For some readers, this will be a controversial post, so let me start with the least controversial entrypoint: the United States government under Donald Trump is not your friend. It is demonstrating an unprecedented willingness to collaborate with surveillance capitalism and openly weaponize that personal information against enemies of the state, and to define the state's enemies according to whatever personal grudge the president forms this morning over his breakfast cereal while watching FOX News or further-right outlets.

Yeah, that's the least controversial part. Now I have to convince you why the problem is older than one bad apple, and why you're not exempt from the problem in the ways you're probably used to rationalizing.

Our civil society depends on certain protections. The legal system couldn't function without attorney-client privilege, for example. Civil rights legislation creates room in our economy for minorities of every kind, and particularly in the case of queer liberation, has allowed invisible minorities to become visible ones with some sense of safety. Therapist-patient privilege resembles both of these examples, especially with decades-long efforts to destigmatize mental health.

Importantly, every single one of those protections is a matter of policy (rules that can be changed or overridden to suit a ruler) rather than structure (things like encryption, which are impossible to violate just by having a position of perceived authority in a human society). That difference is critical when such protections are under attack by an authority. It means that our security, our confidentially, can be _revoked_ as a matter of policy, by the same mechanisms as it was granted in the first place. Imagine signing a contract, except the other party can change the words later and your signature is still binding! Well, okay, imagine that wasn't rapidly becoming the status quo of the digital era, and then make a very concerned face about it.

Attorney-client privilege is well-defended, because lawyers and judges (even in the current state of the Supreme Court) won't budge on it, and you mess with them at your own peril. Civil rights are being rapidly eroded, which has some queer people second-guessing whether they should have come out, or re-closeting - and that's just the people who have some hope of hiding the traits that fascists consider undermensch.[^1]  But the bush I'm beating around today is the last category: mental health, and the people society sees as lacking it.
## Feed me a stray cat

![[mental-problem.png]]

>A still of Dr. Tom ManGuy, a licensed BetterHelp therapist who is [definitely not a bot](https://www.youtube.com/watch?v=YarwUP8lY8s).

If you've trusted your extremely sensitive innermost truths with a licensed therapist under a previous administration, you may be feeling something of an urge to re-closet, but on an axis that we don't usually use the closet metaphor for. Maybe going to therapy felt safe, or necessary, or just a reasonable thing to do - and you weren't entirely wrong to feel that way, at the time. Maybe you needed some characteristic of your brain to be officially recognized in order to get work accommodations, medications that help you, community with people like yourself, or more useful life advice than general-audience materials can provide. Labels can, at their best, act as semantic rallying points for people to better their lives through collective action, mutual aid, independent research, and structural accommodation.

After all, the therapy industry hasn't always been _economically centered_ on information extraction. The point was to get you, or your insurance, to pay a highly technical professional who'd earned a challenging degree to perform very intense emotional and intellectual labor for you - something that, by its nature, deserves high compensation, and by its demand, can ask for that money. Hence, a business model that prioritized privacy, even if the care was economically gatekept. Sure, therapists have always needed open communication to do their jobs, but it's fair to call the present-day VC-backed insatiable hunger for data _a new twist_ within the long arc of the long couch.

Of course, in hindsight, the deal was always subject to change, and not just within the enclosure of the therapy industry itself. Ask the people who got diagnoses for work accommodations a long time ago, have not been to therapy in many years, and are now having to confront a "post-DEI" workplace environment that knows about their autism, ADHD, or personality disorder. It's maybe for the best that "credible" research on the subject is still shoddy enough to amplify ideas like [outgrowing ADHD](https://infosec.exchange/@JessTheUnstill/116958652470192554).

