Plus: Have we been thinking about ADHD all wrong? Use of talk therapy is up and psychotropic medication is down! A dangerous sedative that doesn’t respond to normal emergency treatment shows up in three cities. Certain neuroimmune responses are linked to autism in a new study. And some of Sen. John Fetterman’s former staffers say his mental health is poor, causing abusive behavior.

But first: The New York Times magazine puts out a special issue on happiness🙂. I particularly enjoyed ethicist Kwame Anthony Appiah‘s piece on how our notion of happiness has gotten shallow (and how to deepen it). The What Makes You Happy Quiz also put a smile on my face.

Trump administration cancels $1 billion in mental health services for children 

The Trump administration kicked off Mental Health Awareness Month by abruptly cancelling $1 billion for mental health services for children, saying that the programs – created by a bipartisan law aimed at stemming gun violence in schools – were no longer in “the best interest of the federal government.”

Congress authorized the money in 2022 after a former student opened fire at an elementary school in Uvalde, Texas, killing 19 children and two teachers and injuring 17 others. The Bipartisan Safer Communities Act, signed into law by then-President Joe Biden, broke a decades-long impasse between congressional Republicans and Democrats on addressing gun violence by focusing largely on improving mental health support for students.

School districts across the country have been using the money to hire mental health professionals, including counselors and social workers. A largely rural district of 1,100 students in Corbett, Ore., east of Portland, for example, more than tripled the number of school mental health professionals after receiving a 2023 grant that fully covered the salaries and benefits of five new social workers. “It’s been amazing,” Superintendent Derek Fialkiewicz told NPR, referring to the difference the social workers have made in his school community. He was shocked to hear the funding was being halted. Last Tuesday, the Education Department gave his district the go-ahead to add a telehealth texting service for students. An hour later, Fialkiewicz said, he got an email that the grant would be discontinued.

In other Trump administration news: 

A federal report urges behavioral therapy – not gender-affirming medical care – for transgender youth, bucking expert recommendations: The 400-page “best practices” report was no surprise, since it responded to an executive order from President Trump directing the federal government not to support gender transitions for anyone under 19. HHS said its report, which is limited to children, is not clinical guidance and makes no policy recommendations. Still, it sharply contradicts guidance from the American Medical Association and other professional societies and will likely be used to bolster the government’s abrupt shift in how to treat a population that has become a political lightning rod. And despite pledges by HHS Secretary Robert F Kennedy for “radical transparency,” the report didn’t name its authors, PBS News reported.

Anti-DEI policies adversely affect mental health, according to an opinion piece in JAMA Health Forum.  “Just as policies that promote discrimination lead to poorer mental health among targeted populations, policies that protect historically marginalized populations from discrimination and oppression lead to better mental health outcomes,” writes Ruth S. Shim, a cultural psychiatry professor at the University of California, Davis.Odds & Ends:Tradeoffs reports on what Republican health cuts could mean for people with disabilities. Robert F. Kennedy describes his first acid trip, and federal health leaders appear to be keen on psychedelics, The Microdose newsletter reports. And Behavioral Health Business has begun tracking Trump administration actions involving mental health and substance use in its Trump Tracker.

‘Thunderbolts*’ illuminates declining mental health of Marvel’s rejects

In Marvel Studios’ latest, the heroes aren’t so all-powerful or virtuous, and the struggles take place within them. Star Florence Pugh and director Jake Schreier talked about the film and its themes – depression and mental health chief among them – for a story in Entertainment Weekly. Pugh plays cold, deadpan Yelena Belova, not really a superhero, but superb with a knife. With her anti-hero comrades, she resolves the climactic conflict (spoiler alert) not with an explosion, but with a hug – comforting Bob (Lewis Pullman) rather than letting him beat himself into nothing. (View trailer.)

When Schreier first signed on as director, he knew he wanted to make a very different kind of Marvel movie. He brought in screenwriter Joanna Calo, who he worked with on the Netflix series “Beef,” and who co-created “The Bear,” another award-winning series that centers mental health. Marvel movies aren’t known for digging into mental health themes so overtly. “It’s a huge deal that that theme was made with a Marvel budget, and they cared enough about it to make it the main event,” Pugh says in the interview. “These themes are not niche anymore,” Schreier says. “They’re things that everyone confronts.” 

The response seems to vindicate the approach. The movie got generally good reviews – “The greatest Marvel offering in years,” according to the BBC – and reached No. 1 at the box office with a $162 million global opening weekend. Schreier is pleasantly surprised by the reception and that a film that is “so related to loneliness and being trapped inside your phone and being trapped in isolation” is connecting so strongly with audiences.  

The film opens with Pugh’s Yelena stepping off a dizzyingly-tall building as a voiceover reveals the depths of her depression. (Spoiler alert once again: it turns out she’s wearing a parachute.) That scene was cut at one point – Pugh was “furious,” and fought to restore it: “I was just like, ‘This is such a quick way to explain to the audience who she is and how she’s feeling.”

Pugh’s insistence led to conversations she’s proud of, which meant considering Yelena’s mental health in everything from fight choreography to her wardrobe. “If she’s really asking for the universe to remove her, she wouldn’t be wearing her supersuit,” Pugh says. “She’d be wearing a tracksuit that isn’t protecting her in any way.”

What do we actually know about ADHD? Surprisingly little, it seems.

Attention-deficit/hyperactivity disorder is complex, so it takes a talented and experienced journalist like Paul Tough – who spent a year interviewing leading scientists around the world, disentangling leftover beliefs – to produce a fascinating, surprising, nuanced, thoughtful and very long piece on the subject, for a New York Times Magazine cover story. (There’s a CliffsNotes version but I highly recommend the full 8,900-word piece.)  

