Long before I was a psychologist, I was a humanist, and spent much time debating with religious cults. Today, as a psychologist, I spend my time debating with those who defend psychiatric diagnosis. Increasingly, their arguments are the same.

Let’s dive into what I mean by that.

What is psychiatric diagnosis?

Psychiatry often uses a medical model or disease model of distress. For example, you might be told you have social anxiety disorder, major depressive disorder, or borderline personality disorder.

These are modelled on diseases: it suggests there is something wrong with you and that if we can fix that thing within you, you will be “normal”. You have a mental illness, and we aim to cure that illness.

This isn’t the only lens to view distress, though. Viewed through a social lens, anxiety, depression, and other forms of distress are a result of the social circumstances a person finds themselves in. It’s not an illness but the natural consequence of a society that has let someone down.

Where does the science point?

Those who support psychiatric diagnosis will say that they have all of the evidence. Almost all available research is done based on the disease model.

Unfortunately for them, though, the evidence points in the exact opposite direction.

If distress was an illness, we would expect to find something, like the serotonin theory, that would explain why someone becomes depressed, and fix it simply by giving them more serotonin. We would then be able to identify depressed people by measuring their serotonin levels.

This has not happened. The serotonin theory has fallen apart and been largely abandoned. In fact, after 50 years of well-funded research, we haven’t got a single diagnostic test that can look at biomarkers and tell us what “mental illness” someone has.

I will say that again: not one single test. After 50 years of research.

Absence of evidence

The fact that the research has been so well funded is important because cult leaders and psychiatric diagnostic supporters alike will say “absence of evidence is not evidence of absence”.

But this is not always the case. It’s true that if I haven’t looked in my fridge, that isn’t evidence there is no butter in there. But if I open my fridge, search every corner of it for butter, and find no butter, that is good evidence there is no butter in the fridge.

We have looked for the biomarkers. We can’t find them. We can’t find them because they’re not there.

Still, cult members are unfazed. It doesn’t matter how many times the prophet fails to appear; the cult members just keep saying “next time will be the time they appear”. Just as those who support psychiatric diagnosis keep saying “just one more study and we’ll find the biomarkers”.

It’s worth saying that I am willing to be wrong about this. If we find a reliable biomarker that we can then target with a treatment and solve the “illness”, I will welcome that.

Correlation and causation

Even if we did find some biomarkers, it would not necessarily tell us anything. We know that distress is mediated through the body. Anyone who has had a panic attack will be able to tell you how physical it is.

We used to believe that low serotonin caused depression. Even if we did identify that link, which has since been abandoned, it could still be a classic case of mixing up causation and correlation: depression may well cause low serotonin rather than the other way around. Good science would not only need to find the biomarkers, but show there was a causal relationship between them.

Does science have any answers?

You might conclude at this point that science has no answers to these questions. But it does, in fact, provide some pointers.

And those point to the social model of distress. We do have a marker that can predict depression much more accurately than someone’s body chemistry: their bank balance.

We know that when people live in a society with high inequality, their mental health gets worse.

We also know that if we put social supports in place, people’s mental health gets better. A really clear example of that is making reasonable accommodations for autistic people. If you give them a less noisy office, they feel less overwhelmed and become more productive.

The hypothesis of the social lens is that distress is an intelligible response to the circumstances someone finds themselves in. And the evidence agrees.

Quality over quantity

Another retort from the psychiatric diagnosis cult is that almost all research and systems are built around psychiatric diagnosis and therefore it must be correct.

This is like arguing, as many did, that the Earth is the centre of the universe and that Copernicus and Galileo are minor voices not worth listening to.

It’s a deeply unscientific position because it ignores what the evidence points toward. Despite that, you might fairly ask, “but why has this become the dominant view of mental health?”

We know the answer to this, and it is multi-faceted. First, psychology wanted to gain the respect of the medical profession and therefore attempting to copy it, however flawed, probably seemed like a good idea.

Second, the current system of classifying everything into individual disorders suits the needs of the American health insurance system. You need to be able to classify and measure distress into discrete categories to bill for it.

Third, blaming individuals for their distress suited the neoliberal agenda. The traditional model of workers being distressed because of poor conditions didn’t suit the deregulation of Thatcher and Reagan, whereas the “you are unhappy because there is something wrong with you” did.

In short, there is an assumption that because so much research is done on the disease model, it must be because it’s inherently correct. This is bad science: when we check this assumption, as all good science does, we see there is no evidence for this and a convincing explanation as to why else it has happened.

Working within the system

Some might call me a hypocrite: I rail against labels, and yet you can come to my clinic and undergo an assessment for these labels.

