why attutdes on mental health are stuck in the dark ages, more then you think.

 

Elijah Brahmi

Minxu Press Essay

11/18/2025

The Failures of Modern Mental Health Treatment.

Statistics show that one in four people lives with a mental illness. 23.1% of U.S. adults experienced a mental health condition in 2022, which translates to 59.3 million people. Mental illness and neurodivergence (autism, ADHD, dyslexia, and other neurological conditions, which can have a lot of overlap with mental illness as we currently conceive of it). Now, that is a lot of people. 50 million? That's more people than the entire population of Vatican City in 2025. Diagnoses have only gone up since 2022. So, people who live with mental illness are still a minority, an oppressed and highly discriminated against one at that, but 50 million is still a lot of people, more people than you may think, considering how society treats people with mental illness in a way that frankly is stuck in the dark ages. Chances are, you know someone who lives with a mental illness. So if such a large portion of the population doesn't possess what we consider (in increasingly limited terms) a “normal, healthy mind,” then why are people who have more diverse brains often treated like criminals by default? And imprisoned on the basis of their very brain, their very soul, every day—and such imprisonment is seen as “treatment” and normal. Why are we despite such massive gains in human rights in other areas (even with recent backslides with the Trump Administration regarding trans rights, abortion rights, etc.)? Why has our modern conception and treatment of the mentally ill been so stuck in the dark ages, more so than many other social justice issues? Especially because of recent, even further backslides in policy and public attitudes, with such actions as forcibly imprisoning homeless people in psych wards and RFK’s warning on Medicare, autism, and medicine itself. And public healthcare is slashing access to therapy and medication first, leading many to turn to AI for therapy, causing a troubling rise in AI psychosis, Chat GPT-caused eating disorders, and even several bombshell lawsuits against OpenAI for causing the decline and encouraging the suicide of multiple children. 

So, why have the rights of the mentally ill not been prioritized, why are mentally ill people still feared, criminalised, ignored, blamed, shamed, denied even bare minimum access to life saving help, at the price of basic personal freedom and autonomy everyone regardless of your mental makeup, is enetiled too, why would most people rather mentally ill folks be simply, quietly shoved away, rather than just seeing them as people, like anyone else who simply have unique struggles like anyone else, and have brains that are different, not dangerous and only different because Enlightenment philosophers when redefining humanity as a white able bodied western men, defined everything else as different by comparison, including (especially during the age of “reason”) defining anything outside of Reason, as Madness and thus not fully human, But we see women as humans now, and non-white people, so why not the Mad? 

The truth is, it's complicated, but it all started like a lot of problems of the modern day, during the French Revolution and the Age of Enlightenment, or the age of “reason.” Our present mental health “treatment” system and conception of mental illness on the whole as something fundamentally “othering” is furthering the mission of a harmful legacy, one fundamentally based in oppression, discrimination, and control rather than genuine help. From its colonial origins to current-day practices, psychiatric treatment has often served to marginalize and harm those it professes to help. Understanding this history and current failures is essential to building a more just, compassionate, and effective approach to mental wellness and human rights. Mental illness diagnoses have historically functioned as tools of social control, rather than helping those who suffer from mental illnesses as people, rather than just ending up sidelining them to make sane people comfortable. The current approach is used to pathologize resistance, disagreement, trauma responses, unique personal identities and behaviors, and enforce conformity to dominant cultural norms, even ones that change greatly over time. An example of Western psychiatry being used explicitly to oppress minority groups rather than help genuine struggles or distress includes the mental illness created for the sole purpose of pathologizing escaped slaves'  desire for freedom. In 1851, physician Samuel Cartwright invented "drapetomania," a supposed mental illness that caused enslaved Black people to flee captivity. This pseudoscientific diagnosis exemplifies how psychiatry was weaponized to justify slavery and racial oppression. Cartwright deemed drapetomania as a mental illness that causes slaves to flee captivity, with treatment recommendations including whipping. The very desire for liberty was medicalized as pathology, demonstrating how diagnostic criteria can often serve existing power structures rather than promote healing.

