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.

Full text

CONCEPTUAL ANALYSIS
published: 04 June 2021
doi: 10.3389/fpsyt.2021.645556
Frontiers in Psychiatry | www.frontiersin.org 1June 2021 | Volume 12 | Article 645556
Edited by:
Hector Wing Hong Tsang,
Hong Kong Polytechnic
University, China
Reviewed by:
Rakesh Kumar Chadda,
All India Institute of Medical
Sciences, India
Daniel Kwasi Ahorsu,
Hong Kong Polytechnic
University, China
*Correspondence:
Timo Beeker
timo.beeker@immanuelalbertinen.de
Specialty section:
This article was submitted to
Social Psychiatry and Psychiatric
Rehabilitation,
a section of the journal
Frontiers in Psychiatry
Received: 23 December 2020
Accepted: 10 May 2021
Published: 04 June 2021
Citation:
Beeker T, Mills C, Bhugra D, te
Meerman S, Thoma S, Heinze M and
von Peter S (2021) Psychiatrization of
Society: A Conceptual Framework and
Call for Transdisciplinary Research.
Front. Psychiatry 12:645556.
doi: 10.3389/fpsyt.2021.645556
Psychiatrization of Society: A
Conceptual Framework and Call for
Transdisciplinary Research
Timo Beeker 1
*, China Mills 2, Dinesh Bhugra 3, Sanne te Meerman 4, Samuel Thoma 1,
Martin Heinze 1and Sebastian von Peter 1
1Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf,
Germany, 2School of Health Sciences, City, University of London, London, United Kingdom, 3King’s College London,
Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom, 4School of Education, Hanze University of
Applied Sciences, Groningen, Netherlands
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.
Keywords: psychiatrization, transdisciplinary research, psychiatric epidemiology, medicalization, overdiagnosis,
health system research, medical sociology, mental health

Beeker et al. Psychiatrization of Society
INTRODUCTION: SCOPE OF THE
PROBLEM
According to the World Health Organization, nearly 10% of
the world’s population is affected by common mental disorders
at any given time (1). Depression and anxiety disorders alone
are estimated to cost the global economy more than one
trillion dollars each year (2), while the burden on health-care
systems and societies is allegedly still underestimated (3,4)
and projected to grow constantly (5). However, epidemiological
field studies mostly suggest either consistently high prevalences
since the introduction of DSM-III in the year 1980 or show
rather small increases (6). In the USA, nearly a full half of the
population is claimed to meet the criteria for a DSM-IV disorder
over the course of their lives (7,8), confirming previous data
using DSM-III-R as diagnostic manual (9). A meta-analysis of
mental health surveys across 63 countries identified an average
12-month prevalence of 17.6% for common mental disorders
(10). At the same time, epidemiological research on child and
adolescent mental health indicates that approximately one in five
children and adolescents worldwide are affected by mental health
problems (11,12).
Despite epidemiological research pointing to high, but
relatively stable incidences and prevalences of mental disorders,
there is clear evidence that more and more people are using
in- or outpatient mental health services, regularly resulting
in the prescription of psychotropic medication. For instance,
antidepressant drug consumption more than doubled between
2000 and 2015 in many OECD- countries (13). In Germany,
there have been constant increases of psychiatric hospital beds
and in-patient case-numbers from 2007 to 2016 (14). Also,
disability pensions due to mental disorders have increased in
many countries (15–17). In the USA, the number of outpatient
mental health service users increased by nearly one-fifth within
one decade, while an estimated 1 in 6 US-adults are on psychiatric
drugs at some point per year (18,19) Among American college
students, the rates of past-year psychiatric or psychotherapeutic
treatment nearly doubled from 2007 to 2017 (from 19 to 34%)
(20). Epidemiological field studies concerning mental disorders
in non-Western countries are rare and prevalence rates often
rely on estimates (10,21–23). Nevertheless, Western psychiatric
concepts and mental healthcare are expanding to the Global
South, which is supported by international organizations like the
WHO and World Bank, advocating for “scaling up” access to
mental health services (24).
Explanations for the consistently high prevalences, increase
in diagnoses and rising mental healthcare service use are
diverse. It has been recurrently argued that improved recognition
and advancing destigmatization of mental disorders might be
uncovering its real prevalence for the first time (25–27). Also,
contemporary working and living conditions (28–32), conflict,
poverty and inequality (33), inflated epidemiologic data (34,35),
and overdiagnosis (36,37) are speculated to be contributing to
what seems to be a significant increase in psychiatric morbidity.
Although all of these factors appear to be relevant, the question
remains whether there is a more general, higher-order process
behind these developments, both connecting and explaining
them. In this paper, this process is identified as a progressing
psychiatrization of society.
This article aims to be a theoretical contribution to advance
further studies. Its main purpose is the systematic development
of a model of psychiatrization, which can serve as starting point
for both empirical and conceptual research.
Methodology (Purpose)
There is a rich canon of literature in the social sciences,
medical anthropology, and critical psychology which deals with
various aspects of psychiatrization, but mostly using different
terminology and against different theoretical backgrounds. Also,
this literature usually targets a micro-level [e.g., ethnographic
case studies on the effects of psychiatric diagnosis (38–40)]
or is unspecific to the field of psychiatry (e.g., research
on medicalization, pharmaceuticalization, see below). Yet, as
discussed in the introduction, there is empirical research from
the medical field that points at various developments within
psychiatry (e.g., research on drug safety, prescription rates,
overdiagnosis, and overtreatment), based on numerous sources
and levels of data from different domains and disciplines. Both
fields of discourse are rarely brought into productive contact with
each other. This may result in conceptual research which tends to
neglect empirical data of the criticized psychiatric discourse itself
and then again in medical research which does not specifically
aim at a theory-based interpretation of its own findings in the
light of larger social, political, and cultural developments.
