Mental(izing) Health: Introducing the Ideas and Beliefs of Our Nominee for Surgeon General, Casey Means

Newsletter, #66

Jul 01, 2025

“Think of your consciousness and free will as a military general…” (p. 125). This off-hand suggestion made by the woman nominated to be Surgeon General of the US, Casey Means, in her best-selling book, Good Energy: The Surprising Connection Between Metabolism and Limitless Health (2024), is telling.[i] Casting aside roughly 2500 years of Western philosophy, from Socrates to the present, we are nudged away from Athens and toward Sparta. Rousseau, Kant, and Hegel: spinning in their graves. And forget the Id: where the ego was, the superego shall be? Is the specter of internal authoritarianism even more frightening than living under an authoritarian regime?

Reading this book stirred a host of discomforting emotions, especially because Means happens to be smart, well-informed, and she does have something to say. She mounts a vigorous argument about the health crisis in the US, which she presents personally and enthusiastically. Yet, she also overstates her case, relies on unexamined assumptions, and exhibits marked insensitivities.

It would be hard to dispute Means’ claim about a health crisis, given that “74% of US adults are overweight or obese, and 93.2% have metabolic dysfunction” (p, 21). Metabolic dysfunction, in her account, is at the source of the crisis, analogized to the roots of the tree that has branches in hypertension, diabetes, and a variety of other ailments. Means supports her case with scientific evidence about cellular function, explaining in detail how the positive role of mitochondria becomes disrupted and dangerous free radicals are set loose to wreak havoc on our systems. Her assessment is that the circumstances of modern life, manifest in our lack of sleep, unhealthy food, lack of movement, stress, environmental toxins, and lack of light, conspire to lead us to metabolic dysfunction or, what she terms “bad energy.”

As the title of the book suggests, Means wants us to reverse our current direction and embraces the restoration of “good energy.” The subtitle about “the surprising connection between metabolism and limitless health” perfectly conveys the merit and dubious nature of of her point of view: linking metabolism to health is one thing, limitless health is oxymoronic and an embarrassing stance from a medical doctor and putative public health professional.[ii]

Means makes many valid points in diagnosing our health crisis. My issues are with the rigidity of her thinking, which emerges most clearly as she articulates solutions. Means does not acknowledge where she is venturing beyond the evidence or where there is even controversy. She conjures some astounding examples: tying our “overnutrition” to processed foods and especially to sugar, informing us that one bottle of coke is equivalent to the amount of sugar a kid might have consumed in an entire year 150 years ago (p.171). On other points, she is on shakier ground, going on the war path about the danger of seed oils (https://www.nytimes.com/2024/11/09/well/eat/seed-oil-effects.html). The book formulates what a healthy diet looks like, and ends with recipes for good energy, breakfast, lunch, dinner and even snacks and desserts. Black bean brownies, anyone?

In addressing mental illness, Means emphasizes the brain/gut connection and the link to metabolic disorders. She discusses depression, trauma, ACEs, and stress. She does not pause to grapple with complications, like whether objective measures of stress correspond with subjective experience. Means is comfortable labelling depression as a metabolic disorder (p.244), which repeats previous reductionistic accounts, such as that all mental disorders are brain disorders. Means is a big fan of using technology to treat mental disorders, and touts health tracking and wearable devices (recommending products from her own entrepreneurial company, Levels Health).

It is apparent that Means has a more positive take on mental illness and mental health treatment than the MAHA report (and I wonder how the report has influenced her view). She repeatedly notes that stigma keeps people from getting the help they need, cites statistics about the alarming increase of depression (especially amongst young people, and even more so, among young women). She affirms that therapy (along with counseling and coaching) are “the highest leverage investments” that a person can make (p. 248). Note the business-speak! Yet, the anti-therapy bias that the MAHA report leaned into is missing in this book.

Let’s take a closer look at how Means understands the role of therapy. In addition to advocating self-monitoring devices, she recommends on-line services like BetterHelp. In a revealing passage where Means defends her cherished ideal of fearlessness, she reflects on how we can manage fear: “We do this through psychological modalities like boundary setting, introspection, meditation, breathwork, therapy, plant medicine, spending time in nature” (p, 239). It seems that Means sees therapy as one option amongst others, without bothering to identify its distinct aims (In this connection, see Steve Reidbord’s astute piece on the importance of distinguishing psychotherapy from other forms of therapy: https://psychiatryonline.org/doi/10.1176/appi.pn.2025.06.6.12).

