What is striking about The Lost Art of Healing (1996) is that its author Bernard Lown (1921-2021), the renowned cardiologist who pioneered life-saving technological advances, makes clear that vital to heart health and recovery are human relationships that are being increasingly ignored in technology-worshipping medicine.

For Lown, two relationship areas that are critical in heart health and recovery are: (1) the relationship between the physician and the patient; and (2) the relationships between patients with their partners, family members, and other significant people in their lives. Tragically, the current absurd reality of psychiatry is that it ignores or merely pays lip to these two relationship areas when it comes to our emotional struggles.

Before delving into Lown and The Lost Art of Healing, a few words in anticipation of rebuttals by apologist psychiatrists such as Awais Aftab who claim that psychiatry does not ignore or merely pay lip service to these two relationship areas. Earlier in 2026, Aftab argued that it is unfair to paint all of psychiatry as completely focused on mental illness symptoms to be corrected by pharmaceuticals or other technological means, and as proof he points to George Engel’s “The Clinical Application of the Biopsychosocial Model” which appeared in the American Journal of Psychiatry in 1980.

The problem with Aftab’s “pluralistic” image of psychiatry is that by 2011, the New York Times, in “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy,” reported, “A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since.”

Today, the reality is that damn near every psychiatric patient can tell you that a psychiatrist who does anything more than 10-15 minute “medication management” is rare; and even among that small handful of psychiatrists who actually continue to conduct some talk therapy, it would be a highly unusual patient who would say, “I had a healing relationship with my psychiatrist who put great effort into understanding the important relationships in my life, helped me extricate from toxic relationships, and helped me build caring and loving ones.” This is so rare that such a psychiatrist would be, as the saying goes, “the exception that proves the rule.”

Bernard Lown and The Lost Art of Healing

The pioneering cardiologist Bernard Lown is internationally renowned within medicine for his invention of the modern direct-current defibrillator and his introduction of a new use for the drug lidocaine to control heart arrhythmias. However, he saw the downside of technological advances in medicine, “Every advance exacts a cost. Medicine grew even more depersonalized. Technology took precedence and patients became secondary. A paradox of my life and its ultimate irony is that my research work facilitated that which I utterly deplore.”

Despite establishment psychiatry’s pretensions otherwise, when its outcomes are analyzed with scientific rigor, its latest technologies—which consist mainly of drugs and electrical treatments—have not resulted in life-saving or even quality-of-life advances. However, in much of non-psychiatry medicine, there has in fact been life-saving and quality-of-life technological advances; but such advances have resulted in what Lown calls a “childish faith in the magic of technology” which for him, “is one reason the American public has tolerated inhumane doctoring.”

In the world outside of medicine, Lown is even more renowned for his humanistic advocacy that included being the cofounder of International Physicians for the Prevention of Nuclear War, which garnered him (along with his co-founder) the Nobel Peace Prize in 1985. Lown’s humanistic activism extended to medicine itself which he became so troubled by that he wrote The Lost Art of Healing.

In the introduction to the 1998 edition of The Lost Art of Healing, Lown begins this way: “Patient dissatisfaction is now at an all-time high,” and the present system in health care is “depersonalizing patients.” This dissatisfaction addressed by Lown has only gotten worse, as the majority of people I talk with, both clinically and socially, report being stressed by an increasingly bureaucratic health care system, with some reporting even being traumatized by it. Lown explains how this has happened:

“In a deeper sense the industrialization of medicine now emerging, like that of other commodities, requires two elements: standardization of the product and interchangeability of its parts. . . . It relates to the long-standing marriage of medicine to reductionist science and to burgeoning technology. . . . The elusive properties of mind, accounting for each person’s uniqueness, find scant sympathy in the current state religion that worships business efficiency. Nor do these properties enter the scientific equation. After all, empathy, kindness, altruism, benevolence, insight, joy, suffering, sadness, and tragedy are outside the purview of molecular biology.

The “central thesis” of The Lost Art of Healing, Lown tells is this: “Our health care system is breaking down because the medical profession has been shifting its focus away from healing, which begins with listening to the patient. The reasons for this shift include a romance with mindless technology, which is embraced in large measure as a means for maximizing income.” And Lown notes, “It is uneconomic to spend much time with patients.”

For establishment psychiatrists who dream of status parity with the rest of medicine, I suppose they will be relieved to see that psychiatry is not singled out for being uniquely dehumanizing. However, more rational and compassionate observers would say that for psychiatry, which is societally charged with treating emotional suffering and behavioral disturbances, to be no different than the dehumanizing reality that Lown paints for medicine in general is especially disturbing.

Lown tells that he was very much interested in psychology before he became interested in medicine, and that, “I intended to become a psychiatrist, but soon after I entered medical school, psychiatry lost its luster for me.” If Lown had gone into psychiatry, I have little doubt that he would have become a radically dissident psychiatrist, as he was troubled enough by medicine’s dehumanization of the doctor-patient relationship, and so he would likely have been appalled by witnessing that same reality in psychiatry. He was deeply saddened by the trajectory of medicine:

“A three-thousand-year tradition, which bonded doctor and patient in a special affinity of trust, is being traded for a new type of relationship. Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures. Doctors no longer minister to a distinctive person but concern themselves with fragmented, malfunctioning biologic parts. The distressed human being is frequently absent from the transaction.”