Methodologically, this article is a conceptual paper which
focusses on theoretical considerations and theory development.
Its intention is neither to prove empirically that psychiatrization
exists nor to speculate in whichever ontological sense this could
be true. In line with Grant & Booth’s typology of reviews, it
can be considered as “critical review” that “goes beyond mere
description” to produce “a hypothesis or a model, not an answer,”
and which can serve as a “launch-pad” for further conceptual,
but also empirical research [(41), p. 93]. Drawing on a diverse
literature base on various aspects of psychiatrization, this article
aims at mediating between the plurality of disciplines, concepts,
and available data. It intends to contribute to a synthesis of the
discourses within medical and social sciences, which are not
only heterogeneous but stand in a tradition of being perceived
as incommensurable.
Given that psychiatrization is a highly diverse, ambiguous
and in itself transdisciplinary research object with fuzzy edges, a
systematic literature review covering the multitude of disciplines
involved was not feasible. Instead, literature was selected with
regard to content and by focusing on the most influential
authors and most quoted theoretical contributions surrounding
psychiatrization over approximately the past 25 years. Drawing
on this rich corpus of literature, an overarching, yet preliminary,
model is proposed, which integrates the main actors, drivers and
sub-processes of the field into a larger framework that eventually
aims at setting the stage for further transdisciplinary research.
Given that the main body of research literature focusses on
the Global North, the emphasis of this article will necessarily
lie on how psychiatrization manifests in industrialized countries
where established psychiatric services already exist. However,
Frontiers in Psychiatry | www.frontiersin.org 2June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
despite the limitations of our approach, psychiatrization in low
and middle income countries will remain an equally important
topic for any kind of further research.
CONCEPTUAL ANALYSIS
Related Concepts
The term “psychiatrization” is first mentioned in psychiatric
literature in the year 1983 by Dušan Kecmanovic, who briefly
discusses psychiatric labeling of social phenomena or of deviance
from existing norms (42). Within the last years, a range of
popular criticism about certain aspects of psychiatry’s expansion
has been mostly interested in the soaring use of psychotropic
medication or the inflation of diagnostic categories in the context
of DSM-5, which appeared in 2013 (36,43–46). However, more
ambitious empirical and theoretical scholarship with an explicit
focus on psychiatrization as higher-order process, aiming at an
overarching theory or presenting a comprehensive model is rare.
For instance, the sociologist Nikolas Rose examines reasons
for and interpretations of the inflation of some psychiatric
diagnoses and related treatments, but without using the term
psychiatrization or attempting to systemize his findings under
a different term. Instead, he concludes by advocating a more
complex approach to understand the growth of these diagnoses
in the broader context of Western societies and their cultural
developments (47). The rich work of philosopher of science
Ian Hacking puts an emphasis on how psychiatric classification
interacts with society, but without focusing on the expansion
of psychiatry as a whole, e.g., by considering quantitative
data, or developing a more unified model. However, Hacking
compellingly shows how psychiatric taxonomy can deeply change
the identity of the targeted persons, who, in return, react to
the provided description by various degrees of embracement
or resistance, which then creatively re-shapes the classifications
(“looping effect”) (48,49). Hacking also claims that classification
has the power of literally “bringing into existence” the classified
objects, thus “making up people” and creating “ecological niches”
for new ways of existence as a certain kind of person (50,51).
Furthermore, there is some ethnographic research detailing
a few of psychiatrization’s mechanisms at work in specific
countries and groups worldwide (38–40,52–54). Theoretical
and experiential accounts of psychiatrization are also evident
in psychiatric user and survivor scholarship, the burgeoning
area of Mad Studies (55–57), and, of course, the classic anti-
psychiatric literature of the 1960s and 70s (58–61). Recently,
there have been several campaigns and publications addressing
medical overdiagnosis and disease-mongering in general but
lacking a special focus on psychiatry (62–66). Conceptually,
psychiatrization unfolds as a co-production of various psy-
disciplines (psychology, psychotherapy, psychoanalysis) from
which mostly synergistic processes of dispersion of psy-
knowledge, concepts, and vocabulary are derived (67). It shares
many features with various current or preceding concepts and
theories that are grounded in a plethora of disciplines:
(1) The conceptual framework of medicalization has been
mainly coined by social scientists, among them Irving Zola, Peter
Conrad, and Ivan Illich (68–74). Medicalization is understood
as the process of defining and treating problems as medical that
formerly had been perceived as non-medical, and thus expanding
medical jurisdiction into new realms.
(2) Building on these ideas, the concept of biomedicalization
(75) describes an intensification of medicalization driven by
technological progress in the bio- and life-sciences, whose main
vector of expansion is the conversion of health into a commodity
and normality into something which has to be maintained or
actively produced.
(3) A third line of argument uses the term
pharmaceuticalization to point to a growing consumption of
prescription- and lifestyle-drugs in many fields of medicine (76–
78). More specific to psychiatry, medical anthropologist Janis
Jenkins (79) explores how the cultural constitution of the self is
influenced by widespread use of psychopharmaceuticals, while
Nikolas Rose (80) has coined the expression of “neurochemical
selves” for individuals who experience their own emotions as
epiphenomena of their brain chemistry.
