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All in Your Head: Illness as Identity, Trauma as Fashion, and the Desire to be Disordered
A searing account of the ways in which mental health culture distorts out understanding of mental illness, abandons the severely ill, and threatens the lives of millions who desperately need care.
Mental health culture in the 21st century is broken. After decades of influence from the anti-psychiatry movement, our conception of mental illness has become hopelessly romanticized, distorted by fictional depictions of madness that minimize the harms of debilitating conditions. It’s become fashionable to insist that mental illness is socially constructed, politically imposed, or secretly empowering. But these claims are dishonest and destructive. Psychosis is not creativity; delusion is not just another way of knowing; schizophrenia is not a sane response to an insane world. Mental illnesses are real, biological conditions that cause profound torment and destroy lives. Treating them as metaphors or identities does not liberate the afflicted. It condemns them.
With All in Your Head, Fredrik deBoer offers a powerful and long-overdue critique of modern mental health culture. He shows how deinstitutionalization, a well-intended but ultimately doomed corrective to psychiatry’s early abuses, collapsed into a humanitarian disaster, leaving the severely mentally ill to cycle through homelessness, incarceration, and neglect. More recently, the “gentrification of disability” has turned mental illness into social currency, even as those with the most disabling conditions deteriorate on the streets. The digital age has only intensified this crisis, spreading implausible self-diagnoses and turning rare disorders into identity theater, while the truly ill are left out of the conversation.
Bracing and rigorously argued, All in Your Head is a call for an honest reckoning. Caring for people with mental illness requires material support, institutional capacity, and medical intervention. Psychiatry, despite its flaws, remains the only lifeline for millions. To abandon it is to abandon the most vulnerable among us.
Mental health culture in the 21st century is broken. After decades of influence from the anti-psychiatry movement, our conception of mental illness has become hopelessly romanticized, distorted by fictional depictions of madness that minimize the harms of debilitating conditions. It’s become fashionable to insist that mental illness is socially constructed, politically imposed, or secretly empowering. But these claims are dishonest and destructive. Psychosis is not creativity; delusion is not just another way of knowing; schizophrenia is not a sane response to an insane world. Mental illnesses are real, biological conditions that cause profound torment and destroy lives. Treating them as metaphors or identities does not liberate the afflicted. It condemns them.
With All in Your Head, Fredrik deBoer offers a powerful and long-overdue critique of modern mental health culture. He shows how deinstitutionalization, a well-intended but ultimately doomed corrective to psychiatry’s early abuses, collapsed into a humanitarian disaster, leaving the severely mentally ill to cycle through homelessness, incarceration, and neglect. More recently, the “gentrification of disability” has turned mental illness into social currency, even as those with the most disabling conditions deteriorate on the streets. The digital age has only intensified this crisis, spreading implausible self-diagnoses and turning rare disorders into identity theater, while the truly ill are left out of the conversation.
Bracing and rigorously argued, All in Your Head is a call for an honest reckoning. Caring for people with mental illness requires material support, institutional capacity, and medical intervention. Psychiatry, despite its flaws, remains the only lifeline for millions. To abandon it is to abandon the most vulnerable among us.
- GenresPsychologyNonfiction
336 pages, Hardcover
Published October 27, 2026
About the author
Fredrik deBoer
7 books858 followersFredrik deBoer is a writer. He lives in Connecticut.
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Displaying 1 - 13 of 13 reviews
October 8, 2026
This was definitely an interesting book. A lot of this, I enjoyed reading. The first half in particular felt very well researched. However, I found the second half less well done. Also, this book desperately needs a different subtitle; the current one does not explain the content of this book well.
The first half of this book is essentially a history of the anti-psychiatry movement and major figures who played a role in that movement, both academically and culturally. I really enjoyed this part of the book. My only exposure to anti-psychiatry movements comes from their social media representations, so it was great to see a well researched perspective on the origins of the movement. I especially appreciated the research into the academic originator, Dr. Szasz, showing how he avoided actually treated severely ill patients and suggesting that his politics are largely at odds with modern day anti-psychiatry advocates.
Next, we get a history of de-institutionalization, which was something I was more familiar with, but still not too the level of what is presented here. I really liked the legislative deep-dive, showing just how this gap in coverage first occurred, emerging from various failures of political will. deBoer is an advocate for greater rates of involuntary commitment and he lays out his case well even if you end up disagreeing with it, which is to me a sign of a well thought through argument.
I did find arguments in the second half a bit less well thought through at times. There are various short interstitial chapters throughout explaining smaller issues deBoer has with either mental healthcare or mental health advocates. There is one about halfway through regarding the case of Rohinie Bisesar, who stabbed and killed a woman while psychotic in 2015. She was found not criminally responsible due to the psychosis. Due to this she underwent involuntary treatment for 4 1/2 years before she was allowed some unsupervised community visits and the possibility of supervised out-patient housing. Obviously, this is an incredibly tragic case. the real failure was the fact there was not treatment prior to the harm. deBoer also clearly thinks that 4 1/2 years wasn't long enough, but he never explains what would be appropriate, or why he thinks that the psychiatrists who made that decision shouldn't be trusted in their assessment, despite spending the rest of the book urging people to trust psychiatrists and therapists and avoid self-diagnosing. he also seems to be critical of the fact that the family of the victim has little input on whether someone should be released from in-patient care, despite the fact that there are obviously very good reasons families generally don't get have to input on these decisions—they can’t be impartial, understandably! deBoer notes this himself when critiquing standpoint theory and stating that the families of murder victims wouldn't be an impartial jury in a murder trial.
This interstitial marks the beginning of the more sloppy argumentation in this book (which is why I went on and on about it). **edit to add now that I checked against the published version—this sloppiness extends to factual errors. Harry Lando is mentioned in this book because his participation in the famous Rosenhan experiment. Harry Lando is described as a “Stanford-trained lawyer”. Harry Lando was my professor in college and he is not a lawyer, he has a PhD in psychology.
The second half of this book seems a bit allergic to concrete examples. If I had to guess what chapter motivated this book, I would guess it would be the one on the gentrification of autism. It's the longest of the book and you can tell deBoer is passionate. But despite that, I finished the chapter feeling unsure about what the actual harms are. I would have liked to have seen some sort of statistic or something that suggests that people actually have an understanding of autism that is more focused on its less severe presentations, or that resources are being taken away from those with level 3 autism. That may be true, but we don't see it here.
I used to work in an accommodations office at a university. I did not grant accommodations but provided services to those that had them. In terms of the population, it was very much what deBoer describes - mostly more advantaged students who tended to be white, out-of-state students, likely wealthier. However, in terms of malingering and using resources, we were very much more in the ADHD world still. In general, whether real or not, we had very few autistic students come through the office. This gap itself may be evidence of what deBoer is discussing, as those with the most severe autism are unlikely to make it to college, but I did not leave this book with a clear sense of what resources were being lost at the autism hashtag got more popular on tiktok.
deBoer also takes issues in the idea of a neurodiversity movement. Some of the criticisms I share. The office I worked in believed heavily in the social model of disability and I definitely saw the flaws. However, some of deBoer's critiques struck me as odd. He quotes the originator of the term "neurodiversity" stating
"The ‘Neurologically Different’ represent a new addition to the familiar political categories of class / gender / race and will augment the insights of the social model of disability."
To me, this is a clear call for intersectionality - Black people with autism or a woman with autism will have a different experience than a white person or a man with autism. This seems obviously true based on changes we have seen in diagnosis in these communities. However, deBoer reads this as blurring the lines between having autism and being Black, as an example. This isn't clear until much later, but he sees that as bad because it is comparing a disability (which by definition is bad) with a characteristic like Blackness, which obviously isn't inherently bad. We'll come back to that argument later but to me this is just plainly a misread of the quote. He also suggests some autistic people won't want to be part of a political project. This is probably true but a weak criticism of the project itself. Many women do not consider themselves feminists but that isn't really a failure of the political project that is feminism.
