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The Monetization of Mental Illness Was Not an Accident

How modern economies can create psychological strain, individualize its consequences, and build markets around managing the damage

8/24/202616 min read

a man sitting on a window sill in the dark
a man sitting on a window sill in the dark

How modern economies can create psychological strain, individualize its consequences, and build markets around managing the damage

Author: Trang Phan

Mental health has become one of the defining human and economic challenges of the modern era. More than one billion people worldwide live with a mental health condition, according to the World Health Organization (WHO), while anxiety and depressive disorders remain among the most prevalent conditions globally. Governments nevertheless allocate a median of only about 2% of health budgets to mental health, and the global median workforce is approximately 13 mental-health workers per 100,000 people, with enormous disparities between high- and low-income countries. Depression and anxiety alone are associated with an estimated 12 billion lost working days every year and roughly US$1 trillion in annual productivity losses. (World Health Organization) These figures establish the scale of the problem; they do not, however, establish the more provocative proposition at the center of this report: that modern economies can simultaneously contribute to conditions associated with psychological distress, locate responsibility primarily within individuals, and develop expanding commercial systems for treating, managing and adapting people to that distress. The original thesis developed by Trang Phan argues that the mental-health economy should therefore be examined not simply as a healthcare market but as part of a wider system of work, technology, consumption, institutional incentives and human adaptation. The strongest evidence-based version of that thesis is not that mental illness was deliberately manufactured, that psychiatric diagnosis is illegitimate, or that treatment is unnecessary. Mental disorders have heterogeneous biological, developmental, social, environmental and individual determinants, and effective clinical care can be essential. The more defensible—and potentially more consequential—argument is that societies systematically underprice the psychological costs created by environments, organizations and technologies, while building sophisticated markets to manage those costs after they have reached individuals. That distinction transforms mental health from a narrow healthcare issue into a question of economic design.

1. The First Misdiagnosis: Treating Systemic Harm as Individual Failure

When anxiety, depression, burnout, attentional difficulty, sleep disruption and emotional distress appear across large populations, the analytical starting point should not be a forced choice between defective individuals and defective environments. Human mental health emerges from interactions among biology, personal history, relationships, socioeconomic conditions, work, physical environments, institutions and culture. WHO itself describes mental health as being influenced by a combination of individual, family, community and structural factors and notes that adverse circumstances increase the risk of mental-health conditions. (World Health Organization) The economic significance of this distinction is substantial because where a problem is located determines where money, accountability and intervention flow. If distress is understood predominantly as an individual condition, institutions naturally invest downstream: diagnosis, therapy, medication, employee assistance, coaching, wellness applications, resilience programs and absence management. If working conditions, insecurity, discrimination, excessive workload or lack of control contribute materially to that distress, however, upstream interventions may require redesigning jobs, management systems, incentives, scheduling, platform mechanics or economic protections. WHO explicitly identifies excessive workloads, low job control, job insecurity, discrimination and inequality as risks to mental health at work. (World Health Organization) The implication is not that every employee experiencing depression is experiencing a workplace-created illness; that would exceed the evidence. It is that organizations can make a category error when they treat every manifestation of distress as a problem located solely within the person. Consider an organization in which teams operate under persistent understaffing, unpredictable schedules and unrealistic deadlines. Providing counseling may benefit affected employees enormously, but if workload design remains unchanged, the intervention addresses one part of the outcome while leaving a potentially important source of risk intact. This is the central analytical correction: individual treatment and structural prevention are complements, not substitutes. A mature mental-health system should therefore ask two questions simultaneously: What support does this person need? and What conditions are repeatedly producing or amplifying the problem? The original Trang Phan argument pushes forcefully toward the second question because modern institutions have become exceptionally sophisticated at treating individuals while remaining comparatively weak at redesigning the environments around them.

