Hegel tells us that the great historical actors are made by chance: they emerge when the personal ambitions of some particular man align with the greater ambitions of History. Great critics have more modest starts. They arise when their complaints—their annoyances, their grievances, their petty beefs—become the complaints of a whole culture. The critic thinks enough of this bullshit already at precisely the moment that the world has had enough of that bullshit too.
There is no more bullshit culture in the United States today than the culture of “mental health.” Nobody can say exactly when it got so bad, so totally annoying. It started out so well. After so many decades of repression and denial—denial that ordinary Americans had interior lives worth minding; repression of the insane via warehouse and lobotomy—the United States reached the final decades of the twentieth century in the first blossom of psychological maturity. We emptied the old, decaying asylums. We destigmatized psychiatry and psychotherapy. We extended our compassion to those unfortunates possessed by what we began to call Serious Mental Illness: we would understand that they had a disease, that it was not their fault from now on. Everyone else was still welcome to go to therapy. They were encouraged to go to therapy, in fact. It was nothing to be ashamed of. Beautiful people on television went to therapy. Everybody could benefit from some therapy. Everyone had something to work out, after all. You didn’t have to be sick to mind your mental health. It was as important as physical health, really. It was okay not to be okay. Who didn’t carry some trauma, large or small? Who didn’t feel uncertain, anxious, or even a little depressed sometimes? Perhaps some medication might help.
We didn’t work out all the details, particularly what we ought to do with the enormous number of people who had once lived in our asylums and now lived (if they were lucky) in need of perpetual, expensive medication or (if they were unlucky) in the prisons and on the streets. But at least it was all out in the open now. We believed in mental health. We could finally, finally talk about mental health.
And we were really eager to talk about mental health, it turned out. Not about solving any of those sticky problems involving the spectacularly insane, nor even—if we’re being honest—about addressing any of the conditions that might’ve left so many ordinary people running to the ministrations of the couch, but our own mental health, our culture of mental health, how to stay mentally healthy, the ways that mental health language might be integrated into our everyday lives. Why keep these concepts in the clinic, after all? Couldn’t everything that we were learning about personality types, affective states, defense mechanisms and attachment styles and coping strategies and boundaries be useful in our daily lives? Shouldn’t we talk about them?
Shouldn’t we talk about them all the time? We couldn’t change the fundamental arrangement of our labor conditions or the horizons of our politics, but we could take a mental health day and engage in some self-care when it all got to be too much. We couldn’t really understand each other—psychoanalysis had known that all along—but we could find sophisticated ways to pretend that we did, and to learn that we were the only righteous people all along. Our friends, our mothers, our exes? All narcissists. All conflict? Toxic. Disagreement? That’s gaslighting. We could learn what our emotional labor was worth. We could say we didn’t have the capacity right now. Our bodies could keep the score and it became desirable, as time went on, to score as high as possible.
Those mad out in the streets, meanwhile? Well perhaps they weren’t a medical problem, so much as a social one. Perhaps they were just suffering from stigma. Perhaps they were just the victims of the medical model of psychiatry. After all, there were plenty of people with mental illness all of a sudden, many of whom seemed to suffer almost no discernable impairment from their diseases. They had ADHD, which made them excellent at passing licensing exams. They had autism, but they could speak, and socialize, and perform extremely well in the tech sector. They had manic depression, or psychosis, or disassociative identity disorder, or complex PTSD, but they didn’t act like those scary men who haunted street corners and received psychiatry in prison. They lived in harmony with the voices, their alters, their moods. Many of them had lucrative streaming careers. They had superpowers. They weren’t insane; they were neurodivergent.
They formed online communities and constituencies (suspiciously well organized for the victims of allegedly debilitating psychiatric conditions). These online communities began to discover new symptoms faster than the gatekeeping doctors ever could. This was progress. This was empowerment. Feel anxious? Feel tired? Have trouble hanging with your friends sometimes? Here are ten signs you have an accommodations-qualifying condition and the moral authority to speak for the mentally ill. Please like and subscribe. Please like and subscribe and agree. Please like and subscribe or you hate the disabled.
