Therapy isn't fixing America's mental health crisis

https://time.com/6308096/therapy-mental-health-worse-us/

by Paul-Craft • 3 years ago

34 107 3 years ago

Ancalagon• 3 years ago

I'm sure attending therapy will make me feel tons better until I come home to crushing debt, inflation, sky-high CoL, a culture of overwork, climate degradation, worthless jobs, a divided and failing middle-class, income disparity, lack of upward mobility, etc.

hmmmcurious12• 3 years ago

Yeah psychiatry is basically an effort to take all the collective sins society makes and drops them on your head, they say its your fault youre depressed. Similar to how religions made people feel guilty in the past so they can sell their religious message which is the only way out of this guilt.

mrguyorama• 3 years ago

What are you, Scientologist? That's not how therapy works.

jstarfish3• 3 years ago

Maybe in the 60s. Since then, it's always your parents' fault you're (whatever).

The message for the last decade has been very much don't-feel-guilt-or-shame about anything, just blame those who came before you. Doesn't matter if your parents divorced, stayed together, were overattentive, were underattentive, were poor or were rich. It's their fault you're miserable.

In reality, it's learned helplessness reinforced by social media and ongoing tech developments. Let me drive for you. Let me cook for you. Let me entertain you. Let me tell you what to believe. Let me write "your" speech for you and create "your" art for you.

It's life in captivity. Animals in cages at the zoo are always miserable.

willcipriano• 3 years ago

Problem: People are leading unfulfilled lives and reporting they are depressed.

My solution: Recenter your life around your family unit, do more physical activity, get off social media. Build a life worth living.

The solution we went with: Take some pills so you can manage the horror of your disconnected life devoid of meaning and purpose.

Problem: Energetic young boys are having trouble sitting in school for hours on end.

My solution: Focus more on hands on activities, bring back woodshop and metalshop, include more breaks for physical activity during the day.

The solution we went with: Get the boys so high on stimulants they can sit still like the girls.

It's easier (and more profitable) to feed people pills than to build a society that people are happy in so that's what we do, but hey the line went up!

EatingWithForks7• 3 years ago

The solution we went with: Get the boys so high on stimulants they can sit still like the girls.

This is a bit inaccurate. ADHD is diagnosed more in boys than girls, but is way, way more debilitating than being energetic to the point where they may be incredibly dangerous in a woodshop or metalshop. It's not being able to keep track of each tool being used, or the order in which to use them. It's forgetting to turn machines off, and forgetting to unplug dangerous equipment. It's turning around to grab something and forgetting what you turned around for, and then forgetting the task you were doing before you realized you were missing a part.

I would argue against treating ADHD like it's not a legitimate disability that requires accommodation. In the past, people with ADHD were just told they were stupid, lazy, or absentminded, when in reality they had a neurological disorder that had no diagnosis and no treatment at the time.

That being said I overall agree with the fact that society doesn't allow for breathing room for people to be people and form human relationships that doesn't have a financial or economic angle. This is horrendous, and no amount of therapy or medication will resolve this fundamental, societal-level problem. But ADHD is real, acting like ADHD treatment is just societal feminization of men is a completely incorrect depiction of the disorder. We can simultaneously argue that the medical system is completely fucked and also acknowledge that sometimes you really do need a surgeon to repair broken legs!

footy2• 3 years ago

The solution we went with: Get the boys so high on stimulants they can sit still like the girls.

love to be a woman with ADHD-PH and read this shit

FirmwareBurner• 3 years ago

Build a life worth living.

Easier said than done. You need money and a job fore that. A job which makes many people miserable.

dragonwriter• 3 years ago

Problem: Energetic young boys are having trouble sitting in school for hours on end.

That's not the problem

My solution: Focus more on hands on activities, bring back woodshop and metalshop, include more breaks for physical activity during the day.

Schools today seem to have more hands on activities and breaks for physical activities then they did when I was a kid in the 1980s; at least my kids' school certainly does.

While it helps some for ADHD (not its main purpose), it doesn't actually stop ADHD from being an issue for kids (not just boys) that have it. Individualized support helps more, and, where appropriate, medication helps even more.

