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The site is designed to serve as a resource and a community for those interested in rethinking psychiatric care in the United States and abroad. We want to provide readers with news, personal stories, access to source documents, and the informed writings of bloggers that will further this enterprise. The bloggers on this site include people with lived experience, peer specialists, psychiatrists, p

sychologists, social workers, program managers, social activists, attorneys, and journalists. While their opinions naturally vary, they share a belief that our current system of psychiatric care needs to be vastly improved, and, many would argue, transformed. We welcome feedback and op-ed submissions from our readers.

–Robert Whitaker

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Community Standards

At Mad in America, we are committed to maintaining a space for dialogue about rethinking psychiatric care that is rich with a diversity of voices and experiences. For this reason, we have an in-depth comment moderation policy on our website (see here: https://www.madinamerica.com/posting-guidelines/). We realize that many conversations happen off our website and occur in comments on our page. Consistent with best practices for non-profit social media management, we are now actively extending our commitment to moderate discussion occurring on our page. This means that comments on Facebook posts by and on our page will now be deleted or hidden if they are not consistent with our posting guidelines. In particular, we will, to the best of our ability, remove all forms of hate speech that make disparaging assertions based on a person’s identities or occupation, and calls for violence against any people. *Comments violating hate speech policies will be immediately deleted and user may be banned.*

When commenting on Mad in America's page please keep these guidelines in mind. This includes refraining from posting personal attacks, threats, spamming, misrepresentations of oneself or others, illegal material, profanity, hate speech, disparaging assertions about a person’s character, discrimination based on a person’s identity or occupation, and calls for violence against any people. We ask for good faith and the benefit of the doubt in our effort to allow anybody who wants to join the dialogue to do so without fear of abuse. Please respond to and criticize ideas, not character. This website intentionally brings together individuals with varying backgrounds and values. We believe civil, inclusive dialogue to be crucial to finding solutions to our current paradigm of mental health care. Remain relevant to the present article/topic. Off-topic comments are disruptive and derail the discussion. These may be removed by the moderator. Please see https://www.madinamerica.com/posting-guidelines/ for all guidelines.

A new meta-analysis published in The Lancet Psychiatry offers compelling evidence that what clients value most from psyc...
07/23/2025

A new meta-analysis published in The Lancet Psychiatry offers compelling evidence that what clients value most from psychotherapy often goes unmeasured by traditional outcome tools.

Led by Michaela Ladmanová of Masaryk University, the study analyzed data from 177 qualitative studies spanning eight decades and 24 countries. The findings show that clients report a range of meaningful benefits from therapy that extend far beyond a reduction in mental health symptoms.

The researchers consisted of a group of individuals from universities across Europe, led by Michaela Ladmanová of Masaryk University in the Czech Republic.

“The meta-analysis showed that clients value outcome dimensions beyond symptom reduction, such as deeper self-understanding, enhanced self-agency, and greater social engagement,” the authors write. “By examining psychotherapy outcomes across various diagnoses and therapeutic approaches, we highlight limitations in traditional outcome measures, showing the need for more comprehensive, client-centred assessment tools and the value of incorporating qualitative methods into understanding dimensions of change.”

All eight researchers involved in the study have also been psychotherapy clients themselves. Their approach aimed to better capture the nuanced, lived experiences of people in therapy—something that is often lost in standard clinical metrics.

The authors argue that symptom-focused assessments fail to reflect the complexity of what clients hope to achieve and actually experience in therapy. These outcomes, they suggest, require broader, qualitative tools that can account for personal growth, emotional processing, and changes in how people relate to themselves and others.

Rather than treating mental distress as a problem to be fixed through measurable symptom reduction, the findings highlight the importance of meaning, relationship, agency, and narrative in processes of healing. It points to a broader view of psychological life, understanding therapy as a space where people seek coherence, dignity, and transformation within the context of their lived realities. In doing so, the research invites us to reconsider what constitutes evidence, what counts as change, and whose experiences are considered legitimate in defining the aims of care.

From emotional depth to mindful living, clients name the benefits of therapy that standard measures often ignore.

