Is Psychiatry Keeping Us Sick?

Something is deeply wrong with the mental health system. Instead of leading to recovery, it often perpetuates cycles of dependency on therapy, medication, and diagnoses.

Psychiatric diagnoses, which are unreliable to begin with, have become our identities rather than tools for recovery. While more people are going to therapy than ever before, our collective mental health isn’t improving. For some disorders, such as ADHD and PTSD, medication is prioritized over education or therapy that teaches people how to cope; thus, we see medication as a cure-all and don’t learn tools that can help us heal.

As mental health awareness and interventions become increasingly common, we have to be aware of the iatrogenic effects—unintended, harmful consequences—of psychiatric diagnosis and treatment.

Is psychiatry keeping us sick?

Normal Behavior, Pathologized

Medical professionals and unqualified individuals alike routinely medicalize normal behavior and feelings. Sadness and anxiety, once considered everyday emotions, have become problems to eradicate. As a result, many of us have succumbed to the false idea that negative emotions are bad when, in reality, they are healthy and useful. Just like hunger prompts us to eat, emotions are siren calls that alert us to tend to our well-being. But as emotions have become pathologized, there’s a growing belief that any emotional discomfort needs to be “fixed.”

Psychiatry has a history of categorizing normal feelings and behaviors as disorders. Homosexuality was listed as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1973, and “sexual orientation disturbance” until 1987. Controversy remains over the addition of prolonged grief disorder to the DSM in 2022, which many researchers have argued will “lead to medicalization of normal grief responses and overdiagnosis.”

As mental health awareness has increased, it’s led to both more accurate diagnoses and “overinterpretation,” or over-pathologizing “common psychological experiences,” a 2023 study showed. Psychiatric terms have crept into the way we talk about ourselves, spurred by “wellness” culture. Someone particular about the cleanliness or organization of their home describes themself as OCD (obsessive-compulsive disorder). Another person has a few nights of poor sleep and fears they’re an insomniac. People who are shy or introverted describe themselves as “socially anxious,” even taking it as far as avoidant personality disorder or social anxiety disorder. An overconfident person gets dubbed a “narcissist.”

Worse, overinterpretation engenders a self-fulfilling prophecy: “Interpreting difficulties as a mental health problem,” the study authors wrote, “can lead to changes in self-concept and behavior that ultimately exacerbate symptoms and distress.” They warn that the more mental health awareness increases, the higher the rates of mental health problems.

For example, I’ve heard several people say they think they have ADHD because they can’t concentrate at work or they never seem to get everything done. The mental health system reinforces these beliefs by making it simple to get a diagnosis and prescription: All it takes is one trip to a psychiatrist or physician, or they can even do it on an app. (Meds for anxiety are also super easy to get a hold of.)

This recently happened to a friend of mine. He complained to me that he just never seemed to be able to get anything done at work and that he was a procrastinator who could only work late at night when the pressure was on. He believed he had ADHD.

But when I asked my friend to describe his work day, he told me about being in meetings for five hours a day—and sometimes all day. No wonder he couldn’t get anything done! And no wonder he waited till the quieter hours of the evening to focus.

Between the distraction of constant meetings, which were often ineffective and inefficient, and trying to task-switch to focused work, I’m not surprised he found it difficult to concentrate. His environment, not his brain, was the problem.

Still, he walked away from his doctor’s appointment with a prescription in hand, yet little advice on how to cope with his diagnosis. Unfortunately, pills don’t teach skills.

Has Therapy Become Too Routine?

The pathologization of normal feelings and behavior has made many of us think we need therapy, even when we don’t. Furthermore, there’s ample evidence that many people who spend years in therapy don’t get much better.

Richard Friedman, professor of clinical psychiatry at Weill Cornell Medical College, wrote that psychotherapy, even for people who legitimately need it, is “simply not designed for long-term use.” Freidman says therapy should last only until patients learn how to cope with their problem; terminating therapy and returning to it when needed is fine, but continuous long-term therapy is problematic.