The solution we went with: Get the boys so high on stimulants they can sit still like the girls.

Getting high on stimulants doesn't make people more able to sit still.

Its true that some stimulants have a paradoxical effect that is the exact opposite of getting high in certain doses for people with ADHD, and this is leveraged therapeutically (not just boys), but, well, that's not the same thing.

ADHD isn’t the same as being energetic. Clinical depression isn't sadness.

navjack27• 3 years ago

Stop stop stop right there with energetic young boys theory. https://youtu.be/gQ-rttdz_PI?si=E80n2xXeRrVf_qHy watch this

serjester• 3 years ago

It's sad to see an entire generation of people adopting such a defeatist attitude, when objectively speaking we're living in some of the most prosperous times in all of history.

Having grown up in post collapse USSR where every one of the issues you listed was 10X worse, it's genuinely disheartening to see so many people adopt an external locus of control and let it dictate their life.

EatingWithForks7• 3 years ago

If you grew up in post collapse USSR, you aren't of the age where you have to deal with the problems the parent post describes. It's important to recognize your lack of personal experience with it. I'm not saying that post collapse USSR wasn't a bad time. It was an absolutely horrible time and I am glad you're here.

But it's important to recognize people have different challenges and live different lives than you.

I'm likely much younger than you. My parents were able to afford to raise me in a house they owned, at my current age. I am not and nowhere near that buying power. My parents can look forward to a retirement fund. I cannot. My parents were able to work through the summer to pay for their graduate degrees. Graduate degrees are too expensive for me to attain, now. My parents could afford to take me to the emergency room when I had fevers as a child. I cannot afford a single emergency room visit for anything.

missedthecue• 3 years ago

Do actually poor countries have higher rates of clinical and self-reported depression? Do Colombians or Tunisians suffer worse rates of mental illness than Americans?

I am from a country where the median income is less than $10k, the gini coefficient is higher than the US, and where the six-day workweek is the norm. I literally don't know anyone on an SSRI. Sure, it's very possible someone is suffering in silence, but it's a far cry from when I studied in the United States and more than half of my classmates were medicated for mental disorders or went to therapists.

EA-31672• 3 years ago

I suppose it would help to look at statistical signs of depression then, such as national suicide rate, rates of alcoholism and substance abuse, etc.

camdenlock• 3 years ago

These are luxury diseases that you’ll only find in super-rich countries.

christkv4• 3 years ago

If you have to scramble to live it’s hard to have time to self analyze like we do in the west. I’m sure serious mental illness like schizophrenia or bipolar disorder is similar. Might also be covered up more by societies as it used to be in the west due to the family shame aspect that was very prevalent.

DanBC• 3 years ago

Look at the suicide rates.

World Health Organisation does a bunch of work on safer pesticides because it's so commonly used as a method in lower income countries.

https://www.who.int/news/item/17-12-2020-new-study-highlight...

(Reducing access to means and methods is part of a package of measures that can be used to reduce deaths by suicide, and suicidality. It's important to remember that it's not the only thing being done).

droopyEyelids2• 3 years ago

I see a lot of good replies here but no one posted a bit of material analysis.

Psychiatry is only really significant in wealthy societies. It requires a lot of resources- Look at the psychiatrist themselves: Need a medical education, and then need to choose a field that helps people with more subtle diseases. Most poor countries don't have an abundance of doctors, and the doctors they have focus on illnesses that are going to physically hurt people.

Then look at the patients. They need to have enough money to pay the psychologist, and then they need to have enough time to schedule the appointments, stick with them, and afford the pills.

Looking at the basic resources and constraints of a society, it'd be very surprising if poor countries had as many diagnoses of psychiatric conditions as wealthy countries.

And please note: I'm not making a value judgement on psychiatry here! Only saying that it requires a certain level of prosperity to become an element of society.

kbrannigan• 3 years ago

Pre religion: shaman, witch doctor, priest confessional, pastor guidance

Post religion: therapist, self improvement , life coach, lifestyle guru.

christkv4• 3 years ago

Priest and confessional is probably cheapest option still. The things those people have to hear probably matches most therapists.

omniglottal3• 3 years ago

Yeah, they may be great for empathy, but not so much for advice.

tekla• 3 years ago

I tried therapy a few times, at the insistence of several friends. After 3 platforms, and 7 therapists, I've decided its a complete waste of time. I'm not 11 and require someone telling me things I can find in a dollar bin self-help book at $100 per 30m.

