The line between mental health and illness is becoming increasingly blurred, with a growing number of people receiving diagnoses for conditions that, just decades ago, might have been considered normal variations in human experience. This trend, while aiming to reduce stigma and increase access to care, raises questions about whether we are pathologizing everyday suffering and potentially doing more harm than good.
According to modern psychiatric definitions, the 21st century is witnessing what some describe as an epidemic of mental illness. A 2019 survey in the UK found that two-thirds of young people felt they had experienced a mental disorder. This expansion in diagnostic criteria, coupled with lowered thresholds for diagnosis, isn’t inherently negative – if it leads to individuals feeling understood and receiving support. However, emerging evidence suggests that this broadening of definitions may, paradoxically, be contributing to a sense of worsening mental wellbeing within society.
Historically, cultures have approached mental distress in diverse ways. Psychiatrists working across different cultures note that many non-western societies often view low mood, anxiety, or even delusional states not as psychiatric illnesses, but as spiritual, relational, or religious problems. Framing these experiences within a community and tradition can offer a sense of meaning and integration that may be lacking in purely medical models.
The diagnostic landscape is currently dominated by systems like the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the United States and the International Classification of Diseases (ICD) in Europe. Both have undergone significant expansions in recent decades, classifying an increasing range of distressing feelings and emotions as pathological. These systems, while useful tools, are culturally specific models for understanding the mind, and their limitations must be acknowledged.
As a general practitioner with over 20 years of experience, I see the impact of these trends firsthand. Approximately 30-40% of all GP appointments in the UK involve some aspect of mental health. It’s a reminder that our mental states are fundamental to our experience of life, influencing every sensation and interaction. My medical training has reinforced the understanding that suffering, whether physical or mental, deserves equal attention and compassion.
The approach to mental healthcare has evolved throughout my career. Early in my training, witnessing the immediate, life-saving interventions required in emergency medicine highlighted the necessity of rigid protocols in critical situations. However, transitioning to general practice revealed the importance of flexibility and individualized care. As the Hungarian psychoanalyst Michael Balint described, the doctor themselves can be a therapeutic agent – the manner of engagement is intrinsically linked to patient outcomes. Learning to adapt my approach to each patient, recognizing their unique needs, became paramount.
Mentorship played a crucial role in shaping my approach. Observing Dr. M, a physician known for his kindness and tranquility, demonstrated the power of creating a safe and non-judgmental space for patients to explore their experiences. He prioritized understanding the underlying motivations behind each visit and fostered a sense of hope and redemption. Conversely, observing Dr. Q, a clinician focused solely on technical protocols and prescription management, highlighted the dangers of a dehumanized approach to care.
I worry that the increasing pressures on healthcare systems, like the NHS, are pushing us towards a model dominated by clinicians focused on ticking boxes and adhering to rigid diagnostic criteria, rather than fostering the humanity, curiosity, and humility exemplified by clinicians like Dr. M.
In my practice, I encounter individuals grappling with a wide range of mental and emotional challenges – anxiety, depression, trauma, addiction, and psychosis. This work compels me to continually question the nature of consciousness, mood, and the elements that contribute to a meaningful life. I’ve observed that individuals often carry unresolved experiences from decades past, impacting their present wellbeing. I’ve also seen how seemingly negative traits, such as a degree of obsessiveness or heightened sensitivity, can be sources of strength in different contexts.
The current emphasis on labeling and categorizing mental distress can be limiting. What I see in clinic is never a neat set of diagnostic labels, but rather unique combinations of strengths and vulnerabilities. Symptoms rarely point to clear-cut causes, and experiences are often interconnected. The ancient Indian epic, *The Ramayana*, for example, describes characters exhibiting symptoms recognizable today as post-traumatic stress disorder, generalized anxiety, and even suicidal depression – demonstrating that these experiences are not new phenomena, but rather enduring aspects of the human condition.
The understanding of brain function has evolved significantly over the past century, from early theories of synaptic chemistry to the more recent focus on the “connectome” – the complex network of connections within the brain. However, despite advancements in neuroscience, we still have a limited understanding of the underlying mechanisms of mood and mental wellbeing. The serotonin hypothesis of depression, once widely accepted, has recently been challenged by research indicating a lack of conclusive evidence.
Instead of focusing solely on diagnostic labels, I strive to understand each patient’s unique experience and to help them develop resilience – the ability to navigate life’s challenges without being overwhelmed. I aim to acknowledge the fluidity and dynamism of the mind, recognizing that change is not only possible but inherent to its nature. The goal is not to eliminate suffering, but to help individuals find meaning and purpose in the face of it.
a more compassionate and effective approach to mental healthcare requires a shift away from rigid classification and towards a greater emphasis on curiosity, kindness, humility, and hope. It requires recognizing that the mind is not a fragile entity to be fixed, but a resilient and adaptive force capable of growth and transformation.