(4) A fourth theoretical tradition builds on the notion
of psychologization (81,82) or therapeutization (83), seeing
psychology as a discipline that shares or better reproduces
many of psychiatry’s most fundamental assumptions. Yet,
unlike psychiatry, psychology does not necessarily make claims
about the biological base of mental illness or human behavior
in general. Instead it supports the psychiatric epistemology
by centering around individualist categories (e.g., individual
capacities or deficiencies), and thereby tending to overlook or
neglect political and social contexts. In a slightly different sense,
psychologization is also used to refer to society’s growing interest
in individual emotions and psychological mechanisms in general
over the last decades, preparing the breeding ground for what
has been called a “therapy culture” (84). In a similar vein, it
has been argued that many psychological concepts relating to
harmful events and negative human experience have undergone
semantic shifts within the last years in a way that they now
include a broader range of phenomena or quantitatively less
extreme examples of already known phenomena. This “concept
creep” is hypothesized to mirror society’s growing sensitivity
toward harm and suffering, but on the other hand, criticized for
contributing to further psychologizing and pathologizing normal
experiences (85).
Psychiatrization: A Working Definition
Psychiatrization is notoriously hard to define, as psychiatry itself
is diverse, comprising rivaling branches with very different views
on what causes and defines mental disorders and how to treat
them. Also, the boundaries between psychiatry and neighboring
disciplines like clinical psychology are often fuzzy and difficult
to determine. Synthesizing the aforementioned approaches and
concepts, we suggest to define psychiatrization as a complex
process of interaction between individuals, society, and psychiatry
through which psychiatric institutions, knowledge, and practices
affect an increasing number of people, shape more and more
areas of life, and further psychiatry’s importance in society
as a whole. Psychiatrization is an ongoing process which is
not monolithic. Like other complex social developments, such
as individualization or modernization, it is in itself extremely
Frontiers in Psychiatry | www.frontiersin.org 3June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
heterogeneous and appears in multiple, steadily transforming
sub-processes (86) (see Figure 1). It can include both material
(e.g., growth of psychiatric infrastructures) as well as ideological
aspects (e.g., defining a certain condition as disorder) and is
rooted in numerous fields and disciplines (e.g., psychology,
psychotherapy, etc.). As a whole, psychiatrization reciprocally
both causes and reflects the seemingly high incidences of
psychiatric disorders and growing mental healthcare utilization.
Although there is some criticism that psychiatric
epidemiology might be over-inclusive and biased (87–89),
high prevalences and incidences of mental disorders, and even
more so, strong evidence for growing service-use based on
psychiatric diagnosis indicate that an increasing number of
people currently are or are likely to be affected by psychiatry
either directly or indirectly. This demonstrates the core feature of
psychiatrization: its strong drive toward quantitative expansion
(47), which comes into being, for example, through changes
in diagnostic practices [e.g., through diagnostic inflation
(36,73,90)], the growth of the psychiatric healthcare system
in many countries or the soaring use of psychotropic drugs
worldwide (13,19,91). Changes at the institutional or scientific
level often correspond with more subtle transformations,
such as the infusion of psychiatric terminology into everyday
language (e.g., trauma, paranoid) or the interpretation of life
events and personal experiences through the lens of psychiatric
concepts (e.g., burn-out, depression). Thus, psychiatrization
also transforms the life worlds of people without any personal
connection to psychiatry.
However, the general psychiatrization of society might also
be contrasted with rare examples of de-psychiatrization, which
demonstrate that psychiatrization is not a deterministic one-
way road. Instead, it is actively negotiated and can sometimes
even be openly resisted by professionals as well as by laypeople.
The most prominent case of de-psychiatrization might be
the de-pathologization of homosexuality and its removal from
DSM-II in 1973, showcasing that changing attitudes in society
can also result in the rejection of psychiatric labels and
normalize behavior, which was previously deemed “sick” or
“ill” (92). Also, competing psy-disciplines might sometimes, at
least partially, challenge psychiatrization despite sharing some
underlying logic, for example, when therapists oppose the
pharmaceutical treatment of disorders thought to respond better
to psychotherapy.
Approaching a Comprehensive Model
According to the literature mentioned above and the broad
variety of factors for psychiatric expansion that it displays, it
is important to keep in mind that the various manifestations
of psychiatrization are not under central control or a common
endeavor of certain key-players. Their power derives much more
from public and scientific discourse or economic rationality
than from deliberate actions of specific individuals. This also
implies that explanations that mainly focus on the collaboration
between psychiatry and the pharmaceutical industry run the risk
of scientifically falling short (36,44). However, in most cases,
psychiatrization unfolds in multiple interactions with vectors
going top-down as well as bottom-up. This dynamic can also
implicate looping-effects in the very sense of Ian Hacking’s theory
(48,49).
As a heuristic approximation, relevant protagonists can be
classified into agents on the top-level or on the bottom-
level. Top-level agents are defined as being either mental
healthcare professionals or in other ways professionally tied to
the healthcare system, while the agents on the bottom level are
“laypeople” from a medical point of view, who do not have a
professional connection to (mental) healthcare. A comprehensive
model of psychiatrization and any further analysis needs to
incorporate these two main levels and the vectors of interaction in
between (see, Figure 1). This structure may also serve as a scheme
to help characterize single sub-processes of psychiatrization (93).
