Why Mental Health Treatment Often Fails

In his last New York Times column covering the psycho world, Benedict Carey emphasizes a point that I have often made on this very blog. Every time you hear someone somewhere saying that someone should go into counseling, you must understand that most of the mental health treatment on offer in America today is largely ineffective. 

Carey explores why this is so, but one cannot help but observe that most treatments involve ingesting substances. However much talk therapy has been touted, much of it does not work very well. If it does the reason probably lies more in the abilities of individual practitioners than in their method. I remain persuaded that cognitive behavioral therapies are largely the most effective, and they are certainly pointing us in the right direction. But still, the quality of care for mental health issues does not live up to the promise. 

So, Carey explores a paradox. Scientific research into brain function has leaped ahead, but treatment remains inconsistent and simply not very good. If we follow the indications that are on offer from advice columns, seeing therein the suffering of patients and the psychobabble offered up by columnists, we might understand that the profession is handing out quantities of unadulterated bullshit. The surprise would be if any of it ever worked.

He begins:

On the one hand, the field attracted enormous scientific talent, and there were significant discoveries, particularly in elucidating levels of consciousness in brain injury patients who appear unresponsive; and in formulating the first persuasive hypothesis of a cause for schizophrenia, based in brain biology.

And on the other hand, the nation’s mental health has been getting worse and worse:

On the other hand, the science did little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health — rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use — went the wrong direction, even as access to services expanded greatly.

Why is this so? Carey offers one answer-- there are so many different forms of care that it is nearly impossible to navigate the system:

… the mental health system, for all its caring professionals, is chaotic and extremely difficult to navigate. There are few systemwide standards, and vast and hidden differences in quality of care. Good luck finding an authoritative guide to navigating the full range of appropriate options.

Carey remarks:

Don’t take my word for it. In his forthcoming book, “Recovery: Healing the Crisis of Care in American Mental Health,” Dr. Thomas Insel, former director of the National Institute of Mental Health, writes: “The scientific progress in our field was stunning, but while we studied the risk factors for suicide, the death rate had climbed 33 percent. While we identified the neuroanatomy of addiction, overdose deaths had increased by threefold. While we mapped the genes for schizophrenia, people with this disease were still chronically unemployed and dying 20 years early.”

As for Prozac and the other SSRIs, while they have undoubtedly helped many people, their use entails risks. No one should have been selling them as a panacea, though that is what happened:

One answer to that last question came in the mid-2000s, when the Food and Drug Administration held a series of hearings on whether antidepressant drugs, like Paxil, Prozac and Zoloft, backfired in a small number of users, causing suicidal thinking and behavior.

The hearings were hair-raising. Hundreds of family members who had lost a loved one crowded the rooms, their anger and expectation sucking up most of the oxygen; and some of the parents, it was clear, knew at least as much about the drugs as the doctors.

By 2006, the F.D.A. had concluded that a so-called black-box warning on antidepressant drug labels was warranted, citing the suicide risk for children, adolescents and young adults. Many psychiatrists were dismayed by the decision, insisting it would discourage the use of valuable medications.

I will pass on commenting about psycho pharmacology. It is not my field. And yet, the message that people received from the media frenzy about Prozac was that biochemistry would solve all of their problems. Why then should they not resort to other chemical substances, especially when their neighborhood therapist was mewling about feeling their feelings:

There’s a reason that so many people use binge drinking, playing the lotto and runaway eating to support their mental health: because the effects are reliable. Because they don’t require a prescription. And because they’re available, right now.

As a coda I would note that the most effective treatments for addiction involve 12 Step programs. And they derive from religion, not from science. We also know, or we should know, that regularly attending religious services is largely beneficial for your mental health. As is aerobic conditioning and yoga. And the current pandemic has taught us that socializing does wonders for one’s mental health. Thinking that your goal in life should be individual autonomous independent self-actualization is a formula for trouble. 

Perhaps we are expecting science to do something that it is not designed to do.

In the meanwhile, we always enjoyed Benedict Carey’s columns. We do not know his next gig, but we wish him Godspeed.