I don’t hide that. That’s the system we are working in at present. If you want to access supports and legal protection under the Equality Act 2010, you need to get a label.

However, it is important to point out that these labels rarely get used by us in a therapeutic setting. These labels have little value in treating distress: they are purely a social tool.

Clients often find labels useful. They make us feel less alone with experiences that are often both distressing and confusing. However, the same thing could be achieved with labels that did not place all of the responsibility on the individual.

Conclusion

Mental health disorders don’t exist. These are labels that describe clusters of symptoms. These labels may have some value, but what they are not is a description of an underlying mental illness.

Given that the evidence supports this, we might conclude that psychiatric diagnosis is a cult.

It is important to say, though, that its numbers are much smaller than we might imagine. Many clinicians, myself included, find ourselves forced to work within such a framework, even though we reject its ideas.

In that sense, it might be more comparable to the Anglican Communion. Nobody really believes anymore, but somehow they still run the local school and the parish council.

Whatever it is, it isn’t evidence-based medicine.

Inequality affects our mental health. While it triggers self-esteem issues in those worse off, it also increases “status anxiety” in everyone else, in which we worry about our position. To deal with this anxiety, we consume more: designer clothes, flashier cars, bigger houses, exotic holidays, etc, and work overtime to pay for all of this. As a result, household debt levels rise, and it takes us longer to pay off our mortgage.

Inequality reduces our social circles, which is one of the most significant variables in happiness, because it is harder to maintain friendships across class differences. For example, we risk making friends feel uncomfortable, which can make conversation more difficult. Or maybe you want to go to a nice restaurant, but know your friends don’t have as much disposable income, forcing you to choose between the two.

Inequality increases addictive behaviours, including alcohol consumption and substance use, but also includes behaviours such as shopping or gambling. This happens at all levels of society, i.e., we become more vulnerable to these.

Inequality increases public spending costs. It creates an increased mental health burden (more NHS spending) and the number of people too ill to work (more benefit claimants). It is estimated that the UK could save £39 billion per year just by avoiding the problems inequality causes. That’s more public debt and less money for things we want the government to fund.

Inequality increases crime. We pay for this directly when our houses are burgled, our bikes are stolen, etc, through the increased costs of alarms and security systems, and mentally in the increased fear of being a victim of crime. We also pay for this indirectly: when shoplifting increases, businesses factor the losses into their prices, resulting in more expensive goods, such as groceries, as well as increased public spending on policing, courts, and prisons.

Reducing inequality sounds like it would cost us a lot of money. But it doesn’t. It reduces both public spending and the need to consume to manage our status anxiety, meaning those of us who are well off can spend less, work less, and enjoy greater wellbeing. We all gain from reducing inequality.

Nobody should be subjected to this, and political leaders are right to condemn it. However, these statements often feel perfunctory and make no attempt to address the cause of this rise in violence.

The growing inequality in our society is systematically stripping people of their voice. Our society is supposed to be democratic. But “one person, one vote” does not grant people a genuine say when the world is run by multinational corporations that often wield more power than entire countries. These organisations are run by unelected officials who report to institutional investors and high-frequency trading algorithms.

Individual voices are further drowned out by media publishers and platforms overwhelmingly owned by the 1%. None of this is hidden. Jeff Bezos has directed the Washington Post’s opinion section to defend ‘free markets’ and ‘personal liberties’, effectively excluding dissenting views. Elon Musk bought Twitter to loosen moderation policies, a shift that, according to researchers, has coincided with a sharp rise in hate speech and harassment.

Nor can ordinary people find the time to organise and campaign due to the expanding financial pressures of the cost-of-living crisis. Nor can they organise themselves into bigger units thanks to anti-trade union legislation.

Let me be clear that explaining something is not excusing it. The people who carry out these acts are responsible for them, and no grievance makes violence acceptable. But condemnation alone changes nothing if we refuse to ask what produces the violence in the first place. When we, as a society, systematically deny people access to every “proper channel”, political violence becomes a predictable outcome, and we should not be surprised when it follows. If we want to actually reduce it, rather than simply deplore it, we have to address the root cause: the systematic exclusion of ordinary people from real decision-making. That means extending democracy into the economic sphere.

Research shows that, overall, immigrants pay more in taxes than they receive in benefits, effectively subsidising British taxpayers. If immigration falls, that shortfall would need to be made up through higher taxes on British citizens.

This is in contrast to our neighbours in Ireland, Netherlands, Germany, Luxembourg, Austria, Italy, France, Spain and Portugal, all of whom include healthcare workers.

