A woman applies for a therapy slot because of her anxiety disorder. She is a manager at a large corporation, earns a decent salary, and writes in her application: "What matters to me is status. I bought a house and a car and I'm so proud of myself. That is my greatest pride." Both financed on credit, she explains. By the end of the month, her account is empty. Then the question: whether the psychotherapist, who exclusively treats private-pay clients, might not make an exception after all. Health insurance. She has no money, you see.
One could pity this woman. One could also admire her — for the precision with which she sabotages her own life. For what she describes is not financial hardship. It is a demonstration of what happens when a person confuses value with price.
The Confusion
Modern man knows the price of everything and the value of nothing. He suffers from the Values Neglect1 of the materialist zeitgeist.
Take the car: 80,000 francs. Visible, gleaming, presentable. The neighbors nod approvingly. The car is an object with a price — and therefore, so the logic goes, automatically valuable.
Take the psyche: invisible, intangible, not presentable. No one congratulates you on regaining the ability to sleep. No one admires the ability to get up in the morning without a racing heart. The psyche has no price — and is therefore deemed worthless.
This is the cognitive catastrophe of our time: value is defined by visibility. What cannot be photographed does not exist. What cannot be put on display does not count. What cannot be quantified in francs is air.
Except that air is vital. You only notice when it is gone.
The Wrong Center
Materialist society builds its universe upside down. It places the house at the center, the car, the career, the bank balance. The psyche is regarded as a satellite, an appendage, something to attend to when everything else is taken care of.
This works well enough for a while — until the collapse.
For in truth, the reverse is the case: the psyche is the center. Everything else orbits around it. Without a functioning psyche, the finest house is useless — it becomes a prison. Without a stable psyche, the car is just sheet metal — you cannot get in because you cannot get up. Without a sound mind, the career is just a hamster wheel in which you run until you break down.
You build a high-rise on sand and wonder why it collapses. You invest in the facade and neglect the foundation. And when everything comes crashing down, you stand there bewildered, asking yourself what went wrong.
What went wrong? The priorities. From the very beginning.
The Invisible Value
Anyone who asks what mental health is worth is asking the wrong question. The right one is: what is it worth when it is gone?
The answer is simple and brutal: everything.
Mental health is not the absence of illness. It is the presence of capacities without which everything else becomes worthless:
The ability to get up in the morning. To make decisions based on reason rather than unconscious fear. To be with other people without fleeing inwardly. To look at your child and feel joy instead of emptiness. To sleep at night instead of ruminating. To navigate conflict without ending in hurtful drama. The ability to say "No" without being torn apart by guilt.
A person who is depressed may own a Porsche — but cannot drive it because they cannot get out of bed. A person living in panic may own a dream house — but does not inhabit it; they suffer in it. A person who is burned out may have built a career — but is too exhausted to enjoy it.
The value of mental health lies in the fact that it is the prerequisite for everything else. Without it, everything else is worthless. With it, even the modest becomes valuable.
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This is the Copernican Values Revolution that would be necessary: to grasp that one has been looking at the world upside down. Since childhood, one has been trained: bigger toys mean more value. More possessions mean more happiness. A lie repeated a million times until it became truth. In reality, the thing is not the center — the mind that perceives it is. It is not the car that carries you through life but the psyche. You can invest in a house as much as you like — if you collapse psychologically, you own nothing but four walls and a hell.
The Reckoning for the Reckoners
There are people who think only in numbers. For them: the reckoning.
An untreated depression costs upward of 25,000 francs per year — at a minimum. Lost workdays, treatment costs, secondary conditions. A burnout means on average three months of incapacity for work, often more. Then there are the invisible costs: missed career opportunities, failed relationships, lost years — irrecoverable, beyond price.
Dietmar Luchmann, Psychotherapist: "Anxiety disorders and panic attacks can be perfectly overcome through cognitive therapy. Anyone who instead accepts psychotherapy lasting more than ten sessions, or medication, is allowing themselves to be treated incorrectly."
An effective course of cognitive psychotherapy costs approximately 2,000 to 3,000 francs — over ten sessions. Anxiety disorders and panic attacks can be perfectly overcome through cognitive means. Anyone who instead accepts psychotherapy lasting more than ten sessions, or medication, is allowing themselves to be treated incorrectly. The success rate of cognitive psychotherapy for depression is similarly high, provided patients are willing to change their thinking and do the work. Economists estimate the societal return on investment at 1:4 — every franc invested yields four in return.2
A 400 percent return on cognitive psychotherapy, however, is merely the macroeconomic abstraction.
What cannot be quantified is the personal return: it is the education or the exam that was not abandoned but passed with distinction, thanks to the timely psychotherapeutic healing of pathogenic thoughts. It is the salary from the promotion that became possible through a confident demeanor. It is the divorce costs that never arose because the partnership was saved through constructive communication. It is the value of the catastrophic misguided investment that, thanks to strengthened judgment, was never made.3
And yet: people pay 80,000 francs for a car but not 2,000 for their mental health.
