This is the REAL cause of the explosion of autism and depression: Top psychiatrist DR ALISTAIR SANTHOUSE delivers his damning verdict… and reveals the only answer

A recent cartoon highlighted the societal quandary surrounding mental health, depicting the beds of Snow White’s seven dwarfs. Each bed had a nameplate, but with modifications reflecting the medicalization of emotions. ‘Happy’ was replaced with ‘Euphoric’, ‘Grumpy’ became ‘Depressed’, ‘Sleepy’ transformed into ‘Narcoleptic’, ‘Sneezy’ into ‘Allergic’, ‘Dopey’ to ‘Mentally Challenged’, and ‘Bashful’ to ‘Social Anxiety Affected’. Only Doc remained unchanged.

The Blurring Lines of Mental Health and Everyday Emotions

While humorous, the cartoon underscores a serious concern: the increasing tendency to medicalize ordinary human traits as clinical conditions. As a psychiatrist with over 25 years of experience, I have observed a growing trend towards pathologizing typical emotions and the proliferation of diverse therapeutic approaches.

Student Mental Health: A Case Study in Medicalization

A study by the National Union of Students revealed that a striking 78% of students reported experiencing a mental health issue within a year. Reflecting on my own university years, I recall the academic pressures, exam stress, social dynamics, and relationship challenges. Today, students face additional stressors like loan burdens, social media pressures, and a competitive job market. However, these common difficulties are now frequently interpreted as mental health problems. Students surveyed often identified as ill, rather than simply unhappy or distressed.

Psychiatry at a Crossroads: Defining Mental Illness

This trend places psychiatry at a critical juncture. Mental healthcare should be reserved for individuals with genuine need. However, the opposite is occurring, with an expansion in mental illness diagnoses.

Consider the Diagnostic and Statistical Manual of Mental Disorders (DSM), the definitive guide for psychiatric diagnoses. The first edition in 1952 was a concise 132 pages with 128 categories. Now, seven decades later, it has ballooned to 947 pages, listing 541 categories – a fourfold increase, prompting some to jest it is ‘thick enough to stop a bullet’.

Are We Less Psychologically Healthy?

But are current generations truly less psychologically robust than those before?

The expansion of diagnostic categories has had a positive impact, reducing the stigma associated with mental health conditions and encouraging more people to seek help.

Conversely, we now risk framing life’s challenges, suffering and individual differences as illnesses. We are medicalizing individuals who, in the past, would have been considered within the spectrum of normality.

Life inherently includes hardship and unavoidable difficulties. These challenges are meant to be overcome, and emotions are a natural response to life’s highs and lows, adding richness and meaning. While emotions can be intense, prolonged, or disproportionate, they are not automatically indicators of disease.

Unhappiness, anger, resentment, suspicion, infatuation, disinterest in intimacy, jealousy, and elation are fundamental human emotions throughout history. Interpreting them as pathologies misrepresents human nature and can lead to unwarranted treatments for unjustified diagnoses.

The Patient’s Perspective vs. Clinical Diagnosis

Current trends suggest that self-identified mental disorder claims are almost always validated by professionals. The notion that self-declared depression automatically equates to clinical depression is a common fallacy. While I acknowledge patient suffering, I do not always equate it with mental illness.

Some of my most impactful consultations involve reassuring patients that their experiences are normal, that their emotional responses to life events are psychologically healthy and typical.

Defining ‘Normal’ in Mental Health

‘Normal’ is a pivotal concept in psychiatry, essential for defining mental illness. It serves as the benchmark against which we assess mental health. However, the definition of ‘normal’, and consequently ‘abnormal’, has become increasingly fluid, blurring the lines between them.

How much suspicion qualifies as paranoia? How frequent must checks be to warrant investigation for obsessive-compulsive disorder (OCD)? How profound can grief be before it becomes depression? What constitutes a traumatic event?

Consequences of Broadened Diagnostic Criteria

Our failure to address these fundamental questions has resulted in a shrinking percentage of the population enjoying normal mental health. Conversely, mental ill health has become the most prevalent reason for unemployment in those under 44, surpassing musculoskeletal and chronic physical conditions, traditionally the primary causes of work limitations.