A 2023 meta-analysis of studies on how cognitive behavioral therapy helps people with anxiety disorders suggested that long-term therapy is no more effective than short-term therapy. However, psychologist Juli Fraga said those results make sense, as cognitive behavioral therapy teaches people to manage their symptoms rather than to address the root cause of their problems.

Some people say they are quitting therapy because it causes them to dwell on their issues rather than move on from them.

Perhaps that’s why mental well-being is decreasing even as more people are going to therapy. “That’s not true for cancer [survival], it’s not true for heart disease [survival], it’s not true for diabetes [diagnosis], or almost any other area of medicine,” psychiatrist Dr. Thomas Insel, former director of the National Institute of Mental Health, told Time magazine.

People are unsure when to end therapy, and the mental health system doesn’t help.

Getting Stuck in the Mental Health System

The mental health system tends to medicate rather than rehabilitate, mainly because it’s easier. Doctors are so burned out that they tend to prioritize easy patients—or easy fixes, like medication—over challenging cases because they don’t have enough time to give all types of patients the care they need.

According to Time magazine, psychiatrist Paul Minot “feels psychiatry leans on medications so it doesn’t have to do the more difficult work of helping people understand and fix life circumstances, habits, and behaviors that contribute to their problems.”

Fraga says doctors are taught to rely on medication. “I supervise psychiatry residents,” she says. “They have virtually zero training in psychotherapy. When I finished my doctorate, I had close to 100 hours of clinical work, and my internship and postdoc resulted in 2,000 more hours. Guess how many therapy cases most third-year psychiatric residents have seen? Three! Psychiatry leans on medications because this is what residents are trained to do.”

Overreliance on medication means some people never recover, even when they otherwise could. For example, experts are starting to wonder whether antidepressants prevent PTSD patients from healing. Another example: People often think an ADHD diagnosis is for life. But that’s not true. A third of kids diagnosed with ADHD don’t have it as adults.

If, through behavioral therapy, people learn the coping skills to control impulses, foster positive behavior, and build executive functions like organization and time management, they can manage their ADHD to the point that they don’t exhibit symptoms. Yet, up to 81 percent of children with ADHD are on medication in some US states. These medications come with side effects, while behavioral interventions, like teaching kids to become Indistractable, do not. Are we medicating kids for their benefit, or are we doing so to make life easier for doctors, teachers, and guardians?

Of course, some people do suffer from severe psychiatric disorders and require special care. In those cases, overmedication is often used as a band-aid for a broken mental health system. There’s not enough funding for mental health and not enough beds in psychiatric hospitals to give patients the thorough, long-term treatment they need.

“Since the earliest days of deinstitutionalization, the number of psychiatric hospital beds in America has declined relentlessly, so that it is rarely possible to treat the full episode of illness in hospital,” Harold I. Schwartz, a psychiatrist in chief emeritus at the Institute of Living, Hartford Hospital, wrote in an opinion letter to The New York Times. “It is not unusual to be discharged after three or four days, even when hospitalization was prompted by a suicide attempt or a psychotic episode.” In a 2021 study, 87 of the 88 U.S. pediatric hospitals used their emergency rooms to “regularly board” children who had to wait for an average of 48 hours for space to free up in a psychiatric hospital.

Mental health experts admit that we “lean on therapies and medications that only skim the surface of a vast ocean of need.” Rehabilitation is a lot harder for psychiatry to achieve. Instead, it medicates.

No Offboarding Plan

“offboarding” plan.

Once a mental health patient is on medication, there’s little emphasis on helping them get off it.

Take antidepressants, for example. According to Professor Friedman, “Doctors are experts at prescribing medication but not so good at … knowing when a drug has served its purpose and can be safely stopped.”

