Tuesday, 2 March 2021

Mental illness is a choice, but who is the agent?

Today's post is by Dan Reardon who is currently an MSc student at the Institute for Mental Health, University of Birmingham. Dan is a medical doctor and an entrepreneur who has founded multiple fitness and nutrition companies, including venture capital funded FitnessGenes. He has been featured in InStyle, The New York Times, Men’s Fitness, Inc, Well+Good, Livestrong and on Fox News, ABC News, Inside Edition, Today, BBC News, and “The Doctors.” Dan has a keen interest in the demedicalization of young people, digital wellbeing and resilience.

Dan Reardon

I have a long-held belief that mental illness is far from something that is “real” in the disease sense, and yet the rate of growth of mental disorders, both the number of potential diagnoses (described by Foucault as being an invention of 19th century reformers), and the number of people suffering, is exponential. I’ve read countless accounts of mental illness being a choice of those that “suffer”, but I’ve realised the statement is wrong. The choice to have a mental illness does not solely reside, if at all, with the person seeking counsel, but with the professional that chooses to either reinforce their career decisions, or simply decide that there is an easy way to palm off the challenges of life of that person. 

These choices are heavily reinforced if not lavishly coerced by drug companies, and within this “therapeutic domain” (Hazemeijer and Rasker, 2003), the normal individual having a challenging life becomes the patient with the diseases “anxiety and depression” (that have no biological basis), requiring medications (that don’t fix any identifiable disease) to feel a bit better about all of their life problems that remain exactly the same.

This is not to say, nor to undermine the suffering of the person seeking help, but the second these life challenges become medicalised rather than understood (Laing 1965), is the second that the sense of responsibility to deal with the problems is lost – and it becomes the responsibility of the state. But the state doesn’t fix these underlying challenges, it merely attempts to use poisons (pharmacology from the classic Greek pharmakon meaning 'poison') to make you feel a bit better about the problem or make someone else’s life a bit better/easier.

Let’s look at a stomach-churning example. In 2002 Miami Dolphins player Ricky Williams (adored by many people of all ages) made an appearance on the Oprah Winfrey Show declaring that he suffered with shyness. That sounds quite innocent given 40% of the Western world (in terms of natural temperament) is shy. But this was no ordinary declaration of shyness because Ricky was being paid by Glaxo-Smith-Klein (GSK) to go on the Oprah Winfrey show and declare his shyness. 

In the months following he would become the poster boy of the new “Social Anxiety Disorder” drug called Paxil®/Seroxat® (Paroxetine). Shyness and introversion were now a bona fide pathology (according to the DSM), with a huge opportunity to get 40-50% of the population medicated using a technique called condition branding, and in 2003 alone, sales of Paroxetine globally reached just under $5B.

Alas as if the waters here are not already murky, let’s introduce the 2004 lawsuit by the New York State Attorney suing GSK for failing to disclose important safety and efficacy data about said drug. This all came to light because a memo from 1998 from inside GSK was leaked, telling employees to withhold clinical trial findings that showed the drugs had no beneficial effects in treating adolescents.

Introverted people know all too well the challenges that they face, not least because of how they are socialized with comments like, “he needs to come out of his shell” or “he needs to participate more”, so this insecurity creates a natural “que” to be receptive to a solution to the fabricated social challenges. If you can find a que, and you can build a drug, you will find your title of stigmatization in the DSM.

In her book Lean In, Sheryl Sandberg talks about how young boys on the playground that show leadership are described as “good leaders”, whereas young girls are described as “being bossy”. This is perhaps one of the many reasons why we often lack females in leadership roles, but it’s an example of the effects of stigma and how it can make outcomes in life inevitable. It’s bad enough that we had previously stigmatised shy children, but we now give them a medical diagnosis of social anxiety disorder, autism, or attention deficit disorder, with the perfect medications to fix this.

In conclusion it is my opinion that the fate of people’s mental wellbeing seems to be in the hands of mental health/healthcare practitioners, incentivized to declare a mental illness, and not to make the now contrarian statement that “your health is fine, but you need some support managing your life”, which would not be best managed by the medical profession.


  1. I worry that this account does not differentiate between common life experiences that may be over-pathologised (eg removing the grief exception from the DSM) and more serious mental disorders, such as chronic major depression, bipolar disorder, schizophrenia.

    1. Thanks for this reply. I've actually tried responding a number of times but it didn't post so I'm using a different browser now which seems to be working. You are absolutely right that I make no distinction between common life experiences and other things for two reasons. The first is that I don't think the suffering is any different objectively between the two. The second reason is I'm not sold on the definitions of "more serious mental health disorders" so it's not clear to me how we would separate them. I know what the DSM and ICD say about how they are defined, but I'm not willing to stake anything on the validity of these guides. We need a fundamental overhaul of the entire system.

  2. I completely agree with the notion that we over-pathologise problems relating to mental health and I want to go further and say that psychiatry as it stands is not fit for purpose (although as I say this I worry about offending my NHS/medical colleagues and want to make it clear I see this as a systemic problem relating to the 'medical model'and I know there are people trying to change this from within the system).

    I also think it can/does relate to more severe problems. If a person starts to hear aggressive or commanding voices perhaps this is a 'normal' response to childhood trauma (https://academic.oup.com/schizophreniabulletin/article/38/4/661/1870563?login=true). Our focus should be on helping them come to terms with their experience and preventing children from experiencing trauma in the future - not on giving them chemicals so that they don't 'act out' and upset other people.

    1. Thank you for this response, Rachel. I'm cautious about being anti-psychiatry per say as I genuinely believe psychiatrists have the same ideals as other doctors in that they want to help people. There are two barriers that prevent this. The first is that very few people who are diagnosed with a mental health condition, and prescribed psychiatric drugs, ever see a psychiatrist. I was recently in a lecture where the psychiatrist lecturing us said that they don't use DSM as it's not fit for purpose, yet NICE guidelines are framed using DSM, and 99% of psychiatric prescriptions are coming from primary care. The second problem is that psychiatric education and royal college examinations, are all based on the un-truths that built the psychiatric industry, so it propagates the structural and institutional problems further.

      With regards to your example of a child...it pains me the current mistreatment of young people within this space. And this is at the hands of both the parents, the institution, and the public education system.

  3. I know you just said you're cautious about being anti-psychiatry AND you mention the untruths that have built the industry... I think we agree about this. People working in the field are trying to help people AND the training and tools may not be fit for purpose. I always feel I'm hedging when this topic comes up - I don't want to upset people. But unless the fundamental flaws in the system are called out nothing will change.

  4. There is so much here that absolutely resonates for me! Pathologizing normal and even valuable life experiences or traits (grief, introversion etc.) is absolutely facilitated by the DSM and the psychiatric industry. I have worked within and on the fridges of this industry for some time, and I can attest to your claim that it is common for people to be on psychiatric medications (esp. for depression) and to almost never (if ever) see a psychiatrist. It is a pretty grim situation. I concur that "mental illness is a choice", and that this "choice" is largely on the part of the psych industry. I have also seen quite a bit of evidence for people who are acquiring secondary gain from their psych diagnoses (benefits, attention, no responsibility etc.). In those cases I have come to think of it as "both sides using each other".


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