One explanation for these statistics could be a genuine surge in mental illness rates. However, it is more likely that milder issues are being reclassified as mental health diagnoses, leading more individuals to perceive these problems through a medical lens.

This is not to trivialize these problems for those affected, but they often fall within the spectrum of what was previously considered normal human experience. This trend is concerning.

Rising Demand for Mental Health Services

In the past five years, there has been an increase of nearly one million Britons seeking mental health services. The rate of probable mental health disorders among 17 to 19-year-olds has risen dramatically from one in ten to one in four. An estimated 1.8 million individuals are currently on mental health waiting lists.

Paradoxically, referrals for severe mental illnesses have remained stable during this same period. Conditions like severe depression, anxiety disorders, OCD, bipolar disorder, and schizophrenia require specialized expert care. These serious conditions risk being overlooked amid the surge of new, less severe mental health concerns and the over-medicalization of everyday experiences.

Depression as a Paradigm of Diagnostic Expansion

Depression exemplifies the evolving boundaries of mental disorder. Despite unprecedented wealth and longevity, our society reports increasing unhappiness. Depression, a ubiquitous diagnosis, has become emblematic of the early 21st century.

Like other psychiatric diagnoses, depression is defined by symptoms. There is no definitive objective test, creating inherent diagnostic ambiguity.

During my medical student years, I experienced periods of isolation, sadness, and low motivation. I felt lonely, uninspired, and despondent, but never considered myself to be suffering from depression at that time.

While some cases of depression are clearly diagnosable across generations, others blur with typical daily life. They often reflect disappointment, lack of purpose, or frustrated ambitions. One patient, Sian, believed her life was hopeless and everyone else was happier, an unverifiable assumption.

Observing strangers or even friends, overt ‘happiness’ is rarely evident. People cope with financial pressures, family illnesses, difficult jobs, grief, relationship problems, disruptive children, personal health issues, daily inconveniences, and broader societal challenges. Clinical depression, in its severe form, is qualitatively different from normal unhappiness. But where is the tipping point?

Severe vs. Mild Depression: A Critical Distinction

Severe depression is unmistakable. Individuals in this state are withdrawn, sometimes mute, with evident anguish. They may be inert, neglecting basic needs, lost in profound despair.

Even moderate depression involves distressing and debilitating symptoms like pervasive pessimism and helplessness. However, milder presentations are different. Sadness, low mood, apathy, sleep disruption, hopelessness, changes in appetite – these are now commonly categorized as symptoms of depression.

The Pervasive Use of Antidepressants

A depression diagnosis can oversimplify complex issues. Frequently, the prescribed solution, as with many mental conditions, is medication. Antidepressants, readily available and inexpensive, are often administered for problems that are not, in fact, clinical depression, even if sharing some overlapping symptoms.

In the UK, antidepressant prescriptions nearly doubled from 36 million in 2008 to 71 million a decade later. Pharmaceutical interventions can mask deeper, more complex issues underlying a diagnostic label. Antidepressants cannot effectively address broader 21st-century societal problems, frustrations, or unfulfilled lives.

Clinicians treating depression acknowledge the efficacy of antidepressants, particularly for severe cases. However, in mild cases, their effectiveness is often only marginally better than a placebo.

This raises questions about whether mild depression should be conceptualized differently. While acknowledging its impact on functioning, classifying it as an “illness” may be neither justified nor beneficial.

ADHD: The Rise of Adult Diagnosis

Some diagnoses are actively sought by patients seeking a singular explanation for life’s challenges. ADHD (attention deficit hyperactivity disorder), with its broad diagnostic criteria, fits this pattern, overlapping with many common experiences. Two or three out of ten patients I see question whether adult ADHD explains their difficulties, despite adult ADHD being a relatively recent diagnostic category.

ADHD was initially identified in children to describe inattentiveness or hyperactivity. Often these were signs of immaturity, naturally resolved with age. Persistence into adulthood was seen in only about 15% of cases.