2. The Environment Changed Faster Than Human Requirements Did

Much of modern economic development has been extraordinarily beneficial: longer lives, safer workplaces in many countries, increased material prosperity, unprecedented information access, flexible employment, medical advances and digital connectivity. Yet progress can create new forms of load alongside the benefits. A smartphone can provide education, social connection and emergency assistance while also enabling permanent reachability; flexible work can increase autonomy while eroding temporal boundaries; global digital networks can democratize expression while exposing individuals to continuous comparison and information competition; performance measurement can improve organizational effectiveness while producing surveillance and persistent evaluation. The problem is therefore not “technology” or “modernity” in the abstract but the accumulation of demands without equivalent redesign of human operating conditions. Humans still require sleep, recovery, meaningful relationships, physical activity, psychological safety, periods of sustained attention and some degree of perceived control. An economic system can exceed those requirements incrementally without producing a single identifiable moment of failure. The worker answers messages slightly later into the evening; the manager monitors another dashboard; the teenager checks another notification; the contractor absorbs more income uncertainty; the consumer navigates another personalized engagement system. Individually, these may be tolerable. Collectively and chronically, some can become meaningful stressors. WHO's workplace guidance recognizes precisely this interaction between organizational conditions and mental health rather than reducing workplace mental health to individual resilience. (World Health Organization) The scale is economically material: approximately 15% of working-age adults were estimated to have a mental disorder in 2019, while depression and anxiety are associated with roughly US$1 trillion in annual productivity losses. (World Health Organization) The managerial implication is uncomfortable but important: an enterprise can achieve its operational targets while accumulating hidden human liabilities. Revenue, output and engagement metrics capture what a system produces; they do not automatically capture what the system consumes in attention, recovery, sleep, autonomy or psychological capacity. What appears operationally efficient in one accounting period may therefore be biologically or socially expensive across a longer horizon.

3. Psychology Risks Becoming an Adaptation Layer for Poorly Designed Systems

Mental-health treatment should not be characterized as a mechanism of social control simply because it helps people function; psychotherapy, psychiatric care, medication and community support can reduce suffering and save lives. But there is a legitimate institutional-design question hiding beneath the provocative language of the original essay: when does helping an individual adapt become a substitute for correcting an avoidable environmental problem? Consider two companies experiencing high burnout. Company A introduces counseling, meditation subscriptions and resilience workshops but leaves staffing, workload, management behavior and working hours untouched. Company B offers clinical support while also analyzing workload, removing unnecessary meetings, improving staffing, training managers, increasing schedule predictability and redesigning performance incentives. Both companies can truthfully say they support mental health, but only the second treats psychological outcomes partly as information about organizational design. This distinction is increasingly consistent with public-health thinking. WHO recommendations on mental health at work encompass organizational interventions, manager and worker training, individual interventions, return-to-work support and employment interventions rather than restricting action to treatment after distress occurs. (World Health Organization) That is strategically important because downstream treatment can unintentionally conceal upstream dysfunction when organizational leaders interpret successful coping as evidence that the environment itself is acceptable. A person may become better at tolerating an unhealthy condition without that condition becoming healthy. The same principle applies outside employment: a digital product can offer screen-time tools without changing engagement-maximizing mechanics; a university can expand counseling without examining workload or financial insecurity; a healthcare system can prescribe sleep interventions while working schedules undermine sleep. The issue is not hypocrisy in every case. More often it is institutional compartmentalization: the department responsible for psychological consequences is separated from the department designing the system that influences them. Mental health becomes a service function rather than a design constraint.

