Emotional Support? Law, Social Control, and the Medicalization of the Human–Animal Bond

Abstract

In recent years, the socio-legal concept of emotional support animals (ESAs) has come under increasing scrutiny in the U.S. Widespread confusion about the legal status of ESAs versus service animals and concerns about misrepresentation have resulted in a backlash and a cascade of new legislation addressing “fake service animals.” However, this reaction reveals a broader social problem rooted in policy lag: the integration of companion animals into society has not kept pace with the rise of multispecies families. This article examines law, policy, and public discourse about ESAs within two distinct social contexts: (1) the emergence of multispecies families alongside the systemic exclusion of companion animals from many private and public spaces, and (2) the medicalization of relational bonds and everyday life. Although well-intentioned, the legal and social construction of ESAs creates a two-tiered system where caregivers of companion animals must acquire a medical diagnosis in order to obtain equal access to basic necessities like housing. In addition to resting on weak evidence, the ESA framework diverts attention from macro social issues by pathologizing the individual, creating a problematic medicalization of the human-animal bond that is ultimately detrimental to the well-being of companion animals, their caregivers, and people with disabilities. The construct is also troublingly anthropocentric, centering what animals can do for humans without considering the psychological and emotional support needs of the animals themselves. This article concludes that the anthropocentric medical model advanced by the ESA construct should be replaced with a multispecies social model that supports the human-animal bond without unnecessary medicalization. This approach advocates for equitable laws and policies, such as the expansion of pet-inclusive housing, that benefit families that include companion animals and the communities in which they are embedded.

1. Introduction

The socio-legal concept of emotional support animals (ESAs)—or an animal that provides therapeutic comfort without needing task-specific training—has come under increasing scrutiny in the U.S. over the last decade. Widespread confusion about the legal status of ESAs versus service animals, and concerns about misrepresentation, led to a cascade of new legislation pertaining to so-called “fake service animals” and, in 2021, the removal of federal protections for ESAs under the Air Carrier Access Act [1].

Although both are broadly considered assistance animals, the roles, requirements, and rights of access for ESAs differ widely from service animals. However, until recently these differences were not well understood, which incentivized misrepresentation. Whether through deliberate deceit or genuine ignorance of the law, misrepresentation enabled access to spaces where animals are generally not allowed. Yet this issue of misrepresentation is symptomatic of a broader policy lag: the integration of companion animals into society has not kept pace with the rise of multispecies families. It is important to note that misrepresentation in this context occurs in two ways that are often conflated: misrepresenting pets as ESAs and misrepresenting ESAs as service animals. (For purposes of this article, I use the words “pet” and “companion animal” interchangeably throughout to mean a non-assistance animal).

Misrepresentation has been successful in part because neither service dogs nor their handlers are required to display or carry identification in public. Intended to protect individuals with disabilities from undue burdens, this policy had the unintended consequence of creating conditions that were easily abused and easily misunderstood. However, at the root of this problem is the ESA construct itself, which is inherently flawed due to its conceptual and clinical weakness.

This discussion focuses on dogs because federal law allows only dogs (and much less commonly, miniature horses) to be used as service animals. ESAs can be any type of animal but, despite sensationalistic stories about pigs on planes, alpacas in drugstores, and turtles in museums [2], dogs are by the far the most common ESA.

Finally, the geographic focus of this discussion is the U.S., because the legal recognition of ESAs as a distinct category is largely an American phenomenon, with rights largely restricted to the housing context. The ESA concept has limited applicability in Canada at the provincial level, particularly in housing, but is not explicitly defined by law. In Mexico, national air regulations recognize ESAs and permit them to fly in the cabin free of charge, but unlike the U.S., they do not have legal status in housing contexts. Outside the United States and Canada, legal recognition of ESAs is minimal to nonexistent. Many major jurisdictions, such as the UK, EU countries, and Australia, rely solely on the definition of a service animal or assistance animal [3].

2. The Legal Landscape

The Americans with Disabilities Act of 1990 (ADA), modeled after the Civil Rights Act of 1964, is a sweeping federal law that prohibits discrimination against people with disabilities in the U.S. [4,5]. Service animals are defined by the ADA as a dog or miniature horse who is individually trained to perform a specific task related to a person’s disability. Service animals have broad legal access to public places. The ADA sets minimum legal standards. State and local laws may provide additional protections but if they provide lower standards, federal law prevails via the doctrine of preemption.

In contrast, ESAs are defined and covered by a patchwork of federal, state, and local laws, mostly related to housing. ESAs have no federal training requirements. Their mere presence is considered therapeutic, as attested to in writing by a licensed mental health professional (similar to a prescription). The ADA does not apply to ESAs and they are not granted the broad access to public accommodations that service animals are. However, this important legal distinction was not well understood until relatively recently, when escalating social tensions began to raise awareness around this issue.

