Therapy

Therapy, as the modern world packages it, is mostly a trap.

The position will read harder than it is, so be precise about what’s being claimed. The complaint isn’t that human interior work is fake. The complaint is about the specific modern arrangement — weekly fifty-minute talk sessions with a credentialed stranger, billed through insurance, sustained for years, treated as the central intervention for mental health. That arrangement is the wrong tool for the problem, prescribed to the wrong people, at the wrong stage of their work on themselves, by an industry whose financial model requires the patient to keep coming back. It has produced a population of perpetual patients, billions of billable hours, and almost no measurable improvement in the metric the industry exists to move. The depression rates are higher than ever. The anxiety rates are higher than ever. The suicide rates are higher than ever. Therapy is more available than ever. The four facts are sitting on the same desk.

The position I run on, in our house, is that therapy is only useful after a solid foundation has been built — and once the foundation is there, the need for therapy mostly evaporates.

The foundation is what the rest of this site has been about. The body that’s been fed real food. The body that’s been lifted and biked. The body that’s been put through cold and heat and made to sleep in the dark. The marriage that’s been tended. The inner ring that’s been pruned. The work that’s been chosen on purpose. Most of what gets diagnosed as a mental health problem in the modern adult is, on inspection, the somatic and social signal of a body and a life that have been quietly destroyed by the standard American protocol. The pills the talk leads to are downstream guesses at a chemistry that was never going to be right while the inputs upstream stayed wrong. Fix the inputs and most of the diagnoses dissolve. I’ve watched it in Effie. I’ve watched it in myself. I’ve watched it in friends. The “mental health” condition turns out, more often than not, to have been a metabolic and lifestyle condition the system was happy to relabel as a brain condition because the brain condition was billable.

I find the mental health industry distasteful for reasons that are hard to say in polite company. The industry sells a crutch and calls it healing. The patient walks in broken, talks for fifty minutes, walks out slightly relieved, books another appointment, and the cycle runs for years — sometimes for decades — with the patient never actually crossing the threshold from broken to built. The relief is real, in the same way the relief a smoker gets from the next cigarette is real. The relief is also why the underlying condition never gets addressed, because the symptom is being managed at exactly the level required to keep the patient functional and in the chair next week. The industry calls this progress. The honest word is maintenance. Maintenance forever is the business model.

The exception, named carefully so this essay isn’t read as more sweeping than it is, is the mentor or coach. Some people genuinely need another human to help them navigate the world — to model the things their parents didn’t model, to teach them how the system actually works, to call out the bullshit they can’t see in themselves, to point at the door they’ve been walking past for years. That role is real, that role is ancient, and that role is one of the most important social functions humans have ever organized around. The trainer in the gym essay. The wise neighbor. The grandmother in the kitchen. The senior engineer who took you aside and told you the truth about your career. The friend in the inner ring who has earned the right to call your bullshit. All of those are forms of the mentor/coach role, all of them work, and almost none of them are produced by the licensed-therapist arrangement the modern world defaults to.

Here’s the dirty secret the credentialed industry would prefer you didn’t notice. Most of the people who go into therapy as a profession are themselves bundles of messes. The data on therapist mental health is grim — high rates of depression, addiction, suicide ideation, burnout, and dissatisfaction with their own lives, often above the population baseline. The profession self-selects for the wounded who are trying to understand themselves by trying to fix everyone else, and the field’s training largely fails to actually heal them before they sit down across from the next patient. You’re paying a person who is, in many cases, less metabolically healthy than you are, less physically capable than you are, less married than you are, and less honest with themselves than the version of you who walked in the door. The credential is real. The competence underneath it is, on average, mediocre.

Given how bad mental health has actually gotten across the modern population, the answer isn’t going to be via talk. Talk is what got us here. The entire culture has been talking about feelings for sixty years, in therapists’ offices and in HR seminars and on every screen, and the talking has correlated with the worsening of every metric talk was supposed to improve. An honest observer has to consider the possibility that the talk itself is part of the problem — that the constant verbal rehearsal of pain, in a setting that rewards the rehearsal with attention, deepens the groove the pain is sitting in rather than dissolving it.