Top-Down Psychiatrization
Typical protagonists of top-down psychiatrization would
be psychiatrists, psychotherapists, clinical, and non-clinical
scientists with connections to psychiatry, politicians with an
impact on healthcare on a structural level, health insurers,
pension funds, the pharmaceutical industry, and medical
engineering companies. Examples for top-down-initiated
psychiatrization processes can be large scale restructuring
of mental health services, lawmaking, publication of new
treatment and diagnostic guidelines, the introduction of new
diagnoses into ICD and DSM, diagnosis- or treatment-related
financial incentives by insurers, the development of new and the
approval of existing psychotropic drugs for certain conditions,
compulsory mental health screening in schools and workplaces,
and requirements for diagnoses to access educational support.
In the texts that form the foundation for this conceptual
mapping, various examples for analysis focusing on top-
down-mechanisms are provided. For instance, Whitaker
and Cosgrove detail how top-down psychiatrization
in the USA evolved in close cooperation between the
American Psychiatric Association, the pharmaceutical
industry and academic psychiatry, resulting in the
systematic popularization of overestimated benefits
from SSRI-treatment and in official treatment guidelines
comprising recommendations which contradict solid
scientific evidence (44).
Conrad (72) describes the re-shaping of the DSM-III diagnosis
“social phobia” into “social anxiety disorder” (SAD) in DSM-
IV, which has been criticized elsewhere as “the medicalization
of shyness” (94). Small changes in wording expanded the reach
of this previously rather rare diagnosis considerably. This
was embraced by the pharmaceutical company SmithKline
Beecham’s as an opportunity to sell the SSRI-antidepressant
Paxil, despite the market for depression having already
reached saturation. Conrad highlights the crucial importance
of lawmaking, as the loosening of legal requirements for
direct-to-consumer (“DTC”) pharmaceutical advertising in
the United States set the stage for a new marketing strategy
with emphasis on television commercials. These turned out
to play a key role in creating the “anxiety-market” by
raising public awareness for SAD as a widespread and highly
debilitating condition and, after Paxil’s FDA-approval for SAD
Frontiers in Psychiatry | www.frontiersin.org 4June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
FIGURE 1 | Top-down and bottom-up psychiatrization (original figure). Main protagonists and vectors of psychiatrization consisting of heterogeneous sub-processes,
of which the most important are listed on the right side of the figure.
in 1999, by promoting Paxil as the adequate remedy. In this
case of top-down psychiatrization, changes to the DSM and
federal lawmaking contributed heavily to the creation of a new
epidemic of SAD with estimated point prevalences of up to
13,3% in the US-population on the one hand (72), and Paxil
becoming one of the world’s best-selling drugs of all time on
the other hand (71).
A more recent example of top-down psychiatrization, which
has been discussed extensively in both scientific and popular
literature, is the suspension of the so called “bereavement-
exclusion” from DSM-IV to DSM-5 (95–97). This alteration,
which was performed in a top-down-way by the DSM-5 Task
Force, is criticized for further inflating the psychiatric category
of depression, thus blurring the line between mental illness
and ordinary grief while making more individuals eligible for
psychiatric treatment.
In the Global South, top-down psychiatrization may occur
through turning culturally accepted ways of expressing
distress into psychiatric conditions, e.g., through integration
as culture-bound syndromes into DSM and through mental
health legislation, such as the categorization of specific
psychotropic drugs as “essential medicines” by the WHO or its
encouragement of the use of the mhGAP-Intervention Guide
as diagnostic and treatment algorithm in primary care (24,
98,99). Also, the pharmaceutical industry’s initiatives to open
up new markets for psychotropic medication in non-Western
countries can often be seen as mainly top-down driven cases
of psychiatrization (100). Exporting specific medication may
also entail the export of the very Western concepts of mental
disorders which are the underlying rationales for its use, as has
been discussed e.g., for the marketing of SSRI-antidepressants
in Japan (101,102).
Bottom-Up Psychiatrization
Most criticism about psychiatry’s expansion highlights agents
on the top-level and top-down processes. However, it seems
to be a main characteristic of psychiatrization in modern and
postmodern societies that it is advanced to a significant degree
by laypeople without professional ties to psychiatry or the health-
care system in general (see, Figure 1). This argument is in
line with Michel Foucault’s claim that psychiatrization might be
“requested, rather than imposed” [(103), p. 296] and “does not
come from above, or not only from above” [p. 295]. As opposed
to top-down psychiatrization, where the supply of certain options
(treatments, diagnosis, etc.) precedes and prompts the demand
on the bottom-level, the concept of bottom-up psychiatrization
underlines that the needs and desires of patients, proto-patients,
and consumers can also induce changes on the top-level. This
typically results in widening the range, changing the kind or
facilitating the accessibility of the available options. Hence, the
psychiatric permeation of individual life and collective spheres
in capitalist Western societies is to a large part demand- and
consumer-driven, which resonates with widespread claims about
the gradual transformation of patients into consumers in medical
sociology (70,104,105) and the commodification of individual
health (75,106).
Frontiers in Psychiatry | www.frontiersin.org 5June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
Typical drivers of bottom-up psychiatrization might be people
searching for recognition of subjective suffering or difference
through clinical diagnosis (47), people with mild or unspecific
“symptoms” using professional healthcare services without
clear indication (107,108), or the demand of parents or other
caregivers for diagnoses and treatment of perceived learning
and behavioral disorders (109,110). Individual interests might
also be organized in and articulated by advocacy groups trying
to raise awareness for certain diseases and stimulate political
action in favor of people with specific diagnoses (110,111).