Even in Cardiology, How Technology Alone Fails but Caring Relationships Succeed

The Lost Art of Healing is replete with stories about Lown’s relationships with his patients. In his subsection “Some Chutzpah”—Lown was Jewish and the following anecdotes are about treating Jewish patients—there are two stories that are especially telling about how crucial for heart health and recovery are the relationships (1) between Lown and his patients; and (2) between his patients and their family. What these stories evidence is not only how Lown built enough trust with his patients for them to be receptive to tension-producing confrontations, but how Lown had the wisdom and humility to confront himself about a patient confrontation which, even though having a successful outcome, lacked sufficient caring.

In the first anecdote, Lown tells of a patient seeking medical advice for recurrent atrial fibrillation, which had been treated by various antiarrhythmic drugs that were only temporarily successful. Lown probed for psychologically stressful reasons, and ultimately the wife of the patient told him the family secret that the patient had not told Lown. The patient had reported having three children when in fact he had four. This fourth, denied by the patient, was a daughter who had dated a non-Jewish man and then eloped with him. On learning about this, the patient sat shivah (the Jewish mourning period for the dead), had a “nervous breakdown,” and ordered his wife to remove anything of his daughter from their home.

This patient’s medical situation deteriorated, and he suffered a small stroke. Lown had the feeling that the patient “was committing a slow self-immolation that everyone seemed helpless to prevent.” Lown tells us, “I was frustrated, angry at the whole world for my inept helplessness,” and on one visit Lown began to shout at his patient: “I don’t know why I am wasting my time with a miserable human being like yourself. You make me sick with your self-pity, but more so with what you have done to your daughter, to her family, to your wife, to your other children, and to yourself. You are ruining everyone’s life.” Lown would come to acknowledge that it was improper for him to explode out of anger, but that he couldn’t stop himself from telling the patient that if he had any decency, he should, “On bended knee, ask her for forgiveness.”

The outcome of Lown’s outburst? Lown reports, “I heard a loud suppressed sob” and he saw the patient’s huge body convulsing. Lown was astonished when the patient not only showed up for his next appointment but was a different relaxed man. Acting on Lown’s recommendation to apologize and ask for forgiveness from his daughter, the relationship with her began to heal, and ultimately the patient got along wonderfully with his son-in-law and his family. “Incidentally,” Lown adds, “the atrial fibrillation had ceased to be a problem. The same medicine that previously failed to control his heart rate was now keeping it well in check.”

However, despite this great outcome, Lown would later question his own confrontational behavior, “Poor means are never sanctioned by good intentions or justified by good results. . . . Would gentle persuasion over time have achieved a similar outcome? Provoking such a storm of emotion could have done him great harm, physically as well as psychologically. . . . I never again lost my cool with a patient.”

Lown then tells us how in a similar situation some years later, he accomplished positive results without losing his cool. In this second anecdote, Lown tells us about a sixty-year-old man whom Lown was perplexed by his premature coronary artery disease that had resulted in two coronary artery bypasses and one balloon angioplasty, “yet the angina waxed and waned on a substantially hefty medical program.” Lown saw him many times over several years but was “utterly at a loss regarding his treatment,” constantly tinkering with his various drugs but to no avail.

Once again, Lown began to feel he was missing something psychologically crucial. So, Lown pushed harder, asking the patient if he had problems with his children. The patient’s wife attempted to get him to reveal the truth, but the patient told her to shut up because his son had nothing to do with his angina. Lown pushed and discovered that the patient was estranged from his son because he was homosexual, and the patient proclaimed, “I’d rather he was dying of cancer.”

Lown again confronted his patient, but this time kept his cool, relied on gentle coaxing, and told him, “You surprise me. For a decent man whom I have come to respect, your behavior is irrational and even mean.” Lown explained to him that his son’s homosexuality was not sinful but natural and nothing to feel shame or guilt about. The outcome? The patient followed his advice, reconnected with his son, became a different man emotionally, and “for the first time, a smile played across his face.” The patient happily reported having Passover Sedar with his son and his partner, and the patient became active in gay rights. Lown reports that “combatting bias against homosexuality” became the patient’s major social preoccupation, “and his angina had at last ceased to be a major problem.”

Beyond the Obvious Economic Reasons Why Psychiatrists Are Now What Lown Deplored

Psychiatry has moved in the same direction as medicine in general, and for Lown, as previously noted, “The reasons for this shift include a romance with mindless technology, which is embraced in large measure as a means for maximizing income,” and so “It is uneconomic to spend much time with patients.”

This obvious economic reason was the focus of the previously mentioned 2011 New York Times article “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.” Along with statistics, the article features psychiatrist Dr. Donald Levin who once conducted talk therapy but no longer does so, as the Times reported, “Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. . . . now, he often cannot remember their names.”

Unlike apologist psychiatrists such as Awais Aftab, Levin was candid, though pathetically so, “I had to train myself not to get too interested in their problems.” Levin lamented, “I miss the mystery and intrigue of psychotherapy. Now I feel like a good Volkswagen mechanic.”

Levin claimed that, initially, he and many other psychiatrists didn’t want to relinquish conducting therapy, “But one by one, we accepted that that craft was no longer economically viable. Most of us had kids in college. And to have your income reduced that dramatically was a shock to all of us.”

The Times pointed out that Levin and other psychiatrists could have accepted less money and provided time to patients even when insurers did not pay, but Levin reacted to that reality this way, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years. . . . Nobody wants to go backwards, moneywise, in their career. Would you?”

While there remains the rare “exception-that-proves-the rule” dissident psychiatrist, psychiatry is almost completely comprised of disingenuous apologists such as Aftab and candid albeit pathetic drug prescribers such as Levin.

The obvious reason that psychiatrists have abandoned putting time and energy into creating safe, trusting, and healing relationships with their patients is an economic one. However, there are other reasons, and these reasons explain why other mental health professionals who do conduct talk therapy often provide crappy talk therapy.

