Robert F. Kennedy Jr.’s confirmation as secretary of health and human services, alongside President Trump’s executive order launching the “Make America Healthy Again Commission,” or MAHA, signal that the Trump regime intends to radically reshape the nation’s mental health policy. Their agenda presents itself as a critique of the over-medicalization of mental and social distress, calling for an investigation into the supposed “threat” posed by psychiatric medications. By doing so, it purports to challenge psychiatry’s overreliance on pharmaceuticals, in place of addressing the root social and economic causes underlying much of the human suffering known today as mental illness.
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.
As a group of eminent psychiatrists recently observed in The Lancet, over the last two decades, “most metrics reflecting mental ill health have worsened in the USA, despite having more mental health resources per person than almost any other country … this status quo is the real crisis.”
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.
Today, roughly a quarter of all U.S. adults take at least one prescribed psychiatric medication—a massive increase compared to prior decades, even as there have been no notable improvements in the effectiveness of available treatments, which remain disappointingly limited. Meanwhile, rates of death by suicide, overdose, and alcohol continue to increase, with a striking 37 percent increase in suicide rates between 2000 and 2018—the same period in which rates of antidepressant use in the U.S. more than doubled. Clearly, psychiatric diagnoses and treatments are—by themselves—woefully inadequate responses to the sea of psychic suffering and accompanying nihilism plaguing American society.
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.
Put bluntly, the MAHA agenda—irrespective of the varying intentions of its supporters, who include millions of diverse people failed by our current systems—is quickly being turned by the Trump administration into a eugenics campaign in the guise of reform: a cynical strategy to grant symbolic recognition of widespread pain and anger at failing U.S. mental health care as a perverse means of enabling material redistribution of resources away from redress of that suffering and instead into the pockets of the rich.
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.
Kennedy’s agenda, while highly opportunistic and lacking in ideological consistency, is best understood as an extension of this libertarian and right-wing legacy. He conjoins planned abandonment of poor and disabled groups with a neoliberal strategy of privatizing essential services. By thereby compelling individuals, charitable organizations, or public insurance to pay for-profit companies for basic care, corporations and wealthy individuals like Kennedy can extract maximum wealth from these same populations, even as they slowly suffer and die—whether from suicide, overdose, or preventable diseases born of homelessness or incarceration.
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.
RFK Jr.’s agenda echoes this Szaszian legacy while going considerably beyond it into what should be named for what it is: fascist anti-psychiatry. His repeated baseless claims that antidepressant medications are the cause of school shootings and his advocacy for government “wellness farms” featuring forced labor—particularly targeting Black children—as a supposed alternative to current psychiatric treatment, for example, conjoin the worst of anti-psychiatry with police-state paradigms reminiscent of policies from Nazi Germany and Chinese “reeducation camps” to ongoing American mass incarceration.
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.
Despite the hopes of many of its supporters, MAHA as it is now being wielded by the Trump regime is not a genuine answer to our present problems, but neither is simply falling back on a defense of the status quo. Mental health professionals, public health leaders, and American society writ large can no longer ignore serious, evidence-backed critiques of current psychiatric norms—nor can we afford to delay acting upon them. Continuing to do so will fuel right-wing plans that, unless we rally to stop the Trump regime, will soon leave us with little care infrastructure left to reform.
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.
Fanon analyzed the ways in which psychiatric institutions reinforced racial and imperial domination, emphasizing the “sociogenesis” of mental disorders—that is, the way that systems of colonial oppression give rise to psychiatric conditions that can only be effectively treated by addressing the political conditions behind them. Laing and Cooper sought to replace coercive mental health care with community-based alternatives that value each individual’s unique lived experience over homogenizing diagnostic categories. Foucault traced how psychiatry emerged as a tool for pathologizing behaviors that threatened conservative social order and for isolating “deviant” individuals to quash their subversive potential and freedom from restrictive norms.
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.
Despite their many differences, these thinkers agreed that mental distress was inseparable from broader political and economic structures. They did not reject mental health care in general nor psychiatry specifically but instead called for their transformation. They argued for public investments in social support systems, nonmedical social care, and the recognition of psychic suffering as a fundamentally political phenomenon that, alongside clinical care, required political solutions. Only once this truth was fully embraced could psychiatry as a discipline fulfill its positive potential rather than continue to serve—regardless of individual psychiatrists’ intent—as handmaiden of racism and capitalism by obscuring the root causes of mental illness.
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.
Why, then, are Trump and RFK Jr. so compelling to so many people? Like U.S. health capitalism in general, our mental health institutions and psychiatric norms have betrayed millions of people and caused thousands of deaths. We have bankrupted, gaslit, and then abandoned countless suffering individuals and families—often while criticizing them for showing insufficient deference and gratitude for our medical expertise.
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.
To counter this, U.S. mental health professionals and allied politicians must acknowledge, validate, and own our collective accountability for the suffering upon which Trump and Kennedy are—not unlike their pharmaceutical industry counterparts—preying. We must also conjoin such symbolic recognition with a materially transformative response to this suffering rather than allow MAHA to continue benefiting from its current status as the only widely known alternative to the failed status quo.
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.
The role, profits, and power of the psychiatric industry will slowly shrink if we successfully implement preventative support systems of this kind. And that’s good. It would be a sign of successful mental health policy, as a truly healthy society would have comparatively little—although still some—need for psychiatrists or psychiatric medications.
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.
At its base, the debate over the future of mental health is not a matter of scientific disagreement; it is a political struggle over the meaning of care and of society itself. Kennedy’s agenda presents a vision in which mental suffering is met with stigma, suspicion, and withdrawal of resources together with punishment and coercion. Progressives must present an alternative: one that meets people where they are, validates their suffering, and responds with robust public investment in care systems that address root economic and social causes while also guaranteeing universal rights to medical and psychiatric care.
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.
