How we treat mental illness in the United States is not normal

Why I turned to psychedelics

A few months ago,

Kirsten Powers

put to paper a silent hum deafening many of us in her brilliant essay The way we live in the United States is not normal. This piece is inspired by Kirsten’s essay, exploring what’s wrong with how we treat mental illness in this country (and why I chose an alternative route).

Please note that I am not a therapist, MD, or researcher. I’m a (former) patient. A European transplant with a history of four psychiatric diagnoses, six different psychotherapists, two psychiatrists, hundreds of hours in the US mental health care system, and an (unfilled) Prozac prescription.

Today:

• Why I chose psychedelics over antidepressants

• The frightening science of long-term harm caused by medication

• Why talk therapy is not sufficient to heal mental illness

• What’s wrong with the modern diagnostic model

• Why the psychedelic revolution will transform mental healthcare

From the earliest days of my mental decline, there was a glimmer of hope. A conviction that my “illness” was not life-long, but there for a reason. If I could get to the roots and uncover that reason, I would be able to overcome it for good.

I don’t know when that belief was birthed and often wonder how it survived the many professionals telling me my issues were chronic, the sobering recovery stats, and the years of countless failed attempts to recover — but it did.

It is thanks to this belief that I am no longer a patient of the mental health care complex. It is thanks to this belief that I am no longer a shell of a human being but alive and well. It is thanks to this belief that I now experience the full range of emotions without the need to numb or escape, and that I am deeply connected to the world around me which brings me endless awe and joy.

Five years ago, at the urging of my family, I visited a psychiatrist. I’d just finished my MBA and returned to my fancy job. My life was perfect on paper, but behind the closed doors of my little Chelsea studio, I was spiraling.

My decade-long eating disorder was worse than ever. My relationship with substances grew troublesome. Periodic depression, eventually diagnosed as Pre-Menstrual Dysmorphic Disorder (PMDD), took me out once a month. 34% of women with PMDD attempt suicide. I didn’t, but I thought about it many times. Almost every month.

Within ten minutes, the psychiatrist prescribed the antidepressant Prozac. We need to monitor your mood swings, he said. If your symptoms exacerbate, we could be looking at a Bipolar disorder, in which case we’d need to change the medication.

I’d been resistant to medication. I was unimpressed by the efficacy data, wary of side effects, and skeptical of the thesis that depression resulted from (rather than in) flawed brain chemistry. But then again, a few nights prior, I’d woken up to the image of a knife and the overpowering urge to go into the kitchen and grab one. Maybe medication would help. Maybe medication would help me stay alive.

The next day I awoke to my weekly New Yorker on my doormat. The Challenges of Going Off of Psychiatric Drugs, the cover read. A photograph of a beautiful, young woman in a floor-length, white ball gown and a pearl necklace filled the page. Her name was Laura Delano, who, as the first sentence read, “was excellent at everything, but it didn’t mean anything”. 

Despite top psychiatric care and an ever-evolving prescription cascade, her mental health deteriorated. After withdrawing from all medication, she was doing better than ever. She’d realized that “the objective in being alive wasn’t the absence of pain”.

The New Yorker on my doorstep in reality was The Universe on my doorstep. Medication would be my last resort, I concluded. First, I would give this other thing a try, this thing I’d read about months earlier in a book called How To Change Your Mind.

Five years and many intentional psychedelic journeys later, I am free from ‘mental illness’ — this is the place that I am writing from you today. Throughout my non-conventional recovery, I gained a deeper understanding of why traditional mental health care couldn’t help.

It can be boiled down to one sentence: in modern mental health care, we don’t treat the roots of mental illness but merely (and often poorly) the symptoms. We earn a PhD in how to be mentally ill but learn little about how to be mentally well.

The symptoms-focused approach manifests into three distinct pitfalls of the US mental health care system, which we will explore in the remainder of this essay:

1. Psychiatric medication is ineffective, overprescribed, and harmful

2. Talk therapy is insufficient to address the roots of mental suffering

3. The diagnostic model is unsubstantiated and unhelpful

Psychiatric medication is ineffective, overprescribed, and harmful

The Universe on my doormat prompted an investigation into the safety and efficacy of psychiatric medication. Laura’s story of deteriorating not despite but as a result of medication was not an isolated one, I found. Decades of data paint a terrifying picture, which Robert Whitaker illuminates diligently in Anatomy of an Epidemic.

Early research on antidepressants from the 1970s concluded that "drugs play a minor role in influencing the clinical course of the patient’s illness”. Instead, the National Insitute of Mental Health (NIMH) pointed to the efficacy of the placebo effect: Patients were improving not because of the drug but because of their belief that they were getting a magic pill for their depression. 

Still, perception shifted when Eli Lilly commercially launched Prozac in 1988, a Selective Serotonin Reuptake Inhibitor (SSRI). Once again, researchers began poking holes in the research Eli Lilly and other SSRI manufacturers had submitted to the FDA.¹ By 2009, the British Journal of Psychiatry stated that randomized clinical trials had generated limited valid evidence for the use of drugs. 