New research reveals that trauma, poverty, discrimination, and housing instability have a more profound impact on mental...
07/21/2025

New research reveals that trauma, poverty, discrimination, and housing instability have a more profound impact on mental health than clinical models acknowledge. Yet, mental health providers remain ill-equipped to respond.

A recent scoping review published in Translational Psychiatry offers a sobering analysis of how the social determinants of mental health (SDoMH) continue to be sidelined in clinical practice. Authored by a group of prominent psychiatrists and psychologists, the paper reviews the literature on how these social forces shape mental health outcomes and proposes new guidelines for integrating that knowledge into care.

Despite decades of evidence linking social and structural factors—such as poverty, trauma, and racism—to mental distress, the authors find a lack of institutional training, guidance, or infrastructure to support interventions that address these root causes.

“A healthcare system should start by identifying the SDoMH that apply widely in the community/ies it serves. Next, a community task force should determine which interventions to address the SDoMH are feasible locally or regionally. Finally, when assessing an individual patient, the clinician should determine which specific SDoMH are potentially modifiable and are of particular concern to a patient based on their and their family’s input,” the authors write.

https://www.madinamerica.com/2025/07/why-the-clinic-alone-cant-cure-mental-distress/ Why the Clinic Alone Can’t Cure Mental Distress

Despite widespread recognition of social causes, clinical care remains focused on individual diagnosis.

Grossly Flawed Paper Denies that Antidepressant Withdrawal Effects are “Clinically Meaningful” By John ReadAfter a long ...
07/19/2025

Grossly Flawed Paper Denies that Antidepressant Withdrawal Effects are “Clinically Meaningful”
By John Read

After a long battle that finally succeeded in getting the UK’s medical policymakers to acknowledge these risks, pharma-funded researchers are endangering patient safety by minimising the incidence and severity of withdrawal.

Pharma-funded researchers are endangering patient safety by minimising the incidence and severity of withdrawal.

A new article published in Integrative Psychological & Behavioral Science features a wide-ranging interview between seve...
07/19/2025

A new article published in Integrative Psychological & Behavioral Science features a wide-ranging interview between several Norwegian psychologists and anthropologist Tim Ingold. The conversation is part of the “Return to Reality” research initiative, which challenges the distancing norms of professionalized care and seeks alternatives rooted in presence, responsiveness, and kinship.

Inspired by both philosophy and anthropology, the authors believe Ingold’s approach holds vital lessons for those in the psy-disciplines struggling to meet the ethical and relational demands of their work.

“In the ‘Return to Reality’ research initiative, we seek ways to shift from theoretical models that distance and obscure mental health phenomena and practices as objects of study. Instead, we look for ways, and concepts, that allow us to engage with these phenomena as parts of the world—our common world, the one world in which life is real,” write the authors.

“What Ingold tries to convey through the idea of ‘correspondence,’ as we understand it, is that listening to the world and responding with care, sensitivity, and judgment can help restore our kinship with the earth and its inhabitants. This seems more pertinent than ever in these times of ecological and humanitarian crisis.”

Anthropology can offer different kinds of insights into the human condition from the psychological disciplines, due to its differing areas of focus and modes of observation. Anthropologist Tim Ingold has written several books that, according to the authors of the current paper published in Integrative Psychological and Behavioral Science, hold lessons for psychologists.

The authors of the current paper—Norwegian psychologists Bård Bertelsen, Odd Kenneth Hillesund, Tore Dag Bøe, Per Arne Lidbom, and Rolf Sundet—believe Ingold’s novel ways of considering human experience have much to offer the psychological disciplines.

https://www.madinamerica.com/2025/07/mental-health-needs-anthropology-a-new-humanism-for-psychology/ Psychologists and Anthropologists Call for “Return to Reality” in Mental Health Practice

An interview between several Norwegian psychologists and anthropologist Tim Ingold explores how mental health practitioners could engage more directly and ethically with service users.

The Trouble with Lived Experience: When Peer Support Compounds Trauma by Denying Abuseby Maram KhalifTrauma and abuse ar...
07/19/2025

The Trouble with Lived Experience: When Peer Support Compounds Trauma by Denying Abuse
by Maram Khalif

Trauma and abuse are different experiences, and they require different forms of support, accountability, and healing.