Although ESAs are not covered under the ADA, two other federal laws, more limited in scope, did apply to them until 2021: the Fair Housing Act (FHA) and the Air Carrier Access Act (ACAA). The FHA, enacted in 1968, prohibits disability-based discrimination in housing. Originally covering discrimination based on race, color, religion, or national origin, it was amended in 1974 to include sex, and again in 1988 to include disability and family status as protected categories [6].

The FHA itself does not use the term “emotional support animal.” However, the U.S. Department of Housing and Urban Development (HUD), which enforces the FHA, defines assistance animal broadly [7]. This definition includes both service animals and animals that provide emotional support to alleviate one or more identified effects of a person’s disability. Because of this interpretation, the FHA allows ESAs as a “reasonable accommodation” in rental units that otherwise prohibit pets.

Likewise, the ACAA, enacted in 1986, prohibits disability-based discrimination in air travel. Until recently, the ACAA allowed ESAs to accompany their handler free of charge in the cabin on flights that otherwise prohibit animals over a certain size. However, the U.S. Department of Transportation (DOT) revised its regulation governing air travel, effective in 2021, to remove protections for ESAs [8].

2.1. Peddling Confusion

In the years leading up to the ACAA revision, opportunistic actors took advantage of the uncertainty around the legal status of ESAs versus service animals. A cottage industry of online merchants selling service animal paraphernalia and ESA letters emerged, thriving amid the confusion, and exacerbating it.

Although vests, badges, and other service animal signifiers began to proliferate in public spaces, these symbols have no legal meaning under federal law. ADA service animals—the only dogs allowed by law to accompany their handler virtually anywhere—are not required to wear or display identification, nor must they be certified or registered by any entity [9].

By law, staff may only ask two questions of a person accompanied by a dog when their service animal status is not obvious: (1) is the dog a service animal required because of a disability, and (2) what work or task has the dog been trained to perform. They may not ask about the disability, require medical documentation, or request that the dog demonstrate the work or task [9].

Yet, the empty spectacle of “service animal” signifiers was often convincing—or at least confusing enough to deter confrontation by staff—until perception began to shift in the late 2010s and early 2020s. This shift was driven in part by business efforts to raise awareness, often by prominently displaying signs at their entrances with the legal definition of service animal. It was also driven by media coverage that stoked what has been called a moral panic over fake service animals [10,11]. This panic, in turn, led to the legislative reactions discussed below.

2.2. Removal of ESA Protections Under the Federal Air Carrier Access Act

In 2020, amid mounting controversy over the legitimacy of ESAs and their increased presence on airplanes, along with increased passenger complaints, the DOT amended the ACAA to remove protections for ESAs [8]. This rule became effective in 2021.

The revised rule, which followed more than 15,000 public comments regarding service animals on aircraft, was a significant alteration because it removed federal protections in one of only two settings where ESAs had previously been granted access. Currently, the FHA is the only federal law that covers ESAs.

The revised ACAA did not prohibit ESAs from flying in the plane cabin, but rather delegated decision-making authority to the airlines, permitting them to reclassify ESAs as pets instead of service animals. Within weeks of the changed rule, multiple major airlines announced they would no longer accommodate ESAs. This means those animals must now abide by the same rules as animals defined as pets: unless they are small enough to fit under the seat in a carrier for the duration of the flight, they must be transported as cargo with the checked luggage beneath the plane.

This was a significant change for animal well-being as animals flown in the cargo hold risk psychological harm, physical injury, misplacement, and death [12,13,14,15,16]. Threats to physical and mental well-being include excessive noise, extreme temperatures, and faulty ventilation or pressurization, with brachycephalic breeds being especially vulnerable to these risks [17,18]. Deaths and serious injuries are statistically rare, but even when animals arrive relatively unscathed, being transported in the cargo hold is a stressful and potentially traumatizing experience. Thus, the removal of protections for ESAs under the ACAA affected not only people who wanted or needed to fly with their animals, but also the animals themselves.

2.3. State Laws Banning Fraudulent Service Animals

Independent of these federal changes, state lawmakers across the U.S. also moved to address what the media repeatedly referred to as an “epidemic of fake service animals.” As of 2025, more than 30 states have banned the use of fraudulent service animals [19]. Most of these laws were enacted within the past decade. For instance, the American Kennel Club tracked more than 150 laws related to what it called “the epidemic of fake service dogs” between 2016 and 2022 [20].

Unlike the revised ACAA, these state laws generally did not remove any existing protections for ESAs (of which there are few beyond those that mirror the federal FHA). However, some did tighten regulations. For example, to clamp down on ESA “letter mills” that issue rapid documentation, some laws require a therapeutic relationship of a minimum duration before a letter can be provided. Typical of these laws is California’s AB 468, which became effective in 2022 and requires an established client-provider relationship of at least 30 days [21]. Several other states have passed similar laws.

Other state laws tightened or introduced new criminal penalties for misrepresenting a service animal, and in some cases clarified that definition to expressly exclude ESAs. For example, in 2015, Florida enacted a law that created a second-degree misdemeanor “for a person who knowingly and willfully misrepresents that he or she is qualified to use a service animal.” This law explicitly states: “the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for purposes of this definition” [22].

