This article was first published on Mad in America on Jan 18th 2025
I’m not a psychiatrist. I’m not even a therapist. I’m someone who’s struggled with mental distress and the systems meant to help. If there’s one thing I’ve learned, it’s this: our approach to mental health often misses the forest for the trees. It focuses on individuals as though they exist in a vacuum, ignoring the environments and systems that shape their lives. That’s a mistake, and it’s one I think we can address.
Admittedly, I feel like an outsider to the field of psychiatry. Because, frankly, I am. My insights come not from formal training but from lived experiences, including adverse childhood experiences (ACEs), brief encounters with psychiatric care, and a lot of philosophical reflection. I view some challenges in psychiatry as fundamentally ethical issues, not exclusively clinical ones. Yet there’s a pervasive belief that opinions on the subject are only valid if they come from credentialed professionals.
This tendency to dismiss outsiders reminds me of a story:
I was at a party once where a group of people gathered around a Ouija board, claiming to communicate with a spirit named Harry. When I expressed skepticism, they promptly announced that the Ouija board wouldn’t work with a skeptic in the room. So, I quietly excused myself, amused by the realization that my absence would leave them obliged to believe whatever the board told them.
I sometimes feel psychiatry operates in much the same way. Its practices are so entrenched, its methods so accepted, that skeptics and outsiders are often dismissed as uninformed or unqualified simply because they haven’t undergone the same training that instills confidence in its frameworks. But skepticism, especially from those with lived experience, isn’t just valid—it’s necessary. It forces us to question whether our tools and methods truly serve those they claim to help.
Experience Counts
Experience is highly valued in most areas of life. What qualifies someone for a job? Experience. What imparts wisdom? Experience. Yet, when it comes to mental health, the lived experiences of individuals are often dismissed in favor of academic training. Psychologists and psychiatrists are experts in their fields but not at all in the unique conditions or events of anyone else’s life. Professional expertise often grants them the confidence to “diagnose mental illness,” despite lacking adequate knowledge of a person’s lived experience to understand that person’s situation.
When someone is in distress, modern psychiatry often zooms in on the person—their brain chemistry, behaviors, and past. But what about the people around them? What about their family, their community, their workplace? What about the whispers, judgments, and subtle exclusions that pile up over time? Can we truly help someone without addressing these broader dynamics? Focusing on the individual as the sole source of the problem often leaves these environmental factors untouched.
Mental health is deeply affected by the systems in which we live. From childhood, we are shaped by our environments—our family structures, communities, schools, and workplaces. These environments can either nurture our mental well-being or contribute to our distress. Yet psychiatry tends to isolate mental health struggles from their context, reducing complex issues to individual pathology.
If we genuinely want to help someone in distress, we need to address the environmental factors within our control. By the time a person has been exposed to significant ACEs, for example, basic brain structures and heightened susceptibility to distress have already been established. These exposures are environmental issues, not personal failings. During early development, a person has no control over what they’re exposed to. It’s not their responsibility. But when problems emerge later in life, a competitive society attributes them to personal shortcomings, further burdening the individual. This misplaced responsibility can itself be a powerful driver of distress.
This highlights a critical issue in psychiatry: the tendency to treat individuals without examining the family or community dynamics that contributed to their struggles. Rather than addressing these dynamics, psychiatry frequently equips the distressed person with coping mechanisms to endure toxic environments rather than confronting the root causes of their suffering.
To address the local ramifications, focus on immediate environmental factors, including home life, family discovery—which would imply meeting these people and talking to them. Broader, community through education. Even broader: systems through policy change.
No amount of medication can change a toxic world. A person’s distress often begins with those closest to them—family members who shaped their early environment. The realities of our political, economic, social, and religious systems shape our behavior, too. Until the fundamental governing systems change, the best we can do is to focus on the person’s immediate orbit. How do the people around them think of, talk about, and treat them? These factors are deeply relevant to the environments we encounter every day.
Psychiatry’s search for biological answers sometimes overlooks the part of the story we can actually influence: the environments that nurture or harm us. While medication can influence biological realities, it doesn’t touch the broader systems that perpetuate harm.
The Impact of ACEs on Mental Health and Development
Adverse Childhood Experiences (ACEs) are deeply relevant when considering how early environments shape an individual’s mental health. ACEs include physical, emotional, or sexual abuse, neglect, and household dysfunction such as parental mental stress or distress, substance abuse, or domestic violence. These experiences have been shown to significantly influence an individual’s psychological, emotional, and physical health throughout their lives. The research on ACEs underscores the idea that mental health struggles are not simply the result of individual deficiencies, but often stem from traumatic environments that children cannot control.
One of the key findings in ACE research is the lasting impact these experiences have on brain development. Martin Teicher, a neuroscientist renowned for his work on childhood trauma, has demonstrated how exposure to stress and trauma during critical developmental periods can physically alter the structure and function of the brain. His research was confirmed by CDC-Kaiser Permanente ACE studies involving 17,000 individuals.
