Why Our Mental Health System is Fundamentally Flawed

Mental health problems outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) include:

  • Major depressive disorder
  • Generalised anxiety disorder
  • Social anxiety disorder
  • Panic disorder
  • Borderline personality disorder
  • Post-traumatic stress disorder

This language of ‘disorders’ – the medical/disease model – has been heavily criticised for a long time.

“Deeply flawed and scientifically unsound.” – Professor Allen Frances, the Chair of the DSM-4 committee

“It undermines genuine empathy and compassion; instead of seeing the people’s difficulties as understandable and natural responses to terrible things that have happened to them, the person is seen as having something wrong with them – an ‘illness’.” – Professor Peter Kinderman, former Vice-President of the British Psychological Society (BPS)

“Totally wrong, an absolute scientific nightmare.” - Dr Steven Hyman, former National Institute of Mental Health (NIMH) director

The NHS website also outlines two main criticisms of the current diagnostic approach:

  1. An increasing tendency to "medicalise" patterns of behaviour and mood that are not considered to be particularly extreme.
  2. An unhealthy influence of the pharmaceutical industry on the revision process.

The British Psychological Society (BPS) has long called for a system overhaul in relation to mental health.

They highlight several problems with the current system such as limitations in validity (i.e., inaccurate diagnoses) and reliability (i.e., inconsistent diagnoses), as well as noting the negative impact diagnoses can have on people’s identity.

We believe that the majority of mental health problems are best understood as normal human responses to distressing situations and the culture we live in.

Not ‘disorders’. Not ‘illnesses’. Understandable responses to distress which are made worse through limited mental wellbeing skills.

Mental Health Is a Spectrum

Mental health is best understood as a spectrum that we all move along in our lives.

Viewing mental health as a spectrum helps to show that:

  • There are no clear logical boundaries of what is an ‘unhealthy’ level of mental distress that should qualify as a ‘mental disorder’.
  • The majority of mental distress is primarily due to non-biological causes such as distressing situations and damaging social systems.
  • Whilst either anxiety or depression symptoms can be more prominent, they clearly aren’t separate – ‘mixed anxiety and depression’ is the most common diagnosis.

In the past few years, the National Institute of Mental Health (NIHM) has stopped funding studies that present depression and anxiety as different diagnoses. A spectrum-based framework called Research Domain Criteria (RDoC) is now being developed.

"Psychiatric labels refer to human conditions that cannot be pigeonholed, because they are not diseases, but subjective human experiences that exist along a complex continuum." - Peter Breggin

For these reasons, we – along with many other mental health professionals - believe that focusing on our personal signs of poor mental wellbeing is much more helpful than focusing on diagnostic labels.

To understand more about how poor mental wellbeing impacts you, be sure to download our Understanding Your Mental Wellbeing Workbook.

Share and Help Raise Awareness

Please help us raise awareness by sharing this article on social media and to people who you think might be interested.

As Dr Lucy Johnstone states: "People have the right to know that there are serious concerns about the scientific validity of these labels."

Deeper Dive

For more information, we recommend watching the 'Trauma and Mental Health' talk by clinical psychologist Dr Lucy Johnstone.