In 2020, Florida passed another law that tightened requirements around ESAs [23]. In announcing the bill’s passage, Florida Senator Kevin Rader captured the sentiment of many lawmakers when he said: “people should not be permitted to submit ‘phony baloney psychological papers,’ which can be obtained online for less than $100, to falsely claim that their pet is an emotional support animal” [24].

New York enacted a law in late 2017 that makes it a violation to “knowingly affix to any dog any false or improper identification tag … for identifying guide, service, therapy or hearing dogs” [25]. Arizona passed a similar law in 2018, mandating that a person may not “fraudulently misrepresent an animal as a service animal or service animal in training” in a public place [26]. And in 2023, Texas passed a law making it a misdemeanor to intentionally represent “that an animal is an assistance animal or a service animal when the animal is not specially trained or equipped to help a person with a disability” [27].

In 2025, Iowa amended its existing law regarding misrepresentation of a service animal to make it easier to bring criminal charges. Intentional misrepresentation was already a misdemeanor offense, but previously a person could only be charged if: (1) the person had previously been given a warning and (2) the person knows the animal in question is not a service animal. The new law removes those conditions [28].

3. Backlash and Moral Panic

Both the trend of ESA misrepresentation and the resulting media-fueled backlash reflect deeper issues affecting companion animals in society. Specifically, there are a lot of places companion animals are not allowed to be, yet more people than ever live with them and consider them part of the family [29,30,31]. This tension reveals a policy lag rooted in outdated legal and social structures that have failed to keep pace with modern conceptions of family.

In a society where companion animals are increasingly thought of as family yet are subject to extensive restrictions about where they can be, it is predictable that some guardians would “bend the rules,” exploit loopholes, or even lie to prevent being separated from their animal. This is especially true in the context of the two important spheres in which, until 2021, ESA status did confer privileges of access: housing and air travel.

Yet, the controversy surrounding the legitimacy of ESAs was not confined to these legally protected contexts. It spilled over into other settings where dogs are generally not allowed—including stores, bars, restaurants, public transportation, and other public accommodations.

As public awareness about the widespread conflation of ESAs and service animals grew, uncertainty gave way to skepticism, resentment, and anger—leading to a backlash against not only ESAs but also service animals. This backlash had characteristics of a moral panic, or an exaggerated reaction to a perceived societal threat [32], negatively impacting individuals with disabilities who have a legal right for their service animal to accompany them essentially anywhere the public can go.

This backlash was noted by people with disabilities who experienced heightened scrutiny and doubt about their legitimate service animal, in some cases being denied entry or asked to leave an establishment in clear violation of the ADA, which is unambiguous about the legal obligation of public accommodations to provide access [10,33,34,35,36,37]. While the ADA is straightforward, many business owners are unfamiliar with the specifics of the law. This puts an individual with a disability in the uncomfortable position of having to either insist on their rights and explain the law, or capitulate to avoid conflict and potential embarrassment. Their only recourse is then to pursue an ADA discrimination claim at a later time—an onerous burden to place on an individual who was in clear compliance with the law.

Contributing to this backlash, and tipping it toward a moral panic, were sensationalistic media stories about unusual species brought on planes under the guise of being service animals—such as peacocks, ducks, pigs, and snakes [38,39,40,41]. These incidents were uncommon, and in at least one case involved a gonzo stunt by an undercover journalist whose mission was to expose the laxness of policies around ESAs [2].

Along with the sensational stories were more troubling incidents of ESAs, generally dogs, causing disruptions and even attacking passengers on planes [42,43,44,45,46]. Such incidents received extensive media coverage and caused passengers to worry for their safety while confined with a potentially aggressive and untrained animal in a cramped airplane row.

These incidents also underscored a key difference between service animals and ESAs: training requirements. Service animals are not only trained to perform a disability-related task but also to be well-behaved, quiet, and non-reactive in public. Disruptive behavior from a service animal is one of the few legal reasons they can be removed from a public space. In contrast, ESAs generally have no training requirements and, just as animals defined as pets, may or may not be well socialized for public settings.

No Dogs Allowed

Moral panics tend to result in increased social control [32], which in this case is represented by the legal reforms intended to clamp down on misrepresentation. However, misrepresentation, to the extent it exists, is a symptom and not the cause of a broader social problem: the integration of companion animals into society has lagged behind the rise of multispecies families.

For example, the single context in which ESAs are still legally protected—housing—is a basic human need. However, it is common for housing providers to either ban companion animals outright, or to advertise as “pet-friendly” but maintain policies that exclude a majority of dogs. Examples of such policies include prohibitions on common breeds and permitting only very small dogs (e.g., dogs under 20 lbs.).

