Love this, love your book. I read it before I started working with you, and it blew me away. As a mental health consumer with too many years under my belt of being in the care of pharmacologists playing willy-nilly with meds and my brain, I grew very skeptical over time that they knew what they were talking about. The first time I was ever prescribed an antidepressant in the late 80s, I asked the doctor to explain how the medication worked. He shrugged, and said they had no idea, but that it worked, and that it was due to a chemical imbalance in my brain. The shrug stuck with me. But I still gave my power away for too many years, for too many meds. Living a different life now. The doctor exclaimed, "It's better living through chemistry!" I exclaim, I'm living better by understanding the trauma I experienced, working through those issues that kept me from enjoying a full life, and overall prefer a much more holistic approach to my health, mental, physical, cultural, and social. It's all connected. And I still take an antidepressant. It helps, but it's not the only answer, not by a long shot. Thanks, Sarah, for sharing it, for writing it, and for being so up front about your own history. xo
I was diagnosed with ADHD by a psychiatrist and after trial and error Benzedrine was settled on as a medication. I became so placid and mellow that I ceased to be functional in my work.
As with everything we often know not what we do not know.
Complexity Theory suggests that a full understanding of our brains and our behavior may always be a bridge too far.
As a health psychologist, I could not agree more. I used to sit in a room with other clinicians assessing hours and hours of psychometrics (psychological testing results) and we would argue the resulting diagnoses ("consulting"). One clinician favored ADHD so much that he assigned it *almost every time, even alongside other disorders that would- according to the DSM- rule it out. There is so much human judgment and assumption and error in this process that it became unethical and laughable to me. We are forced into a medical model by insurance companies that demand a code to bill and those little codes become part of peoples' permanent identity. Do you know how many times I just diagnose Adjustment Disorder (?) cuz, we're all adjusting to some life event when we need psychological/emotional help. Thanks for putting this into the world.
O lord, please save me from the world of good intentions—as you describe psychiatry—and from drowning in the well of reductionism and believing we understand something once we give it a name, even if backed by the frequentist statistics world where maybe the Bayesian world of Decision Science would be a more apt tool.
Thank you, Sarah. I appreciate you bringing this up because I've thought a lot about this. I'm not a scientist or medical professional so I can't speak to the science around your points. However, I have wondered how the shift to seeing our emotional states as brain function has changed our expectations on what it's like to live as a human. I have noticed that whenever I struggle in my life, people are very quick to tell me that I might be depressed and that medication would help. For me, life is full of ups and downs. I can't see any reason to categorize life struggles as something wrong that needs to be fixed. In fact, struggles mean that everything is exactly normal. It seems like the range of what we consider normal has become a very narrow definition. Even grieving after the death of a loved one is now medicated.
I'm not suggesting that we should all live a life that's unnecessarily grim. If someone is suffering, I would be the first person to want to help them. But I have wondered what would happen if we changed our expectations so that the normal experience of living included aspects that we now consider depression or anxiety. Could people pass through these periods without defining themselves as depressed or anxious?
I hate being trapped in neuromythology. I flinch when I hear its glibber and glibber manifestations. But in my nail-biting moods, I want to “reach for it” every time because we are all seeking an answer to what can seem intractable. It’s like the God, the Bible. When a family member is in unspeakable pain, one seems to have soap opera choices of WHO is to blame (mummy always popular) or neuro-defect. Where is the third way? Enter the “fresh air and exercise” prescriptions. Well, there’s always going to be half right, except good luck with clean air, water, or food supply. Mental Dis-ease is the most vexing thing there is.
The brain needs real nourishment...and lack of nutrients in processed food affects its ability to function. Sugar and junk food create an even greater need, because they rob the body and brain of nutrients faster. This will result in both physical and mental problems. Using any kind of chemical concoction in a drug will only harm the internal organs further. The organs and cells in the human body require nutrients from wholesome unprocessed chemical-free and pesticide-free food. Real nourishment is key to mental and physical health
I love that more people are accepting and writing about these observations. Even as a graduate student on a neuroscience track in Pharmacology we were taught plainly the tenuous basis for neuropsychiatric treatments and which of the many theories of pathology the drugs hinged on. I was hearing in the late 2000’s ‘they think depression is all serotonin lol.’ It’s one of the prime examples of a field’s mismatch between bench work and clinical treatments. I have a whole spiel about nothing will change until the clinical board exams do first, but I’ll spare it and say I loved reading this instead.