**There is no calendar year you can point to in human history, in which psychiatry both existed for the benefit of patients, and did not also represent existential risks to those patients.** This dual-nature is important to internalize: to dismiss either the benefits or harms of the field is to understand it by half. It has always sought to construct models of its subjects with or without their informed consent, a power gradient that has been used to help and to harm. It has always had an amoral appetite for data, at best, and has at times been purely a harm to the patient in the name of society.
## History and Mythos / Scalpel and Gavel

The earliest history of pre-psychiatry was non-medical, ascribing supernatural explanations to things we'd interpret as mental _health_ matters today. Maybe you've heard of the Labors of Hercules[^2] in Greek myth, but do you know why he was laboring? Well, it's a bit of a tangent to explain why the goddess Hera hated him, but in summary, she did, and drove him to temporary madness, causing him to kill his wife and children. The labors are an act of atonement, for while the gods may take hold of us sometimes, the aftermath is our own to set right.

![[hera-cles.png]]
> A still from the Disney cartoon adaptation of Hercules, with Zeus and Hera lovingly holding baby Herc and Pegasus. The more Greek mythology you know, the more comically offensive this sedate depiction of Hera feels.

Of course, some percentage of brains have always worked a bit differently or wrongly from a social perspective, since before we had society, merely apes acting socially. Mental illness, as we would consider it today, is far older than any earnest study of the mind that we have record of. So the line you draw between pre-psychiatry and psychiatry is subjective and arguable, but I find it useful to draw that line at the transition point where humanity began to apply a medical framework to understanding neurodivergence, and consider psychiatry's founding invention and assumption to be _medicalization._

There is a competing institution to understand mental illness, and that's the judicial - the other side of the story of Hercules, actually. While Hercules did not respect King Eurystheus, serving the king - a governing authority - was the advice of the Oracle of Delphi when Hercules asked _how_ to atone for his crimes. Because humans are humans, we've had a very long history of legal systems needing to accommodate the human intuition: "well he ain't right in the head, a regular sentence don't seem fair." This intuition immediately raises the questions of how you can tell when someone is acting on the basis of a dysfunctional mind, and how to adjust sentences accordingly.

Insanity became a thing you could plead. Mental asylums became a place you could be sentenced to. Bethlem Royal Hospital was established, also known as Bedlam, which would eventually become infamous for the cruelty, corruption and chaos within its walls, and for a period of time offered public tours using the patients as a spectacle in order to raise money. In the process, psychiatry as a medical specialty became a desirable skill for expert witnesses and asylum keepers. It was also a time that conflated poverty and madness, and legally treated them similarly. New legal doctrine like the M'Naghten Rule was formed, new professions. This is a lazy hand-waving summary of centuries of western history, but for our purposes today, it'll do. The point is simple - that much of what you know or think today about mental illness, including the framing _as_ illness, formed organically from the bureaucratic needs of 13th-through-19th century Europe.

The darkness of this history isn't mere squalor conditions that existed prior to the lunacy reforms circa William Battie, Philippe Pinel and William Tuke. The human brain is one of the most exceptionally complex machines nature has given us to study, which is fertile ground for confident, simple, and dangerously wrong models of the brain to prosper for decades before correction, at the expense of a captive patient population. You have probably heard about the icepick lobotomies and electroshock therapy[^3], but you might not know how seriously phrenology was taken in the mainstream. To this day, we still have the idea that specific geographic regions of the brain perform specific functions, which tends to be statistically true, but loses the nuance to comprehend how - for example - [a young girl might be able to recover from the removal of an entire hemisphere of her brain, rebalancing responsibilities onto the remaining half](https://www.npr.org/sections/health-shots/2023/03/22/1165131907/neuroplasticity-plasticity-glass-half-full-girl).