Means has a Silicon Valley state of mind, which also has a tad of Calvinist rectitude, along with the customary nod to contemplative practices. A libertarian philosophy undergirds everything that she says. Personal choice and individual freedom are exalted and are fundamental in how she characterizes the challenge of overcoming our health crisis. Social, political and cultural dimensions are barely mentioned, which, it is worth stressing, stands out in someone who will be responsible for protecting the nation’s public health. Means’ pro-business bias is evident in desisting from the staunch criticism of corporations found in the MAHA report. You don’t have to be a Marxist to be dismayed by the contradictions of a healthcare for profit system. And honestly, doesn’t capitalism bear responsibility for perpetuating and orchestrating our desires, leading us to ever increasing consumption? It is disappointing, too, that Means pays no attention to the outsized role that insurance companies have in contributing to the dominance of our bad energy.

Some of Means’ elaborations for the pursuit of good energy head in directions that do not seem monumental or very appealing. For example, she recommends walking (and getting steps in) as she brushes her teeth. Or a bit more strangely, holding herself accountable for better sleep habits by devising a plan to clean her friend’s home, if she failed to carry them through. Her recommended diet eschews moderation and does not welcome indulgences; there are no invitations to linger in pleasure.[iii] Most importantly, the diet seems quite unrealistic for (most) families who are pressed for money and time, especially since Means is not inclined to envision a role for the government.

Means is partial to stating things in extreme forms, the best example of which is her belief that “cancer is often a preventable disease” (p. 67). Indeed, throughout the book, Means reflects on her mother’s plight, diagnosed with various metabolic disorders and then pancreatic cancer, to which she ultimately succumbed. The book bears a dedication to her mother: “Born in 1949, died 2021 of pancreatic cancer (a preventable metabolic condition).” I pass no judgement on this statement, but I would hesitate to accept the implication that everyone who receives a cancer diagnosis could have prevented it.

The saga of Means’ relationship to her mother lies at the center of this book. Means celebrates their closeness as death approaches, emphasizing how she shared her mother’s cosmological sense of being part of something larger and awe-inspiring, where death is not to be feared. This relates to Means’ stance of fearlessness, which aids her to overcome her earlier fear of death. While it was moving to hear about the bonding between mother and daughter, I was struck by the absence of sadness as part of the experience. Facing death, not avoiding it, has merits; but perhaps not at the expense of making room for the loss that it entails? The limitless health which Means projects for her project feels like a denial of the unavoidable limits of our health, a denial of the anguish and mystery of death. There are moments when something will remind me of my mother (who died almost 30 years ago), where I am pained with longing and deep sadness. And I wouldn’t have it any other way. The pain serves to create a sense of abiding connection.

It is no surprise that someone like Means would be nominated for Surgeon General under the current administration. A non-licensed professional,[iv] undaunted in shilling for her own entrepreneurial projects, and unconcerned with anyone who lacks the time or money to adopt her dietary recommendations, Means augurs the exit of public health into private wealth.

[i] “With Calley Means” is listed under Casey Means’ name as author. Her brother, Calley, is an attorney and senior aide to RFK Jr, who apparently facilitated the rapprochement between Trump and RFK, and is widely regarded as having shepherded the MAHA report (discussed in my last newsletter: https://elliot4cc.substack.com/p/mentalizing-health-78f). There are significant differences between how mental health is characterized in the MAHA report and in this book, which I will note.

[ii] In the Introduction, Means suggests that reversing the course of our metabolic health “is under your control and simpler than you think,” which might seem encouraging but does not seem realistic. Another example of inflated rhetoric is the title of a chapter: “Trust Yourself, Not Your Doctor.” Is it helpful to conjure an either/or that denies the possibility of dialogue between patient and doctor?

[iii] Jessica Winters’ description of Means’ book as part “orthorexic diet guide” is apt: https://www.newyorker.com/books/second-read/what-casey-means-and-maha-small-want-you-to-fear. On orthorexia, see: https://link.springer.com/article/10.1007/s40519-025-01743-2. For a more moderate perspective, see Emeran Mayers’ The Mind-Gut Connection (2016), who urges us to “Enjoy the secret pleasures and social aspects of food” (p. 288).

[iv] Means graduated from Stanford Medical school, but she dropped out of her ENT surgical residency program at Oregon Health and Science University. She had a functional medicine practice.