At first glance, their mission statement echoes long-standing progressive critiques of psychiatry by the fields known as social and critical psychiatry, which argue that psychiatric diagnoses often obscure the structural causes of suffering—poverty, social isolation, racism, homelessness, and exploitative labor conditions, for example—by reducing them to “brain diseases.” This transformation of social problems into medical diagnoses in turn feeds pharmaceutical profits and pathologizes oppressed groups. Meanwhile, an intense focus on neural networks rather than on human needs for social networks often exacerbates suffering, rather than alleviating it.
Despite the superficial resonance between MAHA and progressive critiques of psychiatry, the differences between them could not be more pronounced—nor more consequential. And an untold number of patients could get ground up in the gears of these distinctions.
Social and critical psychiatry respond to this reality by demanding investments in public systems for nonmedical social care that are significant enough to prevent much of the current need for psychiatrists and psychiatric drugs. Trump and Kennedy, by contrast, respond to it by seeking to dismantle public care systems altogether, plotting major cuts to Medicaid, the Indian Health Service, food assistance, and a plethora of other essential programs that threaten to leave those in greatest need with nothing at all. This is a strategy to abandon the most exploited members of our society, exacerbating their suffering and hastening their premature deaths.
As part of this ruse, RFK Jr. is drawing on long-standing traditions of critiquing psychiatry for its many inadequacies—traditions often misleadingly grouped together under the term “anti-psychiatry.” These have historically spanned socialist, liberal, libertarian, and, now, fascist ideologies. Although each of the distinct threads of so-called anti-psychiatry have previously shared common ground in rejecting coercive psychiatric practices, their political goals sharply diverge. Left-wing and liberal critiques have sought to replace biomedical reductionism with expansive, community-based systems of care. Libertarian and right-wing critiques have used psychiatry’s failures as a pretext to withdraw both medical and social support altogether, with little or no regard for what comes next.
This approach can be traced to Thomas Szasz, a libertarian psychiatrist who, in the 1960s, famously argued that mental illness was a “myth” used to justify state control over individuals. His work has been used to argue against not only involuntary psychiatric hospitalization and treatment but also mental health infrastructure in general and even the very idea of public care services.
This purely destructive program does not seek to replace overburdened, profit-driven mental health systems with better ones nor to make psychiatric care more effective. Instead, it aims to strip away mental health care while replacing it with, at best, nothing or, at worst, involuntary work camps and yet more profiteering via snake-oil supplements.
To formulate effective opposition to Trump and Kennedy, we should revisit constructive criticisms of psychiatry that emerged alongside Szasz but that developed through a different trajectory, informed by recognition of the harm inflicted by intertwined colonial and capitalist systems. Frantz Fanon, R.D. Laing, David Cooper, and Michel Foucault, for example, challenged the medicalization of mental distress, but unlike Szasz, they recognized psychiatry’s failings as symptoms of oppressive economic and social policies rather than simply a sign of state overreach.
Throughout his adult life, Foucault—a gay man who lived through an era in which all nonheterosexualities were defined by psychiatrists as mental diseases—advocated for alternative, de-pathologizing forms of social care. He believed that, rather than suppressing individual idiosyncracies, true care for one another must instead support the richness of human diversity and nonconformity to standardized notions of health, sexuality, pleasure, and capitalist value while also addressing the very real suffering that so many people are experiencing.
This left-wing tradition insists on the need for more care, not less—but care that is collective rather than individualistic, public rather than profit-driven, and centrally focused on addressing the political-economic determinants of health. Right-wing anti-psychiatry, by contrast, uses critiques of psychiatry to advocate for the withdrawal of care to accelerate the “survival of the fittest,” in a game rigged in favor of white men with inherited wealth made off the backs of working-class people and violently subjugated Black and brown populations. The evolving MAHA agenda represents the latest iteration of this trend, offering nothing but yet more punishment for the poor alongside lucrative (and still ineffective) private “wellness” programs and potions for the rich.
Psychiatry as a field has responded to poverty, public disinvestment from community support, and deep social isolation with a for-profit mental health paradigm that treats the nation’s distress as if it’s a product of a “disordered brain” rather than a response to ongoing inequality, exploitative and dehumanizing jobs, childhood maltreatment, and mass incarceration and its routine use of rape and torture, for example. The enormous reservoir of desperation, confusion, and anger this has generated is what now allows opportunists like Trump and RFK Jr. to manipulate millions into supporting their destructive agenda via false promises of cure and freedom.
An honest, ethical response to the limitations and corruption of psychiatry must affirm the rightness of the public’s anger while insisting on constructive solutions. Rather than allowing rage to be channeled toward dismantling public health and undercutting responsible use of psychiatric medications as one aspect of care, we must redirect it toward policies that create more equitable, relationship-based, and effective care systems. This means investing in large-scale community care worker and peer support programs and non-police crisis response systems. It also means fully funding and robustly staffing public schools and childcare programs that are essential for child development and parental well-being. And it means ensuring universal access to mental health support, not only through psychiatry and therapy but through direct provision of economic security, housing, and social connection.
But simply stripping people of access to medications and psychiatric care, as Kennedy and Trump threaten to do, without addressing the underlying suffering to which these treatments are a response would provoke a public health disaster. While the rich would continue to pay privately for whatever they may need or want and would turn to the black market as needed, approximately 100 million Americans who are uninsured or underinsured would be cut off from essential care. Millions would suffer from dangerous medication withdrawal, sudden withdrawal of social connections upon which they’ve come to depend, and sudden increases in need for expensive and often traumatic hospitalization. Many would likely die by suicide or overdose.
This is not a debate about psychiatry—and those of us internal to the field must not let the narcissism of small differences prevent us from uniting to do what basic ethical and political responsibility requires of us at this crucial historical juncture. We are in a fight over whether we will, as a society, choose solidarity or abandonment and whether we will meet suffering with care or with cruelty. The future of both mental health and democracy in America depends on our answer.
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