What Psychiatry and Its Critics Both Miss About Depression

When Robert F. Kennedy Jr. called this spring for curbing the use of antidepressants, the annual meeting of the American Psychiatric Association was, by multiple accounts, consumed by the fallout.[^1] One in four American women filled an antidepressant prescription last year. Some clinicians feared patients would stop seeking care. Others quietly acknowledged that the medications had been overprescribed for decades. The room was anxious, and the anxiety was not without cause — but it was also, in an important sense, misdirected.

Both sides of the argument are right about something. The prescribing establishment is right that the medications work for many people and that ideologically driven skepticism can do real harm to real patients. Kennedy's critics are right that political interference in clinical practice is a poor substitute for science. But the debate has settled into a binary — medication as either rescue or ruse — that neither side can move beyond, because neither side has an adequate account of the person being medicated. That account is what this essay attempts to recover.

The signal behind the symptom

The New York Times story that brought this controversy into focus describes a profession shaken by political pressure, uncertain how to respond to a moment when the cultural legitimacy of its most common tool is under attack.[^1] That is a genuine crisis. But the deeper crisis is the one the story only touches: the pharmacological frame that has dominated psychiatry for a generation has produced a culture in which suffering is treated primarily as a malfunction to be corrected, rather than as a signal to be read.

Steven Hayes, whose Acceptance and Commitment Therapy has generated one of the most substantial bodies of outcome research in contemporary psychology, states the problem with unusual bluntness: antidepressants are a ten-billion-dollar industry 'even though their average impact on depression is only 20 percent better than a placebo, too small to be clinically significant.'[^2] He is not dismissing the medications. He is insisting that the expectation placed on them — that psychological suffering is a problem solvable the way dirt on a floor is solvable — is the real pathology driving their overuse.

Gabor Maté illustrates what gets lost in that reduction.[^3] In his account of a chaotic Portland clinic, he describes agreeing to prescribe a patient an antidepressant while the waiting room erupts in protest around her. The medication is offered in a context of noise, urgency, and interrupted dignity. Whatever the pharmacological merits, the encounter communicates something about what the person in front of him is worth. That communicative dimension of care — what it says to the sufferer about who they are — is invisible to a purely biochemical account of treatment.

The distinction that matters

Kevin Majeres draws a distinction that deserves far more prominence in the current debate than it has received.[^4] Benzodiazepines, he argues, flatten the anxiety curve so thoroughly that safety learning becomes impossible while the patient is on them. SSRIs work differently: they make the amygdala less likely to fire on triggers, but they do not change the shape of the response curve, so the person can still undergo genuine reprogramming — still learn that the feared thing is not actually a threat.

This is a clinically significant distinction. The question is not whether SSRIs have a legitimate role; Majeres does not argue they are worthless. The question is whether they are being used as a platform for the deeper work of formation, or as a substitute for it. A medication that lowers the threshold for safety learning is one thing. A medication that replaces safety learning is another. The distinction is the difference between a tool that serves the person's growth and one that merely manages their distress at the cost of their agency.

Aquinas understood the passions not as malfunctions to be suppressed but as movements of the sensitive appetite that, properly ordered, serve the soul's orientation toward genuine goods. Fear, on this account, is not the enemy; disordered fear is. The goal of growth is not the elimination of fear but its rectification — what Aquinas calls the virtue of courage, which does not abolish the experience of danger but enables the person to act rightly in its presence. A pharmacological approach that bypasses this rectification process may relieve the symptom while leaving the underlying disorder of appetite untouched.

The person behind the prescription

The CCMMP framework developed by Vitz, Nordling, and Titus understands the human person as a unity of body and soul whose emotional life is neither a mere epiphenomenon of brain chemistry nor a purely spiritual reality detached from physiology. Both reductions fail the person. The emotional premise of the framework holds that the passions are good — that anxiety, grief, and even despair carry information about the person's situation, their attachments, their losses, and their unmet vocational callings. Treating those signals as noise to be pharmacologically filtered is not neutral; it forecloses the interpretive work that genuine healing requires.

Jordan Peterson, speaking from a Jungian framework that is not Catholic but engages similar anthropological territory, describes clinical depression in terms of social hierarchy and neurochemistry: a person who is genuinely low on a social hierarchy, defeated rather than merely perceiving defeat, will experience a physiological collapse that is real and not merely imagined.[^5] He is describing a condition that is simultaneously biological, relational, and existential. The serotonin deficit is real. So is the relational deficit that produced it. Treating only one is treating half a person.

Hayes arrives at a structurally similar conclusion from a secular direction. The problem he identifies is not that people suffer but that Western culture has convinced them that suffering is a sign of failure, a malfunction to be corrected rather than an experience to be met with what ACT calls psychological flexibility and what the Catholic tradition calls fortitude. When sufferers internalize the belief that their pain is merely chemical, they lose access to the question that pain was asking.[^2] The medication, prescribed in that cultural context, reinforces avoidance rather than interrupting it.

The missing category

The pastoral tradition has a word for what treats the whole person: accompaniment. Benedict Groeschel's account of the purgative-illuminative-unitive arc of spiritual growth is, among other things, a clinical observation: genuine transformation moves through suffering, not around it. The person in the purgative stage is not someone whose symptoms should simply be abolished; they are someone whose pain is doing work. That does not mean withholding medication from someone in genuine crisis. It means that medication, when offered, should be offered inside a larger relationship — one that holds the person, reads the signal with them, and moves toward something.

This is what Maté's chaotic clinic could not provide.[^3] This is what Kennedy's political campaign cannot provide either. The missing category in the public debate is not a better drug policy. It is the formation of practitioners who understand what a human person is — who can sit with suffering long enough to ask what it is saying, and who have the theological and psychological resources to help someone move through it toward genuine flourishing.

The antidepressant controversy, read carefully, is an anthropological crisis wearing a pharmacological mask. The question is not whether a molecule is useful. The question is whether the culture that reaches for that molecule has any remaining account of the person who swallows it — and whether the practitioners dispensing it have been formed to ask not only 'Is this person's suffering biochemically tractable?' but 'What is this person's suffering asking of them?'

That second question will not come from a government agency or an annual psychiatric meeting. It will come from the recovery of a vision of the human person capacious enough to hold both the neuron and the soul — and wise enough to know that neither one, treated alone, is the whole story.

Sources

[^1]: Kennedy's Push to Curb Antidepressants Has Shaken Psychiatry. The New York Times, May 24, 2026. https://www.nytimes.com/2026/05/24/science/rfk-jr-antidepressants-ssri-psychiatry.html

[^2]: Steven C. Hayes, A Liberated Mind: How to Pivot Toward What Matters (Avery, 2019).

[^3]: Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (North Atlantic Books, 2010).

[^4]: Kevin Majeres, How to Approach Anxiety (Catholic Psychiatry Institute).

[^5]: Jordan B. Peterson, 12 Rules for Life: An Antidote to Chaos (Random House Canada, 2018).