Today, the insanity defense is pretty rare - not only because of the difficulty and risk of trying to prove it to a state-approved expert, but also because of the indefinite nature of incarceration. If you plead guilty to murder, you might do 15 years, but you'll know it's 15 years. If you plead insanity, you can't get in until you are _officially_ crazy, and you can't get out until you're _officially_ not, [both of which have more to do with the subjective judgments of another human being](https://www.simplypsychology.org/rosenhan_experiment.html), whose expertise is in a trade best known for how long it holds onto misconceptions. In the meantime, you may be coercively drugged at the practitioner's discretion, so if you didn't have something chemically wrong with you on the way in, you very well might on the way out.[^4]

In short, while there are people with real difficulties or differences who would benefit from genuine help, the help we have to offer them has an unacceptable track record in terms of respect, consent, and accuracy, leading to atrocities on a flimsy but publicly acceptable basis of evidence. The best argument psychiatry can offer in its defense as a real science is that it has changed and improved over time, and that cannot be allowed to be an unexamined thought-terminating cliche.
## Better help?

As a discipline, psychiatry does not exclusively attract power-hungry abusers, any more than nursing does. Plenty of people go into it with good intentions. I pursued a minor in psych in college myself, but had to drop it due to conflicts with the religion I held at the time, particularly squeamishness about sexual topics. Yes, yes, I have to admit, that's pretty funny to me now.[^5]

On many fronts, psychiatry is a kindler, gentler version of itself than it has ever been. I mean, compared to some of the horrors the field is infamous for, there was nowhere to go but up, and thankfully they did. Therapy has been rebranded, palatable to a voluntary audience who expect to walk freely out the door at the end of the session, and who generally find that expectation met. Many of them have excellent experiences, and earlier today I saw someone posting some useful advice they'd received in therapy, which helped them survive a depressive episode.

I guess that means we can roll out the banner, can't we! I'll take my martini dirty, thanks.

![[mission-accomplished.png]]
> George W. Bush holding a thumbs-up in the foreground, with the USS _Abraham Lincoln_ in the background bearing the infamous "MISSION ACCOMPLISHED" red white and blue banner. The celebration of a war well done was, at the time, 8 years premature and a vast overstatement of eventual delivered results.

Well maybe let's take a second in all this self-congratulation to breathe. The state still relies on the psychiatric industrial complex to:

1. Develop and maintain a taxonomy of diagnoses.
2. Determine which diagnoses apply to a given person.
3. Make decisions affecting a person's wellbeing and liberty on the basis of diagnosis.

Which is to say, the intricacy of the human mind and soul is a complex carbohydrate that the impersonal machinery of the state cannot digest - not without a secular priesthood to cook the information down into a necessarily inaccurate simplified form, that we may be seamlessly and efficiently devoured by this election cycle's powers-that-be.

I recently rewatched _Judgement at Nuremberg_, and I should at least give a cursory summary of the Peterson case. The movie is set during the Nuremberg Trials, a post-WWII period when American judges were tasked to decide which straggling vestiges of the Nazi governmental machine to punish for crimes against humanity. It is particularly set after the high-profile cases were over, and the defendants are four German judges who presided over documented atrocities.

Mr. Peterson is an innocent man, and a simple one. Because he and his family were communist, they were targeted for violence even before the Nazis were elected to power, and because they fought back against that pre-election violent home invasion, the family experienced structural retaliation from elected officials afterwards. Mr. Peterson is sexually sterilized to prevent so-called "useless eaters" from breeding with each other. He is a kind, honest, hardworking man, who contests being diagnosed with "mental incompetence", and that his current mental limitations are a result of the sterilization procedure he was railroaded into. The defense attorney humiliates and badgers him. If you're wondering why the court would accept the eugenic sterilization of a man for such a diagnosis, even with it being the letter of the law in Germany at the time, it's established earlier in the film: America has such a strong and documented participation in its own eugenic policies, as defended by respected American jurists such as Oliver Wendell Holmes Jr., that it cannot prosecute another country for eugenic actions.

The state wished to eliminate political enemies, so it relied on its psychiatric experts to create a framework of eugenic justification based on a pipeline of diagnostic criteria, diagnosis, and violent response, in violation of basic human decency and under the pretense of defending civilization. And it took this further, for the sake of efficiency! The diagnostic criteria were simplified and standardized so that diagnosis of mental incompetence could be done by non-professionals, scaling up the bandwidth of the purge. Similar decisions of government efficiency ultimately enabled multiple concurrent genocides with a precision and throughput heretofore unprecedented in the history of eugenic social engineering, including a heavy reliance on IBM's new tabulation machine technology.