In the aforementioned literature and related publications,
several examples for bottom-up psychiatrization can be found,
although the traditional view of psychiatric expansion lays
more emphasis on top-down processes. Conrad (71) and Scott
(112) analyze the inclusion of Posttraumatic Stress Disorder
(PTSD) into the DSM-III as a joined endeavor of returning
Vietnam war veterans and some anti-war psychoanalysts
and psychiatrists. The objectification of PTSD as psychiatric
disorder hence was driven to a substantial degree by political
motivations and private, not least financial interests of
laypeople, namely ex-soldiers, whose psychological distress
due to deeply disturbing war experiences had not been
officially recognized as disorder before (113).
Conrad and Potter (48) describe how Attention Deficit
Hyperactivity Disorder (ADHD) evolved from a condition
which used to be limited to childhood into a lifespan
disorder. This transformation was triggered by a wave
of books and articles in lay media popularizing the idea
that ADHD could persist beyond childhood and might
account for many problems in adult life such as relationship
issues or disorganization at the workplace. The ADHD
support and advocacy group CHADD (“Children and Adults
with Attention-Deficit/Hyperactivity Disorder”) played a
prominent role in the further promotion of the idea that
ADHD should be seen as neurobiologically caused and
consequently as a lifespan-disorder. Within this context,
many adults who claimed to recognize themselves in ADHD-
symptomatology were seeking official confirmation of their
self-diagnosis from GPs and psychiatrists, often also asking
to be treated with medication. In this case, bottom-up
psychiatrization was mainly driven by ordinary individuals’
demand for explanations, official recognition and medical
treatment of their life-problems or suffering as psychiatric
disorder, relating to what Nikolas Rose has described as the
readiness for “the psychiatric reshaping of discontents” [48,
p. 479]. It ultimately led to the inclusion of adult ADHD
into DSM-IV and the FDA-approval of psychostimulants and
other medication for its treatment, which from then on were
routinely prescribed by physicians.
Similar constellations, in which primarily consumers and/or
patients campaign for the official recognition of particular
disease entities, can be found for many psychosomatic
symptom clusters such as chronic fatigue or fibromyalgia
syndrome (114,115). However, because laypeople always
need to mobilize agents of the top-level to achieve effective
changes (e.g., of the DSM), in all of these examples medical
expertise has to be incorporated at some levels. This expertise
may consist of scholars with research interest in particular
conditions, or in clinicians who also identify as activists for
a certain kind of suffering and become “moral entrepreneurs”
[48, p. 476]. Top-level agents may thus even actively encourage
bottom-up psychiatrization (93). Also, as in the case of
CHADD, financial support from the pharmaceutical industry
might help to maximize reach and political leverage of
self-advocacy (48,116). Still, it seems justified to interpret
the above cases as bottom-up psychiatrization, as the main
initiative in all of them derives from ordinary people without
professional ties to the healthcare-system.
In the Global South, bottom-up psychiatrization appears
to happen more rarely or is at least less represented in
scientific literature. Mental health advocacy, e.g., for scaling
up psychiatric services or to reduce stigma, is usually
led by professionals or by human rights activists, mostly
originating from countries of the Global North (24). However,
a key strategy of many NGOs is to train non-specialists
in tasks (diagnostics, administering medication, etc.) which
are usually carried out by mental health professionals. This
re-distribution of professional work known as task-sharing
explicitly aims at laypeople acting as proxies of psychiatric
experts and thus could arguably be conceived as bottom-
up psychiatrization (117). Still, bottom-up psychiatrization
understood in the sense of demand- or desire-driven
induction of changes on the top-level seems to take place
rather in consumerist societies, where economies run on
evoking desires and elaborate psychiatric infrastructures
already exist.
DISCUSSION
Relevance and Consequences
Processes of psychiatrization are increasingly relevant in the light
of a fundamental reorientation of mental healthcare provision in
many countries worldwide (e.g., through digitalization, further
deinstitutionalization, and the scaling up of community care),
which may coincide with ongoing profound political and
social changes (e.g., due to economic crisis, climate change,
globalization) (86,118–121). The extent, and dynamics of
psychiatrization processes largely depend on the economic
situation of a region or country, the structure of its healthcare
system or cultural influences. Given the magnitude of these
factors, which all include a historical dimension that adds further
complexity, a full assessment of context and origins remains a
challenge for future research. Also, the effects of psychiatrization
are diverse, highly ambivalent, and significantly influenced by
the aforementioned local factors. Individuals or groups might
well-benefit from aspects of psychiatrization, as the growing
mental healthcare system can also increase accessibility and
provision of services that are subjectively helpful and medically
clearly indicated. Thus, it can be complicated for research
to distinguish legitimate attempts to meet real unmet-needs
from building up infrastructures which create artificial need or
promote pathologization and overtreatment of mental distress,
especially in areas with little specialized care for mental disorders.
Frontiers in Psychiatry | www.frontiersin.org 6June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
However, further research about the nuances of
psychiatrization is necessary. Besides significant regional
differences in its causes and mechanisms, the role of mental
health professionals other than psychiatrists or psychotherapists
may be a crucial, widely unexplored aspect. Given the trend
to the multidisciplinary treatment of mental distress in the
Global North, professions such as occupational therapists, social
workers, mental health nurses, or rehabilitation counselors
deserve a special focus. They may be agents who play an
important role in mediating between the top- and the bottom-
level of psychiatrization (see, Figure 1). On the one hand,
although they do not exert the power of psychiatric diagnosis
themselves, they might benefit from psychiatric expansion
and their professional (group) interests might be a reinforcing
factor. On the other hand, their work may also contribute to
preventing psychiatrization or to mitigate its effects, e.g., by
avoiding hospitalization or by empowering people in mental
distress to overcome crisis without consulting a psychiatrist or
psychotherapist. In this context, it will also be an important
research question how the growing involvement of mental
health service-users as counselors or lay-therapists in psychiatric
institutions relates to psychiatrization.
