Welcome to the Psychiatry Casino

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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.”

***

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.

45 COMMENTS

  1. Hi Yishay,

    I found your article here revealing and informative about the many often unnoticed flaws in the psychiatric system. There is indeed a lack of precision and lack of real science. Serious decisions like what diagnosis you have or what meds you’re put on are made off of the subjective whims of imperfect human beings, and medication can bring many convoluted problems along with it. We can hope for psychiatry to change and improve, and you are doing your part by sharing your voice.

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    • Hi Ruby,

      Thank you so much for taking the time to read and respond. Your words capture exactly what I was hoping to shine a light on, the lack of precision and the subjective whims that so often determine life-changing decisions.

      I believe that by naming these flaws openly we can create space for change, or at the very least give others the courage to question and seek better answers. I’m grateful for your encouragement, and I truly hope psychiatry can one day live up to the responsibility it carries.

      With appreciation,

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  2. Psychiatry is not a casino because a casino implies occasionally winning. If you say this about psychiatry today then you could have said it in the era of psychosurgery, ECT and barbiturates. You could also make the same case for a night in a police cell, or a night drinking alcohol or a night of abandoning your husband – they can be life saving moves, but as solutions to the real problem they are wildly inadequate and imply desperation. The case is the same with psychiatry if we have sufficient insight to see this.

    If you look at the underlying science and look at the total consequences of psychiatry you see the real picture, and for some reason even prominent critics of psychiatry like Moncrieff are still stuck in the basic affirmation of the role of psychiatrist, and it seems to me obvious that this is owing to socially conditioned difficulty in really seeing and believing the magnitude of harm, dysfunction and moral dereliction is to be found in the whole history of psychiatry up to the present day. So this affirming attitude is a result of blindness, ignorance, and is it seems to me a symptom of the normalization of the horrors of psychiatry that we can still paint such an affirming picture, akin to the justifications of witchcraft persecution in the medieval period.

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    • Hi Zeroxox,

      Thank you for this thoughtful and uncompromising response. I can hear in your words a deep frustration with the entire history and present of psychiatry, and I understand where that comes from. The comparison you make to normalized horrors is powerful, and I share the sense that much of what has been accepted for decades needs to be re-examined without fear or deference.

      In my own writing, I try to walk the line between exposing the dysfunction and harm while also speaking from lived experience of trauma, where sometimes the inadequate “solutions” were still what kept me alive in the moment. That tension — between survival and real healing, is what I hope to explore.

      Your comment reminds me how urgent it is not to accept the surface picture but to continue questioning the very foundations.

      With respect

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  3. The overreaching metaphor is great Yishay. The labels do change with the professional as well as what is the latest label. It doesn’t make sense. And insurance is the machine that requires the label .
    I didn’t realize where you are from and oh my! These are hard times for your country and for the Gaza people . And trauma plays a role for all. I am familiar with the writing of the late writer Amos Oz so I come from more his perspective than not. Take care and I hope all the turmoil and awfulness ends soon and some sort of peace and healing for everyone in your area of the Middle East.

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    • Hi Mary,

      Thank you so much for your kind words and for engaging with the metaphor. You are absolutely right, the labels shift constantly, driven as much by professional fashion and insurance demands as by the reality of people’s suffering.

      Yes, these are very difficult times here, for Israelis and for Palestinians alike. Trauma leaves its mark on all sides, and part of my work — in writing and in life, is trying to make sense of how to live with those scars while still holding on to humanity.

      I also appreciate you mentioning Amos Oz. His voice continues to echo as part of our literary conscience, reminding us to see complexity even in the darkest of moments.

      I too hope for peace and healing for everyone in this region.

      With gratitude,

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  4. I’d say dealing with psychiatry is more like Russian roulette, but I was pretty much always coerced or forced to take six to nine drugs simultaneously, not just one, and that causes anticholinergic toxidrome poisoning. Anything to silence a non-violent, legitimately concerned mother of a child abuse survivor.

    But when my family’s medical records were finally handed over, at least I was able to scare a private school, that had a pedo on their school board, into closing its doors forever … which is a good thing.

