Mental health care pays too little attention to the world around the patient

People who feel restless, depressed, or anxious are nowadays quickly given a psychiatric label. By doing so, mental health care fails to do justice to the complexity of psychological suffering, argue researchers Laura Batstra and Allen Frances in a recently published article. According to them, the strong focus on the individual leaves too little room for the social context in which mental health problems arise.

In the journal Frontiers in Psychiatry, Batstra and Frances describe how, since the publication of the third edition of the diagnostic manual DSM in the 1980s, psychiatry has increasingly come to think in terms of individual disorders. Frances, an American psychiatrist, chaired the DSM-IV task force, but is concerned about how the book is being used. Psychological complaints are wrongly interpreted as defects in the brain, while societal and social factors have faded into the background.

Little evidence


This is striking, Batstra and Frances write, because decades of brain research have failed to uncover biological causes for psychiatric classifications. Moreover, the emphasis on the individual is stigmatizing and often offers little relief: the average effects of medication and psychotherapy are limited—possibly precisely because insufficient account is taken of the circumstances in which people live.

Logical response


Psychological suffering is often a logical response to difficult circumstances, the researchers argue. Poverty, problems at school or at work, loneliness, or discrimination leave their marks. By medicalizing these complaints, both cause and solution are placed one-sidedly with the individual, while contextual factors remain unaddressed.

Context diagnosis


Batstra and Frances therefore advocate a “context diagnosis.” This involves systematically examining a person’s living environment—family, work, social position, and major life events—and asking which factors contribute to the complaints and which might help bring about improvement. The core question should be less about what is wrong with a person, and more often about what is going wrong in the world in which that person has to function.

Different forms of help


This also calls for different forms of support. Not every problem needs to be captured in a label or fought with medication. Sometimes recognition, practical support, or participation in social activities is more effective—from neighborhood initiatives and walking groups to choirs, reading clubs, or volunteer work. Moreover, according to Batstra and Frances, it is the responsibility of care providers and researchers to actively draw attention to the societal causes of psychological suffering.