Advancing research on psychiatrization may be important,
in the light of its obvious risks on the individual, societal
and public health-level: First, on the individual level, negative
consequences of psychiatrization may relate to overdiagnosis and
overtreatment, e.g. medication adverse effects and harms from
long term use (43,122–128), but may also be about the impacts
of labeling and of coercive treatments (129–131). Through
pathologization of minor disturbances of well-being, individual
variation and numerous life issues, psychiatrization can also co-
produce avoidable patient careers, create dependencies on mental
health services, and ultimately promote disempowering changes
to subjectivity and sense of self (80,132–134).
Second, on the societal level, psychiatrization may risk to
further narrow the range of what is perceived as “normal,”
encourage ineffective and short-term medical interventions,
prompt individuals to cope with social problems and impede
the finding of adequate long-term solutions (67,134,135). Such
solutions would be situated rather in the realm of politics, where
psychiatrization might otherwise be contributing to disguising
failed policies.
Third, from a public health perspective, psychiatrization of
society runs the risk of establishing widespread inverse care
by increasingly neglecting the most severely and chronically ill,
when mental health services are tailored to the needs of the mildly
ill and borderline cases (18,136,137). Accordingly, the relative
shortage of psychotherapists and long waiting times for out-
patient services in some countries of the Global North may be
a direct effect of structurally induced healthcare over-utilization
by the “worried well” (138,139).
Fourth, from a global perspective, psychiatrization could
lead to excessive diagnosis and prescription of medication
with little monitoring once people are medicated in countries
with low and middle incomes, where psychiatrization is to a
large degree exerted through task-sharing. In these countries
this may also undermine local support systems and promote
individualized interventions into poverty (67,140). Worldwide,
psychiatrization could contribute to challenging public health
by misallocating scarce resources toward biomedical research
and pharmacological treatment instead of strengthening psycho-
social interventions (141,142).
CONCLUSION AND PERSPECTIVES
Psychiatrization is a highly complex and diverse global process
with various protagonists. Its effects are ambivalent but can
be harmful in many ways to individuals, societies, and public
healthcare systems. To better understand, and also to deal with
negative consequences of psychiatrization, there is primarily a
need for research, which might be accompanied by public debate
and, ultimately, may help inform political decision-making.
On the scientific level, transdisciplinary research is necessary
to empirically establish the existence of psychiatrization by
assessing and, wherever possible, measuring its different causes,
mechanisms and effects in relation to clearly defined areas,
such as a region, a city or a nation. This kind of research
should also include the different perspectives of a broad variety
of professions involved in mental health care, among them,
apart from psychiatrists and psychotherapists, social workers,
occupational therapists, mental health nursing professionals, or
rehabilitation counselors. To this end and due to the complex
and multi-layered nature of the research topic, a mixed-methods
approach seems most suitable (143): Quantitative methods can
contribute to establishing a solid fact base about the growth
of psychiatric infrastructures, local trends in prevalence, and
healthcare utilization (144). Relevant data would comprise
changes in treatment capacities and utilization of psychiatric
hospitals and outpatient-departments, government and health
insurance expenditure for mental health, trends in psychotropic
drug prescription and self-reported usage, availability and
utilization of psychological treatment, numbers of primary-
care physician contacts for psychological problems and all
kinds of available data sets about prevalence and incidences of
mental disorders, e.g., as measured by national mental health
surveys. Qualitative approaches such as expert interviews, in-
depth group interviews or participant observation would be
used to make visible the effects of psychiatrization in the
everyday life of individuals, exploring subjective and collective
meanings of different aspects of psychiatrization and identifying
motives for engaging in psychiatrization processes or resisting
them (145–147).
Both types of research will be necessary prerequisites for
data-based theory development about psychiatrization, its causes,
its mechanisms, and its effects on public health, individuals
and society. As mentioned above, the extent and type of
psychiatrization processes largely depend on the economic and
political situation, culture and history of a region or country.
This renders a complete assessment of context difficult to achieve.
Nonetheless, a data-based theory, enriched with an in-depth
description of contextual factors, seems to be a realistic goal
which can also help inform public debate, stakeholders in
healthcare and political decision-makers. Main overall research
Frontiers in Psychiatry | www.frontiersin.org 7June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
goals will be to better understand how changes on the level
of mental healthcare provision or utilization (1) are shaped
by individual action of both top- and bottom-level agents, (2)
are affecting patients’ and proto-patients’ lives, e.g., through
(over)diagnosis, changing self-definitions or inducement of
patient-careers, (3) advance the dissemination of psychiatric
concepts, knowledge and epistemologies in society, (4) induce
or intensify the permeation of certain areas of private and public
life, and (5) interact with or are determined by larger economic,
social, and cultural developments.
As psychiatrization is transdisciplinary as a research-object,
expertise from various fields other than psychiatry are required,
such as health services research, epidemiology, and public health.
To mediate between the discourses of the various sciences
and disciplinary traditions, researchers with a background in
ethnology, medical anthropology, sociology, and philosophy
etc. should also be involved from the beginning. It will be
equally important for all research to build up collaborative
projects between professionals and service users that value
user, survivor and Mad Studies knowledge, whose common
point of reference are negative experiences with ideology and
practice of clinical psychiatry and its impacts on personal
well-being and biography. Thus, there is an intrinsically
critical view on psychiatrization contained in the experiential
knowledge of service users and the epistemologies derived from
it (148).
