Depressed, Anxious, or Substance-Abusing? But Don’t Buy You Are “Defective”?


Depressed, anxious, and substance-abusing people can beat themselves up for being defective. And psychiatrists and psychologists routinely validate and intensify their sense of defectiveness by telling them that they have, for example, a chemical-imbalance defect, a genetic defect, or a cognitive-behavioral defect.

In plain words, many depressed, anxious, and substance-abusing persons think: “I feel fucked up because I am essentially fucked up,” and mental health professionals routinely confirms this.

For some depressed, anxious, and substance-abusing people, it feels better to believe that they are essentially defective, as it provides them with a defense of sorts against insulting accusations that they are malingering.

But the defect/medical model of mental illness doesn’t work for everyone. Many depressed, anxious, and substance-abusing people think: “The idea that I am fucked up because I am essentially fucked up just fucks me up more.” There is another model that works much better for them—more later on that model.

Those people who embrace their defectiveness can get angry with me when I write about the scientific bankruptcy of a given defect theory of mental illness—for example, the pseudoscience behind the chemical imbalance defect (see CounterPunch 2014), and how even establishment psychiatrists now reject this idea (Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists”).

Embracing defect and practicing self-flagellation has a history of adherents. Self-flagellation as penance for “sin defects” is a practice of some Catholics, including the late Pope John Paul II and some of Catholicism’s more conservative orders and branches such as the Opus Dei. And among a small minority of psychiatric patients, there is a desire to be electroshocked (ECT) for unproven brain defects regardless of research (even by ECT’s proponents) that shows ECT results in major cognitive deficits that indicate the ECT itself causes brain defects.

The “defect model of mental illness” is more commonly referred to as the “medical model of mental illness.” In the medical model, the doctor is essentially a technician charged with fixing a defect. This medical model makes sense for suturing a laceration, removing a bullet, or restoring the body from other identifiable physiological insults.

Not Self-Deceptive and Don’t Buy Defective? Another Path

While some people get angry with me for challenging their defect faith, others become revitalized when they discover that they are depressed, anxious, or substance abusing not because they are defective in some way. For them, discovering that “I may feel fucked up but it is not because I essentially am fucked up” can make them feel more whole, resulting in them beginning to feel less depressed, anxious, or substance abusing—and less self-loathing.

What our society calls “mental health” is sometimes simply a denial of reality. And self-deception and denial aren’t the talents of many of the depressed, anxious, and substance-abusing people who have consulted with me after they’ve been failed by mainstream mental health.

Scientific American Mind in 2005 reported, “Several classic studies indicate that moderately depressed people actually deceive themselves less than so-called normal folks.” Researchers Lauren Alloy and Lyn Abramson, studying nondepressed and depressed subjects who played a rigged game in which they had no actual control, found that nondepressed subjects overestimated their contribution to winning and only believed they had little control when losing, while depressed subjects more accurately evaluated their lack of control when losing or winning. Researcher Peter Lewinsohn found that depressed subjects judge other people’s attitudes toward them more accurately than nondepressed subjects. And my three decades of clinical experience confirm Clark Vaughan’s (Addictive Drinking) and other recovered addictive drinkers’ conclusion that problem drinkers and drug addicts often have a superior ability to see through society’s systems, people’s facades, and bullshit in general.

In Nazi concentration camps, it was not possible for even the best self-deceivers to deny their degradation, humiliation, and extreme physical and psychological pain. So, as Auschwitz survivor Viktor Frankl reported, “The thought of suicide was entertained by nearly everyone.” Yet as Sera Davidow documents, mainstream mental health institutions tell us: “Research has found that about 90% of individuals who die by suicide experience mental illness” (see National Alliance on Mental Illness). It is difficult to imagine how this often repeated assertion would not be an insult to injury for those suicidal in death camps.

Overwhelming pain and trauma—including degradation, humiliation, injustice, an unloving family, alienation, and loneliness—is what fuels our depression, anxiety, and substance abuse, as well as other states that are commonly labeled as even more serious mental illnesses (the research has repeatedly shown the relationship between childhood trauma and psychosis).

To be clear, I do know people who are not in denial of the loveless, degrading, bullshit world that they reside in but who are not depressed, anxious, or substance abusing.

It is possible not to be depressed, anxious, or substance abusing and not to be in denial that mom and dad hate each other’s guts and care more about torturing one another than they care about you, that no one seemed to notice or mind that for five years you were sexually molested by Uncle Asshole, and that you experienced an entire childhood without love.

It is possible not to be depressed, anxious, or substance abusing and not to be in denial over the fact that your U.S. standard schooling likely turned you off from a love of reading; that you are likely disengaged from your job; that if you ever need hospital care, preventable hospital error is the third leading cause of U.S. death; and that Americans are not living in either a democracy or even a representative republic as a recent study concluded: “The preferences of the average American appear to have only a minuscule, near-zero, statistically nonsignificant impact upon public policy.”