In 2004, the American Psychological Association said that antidepressants are typically recommended for 16 to 20 weeks after depressive symptoms end. However, the guidelines “further recommend that maintenance treatment be strongly considered in order to prevent relapse. Recent research [from 2003] has indicated that continued antidepressant therapy for at least one year and as long as three years can significantly reduce the risk of relapse.” In 2011, the APA said that the “continuation phase” should last four to nine months and that people who have a chronic major depressive disorder or have had three or more episodes of major depression should maintain their use of antidepressants.

The United Kingdom’s National Health Service says that antidepressants are typically recommended for at least six months after a depressive episode, but they may be prescribed long-term if the patient is at a high risk of recurrent illness (i.e., has had more than one depressive episode before, which increases the likelihood of it occurring again).

About 2 million people in England have been taking antidepressants for five years. In the United States, more than 60 percent of people on an antidepressant have taken it for two-plus years; 14 percent have taken it for 10 years or longer. So, does that mean all those people are at high risk of recurrence? Not according to one 2021 study, which found that 44 percent of U.K. participants on long-term antidepressants were able to stop taking the medication without relapsing.

Therapy, too, lacks an offboarding plan. For example, measurement-based care (MBC), the process of assessing patients’ progress during mental and behavioral care, has been shown to improve patient outcomes. Yet, less than 20 percent of behavioral health practitionaers use MBC.

One study found that 84 percent of people who had recently ended their psychotherapy said they, rather than the therapist, initiated the termination; 23 percent said the therapy continued too long. “While there is widespread agreement that an ideal termination of psychotherapy occurs naturally, with an agreement of the timing between therapist and client, our research reveals that more often than not—this does not happen,” said study conductor David Roe, a clinical psychologist, and professor at the University of Haifas’ Department of Community Mental Health.

Bad Actors in Health Care

The psychiatric diagnosis process is “scientifically meaningless,” as Dr. Kate Allsop famously put it in a 2019 study that analyzed the DSM and found it wanting. The study notes that diagnoses “mask the role of trauma,” “use different decision-making rules,” and have many symptoms in common with each other, among other issues.

An iconic 1973 Stanford study demonstrated that point by having eight healthy people pretend to have hallucinations so they could be committed to a psychiatric hospital; once admitted, they acted normally, yet all were diagnosed with severe mental disorders. In the second phase of the experiment, the study leader, psychologist David Rosenhan, told a doctor at a prestigious hospital that he would be sending a “pseudopatient” at some point during the next three months. Of the 193 patients the hospital saw in that time, psychiatrists labeled 23 as fake patients. But Rosenhan never sent anyone at all. After the three-year study, he concluded that the psychiatric diagnostic process is unreliable.

That’s a dangerous weakness, and bad actors have exploited it.

Acadia Healthcare, one of the largest chains of psychiatric hospitals in the United States, has been accused of hospitalizing people longer than necessary—against their will—all to squeeze the highest insurance payout. It has been able to do this by falsifying psychiatric reports and exaggerating patients’ symptoms.

This is more common than you think. Across the United States, substance abuse centers, residential treatment centers for kids, and psychiatric centers (including in Colorado, Arkansas, and Texas) have allegedly held people against their will for profit.

How to Navigate Psychiatry

It is important that people who are suffering get the care they need. This post is not intended to discourage anyone from seeking help.

But those who enter the mental health system need to know that it’s riddled with problems. Individuals and families need to be careful that the psychiatric system is helping them get better, not keeping them sick.

Here are some strategies to help people navigate the mental health system and get better rather than get stuck.

1. Be an Informed Patient

2. Learn Behavioral Coping Skills for Your Diagnosis

3. Build a Support System

4. Set Clear Recovery Goals

Enter treatment with a clear understanding of what recovery looks like for you. Work with your therapist or doctor to set tangible, achievable goals that signify progress and a clinical plan. This will help you track your recovery and prevent you from becoming stuck in a treatment rut.

Therapists should invite feedback from you so they know what’s working or not, and they can tailor treatment more effectively—yet many therapists don’t do this. So, be proactive about sharing your thoughts.

Getting professional mental health support is critical. But we must always remember, “caveat emptor,” buyer beware.

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