What happened? It was all going so well, just a few years ago. Now it’s all just so exhausting. The culture is ready. It cries out: Enough of this bullshit already.
In the fall of 2026, two books cried back, both premised on the idea that something has gone badly wrong in how we “talk about mental health” in this country. Unlike so many prior efforts, which largely consisted of grumbling by reactionary critics about “therapy culture” and the softening of the American spirit (and which were thus easily ignored by a progressive Mental Health Culture and by a culture not yet ready to hear it), these books were serious, credible interventions by left-wing critics who had both, in their own way, been waiting for the day that their beefs would meet the cultural moment. The backlash had finally matured.
The only concerns, after the books were announced and the public awaited their arrival, were the identities of the authors themselves: Catherine Liu and Fredrik deBoer. Both were known brawlers. They were, depending on who you asked, either “incisive,” “brilliant,” and “absolutely vital,” or “bullies,” “trolls,” and “assholes,” which is to say that both are well-known iconoclasts who produce the kind of criticism that is thrilling if you share their ire and terrifying if you’re its object. Would these books, so necessary, prove too mean? Too fueled by grievance? Too contrarian? Too polemical to make for palatable polemic?
Well, we have the books now: first, in September, came Liu’s Traumatized: The New Politics of Public Suffering (Verso); then, in October, deBoer’s All in Your Head: Illness as Identity, Trauma as Fashion, and the Desire to Be Disordered (Simon & Schuster). The concerns weren’t totally hysterical. These books are aggrieved. They are annoyed. They are, at times, a little mean. They are both shouting enough of this bullshit already and they are both serious and credible and excellent.
Feel anxious? Feel tired? Have trouble hanging with your friends sometimes? Here are ten signs you have an accommodations-qualifying condition and the moral authority to speak for the mentally ill.
If you’ll indulge me in a bit of shop talk, let me tell you how rare this situation is for me. I’m a bit of a contrarian myself—what I mean is that I’m the author of a psychiatric memoir and have spent a good deal of my career writing essays and reviewing books about psychiatry and all this wound-nursing is only justifiable if I indulge the narcissistic fantasy that I have a particularly unique or useful perspective on these matters; thankfully, I do—and the best I can ordinarily hope for, in our particular, grating mental health culture, is to sift through the piles of new books that are merely wrong in order to find the few that are interestingly wrong, intriguing or challenging or provocative enough for me to stage an argument with the author in the form of a review essay. What a pleasure it is, then, to have two books to endorse!
It isn’t that Traumatized or All in Your Head is perfect. They contain ideas and arguments I don’t quite buy (how couldn’t they? I didn’t write them). I considered taking up my little annoyances with each here: Liu’s sense of the transition from analysis to medical psychiatry is far too tidy (has she never heard of psychodynamics?) and she can be a bit hyperbolic (she has a tendency to grant a lot of agency to what is better understood as historical contingency; because, well, I don’t know, but I suspect it’s because it serves her plot). DeBoer, meanwhile, doesn’t ask the questions I think he should ask about the Rosemarie Junor case (one begins to wonder whether he believes NGRI cases can be rehabilitated at all) and he takes such a broad brush to disability studies that he winds up conflating the “social model of disability” (fairly popular) with the “double social model of disability” (a bit of clown college theory that remains blessedly minoritarian, even in the division of the humanities). Also, both of them—I’m sorry. I can’t help myself.
