The Grift at the End of Mental Health

"Mental Health" graffiti. From Infers Group via Wikimedia Commons

One thing I have absolutely been through the wringer over is mental health.

I half wonder if it would somehow be interesting to collect my comments on this very site, because I have been here long enough that for most of the time – everything but the last two years, in honesty – my issues were uncontrolled. They were uncontrolled because they were unidentified; and they were unidentified because, by and large, nobody bothered to look beyond the first ideas. It’s one thing to go by “if you hear hoofbeats, assume horses, not zebras” but to keep saying ‘horse’ when you’re staring at a stripy black and white walking barcode is taking it much too far.

To be clear: I disagree heavily with Marcus (whose blog I follow assiduously) on this one topic. I believe that psychology and psychiatry very much are scientific disciplines. Empirically, there are hordes of people out there whose lives have been improved immeasurably by psychological techniques and psychoactive medication, so something must be working. But there are also hordes of people (smaller ones I hope and believe, albeit an anecdotal opinion) who aren’t helped.

I do believe psychiatry and psychology are a very young science, and in many respects actually a good solid 50 years younger than they are generally taken to be. We’ve only in the last little while arrived at a definition of ‘mental disorder’ that seems to be practically useful, one which depends on whether the issue at hand causes discomfort or distress to the patient. For most of their history these disciplines have been massively and inappropriately normative in a very Victorian way, trying to define any deviation from the privileged class’s ideas of “normal” as a disorder to be solved. It’s washing that stain off only very slowly and really only in proportion to how quickly marginalized folks enter the field, people carrying the message that “normal” is nowhere near a fixed target…

‘Normal’ is not a place I have ever lived. When I was little, teacher-types called me ‘gifted’. They were also confused by some of the ‘alien-ness’ in my behavior but didn’t think to make anything of it. I was, am, autistic. This went undiagnosed until 2017: professionals did wonder about me and did tests, but this was long before even (now-defunct) Asperger’s was part of the common literature. For reasons mostly to do with societal pressures, autism presents differently in boys and girls. When I was a child, this fact was either not widely known or not widely accepted, and besides, everyone thought I was a boy. Being trans complicates everything, I tell you h’what…

For most of my teen years and adult life, I was monstrously depressed. That isn’t an exaggeration. It was intense, constant, and ruined an awful lot of my life. People would get to know me, then try to help, then discover they couldn’t, then get frustrated and throw me away. I’ve been on a whole palette of SSRIs, and even lamotrigine for a while because I had a doctor who thought I might be Bipolar II. That same guy later complained that he was trying to diagnose me with borderline personality disorder, but couldn’t make it fit. The litany of therapists I went through is a story for another day but I encountered some epic Wrong during that, but the main thing was trying to fit me up for wrong diagnoses over and over, because they know about Major Depression and Bipolar Disorder and so forth, so much spaghetti flung at the wall and none of it stuck.

The most extreme instance of this was in October 2017, when I went to the local municipal mental health provider, told them everything I knew and begged for help. They offered me some group sessions for depression, then just before the first one called and cancelled that. The told me me my ‘case is too unique’, and in its place offered… nothing. Bupkes.

Think about that. An organization whose entire raison d’être is to improve the mental health of the citizens of this municipality, turned away one of those citizens for being too weird. For fuck’s sake, you’re a psychiatric institution, exactly how normal do you expect your clients to be?

This, ludicrous as it was, wasn’t the grift. It was pretty much the opposite of a grift, in fact; this was the work of an underfunded and lowest-common-denominator-serving public institution. Some of those therapists you could argue were a sort of grift, putting in just the needed amount of care and association-approved prepackaged wisdom to keep the client coming back every week at $100+ a pop. The BIG grift, though, is what happens when you’re alone: the self-help industry.

It would be unfair to call it all a grift. Self-help and consumer psychology is a very varied field. But it’s an unregulated very varied field, and one in which the more palatable and magical you make your content, the better it does. I remember my psychiatrist insisting I should read Eckhart Tolle’s ‘The Power of Now’; he told me I would find it useful despite being a bit woo, but less so than the other books he was thinking of.

Folks, have you heard of Eckhart Tolle? He is definitely a grifter. His work is not ‘a bit woo’, it is SOLID woo from stem to stern. It is completely and unremittingly bullshit, of a spiritual new-agey flavor. I found an audiobook version of ‘The Power of Now’ and had the fascinating experience of traveling to work on public transit, huddled inside my coat, becoming angrier and angrier that this nonsense was not just for sale, not just contaminating my eardrums, but was there because my goddamned DOCTOR recommended it!

I stopped when Tolle told me the universe had a plan for me, because otherwise I would have ripped down the next station we came to out of pure indignant fury. I hadn’t even made it out of the introduction.

Psychiatry/psychology is a science. But at this stage it’s a young one, and a pretty stupid one. It’s swallowed an awful lot of nonsense from different quarters, from its origins in “of course white men are best, old bean” to the kinds of sprituality that can actually interfere with healing clamoring for attention because suffering people will pay to stop suffering.

Fact is… I don’t have any of the above. I have c-PTSD: complex post-traumatic stress disorder. You know who finally figured that out? Me. I figured out the autism too, because when I found a list of ways it presents in women, boom, huge match. I brought the literature for all of this to the psychiatrist, who read it all, agreed with everything, made the diagnoses official and… thereby ceased to be of any use whatsoever, because neither of these things has a component that can be treated with pills.