Many mental health professionals are trained to be technicians rather than provided with the opportunity to discover the craft of healing. It would be an unconventional training program that would teach that the job of a psychotherapist is not to try to fix “symptoms” but rather to help create conditions for natural healing, and that the way to do so is to take great care in creating a safe and trusting healing relationship. When such healing conditions are in place, the barriers and defenses to healing are reduced, and this allows us to become open to feeling cared about, which results in us being more likely to become open to caring about others—and this results in healing.

For Lown, properties necessary for healing, as noted, “find scant sympathy in the current state religion that worships business efficiency,” as these properties such as “empathy, kindness, altruism, benevolence, [and] insight” fall outside of “the scientific equation.” Healing is a phenomenon that cannot be quantified and scientifically measured, and so it does not fit into a mechanical model.

Given the current state of health care—termed by Lown as the “the industrialization of medicine”—perhaps Lown’s most radical characteristic is that he loved his patients, and he knew that such love facilitated healing. No doubt his love for his patients was a very different type of love than his love for his spouse and family members, but he was able to discover a type of love that one can have in a professional relationship. Love is the opposite of fear, and Lown was fearless, for example, detesting and rejecting defensive medicine. Lown knew that love is a deep affection for the uniqueness of another, and a valuing and respect for another. It is a heartfelt concern for another’s pain, and an experience of resonation to another’s being.

In summary, in addition to the economic reasons why mental health professionals have either nonexistent or worthless relationships with their patients, another reason is that many of them lack the talent and wisdom when it comes to the craft of psychotherapy And still another reason is that they lack the recognition of how crucial love of their patient is to true healing; and even if recognized, they often avoid the existential struggle required to discover how in a professional role, love can be experienced and communicated. To be clear, it is no easy matter to existentially sort out how love can be felt and expressed in a professional relationship, and so there are soulful individuals who enter professional training and grasp the importance of love to healing but quit the mental health profession because they cannot resolve this existential dilemma.

Thus it is not surprising why many ex-psychiatric patients, including many Mad in America readers, have contempt for mental health professionals. It is not simply the damage caused by chemical and electrical technologies. It is also because they have dealt with psychiatrists who have spent almost no time and effort to develop caring and collaborative relationships, and they have dealt with other mental health professionals who attempted to be merely symptom-fixer mechanics.

All of this has resulted in ex-psychiatric patient activists, their family members, dissident mental health professionals, and others becoming engaged in a rebellion against dehumanizing psychiatry. Lown predicted the growth of a rebellion against all of dehumanizing industrialized medicine:

“Patients will not acquiesce to the ultimate alienation of being reduced to standardized objects. No one will accept for long being merely identified by their illness, as nothing but an assemblage of broken down biologic parts. Patients crave a partnership with their physicians who are as sensitive to their aching souls as to their malfunctioning anatomy. They yearn not for a tautly drafted business contract but for a covenant of trust between equals earned by the doctor while exercising the art of caring.”

Today, the Lown Institute works toward a health system “that rejects low-value care, incentivizes healing over profits, promotes health equity, and honors the value of the clinician-patient relationship.” In addition to many other projects, each year the Lown Institute acknowledges investigative healthcare journalism by conferring the Shkreli Awards “documenting the worst in healthcare dysfunction & profiteering.”

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46 COMMENTS

  1. That is interesting, and possibly quite telling. That your ability to reflect on the possible harms, is through someone you imagine is like you a bit, a cardiologist. But I do understand why for you it is difficult to approach it any other way. Either that, or the more common reason, your ticky ticker is acting up again. aaaand you are feeling a bit uneasy, so a nice sad essay to gain courage. Sound ok to you?

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  2. At the risk of cherry-picking and raining on somebody else’s parade, I’ve got to zero in on one particular statement in Dr. Levine’s exposition here: that psychiatry’s armamentarium consisting of, “drugs and electrical treatments,” do nothing to, “save lives,” and “advance the quality of life,” for mental patients. If this sentence wasn’t being used as an aside in this otherwise superb essay, it would be laughable. Psychiatry isn’t an abomination because of its use of technology, it’s an abomination because of its permissiveness towards drug companies, the news media, television networks, and scriptwriters in Hollywood. Here, I speak of the problem of stigma. That has nothing to do with technology. As it turns out, it has everything to do with treachery and intent.

    It’s only been very recently that I learned of a huge obstacle facing lawyers working to better our lives: that of nothing more than a mere trickle of philanthropy made available for litigation. Lawyers can’t be expected to work for free, and it’s ironic that the very same reason why it’s so hard to extract money from otherwise would-be benefactors is because of stigma, too. Aren’t we talking then about a question of priorities amongst lawyers?

    I want to see an investigation conducted into the exact nature of the relationships between the drug companies on one hand, and the news media, the TV networks, and scriptwriters in Hollywood on the other. Are all of those people being paid off from the drug companies’ largesse for their very-public slander of us?

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    • In an indirect way it does. it advances their life a little more rapidly into forgotten history. But the idea of lawyers is a good one. But it’s tricky. As a satyr, you could be the little joker in the middle, trying to deviate away from the actual point. Keeping the pipes working is another subject, but I get why you are here as well. Personally, Golden Showers are not my thing.

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    • I’m not sure I get your point.
      I think it’s obvious that psychiatrists don’t know what they’re doing. All the drugs and technologies in the world, and all the confidence boosting in the world could not change this basic fact.
      Further, if they wanted to know how to do their jobs properly, they could find out. But they don’t. So on top of everything else, they are arrogant and self-aggrandizing.

