There has been a big push to get more Americans talking about their feelings in recent decades.

But now experts are starting to wonder if the widespread use of therapy may be having the opposite effect and actually fueling America’s depression crisis.

They argue the treatment, however well-intentioned, can instill a ‘victim’ mentality where people become hyper-focused on their feelings and less engaged with the world around them, making them more depressed.

Around a quarter of US adults said they had visited a therapist or psychiatrist in 2022, which is twice as high as 20 years ago and far higher than the around 3 percent in the UK.

Therapy speak has become so common it has permeated mainstream culture in the US. Clinical words used during counseling like ‘gaslighting’, ‘trauma’ and ‘microaggressions’ have become household terms.

Professor Robert Dingwall, a social scientist and adviser to the UK governmenttold that looking on at the situation in America, there is a concern among sociologists that people are being referred to therapy at the slightest sign of hardship in their life. 

‘There is a tendency to medicalize everyday problems in pursuit of commercial interests,’ he said, whether it be rejection from a partner or a failed job interview.

‘This is something that people have been saying for 50 or 60 years, a concern that’s been expressed by both psychiatrists and sociologists.’ 

This fosters a victim mentality, said Shawn Smith, a clinical psychologist based in Colorado.

Professor Dingwall said that whether or not therapy does more harm than good is a long-standing discussion in medical sociology

Mr Smith told therapy may be harming America’s youth by ‘encouraging kids to spend, frankly, too much time staring at their own belly button, and not being involved in the world and developing meaningful relationships and activities.’ 

‘To whatever extent, therapy contributes to that. It’s a problem,’ he said.

More US adults have received mental health diagnoses than adults in any other high-income countries, according to the Commonwealth Fund, leading people to wonder if Americans are that much sicker or just being over diagnosed. 

Comedian and talk-show host Bill Maher recently hit out at the rise in Americans with mental illnesses and said: ‘PTSD is for people who fought in Iraq, not for people who want to bring their dog on a plane.’

‘The way we know people are depressed is, there’s this turning inward… and usually, you will see a relentless scrutiny of the self, of one thoughts, and one’s feelings and one’s presentation,’ said Dr Smith.

Over-therapizing can contribute to this, he said, ‘if we have kids, just pointlessly scrutinizing themselves, then we are setting them up to turn inward and collapse within, collapse in on themselves and become depressed. ‘

Professor Dingwall said that whether or not therapy does more harm than good is a long-standing discussion in medical sociology.

Not only has the number of people in the US getting therapy risen, but the amount of time spent in therapy has also increased.

In 2022, 13 percent of Americans visited a mental health professional five or more times within the previous 12 months, compared to six percent in 2004.

In the UK in 2014, just three percent of the adults were receiving psychological therapy, according to the Mental Health Foundation.

The percentage of adults who report having been diagnosed with depression has reached 29 percent, which is almost 10 percentage points higher than in 2015

Abigail Shrier, author of Bad Therapy, a book about mental health myths and the medicalization of American kids, said on a podcast that she feels therapy is counterproductive.

‘Whenever there’s greater treatment in a population, greater accessibility for anything from breast cancer to maternal sepsis with more antibiotics, you want to see the point prevalence rates going down.

Shawn Smith, a clinical psychologist based in Colorado, told medicalizing everyday problems fosters a victim mentality

‘We want to see the incidence of depression or anxiety in teenagers going down, because we know these kids are getting flooded with treatment. Instead it’s skyrocketing… so we know at the very least it doesn’t seem to be helping.’

In 2021, a group of researchers termed this the ‘treatment prevalence paradox.’

‘We refer to the increasing availability of better treatments, juxtaposed with the absence of a corresponding decrease in depression’s prevalence,’ they said.

A record one in three adults in America have had clinical depression at some point in their lives, a Gallup poll in 2023 has found.

The percentage of adults who report having been diagnosed with depression has reached 29 percent, which is almost 10 percentage points higher than in 2015.

And nearly one in five (18 percent) of US adults are currently depressed, another record high.