Such transdisciplinary research as described could result in
empirically proving that psychiatrization exists, developing valid
indicators for its extent, showing hot spots and key-factors
on a local scale, thickening theory and generating hypotheses
and research goals for more complex, larger scale research
programs. In the long run, as psychiatrization occurs globally,
both local and global perspectives will be required, pointing
out the many different ways that psychiatrization manifests, is
embraced, appropriated, or resisted around the world.
AUTHOR CONTRIBUTIONS
TB, ST, and SP initiated research and were responsible for
devising the article. TB developed the comprehensive model,
wrote the initial draft, and coordinated the other authors’
contributions. All authors contributed to literature search,
interpretation of literature, helped draft the final version of
the manuscript and revised the article critically for important
content. All authors approve the final version to be published and
agree to be accountable for all aspects of the work, its accuracy
and integrity.
FUNDING
We acknowledge funding by the MHB Open Access Publication
Fund supported by the German Research Association (DFG).
REFERENCES
1. World Health Organization. Fact Sheet Mental Disorders. (2019). Available
online at: http://www.who.int/mediacentre/factsheets/fs396/en/ (accessed
May 12, 2020).
2. World Health Organization. Out of the Shadow: Making Mental Health a
Global Priority. (2016). Available online at: https://www.who.int/mental_
health/advocacy/wb_background_paper.pdf?ua=1 (accessed May 19, 2021).
3. Vigo D, Thornicroft G, Atun R. Estimating the true global burden
of mental illness. Lancet. (2016) 3:171–8. doi: 10.1016/S2215-0366(15)
00505-2
4. Takayanagi Y, Spira AP, Roth KB, Gallo JJ, Eaton WW, Mojtabai R. Accuracy
of reports of lifetime mental and physical disorders: results from the
baltimore epidemiological catchment area study. JAMA Psychiatr. (2014)
71:273–80. doi: 10.1001/jamapsychiatry.2013.3579
5. Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR,
Fathima S, et al. The Global Economic Burden of Noncommunicable
Diseases. Geneva: World Economic Forum (2011). Available
online at: http://www3.weforum.org/docs/WEF_Harvard_HE_
GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf (accessed
May 4, 2020).
6. Richter D, Wall A, Bruen A, Whittington R. Is the global prevalence rate of
adult mental illness increasing? Systematic review and meta-analysis. Acta
Psychiatr Scand. (2019 140:393–407. doi: 10.1111/acps.13083
7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE.
Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in
the National Comorbidity Survey replication. Arch Gen Psychiatry. (2005)
62:593–603. doi: 10.1001/archpsyc.62.6.593
8. National Institute of Mental Health. Statistics mental illness. (2019). Available
online at: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
(accessed May 16, 2020).
9. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S,
et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders
in the united states: results from the national comorbidity survey. Arch Gen
Psychiatry. (1994) 51:8–19. doi: 10.1001/archpsyc.1994.03950010008002
10. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et
al. The global prevalence of common mental disorders: a systematic
review and meta-analysis 1980-2013. Int J Epidemiol. (2014) 43:476–93.
doi: 10.1093/ije/dyu038
11. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun
O, et al. Child and adolescent mental health worldwide: evidence
for action. Lancet. (2011) 378:1515–25. doi: 10.1016/S0140-6736(11)
60827-1
12. Collishaw S. Annual research review: secular trends in child and
adolescent mental health. J Child Psychol Psychiatr. (2015) 56:370–93.
doi: 10.1111/jcpp.12372
13. Organisation for Economic Co-Operation and Development (2020)
Statistics Health Status. Available online at: https://stats.oecd.org/index.aspx?
DataSetCode=HEALTH_STAT# (accessed May 16, 2020).
14. Thom J, Bretschneider J, Kraus N, Handerer J, Jacobi F, et al.
Versorgungsepidemiologie psychischer Störungen. Bundesgesundheitsbl.
(2019) 62:128–39. doi: 10.1007/s00103-018-2867-z
15. Viola S, Moncrieff J. Claims for sickness and disability benefits owing to
mental disorders in the UK: trends from 1995 to 2014. BJPsych Open. (2016)
2:18–24. doi: 10.1192/bjpo.bp.115.002246
16. Schofield TP, Kiely KM, Mykletun A, Harvey SB, Butterworth P. Using
longitudinal survey data to estimate mental health related transitions
to a disability pension. J Occup Environ Med. (2018) 60:166–72.
doi: 10.1097/JOM.0000000000001269
17. Portal für psychische Gesundheit am Arbeitsplatz. Daten und Fakten. (2019).
Available online at: https://www.psyga.info/psychische-gesundheit/daten-
fakten/ (accessed 13 May, 2020).
18. Olfson M, Wang S, Wall M, Marcus SC, Blanco C. Trends in
serious psychological distress and outpatient mental health care of US
adults. JAMA Psychiatr. (2019) 76:152–61. doi: 10.1001/jamapsychiatry.
2018.3550
Frontiers in Psychiatry | www.frontiersin.org 8June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
19. Moore TJ, Mattison DR. Adult utilization of psychiatric drugs and
difference by sex, age and race. JAMA Intern Med. (2017) 177:274–5.
doi: 10.1001/jamainternmed.2016.7507
20. Lipson SK, Lattie EG, Eisenberg D. Increased rates of mental health service
utilization by U.S. College students: 10-year population-level trends (2007-
2017). Psychiatr Serv. (2019) 70:60–3. doi: 10.1176/appi.ps.201800332
21. Baxter A, Scott K, Vos T, Whiteford H. Global prevalence of anxiety
disorders: a systematic review and meta-regression. Psychol Med. (2013)
43:897–910. doi: 10.1017/S003329171200147X
22. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE,
et al. Global burden of disease attributable to mental and substance use
disorders: findings from the Global Burden of Disease Study 2010. Lancet.