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      • Obvious is partially an understatement. My amateur fable 10 minutes of fame. The retired pharma exec can prepare a smashing dinner, at least his wife is the perfect host or hostess. After dinner is usually a mess. Cards anyone? Blackjack, poker? Risk, Monopoly perhaps. The evening drags on until its time for bed. The Psychiatrist, the first 4 years is usually a breeze. Then the gruelling stuff begins. Need I say more?

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    • I have a JD but chose not to practice because the drugs would have made me a bad lawyer. I probably could have still been one. There’s no shortage of bad lawyers.

      The question comes with lawyers is that clients are chosen based on a mathematical equation. The likelihood of a high settlement and little work out put.

      It is a denial of justice for people with complicated cases as attorneys will not accept them as clients. Even more toxic is a client targeted with a DSM diagnosis and history of being in “the system”.

      So many people are never going to get the justice they deserve. Not because they have a weak or real case. They’re denied based on the mathematical equation lawyers work with.

      I have no love for psychiatrists. I have even less for lawyers. The legal system became about procedure and not justice and without counsel there is only misery.

      Please go to family court one day and watch the victims of domestic abuse get emotionally raked over the coals of an unjust justice system, mostly because of your attitude.

      Law, like medicine, is about people in need. People hurt. People often in crisis. Often lawyers fail to see the psychology of the opposing parties and lose the case for their clients.

      If I sound bitter from the experience, I am. However, I did work as a clerk and legal assistant during school enough to know you don’t become a living heart donor when coming to work.

      Talking to clients, as the cardiologist talked to his two patients, often pays off too. Had I not had a similar discussion a small case wouldn’t have turned into $100,000.00’s of dollars.

      Listening and being kind and talking with people makes you a better person, doctor and even a lawyer.

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    • Still missing the main point.

      Law says you have to have a good chance of winning when putting your case forth.
      It is mostly impossible to win psychiatry cases based on side effects and adverse effects of drugs and treatments. Great harms have to happen for any action to be taken.

      All that said, trying to prove a DIRECT TEMPORAL CAUSE is just about impossible.

      Psychiatry, Research, Pharma, phaRMa, et al., and their Associations, Insurers, Legal teams, learn from each litigation event, how to get away with things moving forward.

      Class actions might be an option – if the person meets the specific criteria.

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  3. I just had a grand idea. As proof of mad in americas sincerity as to its stated mission, a competition. Bob, the two of you and the the guy that mediates here each do a karaoke version of Motorhead, The Ace of Spades. I am curious, but I do have a feeling I know which one of you will take first prize. However you wish to interpret the prize, is up to you.

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    • You need to read Bruce E Levine’s books and listen to podcasts he has been on in the past to fully appreciate his work. He is one of the best advocates and allies we have in promoting the rights and safety of those of us who have been labeled ‘mentally ill.”.

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      • Don’t take the label. You can take the treatment if you want. But don’t take the label.

        Whatever is written in your notes is for financial benefits, funds, claims. That’s a legal way to change diagnoses whenever it suits the author.

        Go label free.

        Some people like the label because it brings them benefits, privileges, accommodations.
        The psych. Drugs’ risks and adverse effects aren’t worth having a label for.

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  5. An even more important relationship is between the being and its body. The being, if elevated enough in tone (some call it “frequency” or “vibration”), is capable of healing the body (and the mind) in ways that no drug or technology ever could.
    And this is why human relationships are so important to healing. They help give a person a more positive outlook, more confidence in themselves.
    A being is perfectly capable of using drugs or technologies to its advantage, when it can, but these mostly get in the way, and using them tends to invalidate the healing power of the being (the person, the patient.)

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    • Certainly upping the frequency is a good tactic. You need friends to do that. So, you made your point. I’m not against that at all. So that we don’t all get confused, I am talking about the real victims, think someone who is locked up right now, I am not by the way, who needs help and no one is listening.

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  6. Now I have to admit, I didnt read the article, as usual I “jumped the gun”. In any case, i noticed the bands / singer songwriters were all Uk based. So I have a few alternatives. Alice Cooper “i’m 18”, ZZ-Top (you choose the song) or the Late and great (from the Velvet Underground, Lou Reed, not sure) song “take a walk on the wild side”. Thanks for not blocking my comments.

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  8. What is healing?

    What is it to be made whole?

    What is it to become whole?

    What is it to be whole?

    Is it to be….shameless?

    Is anyone, ever?

    Heartfelt thanks for yet another superb essay!

    Comfort and joy!

    Tom.

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  9. Psychiatry is a division of the entire medical industrial complex. Human health has been increasingly monopolized by big bizzness medicine from the get-go, when big oil slapped on a humanitarian front to sell snake oil petrochemicals to a patient public as palliatives to maintain a servile labor force for capital to exploit, including as a permanent customer base for its poisonous products. It’s only a logical extension of the essential pathology of power under which we live, and die like so much useless equipment left for the junk heap, that insult should be added to injury in making money all the more from our misery in the name of our own welfare. The so-called technical advances of today simply represent the latest means for the few, like tech oligarchs, to parasitically prey off the many for their own gain at our expense (‘The AI doctor will see you now…’).

    Disciplinary discourses may make for fine academic distinctions when no real difference should be drawn between myths of mental illness and superstitions of medical science, massively funded charlatanry of made-up diseases from fictions of germs and genes that misdirect us from the unhealthy socio-ecological conditions of our captivity to capital rule. The very idea of finding real relations – if you’re lucky and can afford the entry fees – to this three-ring circus of illusion is already a lie sold suckers born every minute in a social system of abuse and organized crime against humanity that extends from cradle to grave.

