Journalism, Psychiatry, and Public Trust: Q&A with Ellen Barry
"I want to show the readers the human stakes..."
Ellen Barry is a mental health reporter at the New York Times. She grew up in a foreign service family, so got used to moving, and studied English at Yale. After college, she worked at the Moscow Times, the Boston Phoenix, the Los Angeles Times and the New York Times. For 11 years, she worked as a foreign correspondent, serving as bureau chief in Moscow and Delhi and as chief international correspondent in London.
Aftab: Ellen, I deeply admire your coverage of issues related to psychiatry and mental health for the New York Times. Your writing brings a rare combination of elegance and sensitivity to these complex topics. I'm grateful for this opportunity to discuss your work.
What led you to specialize as a mental health reporter? What drew you to this beat? And how has your understanding of these issues grown over your career?
Barry: First of all, thank you. I read you faithfully, so this is high praise. In 2019, I returned to the U.S. after eleven years overseas as a foreign correspondent. I began traveling around New England and was shaken by the homeless encampments that had appeared, it seemed, in every city in the region. There were these mothers who made the rounds, like a hopeless patrol, looking for their children. Usually they found other people’s children. It seemed to me that this had become a crucial American story.
Then the mental health job on Health and Science came open unexpectedly—Ben Carey, who held it for 15 years, had decided to leave. I knew right away that I wanted the job. I had the feeling that, as a country, we were at an inflection point around mental health. The housing crisis had pushed people with severe mental illness onto the street. Young people were narrating their treatment history on TikTok. New frameworks (particularly around trauma) were bubbling up on social media, competing with medical models. I found all those things both morally and intellectually compelling.
Aftab: How do you approach the task of presenting facts and expert opinions relevant to a topic you are writing about while crafting narratives that guide readers toward understanding complex issues? Do you see your goal as nudging the readers towards certain conclusions or as merely exposing readers to certain facts and considerations?
Barry: I am drawn to tension—new ideas, collisions of rights or interests. “Find the heat,” one of my editors likes to say, so that is what I do. Often I choose a topic because I find it difficult and am trying to sort out what I think.
I do a lot of background research, trying to understand fault lines within the field. Often I only use a small amount of that in the final story, because I think the reader needs to remain close to the humans at the heart of it. My aim is not to persuade—I want to show the readers the human stakes, lay out different perspectives and step back and leave it to them to decide. Sometimes that leaves readers passionately divided.
Aftab: ‘The Man in Room 117’ masterfully illustrates the dilemmas surrounding severe mental illness and treatment autonomy. I think it’s my favorite among the articles you’ve written so far. The story poses a profound question about Andrey Shevelyov’s right to refuse medication versus living on the streets. Your story makes clear just how complicated answering this is—both clinically and ethically—but I am curious about your personal views on this issue.
Barry: Thank you for singling out this piece. It’s my favorite, too.
I was initially approached by Andrey’s parents, Sam and Olga. We were in touch for a couple of years before I realized there was a story there, and I felt enormous sympathy for them. Andrey had been repeatedly released from jails or hospitals into homelessness. Olga would visit him in his tent, delivering stacks of carefully laundered clothes, but she was afraid to let him stay in her apartment. His parents felt he needed sustained, long-term treatment—involuntary, if need be—to break this cycle.
However, when I spent time with his medical records, I understood just how many times he had been forced to accept treatment, and how violent it had been. We use force a lot in our system. After reading his records, I felt no confidence that more of this kind of brief, sporadic involuntary treatment was going to help Andrey. On the contrary, it had demonstrated its failure. So I didn’t have an answer when I sat down to write. There needed to be a third way that combined housing and treatment.
Aftab: The intersection of homelessness and mental illness has become increasingly politicized. In your view, what are the key factors that make finding consensus on these issues so challenging? Does the issue need to be this contentious?
Barry: There is a severe housing crisis in this country, and people with mental illness have been affected. Some are homeless because of their symptoms and some have worse symptoms because they lack housing.
Last summer I spent many hours driving around with a team of street psychiatrists in Los Angeles, and I liked the way one of them put it: We need more of everything. More supportive housing, more short-term beds, more long-term beds, more voluntary and more involuntary treatment. The focus is so often on involuntary treatment, pro and con, but I’ve seen how regular attention from a social worker can really move the dial for a person. We need an entire safety net. We don’t have one.
Aftab: You must have observed the online presence and influence of the “antipsychiatry” (for lack of a better word) elements, particularly on social media. The phenomenon fascinates and worries me in equal measure. I am afraid that forces opposed to psychiatry are increasingly using the culture war playbook to shift public opinion. What do you make of all this?
Barry: I heard many of the same critiques of psychiatry twenty years ago, when I covered mental health at the Boston Globe. Psychiatric treatments address symptoms, but they have miserable, sometimes disabling side effects; diagnoses are inexact and subjective; systems of care are fragmented and inadequate. We undertreat some people and overtreat others.
The difference is that these critiques are no longer confined to the margins. Over the last 20 years, Facebook peer support groups have grown into durable movements. Social media platforms have allowed providers to build lucrative mental health practices outside the licensed professions. There’s less gatekeeping overall. Look at the cultural impact of “How the Body Keeps the Score,” whose central idea has been repeatedly rejected by the DSM.
I think it would be a mistake to dismiss all these critiques as part of the culture war. Many Americans now in their 30s and 40s have taken psychotropic medications since they were kids; it seems reasonable to step back and ask how this is working for people over the long term. That doesn’t mean you have to accept the whole bundle of arguments, including RFK’s false claims about antidepressants causing school shootings. You just have to tease them apart.