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    • Hi,

      Thank you for sharing this powerful and painful piece of your story. The image of Russian roulette feels tragically apt, and the reality you describe of being coerced into so many drugs at once is exactly the kind of systemic failure that destroys trust and compounds suffering.

      What stands out in your words is not only the harm you endured, but also the strength you found in exposing injustice and protecting others. Closing those doors must have come at a cost, but it also shows extraordinary courage.

      Your voice matters, and I’m grateful you chose to add it here.

      With respect,

      Report comment

        • The “Russian roulette is not the same without a gun” song came out, just after I escaped psychiatry in 2009. I tell you, He’s “killing me softly with His song, singing my life with His words.” And no, “video didn’t kill the radio star,” I just went off to college when that song came out, so I couldn’t sleep with the radio on. But I did grow up in “the city that never sleeps,” and the NY Jews supposedly chose me, when I was only in 5th grade.

          It was also in 2009, when I had my Chicago awakening, during which the kind souls of Chicago supposedly called me, “the tailor who sings with the Lord,” since I did work retail next to a Lord and Tailor store, when I lived in Chi-town. It’s bizarre, but kind of cool actually. My life’s story should be a musical some day.

          But, yes, Yishay, there were numerous costs. For example, my marriage was destroyed and I lost my childhood religion, due to their “faustian partnership” with the psych industries. “That’s me in the spotlight losing my religion.” But I do still have hope that it is us truth tellers, who will be the ones singing, “We are the champions my friends, and we’ll keep on fighting till the end …” in the end.

          And you’re right, Steve, there are “not many ‘winners’,” when it comes to those who have had the misfortune of dealing with the scientifically “invalid” psych industries. I’m personally still rather shocked they didn’t kill me. Thank you, Jesus, for dying for my sins.

          And defaming and drugging people up for dreaming, since we all dream, renders the meaning of the concept of “psychosis” to be “irrelevant to reality,” psych professionals. Since most people don’t have awareness of, nor awakenings to, their dreams. Thank you, God, for your awakenings of me to my dreams.

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          • Hi,

            Thank you for sharing this deeply personal and poetic reflection. The way you weave music, memory, faith, loss, and survival together is striking, it really does read like the outline of a musical. I can hear both the pain and the resilience in your words.

            I’m sorry for the heavy costs you’ve endured, but I’m moved by the hope you still carry, and the belief that truth-tellers can still “keep on fighting till the end.” Your voice adds something powerful to this conversation, and I’m grateful you chose to share it here.

            With respect

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  5. > 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.

    This is the biggest lie that must be challenged vigorously.

    Hanlon’s Razor tells us to prefer incompetence over malice to explain undesirable outcomes. And while that’s a useful heuristic, when “the system” fails the same people in the same ways over and over again it can no longer be useful.

    “The system is broken” is used far too often to excuse outright negligence and bad behaviour.

    If the people in charge really wanted “the system” to function differently and achieve better outcomes for people, then they would be acting to “fix” this apparently “broken” system. And because that never happens, it can only be concluded that there really is no genuine will to do so, and the system is not “broken”, but working exactly as it is intended to.

    “The system” cannot be “incompetent”, but it can be willfully negligent, and it can be malicious.

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    • Hi Edward,

      Thank you for this sharp and important challenge. You’re right, it’s too easy to hide behind the language of a “broken system,” as if it were simply incompetence. When harm repeats itself in the same ways, against the same vulnerable people, it does start to look less like failure and more like design.

      I don’t doubt that many individual clinicians care, but I agree with you: care at the personal level cannot excuse willful negligence at the structural level. Naming that truth is necessary if there’s ever to be real accountability and change.

      thanks so much

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    • I would argue for a nuance here.

      As a professional who was unfortunate enough to work in this harsh system for 2.5 years and witnessed (AUS) Victoria’s “mental health reform”, I can testify: many professionals do care. But they are tightly trained in the wrong way. In many wrong ways.

