Ninety percent of patients in therapy said their depression had improved. So did 90 percent of the patients still sitting on the wait list. Richard A. Lawhern, a patient advocate and health care educator, uses that result to ask a harder question about the diagnoses now being handed to a generation of students, and about who gets pushed aside when everyone is told something is clinically wrong with them.

⏱️ Chapters:
0:00 Introduction
0:50 The Boston Globe piece that set this off
1:18 From 3 percent to 21 percent in ten years
1:44 The daughter who actually needed the accommodation
2:55 Who gets doubted when everyone has a diagnosis
4:03 Why overdiagnosis is not compassion
4:35 Why he says the whole field is in crisis
5:23 The 1973 book that called this fifty years early
6:15 The wait list did as well as the therapy
8:36 When 65 out of 100 studies fail to replicate
11:39 Students are being handicapped, not helped
12:47 When a life coach may beat a psychiatrist
13:54 The DSM-5 architect who became its sharpest critic
15:45 Why a wave of lawsuits is coming
17:14 Take home messages

About this episode:
Richard A. Lawhern is a patient advocate and health care educator with three decades in the field and more than 400 published papers, and he comes to this conversation from an unusual angle: one of his own daughters was diagnosed with dyslexia forty years ago, back when roughly 3 percent of students carried a disability label. He starts with a Boston Globe piece by Adam Omary on the disability accommodation trap on college campuses, and the Harvard Crimson reporting that the share of Harvard undergraduates receiving accommodations climbed from about 3 percent in 2014 to 21 percent in 2024, a sevenfold jump in a decade. Lawhern agrees with Omary that overdiagnosis is not compassion, then argues Omary stopped short, because the whole field is in a crisis of credibility. He walks through mid-century studies summarized in Martin L. Gross's The Psychological Society, in which patients given Freudian, Adlerian, or other psychotherapy reported improvement at roughly 90 percent, and the wait-listed control group reported the same improvement at the same rate. He then turns to the replication crisis, where attempts to reproduce 100 influential psychology studies failed in about 65 of them, and where the surviving third showed far weaker effects than originally claimed. From there he makes his sharpest claim: students are not being helped by these labels, they are being handicapped by them, and some families would do just as well with a life coach or a marriage and family counselor. He points to Allen Frances, who chaired the DSM-5 and is now among its fiercest critics, and to Frances's book Chasing Normal, as evidence that a counter-revolution is already brewing from inside the field. He closes with the practical path he sees opening: state medical board reviews and a coming wave of litigation from families who believe their children were injured under treatment.

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