[Such priorities would obviously be rejected by the prevailing attitudes in tech today, of course.](https://www.youtube.com/watch?v=b2F-DItXtZs)
## Building on swamps

To save you scrolling up, let's copy and paste the psychiatric industrial complex's responsibilities to the state.

1. <strike>Develop and maintain a taxonomy of diagnoses.</strike> Assume all human neurodivergence to be defective, and simplify that infinite breadth into a mechanically digestible catalog. This not only assumes that the most common human neurotype is "correct", but that it is exclusively so.
2. <strike>Determine which diagnoses apply to a given person.</strike> Fit complex human beings into this catalog, often by force, either subjectively on the whim of a dubious expert, or objectively by fixed criteria that lack nuance.
3. <strike>Make decisions affecting a person's wellbeing and liberty on the basis of diagnosis.</strike> Decide a vulnerable person's future with absolute impunity, and often no or complicit oversight.

Oh gosh, how did those get there?

The shallow reading is that I'm being... well, cantankerous and unpleasable. It seems that there is no easily-imagined change that could be made to psychiatry, to satisfy my exacting standards within its stated mission. But that's almost my own point - that the fundamental assumptions underpinning the discipline are so inescapably anti-human that they are beyond redemption. That helping people with behavioral or cognitive issues is important, but a world where _this_ is the help, can be - for some non-trivial percentage of patients - worse than no help at all.

This is not somehow countered by the people entering the field with good intentions. One of the things that delayed my exit from a harmful religion for so long, is that I couldn't understand how good people could possibly add up to a _bad system._ As above, so below, I thought. I did eventually have to recognize that the system sustains itself by redirecting that good intent, giving it harmful and system-sustaining outlets. We bothered people door-to-door with books because we cared. We genuinely helped some food-insecure people, so we could proselytize to them. We were too steeped in our own mythology to process the harm we were doing, which in many cases was lifelong trauma to the most vulnerable people in our congregation. And the longer you participate, the more you believe, the more reliable a cog you become. This is the glory of the machine, the boiler at the heart of it - throw good into the fire, throw evil! They burn about the same in the end. It doesn't even need some evil master plan - just a millennia of evolution where the evolutionary pressure is _state power._

We are still operating on the same premises that justified and participated in eugenic genocide within living memory. There's a nicer coat of paint on it now. And there's usually tech involved, with friendly Corporate Memphis clip-art and the proverbial 1500-member polycule of data-brokering ad partners. Or at least, that's the version _you_, dear median reader of a queer woman's tech blog, can afford.

And maybe that makes this a good moment to ask: "what's your personal stake in this, Maddie? Maybe I agree, maybe I don't, but why do _you_ feel so strongly about it?" After all, I've never been diagnosed with anything too interesting - nothing a twenty-something would be squeamish to share on TikTok, for example. I don't personally fit the profile. But I know people. Some people who were permanently or indefinitely damaged by psychiatric negligence and irresponsibility. Some people who got great things out of therapy. Lots of trans people who had to convince a practitioner that they were trans, to get access to hormones, because gender dysphoria is still legally a kind of brain-sickness. Many of those people are now scared of being on lists with the government, or having common comorbidities like autism, and having those "mental illnesses" used to persecute them. And for my part, therapy taught me some genuinely useful things, but also was what extended a bad marriage and empowered my husband to weaponize therapy language to manipulate me - something that allowed me to identify a similar abuser for my loved ones later.