Women, as well, have endured psychiatric discrimination throughout history. Hysteria, considered the first mental disorder attributed exclusively to women and frequently described in the second millennium BC, was viewed from both scientific and demonological perspectives throughout history. Throughout history, hysteria was a sex-specific disorder. It was said to affect only those with a uterus, which was often thought to be the basis of various health problems and madness caused by the womb and its mystical power. This diagnosis allowed physicians to pathologize any behavior deemed unacceptable for women, which was most behavior. Everything from emotional expression to sexual desire to interest in politics. Feminist writers pushed back against the notion that socially created “femininities” and hysteria are natural to being female; many argued that hysteria is not a real mental illness caused by internal differences and imbalances in the brain but solely from the external effects of women's fate to suffer in a patriarchal, oppressive society. If hysteria was ever to be said to be real, it could always be chalked up to women's PTSD, pain, and deregulated emotions solely caused by women's oppressed social roles, which stifled them in every conceivable sense. This oppression brought a negative state of mind, as how could it not, rather than madness brought on by the mere existence of a womb? This is evidence that many times, oppressed groups' reactions to oppression are pathologized and blamed on their own moral failings and “mental illness.”

The psychiatric establishment throughout the 20th century similarly weaponized mental health diagnoses against queer individuals. Homosexuality was classified as a mental disorder in the first edition of the DSM published in 1952 by the American Psychiatric Association. It took half a century of activism and advocacy, including direct action at psychiatric conferences, before the APA board of trustees voted to declassify homosexuality as a mental disorder in December 1973, and transsexuality remained in the DSM until 2013, which is only two years before gay marriage was legalized. Continuing to pathologize queer identities. In stark contrast to Western psychiatry's pathologizing approach, many Indigenous cultures have historically integrated those experiencing mental distress into community life. Joseph Gone, who serves as faculty director of the Harvard University Native American Program, emphasizes the Indigenous claim that "our culture is our treatment”. Rather than isolating and over-medicating people. On the other hand, Indigenous approaches typically highlight cultural continuity, self-governance, and community unity as protective features, with studies showing that suicide rates among various communities correlated profoundly with an index of cultural continuity or local control. Almost all the motivation behind creating categories of mental illness, socially constructed binaries of reason and madness, is a deep-seated, colonial, capitalist, and corrupting need to control the behavior of the populations of nations, especially the working class, to keep them in line.

There is a lot of evidence that indigenous understandings of mental illness, like many other aspects of Native American society, are more humanistic and prosperous for the lives of the people living in indigenous societies. This reality suggests that Western society itself creates and propagates a kind of mental illness that is more external than internal on the part of the sufferer and most often is used as an excuse to blame the harmful results of post-industrial revolution capitalism on the citizens rather than question how such conditions might negatively affect those forced to live within it. It's proven that healing happens through connection to culture, community, and spirituality, rather than through forced conformity to Western psychiatric models.

 Contemporary mental health systems continue to fail vulnerable populations, especially at-risk youth. The "troubled teen industry" is an example of this barbarism in the current day; it's a network of residential treatment facilities, therapeutic boarding schools, and wilderness programs that represents one of the most egregious failures of modern youth care and mental healthcare. Troubled teen programs have been legally contested and opposed on moral grounds for human rights abuses, causing the deaths and development of lifelong CPTSD of countless children, failing to offer evidence-based therapies, and using forms of attack therapy descended from Synanon.

Trafficked children who were kidnapped and forced into TTI often reported numerous inappropriate behaviors from “therapists,” conversion therapy, physical and sexual abuse, cult-like structures, religious indoctrination, and many other reported problems with medications, with one participant prescribed incredibly high amounts of medication that led a subsequent psychiatrist to express shock they hadn't died. Many also suffered under a model of breaking the child down to build them back up, similar to psych wards, sanatoriums, and asylums with goals of punishing mentally ill people, or simply “deviants” who didn’t fit the rigid social norms, instead of helping them with their struggles and giving them the support they need to succeed in life with full bodily autonomy and freedom on their own terms. Such positive life outcomes and available supports are sadly rare for those living with mental illness, even to this day, but especially for children. At many TTI programs and teen psych wards and outpatient treatment facilities, children report forced starvation and seclusion for weeks or even months at a time.