While 79% of rental properties claim to allow pets, fewer than 10% qualify as pet-inclusive, with no breed or weight restrictions [47] (p. 7). The only way for prospective tenants with a non-human family member to legally access this abundance of housing is to show their animal is an ESA. The fact that people use ESA designation as a way to secure housing is borne out by research, with one study finding that 41% of ESA designations were motivated at least in part by housing needs, and nearly half of ESA owners cited size or breed restrictions as their primary reason [47] (p. 13).

In addition to being scarce, pet-friendly rental housing is often more expensive due to extra deposits and so-called “pet rent,” which are a key barrier to securing housing. Pet-inclusive housing—without breed or weight restrictions, and without additional “pet rent”—is rarer still. The consequences of these companion animal-exclusionary policies are profound. The study above found that “more than 80% of dog owners reported difficulty securing housing, leading many to rehome their pets, misclassify them as emotional support animals, or hide them” [47] (p. 8).

These policies cause tenants to feel they must choose between housing and keeping their companion animal. “No-pets” policies have wide-ranging negative social impacts that extend beyond their immediate effect on individual families. They are a significant contributor to housing insecurity, and numerous studies show that scarcity in pet-inclusive housing is a top reason why people relinquish their animals to shelter facilities [48,49,50,51]. This is especially true for individuals experiencing economic hardship. Among respondents who rented, one study found that housing reasons were the number one reason for re-homing, and respondents of lower income were significantly more likely to re-home due to cost and housing issues as opposed to pet-related issues [50] (p. 50).

In this context, it is unsurprising that some people will seek an ESA designation, whether “needed” or not, to secure a place to live with their companion animal—and this question of necessity is one of the fundamental flaws of the ESA concept. Many people know that ESA designation is a workaround but have gotten a letter so they can live or fly with their companion animal. It has become an open secret that the ESA designation can be used to circumvent “no pets” policies, as well as pet fees, breed restrictions, and a host of other exclusionary policies.

While air travel is no longer protected, many guardians are understandably reluctant to fly their companion animals as cargo due to the well-documented risks, even though air travel with family members in a country as large as the U.S. is often necessary. The U.S. is also a country in which train travel is both underdeveloped and as restrictive to animals as airplanes now are. Difficulties traveling with a companion animal family member contribute to “creative” solutions, including misrepresentation.

4. The ESA Concept Is Fundamentally Flawed

Policies that make travel and housing off-limits to a large portion of the population, coupled with a confusing legal landscape, incentivize creativity and deception. However, there is a deeper problem at work here. Although it is well-intentioned, the ESA concept itself—even when applied sincerely and adhered to as intended—is fundamentally flawed, for at least two major reasons. First, it diverts attention from macro-social issues by pathologizing the individual and medicalizing the human–animal bond. Second, it is inherently anthropocentric, centering what animals can do for humans without considering the emotional support needs and psychological well-being of the animals themselves.

4.1. The Medicalization of the Human–Animal Bond

Medicalization as a sociological concept refers to “defining a problem in medical terms, using medical language to describe a problem, adopting a medical framework to understand a problem, or using a medical intervention to ‘treat’ it” [52] (p. 211). It also describes the process by which “an ever wider range of human experiences come to be defined, experienced, and treated as medical conditions” [53] (p. 21).

The construction of the boundary between everyday “problems in living” [54] and mental illness has long been the subject of debate. In the late 1960s and early 1970s, scholars began to study issues surrounding social control and a range of human problems that had come under medical jurisdiction [55]. This area of inquiry continues, with many social scientists and clinicians critiquing the increasing medicalization of daily life as a worrisome trend with deleterious consequences [52,56,57,58,59].

The social construction of ESAs represents a problematic medicalization of a commonplace truth: relational bonds generally have a positive effect on mental health. Forming social bonds is a routine feature of everyday life, and a prescription is generally not required to do this. Yet, our bonds with animals are different because activities inherent to the relationship, such as living or traveling together, are restricted by the state. This is because “nonhuman family member” is not a protected legal status.

This medicalization creates a two-tiered system where in order to obtain equal access to basic necessities like housing, caregivers of companion animals must often medicalize some facet of their life. Prescribing the comfort of animals as if they were pharmaceutical drugs contributes both to diagnostic inflation and to the objectification of animals, who have their own emotional needs and do not exist to provide comfort for humans. While laws applying to service animals literally conceptualize them as medical equipment, this is not a status that should be expanded, as it fails to adequately differentiate animals, as living beings, from other types of inanimate property. Animals are not mere tools or assistive devices and the law should be clear on this.

The rhetoric of objectification regarding service dogs is found not only in legal contexts but also in the discourse of their trainers and handlers. As one long-time service dog trainer told a news outlet: “This [dog] is no different than a wheelchair or a walker or oxygen. This is medical equipment” [60].

Companion animals can provide numerous psychological and emotional benefits to their human caregivers, regardless of whether that person has a diagnosed mental disorder or disability. For many people who share their lives with companion animals and consider them family, these animals are a significant source of emotional and social support, which can lead to enhanced subjective feelings of well-being, agency, and purpose.

