Last summer Dr Julie Smith found herself grappling with “fear – in the worst kind of way”. The clinical psychologist and bestselling author was in the process of completing her new self-help book when she received devastating news.
“Just a few weeks before I was due to hand the book in I was diagnosed with breast cancer,” Smith says, over a Zoom call from her home in Hampshire. “I’m fine now. I had the surgery and I’m better.”
But the diagnosis helped inform her approach to her manuscript. The follow-up to her bestseller Why Has Nobody Told Me This Before?, the new book, entitled Open When, features a series of letters from the author, intended to help the reader through difficult moments. With headings such as “When you are overwhelmed” and “When you’re short on willpower”, the letters are paired with practical advice to help the reader reframe their situation and move forward in a positive way.
When Smith received her diagnosis she realised she needed to rewrite one particular chapter of the book. “I just happened to be reading through the chapter on fear, days after I got diagnosed,” she says. The feelings of uncertainty thrown up by her own experience made her “hit delete” and rewrite it.
So, what does she recommend in the new version? “Taking control, making appointments, planning for action, doing bits and bobs that would help along the way – even when uncertainty [is] a part of this,” she says.
As for tackling fear itself, shaking off a “prey” mindset and “not identifying with the prey but identifying with the predator and being an active participant”, is her advice.
“Hopefully someone out there who might be similar to me will find it helpful,” she says.
Smith’s words will almost certainly be lapped up by her fans, many of whom first came across her via her videos on TikTok. Having spent 10 years working in the NHS in Britain, Smith set up a “really small private practice” after the birth of her children. In November 2019 she began to emerge as a TikTok hit after posting videos featuring bite-sized mental health advice.
The response to her short-form content, which provides accessible information on topics including anxiety and depression, was almost instant. “Within a couple of weeks every video was getting more and more traction and people were getting in contact asking for more information,” she says. Spurred on by Covid lockdowns as people sought solace online, Smith says, “it all kind of went crazy”.
Now she is nearing five million followers on the platform, and has amassed two million on Instagram in five years. Viral fame wasn’t necessarily part of Smith’s plan for life, however. “Being in the public eye – it doesn’t come naturally to me,” she says. “I didn’t imagine it would be anything like this. I thought we would share a few videos and it would all be forgotten – one of those projects you do for a little while and then forget about.”
Smith’s usual work sees her speaking one to one with clients, rather than holding a virtual megaphone in front of millions. “I just like doing the one person in a room thing, individual therapy and being with my family and stuff.”
But she has learned how to make best use of her online platform and concedes she is more at ease now. Replaying her earliest efforts, she says she sometimes cringes but takes this as a sign that her content has improved: “When you watch an old video and you think, ‘Oh I can’t bear to watch it’, it’s a good sign of progress.”
Being “disciplined” with her use of social media has helped Smith to find what she feels is the right balance. She finds herself often talking “to people about having that awareness of the function [social media] plays in your life and how or why you use it, how much you use it and who you follow and how you tell the algorithm what to give you”.
She considers herself lucky to have already had a stable career and happy family life – “a good marriage, three lovely children” – when her social-media accounts started to take on a life of their own.
“It meant I wasn’t resting any of my self-esteem on how many likes I got or whether people thought I was this that or the other,” she reflects. “It was just something to do to put something positive into the world.”
One of the most important life skills at the moment in the world we live in is to not take anything at face value that you’ve seen on a screen
— Dr Julie Smith
That grounding enabled her “to have that clear sense of my values and what was most important to me so I didn’t get sucked into the ‘How many likes have I got, what are people saying about me?’ I had too much more important stuff to focus on to let that tie me up in knots psychologically.”
Gaining the approval of fellow professionals – “people I know from the mental health profession but also the medical profession” – has meant a lot to Smith, who admits she was anxious about what reaction she might get when starting out.
“That was probably my biggest reservation. And my biggest fear was, ‘Oh my goodness, what are other professionals going to say?’ I didn’t really tell anyone I was doing it until we were about 100,000 followers in.”
Although “going against the grain professionally” weighed on her mind, ultimately she decided to take a leap of faith. “I thought social media’s not going anywhere and there might be lots of content on there that’s not so helpful for people and so the part that I can play is by offering something that’s decent.”
Now, when people “get in contact to say ‘I’ve been recommending your book’, it’s just the biggest compliment”, as far as she’s concerned. “If other professionals value it, then that’s everything to me because I wanted it to be good quality information that could be helpful to people.”
Discussing the rise of misinformation online and #tiktokdoctors, Smith says it’s important “to question everything”. And yes, that means “even stuff that a professional is saying. You have to think critically about everything”.
[ Managing the surge in demand for online mental health platformsOpens in new window ]
“Never take anything for granted, always seek a second resource and a third, and a different opinion ... One of the most important life skills at the moment in the world we live in is to not take anything at face value that you’ve seen on a screen.”
She recommends that anyone seeking answers to health questions online ensures they “get a blend of perspectives – contrasting ones as well – so that you’re able to come to your own conclusions”.
While “a lot has changed in the last 10 years or so”, attitudes towards mental health have seen a huge shift because of the pandemic, when “everybody was suddenly facing some sort of difficulty and strain, impacting your mental health, and for the first time most people were online” viewing content such as hers, says Smith.
“What some of that content sparked were conversations about mental health that people would never have had in person before because they would’ve been too embarrassed about it,” she says.
Does she think people still have difficulty with the idea of therapy? It’s certainly something that, in her experience, people feel “very private” about. “Because [they’re] struggling. And often people feel very embarrassed and ashamed at the time, depending on what they’re struggling with,” she adds.
[ Why it is important to get the right therapist for youOpens in new window ]
“[But] once it’s done and [they] feel better, people generally just want to help others. I thought when I started private practice I would have to do lots of advertising and things like that and I never really did any because of the word-of-mouth effect – the whole practice was really built on that.”
Smith’s fans have been instrumental in her work in other important ways. The idea for her new book was inspired by a thoughtful gift sent to her by a follower, which provided her with the spark of inspiration for the “open when” idea that the book is engineered around.
“I didn’t realise this was a thing at the time – lots of these little envelopes that said open when you feel sad or when you’re lonely. One of these things that teenage girls do for each other,” she says.
“I didn’t want it to be anything clinical; I wanted it to be those normal human problems that we all face but could do with a little help with, and the sorts of things that are difficult but you wouldn’t necessarily go to therapy for as well.”
Open When by Dr Julie Smith is out now, published by Penguin Random House
