The global rise of diagnosed mental disorders and increased mental healthcare service utilization has caused a growing burden for both healthcare systems and societies. New work from a group of interdisciplinary scholars explores the concept of the psychiatrization of society and its implications and calls for transdisciplinary research on the topic.
By “psychiatrization,” the authors refer to the processes by which more and more individuals are diagnosed and treated as mentally ill, and psychiatric practices shape more and more areas of life.
The increased medicalization of everyday symptoms from loneliness to sadness and depression, a process that converts these symptoms into psychiatric problems, has been both well-documented and highly criticized. The psychiatrization of childhood specifically has received significant attention, and psychiatrization generally has been critically investigated as a tool of coloniality.
Focusing on theory development and theoretical considerations, the authors suggest a basic model of psychiatrization as a starting point for further research. As the authors note:
“Psychiatrization is highly complex, diverse, and global. It involves various protagonists, and its effects are potentially harmful to individuals, to societies, and to public healthcare.”
These potential harms include overdiagnosis and overtreatment, undermining mental healthcare provision for the most severely ill, and “boosting medical interventions which incite individual coping with social problems, instead of encouraging long-term political solutions.”
The authors describe two processes of psychiatrization: top-down and bottom-up. In the top-down model, specialists and politicians, along with the pharmaceutical industry and insurance companies, drive both the usage of psychiatric practices and the application of psychiatric knowledges such as diagnostic categorizations.
Examples of top-down processes of psychiatrization include “large scale restructuring of mental health services, lawmaking, publication of new treatment and diagnostic guidelines, the introduction of new diagnoses into [the] DSM,” approval of existing psychotropic drugs for certain “new” conditions, compulsory mental health screening, and diagnosis requirements for access to educational support.
Bottom-up psychiatrization occurs when the needs and desires of patients and consumers induce changes at the top level and thus is driven by laypeople without professional ties to psychiatry or the healthcare system in general. In bottom-up processes, psychiatrization might be, to paraphrase Foucault, “requested, rather than imposed.”
“Typical drivers of bottom-up psychiatrization might be people searching for recognition of subjective suffering or difference through clinical diagnosis, people with mild or unspecific ‘symptoms’ using professional healthcare services without clear indication, or the demand of parents or other caregivers for diagnoses and treatment of perceived learning and behavioral disorders.”
The effects of both top-down and bottom-up processes of psychiatrization are diverse, highly ambivalent, and significantly influenced by localized and diverse technological, economic, political, and social factors. In doing this work, the authors hope to provide a conceptual framework for new interdisciplinary research on the psychiatrization of society, its impacts, risks, and benefits.
Reorientations of global mental healthcare systems through digitalization, deinstitutionalization, and scaling up of community care worldwide due to ongoing political and social changes make processes of psychiatrization increasingly relevant to social and political life. As the authors note, however, “it can be complicated for research to distinguish legitimate attempts to meet real unmet needs from building up infrastructures which create the artificial need or promote pathologization and overtreatment of mental distress.”
For these reasons, both qualitative and quantitative interdisciplinary research is needed to explore the different aspects of psychiatrization and identify reasons for engaging in psychiatrization processes, or for resisting them.
Beeker, T., Mills, C., Meerman, S., Thoma, S., Heinze, M., and von Peter, S. (2021). “Psychiatrization of Society: A Conceptual Framework and Call for Transdisciplinary Research.” Frontiers in Psychiatry, 20:645556.(Link)