From "The Strange Alliance Trying to Remake American Psychiatry" (NYT). By Daniel Bergner, author of "The Mind and the Moon: My Brother’s Story, the Science of Our Brains and the Search for Our Psyches."
May 15, 2026
"Around 1980, mainstream psychiatry adopted a medical model."
"A new edition of the Diagnostic and Statistical Manual of Mental Disorders, U.S. psychiatry’s bible of diagnoses, published that year, enshrined the change. Ever since, troubles of the mind have been viewed mostly as physiological diseases of the brain, with treatments focused largely on pharmaceuticals.
The medical model was partly a reaction against psychiatry’s decades-long dominance by psychoanalysis and its offshoots.... The discipline, meanwhile, was under attack in popular culture; the antipsychiatry movie 'One Flew Over the Cuckoo’s Nest' won five Oscars in 1976. The field wanted to be viewed as a true science. Then Prozac, an S.S.R.I., was released in the United States in 1987.... The idea of Prozac — and, soon, its close S.S.R.I. cousins — as an unmitigated medical advance was spread by a flood of pharmaceutical advertising. The ads presented readily comprehensible brain science: Mental illness boils down to an imbalance of chemicals.... The chemical imbalance theory has never been substantiated and has been supplanted by other hypotheses that are equally elusive to proof...."
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36 comments:
SSRIs replaced booze and smokes
The chemical imbalance theory has never been substantiated and has been supplanted by other hypotheses that are equally elusive to proof...
For example, "insane in the membrane"?
Now we've moved on to psilocybin microdosing and THC gummies.
"the antipsychiatry movie 'One Flew Over the Cuckoo’s Nest' "
Oy vey. OFOTCN was an allegory that had almost nothing to do with the actual practice of psychiatry, but it sure made a mess of public policy.
This is pretty marginal stuff--the truth is that this country couldn't make it until lunchtime without massive amounts of drugs.
As a means of making money, psycho analysis was effective. For solving mental illness, it was essentially useless. There was a test decades ago comparing the effectiveness of lithium on treating schizophrenia compared to traditional psycho analysis. The results were so dramatic that they ended the test early and it would be considered inhumane to try it again. This led to lawsuits against asylums and the mass release of their patients.
The chemical imbalance theory has never been substantiated
Are you f-ing kidding me? Is anyone vetting anything about medicine?
The late Elizabeth Wurtzel, occasional subject of the Prof's posts, wrote Prozac Nation just a few years after the drug came out, based on her experiences even fewer years after its release. I remember anecdotal news reports about people doing weird stuff on Prozac in 1991. So people knew something was up with a lot of these drugs, from the beginning. CC, JSM
Stop me if you have heard this one-
It's shocking that almost half of all white progressive females are on prescribed psychiatric medications.
Shocking because half are going untreated.
Without women, psychiatry would never exist.
Drug companies found A new source of revenue is all.
Stupid girl bosses who chose career over family needed drugs to make themselves feel better as they aged out of their harem girl Years and approached that time in their life when they get to be grandmothers and see their positive contributions to the world.
Somehow, being a cubicle wage slave Wasn’t as fulfilling, but the drug companies stepped in with drugs. SSRIs are totally different from meth and Coke. They go really well with wine bottles.
"The field wanted to be viewed as a true science."
Poor dears.
"Without women, psychiatry would never exist."
True, but neither would any other human activity.
The problem was creating all of those bullshit jobs for women so we could close the wage gap.
If your job is to sit in a cubicle all day dreaming up ways to make the productive people in the company miserable and to please the C suite at night S.S.R.I.s are a natural choice.
What are the odds that government employees are over represented in S.S.R.I. prescriptions?
As with transgenderism, the main problem in 2026 stems from ACA / Obamacare. Freud has been long dismissed as non-scientific and goofy. Still, between the overt politicization circa the early 1970s (i.e., when homosexuality turned into kickball) and 2010, many treatments were considered dubious and not covered by insurance.
