Flaws of the psychiatric system

“The drug revolution that started out with so much promise may in the end have done as much harm as good. The theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs has become broadly accepted, by the media and the public as well as by the medical profession. In many places drugs have displaced therapy and enabled patients to suppress their problems without addressing the underlying issues… The SSRIs can be very helpful in making traumatized people less enslaved by their emotions, but they should only be considered adjuncts in their overall treatment… I have come to realize that psychiatric medications have a serious downside, as they may deflect attention from dealing with the underlying issues. The brain-disease model takes control over people’s fate out of their own hands and puts doctors and insurance companies in charge of fixing their problems...

Consider the case of antidepressants. If they were indeed as effective as we have been led to believe, depression should by now have become a minor issue in our society. Instead, even as antidepressant use continues to increase, it has not made a dent in hospital admissions for depression. The number of people treated for depression has tripled over the past two decades, and one in ten Americans now takes antidepressants...

Because drugs have become so profitable, major medical journals rarely publish studies on non-drug treatments of mental health problems. Practitioners who explore treatments are typically marginalized as “alternative”. Studies of nondrug treatments are rarely funded. Mainstream medicine is firmly committed to a better life through chemistry, and the fact that we can actually change our own physiology and inner equilibrium by other means other than drugs is rarely considered.”

(Bessel Van Der Kolk M.D., The Body Keeps the Score)

Some people might not agree with the message of this piece - and that’s okay. I’m not writing it for them. I’m writing it for the previous version of myself, 3 years ago, who was so swallowed up by anxiety and depression that she thought she was wholly defined by it. The self who had been in counseling for two years and had spent hundreds if not thousands of dollars but couldn’t see any marginal improvement. The self who didn’t realize that there was an entire other world of healing modalities available that she had never even heard of.

You really have to go “underground” in a sense if you want to explore different options. The medical system and pharmaceutical companies have done a really good job of placing alternatives in a negative light. They’re conscious of the language they’ve chosen, even using the word “alternative” gives negative connotations. The skeptics brush off these alternative treatments due to lack of research without considering the fact that the only reason they haven't been thoroughly studied is due to lack of financial incentive, not because they don’t work. But this is by no means a conspiracy piece. And let me just preface this by saying, if you are on medications for your depression or other mental health issues, that's great. Do what works for you. I am proud of you for doing what you needed to do in order to survive. But if you’ve been taking antidepressants and not engaging in any other forms of healing, you will not fix the underlying issue, because it was never just about a chemical imbalance.

I’m tired of the narrative that I see so prominently that cognitive-behavioral therapy (CBT) (aka talk therapy) and the prescription of pharmaceuticals like SSRIs are the only two options available for people who need help with their mental health. It’s great that mental health is being destigmatized and people can speak openly about their struggles and medication - but the issue that I have with it is it’s become the go-to course of action with no further inquiry into the root causes of our afflictions. And I can understand this, because I tried to do the same thing myself.

At a particularly low point, I asked my doctor about options for my crippling anxiety. She suggested a group therapy program, for which I said I was too busy (I was a full-time student at the time, working two jobs - this was my excuse), so she wrote me a prescription instead. For whatever reason, when it came down to it I couldn’t bring myself to fill it. I’d seen someone close to me become dependent on medications to a point where she barely knew who she was, and a part of me was afraid of following in those footsteps. I didn’t want to lose myself. With that in mind, it seemed safer to continue suffering instead because at least I knew what to expect. The suffering was familiar to me, maybe even comfortable. But that was how easy it would’ve been to get on antidepressants and not do any other form of work on myself. And once again, I get it. It’s natural for people to want to look for “quick fixes” to their problems. But that doesn’t mean that quick fixes will actually work for most people.

I think it’s also human nature to want to label our behaviour so that we can remove ourselves from it in a way… allowing us to relinquish a certain degree of control. “It’s the damn anxiety again, taking over.” And by tying our identity so closely with this label of ‘mental disorder’, I’m left wondering if at some point it becomes a bit of a self-fulfilling prophecy. We can’t possibly see any way out of it, because it’s simply who we are. Did a time before the anxiety ever exist?

We search for help in the place we’d hope to find it: the medical system. When we receive a mental health diagnosis, a part of us is relieved to be placed in a designated category. It can provide a sense of hope, and a solution for some.

But we settle into this label, using it to define who we are. It becomes an excuse for the qualities and behaviours we dislike about ourselves; something we can use to relate to other humans who feel the same way. Who doesn’t love a relatable depression meme? As humans, we love labels. Job titles, relationship statuses, introvert vs extrovert, anxious or depressed. Sure, labels can be helpful at times, but they are not who we are. They are incomplete. They ignore the underlying causes. They overlook the varying degrees of trauma in all of us that we need to work through. It is rarely considered that we can actually heal rather than simply treat the symptoms.