Professor Dingwall said: ‘It’s hard to disentangle the extent to which we are seeing a crisis in mental health among young people, or an expansion of definitions of mental health problems, which is generating more business for pharmaceutical companies and therapists. That’s the debate that needs to be had more widely.’

Dr Smith said that the expansion of definitions of mental health problems may also be a lowering of the bar for some mental illnesses.

The CDC found that one in ten US high schoolers attempted suicide in 2021, up from 8.9 percent a year earlier. Females were struck hardest, with 13.3 percent attempting suicide that year

He said: ‘It certainly can become a bad thing when it interferes with somebody who’s otherwise doing just fine in life, and then suddenly they start to think of themselves as disordered. 

‘And then they start to treat themselves as if they’re disordered and then they’re not doing as well if they were before.’

This can become a self-fulfilling prophecy for teenagers, he added.

The stigma of mental illness has also eased. Eighty-seven percent of Americans agree having a mental health disorder is nothing to be ashamed of, the American Psychological Association found. 

As therapy has become more socially acceptable, Professor Dingwall said, people without mental illnesses may be seeking it out.

‘What we may be seeing is an issue of over diagnosis and overtreatment,’ he said.

‘It is a paradox that once you have once you have a treatment available, more people can be brought into the net, it gets prescribed more widely, it gets used for what would formerly been thought of as marginal cases. That is always a risk unless these things are very closely examined.’

Dr Paul Minot, who has been a psychiatrist for almost four decades, told TIME he feels his industry is too quick to gloss over the ‘ambiguity’ of mental health, cementing diagnoses as certain when there is actually a gray area.

There is also the risk that people become dependent on their therapist.   

‘That’s something that’s been recognized since the days of Sigmund Freud and the beginnings of psychoanalysis,’ said Professor Dingwall.

‘If the experience of therapy becomes overly comforting, a sort of addiction to it and the therapist is certainly possible and we then have what Freud called, an interminable therapy. That is, one that cannot be properly brought to a mutually satisfactory conclusion,’ said Australian psychotherapist David White.

Depending on the type of therapy, some people may come out of it feeling worse off. 

‘There’s also a debate within the therapeutic community themselves,’ Professor Dingwall said. ‘There’s a group known as brief therapists who are very critical of their colleagues, for exaggerating problems, for perhaps trapping people in therapy for unnecessarily long periods, and turning over their lives in a way that increase rather than diminish distress.’

By contrast, brief therapists focus on short-term practical interventions, which are designed to move people on as quickly as possible.

‘The brief therapists argue that they focus on solutions, rather than necessarily  expecting to go sort of deeply into people’s troubles.’

Dr Max Pemberton, British psychiatrist and columnist, said the over diagnosis of mental illness ‘limits’ young people and that therapy can mean ‘they never really move on, [are] stuck in a land of perpetual victimhood, chained to a grief or trauma or difficulty, dragging it around like a weight around their ankle.’

He said that while the younger generation have embraced the idea we must constantly examine our feelings, they are not better off for it, and instead people have become ‘a bit more self-obsessed and a bit more narcissistic.’

‘So many seem to wear their problems like a badge of pride, allowing it to define them,’ Mr Pemberton added.

Any intervention with the potential to help also has the potential to harm patients, Shrier told UnHerd

‘That’s true from everything from Tylenol to X-rays… and it’s true of psychotherapy too.’ 

She listed known harms of psychotherapy as things like making anxiety worse, making depression worse, feeling of inefficacy like I can’t do [things] for myself, a feeling of demoralization as in I’m limited by this diagnosis, and alienation from family members.

Shrier said there are two groups of people: one with severe mental illnesses who are undertreated and underserved in America, and one known as the ‘worried well.’

‘These people don’t suffer in a profound way. They are the bummed out teens of the West. They’re fearful, they’re worried, they’re sad, but they don’t have major depressive disorder.’

‘I don’t think they have mental illness,’ Shrier said. ‘I think they’re being treated as if they have mental illness, they’re encouraged to think of themselves as having mental illness, they’re sort of working themselves into mental illness.’

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