    Professional servants to this slave system stand tallest, often enough arrogantly so, as the biggest suckers of all behind their masks of respectability. They represent the successfully trained managers of bizzness as usual, indoctrinated in ruling institutions of higher (l)earning to administer cures worse than disease in any monopoly of knowledge as power over masses kept in chains of ignorance and uninformed consent to noble lies. Dissidents may break ranks in theory while in practice generally remaining loyal critics when it comes to responsibility to others that transcends their own group identity in the hierarchical, command-obey relations of the pyramid of power, to which they can be comfortably oblivious, perhaps believing some fairy tale of gradualist reform to machinery of production and profit for no more than to make a killing on the market. When it comes to Health Care, Inc., this is literal reality, as its iatrogenic harms to health, makes it the leading cause of death, beyond cancer and heart disease (themselves covering up medical causes), among what (little) counts in the official record when its numbers aren’t doctored.

    If we want real relations that heal and make us whole in substantial and enduring ways of life among us, we will have to revolutionize society so we may become ends in ourselves rather than means to the madness of monsters. Otherwise, life is little more than a wager to get lucky a little longer in a game of Russian roulette.

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  10. I have worked at several different clinical mental health clinics in the past 8 years, mostly as a case manager, sometimes as a therapist. One was a way to cultivate deep relationships, the other very much was not.

    Case management work is ‘community based’ and very intensive. You would be meeting people in their homes, at their jobs, or at homeless shelters or wherever they happen to be, and primarily helping them navigate complex and broken benefits systems- tracking down documents to submit to the welfare office for their state insurance, rummaging through mail to try to find the original notice about missing documents which was why their SNAP/food stamps were cut off, emailing their housing specialist about their subsidy payments and how much of their portion of their social security income is due to rent, etc. In my experience this model and intensive collaboration with the ‘client’ as we call them, is more conducive to having a genuine and positive relationship with that person, where you genuinely get to know them and their struggles. I would often see people much more than an hour once a week (as is the standard for talk therapy) and would often drive them places, as most people on my caseload didn’t have cars.

    By stark contrast, when I talked to therapists at my same agency, and transitioned to working as a therapist at a different agency, it felt like therapists were living in la-la land with regard to knowing what the people they were seeing actually needed. Community mental health clinics only see people with Medicaid/state insurance so by definition everyone you see is living below the poverty line . A lot of therapists I worked with were completely ignorant to the actual realities of this kind of existence. They were naively and proudly writing treatment plans and ‘tracking symptoms’ and talking to the person about their anxiety or their depression, and so eager and proud to use whatever modality they were obsessed with like CBT, DBT, or Acceptance and Commitment therapy. They would be so proud of themselves to integrate teachings of mindfulness and deep breathing. They would tell people to make sure to take their meds and keep meeting with their psychiatrist.

    Additionally, even if as a therapist you really wanted to have deep meaningful conversations getting into the stuff people really needed to talk about, you barely had time. The Medicaid rules for behavioral health treatment are so documentation heavy we often ruefully joked that we had to spend more writing about what we were doing to help the person than actually helping them. When I was a therapist, 95% of all my appointments were telehealth, and we often spent 15 minutes of every session trying to tech-support the person to digitally signing forms that they had to sign every time- not to mention another 15 minutes completing the required screening questions – the patient health questionnaire and the suicide screening assessments. We also had to work on time intensive and detailed treatment plan updates. Then we had to write equally intensive progress notes for the session. We usually would work on them during the session, because due to all the paperwork and person wanting to actually talk about what was bothering them, the session would run the full hour, leaving no time to actually do any progress notes after, especially if you’re in back to back sessions all day. You also can’t bill for writing a progress note separately from the session, and we had productivity billing requirements to be seeing clients for sessions at lease 65% of our working hours.

    Meanwhile the person a therapist is seeing for talk therapy could mention an electricity shut-off notice, or losing their SNAP benefits, or not having a car to get anywhere, and I have seen that generally the therapist would not help with these crucial issues at all, even if they were the only official ‘helping’ person in their client’s life. At most they would provide the number to whatever office managed the benefit, or they might provide the phone number to the utilities assistance program. I don’t think they understood how for these individuals, trying to even navigate calling any of these programs was overwhelming and they usually couldn’t stand to even be on hold for more than five minutes or navigate phone menus (‘press one for account management, press two for other issues’ etc).

    Anyway, therapists are very much trained to, and often proud of, being ‘symptom technicians’, tinkering with the mechanics of the brain via targeted interventions, instead of cultivating a deep and meaningful relationship with the person. My work both as a case manager and a therapist feels very reminiscent of the patient stories discussed here, of fractured families and turmoil weighing on people to the point that it affected their physical health. If having estranged or disowned adult children can exacerbate heart issues, imagine what the effects of systemic and oppressive poverty, unstable income, lack of transportation, disjointed and confusing benefits systems, and housing insecurity can do for both mental and physical health. One hour a week of therapy focused on correcting your distorted anxious thoughts or answering questions about how bad is your depression this week from a scale of 1 to 5, is such a bandaid on a shotgun wound.