I'm mildly convinced that therapy is another big-pharma conspiracy to pay for services that are worthless.

pcurve• 3 years ago

It's not just pharma. It's a big revenue driver for the entire healthcare industry for the past decade. Billions have been spent trying to generate demand and create'awareness'. Everyone is in on it, including HR people at your companies trying to stay relevant, countless mental health related start-ups, insurance companies, and providers.

jonas21• 3 years ago

Why would big pharma want you to spend money talking to someone instead of buying their drugs?

websap2• 3 years ago

Who is going to prescribe the drugs?

hbn• 3 years ago

The thing I don't understand about therapy is that there's no amount of self-inflicted problems you can have that therapy couldn't tell you is someone else's fault.

Think of the worst person you can imagine in your persona life, who goes around causing problems for other people and then complaining that "everyone's an asshole." That person can go shop around for therapists until they find one who reaffirms all their beliefs that other people need to change for them. And I don't think it would be wild to assume therapists like that will receive the highest praise for their work, as opposed to the ones who tell you to fix something about yourself, which many people will take as a personal attack.

If someone can't fix their own problems so they're seeing a therapist, how can they be trusted to select a good therapist for themself? It seems like the whole concept of this system actively incentivizes bad therapy and externalizing blame.

irundebian• 3 years ago

Great comment!

lukev• 3 years ago

I can empathize with this, however, I think it's worth pointing out that the value of therapy does not lie in the insights that are communicated. Even if they weren't in self-help books, you could in theory just go read the textbooks that therapists do.

The value I have found in it is in actually spending time talking about my emotions, with a reasonable human being, and receiving reasonable reactions. It's a chance to build "reps" in emotional intelligence that are otherwise scarcely available in regular life (mine, at least.)

It's like working out. Sure, you can lift buckets of sand in your garage and get strong. People still go to gyms and hire personal trainers.

red-iron-pine6• 3 years ago

It's like working out. Sure, you can lift buckets of sand in your garage and get strong. People still go to gyms and hire personal trainers.

The personal trainer metaphor is one I used when trying to convince a friend (we're both Iraq veterans) to go to therapy.

Something to the effect of: "it's like personal training, they're there to respond and push you, but ultimately you're doing the work and making things happen. sometimes you need someone to push you hard, sometimes you need a soft touch, and sometimes you need someone to just check your form or get you to do different exercises."

bjourne• 3 years ago

But what was the mental disorder you suffered from that made you seek out therapy? If you didn't suffer from one then of course it was worthless. It's like taking iodine supplements when you aren't iodine deficient.

omniglottal3• 3 years ago

Or, as another apt metaphor, its like taking hydration tablets instead of water. Not that they don't help, but that you're using them wrong. In your example, it sounds like arrogance, hubris, and dogmatic conviction could be problematic if a person cannot recognize room for growth without first identifying a character flaw to grow out of.

Retric• 3 years ago

The advantage of therapists is it can help and has fairly low risk of side effects unlike drugs or more extreme methods.

It’s stilly to think they can solve everyone’s problems. Sometimes people just need to sit in front of a bright light to fix a chemical imbalance etc.

thinkingtoilet• 3 years ago

I never understand the attitude of "it didn't work for me, so it is a scam". It feels very myopic.

candiodari2• 3 years ago

There's plenty of studies coming to the same conclusion. Mostly, the conclusions are that therapy can improve a near-absolute lack of human contact but not much else. Famously, going to a sports club, even sometimes just once per 6 months, had more positive effects than 2 hours of therapy a week.

damnesian• 3 years ago

I really jive with CBT methods. Unfortunately, health care allotments even for the otherwise securely insured is VERY limiting. After my initial three visits, I had to start ponying up. After a while whether it helps or not it becomes part of the same calculation most middle and lower class americans have to make when it comes to bills/utilities/food vs "niceties" ie our health.

hamburga• 3 years ago

I was a psychology major in college. In one of my smaller seminars, we had a research psychiatrist come in as a special guest one week. He told us that all the evidence showed that the effectiveness of therapy has no correlation with the training (or lack thereof) of the practitioner. The only factor was the empathy score of the therapist.