Why? Because the car is visible. Because the neighbor sees it. Because it gleams.
The psyche does not gleam. It merely functions. Or it does not.
More insidious still: psychological problems follow the principle of compound interest. A small, unprocessed conflict grows into embitterment. An anxiety avoided today leads to isolation tomorrow. An ignored thought pattern solidifies into a personality disorder. The costs do not rise linearly but exponentially.
Early intervention costs little. Late repair costs everything. Or is impossible. And between the two lies only a decision.
The Rationalizations of Failure
Of course there are reasons. There are always reasons.
"I don't have time," says the person who lies awake at night ruminating. Who functions during the day but does not live. Who spends hours managing their suffering instead of spending one hour ending it. They have no time to repair the leak — but they bail, every day, without pause.
"That's too expensive for me," says the person who pays 1,000 francs for the auto repair shop without hesitation, 2,000 for new furniture, 100 for a tank of gas. But 200 francs for their own psyche? Too expensive. The truth is: it is not too expensive. It is merely deemed worthless.
"I can handle it on my own," says the person who would never dream of performing their own appendectomy or pulling their own teeth. But the most complex organ in the body — the brain — that they want to repair themselves, while trapped inside it, without tools, without guidance, without an outside perspective. A broken bone does not heal by being ignored. Neither does a psychological disorder. It becomes chronic.
All these arguments share the same foundation: fear. Fear of admitting that one needs help. Fear of vulnerability. Fear of the work that is necessary. Fear that it will hurt to look at what is wrong.
Yet here the most fateful paradox unfolds: the psychological disorder itself obscures its own path to resolution. A depression whispers to its host: "You are not worth being helped." An anxiety disorder commands: "Avoid the confrontation; it is safer." Narcissistic personality traits suggest: "You don't have a problem; the others are the problem."
The illness argues against its own treatment. It turns the first step into the most formidable hurdle. This is not a character flaw — it is the internal logic of the symptom.
This fear is understandable. But it costs one's happiness in life. Or one's life.
The Systemic Problem
It would be dishonest, however, to conceal the systemic hurdle confronting those willing to seek a solution in the psychotherapy paradise.4 The psychotherapy market is inefficient, opaque, and in part incompetent. Chatbots as psychotherapists offer no solution — merely a superior simulation of therapy.5
The number of psychiatrists and psychotherapists is growing. At the same time, treatments last on average several years. This is a scandal, because scientific research has demonstrated for decades that most anxiety disorders and depressions can be successfully cured through cognitive psychotherapy in ten to twelve sessions. Even when they have previously been allowed to become chronic over years.
Why, then, the discrepancy?
Because the system enables a tacit agreement between psychotherapists and patients that serves both sides — just not health.
Psychotherapists profit from long, non-committal treatments. No time pressure, no pressure to succeed, no risk. They meet, they talk, they listen. It is pleasant, it is safe, it is well paid. And there is no quality control. No authority that asks after a year: is the patient well now? If not, why not?
Patients, in turn, receive attention, empathy, validation. They can talk, complain, narrate. It feels good. It feels like progress — even when nothing changes. The circumstances of life remain the same, the thought patterns remain the same, the suffering remains the same. But one is doing something. One is going to therapy. That alone feels like responsibility.
In truth, it is avoidance. On both sides.
What Psychotherapy Really Means
For effective psychotherapy is arduous. It is not a wellness program. It is not a massage for the soul. It is the work of the thinking individual upon themselves.
A good therapist is not a consoler. He is a sparring partner. He shows which thought patterns are self-destructive. He shows how to change them. He shows the exercises. But the relearning and the training — that the patient must do alone.
Psychotherapy success cannot be bought. The honest answer to what cognitive therapy costs is: work — on one's own thinking. The fee merely remunerates the guidance to achieve psychotherapy success through one's own effort.
The goal of an honest psychotherapist is not to make himself indispensable. His goal is to become dispensable.
For patients, this means: confronting what hurts. Recognizing thought patterns that have been cultivated for decades. Changing behaviors that have become comfortable. Taking responsibility for one's own suffering instead of shifting it onto others.
This is uncomfortable. This is painful. And that is precisely why it works.
But most people do not want work. They want relief without effort. They want change without changing. They want to get well without doing anything for it.
And the market delivers exactly that. For years. At great expense. Without result.
A fitness trainer who advises against sweating does not understand his job. A psychotherapist who only consoles and never confronts with reality understands his just as little.
The Quality Test
How does one recognize whether psychotherapy is effective?
The findings of psychotherapy research could not be more unequivocal: cognitive psychotherapy for anxiety disorders and depression, as demonstrated by the psychotherapy researcher Klaus Grawe of the University of Bern, "is on average highly significantly more effective than psychoanalytic therapy and client-centered therapy."6 This is not a matter of taste. This is the evidence.
