And what do they focus on? Themselves. Their feelings, their thoughts, and their behavior.

Healthy DMN activity is important for self-reflection. But to develop emotional intelligence, you have to expand your awareness beyond yourself. You have to balance self-focused networks like the DMN with other networks in your brain, related to attention and executive functioning (the ability to organize, abstract, sequence, and plan). And here’s the most interesting piece: we tend to think self-awareness comes from looking inward. In reality, much of self-awareness comes from looking outward. By understanding how the world sees us, we can see ourselves more clearly. That doesn’t mean you have to like what you see. But you do have to see it.

My take on one of the major psychological barriers to developing emotional intelligence is the difficulty of empathizing with people who we don’t have a good relationship with. Maybe we experience them as demeaning or controlling or petty. Either way, it’s hard to empathize with such people. In this context, mastering all domains of emotional intelligence is hard!

Now, let’s go back the scenario I started with. Imagine you’re back in that meeting at work. You’re in a new role. You want to impress the people around you. So, you say something that reflects your expertise. But what if, this time, you pause and notice the expression on the faces of the colleague around you when you speak? You observe how people react. That’s the information that helps you develop emotional intelligence.

If you’re reached this point of my essay, then maybe emotional intelligence is something you’re curious about building. Do you need to read a book? Take a course? Hire a coach? Those are all reasonable next steps, but you don’t have to do them.

My own take on what helps people to develop emotional intelligence is simple:

1) Pay attention to yourself while also paying attention to others. When you’re considering how you feel about an interaction, consider how the people around you feel. When you’re in a meeting, don’t just react to a question and plan what you’re going to say, listen to what people are saying around you. Observe yourself and observe other people. You will surprise yourself with how much information you accumulate. How effectively we can toggle back and forth between an understanding of ourselves and others and regulate that dynamic is what’s critical.

2) Reflect. Once you begin to accumulate information on the world around you and yourself, you have to understand it. So the next time, you’re in an elevator, don’t look at your phone. Reflect. When you’re waiting for an appointment, don’t look at your phone. Reflect. And how do you reflect productively? Should you replay your feelings, your behaviors, your thoughts? Nope, that’s often the DMN at work. Take a moment to consider the feelings, thoughts, and behavior of others around you. And once you have a better sense of that, consider how you can change your own behavior to change how people respond to you.

3) Establish relationships with the right people. These could be friends, partners, mentors, or leaders. What all of these people should have in common is they ask you questions that help you think differently about a scenario. And how do they do that? By challenging you on #1-#5 and ideally, with empathy.

A final thought: recognize that emotional intelligence accumulates with time. People tend to have more emotional intelligence in their 30s than they did in their 20s, more in their 40s than in their 30s, and so on and so forth.

The ability to evaluate your own thinking is metacognition, helping you to catch mistakes, handle the unknown, and create a game plan to reach a goal. Atrophy of metacognition lies a step beyond deskilling. With deskilling, technology reduces your ability to do a task. For example, a doctor who always asks a large language model (LLM) to give them the treatment plan for depression might find that task harder to do on their own over time. But with loss of metacognition, technology reduces your ability to monitor and evaluate your abilities. You’re not just outsourcing your thinking but also the act of judging your own thinking. Over time, the doctor treating depression might grow less sure they trust themselves to do it without digital confirmation. That’s the risk of metacognitive atrophy: the potential to lose clinical intuition.

To care for patients, metacognition is critical. The inner, expert clinician monologue you need, particularly when the stakes are high or cases are ambiguous, emerges from exposure to a breadth of patient care over years of medical training and practice. In navigating these cases, you iterate a precise process of identifying gaps in your knowledge base: you wrestle with ambiguity, debate the evidence that supports different diagnoses, and revise your assumptions about treatments. One of the most rewarding aspects of my role as teaching faculty in Psychiatry is helping trainees to refine this reflective process in real-time. It’s what builds the metacognition that guides them in deciding what they know, when to ask for help, and which questions to ask. Sitting with uncertainty isn’t a vulnerability; it’s part of a productive struggle that drives learning.

Consultation with a colleague, complex case discussions among teams, and review of peer-reviewed textbooks and literature are examples of how you develop collaborative reasoning in medicine. But AI doesn’t just retrieve information or give you answers, it generates outputs that mimic the structure of reasoning.

When used as a reflective tool with attention to how to think through and solve problems, AI has shown value in deepening learning by acting as a coach that can reduce cognitive blind spots. Thoughtful assessment of prompts and output accuracy are part of the critical thinking needed to implement reflective use.

However, the same digital tool that may strengthen reflection is also externalizing it. Dependence on outsourced validation without forethought on how one uses AI could weaken confidence in one’s reasoning. The concern is the potential to shift the growth of professional intuition and cognitive trust in any industry that requires nuanced judgement. Who really holds authority: the human expert or an always-on LLM sidekick?

As I see how AI is shaping the medical landscape, I’m struck by the significance of how doctors come to trust their own minds. The healthiest relationship with AI in medicine might be one where we establish clear processes to deliberately preserve the first go at thinking, originate the ideas that AI expands, and maintain defined checkpoints for internal reasoning. With this, monitoring for overreliance is key. There is no doubt that AI is here to stay and to think with us. What I wonder about is how we know where a machine’s intuition ends, and the doctor’s begins.