John Milton/Satan said that the mind is its own place and can make a heaven of hell, a hell of heaven. Since then, progress in this matter has been slow.
Great analysis. I navigated the system with a child who never ended up getting a believable diagnosis. I noticed that each professional would conveniently find that he had a diagnosis that was their specialty! We had a wonderful pediatrician who said he thought it was developmental and would just work itself out with time, love, and some therapy (OT, PT, LMFT). And guess what? It did. He's now thriving as an adult.
The question I have is why we need to feel that mental health has to be one way or the other? How about just a complex stew that each of us needs to come to terms with? And tailoring the treatment to the individual rather than a population-level "cure." I am not against medication, if it works and there's an exit strategy. But when a child psychiatrist told me that my 5-year-old needed to be on antipsychotics, my question was: and when will we know it's time to take him off? She couldn't answer that simple question.
Sarah, as with every profession, not all clinicians fall into believing the myth that “mental health disorders” are incurable. Hardly. Myself and many colleagues have known for decades that pretty much all of it can be “cured”. (If that word should or even could be applied to my work).
There are some (of course not all) conditions which can be balanced with nutrition and exercise, and others with reframing of learned behavior. All of which is predicated on the client wanting to change.
The DSM was created (and is still only used) for labeling between insurance companies, practitioners and pharmaceutical companies. Much of it is hooey. (Great technical term I just used there! Hah!). I only and ever labeled clients for the purpose of being paid by insurance companies, not for diagnosis.
Medicine, in all its formats (allopathic, naturopathic, psychiatric etc etc) is an “art”.
Our bodies are living breathing and changing things, influenced by our entire environment and heritage, things both seen and unseen. Where one culture might view schizophrenia as a disease to be treated, others treat that person with reverence, a seer of other worlds, and very wise.
I have used the tools as a guide for understanding my clients, not a label. It is sometimes helpful to sift and sort with. And as we learn more, we know more. It is a practice not an exact science.
No need to throw out the entire system, rather simply use it as a chart for eliminating extraneous data, and only one small tool in an entire world full of information. Getting to the causation of what is happening to a client, and how their experience of the world is being created is the process that good clinicians use. I’ve always worked with my clients to bring about a sense of understanding, calm, and insight to their world.
If only I'd had you! You're so amazing, Teyani--truly. I definitely don't want to throw out the system because I have nothing to replace it with. And there are good doctors and mental health practitioners out there--like you.
Awww thank you dear Sarah. I’m so grateful that my thoughts came thru with clarity. And yes, I truly wish I had been able to be there back then for you. It’s terrible what you went thru, and so unnecessary. I’m here for you now, tho.
Thank you for pointing out the hooey factor! I grew up in the US and even worked in a hospital for a time, so the DSM was quite known to me. Now I live in Switzerland— where I have had my health struggles, both mental and physical— over the decades, and you know what? They don’t use the DSM here.
I only realized this in conversation with a psychiatrist here, who mentioned in passing that “the latest DSM has finally recognized xyz, fortunately for us we’ve noticed that long ago.” I must have looked at him quizzically, because he continued to explain that he reads through the DSM out of curiosity, and because he had done some post-doc research in the US in the late 70s he knew the manual.
All of this was fascinating and educational, Sarah, but one thing that really surprised me was the unreliability of medical imaging. The salmon scan was illuminating (no pun intended).
Love this, love your book. I read it before I started working with you, and it blew me away. As a mental health consumer with too many years under my belt of being in the care of pharmacologists playing willy-nilly with meds and my brain, I grew very skeptical over time that they knew what they were talking about. The first time I was ever prescribed an antidepressant in the late 80s, I asked the doctor to explain how the medication worked. He shrugged, and said they had no idea, but that it worked, and that it was due to a chemical imbalance in my brain. The shrug stuck with me. But I still gave my power away for too many years, for too many meds. Living a different life now. The doctor exclaimed, "It's better living through chemistry!" I exclaim, I'm living better by understanding the trauma I experienced, working through those issues that kept me from enjoying a full life, and overall prefer a much more holistic approach to my health, mental, physical, cultural, and social. It's all connected. And I still take an antidepressant. It helps, but it's not the only answer, not by a long shot. Thanks, Sarah, for sharing it, for writing it, and for being so up front about your own history. xo
I was diagnosed with ADHD by a psychiatrist and after trial and error Benzedrine was settled on as a medication. I became so placid and mellow that I ceased to be functional in my work.