But these are small annoyances. They’re arguments for a review to run in Thinking About Psychiatry Quarterly, a boutique Substack where the record for longest-open-comment-thread-before-the-moderators-locked-it is 47 hours. Traumatized and All in Your Head were not written for the narrow culture of interested parties and aficionados. That would’ve been a far easier task, and both deBoer and Liu have greater ambitions: they are trying to say enough already for the benefit of the general public. They are both trying, earnestly, to intervene on the whole of American culture, where talk of trauma and mental health and neurodivergence have become obnoxious, faddish, confused, inescapable, and dangerous. In that capacity, they are—to use in earnest, for once, the dead language of promotional copy—worthwhile, significant, and vital. They are, to use ordinary language, good and righteous and fun.
They would be good enough, worthwhile enough, as mere histories. Traumatized and All in Your Head advance their cases as much by excavation as they do by direct persuasion. They trace the origins and development of the ideas they’re contesting; the project, in both cases, often consists of simply demonstrating how much of what is now in the water as unspoken common sense was placed there by specific people at specific moments for specific ends. Liu is after the history of what she takes to be a single, insidious idea: following trauma from its origins in lawsuits against railroad companies and in Victorian child labor reforms, through feminism, liberalism, the war in Vietnam, the Satanic Panic, psychiatry, Paul de Man, and Oprah Winfrey, until it reaches its current status as “a liberal fetish” designed to mystify the causes of human discontent and provide “a sacred form of moral authority” to Liu’s lifelong bête noire, the professional managerial class. Much of this history was unfamiliar to me—who knew that the earliest American concept of psychological trauma was called “railway spine” and was more or less a litigation scheme?—and I can recommend it in the strongest terms available to an amateur: I learned something from Liu.
DeBoer, meanwhile, is fighting a broad war on two fronts, against what he might call the history of many dangerous ideas: first, against the many flavors of anti-psychiatry (and anybody else who denies the danger and seriousness of severe mental illness) and, second, against the many forms of what he calls “the gentrification of disability” (that is, those whose desire to romanticize and fetishize “madness” is as unserious and dangerous as the anti-psychiatrists). His is the history of psychiatry and anti-psychiatry, from the origins of madness through the contemporary neurodivergence scene; from Freud, Kraepelin, Thomas Szasz, and R.D. Laing through facilitated communication, disability studies, and facetious illness fads on TikTok; from the dark days of lobotomy and asylums little better than prisons through the science of psychopharmacology, deinstitutionalization, and reinstitutionalization-by-disguise. Here, I can speak as an expert. DeBoer does not tell precisely the story I would tell, but he tells the story that I have wanted someone to write for a long time. There are so many dishonest histories of psychiatry. All In Your Head is the one that I would want somebody who has never heard of any of this, who has never engaged with any of these ideas, to read first. It is the way I wish that I were exposed to this history.
These histories are not duplicative. I don’t only mean this in the obvious ways—there are of course differences of style and scope; All in Your Head is twice the length of Traumatized and is significantly broader in its focus—and I am not surprised to discover that two authors with famously iconoclastic dispositions were capable of producing distinct histories of similar ideas despite publishing their books at roughly the same time and in the same cultural moment. I mean that despite being a natural pair, and despite inevitably covering much of the same ground in the history of twentieth century psychiatry, what makes Traumatized and All in Your Head worth reading as a pair is how these histories diverge so often not only in the ground they cover, or the details that are particularly significant to each author’s case, but in their interpretation of their histories. Many of the same events and people appear in both All in Your Head and Traumatized: Freud, Kraepelin, deinstitutionalization, psychopharmacology, Rosemary Kennedy, Ken Kesey, mental illness as public health crisis, mental illness as social media fad, PTSD, poverty, homelessness, and even David Rosenhan’s now largely obscure and completely discredited 1973 study “On Being Sane in Insane Places”—which alleged, largely through fabricated and manipulated experiments, that a malingerer could very easily fool admissions at psychiatric hospital but that no amount of subsequent sanity could get them easily released—feature in both. But their significance varies in Liu and deBoer’s stories; at times, they are even opposed.
