When I saw the Time piece titled "Therapy Won't Save Us," or “American Has Reached Peak Therapy. Why Is Our Mental Health Getting Worse?" I was excited that a major media outlet with such a broad reach was finally catching on to the larger societal factors creating poor health outcomes in the United States.
This topic is worthy of deep discussion and yet I was severely disappointed to the point of embarrassment on behalf of Time with the shallow coverage in the piece.
I’m sure the author and editors didn’t intend to confuse the two very distinct disciplines of psychiatry and talk therapy. In my own professional work as a trauma and health science educator, I often get questions about the difference between these two fields. As many of us in the PACEs Connection community know, psychiatrists are medical doctors, trained through 4 years of medical school, attaining an MD, or Doctor of Medicine. Therapists will have gotten a master’s degree in social work or one of many therapy modalities, achieving formal acronyms such as LMFT, Licensed Marriage and Family Therapist or LSW, Licensed Social Worker.
Modern talk therapy has its origins in Sigmund Freud’s psychoanalysis. Most of us can form a mental image of Freud’s famous couch, the patient sprawled, sharing their deepest and most secret inner thoughts with a patient listener seated beside them. Whereas psychiatry being a medical discipline, sees its mission as “curing” illness by whatever expedient means necessary, talk therapy is much more in the realm of spirituality, philosophy, and personal development. While psychiatry is necessary for managing those who may be a danger to themselves and others, it’s hardly a stand-in for the self-actualizing alchemical magic of talk therapy.
Freud wrote, “One day, in retrospect, the years of struggle will strike you as the most beautiful.” Carl Jung, Freud’s successor, wrote, “Your visions will become clear only when you can look into your own heart. Who looks outside, dreams; who looks inside, awakes.” Therapy is the stuff of beauty, transformation, and meaning-making.
Psychiatry, as is the case with cardiology or neurology, is most often about making sure patients don’t pass away too soon. Psychiatry created the Diagnostic Statistical Manual after noticing that symptoms could be clustered together into different types for ease of diagnosis and writing prescriptions for medications. To say that we are in a time of “peak therapy,” i.e., sharing our struggles with an empathetic witness, should not be conflated with saying that we have reached “peak medication use,” a completely separate form of treatment from a separate lineage.
The piece, in missing this distinction, falls short of clearly defining what it is we’re talking about when we talk about mental health. Greater societal factors such as the Great Recession, the pandemic, and systemic oppression are mentioned perfunctorily when they deserve to take center stage.
In the trauma and Adverse Childhood Experiences science field, we know without a shadow of a doubt that these issues are at the heart of mental unrest. While everyone deserves the luxury of attending to the care of their actualization and soul’s highest fulfillment as could be achieved in therapy, there are more pressing matters at hand.
A 2021 study of 10,784 Wisconsin residents, “showed that severe indicators of childhood poverty are associated with general and chronic health problems as well as adult depression.” The links between poverty and childhood trauma are complex but lay at the intersection of personal and family financial stress, systemic oppression, racism, genocide, marginalization, and many of our most intractable issues.
It is well-studied and known that childhood trauma is correlated with the risk of developing a mental illness. The original 1998 Adverse Childhood Experiences (ACE) study showed “a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied. Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking [and] poor self-rated health.” The field continues to expand and confirm these findings.
What we may want to say about peak therapy and declining mental health in America is that the privilege of self-actualization, while including ever-widening circles of participants, does not make up for the larger impact made by economic hardship and feeling chronically unsafe while a small percentage of the population hoards the vast majority of the wealth.
It is a known fact that adverse childhood experiences are directly correlated with anxiety, depression, and other mental diagnoses. What’s proven to be difficult is shifting the conversation to prevention over treatment. If we can prevent toxic stress in childhood through more family-friendly and economically equitable policies and programs, we will have more people in this country who can attain personal fulfillment through inner work and the stuff of the heart.
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Alison Cebulla has a Master’s in Public Health from Boston University and a BS in Conservation and Resource Studies from UC Berkeley. She has been working in adverse childhood experiences science education since 2019 at PACEs Connection (2019-2022) and UMass Chan Medical School’s Center on Child Wellbeing and Trauma (2022-2023).
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