Then, Obamacare opened the insurance-to-doctor money pipeline. Suddenly, every patient got affirmed for everything in both counseling and psychiatry, and new pills-of-the-week became common because they generate more money.
The industry has been political and shaky and full of quackery for 100 years. The professional attacks on Jordan Peterson after 2016 burned up whatever credibility they had left. It'll require a fresh generation or new rebranding to recover.
There is a very common dynamic, that goes like this;
1 - There is something that people want very much to know.
2 - It is impossible to know it.
3 - There are people who claim to know it.
4 - There are people who believe them.
L. Ron was right about at least one thing. Though I wouldn't take scientology as a counter.
"Then, Obamacare opened the insurance-to-doctor money pipeline."
I don't think that's really fair. Truman invented medical insurance because he didn't want the railroad workers to strike while he was trying to win WW II, but he also didn't want the owners to give in and give them a raise, because it would be inflationary. So, they cooked up the idea that they would get no raise, but would get medical insurance as an untaxed benefit. This tiny sop had ballooned into the insane modern medical catastrophe well before Obamacare. One could argue that Obamacare was intended to scoop up the few remaining uninsured Americans and feed them into the maw of Big Med.
Pharmacological management of mental illness has its problems, but it is of much more substance than the moonbeams and unicorn farts that make up Freudian analysis and much else in the "talking cure" branch of psychiatry. Freud himself talked to schizophrenics for decades and never cured a single patient. Bipolar disease and major depression are only marginally more amenable to non-pharmacologic management. Sadly, the most effective and humane treatment for a lot of the most desperately ill patients is institutionalization.
Bipolar disease
Try zero carb diet. No drugs. No talk therapy.
Just high fat producing ketones, healing the brain.
@Jupiter --
That's not what I meant. ACA was the first to mandate "10 Essential Benefits," with mental health being one. Before that, mental health was a separate add-on. Many types of treatment were considered unverified/failed/not worth the cost.
Pro ACA source as an example:
https://healthjournalism.org/blog/2025/04/how-the-aca-changed-health-insurance-for-the-better/
Enigma,
https://healthjournalism.org/blog/2025/04/how-the-aca-changed-health-insurance-for-the-better/
Goes to an empty page, right?
Freud has been long dismissed as non-scientific and goofy.
What about penis envy?
I remember that era well. I had just gotten out of the Navy and was enrolling in college as a pre-med. I thought I would go into psychiatry at the time, although I actually knew very little about it. The first time I ever heard of the DSM manual was just prior to release of the 3rd version, as I read about it in Time Magazine (wow, this was a long time ago!) Time announced that the learned minds who ran the psychiatry trade had removed homosexuality from DSM III, it was longer to be considered a matter of psycho-pathology. I decided if the tenets of psychiatry were as malleable as that then I needed to find a specialty more rooted in actual science than in popular opinion. Retired now, no regrets.
What if modern civilization itself causes depression and depression is a natural response to the world as we know it? 'As we know it' because ordinary people in past ages didn't know as much of what goes on as we do now.
One trick pony problem: every discussion becomes an excuse to perform the same damn trick.
Psychoanalysis is an attribution of the deranged to the whole populace so violence is healthy discretion is evil etval
that’s a cool point.
Sociopathy is a niche of human behavior not the essancd of it
Living through your own eyes beats living by someone else’s script.
If you are not crazy you are crazy.
“ Josephbleau said...
If you are not crazy you are crazy”
That’s some catch, that Catch 22!”
" I can't talk to you now, I'm being chased by psychiatrists."
Lots of things might work, or at least be valuable. But until they have watched a thousand patients stop hearing voices, or gain control of their mood swings, or be able to get out of bed and sit at a breakfast table rather than soiling themselves because of a standard med regimen for their reliably diagnosed illness, I mistrust the motives of people claiming no benefit for medications. For all the Big Pharma accusations (not all false, by any means) of how much money meds make, look into the supplement sales, books sales, classes and courses and even congregational growth of the supposed skeptics. They ain't skeptics.
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