In recent decades, mental health has become one of the most widely discussed issues in public discourse, health policies, and clinical practice. The explosion of psychiatric diagnoses, the exponential rise in the use of psychotropic medication, and the proliferation of narratives about psychological wellbeing are just some of the symptoms of this new centrality of emotional suffering in contemporary society. Yet, as this centrality grows, a structural conflict — often unspoken — becomes increasingly evident: the tension between psychiatry and psychology.
Although both fields claim a commitment to mental health care, psychiatry and psychology are grounded in very different epistemological frameworks. Psychiatry, historically linked to medicine, operates predominantly within a biomedical model. It tends to view psychological distress as the result of neurochemical, genetic, or brain-based dysfunctions — conditions that can and should be diagnosed and treated, usually through pharmacological means. Psychology, especially in its clinical, community, and critical strands, approaches distress through the lens of subjectivity, life history, sociocultural contexts, and relational dynamics. For many psychologists, care begins with listening — not with labelling.
This deep divide is not merely theoretical: it plays out in clinical settings, within healthcare systems, and in the lived experience of those seeking support. In many contexts, the biomedical model imposes itself as dominant, often subordinating the work of psychologists to the authority of psychiatric diagnosis and medication. This not only generates ethical and technical tensions among professionals but also fragments the experience of service users — reducing them to diagnoses and protocols instead of recognising their complexity and narratives.
The medicalisation of life has become a global trend. Common human experiences — sadness, anxiety, grief, fatigue, disillusionment — are increasingly framed as mental disorders. This pathologisation of suffering fuels a constant expansion of psychiatric categories, feeding the pharmaceutical industry and reinforcing the notion that there is a pill for every pain. Psychology, particularly when grounded in critical listening and contextual engagement, seeks to resist this logic — advocating instead for approaches that value time, subjectivity, and meaning.
Yet the conflict between psychiatry and psychology is not uniform. It manifests differently across cultural, political, and geographic contexts. In the UK, for instance, there is a growing movement questioning the biomedical model. Initiatives like social prescribing and community-based interventions are expanding the spectrum of responses to distress — focusing on meaningful activity, social connection, and peer support. In such spaces, psychologists and other mental health professionals have found greater room to advocate for integrative and holistic approaches, beyond diagnosis and medication.
In contrast, in countries like the United States, while critiques of psychiatry are also gaining ground, the biomedical model still dominates. Deeply entangled with the insurance industry, profit-driven healthcare, and a culture of individual productivity, psychiatric diagnosis often becomes a passport to access services and entitlements — even as it risks fixing identities and narrowing possibilities. The danger lies in how people can become reduced to the label they are given, rather than being recognised in their full humanity.
In countries of the Global South, such as Brazil, the picture is even more complex. On one hand, Brazil has a rich tradition of community mental health practices and a pioneering psychiatric reform movement that inspired innovative services like the Psychosocial Care Centres (CAPS). On the other hand, chronic underfunding, socioeconomic inequalities, and limited access to care often push services toward quick, medicalised interventions. In many peripheral urban areas and rural regions, the only available contact with mental health support comes through brief psychiatric consultations, where dialogue is replaced by prescriptions.
This asymmetry between psychiatry and psychology is further exacerbated by enduring forms of coloniality in global mental health systems. Clinical models developed in the Global North are often exported to the Global South without consideration for local contexts. The standardisation of diagnoses and treatment protocols disregards the diversity of cultural knowledge, practices, and lived experiences. Psychologists working with Indigenous populations, quilombola communities, or in marginalised territories must often navigate the tension between institutional knowledge and traditional forms of care that are frequently ignored or delegitimised.
Critical psychology has much to contribute to a mental health care model that is genuinely humanised and contextually grounded. This demands not only skilled listening, but also an ethical and political commitment to transforming the conditions that produce suffering. As the Salvadoran psychologist Ignacio Martín-Baró, murdered during the civil war, once argued: “One cannot seek to heal a person without also healing the society that has made them ill.”
This is not to say that psychiatry should be dismissed or demonised. There are situations in which medication is necessary and helpful — particularly in cases of acute distress. The issue is not with medication per se, but with the way it often becomes the sole or primary response. The real challenge lies in creating genuinely interdisciplinary practices, where different forms of knowledge coexist in dialogue, rather than in hierarchy.
Sadly, many mental health services remain structured around rigid professional hierarchies — with psychiatrists occupying positions of authority, and other professionals such as psychologists, social workers, and occupational therapists relegated to secondary roles. This hierarchy not only undermines collaboration, but also compromises the quality of care offered to service users.
What is ultimately at stake here is not just a professional turf war, but competing worldviews on human suffering — and, consequently, different ways of responding to it. While psychiatry tends to ask “What disorder is this?”, psychology often asks “What happened to you?”. The former seeks to classify, label, and intervene; the latter seeks to understand, listen, and accompany.
In recent years, service user and survivor movements have brought crucial insights to these debates. The testimonies of those who have experienced coercion, overmedication, or psychiatric institutionalisation challenge the mental health field to re-examine its practices. Listening to these voices is not just a matter of inclusion — it is a matter of justice.
Such listening requires a deep re-evaluation of how psychiatric knowledge was historically constructed — often intertwined with practices of social control, the medicalisation of poverty, and the silencing of dissent. Psychology is not exempt from critique either: in many contexts, it too has colluded with oppressive systems. The task ahead is therefore collective: reimagining mental health care means rethinking institutions, professional training, public policies — and, above all, relationships.
The future of mental health depends on moving beyond illness-centred models focused solely on diagnosis and medication. We need approaches that embrace complexity, prioritise relational care, and make space for difference. That can only happen through practices that honour the time needed for trust, the space required for listening, and the right to meaning-making.
This is not about pitting psychiatry against psychology, but about recognising that, for many people, real care begins when someone is willing to truly listen — without labels, without haste, and without trying to “fix” them. It begins with the recognition that suffering has social, historical, and emotional roots — and that not everything that hurts is a disorder.
The mental health crisis we face today will not be solved with more diagnoses or newer drugs. It demands the courage to face suffering in its full human, social, and political dimensions. And that courage might begin with a simple yet radical question: What if, instead of classifying, we chose to listen?
