Top 5 Myths about Psychiatry in 2023

These days, it is easy to find folks on the internet who seem to have a lot of opinions about what psychiatry is and what psychiatrists do and think. The vast majority aren’t psychiatrists themselves or people who even spend much time with psychiatry, and their often provocative statements are rarely supported with data (other than their book to sell you). Unfortunately, this doesn’t seem to stop these allegations or, even more sadly, from people believing them. As a practicing psychiatrist who has been involved in our professional organizations and who has actually interacted with hundreds of psychiatrists, here are, in my view, the biggest myths out there today from someone who gets zero money from pharmaceutical companies.

A caveat: I’m not going to duplicate the mistake of the people I’m calling out in this article by pretending that all psychiatrists think alike and that there aren’t folks who do, indeed, act in ways that perpetuate these myths, but I do think I’m on very firm ground with articulating these overall positions.

Here we go.

5. Psychiatrists make stuff up to drum up business. This one is kind of painfully obvious to anyone who has actually sought mental health care recently, but many of our armchair critics still actually think a nefarious guild is scheming ways to bring more people to our office. The stark reality, however, is that nearly all psychiatrists have way too much “business” and we would love to spend way less time engaged in the sad task of turning away people in need and trying to find resources for them elsewhere.

4. Psychiatric disorders lack a scientific basis. Pick up any leading psychiatric journal and you will see tons of good science related to biological areas such as genetics and brain imaging as well as rigorous investigations into many other domains, such as psychotherapy, early development, social determinants of health, etc. Yes, it is true that this science is confusing and sometimes inconsistent but it is important to keep in mind that 1) we are dealing with conditions that are dimensional and likely represent the ends of a continuum (so less likely to be related to some “thing” you can simply observe as pathological), and 2) the human brain is by far the most complex creation this planet has ever seen.

3. Psychiatrists think mental health problems are all related to “a chemical imbalance.” I write more about this in a previous post, but the dominant model of mental health problems that has been taught in training programs for decades is called the “biopsychosocial model” which postulates that mental health (both in wellness and illness) is related to many interacting forces that include “biological” factors like genetics and prenatal environment, psychological factors like early experience and parenting, and social factors like poverty and racism. Don’t be conned into thinking psychiatry only thinks about biology.

2. Psychiatrists routinely force and push treatments on people. Psychiatry attempts to walk a difficult balance between respecting the autonomy of individuals while not turning our backs on those who clearly need care. Yes, there continue to be times when involuntary hospitalization and, less frequently, involuntary treatment is recommended, and the circumstances under which this should happen is a topic of legitimate debate. However, what is conveniently ignored from many blogs and social media posts decrying "coercive" treatment is the other side of this equation and the throngs of family members who plead with mental health professionals to be more assertive in helping a loved one who is obviously suffering and struggling but refusing help. Sadly and ironically, we cannot ignore the fact that the cost of an extreme and literal adherence to personal freedom rights is that a large number of individuals wind up incapacitated, incarcerated, or dead. On any given day, the number of people declining treatment or being denied access to it based on not being “acute enough” far exceeds the number of individuals detained against their will—we just don’t hear about it for some reason. To family and friends of these individuals who so desperately want to see them get the help they deserve, this is pure anguish.

1. Psychiatry pathologizes typical human emotions and traits. The dividing line between “normal” traits and behaviors and symptoms or disorders is really fuzzy, and nobody really knows where the exact boundary should lie. It is true that these days the threshold for what “counts” as a psychiatric disorder has been falling and the number of people who qualify for some kind of diagnosis has been rising. That said, even higher percentages of people have, at some point, been diagnosed with some kind of dermatological, pulmonary, or orthopedic condition and this, somehow, is not controversial. Another odd claim is that if psychiatry just understood the power of things like adversity and trauma then there would be no labeling of these impacts as “disorders.” In reality, however, an appreciation for the power of environmental forces is an argument to maintain diagnoses. Nobody is protesting orthopedic surgery conferences, for example, because they dare to pathologize someone’s bone as “fractured” when it gets injured in a car crash, or to advocate a change in name to “femoral car crash trauma reaction.”

The ever-rolling caricature of psychiatry today would be laughable if it weren’t so sad. This is not to say that my field has not made some significant errors or to deny the harm that many people have suffered as a result of psychiatry. Anyone familiar with my work understands that I am not afraid to call out places where psychiatry needs to do better. But unfortunately, sweeping attacks on psychiatry based upon someone’s ungrounded speculation does little to promote either healing or informed policy and, instead, simply perpetuates stigma and repels people from engaging in mental health work either as a client or as a clinician.