As noted above, deBoer makes the point that disability is by definition a bad thing, something that has profound negative consequences on a person's life. This is frequently true. However in making this point (and other) there is some conceptual slippage occurring. This book is clearly about psychiatric disabilities. That's why the first half of this book is about anti-psychiatry and de-institutionalization! However, deBoer several times introduces a criticism by quoting or referring to someone with a physical disability, then argues against their point, then applies that to a mental health issue. This frequently just does not work. As an example, in the disability = bad section he starts by quoting a man discussing how he was a worse person before losing his leg and that he wouldn't go back and have his leg again if he could. deBoer then suggests that most people who lose a limb are probably negatively impacted by that, and then in his prescription section suggests these positive framing of disability get in the way of recover. The recovery angle makes sense if a person is going to therapy, but not if they've lost a leg! My "foreign" language in college was ASL and that also is an example of a group who very much feel like they have their own culture and that their disability is not a bad thing. If you suggest to a Deaf person it is bad, they will be very offended! It is also clear to me that the social model works for physical disabilities! It is a failure of society if a person who has lost a leg has their opportunities limited. Mental illness is different in this regard because humans are a social species and some behaviors will always be classed as anti-social as a response to that. All examples of physical disabilities should have been excised from this book. They just muddle the point and aren't good examples for the claims he is trying to make.
I'll stop rambling on at this point. For me, the fact that I had a lot to say about this suggests that this was an effective book for the most part. It needed more and better examples and concreteness in the second half, but it is well written and compelling. This was a quick read for me. I was unfamiliar with the author before reading, but I now know that he has a substack where he frequently discusses similar topics. Maybe I'll take a look. I would still encourage people to pick this up, but ignore the subtitle. Otherwise you will be disappointed.
The first half of this book is essentially a history of the anti-psychiatry movement and major figures who played a role in that movement, both academically and culturally. I really enjoyed this part of the book. My only exposure to anti-psychiatry movements comes from their social media representations, so it was great to see a well researched perspective on the origins of the movement. I especially appreciated the research into the academic originator, Dr. Szasz, showing how he avoided actually treated severely ill patients and suggesting that his politics are largely at odds with modern day anti-psychiatry advocates.
Next, we get a history of de-institutionalization, which was something I was more familiar with, but still not too the level of what is presented here. I really liked the legislative deep-dive, showing just how this gap in coverage first occurred, emerging from various failures of political will. deBoer is an advocate for greater rates of involuntary commitment and he lays out his case well even if you end up disagreeing with it, which is to me a sign of a well thought through argument.
I did find arguments in the second half a bit less well thought through at times. There are various short interstitial chapters throughout explaining smaller issues deBoer has with either mental healthcare or mental health advocates. There is one about halfway through regarding the case of Rohinie Bisesar, who stabbed and killed a woman while psychotic in 2015. She was found not criminally responsible due to the psychosis. Due to this she underwent involuntary treatment for 4 1/2 years before she was allowed some unsupervised community visits and the possibility of supervised out-patient housing. Obviously, this is an incredibly tragic case. the real failure was the fact there was not treatment prior to the harm. deBoer also clearly thinks that 4 1/2 years wasn't long enough, but he never explains what would be appropriate, or why he thinks that the psychiatrists who made that decision shouldn't be trusted in their assessment, despite spending the rest of the book urging people to trust psychiatrists and therapists and avoid self-diagnosing. he also seems to be critical of the fact that the family of the victim has little input on whether someone should be released from in-patient care, despite the fact that there are obviously very good reasons families generally don't get have to input on these decisions—they can’t be impartial, understandably! deBoer notes this himself when critiquing standpoint theory and stating that the families of murder victims wouldn't be an impartial jury in a murder trial.
This interstitial marks the beginning of the more sloppy argumentation in this book (which is why I went on and on about it). **edit to add now that I checked against the published version—this sloppiness extends to factual errors. Harry Lando is mentioned in this book because his participation in the famous Rosenhan experiment. Harry Lando is described as a “Stanford-trained lawyer”. Harry Lando was my professor in college and he is not a lawyer, he has a PhD in psychology.
The second half of this book seems a bit allergic to concrete examples. If I had to guess what chapter motivated this book, I would guess it would be the one on the gentrification of autism. It's the longest of the book and you can tell deBoer is passionate. But despite that, I finished the chapter feeling unsure about what the actual harms are. I would have liked to have seen some sort of statistic or something that suggests that people actually have an understanding of autism that is more focused on its less severe presentations, or that resources are being taken away from those with level 3 autism. That may be true, but we don't see it here.
I used to work in an accommodations office at a university. I did not grant accommodations but provided services to those that had them. In terms of the population, it was very much what deBoer describes - mostly more advantaged students who tended to be white, out-of-state students, likely wealthier. However, in terms of malingering and using resources, we were very much more in the ADHD world still. In general, whether real or not, we had very few autistic students come through the office. This gap itself may be evidence of what deBoer is discussing, as those with the most severe autism are unlikely to make it to college, but I did not leave this book with a clear sense of what resources were being lost at the autism hashtag got more popular on tiktok.
deBoer also takes issues in the idea of a neurodiversity movement. Some of the criticisms I share. The office I worked in believed heavily in the social model of disability and I definitely saw the flaws. However, some of deBoer's critiques struck me as odd. He quotes the originator of the term "neurodiversity" stating
"The ‘Neurologically Different’ represent a new addition to the familiar political categories of class / gender / race and will augment the insights of the social model of disability."
To me, this is a clear call for intersectionality - Black people with autism or a woman with autism will have a different experience than a white person or a man with autism. This seems obviously true based on changes we have seen in diagnosis in these communities. However, deBoer reads this as blurring the lines between having autism and being Black, as an example. This isn't clear until much later, but he sees that as bad because it is comparing a disability (which by definition is bad) with a characteristic like Blackness, which obviously isn't inherently bad. We'll come back to that argument later but to me this is just plainly a misread of the quote. He also suggests some autistic people won't want to be part of a political project. This is probably true but a weak criticism of the project itself. Many women do not consider themselves feminists but that isn't really a failure of the political project that is feminism.
As noted above, deBoer makes the point that disability is by definition a bad thing, something that has profound negative consequences on a person's life. This is frequently true. However in making this point (and other) there is some conceptual slippage occurring. This book is clearly about psychiatric disabilities. That's why the first half of this book is about anti-psychiatry and de-institutionalization! However, deBoer several times introduces a criticism by quoting or referring to someone with a physical disability, then argues against their point, then applies that to a mental health issue. This frequently just does not work. As an example, in the disability = bad section he starts by quoting a man discussing how he was a worse person before losing his leg and that he wouldn't go back and have his leg again if he could. deBoer then suggests that most people who lose a limb are probably negatively impacted by that, and then in his prescription section suggests these positive framing of disability get in the way of recover. The recovery angle makes sense if a person is going to therapy, but not if they've lost a leg! My "foreign" language in college was ASL and that also is an example of a group who very much feel like they have their own culture and that their disability is not a bad thing. If you suggest to a Deaf person it is bad, they will be very offended! It is also clear to me that the social model works for physical disabilities! It is a failure of society if a person who has lost a leg has their opportunities limited. Mental illness is different in this regard because humans are a social species and some behaviors will always be classed as anti-social as a response to that. All examples of physical disabilities should have been excised from this book. They just muddle the point and aren't good examples for the claims he is trying to make.
I'll stop rambling on at this point. For me, the fact that I had a lot to say about this suggests that this was an effective book for the most part. It needed more and better examples and concreteness in the second half, but it is well written and compelling. This was a quick read for me. I was unfamiliar with the author before reading, but I now know that he has a substack where he frequently discusses similar topics. Maybe I'll take a look. I would still encourage people to pick this up, but ignore the subtitle. Otherwise you will be disappointed.
Review of advance copy received from Edelweiss+
Interesting read, learned a lot. Wasn't entirely what I expected (fair bit more about the history of anti-psychiatry as a political and social project), and I left some topics not completely convinced, but it was compelling. It's an impassioned call to action for reform in how we (as people, as policymakers) treat and think of the mentally ill - sometimes with unpopular or unpleasant-sounding requests. But, well, live anywhere where enough people have slipped through the cracks to essentially be "crazy on the streets" until they die and it's hard to not understand deBoer's action plan.
Like with How the Elites Ate the Social Justice Movement, I appreciate deBoer's point of view and his way of discussing things - maybe because we're often on the same page, and when we're not, I understand where he's coming from. We have similar frustrations about good intentions and reasonable attempts at change ("I could not have lived my life and failed to see the moral logic behind [insert sooo many political or social projects here]" - like this may as well be my new motto in life), but I appreciate how willing he is to call nonsense out ... and it helps that we have the same ideas on what IS nonsense.