This decision was made by the Joint Committee on Vaccination and Immunisation (JCVI), but was explicitly done as a cost-saving exercise. Almost every other European nation has instead chosen to prioritise keeping hospital staff healthy and patients safe.

Meanwhile, in November it emerged that the Michelle Mone-linked PPE company, which took £148 million for faulty equipment, has also avoided a £39 million tax bill.

Holding just one such company accountable would pay for COVID boosters for every healthcare worker in Britain.

This is what systemic inequality looks like in action. There’s always money for millionaires, but never for the people who keep the country running.

What is talked about less is that Bevan originally insisted that dental care and eye care were included in universal healthcare, and when Labour introduced charges, he resigned in protest.

Teeth and eyes are not optional extras. They are part of your health.

This is why we need to start judging success by other measures, such as wellbeing.

You might also wonder why Starbucks UK is opening new shops.

The answer is that Starbucks UK paid Starbucks, the owner of Starbucks UK, £40 million last year to use the name Starbucks. This created a £13 million tax credit in the UK, while transferring tens of millions outside of UK tax jurisdiction.

One of the issues is that as phones “advance”, we use more and more data. More data needs the greater bandwidth available at higher frequency radio waves, and higher frequencies are less good at penetrating buildings. The more data we use, the worse it gets, and this problem is likely to get worse in the future.

It’s also an issue that as we build energy-efficient homes and offices. These are designed to reflect heat, which also blocks radio waves, so again, it’s likely to continue getting worse.

There is a solution: in urban areas, we could replace high-powered phone masts with a higher density low-power ones, placing one on each street, or inside large buildings as the Trafford Centre has already done.

But this is expensive. And this is where it intersects with the “efficiency” of the free market.

Right now, the four big network operators - o2, Vodafone, Three, and EE - all maintain their own networks. We’re paying for this through our phone contracts and because each provider only gets a quarter of the market, they can all only afford to build a shitty network that is pretty much as good as their competitor’s network, leaving a lot of people without signal and no better competitor to switch to.

This is unfortunate because building a network to support the entire population costs pretty much the same as building a network to support a quarter: most of the cost is in installing the infrastructure and not per-user utilisation costs, so having four separate networks that do the same thing is almost entirely redundant.

Instead, if we switched to a nationalised network, as we have with the national grid, there would be almost four times as much money to invest in infrastructure and we could have a much more reliable mobile network for potentially the same cost.

Leeds, Bristol, Liverpool, Cardiff, Belfast and Cambridge all lack a light rail or tram system. This is economically damaging. I know people who have had to turn down multiple jobs because there is no reliable way to get from work to their children’s school on time. People want to work. Companies want to hire them. But lack of infrastructure is turning working people into benefit claimants. I don’t want to pay for that.

The target user of HS2, well-paid professionals, have other options (slightly slower trains, planes, cars, online meetings), whereas the lack of public transport limits people who typically work in-person jobs and have no other options for travel. I do want to live in a society where we look after the most vulnerable.

I don’t know if HS2 is a “good” use of money in isolation. But I do know it’s a poor choice compared to building more light rail.

When I retrained from software engineering to psychology, I did one of my placements in a specialist trauma unit for children who had been sexually abused. I was in my 7th year of university, but as a student, I had to work for free. Helping children overcome the trauma of being raped was worth £0 according to the market.

Earlier this year, Elon Musk took SpaceX public. Ahead of this, he merged xAI, maker of Grok, into SpaceX. Over an 11-day period, the Center for Countering Digital Hate estimated Grok generated around 23,000 sexualised images that appeared to depict children. They call this feature “Spicy Mode”. So it’s a space rocket slash child sexual abuse images company. This is worth £1,500,000,000,000 according to the market.

I’ll freely admit I’m envious of Elon Musk. I chose to spend my time helping children who have been raped. I could have used my considerable skill as a software engineer to create a child sex abuse image machine. If I had chosen the latter, my family would now be set for life.

House prices have doubled relative to wages, and the average deposit is now above £60,000. So saving £2,000 a year by avoiding fancy coffees and avocado toast would still take you 30 years to save up.

But we have also built a society that has significantly reduced what economists call the “pain of paying”.

We created a society with cheap and easy consumer credit: credit cards, payday loans, buy-now-pay-later, and reduced friction in spending: Apple Pay/Google Pay, pay with your smart watch, cashless shops, and we moved everything into a monthly subscription where you either have all of the music or none of the music and no option to decide “I won’t buy a new record this month because cash is low”.

So when someone gives in, that isn’t weakness. It’s a system doing exactly what it was designed to do.