Areas of the brain impacted by having a high ACE score include those responsible for memory, emotional regulation, and executive functioning, which are all critical for coping with life’s natural challenges. When these brain regions are impaired due to early adversity, the individual is at a heightened risk for mental health issues such as anxiety, depression, and post-traumatic stress disorder (PTSD) in adulthood.
The neurological consequences of ACEs are not confined to the emotional or cognitive realms—they also affect physical health. Chronic exposure to stress during childhood can lead to long-term changes in the body’s stress-response system. Elevated levels of cortisol, the body’s stress hormone, can damage vital organs over time, contributing to conditions such as heart disease, diabetes, and chronic pain. These physical manifestations of trauma further highlight the need for a holistic approach to mental health—one that acknowledges the interconnectedness of mind and body and the role that environmental stressors play in shaping both.
While traditional psychiatry tends to focus on diagnosing and treating individuals in isolation, ACE research calls attention to the broader systems that influence mental health. These systems include family dynamics, community structures, and societal expectations—all of which can either nurture or harm an individual’s mental well-being.
For instance, a child growing up in a household where there is domestic violence or substance abuse is likely to develop maladaptive coping mechanisms, such as withdrawal or aggression, which can persist into adulthood. Similarly, children who experience neglect may struggle to form healthy attachments and trust others later in life. These environmental factors must be considered when addressing mental health, as they are often the root causes of distress.
Yet, in the face of this overwhelming evidence, psychiatry frequently focuses on treating the individual in a vacuum, often overlooking the external factors that contributed to their struggles. This tendency to ignore environmental influences is not only an ethical issue but a practical one. If we fail to address the systems and environments that shape mental health, we risk addressing deeply rooted systemic problems at the individual level with temporary solutions, or worse, iatrogenic ones. The current system often prescribes medications and coping strategies to help individuals endure toxic environments, but it does nothing to challenge the sources of that toxicity.
To me it seems we live in a clash between natural systems (e.g., biological) and man-made systems (e.g., economic). The natural systems of order that would shape us have been replaced by human-made systems shaping us instead, regardless of the disparity between the brains that naturally evolved and the man-made systems demanding those brains to function differently than they would in the natural world. In this clash, developing brains adapt to human-made systems rather than natural systems. (If humans actually knew better than nature, this might be beneficial.)
As with any complex issue, a truly effective approach to mental health must be multifaceted. The focus on individual pathology needs to be shifted to the systems that perpetuate harm. A person who has experienced ACEs has likely developed a heightened sensitivity to stress and may struggle with emotional regulation as a result. While medication may help alleviate some distress, it does not address the underlying trauma that has shaped the individual’s mental and physical health. Similarly, therapy that focuses only on individual coping mechanisms, without considering the broader family or community dynamics or even national policies, may fall short of providing long-term healing.
This is where the importance of empathy comes into play. Understanding that mental health struggles are often rooted in systemic and environmental factors allows us to offer more compassionate, context-aware support. It promotes a more realistic view of human beings. It also empowers us to challenge the systems that perpetuate harm, whether that’s through advocating for trauma-informed care, addressing societal inequalities, or supporting policies that promote healthier, more nurturing environments for children. By doing so, we move closer to a model of care that not only addresses the immediate needs of individuals but also works to prevent future harm.
The ACE research provides a critical lens through which we can view mental health struggles—not as isolated issues but as reflections of broader societal and environmental failings. If we are to create lasting change, we must address both the internal and external factors that contribute to mental health. It’s not enough to simply treat the distress; we need to understand the root causes and work to fix the systems that have caused so much systemic dysfunction.
Not Our Natural Selves
None of us are who we might naturally be because we’re molded by our human-made systems from birth. Understanding this doesn’t absolve anyone of responsibility, but it does provide context. The problem isn’t just individual, it’s systemic.
If we’re to challenge these systems, we need to speak up. We need to share our stories, not just as data points but as lived experiences. For those of us who’ve felt the sting of judgment and the weight of systemic failure, our voices matter. We can educate and explain, offering perspectives that promote understanding. Change won’t come quickly, but it can start with a conversation—a shift in how we see and treat each other.
So here’s my plea: let’s stop focusing solely on fixing individuals and start addressing the environments that shape them. Let’s challenge the systems that perpetuate harm and create opportunities for connection. If you want to help someone in distress, show them genuine care. It’s not something they will ever receive from a paid professional in a sterile setting.
For what it’s worth, I believe the most effective therapy comes from those closest to a person—family, friends, and others in their immediate orbit. However, this requires those individuals to first be educated on how their behavior might contribute to or alleviate the distress of their loved one. A person’s environment, particularly the attitudes and actions of those around them, can play a crucial role in their healing process.
Bring kindness into their lived experience. Reach out—ask if they’d like to spend time together. Listen without judgment. Treat them with the same respect and empathy and camaraderie you’d hope to receive. These small acts might not reflect what they’ve experienced before, or what they haven’t had enough experience with, but you have the power to provide that difference. Reach out as best you can to the person’s natural self.