In Liu, the history of psychiatry is the history of how a rigorous, humane, interpersonal exploration of human suffering, grounded in the events of social and political life, was transformed by bad-faith political actors and profit-motivated pharmaceutical corporations into a growth industry, willing to sell psychiatric medication, moral standing, and great material for Harvard admission essays to the striver class best suited to pay. Psychiatrists may be well intentioned, but they cannot resist the material incentives of their industry, particularly the profit motives of “Big Pharma.”
Deinstitutionalization proved the permanent failure of the asylum model; Rosenhan was a fraud but his fraud was against psychoanalysis: it “cast a pall over the profession of psychiatry,” giving reformers the ammunition they needed “to support a carefully orchestrated campaign to push through a thorough overhaul of psychiatric diagnosis” and produce the “scientific, systematic, rational, and fit for purpose” third edition of the Diagnostic and Statistical Manual of Mental Disorders. (She does not mean this as a compliment.) PTSD, Liu’s central concern, is at best a heavy distortion of a dubious set of claims about psychology. “PSTD treatments today are being pushed forward by a desire to cure ‘trauma’ by reducing the biological triggers for hypervigilance and stress responses that afflict trauma survivors,” she writes; this conveniently allows anyone, even the rich and powerful (particularly the rich and powerful, those masters of “the trauma script”) to lay claim to the “prophetic” moral authority of survival, while mystifying the ways imperialism and poverty cause a great deal of the actual trauma in the world.
Perhaps “the recognition of PTSD was not intended to create more opportunities for commodifying mental health care that deliver our brains to Big Pharma, but it did,” Liu tells us. This was “perfectly suited” to contemporary psychiatry’s “commitment to treat the chemistry of psychic disorder, much to the detriment of personal or intrapsychic origins of mental illness.” This is why she appreciates One Flew Over the Cuckoo’s Nest, the 1962 novel and 1975 movie, wherein a malingering Randle McMurphy (played by Jack Nicholson in the film) helps the patients in his forensic psychiatric hospital resist the ministrations of the wicked Nurse Ratched and the whole psychiatric apparatus. Cuckoo’s Nest is, for Liu, a salient countercultural artifact, one in which “abused patients seem more human, more sane, and more honest than their caretakers.”
DeBoer, meanwhile? “I hate One Flew Over the Cuckoo’s Nest, book and film alike,” he reports. “My god, how I hate them.” It’s “no wonder … that fictional portrayals” of insanity like Kesey’s “are so central to antipsychiatry: fiction allows for the romance that reality so rarely does.” Psychosis is not “just unusual thinking or nonconformity”; it’s “not edgy. It’s not cool. It’s not liberation. It’s a slow death.” DeBoer’s history is a history of psychiatry making slow, steady, and uncertain progress, beset on all sides by irresponsible critics, intellectually bankrupt skeptics, and privileged dilettantes with the audacity to “speak for” everyone from the suicidal schizophrenic to the profound, nonverbal autist. In All in Your Head, psychiatrists are not “shills”; they are the most overworked (and poorly paid) of medical professionals. Deinstitutionalization was too much, too fast, with too little follow-up, a “deeply and inherently irresponsible” error that let millions “hurt others, hurt themselves, and all too often slide into desperate lives on the streets.” Rosenhan’s fraud was the perpetuation of a “myth” that people “need to believe about psychiatry and its supposed failings.” Romanticizing and denying mental illness are two sides of the same coin: different ways of denying the intense and desperate immiseration of millions of people afflicted by real, biological, and treatable illnesses and spending decades now allowing them to rot while cranks, cynics, libertarians, and opportunists have gotten rich selling a more comforting story about psychiatric fraud, freedom of choice for the psychotic, and the “superpowers” that come with so many of these conditions, at least if your symptoms aren’t too bad and the superpower you’re interested in is the power to make anybody who criticizes you into a bigot. All in Your Head is the history of one idea that should be obvious—“disability is bad,” as deBoer puts it—struggling to stay afloat in a sea of ideas perfectly suited to contemporary culture’s commitment to creating a culture of neurodivergence to the detriment of the medical and social needs of the dangerously ill.