However, research in the area of companion animals and mental health is inconsistent, with one scoping analysis calling the literature a “plague of mixed results” [61]. Some studies show positive effects, some show no effect (or an ostensibly positive effect that is actually mediated by another variable), and others reveal negative effects [61,62,63,64].

A recent study provides an example of one such intervening variable, finding “attachment to humans fully mediated the positive association between emotional attachment to pets and mental health burden.” The study also revealed potential negative effects of emotional attachment to pets:

A stronger emotional attachment to one’s dog was associated with lower comfort with depending on or trusting in others, whereby lower comfort with depending on or trusting in others was related to higher mental health burden. Moreover, a stronger attachment to one’s dog was also related to a greater fear of being rejected and unloved (Anxiety), which was, in turn, associated with a higher mental health burden.

[65]

Psychologist Hal Herzog is a leading expert in the science of the “pet effect,” or the belief that pets positively impact human health. He has noted an interesting mismatch between common beliefs about the positive impact of pets and the actual research results: “Most pet owners—including me—personally believe that our pets make our lives better. But what we want to believe about pets does not always jibe with the results of empirical research” [66].

New research, which may help explain some of the variability in the studies to date, suggests that the quality of the human-dog relationship, including their dyadic interactions, is an important mediating factor. This study found that mindfulness activated in the presence of one’s dog increased owners’ psychological well-being, as well as interspecies interactivity [67]. This is perhaps unsurprising since animals and their guardians are individuals, and their relationships can be very different.

4.2. Lack of Evidence for the Clinical Concept of Emotional Support

Within this morass of mixed evidence, the ESA concept fares particularly poorly. While anecdotes abound, data supporting the clinical “emotional support” concept is thin.

The American Psychiatric Association (APA), for example, has issued guidance that cautions against the lack of scientific literature supporting the efficacy of ESAs. Its resource document on emotional support animals for psychiatrists and other mental health professionals notes “although some patients may be interested in obtaining an ESA, there is not a strong evidence-base regarding the clinical benefits of ESAs for psychiatric symptoms or disorder” [68] (p. 6). A key takeaway from the APA’s white paper is “although there are reasons to believe that pet ownership may help alleviate impairing psychiatric symptoms, there is limited research to support the use of ESAs” (p. 6).

Given the absence of evidence showing therapeutic benefits of ESAs specifically beyond those that may adhere to pet ownership generally, the APA instructs its members that it is permissible to decline to write an ESA letter. It also notes potential ethical concerns relating to role conflict and cautions against writing letters to help patients “bend the rules” with regard to no-pets policies:

Psychiatrists contemplating writing an ESA letter should be aware of several ethical considerations. It is unethical and illegal to engage in disability fraud by writing ESA letters simply to allow patients to bring pets to non-pet-friendly venues, to avoid fees associated with having a pet, and/or to override restrictions on breeds and species … Even when a patient has a genuine psychiatric disability, given the limited evidence supporting the use of an ESA, it is ethically permissible to decline to write an ESA letter.

(p. 8)

Analyzing evidence for the therapeutic benefit of ESAs, the authors of a research article examining the role conflicts that psychologists may face concluded:

Clearly, this is an area in need of rigorous, empirical research. Given the paucity of evidence regarding the efficacy of ESAs in augmenting human physical/mental health, it is problematic that psychologists are writing letters of support for their patient’s need for an ESA.

[69] (p. 259)

In sum, the evidence about the benefits of companion animals on mental health in general is mixed, but the evidence for the clinical ESA concept in particular is lacking. The upshot is that to the extent benefits exist, they appear to exist for everyone who shares their lives with a companion animal. Thus, the ESA concept pathologizes a normal feature of the human–animal bond.

Making access to fundamental features of society like housing dependent on companion animal guardians sincerely inhabiting—or cannily enacting— a “sick role” [70] is problematic for many reasons. Among them, it erases the lived experience of the vast majority of people for whom a bond with a companion animal provides vital emotional support—in the same way a human family member might—without them being pathologized or labeled as mentally unwell. Medicalizing “emotional support” encourages both fraud and sincere but misguided self-pathologizing, in part because as a clinical concept it is indistinguishable from the ordinary benefits of a healthy relationship, whether with a human or animal companion.

4.3. Diagnostic Inflation

Another negative consequence of the ESA concept, often glossed over in the discourse, is its contribution to diagnostic inflation. Diagnostic inflation in psychology refers to the process by which an increasing number of people are labeled as having a mental disorder, in part by lowering the diagnostic thresholds for existing common disorders. Relaxed diagnostic criteria lead to a higher prevalence of conditions pathologizing normal human behavior [56,58,71,72].

For example, many Americans experience subthreshold symptoms of anxiety, depression, and/or post-traumatic stress without meeting the full diagnostic criteria for a clinical mental disorder, which is based on the number and frequency of symptoms and their impact on daily life. Diagnostic standards also shift over time and are subject to social forces and prevailing cultural beliefs. Subthreshold versions of mental disorders can cause distress and impairment even if they do not meet current criteria for diagnosis. Further, a disorder does not by itself equate to a “disability” under federal law.