I feel like the book was split in two: the failures of psychiatry as it is currently practiced + the anti-psychiatry beliefs that pull it down, and then social attitudes about mental disability as directed by the most obnoxious people online and the loudest ivory tower disability advocates. These two categories didn't always link together perfectly for me. I'll admit I came to this book because of his concept of "the gentrification of disability" (namely, that the people who speak for the disabled are now the least disabled, think someone who speaks on behalf of everyone who's autistic but can write academic journals with their framed diploma from Harvard on the wall), but there were just not enough hard examples of these belief systems actually changing policy or being held by fundamentally serious people for me to be that concerned about it.
I hate the DID fakers, I hate people on TikTok pathologizing things like "getting a song stuck in your head" or "labelling the spice drawer" as being a sign that you're soooo neurospicy lololol, I hate this weird insistence that no one who's disabled actually wants their disability gone (and if you do, you're doing disability wrong), I hate people who are "neurotypical" by any standard demanding accomodations (or attention) for what are essentially personality traits. I think it's compelling to talk about how this is changing how we see disability and how this exemplifies weird, social-media-age brainrottedness, like an inflated need for attention and how people acquire "oppression" markers so they can essentially buy legitimacy in any "social justice" discussion. But next to serious talk about policy changes about involuntary stays in hospitals, I honestly found myself like, "Is this actually affecting anything?" Maybe it will one day and I'll eat my hat, idk. In the meantime, I just deleted social media.
Even though I live in the same online ecosystem as him and I've seen all the same slogans and beliefs about, broadly, "disability as identity," this did show me how exactly that belief developed and how it fits into evolving disability advocacy (especially in regards to the belief/slogan/idk that disabilities are "only" disabling because the world doesn't accomodate them, which I was honestly neutral on before this, but now I see it in 3D).
I would have appreciated many, many, many more actual factual examples because there was sometimes a feeling of him pointing at the most dramatic "crazy person" you can imagine (he mentioned a hypothetical psychotic person eating their own feces a weird amount) or generalized caricatures of social media freaks without actually showing what made them freaks (I know the "you're audhd if you get a song stuck in your head" discourse but not all readers will). The few that were there were immensely appreciated. But even I was like, "What are you EXACTLY referring to?"
yadda yadda yadda. Enjoyed it, will look forward to his next book so we can once again shake hands over our grievances
Like with How the Elites Ate the Social Justice Movement, I appreciate deBoer's point of view and his way of discussing things - maybe because we're often on the same page, and when we're not, I understand where he's coming from. We have similar frustrations about good intentions and reasonable attempts at change ("I could not have lived my life and failed to see the moral logic behind [insert sooo many political or social projects here]" - like this may as well be my new motto in life), but I appreciate how willing he is to call nonsense out ... and it helps that we have the same ideas on what IS nonsense.
I feel like the book was split in two: the failures of psychiatry as it is currently practiced + the anti-psychiatry beliefs that pull it down, and then social attitudes about mental disability as directed by the most obnoxious people online and the loudest ivory tower disability advocates. These two categories didn't always link together perfectly for me. I'll admit I came to this book because of his concept of "the gentrification of disability" (namely, that the people who speak for the disabled are now the least disabled, think someone who speaks on behalf of everyone who's autistic but can write academic journals with their framed diploma from Harvard on the wall), but there were just not enough hard examples of these belief systems actually changing policy or being held by fundamentally serious people for me to be that concerned about it.
I hate the DID fakers, I hate people on TikTok pathologizing things like "getting a song stuck in your head" or "labelling the spice drawer" as being a sign that you're soooo neurospicy lololol, I hate this weird insistence that no one who's disabled actually wants their disability gone (and if you do, you're doing disability wrong), I hate people who are "neurotypical" by any standard demanding accomodations (or attention) for what are essentially personality traits. I think it's compelling to talk about how this is changing how we see disability and how this exemplifies weird, social-media-age brainrottedness, like an inflated need for attention and how people acquire "oppression" markers so they can essentially buy legitimacy in any "social justice" discussion. But next to serious talk about policy changes about involuntary stays in hospitals, I honestly found myself like, "Is this actually affecting anything?" Maybe it will one day and I'll eat my hat, idk. In the meantime, I just deleted social media.
Even though I live in the same online ecosystem as him and I've seen all the same slogans and beliefs about, broadly, "disability as identity," this did show me how exactly that belief developed and how it fits into evolving disability advocacy (especially in regards to the belief/slogan/idk that disabilities are "only" disabling because the world doesn't accomodate them, which I was honestly neutral on before this, but now I see it in 3D).
I would have appreciated many, many, many more actual factual examples because there was sometimes a feeling of him pointing at the most dramatic "crazy person" you can imagine (he mentioned a hypothetical psychotic person eating their own feces a weird amount) or generalized caricatures of social media freaks without actually showing what made them freaks (I know the "you're audhd if you get a song stuck in your head" discourse but not all readers will). The few that were there were immensely appreciated. But even I was like, "What are you EXACTLY referring to?"
yadda yadda yadda. Enjoyed it, will look forward to his next book so we can once again shake hands over our grievances
Review of advance copy received from NetGalley
Thank you to Simon & Schuster and NetGalley for the ARC of "All in Your Head," which was not, as its subtitle would suggest, primarily about "the desire to be disordered." By my estimation only approximately 10% of the book was devoted directly to that subject. Instead, deBoer focuses extensively on the history and consequences of deinstitutionalization, the historical figures who contributed to a "pull yourself up by the bootstraps" ideology, and the anti-psychiatry movement. Although this was not quite the book I expected, I nevertheless found much of the subject matter interesting.
I thought deBoer’s criticisms of Sigmund Freud and Thomas Szasz were particularly noteworthy. For Szasz, "mental illnesses were 'problems in living' that should be addressed through personal responsibility." DeBoer persuasively demonstrates that this aspect of Szasz’s philosophy was riddled with internal contradictions and consequential blind spots. “The insanity defense is not merciful; involuntary mental hospitalization is not a treatment,” he wrote in Fatal Freedom: The Ethics and Politics of Suicide, one of his last books. “Both are coercive methods of social control. . . . Both function as tactical weapons in psychiatry’s war on dignity, liberty, and responsibility.” As deBoer observes, what Szasz does not acknowledge—because it so thoroughly undermines his argument—is that the alternative to the insanity defense is not freedom but ordinary imprisonment, itself a profoundly coercive method of social control.
I found myself annotating many points with which I agreed, several of which I will share below. At the same time, I was tempted to skip portions of the text that became particularly repetitive. The book would have benefited from more rigorous editing; a substantial amount could have been condensed without sacrificing the force or clarity of deBoer’s central argument. These were a few of the passages that particularly resonated:
"There are almost no meaningful ethical issues that benefit from becoming more simplistic and more binary, and this is especially true in the field of psychiatric medicine."
"To argue that mental disorders are not diseases because they cannot (yet) be pinned to a single lesion or pathogen is to apply a selectively stringent standard that no other branch of medicine is held to."
"The notion that psychiatric medications are neurotoxic conveniently avoids evidence that untreated psychotic disorders themselves are associated with eventual serious brain damage."
"The destigmatization effort has been wildly successful, and one result has been a vastly more crowded field of passionate patients and advocates working to influence public perception of these disorders. And the usual dynamics of inequality apply: those who enjoy greater social and financial capital have louder voices and more influence."
"Community Mental Health Centers reduced suicide and homicide rates by 8 percent and 14 percent, respectively, among nonwhite patients, then as now a population of particular concern given basal rates of mental illness. This finding strongly suggests that the concept of community-centered care itself was at least plausibly viable, and perhaps that the ultimate failure lay not in the model itself, but in the political will to fund it consistently and comprehensively."
“The gentrification of disability in its purest form [is] the most affluent, educated, and well connected among those with a given disorder using that status to define the disorder in the public mind.”
“David Mitchell and Sharon Snyder, disability scholars who have done a great deal of work on the intersection between public perception and disability, have written that “Americans learn perspectives on disability from books and films more than from policies or personal interactions.”
“Patients with Somatic Symptom Disorder or Illness Anxiety Disorder are estimated to consume healthcare expenditures at twice the rate of patients without these conditions, demonstrating the significant systemic burden of these concerns.”