There are so many dishonest histories of psychiatry. All In Your Head is the one that I would want somebody who has never heard of any of this, who has never engaged with any of these ideas, to read first. It is the way I wish that I were exposed to this history.
Indeed, the stories that Liu and deBoer tell are at times so different that it would be surprising that I or any other critic would tie them together if not for the even more surprising fact that despite their differences, both books arrive in the same place: enough already. Whether one follows deBoer’s history or Liu’s, one emerges into a present where the promise of psychiatry has given way to its bastard children: pop psychology, therapy culture, and madness as an identity demanding deference. These children, this culture, is specious and cynical, an unserious vulgarization of the language of the clinic, appropriated by well-off and largely sane strivers, and put to work in Ivy League admission essays or, better yet, in cultivating parasocial relationships with these striving bullies’ communities and fans. In both stories, the children of psychiatry are the most annoying people on the planet, who have somehow got themselves appointed representatives of a high–social capital identity class at the expense of the most precarious victims of social and psychiatric pain. For both deBoer and Liu, the contemporary mental health culture is at once draconian and completely silly, romanticizing the dubious “madness” and “trauma” of strivers while demanding total deference from everybody else. This includes, of course, the victims of unheroic madness and unglamorous immiseration.
Both find this state of affairs dishonest and annoying. But more significantly, both believe that this culture has had serious and real consequences, not just for the narrow population of the insane, or of the dispossessed, but for public policy, democracy, and basic reason at large. The trauma script, Liu argues, has “promoted a politics of stasis and narcissistic fixation on subjectivity as ‘lived experience’ that has eviscerated the foundations of liberalism.” It is based on “a savior complex that loves nothing more than moral panics and the spectacle of philanthropic activism.” It has turned “the most private forms of violation” into “consumable narratives,” enabling “the consumption of social problems as morality plays.” It has allowed Americans to ignore the historical, social, and economic causes of most human trauma, abandoning the political quest for “redistribution” in favor of the demand for abstract “recognition,” recognition that almost always flows to the already famous, rich, and powerful. Trauma culture “participates in the destruction of the past and the annihilation of the future,” Liu claims; it “kills democracy not by accident, but by design.” To renounce it would “liberate us from a cultish devotion to survivors, prophets, stupid ideas, and dishonest idols,” to continue it would be to allow us to “foreclose on the building of political organizations in which the struggle against capital and for interests of wage workers takes precedence over fetishized forms of ‘seeing’ and ‘being seen.’”
For deBoer, the stakes are smaller than democracy itself, but they’re no lower: Every movement that chips away at the seriousness and gravity of mental illness helps immiserate and kill the insane. Anti-psychiatry denies the need for research, care, and treatment of the mad; faddishness, romanticizing, and talk of “disability as superpower” not only undermines the moral case for helping those with psychiatric disabilities but picks their pockets. In a section appropriately titled “Why Does Any of This Matter” (“A fairly common response to my points here goes some like this: Who cares? Yes, perhaps it’s true that autism of ADHD or disability generally have been gentrified, in an abstract sense, but so what?,” he explains), deBoer writes: “If our conception of disability is unduly captured by the perspectives and interests of those who are the least disabled, then our idea of what accommodations to provide will be incomplete at best, actively harmful at worst.”
When anti-psychiatrists talk of freedom and the right to be different, they deny “those who suffer from [serious mental illness] the social and legal tools they need to survive.” When high-functioning stigma-fighters deny the life-shattering impairment of profound disability, they make it easier to ignore and even punish the ill. Of what value were “choice” and “freedom” to Rebecca Smith, a schizophrenic woman who refused shelter and died in New York in 1981, deBoer asks, when her “mind was so addled that she did not have the ability to choose not to freeze to death”? Where does it leave the girl with profound autism, the treatment-resistant manic depressive, the incorrigible coprophagiac, when the conversation about “mental illness” is dominated by minimally afflicted scolds? “Resources follow attention,” deBoer writes, and when “the minimally afflicted demand attention for themselves…the most disabled will have to fight and scrap for funding, for research, and for policy initiatives,” the result is their disappearance, “not just from the discourse but from the moral imagination of the very movement purportedly built for them.”