ADHD diagnoses, of course, have been increasing for years, up from 3% of American children in 1993 to 11.4% (7 million kids) in 2022.  More than half of them are prescribed stimulant medications like Ritalin and Adderall, based on thinking so old that a 1937 paper establishing it was published in the American Journal of Insanity, in which one amphetamine dose led to “remarkably improved school performance” overnight. 

A 1999 study eventually set out to research the drugs’ longer-term effects. It found that after 14 months of treatment, children who took Ritalin every day had significantly fewer symptoms than those who received only behavioral training. That finding influenced families, clinicians and pharmaceutical companies, but it wasn’t the end of the study – by 36 months, that advantage had completely disappeared.

Since then, other research has found that while the medications can have a powerful effect on how children behave in the classroom, they do little to improve how well they learn. Perceived benefits might be chalked up to the confidence and the sensation of interest and focus that stimulants seem to drum up. 

Research both quantitative and qualitative increasingly suggests that, for many people, ADHD is a condition they experience, sometimes temporarily, rather than a disorder that they have in some unchanging way. Young people spoke to Tough about reserving their medication for specific situations, rather than taking it every day. Perhaps, some scientists argue, instead of trying to treat and resolve some underlying biology of the disorder, we should be focusing on environments. In lengthy interviews with 125 young adults, all of them diagnosed as children, researchers noticed that their subjects wanted to talk about contexts influencing symptoms rather than the specifics of their disorder. They repeatedly, spontaneously stressed finding their “niche,” or the right “fit,” in study and at work. 

For what it’s worth, a lot of that chimes with my own experiences. I was first diagnosed with ADHD 23 years ago, in my late 40s, although it’s now clear the disorder had held me back since college. I take Dexedrine, which is similar to Adderall, but only when I’m writing or editing, and I can tell almost immediately when the four-hour dose has run out because I lose focus and my organizational skills literally disappear. I now believe that traditional journalism was never a good fit for me; in every story – even this newsletter item – there are too many fascinating tangents that I insist on pursuing, sometimes (often!) to my editors’ chagrin. Last year, I worked as a consulting editor for the medical policy journal Health Affairs, editing and overseeing the peer review process for assigned manuscripts. They were maybe less interesting than stories I’d have chosen and reported on my own, but the narrower parameters of the work meant fewer potential tangents – I found it easier to stay on track, and deadlines became much easier to meet.

In other news … 

Stories about addiction and mental health won three of the top Pulitzer Prizes for 2025, announced on Monday, quite a leap for topics that not long ago were discussed only in whispers: 

• Investigative Reporting: The staff of Reuters, for “Fentanyl Express,” a series that  exposed lax regulation here and abroad that makes fentanyl inexpensive and widely available to users in the United States.
• Local Reporting: Alissa Zhu, Nick Thieme and Jessica Gallagher of The Baltimore Banner and the New York Times, for an investigative series that captured the breathtaking dimensions of Baltimore’s fentanyl crisis and its disproportionate impact on older Black men.
• Feature Writing: Mark Warren, contributor for Esquire magazine, for “Right-Wing Media and the Death of an Alabama Pastor: An American Tragedy,” which examined the suicide death of a Baptist pastor in a small town after a conservative website exposed his online life.

Use of talk therapy alone increased, while psychiatric medication alone decreased in recent years, according to (paywalled) survey data published in the American Journal of Psychiatry. It’s all relative, though. In 2018, 16.5 million people – 6.5% of American adults – were getting outpatient talk therapy, a number that grew to almost 22 million – 8.5% of adults – in 2021, researcher Mark Olfson said in an NPR Q&A. Wider access to telehealth since the pandemic may have played a role. Use of meds alone declined by 8% over the four years, but even with the decline, 62% of people who were receiving some type of outpatient mental health care were getting psychiatric medicines only. A majority of people in talk therapy also take antidepressant or antipsychotic medications, and the number being treated with both is growing, Olfson said. Still, the most recent national survey data shows that only about half of Americans with any mental illness had any treatment at all in the preceding year.

A dangerous veterinary sedative not approved for use in humans has been found mixed with illicit opioids, mostly fentanyl, that caused clusters of overdoses in three cities, according to field studies in CDC’s Morbidity and Mortality Weekly Report. Although the anesthetic medetomidine has been identified periodically in recent years, Chicago’s hospitalized cluster of 178 probably cases last May was the largest reported. In Philadelphia, medetomidine was detected in 72% of street fentanyl samples (while xylazine, aka tranq, decreased from 98% to 31%) during the last four months of 2024. Among 165 patients suffering from likely medetomidine withdrawal – severe, and distinct from fentanyl or xylazine withdrawal – between September and January, 91% required care in intensive care units, including 24% who had to be intubated. 

Certain immune system responses may play a role in autism spectrum disorder, according to a study by Japanese researchers. The findings present a new path for understanding the brain-immune system connections in ASD, and might inform future  targets for therapy. Dive into the Molecular Psychiatry study if you dare. I found the Fujita Health University press release wonky enough. (“Japanese Researchers Link Compromised Synapse-Clearing Ability to Autism / A new study finds that macrophages from individuals with autism have a significantly impaired ability to clear synaptic proteins.”) Either way – it is interesting.Sen. John. Fetterman is getting some unwanted attention: The Pennsylvania Democrat gained widespread respect from mental health advocates and voters, for publicly sharing his depression and mental health treatment in 2022. But now Fetterman’s well-being is in the spotlight for a different reason, New York Magazine reports: Former staff members believe his mental health has plummeted, a decline manifesting as conspiratorial thinking and abusive behavior toward staff. (Fetterman insists he’s in good health.)