For many, antidepressants were not utilized as a short-term intervention but rather as an ongoing treatment, researchers found.² Italian psychiatrist Giovanni Fava raised concerns:

“Antidepressant drugs in depression might be beneficial in the short term, but worsen the progression of the disease in the long term, by increasing the biochemical vulnerability to depression.”

The concerns were not taken seriously in the US. As antidepressant sales soared, Columbia University professor Donald Klein announced that the industry is not interested, the NIMH is not interested, the FDA is not interested. Nobody is interested.

Leaders in American psychiatry blamed these findings on the chronic nature of the illness rather than the effects of medication. They concluded that the chronic nature of depression warranted the long-term use of medication. Medication that worked poorly: A NIMH study in 2007 investigating over 4,000 patients found that fewer than 20% remitted over the course of a year taking antidepressants.

While nobody in the US investigated the disease progression of unmedicated patients to substantiate these claims, European and Canadian research found that long-term depression outcomes were worse for those who used antidepressants. Similarly, a WHO study found that the patients who suffered the most chronic depression were those treated with antidepressants. 

Why are medications so widely prescribed, then?

Over 25 years ago, research pointed to the risk of long-term use. Yet, antidepressants continue to be prescribed to a large share of Americans: over 13% of adults. 

Why?

The answer is found, as so often, in late-stage capitalism. Within a decade, Prozac made Eli Lilly and its shareholders $2 billion annually.³ Pharma companies pay millions to “Key Opinion Leaders”, who serve as consultants and advisors and have become what Whitaker calls “salesmen for Big Pharma”.

Big Pharma also gives directly to practicing psychiatrists in local communities in exchange for talks and education of fellow physicians and the public  — $2 million in Minnesota alone in 2008, which we know thanks to a state law passed to disclose these payments. 

In 2023, a meta-analysis of 17 randomized-controlled trials debunked the theory at the foundation of SSRIs: that depression is the result of lower serotonin levels and activity in the brain. Researchers found no statistically significant correlation between serotonin levels or activity and depression.

But, as we’ve seen in the past, research won’t suffice to change the forces that move billions of dollars from the hands of many into the hands of few. While there may be a place for medication as an acute, short-term intervention, Americans will continue to be overprescribed. They will continue to be told by their doctors that their brain chemistry is chronically flawed and that their depression is a life sentence.

Fortunately, it is not. When I healed the roots of my PMDD with psychedelic medicine, all depression symptoms went away and never came back.

The issues are unfortunately not limited to SSRIs but span various classes of psychotropics — for more details, I refer to Whitaker’s work.

Talk therapy is insufficient to address the roots of mental suffering

Mental illness — whether it comes in the shape of addiction, depression, or anxiety, or all of it — is not the result of faulty brain chemistry but trauma. Trauma that manifests as a dysregulated nervous system, subconscious core beliefs, and repressed emotions.

Talk therapy is ineffective at healing trauma for a simple reason: the problem isn’t housed in the conscious mind.

We have three brains — the neocortex, the limbic system, and the reptilian brain. The neocortex manages all conscious thought, reasoning, and higher-order processes. The limbic system regulates emotions. The reptilian brain governs automatic bodily functions and survival responses.

The impact of trauma manifests mostly in the limbic and reptilian regions of the brain. Both these brains do not understand language. Attempting to heal the roots of trauma exclusively through talk therapy is the equivalent of teaching a blind person colors by showing them a painting.

Indigenous cultures all over the world understand this. In shamanism, the root of mental suffering is a fractured soul which results from trauma. To retrieve the fractured parts in a therapist’s office is impossible because those parts are not “home”.

What’s more, talk therapy can make things worse. Compulsive analysis and interpretation can perpetuate trauma loops and take us out of the moment and into dissociation. There, we remain eternally stuck in the familiar territory of the mind.

“The mind is a place the soul goes to escape from the heart.” — Michael Singer

Therapy can also activate our nervous system even further, which may exacerbate symptoms. Talk therapy never helped me overcome my eating disorder but reliably made it worse.

To be clear, I’m not against talk therapy. Talk therapy is an important first step in the healing journey and a valuable tool for integration and maintenance. I enjoy talk therapy to help me manage the everyday stressors of life in a healthy way and to integrate insights from the work with the unconscious. But it is not sufficient to treat the trauma at the root of mental illness.

The diagnostic model is unsubstantiated and unhelpful

The problem with modern mental health care begins even before any medication or talk therapy is prescribed: it starts with how we diagnose mental illness.

In her journalistic memoir Pathological,

Sarah Fay Writers at Work

challenges the validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of psychiatry. Fay argues that it is presented to the public as a factual resource when, in reality, it lacks scientific merit.

The DSM bundles symptoms into diagnoses that are mostly viewed as chronic. People can “manage their disorders”, Fay argues, but they can’t be cured. When I received my PMDD diagnosis after years of depressive episodes, I felt relief. But I quickly realized it was an illusion. PMDD was merely a collection of symptoms that revealed nothing about the roots of my despair. The proposed treatments, SSRIs to regulate mood and the contraception pill to regulate hormones, would only provide symptomatic relief.