As with everything we often know not what we do not know.
Complexity Theory suggests that a full understanding of our brains and our behavior may always be a bridge too far.
I agree.
I love the shrug. And that they don't know. And that it's not a big deal to them.
As a health psychologist, I could not agree more. I used to sit in a room with other clinicians assessing hours and hours of psychometrics (psychological testing results) and we would argue the resulting diagnoses ("consulting"). One clinician favored ADHD so much that he assigned it *almost every time, even alongside other disorders that would- according to the DSM- rule it out. There is so much human judgment and assumption and error in this process that it became unethical and laughable to me. We are forced into a medical model by insurance companies that demand a code to bill and those little codes become part of peoples' permanent identity. Do you know how many times I just diagnose Adjustment Disorder (?) cuz, we're all adjusting to some life event when we need psychological/emotional help. Thanks for putting this into the world.
DSM. The path to being frozen in ignorance is relying upon check boxes or lists for understanding.
100%
Wow: "almost every time." I love that we're all adjusting to some event. It's so true.
O lord, please save me from the world of good intentions—as you describe psychiatry—and from drowning in the well of reductionism and believing we understand something once we give it a name, even if backed by the frequentist statistics world where maybe the Bayesian world of Decision Science would be a more apt tool.
Well put. We should all be saved from the world of good intentions.
I've been trapped in the DSM realm for a decade while they try "figure me out" You put to words a lot of the thoughts I have had and more. Thank you.
And it makes us obsessed with trying to "figure out" ourselves--as if that's possible.
Excellent article. I also wonder if some of these meds are addictive— impossible to wean off of— my personal situation.
1000%--you're in good company.
Thank you, Sarah. I appreciate you bringing this up because I've thought a lot about this. I'm not a scientist or medical professional so I can't speak to the science around your points. However, I have wondered how the shift to seeing our emotional states as brain function has changed our expectations on what it's like to live as a human. I have noticed that whenever I struggle in my life, people are very quick to tell me that I might be depressed and that medication would help. For me, life is full of ups and downs. I can't see any reason to categorize life struggles as something wrong that needs to be fixed. In fact, struggles mean that everything is exactly normal. It seems like the range of what we consider normal has become a very narrow definition. Even grieving after the death of a loved one is now medicated.
I'm not suggesting that we should all live a life that's unnecessarily grim. If someone is suffering, I would be the first person to want to help them. But I have wondered what would happen if we changed our expectations so that the normal experience of living included aspects that we now consider depression or anxiety. Could people pass through these periods without defining themselves as depressed or anxious?
It's such a great question: Could people pass through these periods without defining themselves as depressed or anxious?
I hate being trapped in neuromythology. I flinch when I hear its glibber and glibber manifestations. But in my nail-biting moods, I want to “reach for it” every time because we are all seeking an answer to what can seem intractable. It’s like the God, the Bible. When a family member is in unspeakable pain, one seems to have soap opera choices of WHO is to blame (mummy always popular) or neuro-defect. Where is the third way? Enter the “fresh air and exercise” prescriptions. Well, there’s always going to be half right, except good luck with clean air, water, or food supply. Mental Dis-ease is the most vexing thing there is.
The brain needs real nourishment...and lack of nutrients in processed food affects its ability to function. Sugar and junk food create an even greater need, because they rob the body and brain of nutrients faster. This will result in both physical and mental problems. Using any kind of chemical concoction in a drug will only harm the internal organs further. The organs and cells in the human body require nutrients from wholesome unprocessed chemical-free and pesticide-free food. Real nourishment is key to mental and physical health
Superb.
Sarah,
Excellent summary of the romantic ease neuromythology demeans health literacy in 2025. We are in this together.
Peace.
Christopher
Hi there! You put it so well: the romantic ease neuromythology.
