Does Psychiatry Do More Harm Than Good?

As mental health awareness and spending grows, mental health outcomes are getting worse.

This summer, in a Plymouth, Massachusetts, courtroom, prosecutors presented rows of prescription bottles as evidence in the murder trial of Lindsay Clancy. Clancy, a 36-year-old mother and nurse, strangled her three young children in January 2023 and then tried to end her own life. Shortly before the killings, she wrote on her phone that “medication stole my motherhood and my life.” Her defense calls it postpartum psychosis compounded by psychiatric overmedication.

The trial ended in a mistrial on September 4 after jurors could not decide on an outcome, and a new hearing is scheduled for September 29. Whatever happens next, the tragic case revives a question that has plagued the mental health industry since its inception. Does psychiatry, on balance, do more good than harm?

For most of the 20^th century, the answer was a clear no. Psychiatry once warehoused hundreds of thousands of people in asylums, induced comas with insulin, and severed the frontal lobes of the mentally ill via the Nobel prize-winning “innovation” of the lobotomy, which left thousands of people with permanent severe brain damage. As recently as the 1970s, the profession’s own manual classified homosexuality as a disease.

The American Psychiatric Association (APA)—the governing body of all psychiatrists in America—does not deny this history. In Shrinks: The Untold Story of Psychiatry, former APA president Jeffrey Lieberman catalogs the field’s long record of pseudoscience and harm and then folds it into a narrative of redemption: a discipline that blundered for a century before maturing, in his telling, into a science that saves lives. Against that history, a field that now seeks informed consent, favors outpatient care, and subjects its treatments to clinical trials is a real scientific and ethical improvement. But that does not mean it is now a net good to society, however well intentioned practicing psychiatrists may be.

A maturing science that spends more and knows more should produce better outcomes. Psychiatry has delivered the opposite. Between 2000 and 2021, American mental health spending more than tripled, from roughly $40 billion to $140 billion. Over the same period, reported rates of mental illness climbed almost as fast. Diagnoses in nearly every category sit at record highs. If the investment were buying health, the curves should have diverged.

Defenders of the mental health industry say that rising diagnoses and costs reflect falling stigma and growing awareness, a backlog of real suffering finally being recognized and treated. An alternative explanation is that the definition of mental illness keeps expanding. The American Psychiatric Association’s manual, which draws those boundaries, has grown with every revision. Its first edition, published in 1952, ran to about 130 pages and listed roughly 100 diagnoses. The current edition runs past 1,100 pages and lists close to 300.

Me comparing the original and latest Diagnostic and Statistical Manual of Mental Disorders.

Even caffeine withdrawal is now a diagnosable condition. Each edition makes it easier to qualify as ill than the one before, and the mental health industry stands to gain financially when its patient population expands.

Over the same period of unprecedented awareness and access to care, the suicide rate climbed to its highest level since World War II and remains roughly 30 percent above where it stood in 2000. As suicide rates are one of the only objectively measurable outcomes in psychiatry, this does not indicate that psychiatry is succeeding. If rising diagnoses truly reflected treating a backlog of suffering, we should have expected suicide rates to fall even if diagnoses continue to rise.

The field’s confidence has also repeatedly outrun its evidence. Over the past decade, at a time when psychiatry claimed to be more rigorous than ever before, tens of thousands of adolescents were placed on puberty blockers and cross-sex hormones under the banner of evidence-based medicine. After a scandal involving suppressed data of National Institutes of Health studies finding puberty blockers to be ineffective at improving mental health in transgender youth, and later worldwide systematic reviews concluding weak evidence basis for the experimental procedures, major medical associations later walked back their claims.

Much like the lobotomy, an experimental procedure predicated on psychiatry’s untested theories of improving mental health was celebrated, then later denounced, but not before leaving thousands of patients with real lasting harms. In a perverse irony of history, the fact that many LGBT individuals experience lasting infertility due to gender-transition interventions eerily resembles psychiatry’s past sterilization of gay people.

Father of computer science Alan Turing was subject to chemical castration for being gay (as depicted in The Imitation Game).

Psychiatry’s worst harms come from experimental procedures meant to address small proportions of the population with unique psychological challenges. But a far larger proportion of the population is treated for generalized disorders such as depression and anxiety. In 2024, 60.1 million American adults received mental health treatment, including 43.8 million who took prescription medication.

Many undoubtedly benefit from these treatments, as randomized clinical trials consistently show. But treatment sometimes produces the very outcomes it was intended to prevent. Antidepressants carry an FDA black box warning about increased suicidal thoughts and behaviors, and can precipitate mania. Even for those who initially benefit, the drugs can induce neurological dependency with long-term use. Withdrawal from psychiatric medication can produce psychotic symptoms that are not noted in standard clinical trials.

The balance sheet of potential benefits and harms is remarkably difficult to tally. How many suicides and psychotic episodes did treatment prevent, and how many did medication, withdrawal, or misdiagnosis precipitate? When does focusing attention on anxiety and depression relieve distress, and when does it deepen rumination or teach patients to organize their identities around illness? How many people regained functioning, and how many lost sexual function, metabolic health, emotional range, fertility, or years of their lives to an inappropriate diagnosis? How often did the distinction between sanity and insanity protect vulnerable people, and how often did it excuse injustice?

As a psychology researcher, I hope that the benefits outweigh the harms. But after decades of reform and trillions of dollars of investment into mental health care, reported rates of mental illness remain near all-time highs and suicide remains far above where it stood at the turn of the millennium. If the mental health industry cannot demonstrate that its expansion has improved the outcomes it exists to address, despite record high spending, more public funding should not be the default response. We should be willing to consider the opposite: ending the presumption that more psychiatric intervention is a sign of progress.

This article originally appeared in The Dispatch.