No More Normal
Mental Health in an Age of Over-Diagnosis
Dr Alastair Santhouse
Published by Granta
Consultant neuropsychiatrist Alastair Santhouse has for more than a quarter of a century worked to try to solve the diverse and complex issues of those considered to be abnormal.
Increasingly, the problem has become overwhelming as it would seem fewer and fewer of us are normal, depending on how you define the word – and the definition has narrowed.
In 1952, the first edition of the Diagnostic and Statistical Manual of Mental Disorders, produced by the American Psychiatric Association, was 132 pages long, covering 128 categories. By 2013, it had expanded to 541 categories and at 947 pages was “thick enough to stop a bullet,” according to a quote from an anonymous psychiatrist.
A new edition is being worked on, and Santhouse argues the validity of some of its diagnoses should be reconsidered.
He tells us he hesitated to speak out “for fear of being misunderstood”. He also implies it would be irresponsible to ignore the mounting evidence that so many borderline cases are clogging up the system that those in greatest need are being overlooked.
The general public would be justified in demanding: “You were meant to be the experts. Why didn’t you say anything?”. The same question arose after the global financial crisis was predicted by those in a position to know and still allowed to happen.
Santhouse is all the more persuasive because, while we sense his frustration is deeply felt, his book is carefully argued, his tone measured and accessible to a non-scientific reader.
He works his way through earlier fashions in psychiatry to the present day, when the stigma historically attached to mental illness has to an extent been overcome.
ADHD, for instance, is a label embraced by many, not least because it can be useful in helping children to navigate the exam system and in getting access to drugs.
Other topicalities aired by Santhouse include Trump’s alleged narcissism. Disappointingly, he is far too professional to comment in the absence of a consultation with the president.
The pandemic, in combination with social media, is widely held to blame for an upsurge in “abnormality”, especially among young people.
Santhouse acknowledges “TikTok tics” as a response to watching viral videos of people suffering from Tourette syndrome. Some viewers become convinced they too have a tic and their body acts accordingly. It is involuntary, but has no basis in structural damage to the body.
On a still darker level, websites on anorexia can have the effect of making people anorexic, which is especially worrying as it is one of the mental disorders with the highest mortality rate.
It is tempting to agree with those who say we really are less normal than we used to be, but Santhouse is a self-declared optimist and a circumspect scientist.
For him, life has got worse in some ways, but better in others.
Abnormal mental health is influenced by social context, perhaps more than any other branch of medicine. That said, from a scientific point of view, there are objective measures – increasingly so as evidence mounts that the most severe cases have their basis in neurological change. With more research – and perhaps more mass data crunching with the help of AI – they could eventually find a cure.
Santhouse ends a work that has the potential to be gloomy but is anything but on a note that is at once self-deprecating and positive.
His final example is Chris, who sought help for depression and was duly prescribed anti-depressants. On a return appointment, he was clearly better and Santhouse was secretly congratulating himself on having chosen an effective course of treatment only to learn from his patient that he had decided not to take the tablets.
Santhouse concludes he had failed to take due note of the “bereavement exclusion”. Chris had told him he had lost his mother, meaning his psychiatrist needed to assess whether he was suffering the kind of sadness that enters all of our lives at intervals or was clinically depressed. In sum, Chris did not need medication because what he was experiencing fell within the bounds of normal — a category that is wider than we are sometimes led to believe.
Barbara Lewis © 2025.
No More Normal
Mental Health in an Age of Over-Diagnosis
Dr Alastair Santhouse
Published by Granta
Consultant neuropsychiatrist Alastair Santhouse has for more than a quarter of a century worked to try to solve the diverse and complex issues of those considered to be abnormal.
Increasingly, the problem has become overwhelming as it would seem fewer and fewer of us are normal, depending on how you define the word – and the definition has narrowed.
In 1952, the first edition of the Diagnostic and Statistical Manual of Mental Disorders, produced by the American Psychiatric Association, was 132 pages long, covering 128 categories. By 2013, it had expanded to 541 categories and at 947 pages was “thick enough to stop a bullet,” according to a quote from an anonymous psychiatrist.
A new edition is being worked on, and Santhouse argues the validity of some of its diagnoses should be reconsidered.
He tells us he hesitated to speak out “for fear of being misunderstood”. He also implies it would be irresponsible to ignore the mounting evidence that so many borderline cases are clogging up the system that those in greatest need are being overlooked.
The general public would be justified in demanding: “You were meant to be the experts. Why didn’t you say anything?”. The same question arose after the global financial crisis was predicted by those in a position to know and still allowed to happen.
Santhouse is all the more persuasive because, while we sense his frustration is deeply felt, his book is carefully argued, his tone measured and accessible to a non-scientific reader.
He works his way through earlier fashions in psychiatry to the present day, when the stigma historically attached to mental illness has to an extent been overcome.
ADHD, for instance, is a label embraced by many, not least because it can be useful in helping children to navigate the exam system and in getting access to drugs.
Other topicalities aired by Santhouse include Trump’s alleged narcissism. Disappointingly, he is far too professional to comment in the absence of a consultation with the president.
The pandemic, in combination with social media, is widely held to blame for an upsurge in “abnormality”, especially among young people.
Santhouse acknowledges “TikTok tics” as a response to watching viral videos of people suffering from Tourette syndrome. Some viewers become convinced they too have a tic and their body acts accordingly. It is involuntary, but has no basis in structural damage to the body.
On a still darker level, websites on anorexia can have the effect of making people anorexic, which is especially worrying as it is one of the mental disorders with the highest mortality rate.
It is tempting to agree with those who say we really are less normal than we used to be, but Santhouse is a self-declared optimist and a circumspect scientist.
For him, life has got worse in some ways, but better in others.
Abnormal mental health is influenced by social context, perhaps more than any other branch of medicine. That said, from a scientific point of view, there are objective measures – increasingly so as evidence mounts that the most severe cases have their basis in neurological change. With more research – and perhaps more mass data crunching with the help of AI – they could eventually find a cure.
Santhouse ends a work that has the potential to be gloomy but is anything but on a note that is at once self-deprecating and positive.
His final example is Chris, who sought help for depression and was duly prescribed anti-depressants. On a return appointment, he was clearly better and Santhouse was secretly congratulating himself on having chosen an effective course of treatment only to learn from his patient that he had decided not to take the tablets.
Santhouse concludes he had failed to take due note of the “bereavement exclusion”. Chris had told him he had lost his mother, meaning his psychiatrist needed to assess whether he was suffering the kind of sadness that enters all of our lives at intervals or was clinically depressed. In sum, Chris did not need medication because what he was experiencing fell within the bounds of normal — a category that is wider than we are sometimes led to believe.
Barbara Lewis © 2025.
By Barbara Lewis • books, psychiatry, society, year 2025 • Tags: Barbara Lewis, books, psychiatry, society