What is decisive is the choice of the specific psychotherapist: many put "cognitive behavioral therapy" on their shingle and deliver nothing but conversations.
But after the first session, the following should be clear: what is the problem — cognitively speaking? Which thought patterns sustain the disorder? How will the work proceed: which specific cognitive restructurings, confrontations, and exercises in thinking? How long is it expected to take?
A capable psychotherapist can explain his treatment concept in comprehensible terms and estimate the duration.
If these questions remain unanswered after the first session, one is with the wrong psychotherapist. Either he does not know what he is doing. Or he knows but does not want to say, because clarity means commitment.
Effective psychotherapy has a goal, a method, a timeframe. It is not an open-ended conversation on offer for years. It is an intervention with a beginning, a middle, and an end.
Whoever does not offer this is not selling psychotherapy. He is selling conversations. That is not the same thing.
The Responsibility
But even the best psychotherapist cannot deliver health. He can only show the path. Walking it is your own affair.
Mental health is not a service to be consumed. It is the result of one's own work: the confrontation with oneself, with one's own blind spots, with the thought patterns that make one ill.
And that is precisely what makes it so valuable. Mental health is the only thing that no one can take from you — and that no one can give you. It is the only genuine autonomy one can acquire.
No one relieves you of this responsibility: neither the state nor the health insurer, neither the psychotherapist nor your partner. The work on one's own thinking is the most private of all tasks — and the most consequential.
You can work to achieve mental health. Or buy a car.
The Fork in the Road
The woman with the house and the car stands at a fork in the road. Whether she knows it or not — she stands there.
She can carry on as before. Collect status symbols, service loans, take pride in things. While simultaneously suffering, not sleeping, feeling empty inside. She can keep this up for years. Many do. Until it is no longer possible.
Or she can recognize that she has set the wrong priorities. What is a house worth if you are psychologically breaking down inside it? What is a car worth if you are too exhausted to drive? What is visible property worth if you are impoverished within?
She need not become a forest walker.7 But she could recognize that she needs to invest only 2,000 francs and ten weeks of work to learn to enjoy her life. That mental health is not a luxury but the foundation for everything else.
Most people make the first choice. Not because they do not know better. But because the visible is more seductive than the invisible. Because consumption is easier than work. Because self-deception is more comfortable than self-responsibility.
But the bill comes. Always. In the form of breakdown, depression, panic attacks, burnout. Then the value of mental health suddenly becomes very visible — as an abyss.
You can invest before you fall. Or you can fall and then invest. If you survive.
The Bitter Truth
Switzerland has the highest density of therapists in the world. And yet mental disorders are on the rise. This is not a contradiction. It is a symptom.
It is the symptom of a society that measures the value of everything by its visibility. A society that would rather invest in the car than in the mind. A society that believes health is a product one can buy rather than an achievement one must earn.
And it is the symptom of people who do not use the intellect they were given. For it is no arcane science: the most valuable foundation of life is invisible — mental health. Whoever ignores this foundation builds on sand. No matter how expensive the house on top of it.
The uncomfortable truth is this: unprocessed psychological deficits and conflicts do not vanish. They are projected. Onto the partner, onto the children, onto society. The inner emptiness — that emptiness which cannot be filled with house and car — is compensated through the pursuit of power, status, self-aggrandizement. Personal frustration becomes political fanaticism. Private psychological suffering becomes public dysfunction.
The price for refused self-responsibility is not paid by the individual alone — it is paid by society as a whole.
One could be wiser. One would merely have to be willing to think for oneself.
1 Neglect (Lat. neglegere — to disregard, to pay no attention to) is the term used in neurology for a perception deficit, caused by brain damage, affecting one side of the body or part of the environment, frequently accompanied by a lack of awareness of the condition. My coinage "Values Neglect" denotes the loss of the spiritual as the transcendent source of meaning in our existence, which includes the awareness that prosperity and survival are owed in larger part to productive and reproductive activities performed without remuneration within the family and the social environment.
2 Schuler, D., Tuch, A., Buscher, N. & Camenzind, P.: Psychische Gesundheit in der Schweiz. Monitoring 2016 (Obsan Bericht 72). Neuchâtel: Schweizerisches Gesundheitsobservatorium, 2016, p. 14.
3 Luchmann, D.: A 400 Percent Return on Cognitive Psychotherapy — Are You Joking, Doctor? Psychotherapie. 12.07.2025.
4 Luchmann, D.: Switzerland as a Paradise of Psychotherapeutic Inefficiency. Psychotherapie. 14.08.2025.
5 Luchmann, D.: Chatbots as Psychotherapists? Perfect Accomplices to Madness. Psychotherapie. 10.10.2025.
6 Grawe, K.; Donati, R.; Bernauer, F.: Psychotherapie im Wandel: Von der Konfession zur Profession. Göttingen: Hogrefe Verlag, 1994, p. 670.
7 Luchmann, D.: The Forest Walker — Cognitive Psychotherapy of a Physician. Psychotherapie. 16.07.2025.
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