While the DSM does little to illuminate the roots of mental illness, it excels at pathologizing the symptoms into an ever-growing list of disorders. The DSM has ballooned from 128 diagnostic categories in its inaugural 1952 edition (DSM-1) to over 541 in its latest 2013 edition (the DSM-5). 

A 2023 study found that non-unique symptoms account for 725 of all symptoms in the diagnostic criteria. Every symptom of Bipolar and Related Disorders is repeated in other chapters of the DSM-5. 10 out of the 15 most frequently repeating diagnostic criteria are symptoms of Major Depressive Disorder (MDD). Rather than a separate disorder, MDD symptoms may better be considered as a psychological response to stress, just as fever represents an inflammatory response to various infections.

But guess what still hasn’t made it into the DSM? Complex PTSD, aka developmental trauma, which is at the root of addiction, anxiety, and depression for many.

Why is the DSM flawed and objectively not in the interest of patients?

It is another product of late-stage capitalism, Fay argues. The DSM is authored by psychiatrists who obtain much of their information at conferences where researchers present the results from Big Pharma-funded studies. Drug companies have moved from marketing drugs to marketing indications. As a result, well-meaning mental health professionals incentivize patients to pathologize their symptoms, which in turn makes them more receptive to pharmacology.

In the US, almost everyone has some type of diagnosis, Generalized Anxiety Disorder (GAD) perhaps being the most common one. In Europe, I cannot think of one single person I know with GAD, which is not to say that nobody is anxious. It’s just much less common to pathologize anxieties, and even less common to mute them with psychiatric medication.

The biggest problem with the DSM and its diagnoses, Fay argues, is that they are not valid. They lack essential properties and rely on the subjective perception of the patient and the doctor’s evaluation of those perceptions. Perceptions that are shaped by a culture in which diagnoses are proudly revealed on social media because #mentalhealthmatters, as

Freya India

regularly explores. These perceptions are then evaluated by doctors who receive schooling that’s deeply influenced by the for-profit Pharma complex.

The DSM is one big mess, and Americans are being harmed as a result of it.

Hope is on the horizon: the psychedelic revolution is coming

Over the past nearly four decades, there has virtually been no innovation in psychiatry since the commercialization of SSRIs. That’s unheard of in virtually all other other medical fields. It is time for a revolution, and the revolution is coming, as the New York Times announced. Psychiatry will (hopefully) never be the same.

In the words of famous LSD psychiatrist Stanislav Grof:

“Psychedelics are to the study of the mind what the microscope is to the study of biology and the telescope is to astronomy.”

Unlike medication and most talk therapy, psychedelics help us get to the roots of the issues, which is reflected in the astounding clinical results: after 3 sessions of MDMA-assisted therapy, 71% of patients no longer meet the DSM-5 criteria for PTSD. A single dose of psilocybin reduces depression in treatment-resistant patients. A single dose of LSD alleviates anxiety in 64% of patients.

The FDA has designated MDMA, Psilocybin, and LSD as Breakthrough treatments. More medicines are to come, such as Ibogaine, which reduced 88% of PTSD symptoms, 87% of depression symptoms, and 81% of anxiety symptoms in a small Stanford study on veterans with TBI.

I will stop myself here. If you’re curious to explore the world of psychedelics, you are in the right place, it is the theme of this publication. You’ll find resources below to dive deeper.

〰️ Anatomy of an Epidemic, an expose of the dark side of psychiatric medication

〰️ The heartbreaking story of Laura Delano in The New Yorker

〰️ The Body Keeps the Score makes the case for healing trauma where it’s housed: in the body rather than the mind

〰️ Pathological explores the pitfalls of the DSM based on the author’s story of six misdiagnoses

〰️ The book that introduced me (and thousands of others) to psychedelics

〰️ A curated list of 20+ resources to learn more about psychedelics

〰️

Dr. Roger McFillin

exposes the harm caused by psychiatric diagnoses and drugs

“Until you make the unconscious conscious, it will direct your life and you will call it fate.” — Carl Jung

1. Arif Khan found in a 2000 study that symptoms reduced in 42% of the patients with tricyclics (the old class of antidepressants), 41% in those taking SSRIs, and 31% in the placebo group. In 2008, Oregon-scientist Turner found that 48% of the clinical studies submitted to the FDA in support of SSRIs between 1987 and 2004  had failed to show any statistically significant effects. These findings were confirmed in 2008 by UK researcher Kirsch.

2. 50% of patients who withdrew from antidepressants returned to them within fourteen months, a study from Harvard Medical School found in 1997. A study published in the British Medical Journal a year later confirmed that “after stopping an antidepressant, symptoms tend to build up gradually and become chronic”.

3. Ken Kusmer, “Prozac, the Blockbuster Antidepressant Drug,”, AP News, February 1997.