Why "Against Mental Health"?

This community had been live for about 6 hours before someone discredited me by pointing out that I was the mod here, so maybe let's explain what my thinking is when I called it "Against Mental Health."

It is not a community against:

• human happiness,
• human development,
• personal growth,
• development of the self,
• etc.

But when we say "mental health", we are putting the entirety of those personal endeavours inside a medical model, and primarily a medical model of disease. This brings with it a host of assumptions that are inappropriate for this area of human experience.

The primary problematic assumption of the disesase model is this:

We can use science to learn about the problem, then we can train people to be experts in this science to fix the problem for other people.

This works great for heart disease and syphilis, but not so great for mental health.

This community had been live for about 6 hours before someone tried to discredited me by pointing out that I was the mod here, so maybe let's explain what my thinking is when I called it "Against Mental Health."

It is not a community against:

• human happiness,
• human development,
• personal growth,
• development of the self,
• talking to people about your problems.

When we say "mental health", we are putting the entirety of those personal endeavours inside a medical model, and primarily a medical model of disease. This brings with it a host of assumptions that are inappropriate to this area of human experience. [I'm primarily focusing on talk therapy in this post, I'll save a discussion of psychiatry for another time.]

The two problematic assumptions of the application of the disease model are:

1. We can use science to learn about the problem and then
2. We can train people to be experts in the problem and then
3. We can have these experts fix the problem for other people.

Let's examine the first claim on which the other two depend: that talk therapy is a matter of applied research.

Part 1: The Primacy of Information?

"Well, of course there's a lot of great research!" you may say, "There are so many studies and new therapies that have come out that have helped a lot of people!"

There is a lot to be said about that, but ultimately the problem is this: therapeautic outcomes have not changed almost since the days of Freud: the same percentage of people get better, stay the same, or get worse on average. [Most of this information is from a non-crank-authored book titled The Heart and Soul of Change, and I wish I'd bought a hardcopy so I could fill it with post-it notes; the podcast Very Bad Therapy (run by two therapists) also has a close look at the research.]

Further: there is no training that demonstrably improves client outcomes. You bet there are generations of therapists desperate to help their clients as best they can and they want to know: what school should I go to? what training should I get? what books should I read? And if they are diligent about their research, they will learn there isn't any simple learning of information that will make them better therapists as far as helping clients get better go.

If it were the case that talk therapy was a matter of scientific research, we'd be seeing a steady increase in clients who get better in therapy. That we don't tells us something very important: whatever is happening inside talk therapy rooms is not about the application of esoteric knowledge.

The Heart and Soul of Change goes into what it thinks makes effective therapy. The experience of the therapist plays a surprisingly small role--therapisst reach peak effectiveness after a year or two, then actually might experience a slight (or severe) dip later in their careers. Instead, what the research points to is the primacy of the personal relationship between the client and the therapist; and they also find that transcripts of truly high performing therapists are a bit puzzling. That is to say, they can't see the transcripts of a high performing therapist and figure out what they're doing or why they're so effective; in fact, they'd rate them rather poorly as therapist just by the transcript alone.

Part 2: The Primacy of the Relationship

So if the relationship is the most important aspect of therapy, what happens when we put it in the context of expert and naif, of actor and acted upon? In short: it goes to shit. Clients are seen as a bundles of symptoms that require appropriate treatment (the APA even has a website where you can pick the diagnosis and find the most scientifically validated treatment for it). Their life issues and histories are boiled down now to personal dysfunction. If there is a disagreement between the therapist and the client, the therapist is the expert and the client is there for help, so the therapist will assume they are right and the client is wrong. This is all corrosive to the relationship.

Can a therapist be empathetic and sincerely value their client? Absolutely. But to do so, they have to go upstream against the medical model of "mental health" and enter a world where they are guided by their intuition and personal values more than peer-reviewed research on methods and techniques.

Part 3: The Primacy of the Self

We've discussed the relationship of science to therapy (minimal), the relationship of the therapist to the client, and I'd like to close by discussing the relationship between the client--the person who is bringing suffering to be allieviated--and themselves. When we are inside the medical model, our every passing dissatisfaction is looked at with suspiscion, as a sign that something is wrong with US. We can become obsessed with identifying ourselves as ill. We have a tendency, enforced by the medical model, to give our personal sovereignty over to experts who "know better." Inside the medical model, your problem with unemployment is reduced to an unhealthy anxiety about your future; your unhappiness with an abusive boss is cast as lack of coping skills; and even your reaction to experts invalidating your personal experience is described as a personality disorder!

The system says: you are sick, you can't trust yourself. You learn to stop listening to the signals your body is giving you and you wait, patiently, sometimes for years, sometimes for decades, sometimes an entire lifetime, for "it to work", and as long as your insurance or money doesn't run out, there will always be someone willing to see you for 50 minutes a week to implicitly reinforce your helplessness.

What I've learned separating myself from the mental health system is to trust myself, to trust my instincts, to not pathologize everything (while realizing that there are things I can improve), and step-by-step, day-by-day, I've gotten steadily better, steadily happier, steadily more aware and sure of myself.

The Purpose of this Community

If you find something that works for you, whether a theory, a technique, or a therapist, that's wonderful! Keep it up! This isn't a strictly anti-therapy or anti-therapist space!

This community is here to raise awareness of the risks of everything that goes into ""the mental health system" and provide support for people looking to make their way outside of it.