Aftab: In “24, and Trying to Outrun Schizophrenia,” there is a striking moment when Kevin Lopez, who was in a vulnerable state and trying to work through his psychotic symptoms, asks you to accompany him.
“In these moments, he needed a person to sit with him, to help him identify what was real and what was not. In the past it was Maria, or his mother, or Raquel. This morning, alone in the basement room, he texted the only other person he could think of, the New York Times reporter who was following him.
“I’m getting symptoms,” he wrote. “Can you come and record.”
When I arrived, Kevin was jittery. I sat there as he paced, did push-ups against the wall, practiced the grounding exercises Maria had taught him. His thoughts raced — did he have an exam tonight? Should he be studying? Every time he seemed to be drifting off, he caught a glimpse of his nose in his peripheral vision and it looked strange, distorted. He kept thinking that if he allowed himself to sleep, he might become paralyzed.
But then he ate a sandwich and settled. An hour passed, and he fell into a deep sleep.”
How do you navigate situations like these as a journalist? What was going through your mind?
Barry: I didn’t know how to write that scene. I tried to keep myself out of the first few drafts, but the truth was that he needed a person to sit with him, and on that occasion, I was that person. That was the truth. I was touched that Kevin trusted me enough to call me at a moment like that. And I realized it was a real survival skill to be able to ask for help. That story, about Kevin, was one of the most uplifting reporting experiences I’ve had. He clearly credited his care team with getting him through a terrifying time in his life. And he had come out the other end.
Aftab: Looking back at your body of work, which stories related to mental health have had the most significant impact, either personally or in terms of public response?
Barry: Readers have responded powerfully to stories about severe mental illness, particularly “The Man in Room 117.” Often, they respond with their own stories—lifetimes, sometimes, spent trying to manage the illness of a loved one. One woman—I will never forget—said she and her brother had tried for years to find a solution for their mother, who had schizophrenia, and that ultimately, the best thing they could do was put her in a house that was isolated, so that the neighbors could not hear her screaming. That letter has haunted me.
Other topics get a massive response because they are polarizing. When I wrote about the therapeutic trend around “going no contact” last year, it was like a dam burst of emotion. I got lots of mail, much of it angry, when I wrote about Laura Delano’s Inner Compass project and the notion of peer support in tapering off medications. To me, it’s a signal that the question is not being adequately addressed, pressure is building up around it.
Aftab: In your coverage of psychiatry, have you encountered any practices or approaches that seem counterintuitive and puzzling to you, where you find yourself wondering why psychiatrists would choose to do it that way?
Barry: I think most psychiatrists get into the profession because they are interested in people, but the health care system, and the way care is paid for, often narrows their role to medication management. I don’t think that’s their choice. That’s one. Also we generally don’t provide case management in this country. People struggling with severe symptoms, or their family members, are too often left to manage their care themselves, which means that even quality care may fail. I saw coordinated care work in interventions like OnTrackNY or in the HOME team, the street psychiatry program I wrote about in Los Angeles, and was struck by how powerful it was.
Aftab: There has been massive erosion of public trust in scientific and medical institutions, including psychiatry. Traditional media itself is facing tremendous challenges, and some seem to think that legacy institutions like the New York Times are heading towards irrelevancy. How do you envision your role in this new information landscape?
Barry: I think the press in this country does a good job of holding government accountable. You’re right about the challenges—regional outlets are disappearing, people are less trusting of media, the press has less political power. But I’ve spent enough time in countries without a free press to appreciate what we have.
I also feel pretty strongly that the digital age has made us better at our jobs. We get feedback instantaneously. We communicate with our readers. We have a larger audience than ever, and it spans the world. And podcasts, open-source investigations, rich graphic data, video—these are absolutely new ways of investigating and reporting the news.
Aftab: Continuing the context from the previous question about today’s information landscape, any advice for Psychiatry at the Margins?
Barry: Psychiatry at the Margins does something unusual by bringing critics of psychiatry into active dialogue with the profession. In the past, I don’t think there was a place for those conversations to happen. You’re able to engage, and sometimes debate, without being rigid or defensive. That’s a big contribution.
Focus on the dynamic areas in the profession. I would like to read more frank interviews with clinicians about how they manage tensions in their work around issues like coercive treatment, uncertainty in diagnosis, the dilemmas of overtreatment and undertreatment. I’m interested in what’s happening with young people entering the profession. I want to know what reform in psychiatry might look like.
Aftab: Thank you!
This post is part of a series featuring interviews and discussions intended to foster a re-examination of philosophical and scientific debates in the psy-sciences. See prior interviews here.
See also:
Reading this conversation and the related NYTimes story about Andrey, The Man In Room 117, is emotionally exhausting for me as a caregiver for someone like him in many ways. No easy and appropriate answers for all patients, consumers, or survivors can be found to consistently favor civil liberties, the medical model, involuntary care, housing first, genetics, epigenetics, trauma-informed, peer led, neurodiverse, or other perspectives that exist. To those who says “research shows” I can often cite a contradictory study. To anyone who claims to know the policy answers, I say do more reading and think again to be less certain.
In 2024, more than 200 homeless persons died on the streets of Austin, Texas where my family lives. That is close to the annual average in this city of about a million. It is probably not far off to assume that 50 of those persons had a serious mental illness, or to guess that far fewer than 50 people die annually in our local psychiatric hospitals, shelters, and jails. We probably all agree that we don’t spend the money to provide better services for politically and economically powerless victims of serious psychiatric illness in the USA, even if we disagree on what those services should be.