I have seen a few therapists over the years, but that always stuck with me. I'd take good conversation with a trusted friend or family member over a therapist any day. It might even serve us better to do away with the credentialing process altogether and sort of lift the veil on actually what happens in therapy.

The one really great therapist I had didn't even "do therapy" but instead helped with all sorts of practical advice when I was navigating a complicated divorce.

EatingWithForks7• 3 years ago

I agree that empathetic, compassionate human connections are way more useful than therapy is GENERALLY. (Therapists that function in an occupational manner, such as doing exposure therapy, DBT, EDMR, etc is different and I do not want a trusted friend to do any of that to me!)

I however would push against doing away with the credentialing process. You can threaten an abusive/shitty therapist with losing their license. There are plenty of absolute quacks, especially religious-specific therapy, and being able to say "do not associate me with these dumbfucks" is important. [It's not uncommon for religious counseling to discourage reporting rape or child abuse!]

tnecniv• 3 years ago

To me, the two have served a similar but non-overlapping function. There’s stuff I’ve find a lot easier to bring up in therapy, or bring up in therapy and then talk to friends about when I feel more comfortable.

chris_wot• 3 years ago

Priests do not need to be credentialed in counselling. I wonder how this affects things?

Telemakhos• 3 years ago

If empathy scores correlate better with therapy effectiveness than training, does the existence of a mental health crisis suggest a general decrease in available empathetic interlocutors throughout society? Are people having fewer empathetic relationships or encounters in their daily life than in the past?

ramesh31• 3 years ago

If empathy scores correlate better with therapy effectiveness than training, does the existence of a mental health crisis suggest a general decrease in available empathetic interlocutors throughout society?

I think that's a great insight which tracks well to my anecdotal experience from the last 10 years.

Dating apps have turned potential partners into Pokemon on your phone to be collected. Doordash has stripped delivery drivers of all humanity and abstracted them away into mindless automata. Social media has gamified and commodified outrage and hatred on a global scale. At every corner you look today, the bonds of human society have been disolved and replaced with pay-gated third party API calls. And this mindset has extended like a cancer to all aspects of life. Even "therapy" itself conforms to this. What was once something relied upon friends and family has been outsourced to the "heres my money, now fix my problem" mentality.

Corporate greed has effectively atomized us in a way that 20th century totalitarian states could have only imagined. And once we've been atomized, it becomes trivial to sell basic human experiences back to us in a nice neat package. Empathy becomes just another service you can summon with your phone, so why bother practicing it?

benterix3• 3 years ago

It might be. And as people get more and more lonely, the problem gets more serious, as statistically speaking the amount of empathetic interlocutors you meet decreases.

onlyrealcuzzo• 3 years ago

From my experience, the people who have therapists tend to either be far from family, not close with family, and/or from a dysfunctional family.

In a statistical sense, the role of the family therapist was probably traditionally filled by women - but now those women have real jobs - and the family doesn't have a part-time therapist as available anymore (on average).

At least in my family - it is astounding the difference between my grandmother and her daughters.

Anecdata of one family. My Grandma was a legendarily empathetic. Maybe no one could fill her shoes?

But it seems like especially tough shoes to fill when you already have a full-time job...

red-iron-pine6• 3 years ago

I would have guessed church and related groups but if you want to make it gendered...

christkv4• 3 years ago

A lot of what passes for therapy could probably be done cheaper by going to a confessional and telling a priest.

CBT seems to have some scientific research backing it but I’m skeptical.