Because a disability is often required to designate a companion animal as an ESA, the lines between everyday problems, clinical mental disorders, and legal disability are further blurred. For example, a diagnosis of generalized anxiety disorder is not enough on its own. To meet the legal threshold of a disability, a person generally must experience functional impairment from the disorder, meaning it substantially limits one or more major life activities. This is also a confusing area of the law that is subject to different interpretations and substantial litigation around definitions of disability, “reasonable accommodation,” and related terms. The ESA concept incentivizes people with companion animals to seek out a disability diagnosis, which would otherwise not be needed, in order to secure housing or other accommodation.

Given these legal complexities, mental health professionals have issued warnings about both the stringent criteria and the limited scientific support for ESAs, as noted in one study:

What is clear from the literature … is that the person that qualifies for an ESA not only has to present with a DSM [Diagnostic and Statistical Manual of Mental Disorders] diagnosis, but they have to be significantly impaired by that psychological disorder or problem. Finally, the presence of the ESA has to have a significant impact on their psychological disorder or problem such that without its presence, the individual cannot adequately function … Psychologists who perform these assessments also need to be aware of how little scientific literature exists that supports the assumption that the presence of an animal has any palliative impact on a patient.

[69] (p. 258)

In sum, the ESA concept medicalizes common experiences, such as difficulties and emotions that are rational responses to daily life, and in doing so, brings them under the control of the state. It also motivates individuals who have “normal” (sub-diagnostic) levels of anxiety and depression to exaggerate everyday difficulties to obtain unnecessary medical diagnoses so they can keep their companion animal with them. This process contributes to the problem of diagnostic inflation.

4.4. Anthropocentricity: Emotional Support for Whom?

Another troubling aspect of the social construction of the ESA concept is that it supports an anthropocentric medical model where companion animals are perceived to exist as support for humans, but where that support only flows one way. Animals need to be supported too, and they have their own emotional, social, and psychological needs. The one-sided expectation that dogs provide humans with emotional support is indicative of anthropocentric narcissism.

Framing these expectations in positive terms as something dogs are inherently good at—an essential part of their nature—is an example of benevolent speciesism. Similar to benevolent sexism [73,74], these stereotypes at first glance may not appear harmful to dogs because they are complimentary:

Benevolent speciesism may include ideas about how ‘wonderful’ dogs are—similar to the ‘women are wonderful’ effect in which women are regarded positively but paternalistically … [But] the wonderful qualities that dogs are thought to possess often reflect what dogs do for us and how they make us feel—not who they are. Dogs are often exalted because of how well they seem to exalt humans. Yet dogs have their own experiential worlds and subjective experiences apart from their role as mascots in human lives.

[75] (p. 5)

The National Service Animal Registry, a private organization that provides registration for service dogs and ESAs (but does not confer any legal status), exemplifies this attitude in a blog post extolling the positive effects of emotional support animals:

The joy of owning a pet is the unconditional love they give, no matter what. An ESA doesn’t care if you’re feeling out of sorts. They love you anyway! There’s nothing like the unconditional love of an animal, but it’s especially helpful to a person with emotional health issues. It’s not uncommon for a person who has a mental health condition to feel unlovable. At the least, they may not feel like being around people. Your ESA will stay by your side, loving you right through the dark moments.

[76]

The last section of this blog post urges readers to “order your ESA letter today,” which links to a payment form on their website where you can buy an ESA letter for $179.95 (on sale from $250.00).

Your animal may stay “right by your side” but, unlike human adults (yet similar to human children), they literally cannot leave. The assertion that your ESA will “love you no matter what” is widespread in the discourse around companion animals and mental health and focuses only on the human’s needs. This reflects the cultural concept of “unconditional love,” which as applied to dogs is problematic for many reasons [77]. Among them, it ignores power dynamics and the fact that dogs are dependent on their legal owners to fulfill all of their needs—from basic survival needs, such as food, water, and shelter, to higher-order psychological, social, and behavioral needs, such as companionship, exercise, and mental stimulation.

In 2014, well before the ACAA revision that removed protections for ESAs in air travel, a passenger caused a disruption when she brought her “emotional support pig” onto a US Airways flight:

Fellow passengers [said] that the big brown pig stank up the cabin of the tiny D.C.-bound aircraft and defecated in the aisle … When she tied him to the armrest and tried to clean up after him, he began to howl. ‘She was talking to it like a person, saying it was being a jerk.’

[39]

A pig who is howling and defecating in the aisle is likely experiencing stress, of course, not being a “jerk.” While the passenger and her pig eventually deplaned, the pig appears to have survived this incident. The same cannot be said for the unfortunate “emotional support hamster” who was flushed down the toilet in an airport bathroom—causing his death—when his owner, a college student trying to travel home for the holidays, was told she could not bring him aboard the flight [78]. These are egregious examples of the anthropocentricity of the ESA concept, but the emotional support dogs who have bitten people on planes are also undoubtedly stressed.