4. Once Distress Becomes Measurable, a Market Forms Around It

The expansion of mental-health markets is not intrinsically problematic. When more people seek help, greater investment in therapists, psychiatrists, digital tools, pharmaceuticals and community services can represent social progress rather than exploitation. WHO reports that more than a billion people live with mental-health conditions and that most remain underserved; in that context, greater supply is clearly necessary. (World Health Organization) The structural concern begins elsewhere: markets are generally better at monetizing identifiable demand than eliminating diffuse upstream causes of that demand. A therapy session has a provider, purchaser, price and measurable transaction. Reducing economic insecurity, improving community cohesion, redesigning algorithmic incentives or changing an organizational culture has distributed costs and benefits, uncertain attribution and often no single customer willing to pay. This creates an asymmetry between prevention and remediation. The economic burden reinforces the incentive to build downstream solutions: WHO's 2025 assessment estimates the broader burden of mental-health conditions at approximately 0.5% to 1.0% of GDP in analyses across several countries and reiterates the enormous productivity cost associated with depression and anxiety. (Iris) Once psychological distress produces absenteeism, turnover, impaired performance, healthcare expenditure and consumer demand, an ecosystem of solutions logically emerges. Some of those solutions create substantial value. The danger is not commercialization itself; it is allowing commercial treatment capacity to become evidence that upstream conditions no longer require examination. Healthcare can become more effective at treating the consequences of a system without the system becoming better at preventing avoidable harm. Economically, this resembles industries built around pollution remediation while pollution continues upstream: remediation is valuable and necessary, but its existence should not eliminate incentives for prevention.

5. The Mental-Health Economy Treats Consequences More Easily Than Causes

Modern societies have become increasingly capable of intervening once psychological distress is visible. Individuals can access psychotherapy, medication, telehealth, coaching, employer assistance, peer communities, crisis services and digital mental-health tools. Yet the upstream determinants of distress often sit outside the healthcare system's authority. A therapist cannot redesign a patient's employer. A psychiatrist cannot set housing policy. A wellbeing application cannot eliminate household debt. A clinician cannot rewrite a social platform's business model. A corporate counselor generally cannot change executive incentive structures. This fragmentation means that the institutions treating distress frequently do not control the systems contributing to it. The result can be rational behavior by every actor and a poor system-level outcome. Clinicians treat patients because that is their responsibility; employers purchase benefits because they want support available; technology companies optimize products according to commercial objectives; governments allocate healthcare budgets; individuals seek whatever relief they can access. No conspiracy is required. Incentive alignment alone can produce a system that spends heavily on consequences while underinvesting in prevention. The original essay describes this starkly as treatment becoming maintenance and healing becoming containment. Evidence supports a more qualified formulation: treatment can become functionally compensatory when upstream risk factors remain unchanged. This is why WHO's mental-health-at-work framework matters: it explicitly combines prevention of psychosocial risks with support and treatment. (World Health Organization) The strategic objective should not be to replace treatment with structural intervention. It should be to stop pretending that one can reliably substitute for the other.

6. Human Fragility Is Not Necessarily Designed—but It Can Become Economically Useful

The strongest claims in the original thesis require careful qualification here. It is not established that modern economic systems intentionally maintain people at a “profitable level” of psychological fragility, nor would population-level mental-health statistics prove such intent. A more defensible concern is that business models can profit from behaviors associated with insecurity, urgency, habitual engagement or emotional arousal without explicitly intending to create mental illness. Commercial systems routinely optimize measurable outcomes such as clicks, time spent, purchases, conversion, productivity, retention and advertising yield. If a design feature improves those outcomes while imposing psychological costs that are difficult to measure, delayed or borne by someone else, conventional optimization may underweight those costs. This is a familiar economic problem: externalities. The mechanism matters because it changes the policy response. If deliberate psychological injury were required, the solution would primarily be identifying malicious actors. If the problem is an externality generated by ordinary optimization, then perfectly rational actors can collectively produce harmful outcomes. A product manager optimizes engagement, an investor optimizes return, an employer optimizes utilization and a consumer optimizes convenience; nobody needs to intend population-level distress. Yet if the metrics exclude sleep, cognitive fragmentation, perceived autonomy or long-term psychological load, those costs can remain economically invisible. Mental-health governance therefore needs to move beyond asking whether companies intend harm and ask whether their systems systematically create costs that are not represented in their optimization functions, accounting or accountability structures.

