Psychiatrization of Society: A Conceptual Framework and Call for Transdisciplinary Research

Abstract

Purpose: Worldwide, there have been consistently high or even rising incidences of diagnosed mental disorders and increasing mental healthcare service utilization over the last decades, causing a growing burden for healthcare systems and societies. While more individuals than ever are being diagnosed and treated as mentally ill, psychiatric knowledge, and practices affect the lives of a rising number of people, gain importance in society as a whole and shape more and more areas of life. This process can be described as the progressing psychiatrization of society.Methods: This article is a conceptual paper, focusing on theoretical considerations and theory development. As a starting point for further research, we suggest a basic model of psychiatrization, taking into account its main sub-processes as well as its major top-down and bottom-up drivers.Results: 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. To better understand, prevent or manage its negative aspects, there is a need for transdisciplinary research, that empirically assesses causes, mechanisms, and effects of psychiatrization.Conclusion: Although psychiatrization has highly ambivalent effects, its relevance mainly derives from its risks: While individuals with minor disturbances of well-being might be subjected to overdiagnosis and overtreatment, psychiatrization could also result in undermining mental healthcare provision for the most severely ill by promoting the adaption of services to the needs and desires of the rather mild cases. On a societal level, psychiatrization might boost medical interventions which incite individual coping with social problems, instead of encouraging long-term political solutions.

Designed to Clash? Reflecting on the Practical, Personal, and Structural Challenges of Collaborative Research in Psychiatry

“…Also, the economic inequality between CR and EE increased steadily over the three years, as academic payment structures determined that the EE were paid significantly less than the CR. On the other hand, our results will most likely contribute to bringing about a reform of mental health care toward approaches which are more emancipatory in some aspects, firmer grounded in human rights, and which may even serve to counteract the progressing psychiatrization of society ( 56 , 57 ). Furthermore, although the material gap between CR and EE could not be closed, our project opened up what could be called a new career path for all three EE: Even prior to the official termination of PsychCare, all of them had signed contracts in successive projects.…”

Concept Creep and Psychiatrization

“…Without making the naïve assumption that the benefits and costs of psychiatrization are equal, viewing it through the lens of concept creep may clarify its ambivalent character. Beeker et al (2021) recognize this ambivalence in their overview of the topic, and concept creep provides a way to think through its benefits and costs.…”

“…In the psychiatric domain, for example, expansive concepts of mental illness may originate in psychiatry’s diagnostic manuals and then disseminate into the wider public through education, the media, and encounters with professionals. Psychiatrization is understood to involve professionals and specialist interests as well as the citizenry, and to include the institutional practices of mental health professionals and their associated institutions as well as the everyday language use of laypeople, so the nature of the relationship between these ‘top level’ and ‘bottom level’ actors ( Beeker et al, 2021 ) is important for understanding it. By recognizing a combination of top-down and bottom-up processes that jointly produce psychiatrization, Beeker and others acknowledge that the links between these levels are important to grasp.…”

“…The concept of psychiatrization identifies a pattern of correlated societal and cultural changes that have been underway for several decades but now seem especially urgent to address. Beeker et al s (2021) review of the field points to rising rates of mental illness, increasing mental health service utilization, and evidence of over-diagnosis, over-treatment, and over-prescription ( Paris, 2020 ). Coupled with these changes is an expansion in the number and inclusiveness of psychiatric diagnoses that has led critics to lead campaigns to save normality from the relentless encroachment of diagnosable pathology ( Frances, 2013 ).…”

Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach

“…In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide, even though the incidence and prevalence of so-called “mental disorders” have remained relatively stable ( Beeker et al, 2021 ). A recent article, to which this manuscript responds, proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment (ibid): psychiatrization can be promoted by political or psychiatric actors themselves (top-down), as well as by citizens or users (bottom-up), and can lead to various negative social effects, such as an expansion of diagnostic categories, an increasing use of psychotropic drugs or the pathologization of life challenges.…”