Unfortunately the majority of us will never do this work because we think we are destined to be anxious and depressed forever. We have no grasp of the possibility that we can live a different way. Our anxiety has become a sense of comfort to us because it’s familiar - we’ve gotten really good at being anxious. It’s second nature at this point. Of course it’s easier to slip into good ol’ isolation mode rather than actively choose an alternative. I know this because I’ve been there. We’ve learned to protect ourselves through disassociation, anger, and anxiety because we don’t have any other tools to cope with our pain. A diagnosis and prescription is often the final step in our short journey to feel better.

In The Body Keeps the Score, Van Der Kolk discusses the imprecision of psychiatric labels. He and a team of trauma experts voted to change the DSM (Diagnostic and Statistical Manual of Mental Disorders) in order to include Complex PTSD, a new trauma diagnosis for victims of interpersonal trauma. In the end, much to their surprise, the diagnosis did not appear in the final version of the manual. To this day, after twenty years and four subsequent revisions, the DSM and the entire system based on it fail victims of child abuse and neglect.

Van Der Kolk asks, “How do we treat people who are coping with the fall-out of abuse, betrayal and abandonment when we are forced to diagnose them with depression, panic disorder, bipolar illness, or borderline personality, which do not really address what they are coping with?”

So if these labels are incomplete, and the treatments are not actually helping us uncover the root cause of our problems, where does that leave us?

With hope! Because it means we get to stop being a patient and become an active participant in our own healing journeys.

We know that trauma is stored in the body. For this reason, no amount of cognitive thinking and talking about our trauma alone will help us. We have to allow ourselves to work through our triggers and feel the pain as it comes up. Talk therapy works for some, but in my opinion it is an incomplete modality. It’s outdated. Psychotherapists often go on to publicly say they didn’t learn anything about complex trauma in their many years of education, one prominent example of this being The Holistic Psychologist. Dr. Gabor Mate, a medical doctor, also speaks openly about taking on the role of therapist for his patients because he didn’t trust any of the psychiatrists he knew to effectively work with trauma. Today he is one of the most respected leaders in the field of trauma and has never taken any sort of psychotherapeutic training.

This might seem confusing, and I know it can be difficult to know where to begin. The good news is, there is plenty that we can do on our own. This is the entire premise of the “self-healing” movement. This functions by fostering deeper levels of self-awareness. I truly think self-awareness is the greatest key to gaining control of our psyche and our lives. My recommendations for beginning to deepen awareness are to start a journaling practice, read books about trauma and self-acceptance, watch documentaries. Maybe take some psilocybin mushrooms if it’s safe for you to do so. Expand your perspective. And when you’re ready to go deeper, that’s when you should reach out for guidance.

I used to think I could do it all on my own, but there is so much power in allowing ourselves to be seen and experience healing in a relational setting. In one of my recent Compassionate Inquiry practice sessions, the simple act of having what I said repeated back to me, with a clear understanding of where I was at and what I meant, unexpectedly brought me to tears because it’s so rare that I feel truly seen and understood for my truth. So let’s never underestimate the power of bringing someone else into our process.

For anyone who thinks they’re ready to take that next step, there are a plethora of therapies and treatments that aim to work with the body. Here are the names of a few options worth exploring:

EMDR therapy, Somatic Experiencing, Compassionate Inquiry, Craniosacral Therapy, Focusing, Authentic Movement, Sensorimotor Psychotherapy, Hakomi, Gestalt Therapy, Bioenergetics, Psychedelic Therapy, Trauma-Informed Coaching, Mind-Body Medicine (meditation, breathwork, yoga, hypnotherapy), Shamanic Healing, and many others.

There is no one correct or “best” option, as we are all different. This works in the same sense that we cannot claim that talk therapy works for everyone.

While these are the names of well-defined modalities in trauma work, I’d like to add one final note about the tendency for people to believe those with more credentials or letters behind their name will be the best help they can receive. On a personal note, my deepest work and greatest realizations have happened in the presence of people without PhDs. This is not to say that the Instagram influencer with zero experience should be holding space for you to process deep trauma, but let’s not be so quick to dismiss those who received their education in the school of life rather than that of institutions. Typically, they’ll be able to relate to you on a much deeper level, because they’ve actually been through their own process and that is what motivated them to get into the healing profession. The mental health field needs to be decolonized. Many of the people who went straight into academics have never done their own inner work, and that’s when they run the risk of causing unnecessary harm to their clients.

For any of these options to work, most importantly, we cannot be afraid of our pain. And we need to choose to be compassionate towards ourselves and patient with the process at every step of the way. Nothing is a quick fix, but if there’s even a possibility of making these changes, wouldn’t you want to at least try?

“The natural impulse when pain arises is to try and get rid of it somehow. All of western medicine is built on the goal to get rid of pain. But getting rid of pain is not the same as healing. Healing is actually the capacity to hold pain.”

(Gabor Mate, M.D.)