Thank you, Gavin Francis, for your long read (‘What I see in clinic is never a set of labels’: are we in danger of overdiagnosing mental illness?, 10 February). It powerfully captures some of the traps modern psychiatry finds itself in and beautifully describes the all-important – and indeed, threatened – relationship at the heart of any good doctor’s practice. I have been a psychiatrist and psychotherapist for over 40 years and would like to make two points about the “epidemic” of mental illness now upon us.
First, there is a mass of evidence that shows mental ill-being, suffering and disturbance, at all degrees of severity, are affected by the level of inequality in society and by social hardship such as poverty, violence and discrimination. Between them, this explains some of the increase we are seeing.
Second, and more anecdotal, many patients who now come to see me want to discuss the possibility that they have ADHD or autism spectrum disorder, diagnoses that have contributed disproportionately to the statistics and often attract a sceptical press. Like Francis, I prefer to tread very lightly around labels, but I am finding some of the perspectives that are emerging through the study of neurodiversity can become a valuable part of the therapeutic conversation. They can offer a useful way into thinking about one’s mind – the capacity psychotherapists refer to as mentalisation. I am also tentatively optimistic that sensitively applying our developing understanding of neurodiverse minds, will, in some cases, prevent the emergence of severe mood disturbance and psychotic symptoms in later life.
Dr Penelope Campling
Leicester
Gavin Francis’s excellent article raises some interesting points on the application of diagnostic classification to explain what might be normal psychological responses to situations, events and experiences.
As a mental health nurse working in primary care, I, along with my colleagues, independently see and treat thousands of primary care mental health patients per year in clinics across Forth Valley. We’re not medically trained diagnosticians. Instead, through a combination of nurse training, clinical experience and personal preference, we bring a flexible psycho-social model to this work and, in doing so, patients recover or move towards “better” without a formal diagnosis, label or a reliance on medical terms to get them there.
The debate is interesting, but I wonder if it’s becoming more academic and less relevant to what is happening on the ground.
Michael Griffiths
Braco, Perth and Kinross
Gavin Francis’s insightful article should be required reading for all health professionals, not only doctors. He is evolving a hybrid of medicine and psychotherapy, as shown in his citations of both a psychoanalyst and a Jungian analyst. But it should not be a case of therapy good/medicine bad. The therapy world is going through its own vicissitudes nowadays, as AI-based advice and what Elizabeth Cotton calls UberTherapy take hold.
Still, I was very impressed with Gavin’s encouragement to GPs to make use of their subjective reactions to the individual patent (the countertransference), rather than seeing these as damaging phenomena. And his passages on the ruination of emotions via leaden language is something we therapists are definitely also guilty of. There were two things I feel moved to add. The first concerns who might work in the way Gavin describes. Here, I am thinking of the collective image of the wounded healer. This is a person who heals because they are damaged, not despite it.
The second point concerns the social and cultural roots of emotional distress. These are not only to be found in the patient’s personal history in their family. Contemporary psychotherapists pay a lot of attention to what the psyche takes in from economic inequality, planetary despoliation, sexual and racial prejudice, misogyny, and corrupt leaders. Today’s soul is deeply mired in such political problems.
Prof Andrew Samuels
Former chair, UK Council for Psychotherapy, and Jungian psychoanalyst
As someone diagnosed with inattentive ADHD in my late 40s, I found this article deeply frustrating. Until my diagnosis, I considered myself “functional”. What I didn’t recognise was how much of my life had been spent masking, compensating and blaming myself for difficulties I couldn’t explain. The diagnosis didn’t reduce me to a label – it gave me a framework to finally understand my own brain.
Inattentive ADHD is hard to spot and often missed until later in life, which makes scepticism from friends, family – and sometimes clinicians – common. Articles like this can reinforce that disbelief by framing rising diagnoses as largely cultural or lifestyle-driven, rather than acknowledging well‑established neurodevelopmental differences in brain structure and function.
I agree that mental health care should be holistic, and that not all distress requires a medical label. But collapsing neurodevelopmental conditions such as ADHD into a broader narrative about overdiagnosis risks erasing people who have spent decades being under-recognised and unsupported. We need a balanced conversation that recognises both the risks of misdiagnosis and the very real harm caused by disbelief and delay.
Joe Ryan
Bristol
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