America Has Reached Peak Therapy. Why Is Our Mental Health Getting Worse?


From TIME: “By the latest federal estimates, about one in eight U.S. adults now takes an antidepressant and one in five has recently received some kind of mental-health care, an increase of almost 15 million people in treatment since 2002. Even in the recent past—from 2019 to 2022—use of mental-health services jumped by almost 40% among millions of U.S. adults with commercial insurance, according to a recent study in JAMA Health Forum.

But something isn’t adding up. Even as more people flock to therapy, U.S. mental health is getting worse by multiple metrics. Suicide rates have risen by about 30% since 2000. Almost a third of U.S. adults now report symptoms of either depression or anxiety, roughly three times as many as in 2019, and about one in 25 adults has a ‘serious mental illness’ like bipolar disorder or schizophrenia. As of late 2022, just 31% of U.S. adults considered their mental health ‘excellent,’ down from 43% two decades earlier.

. . . Dr. Robert Trestman, chair of the American Psychiatric Association’s (APA) Council on Healthcare Systems and Financing, says there are multiple factors at play, some positive and some negative. On the ‘positive’ side, more people are comfortable seeking care as mental health goes mainstream and becomes less-stigmatized, increasing the total number of people getting diagnosed with and treated for mental-health issues.

Less positively, Trestman says, more people seem to be struggling in the wake of societal disruptions like the pandemic and the Great Recession, driving up demand on an already-taxed system such that some people can’t get the support they want or need.

Some experts, however, believe the issue goes deeper than inadequate access, down to the very foundations of modern psychiatry. As they see it, the issue isn’t only that demand is outpacing supply; it’s that the supply was never very good to begin with, leaning on therapies and medications that only skim the surface of a vast ocean of need.”

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  1. This article does try to provide balanced coverage.

    I see several things it didn’t say:

    1.- Reduction in mortality for some diseases might/is due to earlier diagnosis or at a younger age. One strong determinant of cancer mortality is actually age. Breast cancer mortality grows almost exponientially with age. Despite most women with breast cancer over 65-70yrs die of something else. “Lead and age” time bias contributes to apparent efficacy of “modern” treatments.

    From the 80s to the 2020s the percentage of survivors of breast cancer after 5yrs of diagnosis went from around 78% to around 82%. Not really that great in individual terms. And that 4-5% increase in survivors is similar in the top 10-15 cancers, from the low mortality ones like Breast/prostate, to the middle mortality ones, i.e. 50% survive 5yrs posdiagnosis, to the high mortality ones. i.e. less than 10% survive 5yrs after diagnosis. The lines in increased percentage of survivors after diagnosis are almost parellel for all of those top cancer.

    2.- The value of antihypertensives, cholesterol lowering drugs, coronary by-pass and coronary stenting is not that great. Particularly in those more likely to die from the diseases treated by it: the elder.

    3.- It omits that persons with hypertension treated with beta-blockers and some calcium chanel blockers acutally died more often because of the treatment, not the disease.

    4.- It omits the scandal of the COX-2 blockers and some “glitazones” for diabetes.

    Seen that way, it’s no wonder psychiatry is worse!, even if KOLs do try very vociferously to say “treatments in psychiatry” … “are of similar efficacy as in the rest of medicine”.

    Even clozapine has not been withdrawn from the market! Yeah! way too similar!.

    5.- Why didn’t TIME magazine interview Robert Whitaker for this article?

    Insel: ‘“People who think [depression] that’s just on the continuum of the human experience…have never met anybody who’s truly depressed,” he says.’ [Yes, I know, because I don’t and can’t meet ALL “depressed” people is why I want SCIENCE to tell me that in a way more scientific than the “lemma” inside a fortune cookie.

    Me: Well Insel might have met a lot of people and he probably does not know them either. He might have met a lot of criteria and not only Insel, but no one will know about it. Insel might not have met a criteria, and still believe he met them or know them. Others might agree or disagree…

    And if 20-30% of people over a life course will by probability fulfill the “depression criteria” to be diagnosed with it, then 20-30% loosing a golden fish seems to me part of the human experience.

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  2. And! when Insel said “meeting” someone “truly” depressed is a reformulation of: Seeing is Believing, and I am a better seer (implied since he knows what the “truth” is as used in truly, hence when it comes to depression). Sounds ad hominem and appeal to authority.

    I can’t help noticing the worid “truly” preppended to depressed. That’s just… well…

    But it might sound like an admission there’s overdiagnosis in depression. It’s way more cheatty than that.

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  3. I think there’s merit to how the comfort in getting an appointment by the masses is clogging and taxing an already stressed system. I just had a young 20 something kid the other day take up a slot because they are regurgitating that mental health care is “good for everyone”; they have no symptoms and very little to work on. Then later that day, I had a person that was so dysregulated that they couldn’t focus in session; so we had to do basic de-escalation exercises to get them into a space to receive the counseling…

    All of these people that are getting counseling/therapy because everyone else is doing it and they have no diagnosable concern, perceptions of stress, or problematic behaviors to themselves, need some kind of other help that doesn’t stop therapist from being able to see people that need help the most.

    Maybe we need a different kind of counselor, like a proactive one that non-clinical clients could check in with. That could ease some pressure if we had more of those. They could always escalate to the therapists that work with diagnosable concerns/adjustment disorders/unspecified mood disorders in the least

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    • We need to look at the where “the comfort in getting an appointment by the masses” came from. It came from propaganda (“Don’t be afraid to ask for help, help is available”), from a bloated and always-growing “bible” of mental disorders put out by elites, endless marketing of psych drugs, constant, unavoidable “mental health screenings” that no one asked for. Now the system is a monster choking on its own tale. Of course its clogged.

      What is a “diagnosable concern”? That could mean anything at all. How dire does our shared reality have to become before we stop telling people they have an “adjustment disorder” because being inundated with reminders of everything falling apart bothers them? How can you tell that the kid who has “no symptoms” and “very little to work on” is just taking up a slot?

      The calls for more money, more screenings, more beds, more counselors, more therapists, more psychiatrists come from a basic refusal to accept that the paradigm of “treatment for mental illness” is a failed paradigm. Let the money spigot be shut off and see what happens. It couldn’t be worse than the current situation, including mass violence and millions on disability due to psychiatric drugs that were put on the market without any warning to the public about how incredibly dangerous they were. Let the monster starve.

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      • Excellent comment.

        Insel has one hell of a lot of nerve saying this: “People who think [“depression”] is just on the continuum of the human experience have never met anybody who’s truly depressed”. He should try being someone who’s truly broke and “diagnosed” as “mentally ill”.

        Nothing will change until enough people start seeing sadness, worry, and even “mania” for what most often these truly are: understandable reactions to a stressed-out, corrupted, profit-driven world, not as “diagnosable conditions”.

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