I love that more people are accepting and writing about these observations. Even as a graduate student on a neuroscience track in Pharmacology we were taught plainly the tenuous basis for neuropsychiatric treatments and which of the many theories of pathology the drugs hinged on. I was hearing in the late 2000’s ‘they think depression is all serotonin lol.’ It’s one of the prime examples of a field’s mismatch between bench work and clinical treatments. I have a whole spiel about nothing will change until the clinical board exams do first, but I’ll spare it and say I loved reading this instead.
Thank you, Kimberly. What an incredible experience you had. Wow. The neuroscience track in Pharmacology. I can't imagine what that was like.
John Milton/Satan said that the mind is its own place and can make a heaven of hell, a hell of heaven. Since then, progress in this matter has been slow.
I'm laughing: Since then, progress in this matter has been slow. So true. Milton/Satan had it.
Great analysis. I navigated the system with a child who never ended up getting a believable diagnosis. I noticed that each professional would conveniently find that he had a diagnosis that was their specialty! We had a wonderful pediatrician who said he thought it was developmental and would just work itself out with time, love, and some therapy (OT, PT, LMFT). And guess what? It did. He's now thriving as an adult.
The question I have is why we need to feel that mental health has to be one way or the other? How about just a complex stew that each of us needs to come to terms with? And tailoring the treatment to the individual rather than a population-level "cure." I am not against medication, if it works and there's an exit strategy. But when a child psychiatrist told me that my 5-year-old needed to be on antipsychotics, my question was: and when will we know it's time to take him off? She couldn't answer that simple question.
Wow. Wow. Wow. Good for you for asking that question of the child psychiatrist. So wise.
And this: How about just a complex stew that each of us needs to come to terms with? Exactly.
I'm so glad your son is thriving!
I appreciate your excellent writing.
Thank you, Georgia!
Sarah, as with every profession, not all clinicians fall into believing the myth that “mental health disorders” are incurable. Hardly. Myself and many colleagues have known for decades that pretty much all of it can be “cured”. (If that word should or even could be applied to my work).
There are some (of course not all) conditions which can be balanced with nutrition and exercise, and others with reframing of learned behavior. All of which is predicated on the client wanting to change.
The DSM was created (and is still only used) for labeling between insurance companies, practitioners and pharmaceutical companies. Much of it is hooey. (Great technical term I just used there! Hah!). I only and ever labeled clients for the purpose of being paid by insurance companies, not for diagnosis.
Medicine, in all its formats (allopathic, naturopathic, psychiatric etc etc) is an “art”.
Our bodies are living breathing and changing things, influenced by our entire environment and heritage, things both seen and unseen. Where one culture might view schizophrenia as a disease to be treated, others treat that person with reverence, a seer of other worlds, and very wise.
I have used the tools as a guide for understanding my clients, not a label. It is sometimes helpful to sift and sort with. And as we learn more, we know more. It is a practice not an exact science.
No need to throw out the entire system, rather simply use it as a chart for eliminating extraneous data, and only one small tool in an entire world full of information. Getting to the causation of what is happening to a client, and how their experience of the world is being created is the process that good clinicians use. I’ve always worked with my clients to bring about a sense of understanding, calm, and insight to their world.
If only I'd had you! You're so amazing, Teyani--truly. I definitely don't want to throw out the system because I have nothing to replace it with. And there are good doctors and mental health practitioners out there--like you.
Awww thank you dear Sarah. I’m so grateful that my thoughts came thru with clarity. And yes, I truly wish I had been able to be there back then for you. It’s terrible what you went thru, and so unnecessary. I’m here for you now, tho.
Thank you for pointing out the hooey factor! I grew up in the US and even worked in a hospital for a time, so the DSM was quite known to me. Now I live in Switzerland— where I have had my health struggles, both mental and physical— over the decades, and you know what? They don’t use the DSM here.
I only realized this in conversation with a psychiatrist here, who mentioned in passing that “the latest DSM has finally recognized xyz, fortunately for us we’ve noticed that long ago.” I must have looked at him quizzically, because he continued to explain that he reads through the DSM out of curiosity, and because he had done some post-doc research in the US in the late 70s he knew the manual.
All of this was fascinating and educational, Sarah, but one thing that really surprised me was the unreliability of medical imaging. The salmon scan was illuminating (no pun intended).