In 2007, the Government Accountability Office published a study verifying thousands of reports of abuse and death in these facilities dating back to 1990. Adult psychiatric facilities often fare little better. Forced hospitalization, often lying to patients in order to get them to sign themselves over, a culture of punishing suicidality with imprisonment, creating a lack of trust between therapist and patient because of known reality of therapists often being required to admit a person if they are a danger to themselves or others ignoring the nuance of intrusive thoughts and personal autonomy, even if its against their wishes, as well inadequate informed consent regarding medication, and coercive treatment practices remain common to this day, such treatment of “sane” children in schools would be seen as aracic and outrageous, but with mentally ill children and adults, little thought is given to the well being of a very sizable portion of our population. The closure of psychiatric hospitals during deinstitutionalization in the 1970s and 1980s led not to community-based care but to mass incarceration of people with mental illness, creating what critics call the "prison-industrial complex." Now the prison-to-school pipeline, with cops or "resource officers" in public schools, now handling children suffering with mental illness instead of trained counselors or caring teachers."

Another barrier to getting diagnosed and finding decent treatment today, aside from the severe income gap, is that a vast majority of people on Medicare or who have poor health insurance or no health insurance struggle to obtain therapy (let alone good therapy) and access to life-saving medication because it's too expensive or is behind an insurance paywall. Such insurance can only be obtained by having a job, and right now the job market is at recession levels. So income inequality is certainly a massive barrier; another one is bigotry. Women, queer and autistic people, people of color, and especially children are often not believed or have a hard time being taken seriously enough to get diagnosed by doctors, often times leading to the mental illness being written off as “bad behavior” and blaming the person for things outside their control, which can create further trauma and distrust. 

Another large hurdle to getting adequate care, aside from stigma, shame, and lack of accurate information on mental illness, is the persuasive influence, especially in many religious communities, that blames all mental illness on sin and talks about it in a way that's very dangerous and inaccurate. Another major roadblock for people nowadays is the fact that certain diagnoses carry a particularly heavy stigma that threatens true recovery and access to care and compassion. Research shows that stigma levels vary significantly by diagnosis, with DID, schizophrenia, antisocial personality disorder, narcissistic personality disorder, and borderline personality disorder being among the most stigmatized, especially women with BPD, or if you have more than one comorbid diagnosis. People with borderline personality disorder are considered the most challenging group to work with in therapy, with a majority of psychiatric staff reporting finding them moderately to profoundly challenging to work with. This stigma is so severe that mental health professionals frequently refuse to provide services to those diagnosed with BPD, which itself is a major injustice, and countless people are terminated from treatment early or not informed of their diagnosis. The diagnosis itself becomes a self-fulfilling prophecy, as negative treatment triggers the very behaviors that led to the diagnosis, which is often caused by severe childhood sexual abuse and can be inherited and worsened by imprisonment and drug abuse, which many turn to to cope with their untreated symptoms, often leading to early deaths if not by suicide, then by overdose, or by mentally ill people simply putting themselves in unknowingly dangerous and reckless situations, leading to their tragic and untimely demise.

Similarly, 94% of people living with severe mental illness report feeling they have been discrimination against because of their illness, though the legal statutes are unclear with the standard for suing for discrimination for employment, or housing, discrimination on the grounds of mentally ill falling under the category of disability, as a protected class that cant legally be discrimination against solely on the basis of ones inherit traits, witch was fought for in the Americans with disability Act, though sadly many mentally ill people cant afford lawyers, lawsuits and dont understand the law or their own rights, not even mentioning the fact such discrimination is often difficult to prove in court.  With 86% saying fear of stigma and discrimination has stopped them from doing things they wanted to do. In response to these systemic failures, psychiatric survivors have organized powerful resistance movements. In the 1960s and 1970s, organizations like the Insane Liberation Front and the Network Against Psychiatric Assault emerged, as well as the Mental Patients' Union in 1971. Many of these groups were vital to changing public opinion, raising consciousness, and changing several laws at the time. Organizing demonstrations, including protests against electroconvulsive therapy, which led to San Francisco discontinuing ECT use for 10 years.

A rather forgotten but vital wing of the rise in social justice movements in the second half of the 20th century, right along with the Civil Rights Movement, the Black Panthers, the Women's Liberation Movement, and the Gay Liberation Movement, and deserves to be studied and revered right along with them. Mad Pride was formed in 1993, with activists seeking to reclaim terms such as "mad," "nutter," "crazy," and "psycho" from misuse and transform them from negative to positive descriptors, with a lot of overlap in the addiction recovery and punk rock scenes. Judi Chamberlin published "On Our Own: Patient Controlled Alternatives to the Mental Health System" in 1978, which became a foundational text for the Mad Pride movement. These movements rightfully highlight bodily autonomy, peer support, and the right to make one's own choices about treatment rather than having care imposed by professionals. The Mental Patients Liberation Front of the 1970s laid the groundwork for today's peer support networks and psychiatric survivor activism. These movements recognize that those with lived experience are experts on their own conditions and should lead conversations about treatment and recovery.

