Opinion | It’s Not Just a Chemical Imbalance

Psychiatrists are full doctors with the ability to issue diagnoses and prescribe medication. But these days, many of them spend much less time than they did in the past practicing psychotherapy, or what we might call “talk therapy.” Instead, they tend to meet with patients briefly and write prescriptions. As a result, “psychiatry” has more or less become shorthand for an industry of medication management.

When, in my early 20s, I asked a new psychiatrist — one of the only mental health providers I could find who would accept my insurance and had openings for new patients — if we could try discussing some of the problems I’d been having, she looked at me as though I’d proposed a joint mission to Mars. “Ohhhhh,” she said, nodding, as my meaning dawned on her. “You want to see a counselor.”

What I wanted, and still want, were options.

The jury is out on the extent to which mental illness is hard-wired, but black-and-white narratives of psychopathology neglect the tremendous psychological impacts of social and material circumstance: access to the basics of survival; the burdens of intergenerational trauma and insufficient social support systems; the existential gut punch of pervasive injustice.

A more realistic, nuanced approach to the way we conceive of mental illness would go a long way toward validating the myriad potential causes for human suffering and clearing paths for many more in need.

To be sure, many people need medication, and greatly benefit from it. The right drugs have made my life better too. But I fantasize about a future in which mental illness is understood less in terms of static diagnoses and psychopharmaceutical stopgaps than each individual’s symptoms and the circumstances that might inform them.

I don’t mean to say that the current system doesn’t offer some hope — at least for those with the means to pursue it. Now in my early 30s, I remain firmly entangled in the American mental health care apparatus, albeit on my own terms. I see a therapist (which I’m now in the fortunate position to be able to pay for, out of pocket) who helps me contextualize and work through problems. I manage medications with a psychiatrist, and purchase pills with some coverage from insurance.

I also make it a daily priority to get at least some light exercise, whether a walk or a jog or a bicycle commute. I maintain a regular yoga practice, try to eat a balanced diet and get enough sleep, read constantly, and work to nurture social connections and build community. All of these, I’ve learned, I can do to maintain my emotional and psychological well-being, and the key word here is “maintain.” It’s about process, not prognosis.

Rather than view my psychological experience as a biologically fated roller coaster, I’ve come to think of my mental health as a reflection of the complex ebbs and flows of life; accordingly, I’ve developed tools to better mitigate that which I can’t control, an agency I once wouldn’t have imagined possible. I feel, for the first time, like a person who belongs to the world.

Kelli María Korducki is a writer.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: [email protected].

Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.