      It is wonderful to see what training, social norms and peer pressure can do. It can blind you to service-induced harm that happens right under your nose. It can deafen you to rightful protests and true arguments of the people you “treat” because you were taught to see them as symptom – and most your colleagues follow suit.

      I saw in my very eye how a man of over 190cm height with a broken arm was given a too small sling, and both a doctor and a senior nurse ignored his complaints and blamed it on his behaviour or his “symptoms”. One awful injustice (not to mention negligence) out of many.

      The system is not the issue. The issue is the “mental health” field, and the way it teaches us to think, to talk, to scorn and disrespect, to un-listen and put people down.

      And yes, not enough leaders are motivated enough to change THAT.

      Many of them yearn to change, but won’t agree to face the devastation involved, the deep and demanding reflection involved, the harsh realisation that we have hurt, harmed, aggravated suffering and brought an immature death on more people than we can count. Definitely more people than we have ‘saved’.

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      • There can be no positive change without a full acknowledgement and accounting of the harms done in the name of “mental health” today and in the past. I have been “in the system” and been attacked or ostracized for pointing out scientific realities that are inconvenient. I see some wishing that change would happen, but very few willing to confront that the entire edifice needs to be brought down in order to start over again with different assumptions. I don’t anticipate change from within. Too many have their snoots in the trough to accept the harsh reality that you and I see so clearly.

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    • Edward, I think you’ve articulated something that too often gets swept under the rug. Calling the system “broken” lets it off the hook, as if it were an accident of incompetence. But when the same people are failed in the same ways over and over, it stops being incompetence and becomes design. What looks like chaos is in fact order just not the kind that serves those who suffer within it.

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  7. Yishay, I could not agree more. This is my exact thoughts. When given a MH label/diagnosis it’s like a game of spin the wheel – but the game is the ‘Wheel of Misfortune’. Every time they spin the wheel it lands on a new label. The same thing happens with the meds. It’s so simplistic and primitive it’s unbelievable, and sadly it is people’s lives they are playing with.
    In medicine it can be proven when a doctor makes a misdiagnosis. This cannot happen in psychiatry because any and every diagnosis is considered ‘correct’. It’s so totally bush league and absurd.

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    • I disagree, if you’re put on multiple anticholinergic drugs (including the antidepressants and/or antipsychotics) and become “psychotic,” then you can point out you’ve dealt with anticholinergic toxidrome poisoning. Not that our legal system, medical system, et al, is/are wise, or ethical enough, to understand/confess to this yet.

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        • Which is why the psych industries need to be weaned out of existence, Rosalee.

          Thankfully for me, I did find the head of family medicine at the reputable Cleveland Clinic hospital, did have a brain in his head … not to mention doctors at other local hospitals, when I helped a loved one.

          Speaking the truth of the fraud of the psych industries is understandable to the decent mainstream doctors.

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    • Hi Rosalee,

      Thank you for your powerful comment. “Wheel of Misfortune” is such a painfully accurate way to describe it, labels and meds spun around as if people’s lives were a game. You’re right, in psychiatry misdiagnosis is often invisible, because any label can be made to fit. That absurdity is exactly what I hoped to shed light on.

      With appreciation,

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      • The DSM-5 is best seen as a catalog of billing codes. Everything in the DSM was either invented or created. Nothing in the DSM was “discovered”. Think about the difference.
        Try reading “The Myth of Mental Illness” by Dr. Thomas Szasz. (The 2010 edition has an excellent author’s preface/forward.) Basically, he’s saying that so-called “mental illnesses” are only as “real” as Santa Claus. No, he isn’t discounting human pain & suffering, though….
        Also, I recommend anything from Dr. Peter Breggin, especially his 1991 “Toxic Psychiatry”. And of course “Anatomy of an Epidemic”, & “Mad in America” by Mr. Robert Whittaker.
        (So you see who started this very website!)
        KEEP UP the GOOD WORK!

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  8. Thanks for the opportunity to add my voice.