As they the jokes go most psychologists study it, trying to understand their mental health issues and most studies are done on psychology students students.

omniglottal3• 3 years ago

Going to a priest may be cheaper, but when they say to "go to god" instead of to the police when reporting rape and abuse, it becomes quite costly.

probably_wrong• 3 years ago

I'd like to believe that a therapist, unlike a good friend, would know the difference between well-meaning advice and good advice. Because I can give the former, but I'm not sure about the latter. A therapist should know better, if only due to the number of times they saw the effects of suggesting A instead of B.

benterix3• 3 years ago

I'd say it's not even about giving advice, just listening can make wonders. As a side note, any advice from a therapist is a slippery slope and they tend to avoid it, rather make the patient discover what they need by themselves and not impose something externally just because they're their therapist. (With some notable exceptions, e.g. in CBT.)

itiro• 3 years ago

US mental health crisis is 100% driven by systemic lack of empathy. Makes sense it’s not getting better.

Jpow and corporate are coming for worker gains.

Climate change is waved off as a subjective mental illness.

Religious and secular toxic positivity crackpots demand we all smile and express nothing but happy thoughts lest we hurt their fee-fees.

“Experts” like Haidt blame social media, not the world teens see via social media; ossified minds of leadership chant the same old catechisms screwing the kids futures up. What teen girl wouldn’t go bananas as her body starts buzzing with hormones driving her to procreate given the obvious uncertainties.

The demand to exist in a cognitive dissonant state is only getting worse.

Yhippa• 3 years ago

I'm going to go out on a limb and posit that what we need to do to survive on a daily and short-term basis has far outpaced our ability to cope with it.

nine_zeros• 3 years ago

I'm going to go out on a limb and posit that what we need to do to survive on a daily and short-term basis has far outpaced our ability to cope with it.

Our ancestors never had to do so much to just survive. Humans are just not designed for this level of stimulation, keeping track of resumes, jobs, bills, credit scores, investments, children, retirement, mortgages, cars, a pushy manager, performance ratings and who know what else.

Life has become miserable because too much is asked of an individual. It takes immense strength and mental clarity to get rid off all these burdens. The hardest to get rid of is poor quality of jobs.

wlpu• 3 years ago

I don't really agree with your proposition, I think the base issue is more fundamental, simply put I think it comes down to the atomisation of the individual due to the structure of higher education and zeitgeist of fear of being accused or misinterpreted.

While is it easier than ever to enter social spaces, I think people are struggling to build real meaningful relationships (romantic and platonic).

There is the western "coming of age" ritual that involves going off to university by yourself for a few years and then a few years later going off to another place by yourself.

Whether the fear of being misinterpreted is real, it is there for many people. People I know have changed a lot about what they say and the way they speak when people they don't know show up or enter a conversation, often saying things they don't believe in to give a good impression.

throw18376• 3 years ago

i've heard people speculate that there are just not enough people capable of being good therapists. it may be that it is too hard of a job, there's skill/talent that can't be taught, and only so many people can do it. maybe we can train more and more therapists but not more effective therapists.

on the other hand accountability, social interaction in a safe context, providing an objective viewpoint, successfully teaching people "manualized" techniques like CBT -- these are all ways where a therapist could be helpful despite not being personally skilled at the art or craft of psychotherapy.

syndicatedjelly• 3 years ago

We’ve reached peak TaaS (Therapy as a Service). The industry went from outcome oriented to service oriented because people in tech saw an opportunity for some cash grabs

red-iron-pine6• 3 years ago

don't blame tech for this, the healthcare industry in the US is ruthless and willing to chase any dime

AtlasBarfed• 3 years ago

It's my general suspicion that collective mental health is tracking with collective physical fitness, especially considering that exercise performs all antidepressant drugs by a fair amount

As America keeps getting unhealthier and more obese, it isn't much of a stretch to say that mental health is following it

francisofascii• 3 years ago

Not just fitness, but friendships and communities.

neonate• 3 years ago

https://archive.ph/cvOub

useEffect• 3 years ago

deleuze intensifies

sdsd• 3 years ago

I think therapy works, but I think other things (like exercise, friendship, and having a good reason to expect good things in the future) usually are much more important, and it's hard for a therapist to help with any of those problems.

yosito2• 3 years ago

One of the reasons is that the APA has guidelines that are hostile to a safe therapeutic environment. I've had much better luck working with non-American therapists that aren't subject to the APAs ideology.

Qem• 3 years ago

the APA has guidelines that are hostile to a safe therapeutic environment.