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    • This is a great write-up; almost an article in itself.
      Most of the “clients” you described didn’t belong in therapy. Not because the didn’t need help, but because therapy could not help them in the condition they were in.
      A case manager (used to be called a “social worker”) would be about as much help as they could get. And most social workers are not trained well, either.
      I guess a lot of people think they can help most when a person is in their most desperate condition. Emergency doctors work that way. But mental health – even getting someone’s life in order (which I would call an “ethics handling”) – doesn’t work that way. When they are most desperate they are the least rational and the least able to cooperate.
      It’s a shame, because it does limit what we can do to help each other. When a person is in bad shape (emotionally, not physically) I am trained to administer “assists.” But those require a high degree of command strength which I cannot always muster.
      So we also need to use the strategy of discovering and exposing the people who are causing all this suffering, and doing something effective about them. This is more of a justice action than anything else. It only spills over into the field of mental health because the people we are trying to expose are insane, and thus you would think that “mental health professionals” could be of some assistance. But unfortunately, too many “mental health professionals,” especially those in key positions, are also insane and are part of the problem.
      Real mental or emotional healing usually requires a calm space to work in and a relatively calm and healthy person to work with. The insane among us are doing the best they can to deprive as many of us as possible the chance to heal. They know that a more able population would diminish their ability to rape and pillage.

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    • Now that’s some truth telling Katie. I am personally grateful for your framing of therapists as “symptom technicians”, the exact term/wording I’ve used in MIA comment sections for several years. But that you said therapists are “proud of being” symptom technicians, is deeply troubling, though not particularly surprising to me. You’ve effectively outlined a mental healthcare system whose ‘entire’ infrastructure is designed to manage people as vassals of universalized psychiatric designations (diagnoses), rather than individuals emanating from complex systems (developmental and social structures) and relationships over their respective lifetime.

      As social psychologist Lynn Layton wrote in her book, “Toward Social Psychoanalysis” bourgeois (PMC) ideology operates by dehistoricizing and universalizing people and history so as to propagate its class interests as the self evident laws of nature ( a distilled explanation from several dense passages). I reference Layton because I believe the primary institutional function of a psychiatric diagnoses is to dehistoricize and universalize people , that, if actual critical, social, and reparative “therapy” were provided, not only would the vast majority of people’s issues (challenges and distress) be helped, they would feel and be more empowered by the conscious raising of self awareness ‘in relationship’ to the more objective conditions (structural power, dysfunctional relationships, vast contradictions, bullshit, etc.) in their lives and others, that were previously internalized (unconscious). That todays therapist really believe they are helping people through symptom management, is, in my estimation, not only contributing to a sicker society, its actually a form of passive and regressive oppression upon any therapists (and the larger profession itself!) who practice this form of social control. The question I have is, why would someone like me, with no education and training in mental health disciplines (save a couple course electives as an undergrad), understand these dynamics, and not an educated mental health professional?

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    • Yes Katie that is / was a great description of many community mental health centers. The case manager role was created in New York State perhaps with NAMI help and the zine Community and Hospital Psychiatry had several articles on that in the early 1980’s. Case aids we’re part of Hospital
      Social Service Departments from what I know post WWII for a time. One would have to go back and research Ida Cannon and Mary Richmond’s work in social services. The centers were not social work/ settlement house based though things leaked in. Many centers at least early on had cats. Client and staff roles merged at times so in some places as in Lancaster Ohio the community mental health center still back ten years or so ago a peer/ professional base.Pat ? I think was part of the survivor movement. The peer workers I knew all said they had issues with being used a mere cogs in the system and not as integral and at times their perspective not honored. All depends on the county boards ( source of many things ) and county levies monies and who is hired. Sone states have both d
      and mh tied in together with levies some not. Children services also a huge huge issue. So again from Settlement House efforts to Fresh Air Camps, from the Orphanages to Foster Care and the orphan trains. Child Labor issues documented by Jacob Reiss and his camera. All just waves of this and that and never a strong strong wave of change that is so so much need and I would say tsunami at this point. Quaker moral treatment a good idea but they didn’t realize muchlike the MBA CEO and CFO s of any support agency not all folks are able to get better or improve the way a machine does. And the concept of we all are survivors of many things and more than one crisis in life is essential.

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  11. Katie Dempsey, should ai ever feel an acute need to restore my faith in human nature, I know I need only come back to reread the above: Thank you!

    I don’t know if you’re familiar with the work of John E. Sarno, M. D., or, more significantly, of Professor Howard Schubiner M.D., who was inspired by him, in relation to psychosomatic conditions, chronic pain states, “anxiety-depression” (or being human), insomnia, fatigue, “brain fog” etc., but, if not, I think you’re in for a treat better than all the CBT, DBT, Acceptance and Commitment and mindfulness therapy can offer you or your colleagues.

    Nor do I know if, a couple of thousand years or so ago, that Jesus of Nazareth character actually lived and breathed and ate and drank and pissed and shat and actually said/counseled something to the effect of

    “Be you whole/perfect, even as your Heavenly Father is whole/perfect,”

    meaning, “Please, like a good chap/chapess, realize that there is damn all wrong with you and never was, and that, as Consciousness expressing itself and becoming conscious of itself, you are all that you need to be, now, and any notions of “sins” you ever thought you had were actually fore-giiven you, too, of course,”

    but I happen to believe he probably did all seven.

    You seem to me like a nicer person than he, Katie.

    As you have listened to some folks, at least, obviously aching to be able to do SO much more to help them materially, physically, emotionally, psychically, please know that even the most drugged/demented of them cannot not have sensed yor love and, to the extent that they did, sensed, too, that they, like you, were and are all they need to be.

    Thank you for convincing me that we all must be, and that I am, too – as are all those responsible for the deprivations suffered by your “clients,” for NOW.

