From the author of The Cult of Smart comes a searing account of the ways in which mental health culture and online discourse distort our 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 through social media 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.