Approximately thirty-five percent of Americans do not have access to a psychiatrist or psychologist in their state of residence, proving that the issue stretches far beyond cost to fundamental questions of resource. Improving mental health treatment requires fundamental systemic change: Prioritize bodily autonomy: All mental health interventions should be based on informed consent, with individuals maintaining the right to refuse treatment. Forced medication, involuntary hospitalization, and coercive practices must be eliminated except in the most extreme circumstances, with robust oversight and appeals processes. Community integration over institutionalization: Rather than isolating people in hospitals or residential facilities, support should enable people to remain in their communities. This includes supported housing, peer support networks, crisis care centers run by psychiatric survivors and people with experience with the patients they're helping, and flexible community-based services not limited by insurance access. Reduce policing of mental health: Crisis response should be led by mental health professionals and peer supporters, not armed police officers, a change Mayor Zorahn Mandani has actually pledged to make. Cities implementing alternative crisis response teams have seen better outcomes and fewer violent encounters; examples include many cities in Sweden and Finland that have cops without guns and have greatly improved quality of public health, as well as radical prison reform, and many countries in Scandinavia have proven to outright end homelessness in many of their major cities. The true solution isn't just that thought; it's a fundamental change in how we view mental illness and what makes someone human or able to make their own decisions and participate in society. 

In general. Cultural competency and Indigenous approaches: the public view and care approach needs to be refrained from a post-colonial lens. Mental health services must respect diverse cultural understandings of wellness and distress, incorporating traditional healing practices and Indigenous knowledge alongside Western approaches when appropriate and desired by those seeking care. The history of psychiatry reveals it has often functioned as an instrument of social conditioning rather than healing or anything relating to “public health.” True progress, and the long overdue emergence from the dark ages on this issue, requires funding, concerted media campaigns, and genuine, widespread education, not just guilt-focused suicide “awareness” campaigns, but empathy-based education coming from mentally ill people themselves, nothing about us without us. The governments of many nations need to reallocate funds, dismantling and shutting down psychiatric wards and redesigning the care apparatus from the ground up, centering the voices of those with lived experience, respecting autonomy and dignity, and recognizing that healing happens in community, treating the person, not the diagnosis, and not in isolation. The first step is ending the idea and practice that punishment and imprisonment are acceptable and humane treatment. Only by analyzing this history and our ongoing failures amid a global loneliness and mental health crisis can we admit increasing stigma under the Trump administration. It's more important now than ever that we change our tune on this; millions of lives are literally at stake. Together, we can build a better mental health system worthy of the name, one that truly serves those it claims to help, helping them to live full, happy lives that everyone living with mental illness has always deserved.

Cited Sources: 

• O’Keefe, Victoria M, et al. “Increasing Culturally Responsive Care and Mental Health Equity with Indigenous Community Mental Health Workers.” Psychological Services, U.S. National Library of Medicine, Feb. 2021, pmc.ncbi.nlm.nih.gov/articles/PMC6824928/. 

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• Reaume, Geoffrey (July 14, 2008). "A History of Psychiatric Survivor Pride Day during the 1990s"

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• Creech, Jeffrey (2020-07-13). "A History of Mental Illness Treatment".

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•  Lincoln, William (1862). "History of Worcester, Mass. from its Earliest settlement to 1836" by Charles Hersey. Worcester, Mass.: Hersey/Henry Howland Press. 

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• "DIGITAL TREASURES: Item Viewer". Digital Treasures, Samuel Willard ran a "hospital for the insane" l and trained young physicians, East side of Uxbridge Common, 

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• Meyer, Jerrold S. (2005). Psychopharmacology: drugs, the brain, and behavior. Quenzer, Linda F. Sunderland, Mass.: Sinauer Associates, Publishers. 

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•  R. Carlson, Neil (2010). Psychology the Science of Behaviour. Toronto, Ontario: Pearson Education Incorporated. pp. 548–549.