The answer, like the answer to almost everything else on this site, is action. Move the body. Eat the food. Sleep in the dark. Lift the weight. Walk the long walk. Sit in the cold. Sit in the sauna. Pray, if prayer is real to you. Show up for the people in your ring. Build the household. Take the harder door. The interior follows the exterior, in almost every case I’ve personally watched the protocol run on. The exterior leads, the interior follows, and the interior runs on whatever the exterior has been feeding it.

For the residual interior work — the genuine deep wounds that don’t dissolve under protocol alone, the grief that won’t file itself, the loop that has been running since childhood and won’t shut off through any amount of action — the tool I’d actually point a serious person at isn’t the weekly fifty-minute office visit. It’s the careful, intentional use of psychedelics, run as a quasi-religious shamanic practice, with a person who knows what they’re doing.

I’ve written about this once already. Psilocybin was the lever that finally loosened the grip the question of my mother’s suicide had on me, after years of being unable to put the question down by any other means. I’m not selling it as a recreational substance or as a self-help fad. I’m pointing at it as the closest thing the modern world has produced to the older spiritual technologies — the ayahuasca ceremony, the vision quest, the dark retreat, the long fast in the wilderness — that pre-modern cultures used to do the interior work the modern arrangement now defaults to a forty-thousand-hour talk-therapy career for. The ancient tools worked in days or weeks. The modern tool works in years or decades, if it works at all. The trade is bad.

Neither Effie nor I are in talk therapy. Not because we’re in denial about the value of interior work — the entire site is a kind of public interior work — but because we’ve run the protocol, and the protocol has produced the calm the talk was supposed to produce. We sleep. We eat. We lift. We move. We tell each other the truth in the rooms where the truth needs to be told. When a piece of interior wreckage shows up that’s too big for the protocol to dissolve, we don’t book a recurring weekly appointment. We do the thing that actually moves the wreckage — sometimes through the protocol pushed harder, sometimes through the careful use of the older tools. The talk wouldn’t move it. The talk is, in the population I’ve watched closely, almost never the thing that moves anything.

The part of all of this that has me most concerned is what’s being done to children.

Therapy for kids, in the modern American arrangement, has expanded enormously over the last twenty years, and the outcomes are not good. The kid gets handed off to a stranger to talk about feelings the kid hasn’t yet developed the framework to interpret. The kid learns to narrate their inner life to an adult whose attention is contingent on the narration continuing. The kid is taught, by the structure of the engagement, that the inner life is a condition that requires professional management, rather than a normal range of weather every human passes through. The result is a generation of children who have been trained to over-monitor their own moods, label every uncomfortable feeling as a symptom, and reach for an adult intervention whenever the discomfort spikes. The data on this cohort — the post-2010 explosion of teen anxiety, depression, and self-diagnosed mental illness — is consistent with the framing I’m offering and inconsistent with the framing the industry is selling.

The kid doesn’t need talk therapy. The kid needs the protocol the household used to provide before the household outsourced it. Outside, in the sun, on a bike, in the dirt, lifting heavy things the body did not want to lift, swimming in cold water, sleeping in a dark room, eating real food, fighting with siblings, losing at games, recovering, trying again, going to bed tired. The kid needs adults around them who model what a working adult life looks like, who hold the standard, who say no when no is the right answer, and who are physically and emotionally present in the way no licensed stranger ever can be. The talk-therapy intervention for a child is, in many cases, a substitute for the parental presence the modern arrangement has eroded — and the substitute, however well-intentioned, is structurally incapable of providing what the missing thing was supposed to provide.

In children, talk therapy is worse than useless. It’s actively harmful, because it installs a self-monitoring habit that becomes the lifelong predisposition to read every internal weather pattern as a clinical condition requiring professional management. We’re producing a generation of permanent patients, by design, by the people who have a financial interest in the patients staying patients.

If the foundation is right, you mostly don’t need it. If the foundation is wrong, no amount of talk is going to fix what the foundation is failing to support. The intervention you can buy isn’t the intervention you need. The intervention you need is the one nobody can sell you — the daily work on the body and the life that the talk-industry has been monetizing the avoidance of for sixty years.

Build the foundation. Walk out of the office. The work isn’t in the chair.