    I believe it’s about Min 37:59-38:09 of this,

    https://youtu.be/qINdA6E14Sk?si=qAbQy1ZVlhAkqN7c

    that Howard explains that he’s (just) a “faith healer,” as we all can be – through listening with enough love, as Bruce reminded us above.

    Thank you, Katie Dempsey.

    Tom.

    ‘…I don’t want it to end, and so, as every therapist knows, the ego does not want an end to its “problems” because they are part of its identity. If no one will listen to my sad story, I can tell it to myself in my head, over and over, and feel sorry for myself, and so have an identity as someone who is being treated unfairly by life or other people, fate or God. It gives definition to my self-image, makes me into someone, and that is all that matters to the ego.’
    Eckhart Tolle.

    But, if someone DOES listen lovingly enough to “my problems,” of course…

    https://youtu.be/lyUxYflkhzo?is=NSfv6mVvckJiKFXy

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  12. Medicine’s obsession with technology is real; visit your physician and while you are talking they will probably be reading their computer screen. The situation is exacerbated in Canada (don’t know about other countries) by the creation of “standards of care” developed by bureaucrats that push all physician decisions in the direction of one-size-fits-all solutions, the very opposite of concerned, patient-centered care. As for psychiatry, it has long failed to realize that diagnosed people are often the canary in the mine, and always part of a larger social dynamic. The perceived dysfunction of one person does not develop in isolation and is always a reflection of their experience, including their reactions to significant others in their lives. Because it attempts to diagnose people in isolation from their lives, psychiatry could never succeed, even if it was not beholden to Pharma and in turn to false premises which are its foundation.

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    • Standards of care are definitely a part of the U.S. medical system. They seem to have been created as a defense against malicious malpractice litigation. But they have become a justification for failing to help the person in front of you.
      As far as mental health goes, research has shown that there are many conditions that are only loosely – if at all – connected to the current social environment of the patient. That research, however, is almost totally unknown in Psychology and Psychiatry. And if they knew it, God knows what they would do with it. The distress caused by non-optimum social environments should not be part of the field of mental health, but of education, charity (social welfare), social justice, law and politics. All these fields have severe failings that they would like to blame on the “mental health” of their publics. They all need to rise to the occasion and help solve these problems. Psychology and Psychiatry are not here to handle them and will fail to do so.

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    • “Because it attempts to diagnose people in isolation from their lives,”
      Psychiatry does the opposite – it creates a psychiatric version of everything that happened or is happening in people’s lives, and then they are isolate with mind altering, emotion blunting, physiology changing drugs.

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  13. Dr. Levine has reminded us that the problems we deal with in the so-called “mental health” field also exist in traditional medicine. We tend to consider psychiatry an outlier for the obvious reason that it has no legitimate medical basis.

    Much of the criticism of health care focuses on the lack of access, that is, the millions of Americans who either have no health insurance, or have paltry insurance that is inadequate to protect their health.

    But medicine has traded its soul for a bunch of laboratory tests and drugs. The medical specialties set standards of care with committees stacked with doctors who have serious conflicts of interest with drug companies. Then the hospital systems track doctors to ensure that their patients meet the targets, which keep expanding to cover more and more people. Doctors are now financially rewarded for putting their patients on all kinds of drugs for cholesterol, blood sugars and blood pressure.

    While it would help if medicine were to form a committee to examine whether psychiatry has a legitimate place within it, it would not solve the myriad problems posed by the reduction of humans to whatever numbers show up in their lab tests. Are medical schools simply producing doctors who will end up doing the bidding of drug companies in their practices?

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    • Receiving medical care is the third leading cause of death in the USA. Not errors, but receiving medical care of any sort. The majority of the deaths (over 120,000, as I recall) were from side effects of properly prescribed and properly administered drugs.

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    • I rather vigorously agree with you. We question psychiatry here because it is so blatantly off the rails. And many of us still have fond feelings for our (medical) doctors. But the whole broader profession – and you can even extend that beyond the realm of Medicine if you want – has compromised itself to corporate interests and really failed to carry out its true purpose and calling. That is now close to possible here on Earth but the business tycoons who live off human suffering don’t want to hear it. We now have the task of humanizing the whole activity. It includes Medicine most alarmingly, but also Law and Politics. Even Physics and Biology are affected. There seem to be a lot of people who have forgotten they are human and someone needs to remind them that they are.

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    • How could such a committee not result in effectively the same outcome from the FDA panel convened to examine antidepressants in pregnancy-as covered by Robert Whitaker in Aug of 2025? Given the APA’s rigorous defense of perinatal antidepressants-despite the panels compelling counter-indicated findings, I’m hard pressed to believe the medical establishment would change course when the entire institution of psychiatry were in question. Sorry, wealth and power and the politics therein, rule our institutions, not science, not facts, not ethics or moral concerns, and no committee-or any organization-is going to change or alter that fact. To my mind there’s no daylight between the AMA and the APA et al. In fact, I’m not so sure there’s any substantive daylight (ideological, moral, etc.) between the APA and the Pentagon, err… excuse me…The Department of War.

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  14. Soon, we may learn to forego so very many of those drugs, I believe.

    Mainstream medicine may seem to be taking forever to change course, but it is changing:

    “One patient who vividly conveyed to me the connection of old trauma to hypertension was Anna.

    At forty-nine, Anna had severe hypertension that even five medications could not control.

    She had been seeing me for five years when she began to suffer recurring nightmares about being attacked. Seeing me six weeks after the nightmares had begun, her blood pressure was extremely elevated at 250/140. In response to my questions, she acknowledged having been raped by close relative when she was fourteen, an event she had forgotten about until she recently met the adult son of the rapist. His striking resemblance to his father had triggered the nightmares. After her emotional disclosure, the nightmares ceased to enter blood pressure plummeted overnight to 110/80, and remained under control on just two medications. I report this striking case in the journal Psychosomatic Medicine (Mann and Delon, 1995.)”

