The End of Therapy: MAHA, Medicalization, and Moral Agency
Warren Kinghorn, MD, ThD, MTS, Duke University
Both The MAHA [Make America Healthy Again] Report (May 2025) and the Make Our Children Healthy Again Strategy Report (September 2025), each released by the US Department of Health and Human Services, single out “the overmedicalization of our kids,” particularly the overmedicalization of children’s mental health, as a particular focus of concern. Providing important background context, The MAHA Report favorably cites conservative journalist and polemicist Abigail Shrier’s Bad Therapy: Why the Kids Aren’t Growing Up (2024). In Bad Therapy, Shrier argues that modern forms of psychotherapy for children and adolescents, along with other practices such as “social-emotional learning” and “gentle parenting,” paradoxically harm children’s mental health when they teach children to ruminate on their own emotions and experiences, encourage them to develop identities around particular mental health diagnoses, reduce opportunities for risk-taking and play, and sever family relationships. Psychiatric medications, Shrier argues, cause further harm when they attempt to blunt the pain caused by “bad therapy” and/or attempt to conform undisciplined children to restrictive behavioral norms.
While both The MAHA Report and Shrier’s book have been criticized by researchers and clinicians, and while Bad Therapy received mixed reviews even among evangelical Christian reviewers, each represents the priorities of the current federal administration and each raises substantive moral questions about the ends and purposes of mental health care for children and adults. What, specifically, is mental health care for? These questions are moral, philosophical, and theological in nature and that cannot be answered by scientific inquiry alone.
In this paper, drawing on the moral psychology of St. Thomas Aquinas and modern Catholic social teaching, I will argue that Shrier and the authors of The MAHA Report, despite their flaws, correctly criticize two common ends/goals of mental health therapy: symptom reduction (comfort, alleviation of distress) and social cohesion. Mental health therapy, whether psychotherapeutic or pharmacotherapeutic, must not aim at symptom reduction as its chief end because neither pleasure nor bodily health nor any immanent “goods of the soul” are constitutive of beatitudo (STh IaIIae q. 2). But neither should mental health therapy aim at social cohesion as its chief end (as, for example, when children are medicated to facilitate quiet classrooms), because “the order of things must be subordinate to the order of persons, and not the other way around” (Gaudium et spes 26, Catechism of the Catholic Church 1912). Instead, the end and goal of mental health therapy must be first and foremost the moral agency of the acting person. This moral agency, understood as the capacity to be the principium of one’s actions and to act meaningfully (and normed by virtue) toward purposes and goals, also requires political agency, the capacity to navigate interpersonal and economic relationships and to contribute meaningfully to the common good. Centering moral and political agency, not symptom reduction or social cohesion, as the end of mental health therapy addresses some of the valid concerns of modern conservative critics of modern mental health care while also highlighting their shortcomings.
While both The MAHA Report and Shrier’s book have been criticized by researchers and clinicians, and while Bad Therapy received mixed reviews even among evangelical Christian reviewers, each represents the priorities of the current federal administration and each raises substantive moral questions about the ends and purposes of mental health care for children and adults. What, specifically, is mental health care for? These questions are moral, philosophical, and theological in nature and that cannot be answered by scientific inquiry alone.
In this paper, drawing on the moral psychology of St. Thomas Aquinas and modern Catholic social teaching, I will argue that Shrier and the authors of The MAHA Report, despite their flaws, correctly criticize two common ends/goals of mental health therapy: symptom reduction (comfort, alleviation of distress) and social cohesion. Mental health therapy, whether psychotherapeutic or pharmacotherapeutic, must not aim at symptom reduction as its chief end because neither pleasure nor bodily health nor any immanent “goods of the soul” are constitutive of beatitudo (STh IaIIae q. 2). But neither should mental health therapy aim at social cohesion as its chief end (as, for example, when children are medicated to facilitate quiet classrooms), because “the order of things must be subordinate to the order of persons, and not the other way around” (Gaudium et spes 26, Catechism of the Catholic Church 1912). Instead, the end and goal of mental health therapy must be first and foremost the moral agency of the acting person. This moral agency, understood as the capacity to be the principium of one’s actions and to act meaningfully (and normed by virtue) toward purposes and goals, also requires political agency, the capacity to navigate interpersonal and economic relationships and to contribute meaningfully to the common good. Centering moral and political agency, not symptom reduction or social cohesion, as the end of mental health therapy addresses some of the valid concerns of modern conservative critics of modern mental health care while also highlighting their shortcomings.