7. Awareness Is Progress—but Awareness Without Redesign Has a Ceiling

The destigmatization of mental illness is a genuine achievement. People who once concealed depression, anxiety, trauma or other conditions increasingly have language, communities and institutional permission to seek help. That should not be dismissed as cosmetic. Yet awareness campaigns reach diminishing returns when organizations become comfortable discussing suffering without examining their contribution to it. A company can celebrate Mental Health Awareness Month while maintaining workloads that employees consistently identify as unsustainable. A university can encourage students to seek counseling while structural academic or financial pressures remain unexamined. A platform can publish digital-wellbeing guidance while its commercial success remains tied to maximizing attention. These contradictions do not prove bad faith, but they reveal a governance gap: disclosure is not prevention, empathy is not redesign, and awareness is not accountability. WHO's own framework reinforces this distinction by calling for concrete organizational measures addressing risks including heavy workloads and negative workplace behaviors. (World Health Organization) The next phase of mental-health leadership therefore requires moving from cultural permission to operational accountability. Boards and executives should increasingly ask which features of organizational design predict psychological harm, what indicators reveal deterioration before clinical absence occurs, which interventions modify the environment rather than merely the individual, and whether wellbeing investments are reducing underlying risks or simply financing adaptation. The question is no longer whether an organization talks about mental health; it is whether its operating model produces conditions compatible with it.

8. The Incentive Architecture Explains More Than a Conspiracy Theory Ever Could

The most powerful interpretation of the original thesis is economic rather than conspiratorial. Systems do not need centralized intent to generate persistent harmful outcomes. They need incentives that reward one outcome while externalizing another. Employers may be rewarded for short-term output while turnover, exhaustion and long-term health consequences appear later. Digital platforms may earn revenue from engagement while users absorb the opportunity cost of attention. Healthcare systems may receive resources to treat diagnosed conditions while prevention spans ministries, employers, schools, housing systems and technology companies that do not share one budget or accountability structure. Individuals therefore encounter a fragmented system in which nobody owns the complete causal chain. The economic numbers illustrate why this fragmentation matters. Depression and anxiety alone are estimated to remove 12 billion productive working days annually, creating approximately US$1 trillion in lost productivity, while WHO reports that median government spending on mental health remains about 2% of total health budgets. (World Health Organization) The contradiction is striking: societies absorb enormous economic losses while maintaining relatively limited public investment in mental health and often even weaker mechanisms for preventing structural risk. The rational response is not simply to increase treatment budgets, although substantial service expansion is clearly required. It is to redesign incentives so that institutions producing psychological risk bear more responsibility for identifying and reducing it.

9. The Closed Loop: Create Load, Externalize Cost, Sell Adaptation

The most commercially important insight in Trang Phan's thesis is the possibility of a closed economic loop. A system can increase human load; the resulting distress can be experienced privately; individuals or employers can purchase services that restore functioning; restored individuals return to essentially unchanged environments; and the cycle repeats. This should not be interpreted as proof that the provider treating distress caused it. The therapist, physician, wellbeing company or employer benefit may be solving a genuine problem. The structural concern is that the revenue-producing solution may sit downstream from the cost-producing mechanism, leaving neither actor with sufficient incentive or authority to close the upstream loop. Consider burnout: a company may spend substantial money on counseling and absence management while the operational unit continues running chronically understaffed. Both the care provider and employer can deliver measurable interventions, yet the demand for intervention persists because the operating condition remains. The same logic appears across environmental economics, cybersecurity, chronic disease and infrastructure maintenance: remediation markets expand when prevention is fragmented, delayed or insufficiently rewarded. Mental health should be analyzed through the same systems lens.