    So wrote Samuel J. Mann, M.D., in Chapter Five, Page 204 of “THE DIVIDED MIND The Epidemic of Mindbody Disorders.”

    That chapter begins:

    “Samuel J. Mann, M.D., a physician and researcher, an associate professor of medicine at the renowned Hypertension Center for the New York Presbyterian Hospital-Weill/Cornell Medical Center. His work, which encompasses both medical and psychological aspects of hypertension, has been featured in the New York Times and other publications. He lectures widely and has published many articles in professional journals. He is the author of a book on the mind /body connection of hypertension, Healing Hypertension: A Revolutionary New Approach (Wiley, 1999).
    Dr Mann’s chapter is included in this book because, to my knowledge, he is the only expert in hypertension who has established the fact that a significant number of people have high blood pressure due to repressed, unconscious emotions.”

    Mann says that that chapter is like a short version of that book of his, and writes “I believe that psychological factors provide an explanation for about 20 to 25 percent of [cases of] hypertension.”

    He says “Studies show that up to 40% of hypertension is determined genetically, and up to 30 to 40% is determined by lifestyle factors such as diet, weight, salt intake, lack of exercise and alcohol abuse.”

    My opinion is that when people are less stressed, worried, anxious, fearful – or more enlightened – they may be expected not only to be more mindful about what and how much they eat and drink, but also become instinctively drawn towards foods and drinks (including sodium intakes) which are more likely to promote physical health and general well-being.

    And, as illustrated again by the above anecdote, if it is true, the very act of compassionate listening may have very dramatic effects indeed.

    Thanks, again, to Bruce for such a wonderful essay!

    Tom.

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    • Psych. meds and the like, cause psychiatric disorders by altering human brain functions and body systems and behaviours.

      Drugs are the cheapest option of treatment to be given.

      Calibration of machines if wrong, causes harms.

      There is no care to be seen and or felt.

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  15. Bozolandia. The Final Cut. 600 “peaceloving” hippies wander off into the woods and find a dark cabin. Inside there is a trapdoor. Each take turns defecating in it. The final remake of Evil Dead. Parody on real life. With just a touch of sparkling dust. Do you like it? Now this in no way implies “which side” or anything, so forget that.

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  16. Either Bob is asleep again, the sheriff is out of town, or you have really blown a gasket. So the only song left for you Bob, to sing along to, is the 70’s AKADAKA vibe, HIGHWAY TO HELL, horns included. As an “after” thought, if you like, you can call me Uncle Remus. Bwahaha

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  17. ‘I don’t, though I’m not sure where Bob comes down on that question. I try to always put “mental health” in quotes if I do need to use the term. “Behavioral health” is even worse.’

    So you wrote above, Steve McCrae,

    thank you very, very, very, very, very, very, VERY much, indeed.

    But, actually, “behavioral” health is kind of up there with “double depression,” “hyperreligiosity,” “gambling disorder” (…or “bad luck,” as Szasz called it) and, though I’m still waiting for it, “personality illness,” a bit like the Cosmos sending us more and more hyper-enlightened, magnanimous , noble, self-effacing, people-loving political leaders, as though to say,

    “Hey, you guys, do we get it…..YET?”, and forcing us to go beyond Democracy to live Love?

    https://youtu.be/LL2RS7SjHoY?is=z-YVijxhCfZN7Vk2

    One of the many wise women, all of them perfect strangers, of whom I very sincerely if not always too solemnly enquired

    “What is the meaning of Life?”,

    after giving me the usual enlightened “Huh?!” which once more failed to enlighten me into offering her other than a repetition of my question then asked

    “How d’you mean?”, which, now I think of it, and get it, ?ten years on, was very funny, too, but to which I replied, sincerely if not over solemnly:

    “I mean, OBviously, we are here to learn lessons, lessons and lessons and lessons and lessons and lessons and the more freaking lessons, but do we ever get to USE any of these freaking lessons – I mean, for freaking ‘God,” or any freaking thing, I mean?!”

    At this, the lady (a retired attorney, as I think I discovered) laughed, which meant we were obviously making progress.

    “Well, ONE thing’s for sure,” she laughed.

    “Oh! And what’s THAT, please?”

    “The lessons get harder until we GET them!”

    They do, too, don’t they?

    But maybe it’s always just the same lesson in different disguise, the old “Where the **** is your sense of humor?” lesson?

    And maybe all “mental illness” etc. is just loss of humor, again?

    Helps me to see “mind,” itself, if defined as our thoughts and emotions, as the disorder, the devilishly humorlessly overprotective surveillance product of millions of years of predation…until we are not forced to evolve to stop taking it so freaking seriously. Thank YOU, Eckhart Tolle.

    “The human condition: lost in thought.” – Eckhart Tolle in his “Stillness Speaks,” possibly the funniest ever (joke free) book that ever was or could be and worth more than every other book that ever was or could be, all out together, like one slim human hitchhiker’s Guide to Reintarnation on Planet Dirt which they going out after each of us as we hit this planet’s atmosphere but burned up on entry…only to rematerialized with Tolle’s “The Power of Now” etc. in recent years…when we needed the lessons to get easier, again?

    Ever tell you how much I love you, Mr Steve McCrae, and Bob for never leading us TOO far astray?

    Wishing you mirth, and ever more,

    sincerely, Tom.

    And T H A N K you!

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