This is not meant to challenge the fact that companion animals can, by their mere presence, provide emotional support to their caregivers. Rather, it is a call to be mindful that this care and support should go both ways.

5. From an Anthropocentric Medical Model to a Multispecies Social Model

In addition to its dubious clinical underpinnings, I have argued that the ESA construct is inherently flawed because it advances an anthropocentric medical model potentially harmful to animals. This model should be replaced with a multispecies social model characterized by equitable laws and policies that recognize the validity of multispecies families. This would foster interspecies relationships that are mutually beneficial, centering the emotional and psychological well-being of both members.

The traditional medical model focuses on disability as an individual defect or pathology. Thomas Szasz [54], an influential critic of institutional psychiatry who drew attention to the political nature of psychiatric diagnosis throughout his lengthy academic career, coined the term “medical model of disability.” The medical model of disability critiqued the pathologizing of mental health conditions as “illnesses,” highlighting the complex psycho-social aspects of health and illness [79]. In contrast, the “social model of disability”—coined by sociologist and disability rights advocate Michael Oliver [80]—focuses on societal, rather than individual, problems and looks to equitable legal, political, and policy solutions to improve access to society for those with impairments. In the ESA context, we can add another dimension to these models: anthropocentrism.

The ESA construct removes the focus from social conditions and policies that should be improved to better support the human–animal bond, such as fair housing policies, and places the onus instead on the medicalized individual. This creates a two-tiered system where people with companion animals must have a diagnosed disability to secure basic necessities like housing. This approach erases the lived experience of the vast majority of people who benefit from their bond with an animal without being labeled as mentally unwell. It also encourages fraud and sincere but misguided self-pathologizing, as the clinical concept of “emotional support” is indistinguishable from the ordinary benefits of a healthy relationship with a companion animal.

Under a multispecies social model, laws and policies support the human–animal bond without the need for medicalization. Prohibitions on sweeping “no pets” policies in rental housing, as well as arbitrary bans based on weight, are an example of such laws.

6. Policy Solutions

The legal and cultural recognition of companion animals as family would support any positive effects of the human–animal bond on mental health without pathologizing that bond. This in turn would remove incentives for the deception and fraud that new laws against “fake service animals” are purportedly addressing.

It is worth noting that the laws criminalizing service animal fraud are considered by some to be harmful rather than helpful to individuals with disabilities who use legitimate service animals. Making things more difficult for those with disabilities is an unintended negative consequence of these laws, and the opposite of what they are meant to do [10,81,82].

6.1. Animal Family Member as a Protected Legal Status

If animals were legally defined as family members under the FHA—the only current federal context in which ESAs are recognized—discrimination against renters with companion animals in housing would be illegal. There is policy precedent for restricting housing providers’ discretion to impose sweeping bans on certain types of tenants. For example, the current legal protections that exist for renters with children have only been in place since 1988, when the FHA was amended to include family status. Before these amendments, landlords were able to set “no children” policies and restrict the ages and number of children allowed in rental units. This eventually came to be understood as unfair and discriminatory.

Family status could be expanded to include companion animal family members, which would reflect social changes in the definition and composition of family. Regarding the current definition of family status under the FHA, one commentator argues:

The statutory language quite apparently refers to human children, and it can be assumed that the federal government had only humans in mind when crafting the amendment. However, shifting American family dynamics call for either an amendment to or a judicial reinterpretation of this definition to include pets. Congress should amend the definition to explicitly include pets as part of the familial status for which landlords may not discriminate against renters.

[83] (p. 467)

Although the U.S. legal system is ambiguous about animals holding the dual status of property and family member, this area of law is also evolving. Multispecies family law—where family law and animal law intersect—has seen advances in the areas of pet custody, domestic violence protective orders that include companion animals, and co-sheltering in cases of disaster evacuations, among others [84]. Outside the U.S., there have been some important judicial rulings in Latin America that have made further strides toward codifying companion animals as family members [85,86,87].

For now, more modest but achievable policy inroads, such as expansion of pet-inclusive housing, will not only mitigate deception but also reduce companion animal relinquishment, which will help alleviate the ongoing shelter capacity crisis [88,89]. It will also help people by not forcing them to choose between their companion animal and a basic necessity like housing.

There have been positive trends in this area. For example, in 2024, Washington, D.C., enacted the Pets in Housing Amendment Act, which limited pet fees and banned breed and size restrictions in rental housing that allows companion animals [90]. That same year, Florida prohibited public housing policies that ban dogs based on breed or size [91], and Colorado limited the amount of fees landlords can charge tenants with companion animals [92].

