Mental-health “epidemics” now dominate public discourse, with soaring rates of anxiety, depression, autism, bipolar disorder and ADHD diagnoses, to name a few. At the same time, the Western world faces social and economic decay: job insecurity, unaffordable rents, homelessness, decaying infrastructure, rising debt burdens, food banks and impossibly high living costs. The promise that each generation would live better than the last has evaporated.
Population data reflect this crisis. A 2023 cross-national analysis of surveys from 29 countries found that by age 75, half of all people will have experienced at least one mental-health condition, typically beginning in youth. Surveys paint an even bleaker picture. In a 2019 UK survey of 1,000 young people, 68% believed they had experienced a mental-health problem, and referrals for under-18s had jumped 45% in just two years. Another study published that year found 42% of 11- to 15-year-olds met criteria for a mental-health problem using standardised questionnaires.
Despite unprecedented access to therapy, medication, and novel treatments, population-level mental health is not improving. In fact, it is deteriorating. Suicide rates are up. More people report anxiety and depression. The mortality gap between those categorised as having a severe psychiatric condition and the general population is widening. Disability claims for mental-health reasons continue to rise. International comparisons show declines across all demographics, with English-speaking countries faring worst and 18- to 24-year-olds suffering the most. These trends are the opposite of what we see in many other areas of medicine. Cancer, heart disease and diabetes have all seen significant improvement in outcomes. Mental health has not.
Most institutional responses simply call for more: more early detection, more services, more interventions. But adding more of the same may worsen matters if the very foundations of our concepts and practices are flawed.
Why We Don’t Know What We’re Talking About
The boom in mental-health awareness rests on the assumption that we have a clear, objective idea of what “mental health” and “mental illness” actually are. We do not.
The World Health Organization defines mental health as a state in which a person “realises their abilities, can cope with the normal stresses of life, work productively and fruitfully, and contribute to their community.” This definition is full of subjective, difficult to define, terms like “realise,” “cope,” “normal stresses,” “productively”, “fruitfully” and “contribute”. Nothing here anchors the concept to measurable facts.
All definitions of mental health and illness share this problem: they are belief-based, rather than empirically supported. Because we lack objective tests to detect mental disorders or their causes (beyond ruling out physical illness), we cannot define a “case” in the way that much of physical medicine can. Psychiatric classifications are descriptions (and pretty unreliable ones too), not explanations.
Psychiatric Diagnoses as Commercial Brands
Diagnosis is a system of classification that is based on explanation. A garage mechanic uses ‘diagnostics’ to identify the cause of engine trouble, in the same way that an IT technician runs diagnostics on your computer to identify the cause of a malfunctioning programme. In medicine, diagnosis is the process of identifying the immediate cause of symptoms. Diagnosis points to pathology and guides treatment.
In psychiatry, however, diagnoses cannot point to causes. Most have no known biological markers. If we asked “What is depression?” we can only describe experiences such as persistent low mood and negative thinking. We are unable to identify a biological abnormality. Saying “low mood is caused by depression” leads to what is known as a tautology – a circular thinking trap illustrated by the two simple questions, “What is causing this low mood?”, answer “depression”, “How do you know it’s depression?”, answer “because they have low mood”.
In this technical sense, psychiatric diagnoses are not diagnoses at all. Yet they have spread globally and gained enormous authority. Why? Because their rise coincides with worsening economic insecurity and political decay in the West. As distress grows, it becomes a new market opportunity. A vast Mental Health Industrial Complex (MHIC) now profits from individualising suffering, shifting attention from structural causes to personal pathology. The MHIC redirects anger away from the political realm, where oligarchic wealth concentration shapes people’s lives, and into the private realm of individual self-scrutiny.
If we redirected attention outward, we might pursue socio-economic strategies that address the material determinants of distress: poverty, insecure housing, discrimination, social injustice, exclusion. But doing so within a decaying capitalist order, one increasingly incapable of delivering important protections and welfare for the population, may be unrealistic. Instead, we see anger channelled into various commodified rebellions (any activism that does little to dent the power of the oligarch ruling class) and an expanding MHIC that internalises suffering rather than contesting its origins.
The War on Emotions
Post-Enlightenment Western culture idolises rationality and mistrusts emotion. The word emotion comes from the Latin root “emovere”, with the e being a prefix meaning “out” or “from”, and movere is a verb meaning “to move”. Emotion therefore refers to motivated movement (toward or away from something). Without e-motion we would do nothing.
In today’s hyper-competitive performance culture, emotions are seen as threats to efficiency. The most dominant form of therapy – cognitive behaviour therapy – is premised on encouraging “scientific thinking” to discipline unruly feelings. The rise in psychotropic prescribing reflects a drive to numb emotional intensity. Even socially valued emotions must be reframed as cognition (as in “emotional intelligence”) to be palatable.
But emotion is the basis of human connection. Love, anger, and worry are all emotions meant to keep others vividly present in our minds. When emotion is pathologized, social bonds weaken and loneliness, insecurity, and shame thrive.
Our minds are meaning-making systems; we constantly weave stories that give coherence to experience. The idea that psychiatric diagnoses are the cause of our alienation, despondency, anxiety and misery has consequences. Diagnostic language and mythology are all around us these days. A teacher’s comment, a TikTok trend, a friend’s diagnosis and parental concern can all lead down the path of pathologization. Diagnostic language reshapes our sense of identity and directs behaviour, often making us suspicious of our own emotions.
Have we inadvertently popularised a form of “mental-health literacy” that fosters fear of emotion? Are we encouraging young people to interpret the ordinary storms of life as signs of internal defects? Evidence suggests these risks are real. We remain in thrall to the fantasy that mental life can be analysed like computer code or cured like bacterial infections.
Rehabilitating Emotion
A progressive mental-health movement must restore emotion to its rightful place in human life and reaffirm our impulse to connect and find meaning beyond self-interest. This requires honesty:
We possess opinions, not objective truths, about the causes of distress.
Psychiatric medications produce chemical changes; they do not correct known imbalances.
Most suffering reflects adversity, not broken brains.
Intense emotions are not dangerous – they are human.
Successful approaches view people not as malfunctioning machines but as human beings navigating difficult dilemmas. Clinics are filled not with defective brains but with people who have lived through hardship; especially the young, for whom adversity cuts deepest.
We cannot single-handedly fix the structural forces eroding well-being.
But we can resist the cultural war on emotion, challenge the narrative that distress equals disorder, and help re-humanise how we understand suffering.
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.