The psychiatry casino spans two shiny, unpredictable floors: one for diagnoses, the other for drugs. As someone who’s lived this world from the inside out, I can tell you the slots never stop spinning.
Psychiatric labels aren’t as solid as the DSM would like us to believe. They shift. They mutate. Sometimes, they vanish overnight. You can enter the system with generalized anxiety, come out with PTSD, and then get bumped to borderline personality disorder six months later, not because your symptoms changed, but because the psychiatrist did.
I’ve seen it more times than I can count. Diagnoses handed out like poker chips. “Let’s try this one.” Pull the lever. “Maybe you’re bipolar.” Spin again. “Could be a psychotic break.” Ding ding ding. And suddenly, you’re surrounded by well-meaning professionals treating your life like a diagnostic roulette wheel.
Even with so-called “serious” disorders, schizophrenia, bipolar disorder, schizoaffective disorder, the lines blur. I’ve met people who were diagnosed with schizophrenia for years, only to have it revised to bipolar disorder after a single manic episode, or downgraded to trauma-related psychosis with the right kind of backstory. It’s not that the clinicians don’t care. Many of them care deeply. But the truth is: the system doesn’t know. Not really.
And that’s just the first floor.
Now head upstairs, to the drug lounge. This is where the cocktail changes faster than the seasons. You might start on an SSRI. Then comes the mood stabilizer. Then an antipsychotic “just to help with sleep.” And then, inevitably, the benzos.
They say the medications are evidence-based. And maybe, in theory, they are. But in practice? It often feels like trial and error. Heavy on the error.
Let me be clear: I’m not anti-psychiatry. I’m not saying there’s no need for medications or mental health professionals. I’ve met some incredible doctors along the way, and in moments of crisis, medication has saved lives, including mine. But the system sells a story of precision. Of expertise. As if what’s happening in that office is the mental health equivalent of open-heart surgery. As if each diagnosis is the result of rigorous testing and each prescription finely tuned to your brain chemistry.
It’s not.
For most patients, the process is imprecise at best,  and misleading at worst. Diagnoses are based on subjective interviews. Medications are chosen from a menu of guesses. And changes are often made not because of breakthroughs in your condition, but because “we’re trying something new.”
Here’s the truth I wish more people heard from the start: modern psychiatry is still, in many ways, closer to educated gambling than science. And patients deserve to know that. They deserve to hear:
“This is what we know, and here’s what we don’t. We’re going to try, together. And we may be wrong before we’re right.”
But that kind of honesty doesn’t fit neatly into a clinical setting, or a pharmaceutical brochure.
As a combat veteran with PTSD, I’ve personally been diagnosed with at least four different disorders over the years and prescribed more than ten different medications. Sometimes the pills helped. Sometimes they numbed me. Sometimes they made things worse. What I’ve learned is that healing doesn’t always come in a capsule. Sometimes it comes through art. Through therapy. Through community. Through meaning. Through movement. Through long walks in silence. And sometimes, it just comes with time.
I wish the system encouraged those paths more, or even acknowledged them. But the truth is, there’s no incentive. You can’t patent a walk in the woods. You can’t bottle grief and call it a breakthrough.
Every time my mental health dips low enough that I end up sitting in a psychiatrist’s office again, I feel two things: hope and ambivalence. Hope that maybe this time will be different. Ambivalence because I already know how it usually goes.
Best case? They change my meds.
Worse case? They add another one.
And somewhere, deep in the background, I can almost hear the click of a lever, the spin of a wheel, and the voice of the dealer saying:
“Place your bets, and good luck.”
