Re-Examining Mental Illness: Have We Gotten It Wrong?

Since the work of Emil Kraepelin, the concept of mental illness has dominated western society. In recent years, there has been a notable increase in diagnosed mental health conditions, with around 20% of the world’s children and adolescents now being labeled with a disorder. However, the more that psychiatric theory and practice are promoted, the worse humanity’s mental health seems to become.

This trend prompts an important question: Have we gotten mental health wrong? Recent research by Joanna Moncrieff has debunked what we thought we knew about depression, suggesting we may indeed be misguided. It is a tricky issue to unpack, and I don’t claim to have the answers. However, a thoughtful discussion is warranted.

As someone who works in the mental health field, I ask these questions at the risk of offending colleagues, which is not my intent. I aim only to provide care for those in need. Over time, though, it feels as if we have been going backwards despite our efforts.

How do we explain the dramatic rise in diagnosed disorders? The standard explanation refers to mental illness as a biological disease of the brain, caused by genetic or neurochemical defects. Brain imaging seemingly reinforces this disease model. Yet there is no definitive evidence of any biological cause or reliable biomarker for any common psychiatric disorder. When I first learned this, I was shocked, as it contradicts what we are told.

Without biological tests, what is the basis for so many diagnoses? Disorders are delineated in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which aims to provide scientific classifications. This approach originated with Kraepelin, who pioneered dividing psychoses into categories like schizophrenia and manic-depression. The DSM builds on this method, continually assuming disorders stem from biological flaws despite lack of proof.

Over time, more classifications emerged, like replacing manic-depression with bipolar disorder and depression. Criteria were also developed, like specifying that depression requires one month of symptoms like low energy and sleep problems. However, these criteria were created arbitrarily without scientific validity, yet reinforced the disease model. Consequently, millions have been prescribed antidepressants based on the now-questioned theory that low serotonin causes depression.

Problematically, the disease paradigm focuses on symptoms rather than context, turning fleeting phenomena into permanent conditions. This reification fallaciously confuses abstraction with reality. We are told mental illness is biological, and we believe it is, but the evidence suggests otherwise. Psychiatrists are thus trained to view individuals as sick, diagnose disorders, predict prognosis, speculate on causes, and prescribe treatment.

For instance, John who is unemployed and sad may be diagnosed with depression and given antidepressants. But his sadness could actually stem from life circumstances, not brain chemistry. Or Sarah, who attempts suicide due to abuse, may be deemed disordered and unstable. But her trauma appears to be the issue, not a chemical imbalance. In both cases, the disease model masks societal factors and blames individuals.

An alternative approach would be to accept human differences as just variations rather than deficits. People do suffer and need support, but treatment could focus on their life experiences rather than presumed disorders. Critics may argue this view unrealistic. However, might inequality, capitalism, and medicalization better explain suffering? We pathologize normal emotions instead of addressing societal problems.

Rather than numbing grief over loss with pills, we could embrace it as part of life. We could surround people with care and empower them to find purpose again. This may sound idealistic only because of our current mindset. But with open minds, a paradigm shift could occur in mental health. The next decade may see big changes, if we are willing to consider alternate perspectives. I welcome thoughts and feedback. A constructive discussion could help move us forward.