The excerpts concerning lobotomies, the classification of autism spectrum disorder in the DSM-5, the concept of the ‘Intact Mind’, disorder as identity, social contagion, and the proliferation of “TikTok Dissassociative Identity Disorder” were among the most compelling portions of the book. I was less persuaded by some of deBoer’s discussion of the social model of disability, which I believe has a legitimate place alongside other interpretive frameworks. The medical and social models need not be treated as mutually exclusive; each describes different, sometimes overlapping dimensions of disability.
DeBoer discusses a Harvard symposium canceled following objections from disability “advocates,” as well as physicians who fear professional repercussions arising from negative patient—or customer—feedback. These examples raise legitimate concerns about whether advocacy and consumer pressure can constrain clinical judgment. However, they also appear somewhat isolated, leaving me uncertain whether they demonstrate a pervasive institutional problem or merely amplify the loudest and most conspicuous voices. I agreed with several of deBoer’s arguments that autism may now function as an excessively broad umbrella category and that physicians must uphold meaningful diagnostic standards rather than capitulate to patients who insist that their self-diagnoses are correct. Even so, I wanted stronger evidence regarding how prevalent such capitulation actually is. Anecdotes can illustrate a problem, but they cannot establish its scale.
As an occupational therapist, I regularly read nonfiction addressing disability and adaptations to it. One of my earlier reads this year was “Against Technoableism” by Ashley Shew, which offers a useful counterpoint to deBoer’s position through its discussion of the etymology of disability. DeBoer emphasizes “Disability is Bad! Disability is disabling!”—a claim I cannot altogether reject—but I also agree with Shew’s assertion that disability is not synonymous with inability. She describes how Lawrence Carter-Long has written beautifully about the word “disabled,” emphasizing the meaningful distinction between the prefixes dis- and un-. As he points out, dis-abled is different from un-able. He talks how one meaning of dis- is “to twain.” In a popular Facebook note from 2015, he writes: Twain literally means “in different directions, apart, asunder.” Use of the prefix in this way has given us perfectly good words like “discern,” “discuss,” “dismiss,” “dissent” and “distill.” When used in this way being disabled does not suggest a lack of anything—including ability.
In other words, I understood deBoer’s criticisms of the social model while continuing to recognize the validity of several of its central tenets. Disability can involve intrinsic impairment while also being intensified—or mitigated—by the physical and social environment. This left me at an intellectually productive crossroads: I both agreed and disagreed with deBoer and Shew, finding each author persuasive in some respects and overly categorical in others. A more integrated account, rather than a contest in which one model must displace the other, seems better suited to the actual complexity of disabled experience.
In sum, "All in Your Head" offered several incisive critiques and explored a number of subjects I found genuinely absorbing, but it did not consistently deliver the examination promised by its subtitle. Its strongest arguments were weakened by repetition, and some of its broad cultural claims required more evidence than a handful of provocative examples could provide. I appreciated the book most when it challenged me to examine tensions among diagnosis, identity, clinical authority, and disability advocacy. I rated it 2.5 ☆, rounded up to 3 ☆ for the strength of its most engaging sections.
"A society that rewards genuine recovery, stability, and resilience rather than theatrical fragility is a society better positioned to care for the people who cannot perform their suffering at all.”
I thought deBoer’s criticisms of Sigmund Freud and Thomas Szasz were particularly noteworthy. For Szasz, "mental illnesses were 'problems in living' that should be addressed through personal responsibility." DeBoer persuasively demonstrates that this aspect of Szasz’s philosophy was riddled with internal contradictions and consequential blind spots. “The insanity defense is not merciful; involuntary mental hospitalization is not a treatment,” he wrote in Fatal Freedom: The Ethics and Politics of Suicide, one of his last books. “Both are coercive methods of social control. . . . Both function as tactical weapons in psychiatry’s war on dignity, liberty, and responsibility.” As deBoer observes, what Szasz does not acknowledge—because it so thoroughly undermines his argument—is that the alternative to the insanity defense is not freedom but ordinary imprisonment, itself a profoundly coercive method of social control.
I found myself annotating many points with which I agreed, several of which I will share below. At the same time, I was tempted to skip portions of the text that became particularly repetitive. The book would have benefited from more rigorous editing; a substantial amount could have been condensed without sacrificing the force or clarity of deBoer’s central argument. These were a few of the passages that particularly resonated:
"There are almost no meaningful ethical issues that benefit from becoming more simplistic and more binary, and this is especially true in the field of psychiatric medicine."
"To argue that mental disorders are not diseases because they cannot (yet) be pinned to a single lesion or pathogen is to apply a selectively stringent standard that no other branch of medicine is held to."
"The notion that psychiatric medications are neurotoxic conveniently avoids evidence that untreated psychotic disorders themselves are associated with eventual serious brain damage."
"The destigmatization effort has been wildly successful, and one result has been a vastly more crowded field of passionate patients and advocates working to influence public perception of these disorders. And the usual dynamics of inequality apply: those who enjoy greater social and financial capital have louder voices and more influence."
"Community Mental Health Centers reduced suicide and homicide rates by 8 percent and 14 percent, respectively, among nonwhite patients, then as now a population of particular concern given basal rates of mental illness. This finding strongly suggests that the concept of community-centered care itself was at least plausibly viable, and perhaps that the ultimate failure lay not in the model itself, but in the political will to fund it consistently and comprehensively."
“The gentrification of disability in its purest form [is] the most affluent, educated, and well connected among those with a given disorder using that status to define the disorder in the public mind.”
“David Mitchell and Sharon Snyder, disability scholars who have done a great deal of work on the intersection between public perception and disability, have written that “Americans learn perspectives on disability from books and films more than from policies or personal interactions.”
“Patients with Somatic Symptom Disorder or Illness Anxiety Disorder are estimated to consume healthcare expenditures at twice the rate of patients without these conditions, demonstrating the significant systemic burden of these concerns.”
The excerpts concerning lobotomies, the classification of autism spectrum disorder in the DSM-5, the concept of the ‘Intact Mind’, disorder as identity, social contagion, and the proliferation of “TikTok Dissassociative Identity Disorder” were among the most compelling portions of the book. I was less persuaded by some of deBoer’s discussion of the social model of disability, which I believe has a legitimate place alongside other interpretive frameworks. The medical and social models need not be treated as mutually exclusive; each describes different, sometimes overlapping dimensions of disability.
DeBoer discusses a Harvard symposium canceled following objections from disability “advocates,” as well as physicians who fear professional repercussions arising from negative patient—or customer—feedback. These examples raise legitimate concerns about whether advocacy and consumer pressure can constrain clinical judgment. However, they also appear somewhat isolated, leaving me uncertain whether they demonstrate a pervasive institutional problem or merely amplify the loudest and most conspicuous voices. I agreed with several of deBoer’s arguments that autism may now function as an excessively broad umbrella category and that physicians must uphold meaningful diagnostic standards rather than capitulate to patients who insist that their self-diagnoses are correct. Even so, I wanted stronger evidence regarding how prevalent such capitulation actually is. Anecdotes can illustrate a problem, but they cannot establish its scale.
As an occupational therapist, I regularly read nonfiction addressing disability and adaptations to it. One of my earlier reads this year was “Against Technoableism” by Ashley Shew, which offers a useful counterpoint to deBoer’s position through its discussion of the etymology of disability. DeBoer emphasizes “Disability is Bad! Disability is disabling!”—a claim I cannot altogether reject—but I also agree with Shew’s assertion that disability is not synonymous with inability. She describes how Lawrence Carter-Long has written beautifully about the word “disabled,” emphasizing the meaningful distinction between the prefixes dis- and un-. As he points out, dis-abled is different from un-able. He talks how one meaning of dis- is “to twain.” In a popular Facebook note from 2015, he writes: Twain literally means “in different directions, apart, asunder.” Use of the prefix in this way has given us perfectly good words like “discern,” “discuss,” “dismiss,” “dissent” and “distill.” When used in this way being disabled does not suggest a lack of anything—including ability.
In other words, I understood deBoer’s criticisms of the social model while continuing to recognize the validity of several of its central tenets. Disability can involve intrinsic impairment while also being intensified—or mitigated—by the physical and social environment. This left me at an intellectually productive crossroads: I both agreed and disagreed with deBoer and Shew, finding each author persuasive in some respects and overly categorical in others. A more integrated account, rather than a contest in which one model must displace the other, seems better suited to the actual complexity of disabled experience.
