Our mental health care is radically affected by our socio-economic conditions. To overlook class, race, or gender conditions in discussions around mental health—as if they were not central to our experience of the world—is to ignore, from a place of privilege, the human condition as something strictly intertwined with its environment. It is essential to recognise from where theories of knowledge, approaches, and processes of pathologisation are generated, in order to understand whom they serve and how they perpetuate and reproduce (or, conversely, challenge and disrupt) the current state of things.

The model upon which higher education in psychology in Spain is based starts from premises rooted in US biomedical institutions, which are, at best, insufficient for accompanying human suffering, and at worst, dangerous, as they perpetuate reductionist, pathologizing, and dehumanizing approaches without considering the violence that mental health institutions themselves can exert.

There are several “fetishes” within psychology education in Spain (which I speak about because I know it firsthand, though this does not mean it is not the model in many other contexts). One of the main ones is the constant struggle by professors, universities, and official curricula to be recognized as a “scientific,” “evidence-based,” “medical,” and “health” discipline. From this standpoint, psychology is positioned as inherently more legitimate when it fits within these frameworks, without acknowledging that scientific research operates within institutions that have specific interests and receive funding for particular projects—as if research and medicine were neutral—and as if knowledge were only useful when centered on the brain, cognition, and behavior. This leaves entirely aside questions of meaning, spirituality, and collective histories and forms of suffering.

Thus, while cognitive-behavioral therapy is essentially the only approach valued in higher education (and the one that receives funding from public institutions and funding bodies), other orientations such as humanistic, systemic, somatic, narrative, psychoanalytic, or transpersonal approaches have no place or recognition. And as for liberation psychology, decolonial psychology, and anti-psychiatry—these are not even mentioned in any course throughout five and a half years of higher education. Paradigms generated outside the West, as well as disciplines within the social sciences such as philosophy, politics, history, sociology, economics, or anthropology, have no place in mental health studies. What a void.

Another fundamentally unjust issue—one that serves a system that keeps the state of psychology unchanged in Spain—is the very structure of the training curriculum. When a student finishes the four-year undergraduate degree, they are not legally recognized as a psychologist who can provide therapy, as confirmed by law. During those four years, students are not trained with the foundations necessary to accompany suffering and all that it entails: there is no access to practice with real cases, no work on supervision, no attention to self-care as a therapist, nor to issues of transference and countertransference. Instead, students learn to diagnose, over and over again, according to the most recent DSM (whose criteria change every couple of years), and to reinforce the dogmas of the institutional discipline: “evidence-based,” “diagnostic labels,” “administer tests to first evaluate, then diagnose, and finally treat with CBT.” There is no space to understand human experiences outside these frameworks.

However, the training required to practice legally is nothing more than a continuation of the same curriculum, with no trace of a broad, critical, and situated perspective on mental health. In fact, it is a mandatory qualifying master’s degree with only around 30 or 40 places in public universities, and costing between €8,000 and €15,000 in private institutions. The approach is essentially a squared intensification of undergraduate content, with subjects such as “Scientific and Professional Foundations of Health Psychology.”

A concrete example of how the curriculum perpetuates the hegemonic system without questioning it can be found in the course “Intervention in Couple Problems and Main Dysfunctions”: after learning about the “theory of subjective well-being,” which states that “one of the greatest predictors of subjective well-being is having a stable partner,” we move on to study “the differences between men and women in mate selection: men focus on physical appearance—preferring young women with an hourglass figure who give them attention—while women focus on formality, status, being a good provider of resources, fidelity, and personality.” Someone please tell me that what I had to study for my exams is not saturated with ideology. At least, in the master’s program we do work with real clients under supervision, with a focus on therapeutic skills.

However, who benefits from this inaccessible postgraduate training? Given the effort required to complete this master’s, my sense is that many young people cling to the institutional model in order to validate their training, perpetuating the narratives learned during the program. Certain techniques are treated like the Bible due to their “scientific” status (functional analysis of behavior, psychometric assessment tests, the DSM-5…), centering support on technique over the human element, and remaining comfortable within a privatized mental health system in which only those who can afford to pay—or wait through long public system queues—have access to psychological support. After such an investment, each of the thousands of students graduating every year ends up repeating institutional mantras, which serves as a perfect mechanism for reproducing the paradigm.

The same occurs with the training of students preparing for the public sector through the PIR system, where education follows the same frameworks but over a longer and more tedious period, further reinforcing these paradigms as sacred and rigid among public mental health professionals.

To end on a more propositional note, I would like to invite you to engage with movements, authors, and proposals from anti-psychiatry and liberation psychology, as well as any school of thought that considers the axes of coloniality and the capitalist mode of production as fundamental in the generation and reproduction of knowledge. If you are in Utrecht, I invite you to join our reading group where we meet to read and discuss materials on decolonial and liberation psychology. If you're not around, I invite you to start your own! Thank you for reading, for questioning, and for honoring the complexity of human experience.

Comments, questions, critiques? Feel free to reach out to me, I'd love to hear your thoughts!

Family and educational spaces—both formal and non-formal—often function as mechanisms of control in which power relations are enacted. Children and adolescents are, in these cases, understood more as objects than as subjects, expected to comply with mandates imposed on their bodies and their time, without consideration of consent and without questioning authority. This takes place at a crucial stage in the development of their autonomy, interoception, self-knowledge, and self-esteem. The lack of contact with (and the limited credibility given to) their own needs, desires, bodies, emotional states, and opinions distances them from themselves. Over time, this can turn them—both as individuals and as collectives—into people who are disconnected from their own feelings and sensations, highly vulnerable to external pressure, less able to validate and honestly express their experiences, and prone to present and future distress related to not attending to their needs.

These dynamics become far more harmful for people who fall outside the norm, whose needs are not even seen or recognized—often not even by themselves. I am referring to those who go through childhood, and especially adolescence, overstimulated, exhausted, and dysregulated, many times without even perceiving it or knowing how to name it due to the rigidity of their environments. Their lives are shaped by a system that is alien and suffocating to them, which is why many adolescents live on autopilot, feeling powerless and lacking agency over their own bodies: they consistently sleep less than they need, feel uncomfortable without being able to move to other spaces, and try to fit into alienating molds. Naming these experiences—from difference and from the margins—becomes almost impossible for these individuals, who will simply feel “weird,” uncomfortable, and misunderstood, with all that this implies for their self-perception, self-esteem, and self-care.

I propose humanizing childhoods and adolescences: recognizing children and adolescents as subjects, as agents, and as deserving of care; their autonomy, needs, rhythms, and individualities matter. The spaces of minors function as sites of power that replicate and rehearse what will potentially become their future work, family, and social environments. By integrating the idea that not questioning authority is morally correct, we strip them of their most powerful tool for self-care and collective transformation: self-listening and connection with themselves—affecting especially those who align least with the norm. It is time to take responsibility: to dare to listen to their voices, and to discover what might happen if we gave back to them what should always have been theirs.

Comments, questions, critiques? Feel free to reach out to me, I'd love to hear your thoughts!