It is possible not to be in denial of personal and societal injustices and humiliations and not to be depressed, anxious, or substance abusing. But it’s not easy. It requires the development of a philosophical-psychological-spiritual lens that enables us to, while not denying the misery of our lives, not become overwhelmed by our pain.

A window as to how we can survive misery without self-deception and denial is provided in the memoirs and accounts of people who have survived extreme states of injustice, degradation, deprivation, and humiliation that was impossible to deny. Terrence Des Pres in his book The Survivor: An Anatomy of Life in the Death Camps examined memoirs and accounts of Nazi concentration camp and Soviet Gulag survivors, both the famous (Primo Levi, Viktor Frankl, Elie Wiesel, Bruno Bettelheim, and Aleksandr Solzhenitsyn) and the non-famous.

What Des Pres reports is that surviving undeniable extreme degradation and humiliation is often about discovering a way to not to be overwhelmed by it. These methods included: a journalistic detachment so as to bear witness as both an obligation to those who didn’t survive and a vehicle for future justice; discovering one’s meaning and purpose for survival rather than being drowned by one’s pain; a dark sense of humor that did not deny the injustices, humiliations, and degradations but flipped them to absurdity and laughter; collective resistance, cooperation, and altruism with one’s fellow prisoners which allowed for some sense of dignity and freedom from complete self-focus on one’s own suffering; temporary respites from hellish existence by focusing on the beauties of nature outside the death camp such as a tree in the distance or a sunset.

My clinical practice has mostly consisted of depressed, anxious, and substance abusing people who have lacked the “talent” for denial and self-deception, and have been previously failed by mainstream mental health and its defect model of mental illness. For such people, it is more helpful to view their depression, anxiety, or substance abuse not as evidence of a defect but simply as one edge of a double-edged sword—with the other edge being their lack of denial and self-deception.

This double-edged sword view often rings true for depressed, anxious, and substance-abusing people who have been previously failed by mainstream mental health. This view provides them with wholeness and dignity. And with that wholeness and dignity, they are more likely energized to discover and implement one or more of the various ways that people have utilized to survive miserable circumstances without denial or self-deception. And they may well begin a journey to discover what restorative path—among the various ways people heal from trauma—that is best suited for them.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. I noticed this article on Counterpunch earlier in the week, and I applaud Dr. Levine’s efforts to link the struggle on MIA against psychiatric abuse to wider social justice concerns. Of the left-wing websites, I find that Counterpunch reaches out to the broadest array of societal concerns. And while not all on MIA tilt to the political left, I find that social justice activism best dovetails with our concerns. I recently attended a workshop of the local WVa. Public Workers union which falls under the Union of Electrical workers umbrella. Recently, its members rallied at the state legislature to beat back a bill to privatize four state run nursing home (these nursing homes provide psychiatric services and are affiliated with the two remaining state psychiatric hospitals). I was invited to the organizing meeting as a member of the Mountain Party-I am running for statewide office in the 39th District of the House of delegates. From what I can gather, the UE has a more democratic structure than is typical of the business unionism of big labor, and UE was one of the few unions to remain steadfast and to survive McCarthyism with its principles in tack. During breaks in the meeting, I focused most of my attention on union related activities surrounding legislation pertaining to school privatization I am a member of AFT. It is my hop that I will be able in the future, to voice my concern on the issues surrounding psychiatric care.

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  2. Great post Bruce.

    Here’s a common interaction from psychiatric consulting rooms across America:

    Patient: I was molested for five years by Uncle Asshole, experienced an entire childhood without love, I’m poor, don’t have any friends, and I’ve started hearing voices.

    Psychiatrist: It sounds like you have schizophrenia. It’s a lifelong brain disease but it’s treatable. We’ll prescribe you a drug. See you in a month.

    More likely the client doesn’t even admit these traumatic things like abuse and neglect… they just report hearing the voices or being nonfunctional. But even when they do describe the trauma, the psychiatrists are too ignorant or even terrified of the real psychosocial causal factors to imagine that they are the real causes of the psychotic experience.

    The medical model would be better renamed as The Defect Model. That is what I’ll try to remember to call it from now on. It encapsulates the lies people are told by psychiatrists: There is something wrong with you, not with what happened to you or with the environment around you. Your brain chemistry or genes are a primary causal factor in how bad you are feeling. You need our pills. That way we psychiatrists can keep making $180,000 a year even though we are no better at helping people than therapists who make $50,000 a year.