In sum, "All in Your Head" offered several incisive critiques and explored a number of subjects I found genuinely absorbing, but it did not consistently deliver the examination promised by its subtitle. Its strongest arguments were weakened by repetition, and some of its broad cultural claims required more evidence than a handful of provocative examples could provide. I appreciated the book most when it challenged me to examine tensions among diagnosis, identity, clinical authority, and disability advocacy. I rated it 2.5 ☆, rounded up to 3 ☆ for the strength of its most engaging sections.
"A society that rewards genuine recovery, stability, and resilience rather than theatrical fragility is a society better positioned to care for the people who cannot perform their suffering at all.”
Review of advance copy received from Publisher
This book is well articulated giving readers a clear understanding of pertinent issues from the past and present related to mental illness in the US.
It’s personal to Fredrik DeBoer with inside awareness. When he was 21, he was diagnosed at a local hospital in Connecticut with bipolar disorder. Over time, he has managed with meds and therapy and is now focused on his family along with the reconstruction of a better health care system in the US.
This book doesn’t report on how the brain reacts to antipsychotic meds or what words of wisdom comes from a psychiatrist. It starts by taking us back in time to understand anti-psychiatry, electric shock therapy, lobotomies, asylums and so much more. Parts are detailed and long.
I found the last half to be the most interesting. In 1975, the US Supreme Court’s case, “O’Connor vs. Donaldson” ruled that states cannot confine non-dangerous individuals. A police officer cannot take someone against their will even if they are suffering from known symptoms. A person who is paranoid may be easily threatened rejecting medical care. As a result, thousands experience homelessness and die annually in the US from hunger, overdoses, extreme weather and violence.
He said people have learned from movies such as “One Flew Over the Cuckoo’s Nest,” “Forrest Gump” and “The Accountant” along with many others. It creates a sigma of mental illness and those that are affected feel the shame, reluctant to get help. And when the disease takes over their thought patterns, they might refuse help.
The information presented is current and important. This is a must read to understand why it’s urgent for our country to address the growing concern of mental illness in the US.
My thanks to Simon and Schuster and LibraryThing for an advanced copy of this book. The views I share are my own.
It’s personal to Fredrik DeBoer with inside awareness. When he was 21, he was diagnosed at a local hospital in Connecticut with bipolar disorder. Over time, he has managed with meds and therapy and is now focused on his family along with the reconstruction of a better health care system in the US.
This book doesn’t report on how the brain reacts to antipsychotic meds or what words of wisdom comes from a psychiatrist. It starts by taking us back in time to understand anti-psychiatry, electric shock therapy, lobotomies, asylums and so much more. Parts are detailed and long.
I found the last half to be the most interesting. In 1975, the US Supreme Court’s case, “O’Connor vs. Donaldson” ruled that states cannot confine non-dangerous individuals. A police officer cannot take someone against their will even if they are suffering from known symptoms. A person who is paranoid may be easily threatened rejecting medical care. As a result, thousands experience homelessness and die annually in the US from hunger, overdoses, extreme weather and violence.
He said people have learned from movies such as “One Flew Over the Cuckoo’s Nest,” “Forrest Gump” and “The Accountant” along with many others. It creates a sigma of mental illness and those that are affected feel the shame, reluctant to get help. And when the disease takes over their thought patterns, they might refuse help.
The information presented is current and important. This is a must read to understand why it’s urgent for our country to address the growing concern of mental illness in the US.
My thanks to Simon and Schuster and LibraryThing for an advanced copy of this book. The views I share are my own.
November 9, 2026
This was a thorough and easy to understand exploration of how the United States treats mental illness, and where it’s going right and wrong. deBoer includes the necessary historical context for how things came to be currently, and he does it in a way that I have a good handle on the important arcs and figures and I can follow the connections.
In discussing current attitudes and challenges in mental health treatment, deBoer describes both the ways that we take mental health claims too seriously and credulously, as well as the ways we don’t take them seriously enough. He makes an excellent case that without robust standards, guidelines, and accommodations, we are unable to effectively serve anyone’s mental health needs.
One of my favorite things about deBoer’s writing is that he embraces the contradictions and nuances of whatever topic he tackles. He does so here, acknowledging that there’s no easy answer when it comes to limiting people’s choice and freedom, but that an expansion of involuntary treatment is morally necessary for certain patients with serious mental illnesses. This is a complicated challenge, and he never pretends it’s simple.
I think everyone should read this book, because even if you don’t directly know someone with mild or severe mental illness, the institutional consequences of how we treat these conditions impacts all of us. deBoer provides valuable knowledge and arguments as well as practical suggestions without being over dramatic or sensational. I greatly enjoyed reading this book!
In discussing current attitudes and challenges in mental health treatment, deBoer describes both the ways that we take mental health claims too seriously and credulously, as well as the ways we don’t take them seriously enough. He makes an excellent case that without robust standards, guidelines, and accommodations, we are unable to effectively serve anyone’s mental health needs.
One of my favorite things about deBoer’s writing is that he embraces the contradictions and nuances of whatever topic he tackles. He does so here, acknowledging that there’s no easy answer when it comes to limiting people’s choice and freedom, but that an expansion of involuntary treatment is morally necessary for certain patients with serious mental illnesses. This is a complicated challenge, and he never pretends it’s simple.
I think everyone should read this book, because even if you don’t directly know someone with mild or severe mental illness, the institutional consequences of how we treat these conditions impacts all of us. deBoer provides valuable knowledge and arguments as well as practical suggestions without being over dramatic or sensational. I greatly enjoyed reading this book!
November 3, 2026
The Cruelty of Good Intentions:
“We have to undo the kindhearted lies that have taken root in recent decades.”
Mental illness is an urgent concern that nobody seems willing to address—not in campaign ads, not in midterms, not anywhere. No candidate is saying, "I want to make it easier to involuntarily commit people," or "I want to spend billions on state psychiatric hospitals."
We used to shuffle the "crazies" into mental wards, but terrible things happened there. Instead of reforming these institutions, we closed or downsized many of them, often without building adequate replacements. Half a century later, a shortage of medical specialists, inpatient facilities, and community-based services has left a heartbreaking number of people on city sidewalks, in jails, or in cramped, overused emergency rooms.
The subject did come up briefly in Iowa's final gubernatorial debate. Both candidates acknowledged the shortage of psychiatric beds and the need to do more for people with serious mental illness, although they disagreed on how to pay for it. The shortage of inpatient care is a public health crisis. Many who desperately need help aren't getting it. The sickest souls are unmentionable in many of the domains where mental healthcare is debated.
Fredrik deBoer tackles this issue, and more, in his latest book, All in Your Head: Illness as Identity, Trauma as Fashion, and the Desire to Be Disordered (Simon & Schuster, October 2026). "Freddie," as he's known on Substack, writes with passion, conviction, and academic depth about subjects that everyone else seems unwilling to confront, much less discuss, much less do anything about.
Who Is Only Mildly "Mental," and Who Is in Dire Need of Help?
The silence includes a taboo against acknowledging how bad mental illness actually can be. Freddie is here to tell us "how unpleasant, unstable, and dangerous the mental can be."
Decent people trying to destigmatize mental illness have created "an equal and opposite myth, that of the blameless and harmless mentally ill patient." The latest school shooter should not be labeled psychotic, some insist, because "mental illness doesn't do that." Freddie opens this book with the sad story of Jessica Short because, as he explains, "it illustrates the profoundly misguided effort to support the mentally ill by lying about the severity of their problems."
Jessica, age nine. Freddie's hometown. 1989.
It hit so close to home for him, I can see why it occupies such a prominent place in this book. He wasn't there that day, at that time, but he could have been. A "serially violent mental patient" was allowed to wander away from his forensic ward and catch a bus into town. David Peterson stabbed nine-year-old Jessica Short in front of her mother, sister, and horrified onlookers.
"I'm a bleeding heart lefty who's opposed in principle to life imprisonment," Freddie writes, but he hopes Peterson, "who has proven himself repetitively violent and ready to kill, is never released. You are free to point out the tensions within that position as you'd like."
Nothing but luck separated him from the killer's knife.
"That chance was the only real governor of our universe came to occupy my mind as my own life got harder and harder," he explains.
To fight unfair stigma, we deny that some of the mentally ill really are dangerous.