This is not just so much grievance, so much cultural beef. In their own ways, Liu and deBoer both tell the story of a mental health culture that went badly wrong for a simple reason: it was easier to do it this way. It is easier to make “trauma” a social product than it is to overthrow the foundations of a traumatizing economic order. It is easier to afford high-functioning “neurodivergent” media celebrities a little recognition and authority than it is to undertake the enormously complex legal, social, and economic burdens of providing adequate care to an insane population that is frequently unpleasant, resistant, and frightening even when they receive care. It’s “easier to yell at people for perpetuating stigma than it is to actually provide material accommodation for disabling conditions,” de Boer writes, late in his book. “Trauma culture has given rise to a mass-produced, media-friendly script that has been fully monetized by entrepreneurs, influencers, psychopharmacological companies, universities, publishing houses, and not-for-profit organizations that use it to market cures to people suffering from the chronic stress of living, in a ruthlessly competitive, exploitative, dishonest, corrupt, and punishing world,” Liu writes late in hers. That script comes “prepackaged” in “small bites,” easier to swallow than what we’d need to do to make the world less punishing. We live in the bullshit culture of the easy, romantic, and self-flattering: that is the thesis on offer in both books here. We got there by following the path of least resistance, and the cost can be tabulated in corpses.
Liu and deBoer are not simply asking us to share in their annoyance with the easy thing, although it is annoying and that annoyance comes easily. They both are asking us to do the hard thing. They are asking us to do the hardest thing in American life: they are asking us to help those who are suffering, even when it is difficult. Even when it is expensive. Even when the people in need of help cannot hope to compete with the messaging apparatus of those incredibly annoying strivers trying to hoover up all the attention for themselves; even when those strivers might get really mad.
Liu and deBoer arrive at their destinations by different paths. They are different writers, with different concerns, telling fundamentally different stories about the history of American psychiatry. All the more reason to be wary when doubting either one. It is dangerous enough to dismiss the conclusions of just one frequently vindicated contrarian critic. When two find themselves simultaneously drawn to the same subject and produce, despite radically different interpretations of the facts, the same righteous grievance: well, how likely are they to be wrong?
Both find this state of affairs dishonest and annoying. But more significantly, both believe that this culture has had serious and real consequences, not just for the narrow population of the insane, or of the dispossessed, but for public policy, democracy, and basic reason at large.
And yes, at long last: both books are a little mean. They are polemical; occasionally sneering. Liu is particularly gleeful: opening to a random page—a random page!—I find her writing that “all human beings are born into delusion,” that American politics are “both static and corrupt,” and that even liberal (by which she means non-socialist) solutions to economic problems “reflect the values of a defensive and deluded professional class.” DeBoer is more restrained—fans of deBoer will, if anything, (mostly) miss the more biting style found in his most popular essays—but every dozen pages or so, he can’t repress it anymore, and somebody gets called “sublimely callous,” “arrogant,” “brazen,” or “irresponsible,” while he rolls his eyes, somehow through the page, at the fact that some of this even needs to be articulated. There are people who will call this tendency “trolling,” or claim that it transforms these books into works of seething by authors not infrequently accused of producing barely concealed expressions of personal resentment toward what they saw on Twitter and on television and calling it a matter of national urgency. But there is another term for this style: jeremiad, a burst of righteous fury against a deserving foe.