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    • You have to remember that psychiatry is only pretending to be really medical, but is actually in the same boat as general medicine was prior to the 19th century, the clinical microscope and germ theory. One issue I never see brought up in these descriptions of SOB relatives is their biophysical state giving a hint to proper treatment (e.g., family history of bipolars + many male relatives with red-green color blindness suggests B12 dependency in depressed interviewee). Such information can also come from beaters, addicts, compulsives, etc., if you know how to look and what to look for,

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    • Thanks, BPDTransformations. Yes, a major point I wanted to get across in this piece is that what is commonly called the “medical model of mental illness” is really the “defect model of mental illness.” Mainstream mental health is quite okay with being associated with the “medical model” but they get upset when we call it the “defect model” because they know that gets people thinking – “Do I really want to be labeled as defected and treated as though I am defected”? — Thanks again, Bruce

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    • Thanks, Diana – Yes, Truthout is another publication that will also publish my pieces. While I try to get the word via Counterpunch, Truthout, Alternet, Z Magazine, and other publications, those of you who write only for Mad in America are NOT just “preaching to the choir” as some of my Mad in America pieces get placed on social media sites including Reddit etc, and get around to people who have no idea that Mad in America exists – that’s why you see my 2013 piece Societies With Little Coercion Have Little Mental Illness currently being one of the top MIA stories this week — Bruce

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  3. Dr. Levine:

    I am a big fan of yours. But I want to address the point you made:
    “Researcher Peter Lewinsohn found that depressed subjects judge other people’s attitudes toward them more accurately than non-depressed subjects”
    This finding doesn’t square of with my own experience of depression. When I am in a depressed state, I am more more likely to think that others are talking negatively about me behind my back even in instances where there is no evidence to prove it. I have to work hard to remember that the muffled laughter I hear in the office is as likely as not to be about something completely unrelated to me. Yes, I believe that there is some truth in your point that depressed people often see their flaws and warts more truthfully than their non-depressed counterparts but depressed individuals like me, often exaggerate or become fixated on our flaws. At times, we become obsessed with unattainable ideals of self and fail to balance truth and pragmatism.

    President Lincoln was said to be an example of a depressed individual. Perhaps his depressed temperment and ability to face ugly truths about mankind unflinchingly uniquely qualified him to lead our nation in a time of great crisis.

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  4. I’ll join the chorus of those who are also encouraged by Truthout & Counterpunch giving some attention to psychiatric mystification of the predictable consequences of capitalist alienation. It’s vital for the true left (of which Obama is not a part) to regain some semblance of an understanding of psychiatric oppression, as it had in the late 70’s when it supported the movement-wide boycott of (then) Smith Kline & French pharmaceuticals.

    “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists”

    We need a compendium of similar statements and quotes from highly regarded top-ranking psychiatrists to pull out as part of our standard talking points, and make it easy for everyone to access. Any suggestions?

    Also one quibble:

    The “defect model of mental illness” is more commonly referred to as the “medical model of mental illness.”

    Saying “the medical model of mental illness” is tautological; if one uses the term “mental illness” they are by definition using the medical model. So-called biological psychiatry is simply an extreme version of the medical model which carries its inherent absurdity to its logical conclusion.

    I think it’s worth mentioning that, once one sees through the empire’s new clothes as per psychiatry and recognizes that feelings of despair, hopelessness, extreme sadness, etc. are not symptoms of a personal defect but logical reactions to objective external (read political) conditions, a very normal reaction to this realization can be great anger, which can either be misunderstood and turned against oneself or others, or channeled into methods of collectively dealing with our collective oppression. “Depression” itself is a euphemism, functioning to mystify the experience of emotions the system deems unacceptable and unproductive, and to turn people’s anger — the “healthy” response to oppression — against themselves.

    And as Dr. Bonkers asks, what about “asymptomatic depression” — i.e. experiencing contentment amidst conditions that would make a rational person “depressed”?

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    • Thanks Oldhead for your kind words. Yes, what you call the “true left” is what I often call the “anti-authoritarian left,” as distinguished from mainstream liberals who may purport to caring about certain social justice issues but don’t really have a passion for shared power, real autonomy, and genuine democracy. Yes, you are right that the term “illness” conveys defect and is thus a “medical model.” Thanks again — Bruce

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  5. Hi Bruce,

    great article. Viktor Frankl was also a psychiatrist as well as a camp survivor. The second part of his book dealt with his logotherapy, and how it was hope which saw people through traumatic experiences. Looking a little deeper and using the attribution model developed by Seligman one can see plainly how mental health services are producing learned helplessness in ‘patients’, and taking away any hope that they will ever be well again.

    Medical model, defect model? Did God issue a recall and I didnt get the memo? lol

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  6. Thank you, boans, for your kind words. While Frankl as a concentration camp survivor has lots of valuable insights about surviving extreme conditions, I was troubled to discover several years ago the following about him reported by Thomas Szasz who quotes Frankl saying: “I have signed authorization for lobotomies without having cause to regret it. In a few cases, I have even carried out transorbital lobotomy,” Viktor E. Frankl, “ ‘Nothing but—’—‘: On Reductionism and Nihilism,” Encounter, (November, 1969), p.56, cited in Thomas Szasz, The Myth of PychotherapyPsychotherapy: Mental Healing as Religion, Rhetoric, and Repression (Syracuse, New York: Syracuse University Press, 1978, 1988), p. 205.

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