That's the uncomfortable distinction Freddie wants us to acknowledge. Most people with mental illness are not violent. Many are themselves vulnerable, victimized, and in need of help. But that doesn't mean nobody with a serious psychiatric illness can be dangerous, or that pretending otherwise helps anyone.
The Truly Mentally Ill
Freddie takes aim at the anti-psychiatry movement, which he calls a "right-wing, conspiratorial cult." He also argues that hippies and "crunchy" New Age idealists helped fuel distrust of the medical establishment and pharmaceutical companies.
His argument is that the people most in need of psychiatric care are often the people least able to demand it, explain their circumstances, or make themselves heard.
Thousands die on the streets every year, he argues, not because their illnesses are untreatable but because the law demands that they consent to treatment they may be incapable of understanding they need. These are not conditions that can be managed through outpatient therapy, apps, wellness culture, or "holding space," he says. They require robust medical institutions staffed by professionals whose entire practice is built around the most severe forms of illness.
In too many cases, refusing treatment is not freedom; it is a symptom of the disease itself. A society that refuses to intervene when illness destroys the very capacity for self-determination is not respecting freedom but abandoning people who cannot save themselves.
That's a powerful argument. It is also an argument that demands scrutiny. Who decides when someone is incapable of making that decision? What safeguards protect the person who is wrongfully confined? And how do we distinguish necessary treatment from the abuses that have made so many people distrust psychiatry?
The Dark Side of Psychiatry
Psychiatrist Thomas Szasz fought compulsory detention of the mentally ill and challenged the medical model of mental illness itself. Freddie comes down hard on Szasz, dedicating an entire chapter to the damage one doctor did to the reputation of psychiatry.
He makes a forceful case against Szasz's influence while acknowledging that the abuses Szasz opposed were real. Szasz may have been wrong about many things, but not about the dark side of his profession.
The former Soviet Union's detention of dissidents under the guise of psychiatric treatment is just one example of what caused widespread distrust of psychiatry, a field Freddie is working hard to defend. He acknowledges the horrors. He also argues that we've come a long way—that today's psychiatric professionals are more trustworthy and helpful.
The history of psychiatry is not something we can simply wave away. Nazi Germany's murder of institutionalized psychiatric patients is among its most horrifying chapters. Forced sterilization, institutional abuse, and the political misuse of psychiatric diagnoses have left a legacy that cannot be dismissed as ancient history.
If psychiatry is necessary to care for people who cannot care for themselves, how do we make that care trustworthy when psychiatry itself has such a terrible history?
The anti-psychiatry movement isn't helping the mentally ill, Freddie argues. "It doesn't provide better treatment, more access to care, or more social support. It doesn't create housing, or jobs, or medication options with fewer side effects." Instead, he says, "It just creates a rhetorical shield for people who want to feel virtuous while doing nothing."
That's Freddie's indictment. And it raises a question I can't ignore: How do we defend the need for psychiatric treatment without forgetting the people who have been harmed in its name?
Good Intentions, Gone Bad
Freddie also takes on some of psychiatry's most controversial treatments, including electroconvulsive therapy (ECT) and lobotomy.
Lobotomy is one of the great examples of the cruelty and ugliness that can arise from good intentions. The procedure was promoted as a way to make it possible for some severely ill patients to live outside institutions. That intention did not make the results any less devastating.
Freddie argues that lobotomy's popularity owed much to anti-psychiatry sentiment, not psychiatry itself. I find that argument important, although it deserves careful examination. Good intentions do not excuse disastrous outcomes, and the history of medicine is full of examples in which the desire to help was not enough to prevent harm.
"The Work of Staying Sane Is Enervating, Degrading, and It Never Stops."
Nobody wants to be "committed." What do people do all day in these wards full of walls and "psychiatric beds"? We hope it isn't really like the haunting song "Memory Lane" by Elliott Smith:
*I do what people say
And lie in bed all day
Absolutely horrified
I hope you're satisfied*
Freddie isn't writing about psychiatric treatment from a comfortable distance. He is open about living with bipolar disorder and having been involuntarily committed in 2002. He describes the "black, all-encompassing emptiness that left me motionless on the floor for hours, unable to move," avoiding friends, withdrawing further into himself, and unable to see that he was going insane.
A confrontation with his neighbor eventually landed him in the local emergency room, and from there in a hospital. He received a diagnosis of bipolar disorder and a list of psychiatrists and prescriptions for lithium and antipsychotics.
"I've been in treatment since August of 2017," he writes. "The side effects are hard. Taking the pills some days feels like pushing the mythical rock up the legendary hill. But I'm alive..."
And then this:
"I have a thing in me that wants to kill me. I have wrestled it into a closet in my mind, and every day I lean against the closet door and try to keep it inside. Much of the time the animal is quiet, sedated by medications and therapy and my petty, stubborn desire to win a fight. But it is not dead or even asleep. It waits for me to relax, to once again decide that I'm fine and don't need the drugs, that I can rely on self control alone."
He describes the drugs he takes, for all their ugly side effects, as the difference between a life of permanent chaos and friendlessness and a stable, happy life.
His message is blunt: "See your doctor. Take your meds. Stay in therapy."
That's his experience. He credits medication and counseling with helping him stay alive and live a more stable life. He isn't pretending that treatment is easy, or that the side effects are trivial.
Not everyone is helped by psychiatry. Some have been harmed by it. Some have been denied care. Some have been confined unnecessarily. Some have been left without care until a crisis occurs.
Those realities don't cancel one another out. They are part of the same difficult conversation.
"The Unpalatable Crazies"
While people who are "verbal, articulate, internet-connected, and often well educated" spread the message that diagnostic labels are cruel, Freddie argues, the floridly psychotic are not on Twitter. They are sleeping in shelters, cycling through jails, or locked in wards that psychiatry's critics have never set foot in.
His passion and anger resonate. He has skin in the game. Freddie describes his own psychosis and credits medication and counseling with helping him live. He isn't asking us to feel sorry for him. He's asking us to stop pretending that the most severely ill people don't exist.
"This book is my probably-doomed effort to insist that the unpalatable crazies not be erased, even in their ugliness," he writes on his blog.
"Mental illness is a problem from hell. And that's why you shouldn't pretend. It's that hypocrisy that I can't stand, and that's why I wrote this book. And I hope that you'll buy it and read it. Even if you don't share my anger, maybe you can come to understand it, can come to see that I have earned it, not just that I feel it, but why."
As a culture critic who describes himself as "cool and rude," Freddie writes with fearless conviction, never soft-pedaling his opinions lest someone get angry.
I agree that he is one of Substack's most controversial writers. I don’t agree that rude is ever cool. No matter: Freddie yanks back the curtain, and I’m not looking away.
Go ahead. Get angry. This is a man on a mission, not a wee small voice in the wilderness.
He got me to listen.
Thank you to Simon & Schuster and NetGalley for an ARC of this book. The views I share are my own.
“We have to undo the kindhearted lies that have taken root in recent decades.”
Mental illness is an urgent concern that nobody seems willing to address—not in campaign ads, not in midterms, not anywhere. No candidate is saying, "I want to make it easier to involuntarily commit people," or "I want to spend billions on state psychiatric hospitals."
We used to shuffle the "crazies" into mental wards, but terrible things happened there. Instead of reforming these institutions, we closed or downsized many of them, often without building adequate replacements. Half a century later, a shortage of medical specialists, inpatient facilities, and community-based services has left a heartbreaking number of people on city sidewalks, in jails, or in cramped, overused emergency rooms.
The subject did come up briefly in Iowa's final gubernatorial debate. Both candidates acknowledged the shortage of psychiatric beds and the need to do more for people with serious mental illness, although they disagreed on how to pay for it. The shortage of inpatient care is a public health crisis. Many who desperately need help aren't getting it. The sickest souls are unmentionable in many of the domains where mental healthcare is debated.
Fredrik deBoer tackles this issue, and more, in his latest book, All in Your Head: Illness as Identity, Trauma as Fashion, and the Desire to Be Disordered (Simon & Schuster, October 2026). "Freddie," as he's known on Substack, writes with passion, conviction, and academic depth about subjects that everyone else seems unwilling to confront, much less discuss, much less do anything about.
Who Is Only Mildly "Mental," and Who Is in Dire Need of Help?
The silence includes a taboo against acknowledging how bad mental illness actually can be. Freddie is here to tell us "how unpleasant, unstable, and dangerous the mental can be."