We should have more jeremiads. Why are Mencken, Hazlitt, Macdonald, Swift, or Juvenal still read? Not for their restraint. It is not a sin for a work of criticism to be alive, to be animated, to be, even when it is dealing in serious matters, a little fun—and that is particularly true in this area. Both Liu and deBoer are fighting against entrenched ideas, defended by many of the most annoying and unpleasant figures in contemporary life. It would be far stranger to respond to this state of affairs in completely flaccid prose, to forgo enough of this bullshit already in favor of the “have you perhaps considered, not to give offense, but the possibility that alternative paradigms for interpreting these problems exist” of an inoffensive white paper. Many Americans are suffering under the misapprehension that in order to persuade an easily distracted public, you must approach them in completely reasonable, measured terms. But that is not where great critics come from. They come from seething. They come from having had enough. They come bearing their teeth.
Still: these aren’t mad dogs. deBoer and Liu are not, despite their caricatures, just shapeless, temperamental writers whose joie de vivre in confrontation seeps in to spoil their books. Their annoyance, their anger, their contempt is a classic of American cultural combat; it is, despite everything that separates Traumatized and All in Your Head, remarkably similar in character. You begin to notice, after a while: both deBoer and Liu are fond of the language of authenticity. Both use “gentification” to refer to what has happened to American psychiatry. Both write about “fakers,” about “fads,” about “kayfabe,” about “fashion,” about “real” madness, “real” disability, “real” suffering, and about all the “trendy” nonsense that has swooped in to obscure it and replace it. The “trauma script” is meant to manufacture “authentic” subjectivity, Liu writes; the trouble is that it’s completely phony, made for feed and for TV. When discussing the “bizarre world where tens of thousands of young women spontaneously decide that they have an incredibly rare and deeply debilitating psychiatric disorder,” deBoer writes, regarding the epidemic of disassociative identity disorder on TikTok, a “useful metaphor … is kayfabe,” the “mutual, willful deceit about just how authentic professional wrestling and its outcomes are.” What is this but the same accusation that once gave American music criticism its old bite? The accusation that is always seething and which we used to see quite a bit more of before we all decided that the worst sin a critic could commit was getting mad online. DeBoer and Liu are not just calling the high priests of contemporary mental health culture annoying or wrong. They are calling them poseurs.
They should. Liu and deBoer’s targets are poseurs. That’s why they’re so annoying. That is why it is so embarrassing, at bottom, to find such large segments of urgent American cultural and medical policy under their control. Like, they aren’t even serious, man. Come on. Like deBoer, I have spent many years in treatment for a serious mental illness. I have had work, relationships, and bare years of my life annihilated by mania, psychosis, medicine, and hospital. I have watched the history that deBoer and Liu describe: the steady transformation of psychiatry from a sight of horror into a site of brutal neglect; the trading of doctors too eager to lobotomize at the first sign of difficult behavior for a class of activists too eager to say “uh, mental illness doesn’t do that” in response to the same, and felt that both would prefer it if I were dead. I have watched therapy become fashionable; I have watched facetious illness become a fad; I have found myself “spoken for” by people who claim to suffer from debilitating psychiatric conditions but for whom these conditions have never seemed to do anything but advance their careers. I have watched us fail, year after year, to build anything like a real infrastructure for the treatment of insanity. I have watched people ranting and raving on the streets and thought there but for the grace of my health insurance go I, and even that may disappear someday. I have felt annoyed; I have felt, as deBoer writes, that the abolition of stigma did not actually constitute the abolition of insanity, and I would love, if there is no other option, to be left to “suffer in peace.” I reveled in the contempt of All in Your Head and Traumatized; in the language of the poseurs: I “felt seen” by them.
I felt ambivalent about that feeling, once the thrill had faded. DeBoer and Liu are prosecuting real, serious cases. They are concerned with matters of life and death. But I was delighted to see them sneer a bit along the way. Would it be better to remain measured, to remain reasonable, to encounter these cases as calm, unassailable arguments? Would that better respect the stakes? I miss that old school jocular gatekeeping style in American criticism as much as anybody, but we’re talking about a plague here, not pop acts copping punk cred for their radio-friendly hits.