What guidelines are bad?

yosito2• 3 years ago

https://www.apa.org/about/policy/boys-men-practice-guideline...

8f2ab37a-ed6c2• 3 years ago

It's been fascinating to watch the trend of therapy explode by orders of magnitude in popularity over the last 3 years.

For anybody else keeping the finger on the pulse of trends through what people put on their online dating profiles, the "I hope you are in therapy" stated expectation went from 0 to every-other-profile almost overnight.

It makes me question how much this is driven by the effectiveness of the therapeutic approach vs what is simply trendy and mimetic among bourgeois urban millennials.

FooBarBizBazz• 3 years ago

the "I hope you are in therapy" stated expectation went from 0 to every-other-profile almost overnight.

Wait, what? Could you expand on this? I don't use these apps, so I wouldn't see this trend myself. But I hear plenty of therapy-speak elsewhere, so I'd believe it.

Is the idea that they honestly want a potential romantic partner to be undergoing therapy? Is the theory that this will make the person a better partner? Or is there some horrible idea like it'll reduce the amount of "emotional labor" they have to perform in the relationship? What's the underlying worldview?

8f2ab37a-ed6c2• 3 years ago

My most charitable read of that trend is the narrative that everybody is broken and traumatized and if they're not in therapy then they're in denial about their unaddressed issues, and a therapist is the only person who can truly fix you before you bring those issues into a relationship.

I'm quite confident that this isn't a thoroughly examined belief for most people espousing it, it's a meme that's supposed to show sophistication as a partner.

what-no-tests• 3 years ago

The (un)funny thing about CBT is that it is almost indistinguishable from the totalism and thought reform techniques deployed by the Communists in China, as described by Robert Jay Lifton in his work -- Thought Reform and the Psychology of Totalism: A Study of "Brainwashing" in China [0].

A read through Wilhelm Reich's earlier work [1] and a look at his fundamental dispute with Freud (i.e. - is depression and anxiety a problem in the individual, or in society, and if it's a problem with society then why adjust the individual instead?) will expose the status quo in psychology as simply a way to maintain exactly that.

[0] https://en.wikipedia.org/wiki/Thought_Reform_and_the_Psychol...

[1] https://en.wikipedia.org/wiki/Character_Analysis

websap2• 3 years ago

People are trying to replace family, friends, relationships, hobbies, goals, and sense of purpose, with therapy. Use therapy to learn your blindspots and improve, not as a replacement for living a full life.

0xbadc0de5• 3 years ago

It seems like the more people rely on therapists, the worse the mental health crisis becomes. Couple that with the replication crisis and the opioid epidemic and I'm becoming increasingly skeptical of the entire profession. Given enough bad apples, one starts to suspect the entire tree is sick.

juancn• 3 years ago

The US psychology school tends to be very pavlovian in the way they apply therapy. It's prescriptive rather than empathic (do this vs helping you re-position your views of yourself). My guess is probably due to cost.

Other schools of therapy take a long time, and healthcare in the US is extremely expensive, so I don't see those other techniques becoming popular.

notacoward• 3 years ago

I'm sure there's a real effect here, but it's hard to determine the magnitude of the effect when they fail to distinguish between diagnosis vs. actuality. How many people reporting excellent mental health really are OK? How many are just suppressing their problems, or aren't even the most affected by those problems (e.g. dark-triad folks who will never seek therapy on their own)? On the flip side, how many are catastrophizing, treating every-day things as problems requiring professional help and/or medication? How many then, and how many now? Without knowing those answers, we can't really tell how big the problem is.

This has definitely been a problem with autism and ADHD diagnoses over the years. There's no reason to suppose it isn't also true e.g. with depression diagnoses.

bigfryo• 3 years ago

Definitely a healthcare crisis in America no doubt about it.. all you have to do is look at all these so called "Karen" videos on the internet.. . when I was a kid back in the 60s 70s 80s whatever even the 90s, there was nothing like this phenomenon... you never heard of a woman freaking out like this... starting fights in public... Etc... now men might have started fights, but it was almost unheard of for women to raise their voices and scream and yell... maybe inside the home but never in public... there's something going on in modern society that is driving people crazy really

Therapy isn't fixing America's mental health crisis

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