Decent people trying to destigmatize mental illness have created "an equal and opposite myth, that of the blameless and harmless mentally ill patient." The latest school shooter should not be labeled psychotic, some insist, because "mental illness doesn't do that." Freddie opens this book with the sad story of Jessica Short because, as he explains, "it illustrates the profoundly misguided effort to support the mentally ill by lying about the severity of their problems."
Jessica, age nine. Freddie's hometown. 1989.
It hit so close to home for him, I can see why it occupies such a prominent place in this book. He wasn't there that day, at that time, but he could have been. A "serially violent mental patient" was allowed to wander away from his forensic ward and catch a bus into town. David Peterson stabbed nine-year-old Jessica Short in front of her mother, sister, and horrified onlookers.
"I'm a bleeding heart lefty who's opposed in principle to life imprisonment," Freddie writes, but he hopes Peterson, "who has proven himself repetitively violent and ready to kill, is never released. You are free to point out the tensions within that position as you'd like."
Nothing but luck separated him from the killer's knife.
"That chance was the only real governor of our universe came to occupy my mind as my own life got harder and harder," he explains.
To fight unfair stigma, we deny that some of the mentally ill really are dangerous.
That's the uncomfortable distinction Freddie wants us to acknowledge. Most people with mental illness are not violent. Many are themselves vulnerable, victimized, and in need of help. But that doesn't mean nobody with a serious psychiatric illness can be dangerous, or that pretending otherwise helps anyone.
The Truly Mentally Ill
Freddie takes aim at the anti-psychiatry movement, which he calls a "right-wing, conspiratorial cult." He also argues that hippies and "crunchy" New Age idealists helped fuel distrust of the medical establishment and pharmaceutical companies.
His argument is that the people most in need of psychiatric care are often the people least able to demand it, explain their circumstances, or make themselves heard.
Thousands die on the streets every year, he argues, not because their illnesses are untreatable but because the law demands that they consent to treatment they may be incapable of understanding they need. These are not conditions that can be managed through outpatient therapy, apps, wellness culture, or "holding space," he says. They require robust medical institutions staffed by professionals whose entire practice is built around the most severe forms of illness.
In too many cases, refusing treatment is not freedom; it is a symptom of the disease itself. A society that refuses to intervene when illness destroys the very capacity for self-determination is not respecting freedom but abandoning people who cannot save themselves.
That's a powerful argument. It is also an argument that demands scrutiny. Who decides when someone is incapable of making that decision? What safeguards protect the person who is wrongfully confined? And how do we distinguish necessary treatment from the abuses that have made so many people distrust psychiatry?
The Dark Side of Psychiatry
Psychiatrist Thomas Szasz fought compulsory detention of the mentally ill and challenged the medical model of mental illness itself. Freddie comes down hard on Szasz, dedicating an entire chapter to the damage one doctor did to the reputation of psychiatry.
He makes a forceful case against Szasz's influence while acknowledging that the abuses Szasz opposed were real. Szasz may have been wrong about many things, but not about the dark side of his profession.
The former Soviet Union's detention of dissidents under the guise of psychiatric treatment is just one example of what caused widespread distrust of psychiatry, a field Freddie is working hard to defend. He acknowledges the horrors. He also argues that we've come a long way—that today's psychiatric professionals are more trustworthy and helpful.
The history of psychiatry is not something we can simply wave away. Nazi Germany's murder of institutionalized psychiatric patients is among its most horrifying chapters. Forced sterilization, institutional abuse, and the political misuse of psychiatric diagnoses have left a legacy that cannot be dismissed as ancient history.
If psychiatry is necessary to care for people who cannot care for themselves, how do we make that care trustworthy when psychiatry itself has such a terrible history?
The anti-psychiatry movement isn't helping the mentally ill, Freddie argues. "It doesn't provide better treatment, more access to care, or more social support. It doesn't create housing, or jobs, or medication options with fewer side effects." Instead, he says, "It just creates a rhetorical shield for people who want to feel virtuous while doing nothing."
That's Freddie's indictment. And it raises a question I can't ignore: How do we defend the need for psychiatric treatment without forgetting the people who have been harmed in its name?
Good Intentions, Gone Bad
Freddie also takes on some of psychiatry's most controversial treatments, including electroconvulsive therapy (ECT) and lobotomy.
Lobotomy is one of the great examples of the cruelty and ugliness that can arise from good intentions. The procedure was promoted as a way to make it possible for some severely ill patients to live outside institutions. That intention did not make the results any less devastating.
Freddie argues that lobotomy's popularity owed much to anti-psychiatry sentiment, not psychiatry itself. I find that argument important, although it deserves careful examination. Good intentions do not excuse disastrous outcomes, and the history of medicine is full of examples in which the desire to help was not enough to prevent harm.
"The Work of Staying Sane Is Enervating, Degrading, and It Never Stops."
Nobody wants to be "committed." What do people do all day in these wards full of walls and "psychiatric beds"? We hope it isn't really like the haunting song "Memory Lane" by Elliott Smith:
*I do what people say
And lie in bed all day
Absolutely horrified
I hope you're satisfied*
Freddie isn't writing about psychiatric treatment from a comfortable distance. He is open about living with bipolar disorder and having been involuntarily committed in 2002. He describes the "black, all-encompassing emptiness that left me motionless on the floor for hours, unable to move," avoiding friends, withdrawing further into himself, and unable to see that he was going insane.
A confrontation with his neighbor eventually landed him in the local emergency room, and from there in a hospital. He received a diagnosis of bipolar disorder and a list of psychiatrists and prescriptions for lithium and antipsychotics.
"I've been in treatment since August of 2017," he writes. "The side effects are hard. Taking the pills some days feels like pushing the mythical rock up the legendary hill. But I'm alive..."
And then this:
"I have a thing in me that wants to kill me. I have wrestled it into a closet in my mind, and every day I lean against the closet door and try to keep it inside. Much of the time the animal is quiet, sedated by medications and therapy and my petty, stubborn desire to win a fight. But it is not dead or even asleep. It waits for me to relax, to once again decide that I'm fine and don't need the drugs, that I can rely on self control alone."
He describes the drugs he takes, for all their ugly side effects, as the difference between a life of permanent chaos and friendlessness and a stable, happy life.
His message is blunt: "See your doctor. Take your meds. Stay in therapy."
That's his experience. He credits medication and counseling with helping him stay alive and live a more stable life. He isn't pretending that treatment is easy, or that the side effects are trivial.
Not everyone is helped by psychiatry. Some have been harmed by it. Some have been denied care. Some have been confined unnecessarily. Some have been left without care until a crisis occurs.
Those realities don't cancel one another out. They are part of the same difficult conversation.
"The Unpalatable Crazies"
While people who are "verbal, articulate, internet-connected, and often well educated" spread the message that diagnostic labels are cruel, Freddie argues, the floridly psychotic are not on Twitter. They are sleeping in shelters, cycling through jails, or locked in wards that psychiatry's critics have never set foot in.
His passion and anger resonate. He has skin in the game. Freddie describes his own psychosis and credits medication and counseling with helping him live. He isn't asking us to feel sorry for him. He's asking us to stop pretending that the most severely ill people don't exist.
"This book is my probably-doomed effort to insist that the unpalatable crazies not be erased, even in their ugliness," he writes on his blog.
"Mental illness is a problem from hell. And that's why you shouldn't pretend. It's that hypocrisy that I can't stand, and that's why I wrote this book. And I hope that you'll buy it and read it. Even if you don't share my anger, maybe you can come to understand it, can come to see that I have earned it, not just that I feel it, but why."
As a culture critic who describes himself as "cool and rude," Freddie writes with fearless conviction, never soft-pedaling his opinions lest someone get angry.
I agree that he is one of Substack's most controversial writers. I don’t agree that rude is ever cool. No matter: Freddie yanks back the curtain, and I’m not looking away.
Go ahead. Get angry. This is a man on a mission, not a wee small voice in the wilderness.
He got me to listen.
Thank you to Simon & Schuster and NetGalley for an ARC of this book. The views I share are my own.
Review of advance copy received from NetGalley
Well...ok. Here we go....
Honestly, I had to take a few day (edit: 1 week!) break before I wrote the review for this book. I also had to read it in smallish chunks because I kept finding myself so aggravated while reading that I had to keep putting it down. So, if a book gets stars for getting an emotional reaction out of me, this book would deserve 5 stars for sure.