    I likened those so called experts, the prescribers, to a 7 year old, playing with a toy chemistry set – on my brain! They have no idea! It ought to be criminal. I was poisoned. Now 25 years later and 8 years “clean” … there is no possible way for me to believe anyone in the health care industry. If I hadn’t walked away, I believe “they” would have killed me. By accident, of course. “They” simply don’t know.

    Here’s a thought I haven’t seen expressed, yet. The so-called “chemical imbalance” a marketing slogan, not a scientific fact … they can’t measure it, then they experiment by telling the patients to take this or that and even take this AND that … it’s entirely possible under these conditions that “they” are causing “chemical imbalances”.

    Be your own best friend. Do what is best for you. I saved my own life.

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    • Oh, Hope, you don’t know just how CORRECT you are! It’s not only “entirely possible”, but, in fact, THAT IS WHAT THEY ARE DOING!…. Think about it like this, maybe….
      When more drugs are given to more people, more people are sicker. When more people are sicker, more drugs are given. When more drugs are given, more people are sicker. When more people are sicker, more drugs are given. When more drugs are given, more people are sicker. When more people are sicker, more drugs are given. When more drugs are given, more people are sicker. When more people are sicker, more drugs are given. When more drugs are given, more people are sicker…..etc.,etc.,…..
      See what a beautiful little drug racket PhRMA & Psychiatry cooked up?….

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  9. Hi Hope,

    Thank you for sharing your story so openly. The image of a 7-year-old with a toy chemistry set is painfully accurate and devastating when it’s people’s brains and lives on the line. I’m so sorry for what you endured, and at the same time deeply moved by the strength it took to walk away and save your own life.

    You’re absolutely right: the “chemical imbalance” slogan has done tremendous harm, and as you say, it may well be that the treatments themselves create the very imbalances they claim to fix.

    Your voice is a reminder of resilience, and I’m grateful you added it here.

    With respect,

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      • Hi Bill,

        Thank you for sharpening the point. You’re right, too often the so-called “treatments” don’t just miss the mark, they actively create the very imbalances they claim to correct. That’s not a side issue, it’s central to the harm. Naming it plainly is part of the truth-telling we desperately need.

        With respect,

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        • As a years-long reader & commenter here, yes, MiA articles HAVE DOCUMENTED that the old “chemical imbalance” lie was crafted by the PR & marketing departments of PhRMA, with NO legitimate scientific evidence to support it….and combined with government force & coercion, it’s the epitome of medical fascism….

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          • It was actually disproven BEFORE Prozac even hit the market. It’s 100% a marketing scheme, and the psychiatric world did nothing to dissuade consumers from believing this known deception, and most of them supported it whole hog despite knowing it is false. One of the more disgusting episodes in human history!

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          • Hi Bill,

            You’re absolutely right, the “chemical imbalance” story was a marketing slogan, not science, and the damage it caused is immense. When you add the weight of government force and coercion, the result really does look like a system that abandoned truth for control. Thank you for underlining this so clearly.

            With respect,
            Yishay

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    • Hi Craig,

      Thank you so much. It means a lot to know the metaphors resonated with your own experience. I think when we arrive at similar conclusions from different paths, it confirms just how widespread these realities are. Grateful you took the time to share this.

      With appreciation,
      Yishay

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      • Also thank you for your service in the IDF. Not sure how you or the typical readers of this site feel about that comment. It’s not very popular to talk about the IDF these days.

        I lived in Israel, early on in my college career and still have tremendous reverence for the country and the army, even if they might not be doing everything perfectly. Nonetheless, I think many of the actions and motivations come from the right idea relative to an imperfect world right now.

        I hope this comment does not result in a downward spiral into whether or not genocide is occurring in Gaza now. I’m simply praising the author here for his forwardness and insight.

        Any chance “Dog” will be available on Audible soon? I didn’t see it there just now.

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  12. Hi MJ,

    Thank you so much for your kind words, they mean the world to me. I’m grateful you’re taking the time to read Dog, even if slowly. It was written from a place of raw pain, so if it feels gut-wrenching, then perhaps the honesty is reaching through.

    With gratitude,
    Yishay

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