However, ADHD emerging for the first time in adulthood is a novel phenomenon. It is now among the fastest-growing areas within psychiatry, raising concerns and overwhelming NHS referral services.

In many UK regions, adult ADHD assessment waiting lists are reported to be at least eight years, affecting approximately 196,000 adults.

Diagnosing adult ADHD is challenging due to its spectrum, ranging from normal behavioral variations to clearly atypical patterns.

For individuals with minimal life impairment, diagnosis enters a grey area where societal expectations influence diagnostic boundaries. If any deviation from the norm qualifies as a diagnosis or warrants treatment, we risk a scenario where diminishing numbers are considered ‘normal’ and nearly everyone is labelled with mental health issues.

Autism and Diagnostic Expansion

Autism is another example of diagnostic expansion, with a 787% increase in diagnoses over 20 years. Previously, autism described severe deficits in communication and learning, often involving non-verbal individuals in specialized educational settings. Now, the diagnosis encompasses individuals who are socially awkward or idiosyncratic, yet function well in careers and relationships.

A negative consequence is that individuals with severe autism face increased difficulty in accessing care. The same trend applies to PTSD (post-traumatic stress disorder).

PTSD: From Battlefield Trauma to Everyday Adversity

PTSD is a legitimate condition, and I have encountered patients with harrowing accounts of torture, war, or near-fatal accidents. These instances, however, are infrequent.

The concept of trauma has become increasingly diluted. There are significant traumas like war and hostage situations, and then there are everyday life adversities. While severe, life-threatening events can have psychological repercussions, most individuals cope without clinical intervention, relying on social support and established coping mechanisms. They address challenges rather than dwelling on them.

Increasingly, trauma is defined by personal perception. It has become a self-diagnosis, requiring only a declaration of being traumatized. Following an on-air disagreement, a US television personality suggested she might have PTSD.

Trauma has expanded from battlefield experiences to television disagreements, and from hostage crises to hurt feelings. This expansion of mental health terminology to describe non-clinical experiences negatively impacts the well-being of vulnerable individuals.

The Case of Gillian: Navigating Life’s Realities, Not Trauma

One patient, Gillian, in her 30s, was referred for depression. She attributed her struggles to ‘trauma therapy’, citing a recent divorce and business failure. I challenged the trauma framing. Her issue was navigating life’s difficult realities, not processing traumatic memories. While she faced genuine challenges, conceptualizing them as trauma obscured the core issues: her life perception and coping mechanisms.

Social media amplifies the focus on trauma with videos like ‘Five signs you have trauma you didn’t know about’. These can frame normal emotions and behaviors as indicators of mental illness, suggesting that feelings are caused by unrecognized past trauma, providing a potentially misleading explanation.

Trigger Warnings: Compassion or Counterproductive?

Trigger warnings, intended to alert audiences to potentially distressing content, exemplify the current obsession with trauma. Introduced with kindness and good intentions, they align with our compassionate cultural climate.

However, research suggests trigger warnings may increase anxiety in anticipation and do not alter emotional responses to the content itself. Evidence is superseded by a seemingly compassionate cultural practice that is either ineffective or potentially harmful.

Common Sense and the Limits of Medicalization

Despite the prevailing trend of over-diagnosis, common sense sometimes emerges.

The inclusion of bereavement-related depression in the DSM sparked public disapproval. Grief, a universal and understood human experience, was being subjected to medical reductionism. Concerns arose that grieving individuals might be mislabeled as simply ‘depressed’.

An article in The Lancet criticized the ‘infiltration of bureaucratic standards and regulations ever more deeply into ordinary life’, suggesting a reduction of spiritual and ephemeral experiences to diagnostic categories.

The author, recently bereaved, felt his grief served a purpose, an integral part of transitioning to a new life, not a problem to be eliminated.

Grief: A Normal Human Response

A study indicated that a third of bereaved individuals might meet criteria for ‘prolonged grief disorder’, especially after child loss or death by suicide, homicide, or overdose. However, most did not perceive their grief as abnormal. Grieving is a normal human response to loss, not requiring medical classification. Psychiatry’s role in grief is largely superfluous.

Now there is a diagnosis I wholeheartedly agree with.