10. Better Therapy Is Necessary—but It Cannot Carry the Entire System

The argument for structural reform must never become an argument against clinical treatment. Effective mental-health care matters precisely because psychological suffering is real, heterogeneous and sometimes life-threatening. WHO reported 727,000 deaths by suicide in 2021, underscoring the stakes involved. (World Health Organization) Treatment access also remains profoundly inadequate; WHO's latest global assessment says most people living with mental-health conditions remain underserved. (World Health Organization) The mistake is therefore not providing therapy. The mistake is expecting therapy to compensate indefinitely for avoidable environmental risks. A clinician can help someone manage anxiety; that does not make chronic workplace harassment acceptable. Medication may enable a person with depression to recover; that does not eliminate the effects of poverty or isolation. Cognitive-behavioral techniques can strengthen coping; they cannot independently create predictable schedules, affordable housing, supportive communities or reasonable workloads. The future model should consequently combine care + prevention + environmental redesign rather than forcing an ideological choice among them. Clinical systems should treat illness. Organizations should reduce avoidable psychosocial hazards. Governments should address population-level determinants. Technology companies should examine psychological externalities created by product design. Individuals should retain agency and access to evidence-based support without being assigned sole responsibility for conditions partly outside their control. That is a much more demanding architecture than simply expanding the care economy—but also a more coherent one.

11. Mental Distress Should Be Treated as Information, Not Automatically as Defect

One of the most useful reframings in the original essay is that pathology can sometimes function as feedback. This needs qualification: a diagnosed mental disorder cannot simply be reclassified as a healthy response to society, and biological vulnerability, developmental history, genetics and individual circumstances remain important. Yet symptoms can contain information about environmental fit. Persistent exhaustion across an entire department may tell management something different from exhaustion affecting one employee. Rising anxiety among students across multiple cohorts may justify investigating environmental conditions alongside individual treatment. Increasing turnover, sickness absence and psychological complaints after an organizational redesign may constitute a system signal rather than thousands of unrelated personal failures. The strategic principle is familiar from engineering: when failure patterns cluster, inspect the system as well as the components. Mental-health systems have historically been stronger at inspecting the human component than at integrating upstream operational data. That should change. Organizations could combine confidential workforce surveys, absence patterns, workload indicators, turnover, schedule volatility, manager behavior and psychosocial-risk assessments to identify structural hotspots while protecting privacy and avoiding surveillance. The objective is not to diagnose employees algorithmically; it is precisely the opposite—to detect when the environment itself deserves investigation before individual pathology becomes the default explanation.

12. The Boundary Society Must Now Define

The central ethical and economic question is therefore not whether anyone should profit from mental-health care. Doctors, therapists, researchers, hospitals, technology developers and care workers create legitimate value and require sustainable economics. The harder question is whether institutions should be permitted to externalize psychological costs while paying little or nothing for the conditions that produce them. This is fundamentally a governance problem. Environmental regulation evolved because societies eventually recognized that a factory's financial accounts could look profitable while pollution costs were borne elsewhere. Occupational safety regulation emerged because labor markets alone did not reliably price injury and death. Data protection developed because digital business models created information asymmetries individuals could not efficiently negotiate alone. Mental health may be approaching a similar institutional transition. WHO already recognizes psychosocial hazards at work and recommends organizational intervention. (World Health Organization) The next step is broader: organizations should begin measuring psychological externalities with the seriousness currently applied to physical safety, cybersecurity, financial controls and increasingly environmental sustainability. That does not require turning every unpleasant experience into a corporate liability. It requires distinguishing normal challenge from systematically harmful design and creating accountability where evidence demonstrates preventable risk.