But, that's not the only way I judge a book, so we're going to have to settle for 2 stars here.
I wrote so many notes and comments to myself while I was reading. After some time, they just kind of devolved into a lot of "what?!", "seriously...", "oh no, here we go again", etc.
As some others have mentioned, this book isn't exactly what it seems like it would be about based on the title. Or it is, but only partially. This guy really, really, REALLY hates One Flew Over the Cuckoo's Nest. He also seems to think that if someone went to an Ivy League institution, they shouldn't be allowed to suffer from mental health disorders such as autism.
There's a large chunk of the book that has an issue with adult-diagnosed Autism and ADHD. The logic seems to be that if you were able to get to adulthood without receiving a diagnosis, it's really not that bad for you and therefore you shouldn't talk about it. This seems like telling someone who has had Stage 1 cancer that their cancer isn't as bad as someone with Stage 4, and so the difficulties and grief that they (and their loved ones) have experienced isn't legitimate. I don't know, maybe I'm overstating the point, but this is the reaction that I'm still having about this book literally a full week after I finished reading it.
I could keep going, but I will try to focus on some of the things that were more positive about this book. I thought it had some interesting points about the evolution of mental health practices over time, and it had some interesting policy proposals. I won't get start on why I think these policy proposals have some issues, because my bigger point here is that I think it has the potential to start an interesting dialogue.
I didn't known anything about Fredrik deBoer going in. Like others, I was really intrigued by the title. Overall, I'm still glad I read this, even if I felt totally infuriated at times! I'm weird, I know.
Thank you to NetGalley and Simon & Schuster for the ARC of this book!
1.5 stars, rounded up to 2
Honestly, I had to take a few day (edit: 1 week!) break before I wrote the review for this book. I also had to read it in smallish chunks because I kept finding myself so aggravated while reading that I had to keep putting it down. So, if a book gets stars for getting an emotional reaction out of me, this book would deserve 5 stars for sure.
But, that's not the only way I judge a book, so we're going to have to settle for 2 stars here.
I wrote so many notes and comments to myself while I was reading. After some time, they just kind of devolved into a lot of "what?!", "seriously...", "oh no, here we go again", etc.
As some others have mentioned, this book isn't exactly what it seems like it would be about based on the title. Or it is, but only partially. This guy really, really, REALLY hates One Flew Over the Cuckoo's Nest. He also seems to think that if someone went to an Ivy League institution, they shouldn't be allowed to suffer from mental health disorders such as autism.
There's a large chunk of the book that has an issue with adult-diagnosed Autism and ADHD. The logic seems to be that if you were able to get to adulthood without receiving a diagnosis, it's really not that bad for you and therefore you shouldn't talk about it. This seems like telling someone who has had Stage 1 cancer that their cancer isn't as bad as someone with Stage 4, and so the difficulties and grief that they (and their loved ones) have experienced isn't legitimate. I don't know, maybe I'm overstating the point, but this is the reaction that I'm still having about this book literally a full week after I finished reading it.
I could keep going, but I will try to focus on some of the things that were more positive about this book. I thought it had some interesting points about the evolution of mental health practices over time, and it had some interesting policy proposals. I won't get start on why I think these policy proposals have some issues, because my bigger point here is that I think it has the potential to start an interesting dialogue.
I didn't known anything about Fredrik deBoer going in. Like others, I was really intrigued by the title. Overall, I'm still glad I read this, even if I felt totally infuriated at times! I'm weird, I know.
Thank you to NetGalley and Simon & Schuster for the ARC of this book!
1.5 stars, rounded up to 2
Review of advance copy received from NetGalley
I must say, I am regular reader of Fredrik deBoer and check in on his Substack weekly. Being familiar with his work and the topic made me excited to receive an ARC of this book from Simon & Schuster. The blurb, description, and tagline for the book all All in Your Head suggest a book that is focused on modern disorders mental-health identities. In fact the description from the publisher shares the following: “A searing account of the ways in which mental health culture distorts our understanding of mental illness, abandons the severely ill, and threatens the lives of millions who desperately need care.”
But this is only about 35% of the book. The rest of the book is an examination of the anti-psychiatry and deinstitutionalization movements tracking changes in attitudes towards mental healthcare in the West. That is not to say that it is a bad book, but it is not the book I expected from the pre-print material.
Despite that my rating of this book is not merely because it did not deliver on its premise effectively, it is because this book pales in comparison to another recent non-fiction account detailing mental health in this country. Earlier this year I read Emmett Rensin’s engrossing The Complications: On Going Insane in America, which covers much of the same terrain. While reading deBoer, I found myself going back and forth between these two books and comparing the effectiveness of each. While Rensin’s analysis is nowhere near as academic as deBoer, his pointed critiques of deinstitutionalization, anti-psychiatry, incarceration, and the true toll of mental illness are significantly more effective. Probably because they are all connected back to real individuals, real stories of harm this movement has perpetrated on not only the mentally ill, but also the populations who care about these individuals.
I think deBoer’s strength is in the citations and references provided throughout. As a book it may be useful for those looking for resources into this underexplored topic. Unfortunately it was not the book I expected and I never really felt like it answered the questions it posed with its marketing.
But this is only about 35% of the book. The rest of the book is an examination of the anti-psychiatry and deinstitutionalization movements tracking changes in attitudes towards mental healthcare in the West. That is not to say that it is a bad book, but it is not the book I expected from the pre-print material.
Despite that my rating of this book is not merely because it did not deliver on its premise effectively, it is because this book pales in comparison to another recent non-fiction account detailing mental health in this country. Earlier this year I read Emmett Rensin’s engrossing The Complications: On Going Insane in America, which covers much of the same terrain. While reading deBoer, I found myself going back and forth between these two books and comparing the effectiveness of each. While Rensin’s analysis is nowhere near as academic as deBoer, his pointed critiques of deinstitutionalization, anti-psychiatry, incarceration, and the true toll of mental illness are significantly more effective. Probably because they are all connected back to real individuals, real stories of harm this movement has perpetrated on not only the mentally ill, but also the populations who care about these individuals.
I think deBoer’s strength is in the citations and references provided throughout. As a book it may be useful for those looking for resources into this underexplored topic. Unfortunately it was not the book I expected and I never really felt like it answered the questions it posed with its marketing.
November 6, 2026
This book is persuasive, in its way, as a diatribe against deBoer’s naysayers and even as an argument against a certain strand of activist thinking and political philosophy. The trouble is that the first half reads as a rant against a certain movement; it takes 50% of the book for deBoer to come to his main subject. That background is useful, but he doesn’t really make the bridge from one topic to another; he doesn’t show how the first subject leads to the second or lay the foundation for it. Indeed, he doesn’t fully develop his philosophy in the book. It is mostly assertions coupled with some anecdotes and some reasoning.
I don’t know I hoped for more from this book. It did give me some fuller perspective that I didn’t have before though.
I don’t know I hoped for more from this book. It did give me some fuller perspective that I didn’t have before though.
November 5, 2026
I was worried this book would be a tirade against the psych establishment. Instead it is a polemic against both anti-psychiatry and the popularity of people self-assigning mental illnesses. It calls for serious mental illness to be taken seriously, which means fighting against the stigma of treatment and also not trivializing mental illness by ascribing everyday problems to it.
I strongly disagree with some of the things in this book, such as the call for making mandatory hospitalizations significantly easier for patients who do not pose any threat, but all of its arguments are laid out so thoughtfully that it warrants five stars.
I strongly disagree with some of the things in this book, such as the call for making mandatory hospitalizations significantly easier for patients who do not pose any threat, but all of its arguments are laid out so thoughtfully that it warrants five stars.
November 10, 2026
While I certainly agree that our current mental health culture is not necessarily doing the mental ill many favors, I wish deBoer had been better defined what exactly is the anti-psychiatry movement/what he is against. The history and philosophy were interesting, but as definitions of mental health and psychiatry change throughout time, the precise “what” deBoer is against became a moving target.
I listened to this as an audiobook so perhaps that’s why I don’t have a better sense of “what”!
I listened to this as an audiobook so perhaps that’s why I don’t have a better sense of “what”!
Review of advance copy received from Edelweiss+
Reviewing for Library Journal. My Goodreads rating is unrelated to my professional review.
Review of advance copy received from Publisher
Full of insight about young people want to label themselves mentally ill
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