My case ultimately is a success story, but not because of the mental health industry; it’s in spite of it. When the whole thing is this much of a mess and fails so often, what is the point of it? It needs to be better, massively better, so that people like (and unlike) me don’t fall through the cracks so often, because when we do, there’s only a couple of places to wind up: on the streets, in isolation, or in the predatory clutches of the grifters.


  1. Jazzlet says

    Oooof. You have my sympathy, I’ve had problems with depression for years, tried lots of pills which do help me to not be suicidal all the time, but don’t help with the underlying problem. I’ve done CBT, Mindfulness, talking therapy ditto. I’m now on a waiting list for CBASP (Cognitive Behvioral Analysis System of Psychotherapy), I’ve no idea if it will make any difference.

    Anyyway I’m glad you have yourself a blog 🙂

  2. Sean Boyd says

    Recently diagnosed as Bipolar II (after seeing the pattern of behavior and developing the willingness to be honest with myself about it), and given lamotrigine. Only been on it a couple of months, and already I feel a major shift in the way I feel and react. I also had recent experience with ‘woo’ from a counselor who, after learning I was extremely non-spiritual, proceeded to give me some handouts for reading, two of which were subtly (but definitely) Jesus-based. Needless to say, that person is no longer my counselor.

    My favorite (?) episode from my mental health adventures? It was after my first hospitalization, following an adverse reaction to Zoloft (which apparently doesn’t play well with bipolar if a mood stabilizer is not also included.) An office mate cornered me in the office one day, and told me, very seriously, that it was likely that my mental health problems were a result of demon possession. He was completely serious.

    Glad to see new bloggers. Happy posting!

  3. Allison says

    Fellow trannie and c-PTSD sufferer here. I’ve had people say I’m on the autistic spectrum, but not people I would trust to actually know. I have a child (grown now) who definitely is, plus a brother, father, and aunt who are enough like him that I believe they are also, but I’m not like them, so I don’t think I am.

    It’s interesting: I’ve found that people in the trans community have a lot more familiarity with trauma than the cis people I know. It was a person on a trans support website ( who pointed me to Judith Herman’s Trauma and Recovery, and a genderqueer person who pointed me to the term C-PTSD. I later saw a presentation on C-PTSD a year or so ago at the Philadelphia Trans-Health Conference which had a list of symptoms for C-PTSD, and I definitely had most of them.

    In particular, I’ve been able to talk about my suicidal ideation, which I’ve had at least since I was 10, and nobody freaks out. The few times I’ve mentioned it to cis people I know, most of the time they freak out and start analyzing me to see if I’m about to go through with it. The fact that I’ve lived with it for 55+ years and never even made an attempt doesn’t seem to register with them.

    BTW, I can definitely recommend both Trauma and Recovery and Bessel van der Kolk’s The Body Keeps the Score for a comprehensive and sympathetic coverage of trauma. I keep both near my bed as comfort reading; it’s nice to finally feel like what I’ve lived with all my life actually makes sense. I especially like the first sentence or two in Herman’s chapter on child abuse, where she says that repeated trauma in childhood shapes (and warps) the child’s personality as it is developing, because it is so true for me: based on what people have told me of my infancy (I have almost no memories from before I was 10), my traumas started before I could talk, and I’ve noticed that C-PTSD isn’t something I have, it’s actually what I am. There is no “me” that exists or ever existed apart from the trauma.

  4. says

    Thanks for the welcome. The way the symptoms manifested with me it actually FELT like (I imagine) being possessed. Lamotrigine’s one of those things that needs to be where it needs to be and ABSOLUTELY NOT anywhere else: its effect on me was not to put a floor under my mood but a low ceiling above it. The world felt grey and I couldn’t smile for three weeks. That wasn’t a good time.

  5. voyager says

    I have a 21-year-old friend who suffered from terrible anxiety and depression in her teens. In her senior year, there was a suicide pact at her high school, and she lost 2 friends who both jumped in front of trains. 7 kids in total committed suicide that year. The counselling centre that she was referred to would not assign her a regular therapist. Instead, she saw someone different every time she needed help. They also had no sort of follow-up care, except to suggest a private psychologist that her family couldn’t afford. She tried to work part-time to help pay for it, but she had too many bad days to keep a job. I finally hired her to help me with chores just to keep her in therapy. That was a few years ago, and she’s doing well now, but no thanks to the mental health support system in Ontario.

  6. invivoMark says

    Oh snap, you’ve got a blog now! I’ve liked your posts. Happy to look forward to seeing the longer form.

    I’ve got at least a couple untreated mental health problems, but sadly mental health care where I currently live is fucking miserable so I’ve just had to do my best to deal. I’m moving soon, so hopefully that will change.

    I rode the diagnosis merry-go-round as a teenager, and went on the medication pub-crawl. But all the professionals where I grew up missed the blindingly obvious one: a type of obsessive-compulsive-adjacent disorder that my parents tried for about a decade to “correct” with ever-more-elaborate punishment-and-reward (mostly punishment) mechanisms.

    Yes, psychology and psychiatry are sciences. The fact that the ones treating patients are often garbage at it doesn’t change that.

  7. says

    I’ve just decided to stick with unthreaded comments after all. I do wish there were ways to mark the replies more cleanly than the conventions we made up, but, oh well.

    @5 invivoMark

    Thank you!

    You’ve said something interesting there. I think there’s a good chance that psych* as a discipline is infected with Dunning-Kruger syndrome more than any other legitimate medical discipline. After all, people with a shallow understanding of psychology are the ones who tend to normative thinking and believing they know all of it, and there’s a lot of therapists out there who aren’t even educationally accredited in the specialty. Combine that with the slow-to-change normative history, and you have a recipe for inviting terrible practitioners who aren’t aware they are terrible…


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