Mainstream mental health services are a disaster

They are a ‘busted flush’, long past their sell-by date, says consultant psychiatrist, Dr Sami Timimi.

NOTE: First published on August 23, 2020.

Hardly a week goes by without another headline about the epidemic of mental health problems coming our way…

Former US First Lady Michelle Obama has joined the ranks of celebrities popularising the idea that we are sinking in a sea of mental ill health saying she has “low-grade depression”. A recent report from the Office for National Statistics claimed twice as many adults in Britain are reporting ‘symptoms of depression’ now compared with this time last year.

The real problem is not a mental ill health epidemic, but the mindset where the ‘ordinary’ and the ‘understandable’ become symptoms and sickness. Of course there are more people who are unhappy, insecure, and stressed. We have been in enforced isolation, many are losing their livelihood, and uncertainty about the future is ubiquitous. Are human responses to adversity ‘depression’?

What sort of ‘thing’ is a mental disorder like ‘depression’ anyway? When does a behaviour or experience become abnormal, disordered, or pathological? Who decides? Based on what?  

When somebody has an accident and experiences extreme pain and swelling in their leg, and an X-ray reveals there is a fracture in the tibia (shin bone), we know what sort of ‘thing’ we’re dealing with. The diagnosis of a fracture explains the symptoms. There is an abnormality that can be scientifically verified and so exists out there in the world beyond our subjectivity – ie) the opinion of one person.

In mental health, the territory for what we refer to as ‘symptoms’ of a mental disorder are experiences and behaviours. Each of these are interpreted differently by different cultures, times, and settings. We have no tests, no physical comparisons, and so are entirely reliant on observations and reports of that person and/or their significant other(s). This means we are no longer dealing with a thing that can be ‘diagnosed’.

Diagnosis is a system of classification based on cause. That’s why we say “My doctor said that the cause of my chest pain was acid reflux, not a heart attack”. This enables matching of specific treatments to address specific abnormalities. Pseudo-diagnoses, like ‘depression’, cannot really explain what is going on: there are only symptoms that are descriptions (not explanations) of behaviours or experiences.

Even using the word ‘symptom’ is problematic, as in medicine, symptoms usually refer to patients’ suffering/experience as a result of an underlying disease. If I were to ask the question “what is depression?” it’s not possible for me to answer that by reference to a particular known abnormality. Instead I’ll provide a description such as “depression is the presence of the low mood, negative thinking” and so on. A description cannot explain itself.

Using depression to explain low mood is like saying the pain in my head is caused by a headache.

Kidneys don’t worry about paying the bills, seek meanings for their suffering, or harbour dreams about their future. In mental health practice, nothing can escape interpretation and subjectivity. There is no concrete measurable ‘thing’ out there in the real world, until we turn an idea – for example, that depression is a disease – into its real-life stereotype. Then our psychiatric labels function like any other social labels (such as ethnicity) where more subtle differences are swept away and with it the uniqueness of the sufferer.

Is that patient in front of me who reports intense sadness, difficulty getting to sleep, and waking up before 5am; suffering from a ‘depressive disorder’ or experiencing understandable heartbreak following the breakup of a long-term relationship a few months back? 

If the decision is to ‘diagnose’ you with ‘depression’, the ‘ordinary’ and ‘understandable’ interpretation of the person’s circumstances may slip away . They are now in danger of being invited to adopt the identity of a mentally ill patient.

If they then have the misfortune of being sent to mainstream mental health services, horrors may await.

Mainstream mental health services are a disaster.  The problem isn’t under-funding or the scale of the mental health challenge in society. It isn’t social media, stigma, lack of education, lack of doctors or therapists. The problem is the dominant ideology. It’s the concepts of mental health, mental ‘wellness’, mental illness, and mental disorder that pervade our societies.

It’s the way we have come to talk and think about mental health. It’s the narratives that the public are exposed to, day in day out, popularising a jaundiced, scientifically illiterate idea that we know what sort of a ‘thing’ mental disorder is, that it is widespread, and needs diagnosing, so that effective treatments can be provided. It’s the endless expansion and commercialisation of so-called psychiatric diagnoses, so that they operate as lucrative brands rather than legitimate categories that help build knowledge and improve clinical practice. 

It’s even worse than this. The dominant ideologies are dripped daily into our consciousness, turning us all into potential patients, alienating us from ordinary and understandable emotions, convincing us we have mental disorders that need experts, and terrifying us that our experiences (or of those whom we love) are markers of a deep dark problem lurking in our broken, dysfunctional minds. How else do you explain a 2019 survey of 1,000 young people that found that 68% believed they had or did have at some point a mental disorder?

We have created with our astrological star-gazing mental health ideologies a vast sea of people who believe they are broken, who see their emotional intensity as dangerous and as a foreign body needing to be excised, rather than a human experience needing compassion, empathy, challenge, whatever.

Mental health services have become the mouthpieces of an industry of decontextualising and individualising hurt, fear, sadness, and anger, turning so many into the embodiment of the caricatures we label them with. The mental health industry creates and solidifies the mental disorders it claims to alleviate. It’s horribly sick. It misses people’s natural resilience in the face of all kinds of adversity, believing resilience is something you can teach rather than innate and waiting to be discovered. Instead it carves open chasms of vulnerability alongside patronising paternalism and sympathy.      

We have spread the idea that our mental disorders are rooted in our genes and expressed in alien takeovers of our brain by our biology. There is little evidence to support this view. Our modernist voodoo theory is arguably more sinister as at least the idea that an external spirit takes over your mind and body gives potential room for recovering an independent self.

But this problem will not last. The current dominant ‘diagnosis followed by specific treatment model’ we use is finished.  It’s a busted flush, long past its ‘use by’ date. Whether it takes five, 10, or 50 years, there is no rescuing this ideology. It’s horrendous record. And it will not last.

Photo credit: Wallpaper Flare

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Sami Timimi

Sami Timimi is a Consultant Child and Adolescent Psychiatrist and Visiting Professor of Child Psychiatry and Mental Health Improvement at the University of Lincoln, UK. In addition to numerous articles and book chapters, he’s authored four books on adolescent mental health, including 'Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture’.

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  1. What a breath of fresh air you have given us in this article about mainstream mental health services.
    You are right about everything and it has to end.
    I have worked in psychiatry for 45 years and believe that the system has created a chronic population by how you describe the system.
    it is heartbreaking to have observed people being robbed of their lives by being diagnosed and having limits put on their dreams and expectations for their lives. Being told they will have to take poisonous medicines for the rest of their lives, never be able to work and much more.
    Medicalizing daily life experience is a serious abuse perpetrated by the medical profession and bought into by ordinary people.
    Michelle Obama is lucky if she is experiencing low grade depression. Any one living in the USA today is normal if they are suffering depression because of the state of the country.
    Change has to come but it is too slow.

    1. The kinds of problems people have when they’re told they’ll need to take medication for the rest of their lives are, generally, not the kinds of problems one could categorise as “daily life experience”.

      1. They may just be extreme versions of those experiences, however.
        (And being told you have a defective brain [and possibly defective genes] for which you’ll need to take drugs the rest of your life, the action of the drugs themselves, is very rarely health-promoting).

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