13. The Economic Opportunity Is Prevention, Not Simply a Larger Care Industry

The scale of unmet need guarantees that mental-health services must expand, but a strategy based solely on expanding treatment risks building an ever-larger downstream economy around an upstream problem. WHO reports more than one billion people living with mental-health conditions, major shortages in services and workforce, and government spending that remains strikingly low relative to need. (World Health Organization) The economic burden simultaneously extends far beyond healthcare expenditure because productivity losses, unemployment, caregiving, disability and reduced participation affect households, employers and governments. WHO's 2025 assessment notes that societal costs can significantly exceed direct treatment costs. (Iris) This creates a potentially large prevention dividend. Employers can redesign workloads and increase job control; governments can integrate mental health into primary care and social policy; educational institutions can redesign environments around realistic human capacity; digital companies can incorporate wellbeing constraints into product metrics; cities can invest in social connection and accessible public environments; insurers and healthcare systems can reward prevention rather than reimbursing only downstream episodes of illness. The strategic opportunity is not merely a larger mental-health market. It is a healthier human operating environment that reduces avoidable demand while expanding high-quality care for conditions that still arise.

14. What Leaders Should Do Differently

For executives and policymakers, the implication is practical. Stop treating mental health exclusively as an HR, benefits or healthcare issue and begin treating it as an operating-system variable. Every major transformation—automation, restructuring, AI deployment, performance-management redesign, workforce reduction, digital monitoring, scheduling reform or return-to-office policy—should consider psychological consequences alongside financial and operational ones. Organizations already conduct cybersecurity reviews before launching technology, financial controls before capital deployment and safety assessments before hazardous operations; comparable psychosocial-risk assessment is increasingly defensible where changes materially affect workload, autonomy, surveillance, uncertainty or employment security. The objective should be prevention without paternalism: protect worker autonomy, avoid intrusive monitoring, use aggregated indicators wherever possible, preserve confidentiality and give employees genuine channels to challenge harmful conditions. Critically, leaders should separate support metrics from system-health metrics. High utilization of counseling is not automatically evidence of a successful mental-health strategy; it can mean access has improved, distress has increased, stigma has declined, or several of these simultaneously. Similarly, low utilization does not prove a healthy workplace. Management must measure causes and conditions as well as service consumption. The most sophisticated organizations will eventually ask not “How many employees used our wellbeing program?” but “Which aspects of our operating model generate preventable psychological load, how do we know, what changed after intervention, and what evidence would prove our hypothesis wrong?”

Conclusion: From a Mental-Health Industry to a Mental-Health Economy

The original proposition—“The monetization of mental illness was not an accident”—is strongest when understood as a systems argument rather than an allegation of coordinated intent. There is insufficient evidence to conclude that modern institutions collectively engineered mental illness in order to profit from it, and claims that mental disorders are simply rational responses to modern life would ignore extensive clinical and biological evidence. But there is strong evidence for several components of the broader thesis: mental-health conditions affect more than a billion people; working conditions including excessive workloads, insecurity, discrimination and low control can threaten mental health; depression and anxiety alone impose roughly US$1 trillion in annual productivity losses; treatment access remains inadequate; and public investment remains small relative to the burden. (World Health Organization) Put together, these facts support a serious economic question: why do societies remain substantially better at pricing the treatment of psychological damage than pricing the systems that may contribute to it?

The next generation of mental-health policy should therefore reject the false choice between personal responsibility and structural responsibility. People need treatment, agency, coping capacity and support. They also need environments that do not unnecessarily consume those capacities. Companies need productivity, innovation and growth, but sustainable performance cannot mean repeatedly extracting human capacity and purchasing recovery afterward. Healthcare markets need investment, but their success should ultimately be measured partly by how much preventable suffering never becomes demand.

That leads to a different definition of progress. A successful mental-health economy is not one in which therapy subscriptions, pharmaceutical revenues, wellness applications and corporate programs grow indefinitely because more people require them. It is one in which people who need care can obtain excellent care while institutions systematically reduce avoidable causes and amplifiers of distress.

The strategic transition is therefore simple to state and difficult to execute:

Do not merely build a better economy for treating distressed humans. Build an economy that has less need to distress them in the first place.

— Trang Phan