Trauma and abuse are different experiences, and they require different forms of support, accountability, and healing.

Brain Disorders or Problems with Living? How Research on “Mental Illness” Went Awryby Patrick HahnIs it time to consider...
07/17/2025

Brain Disorders or Problems with Living? How Research on “Mental Illness” Went Awry
by Patrick Hahn

Is it time to consider the possibility that the entire field is a failed enterprise, a wrong turn in human history?

Is it time to consider the possibility that the entire field is a failed enterprise, a wrong turn in human history?

Seventeen years after the United Nations called for an end to coercive psychiatric practices, forced treatment remains w...
07/17/2025

Seventeen years after the United Nations called for an end to coercive psychiatric practices, forced treatment remains widespread, legally sanctioned, and largely unreformed.

In a new article published in a special issue of the International Journal of Law and Psychiatry on “Mental Health Law,” legal scholar Laura Davidson reviews the limited progress made in this area. Despite the 2006 adoption of the Convention on the Rights of Persons with Disabilities (CRPD), which demanded a shift from involuntary treatment and institutional care to autonomy, equality, and non-discrimination, Davidson finds that the core practices the treaty sought to eliminate remain firmly entrenched.

Focusing on the legal frameworks of England and Wales but drawing implications for global mental health governance, Davidson critiques the continued dominance of the biomedical model and the political deadlock among UN bodies over coercive care.

“Hard cases”— those involving violence, crisis, or perceived incapacity—are still routinely used to justify detentions and forced interventions, in direct contradiction to the CRPD’s call for rights-based alternatives.

“The wide-ranging scope of discriminatory, coercive practices prohibited under the CRPD encompass involuntary hospitalisation and enforced medical treatment, mechanical, physical, and chemical restraining, and forced seclusion and segregation,” she writes.

Despite nearly two decades since the adoption of the UN CRPD, forced treatment and institutionalization remain widespread, a new review of UK law and international policy finds.

Becoming Stewards of Shadow: Beyond Great Men and Myths of Inventionby Jessica Del PozoBefore the psyche was carved into...
07/16/2025

Becoming Stewards of Shadow: Beyond Great Men and Myths of Invention
by Jessica Del Pozo

Before the psyche was carved into parts with elegant diagrams and marketed methods, cultures around the world were walking with shadow.

Before the psyche was carved into parts with elegant diagrams and marketed methods, cultures around the world were walking with shadow.

A new study, currently in preprint for BMC Psychology, finds that adverse experiences in youth are linked to higher rate...
07/16/2025

A new study, currently in preprint for BMC Psychology, finds that adverse experiences in youth are linked to higher rates of depression and anxiety symptoms. This was true regardless of gender, socioeconomic background, and ethnicity.

The current research, led by Laura Havers from Queen Mary University of London, additionally finds that support from parents and peers did not weaken this effect. While youth adversity had similar effects on depression and anxiety symptoms across all groups measured in the current work, participants from lower socioeconomic backgrounds were more likely to have adverse experiences. These findings add to the mountains of evidence linking environmental (rather than biological) factors to mental health struggles.

Contrary to previous research, the current work did not find that support from peers and parents could mitigate the negative mental health effects associated with adverse experiences in youth. The authors note that this difference may be due to the specific support factors they measured in the current research and warn that parental and peer support should not be dismissed as protective factors.

The authors write:

“The findings indicate that youth adversity has pervasive, detrimental effects on combined depression and anxiety symptoms across multiple intersectional positions. However, parental support and peer support did not broadly or uniformly account for these effects … Importantly, the current findings should not be interpreted as suggesting that parental and peer support are unimportant. Rather, they may demonstrate that other aspects of parental and peer support have a greater impact in buffering against the harmful effects of youth adversity on mental health than those considered in the current study.”

https://www.madinamerica.com/2025/07/youth-adversity-linked-to-depression-and-anxiety-regardless-of-background-new-study-finds/ Youth Adversity Linked to Depression and Anxiety Regardless of Background, New Study Finds

Despite variations in childhood adversity rates by class, its impact on mental health remains consistent across all groups.