What I mean is: has it really come to this? At long last? The worst thing that has ever happened to me—this malady, this terrible luck, this disease—defended like the territory of a minor record label? This perverse, protective impulse toward a life that many of us would undo in an instant, if we had the medical technology required, transformed into an occasion for a little cathartic sneering? Is this all that we have left? Nursing a shameful wound and begging the world stop transforming it into so much stupid, deadly slop? Growing ever more incredulous, year after year, that these poseurs have managed to rack up a body count?
Well: we didn’t start it. This unbearable, obnoxious, and dangerous “mental health” culture did not just happen one day. For decades, psychiatry developed a series of products that did a great deal to alleviate the suffering of the insane: talk therapy, psychopharmacology, intervention manuals, medical frameworks to help sort the tricky moral and social questions that arise in the face of insanity. But after investing all that time and energy, the kind men and women who administer the American healthcare state discovered that they had a serious problem. These tools were expensive, but their patients were poor. The government wasn’t even willing to chip in much anymore. Worse, these destitute patients were difficult. They didn’t always comply with their treatment plans. Worse, they were sometimes treatment resistant, and even when they were both compliant and susceptible, they were dependent on years of assistance that did little more than allow these troubled cases to suffer a little less, in peace. This was a poor market in any economy. It was an untenable market in a country that gets a little twitchy whenever it might have to spend money helping people who are unlikely to pay it back.
So justifications were invented to begin to roll it back: We should close the hospitals in the name of freedom. We should cut Medicaid in the name of responsibility. We should curtail the insanity defense in the name of fighting stigma. We should let people freeze on the streets in the name of, look, man, it’s a tragedy, but shit happens.
Luckily, the abolition of traditional psychiatric services did not entail the abolition of psychiatry, nor do anything to imperil the growing romance of insanity. While the hospitals closed, the seminars on neurodiversity, on trauma, on managing your mental health multiplied. For a population of strivers who understood the rhetorical authority that they could derive from claims of marginalization (but for whom there was, sadly, no obvious economic or other basis on which to claim that authority), the appeal of invisible, unprovable, and endlessly capacious claims of psychiatric suffering became impossible to resist. Unlike the old patients—the schizophrenics, the manic-depressives, the victims of American war and poverty—these new patients could accumulate the social capital of their position without ever risking much more than mild impairment from their “disease.” Better yet, they could pay. They could attend therapy. They could pay out of pocket for therapy. They could reliably afford their medication. They were very eager to take their medication. They were very eager to talk about it, to advertise it, to encourage their friends and neighbors to look after their own mental health. They could speak and organize and advocate for “the disabled” with an alacrity that is usually unavailable to the very ill.
These were the patients that the clinics had long waited for. A beautiful and very lucrative partnership was born. The only impediment was, of course, the old patients: the expensive, the poor, the difficult, the belligerent, the unglamorous and inconvenient and terrible for television; the insane. For mental health to triumph, mental illness would have to die: by anti-psychiatry, by mad pride, by the endless, drowning chorus of well-mannered and well-positioned voices going on and on about their “superpowers” and their “burnout” and their “self-care” and their “trauma.” By the suggestion that anybody who believes that all of this is bullshit with a body count is frankly ableist, and problematic, and actually just a troll. God, they’re so annoying. God, what poseurs these people are. God. It is so much easier to feel annoyed than it is to feel desperate, to feel hated, to feel abandoned and immiserated and scared.
What a terrible, annoying moment we live in. What unserious, dangerous, and cynical times. What a pleasure it is to see these feelings put in print, not once, but twice, in just one month! What a danger it is to hope these books might herald the long-awaited turn toward a more serious and humane future. I have no doubt they’ll meet with resistance. “Uh, excuse me, but these books are actually really stigmatizing and—” Enough of this bullshit! Enough already! Enough!