And so I find myself keeping my boring diagnoses to myself, more and more strictly. I become more and more skeptical that making myself legible and digestible to the soulless machine with a rotating master is somehow in my best interest. I feel more and more strongly that suicide hotlines should not be allowed to call 911 on you to prevent suicides, because as long as the incarceration pipeline is a risk, people will _rationally_ turn down help in the moment they need it most. I begin to feel it as a troubling lapse of people's leftism when they say "men will do anything except go to therapy," despite the fact that so many men do just need some kind of professional help untangling the ways they were raised. The answer can't be nothing, but it also can't be what we're doing!
## Building on bedrock

I don't think cursing the darkness is adequate as anything more than a starting point. There is a need for real help, realer than we have today. That need won't go away if we abolish the exploitative system currently stop-gapping that need.

So consider my proposal humble, and a mere drop in an ocean of discourse that _ought_ to happen, but here it is: _knowing people and meeting them where they're at, without a requirement of labels, is good._

Okay that's a little facile on its own. But consider the vastness of the autistic spectrum, and the ways in which it's not actually linear. "I'm autistic" tells you almost nothing about a person. What matters is what they need from the world in order to function, and what they can give back to the world when they're enabled to thrive, and that is unavoidably individual. So let's stop pretending otherwise. While labels can be useful, and I'm not declaring war on them, I am declaring the hard requirement of labels harmful.

Secondly, treating neurodivergence, gender divergence etc. as medical matters was always a mistake, a shortsighted bid to borrow the credibility of a harder science. _We can't merely destigmatize diagnosis, we have to demedicalize our relation to the human spirit._ We've tried the former, and there's a reason our results were piddling and partial. Sickness is a terrible way to model the diversity of human brain function, even if it superficially applies to extreme cases.

And if we're going to do that, it's going to require one final thing: _moving more of our society's behavioral resources to an informed consent model._ It should not be a practitioner's place to decide if I have access to a particular pill or pamphlet. That role should be to guide, advise and contextualize, so that I can decide for myself. This might be the hardest sell, because there's a large part of the mainstream that would rather 100 people go without something they need than have 1 person scam "the system."

Which leads into something that isn't really a proposal, but an important observation - perhaps a good one to close off this document. From a behavioral or outcome-base perspective, "normal" people are pretty dysfunctional and sick, and make for a terrible yardstick to measure everyone else by. Normality is appeasing bosses when you know it's wrong. Normal is looking the other way when the machine feeds on your fellow human beings. Normal is fealty to authority. Normal is conflating legality with morality. Normal is romantic jealousy. Normal is trying to fill the hole in your heart with spent money and bought trinkets. Normal is fuck-you-I've-got-mine. Normal is not thinking about where your conflict minerals come from. Normal is uncontrolled wealth hoarding - if anything, that makes you better than normal! We reward that all day long! _So maybe, healthy should no longer be measured by what maintains a status quo of untouchable elites and obsequious peons and a vanishing middle between the two._

Huh. I guess that does make for a snappy proposal after all.

[^1]: Good luck being a closeted black person, for example.

[^2]: Yes, yes, I know Heracles is more accurate, by being directly anglicized from Greek rather than the Greek > Roman > English pipeline that gave us Hercules. But there's somebody reading this footnote who *didn't* know that, for whom Hercules was a more accessible and familiar name, which matters when trying to draw on and expand someone's existing knowledge of Greek Mythology.

[^3]: You probably think we don't do electroshock anymore. Zapping someone's brain and crossing our fingers it does more good than harm? Barbaric! Hahahah. Well, I literally know someone who went through electroshock in the last couple years, voluntarily, as a near-last resort attempt to fix some problems that the doctors had been unable to solve for years. The last time I messaged her to wish her a happy birthday, she never responded back. I have no idea if she's okay.

[^4]: Different personal anecdote from my life: a woman who's still having flashbacks, tremors, and other minor side effects from high-dose antipsychotics she was prescribed as a permanent solution to temporary recreational drug withdrawal. I don't understate it when I say she's the single most physically resilient person I have ever known in person, with a medication metabolism that would frighten God. And _she's_ still recovering after discontinuing treatment over a year ago.

[^5]: If you know me via Mastodon, you already know how open I am about being a lesbian dominatrix, at least to the degree my health allows. It's been quite a road of personal growth, I tell ya.