In 2024, California also considered a bill that would have made it the first state prohibit blanket “no pets” policies in all rental units, requiring “landlords to accept pets in their rental properties without imposing any additional pet rents or security deposits” [93]. This bill adopted a similar framework to existing California law prohibiting blanket “no pets” policies in public housing and would have extended these protections to all renters in the state. However, the bill was withdrawn following strong opposition and persistent lobbying efforts from rental property associations and industry organizations [94].

While no state yet has banned sweeping companion animal-exclusionary policies, some jurisdictions outside the U.S. have enacted similar laws. For example, the Australian state of Victoria banned “no pets” policies in all rental housing in 2020 [95]. Likewise, the Canadian province of Ontario has made “no pets” clauses in leases unenforceable since 1997 [96].

6.2. Exclusionary Policies and Everyday Dilemmas

Misrepresentation came to be identified as a social problem in part because of consternation over the proliferation of dogs in public spaces. While some reasons for bringing a companion animal into a public place may seem frivolous—or selfish in the case of a dog who is visibly distressed or anxious and would be happier at home—there are other times when “no pets” policies create a genuine hardship.

Imagine you are on a long drive with your dog—perhaps a multi-day trip across several states since air travel is not an option if you are unwilling to fly your dog as cargo. Now you need to use the restroom. You will be faced with signs prohibiting any animals except service animals in every public restroom. But what if it is too hot to leave your dog in the car and you are alone with her? This is but one example of a real dilemma faced by responsible dog guardians traveling with their dog.

Or what if you do not have a car, but you need to bring your animal to the vet? Public transportation often has “no pets” policies, especially for larger dogs.

We do not know why someone has brought their dog with them into a public space, and it is tempting to assume they are entitled, self-centered, clueless, or worse. And they might be. But blanket no-pet bans are not the best response to rude or anti-social behavior by some humans. In the U.S., it is not uncommon to observe unruly children in public whose behavior may be annoying to others. This is rightly considered a private or individual problem not solved at the policy level of banning children from all public places. Of course, dogs are not children. However, as the culture pays increasing lip service to them being family members, policy reform is clearly needed.

6.3. Training Requirements and “Canine Good Citizens”

Pervasive misuse of the ESA construct reveals a real social need. Sweeping bans on companion animals disproportionately affect lower-income individuals, especially in the areas of housing and public transportation. A more equitable and reasonable solution would be to establish training requirements for dogs in public.

This would require enforcement and oversight, but a standardized training certification (such as the American Kennel Club’s (AKC) Canine Good Citizen, which is earned by passing a 10-skill test "that teaches good manners to dogs and responsible dog ownership to their owners") could be one way to implement this alternative solution.

Americans must pass a test and get a driver’s license to operate a motor vehicle. Having a companion animal is likewise a privilege and not a right. It is sensible there would be a similar requirement for having a potentially dangerous or disruptive animal in public spaces. Socializing and training dogs to be in public spaces is beneficial for the dog and those around them. Those who do not want to comply would not have the privilege of their dog accompanying them in such places.

Although beyond the scope of this paper, the question of whether it is a net positive or negative experience for an individual dog to be in whatever public space must also be considered. Not all dogs are comfortable in crowded or noisy public settings; others are unfussed. But for purposes of this discussion, a training certification with a relatively low barrier to entry that could easily be made visible, perhaps affixed to a dog’s harness, is a potential solution. (AKC’s Good Canine Citizen training program, for example, is self-administered but you must enroll your dog in AKC for a fee of approximately $45.) As with fake service animal signifiers, these could potentially be forged, but IDs for humans, including driver licenses, are also vulnerable to forgery and fraud. There are already laws and penalties around possessing a fake ID, as well as the fraudulent service dog laws discussed above.

While policies that support multispecies families are crucial, equally important are laws that hold guardians accountable for their animal’s behavior. Dangerous dogs can pose a public safety threat to both humans and other animals. Leash laws already exist virtually everywhere, yet unleashed dogs abound, at times with tragic consequences when an animal is aggressive. As with all regulation, enforcement is key. Addressing these thorny issues will support the integration of companion animals into society.

7. Conclusions

The “epidemic of fake service animals” or the “moral panic around fake service animals—depending on your view—reflects inherent challenges of living in an increasingly multispecies society. Companion animals have been a part of human society since their domestication, but their cultural status as family is a more recent phenomenon. The emergence of an ascending family member status for companion animals brings new questions about how to successfully integrate them into home and community life. This challenge is complicated by a persistent policy lag, rooted in an anthropocentric legal framework, that has exacerbated the medicalization of the human–animal bond, ultimately creating a two-tiered system that is neither equitable nor just. Therefore, this article proposes replacing the anthropocentric medical model with a multispecies social model. This model would be characterized by policy changes that include equal access to essential features of society (like housing and transportation), standardized training certification to support that access, and the establishment of laws that recognize the importance of animals’ psychological well-being apart from their expected function as emotional support for humans. With these challenges come opportunities to advance social conditions for companion animals and their guardians, and to strengthen multispecies families in ways that positively affect all members, as well as the communities in which they are embedded.