The Degrees on the Wallby Yishay Ishi RonThe therapists who helped me most weren’t the ones who dazzled with their knowl...
07/15/2025

The Degrees on the Wall
by Yishay Ishi Ron

The therapists who helped me most weren’t the ones who dazzled with their knowledge. They were the ones who made me feel less alone.

The therapists who helped me most weren’t the ones who dazzled with their knowledge. They were the ones who made me feel less alone.

A new study published in JAMA Network Open finds that LGBTQ+ individuals face disproportionately high rates of psychiatr...
07/15/2025

A new study published in JAMA Network Open finds that LGBTQ+ individuals face disproportionately high rates of psychiatric diagnosis. The researchers link these disparities to the cumulative effects of social discrimination, political hostility, and structural harm.

Drawing on data from nearly 270,000 participants in the All of Us Research Program, the authors identify significant mental health disparities across sexual and gender minority groups.

In a moment of escalating political and cultural attacks on LGBTQ+ communities, the study offers a data-driven account of how marginalization produces emotional suffering, diagnostic labeling, and barriers to care.

As Mandi Pratt-Chapman writes in her accompanying commentary, the social context of these disparities cannot be ignored:

“Minority stress theory posits that excessive social stress drives health disparities among sexual and gender minority persons. Distal stressors, such as discriminatory laws, and proximal stressors, such as family rejection, elevate chronic stress among sexual and gender minority people. Structural bias, including pathologization of sexual and gender minority groups, social erasure and isolation, school bullying, health care denial, hate crimes, and other social and political determinants of health lead to heightened chronic stress for sexual and gender minority people, a proven cause of poorer physical and mental health.”

The study, authored by J.A. Lu and colleagues, uses a cross-sectional design to assess electronic health records and self-reported data from 2017 to 2022. Of the 269,947 participants analyzed, 8.9% (22,189) identified as sexual and gender minorities. Researchers compared this group to cisgender, heterosexual participants across ten commonly assigned psychiatric diagnoses: anxiety, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, eating disorders, depression, obsessive-compulsive disorder (OCD), personality disorders, post-traumatic stress disorder (PTSD), and schizophrenia.

They found that LGBTQ+ participants were more likely to receive diagnoses of PTSD, depression, ADHD, bipolar disorder, and personality disorders. Gay cisgender men showed higher rates of bipolar diagnosis, while le***an, bisexual, and q***r women were found to be at elevated risk for nearly all diagnoses studied. Transgender and gender non-conforming individuals had the highest rates overall. For instance, gender non-conforming people assigned female at birth were most likely to receive PTSD diagnoses, and those assigned male at birth were more frequently diagnosed with ADHD and bipolar disorder. Transgender men were disproportionately diagnosed with depression, and transgender women with personality disorders.

The authors emphasize the role of social determinants in driving these disparities:

“Based on the body of research documenting the adverse impacts of minority stress on sexual and gender minority individuals, driven by organizational, cultural, and societal stigma and discrimination, it is likely that these factors underlie the marked mental health disparities we observed… These factors not only affect mental health directly by increasing stress and dysregulating neuroendocrine functions but also compromise immune responses, heightening the risk of mental health issues over time.”

With nearly 270,000 participants, a new study points to the social forces shaping LGBTQ+ mental health outcomes.

The Launch of Mad in Puerto Rico Puerto Rico needed its own Mad in the World affiliate. While Puerto Rico is officially ...
07/14/2025

The Launch of Mad in Puerto Rico

Puerto Rico needed its own Mad in the World affiliate. While Puerto Rico is officially a territory of the United States, Luiggi-Hernandez explains, “The only thing that’s actually American about Puerto Rico is the legal aspect.”

Because of this, he says, “A lot of people here wouldn’t be able to read Mad in America articles,” not only because their first language is Spanish rather than English, but also because the challenges Puerto Ricans deal with have little overlap with those faced by Americans. In particular, since Puerto Rico is, in essence, a colony of the United States, colonialism has a heavy impact on both Puerto Ricans’ mental health and the ways their distress is addressed by the health system.

“It’s been pretty colonized into the minds of the people here that the only approach and the best approach is the biomedical approach,” says Lopez-Aybar.

Since Puerto Rico is, in essence, a colony of the United States, colonialism has a heavy impact on mental health and the healthcare system.

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