(2013) 382:1575–86. doi: 10.1016/S0140-6736(13)61611-6
23. Ferrari A, Somerville A, Baxter A, Pacella RE, Patten S, Vos T, et al. Global
variation in the prevalence and incidence of major depressive disorder:
a systematic review of the epidemiological literature. Psychol Med. (2013)
43:471–81. doi: 10.1017/S0033291712001511
24. Mills C. Decolonizing global mental health: the psychiatrization
of the majority world. London /New York, NY: Routledge (2014).
doi: 10.4324/9780203796757
25. Richter D, Berger K. Are mental disorders increasing? Update of a systematic
review on repeated cross-sectional studies. Psychiat Prax. (2013) 40:176–82.
doi: 10.1055/s-0032-1333060
26. Mars B, Heron J, Kessler D, Davies NM, Martin RM, Thomas KH,
et al. Influences on antidepressant prescribing trends in the UK:
1995–2011. Soc Psychiatry Psychiatr Epidemiol. (2017) 52:193–200.
doi: 10.1007/s00127-016-1306-4
27. Mojtabai R. Mental illness stigma and willingness to seek mental health
care in the European Union. Soc Psychiatry Psychiatr Epidemiol. (2010)
44:705–12. doi: 10.1007/s00127-009-0109-2
28. Dittmar H, Bond R, Hurst M, Kasser T. The relationship between
materialism and personal well-being: a meta-analysis. J Pers Soc Psychol.
(2014) 107:879–924. doi: 10.1037/a0037409
29. Eckersley R. Is modern Western culture a health hazard? Int J Epidemiol.
(2005) 35:252–8. doi: 10.1093/ije/dyi235
30. Rosa H. Social Acceleration. A New Theory of Modernity. New York, NY:
Columbia University Press (2015).
31. Cvetkovich A. Depression. A Public Feeling. Durham/London, Duke
University Press (2012). doi: 10.1215/9780822391852
32. Ehrenberg A. The Weariness of the Self: Diagnosing the History of Depression
in the Contemporary Age. Montreal, McGill-Queen’s University Press (1998).
33. Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et
al. The Lancet Commission on global mental health and sustainable
development. Lancet. (2018) 392:1553–98. doi: 10.1016/S0140-6736(18)
31612-X
34. Horwitz AC, Wakefield JC. The epidemic in mental illness: clinical
fact or survey artefact. Contexts. (2006) 5:19–23. doi: 10.1525/ctx.2006.
5.1.19
35. Brhlikova P, Pollock AM, Manners R. Global burden of disease estimates of
depression-how reliable is the epidemiological evidence? J R Soc Med. (2011)
104:25–34. doi: 10.1258/jrsm.2010.100080
36. Frances A. Saving normal: an insider’s revolt against out-of-control
psychiatric diagnosis, DSM-5, Big Pharma, and the medicalization of
ordinary Life. New York, NY: William Morrow (2013).
37. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop
harming the healthy. BMJ. (2012) 344:e3502. doi: 10.1136/bmj.e3502
38. Jain S, Orr DM. Ethnographic perspectives on global mental health. Transcult
Psychiatr. (2016) 53:685–95. doi: 10.1177/1363461516679322
39. Behrouzan O. Prozak Diaries: Psychiatry and Generational Memory in Iran.
Bloomington, Stanford University Press (2016). doi: 10.1515/9780804799591
40. LeFrançois BA. The psychiatrization of our children, or,an autoethnographic
narrative of perpetuating First Nations genocide through ‘benevolent’
institutions. Decolon Indigen Educ Soc. (2013) 2:108–23. Available online
at: https://jps.library.utoronto.ca/index.php/des/article/view/18687/16239
(accessed May 19, 2021).
41. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types
and associated methodologies. Health Inform Libraries J. (2009) 26:91–108.
doi: 10.1111/j.1471-1842.2009.00848.x
42. Kecmanovi´
c D. Psychiatrization: a general view. Int J Soc Psych. (1983)
29:308–12. doi: 10.1177/002076408302900411
43. Whitaker R. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and
the Astonishing Rise of Mental Illness in America. New York, NY: Broadway
Books (2010).
44. Cosgrove L, Whitaker R. Psychiatry Under the Influence. Institutional
Corruption, Social Injury, and Prescriptions for Reform. New York, NY:
Palgrave Macmillan (2015).
45. Paris J. Overdiagnosis in Psychiatry. How Modern Psychiatry Lost Its Way
While Creating a Diagnosis for Almost All of Life’s Misfortunes. New York, NY:
Oxford University Press (2015). doi: 10.1093/med/9780199350643.001.0001
46. Kirsch I. The emperor’s New Drugs. Exploding the Antidepressant Myth.
London, Random House (2009).
47. Rose N. Disorders without borders? The expanding scope of psychiatric
practice. BioSocieties. (2006) 1:465–84. doi: 10.1017/S1745855206004078
48. Hacking I. Rewriting the Soul: Multiple Personality and the Sciences
of Memory. New Jersey, NJ: Princeton University Press (1995).
doi: 10.1515/9781400821686
49. Hacking I. The Social Construction of What? Cambridge, Harvard University
Press (1999).
50. Hacking I. Mad Travelers: Reflections on the Reality of Transient Mental
Illnesses. Charlottesville: University of Virginia Press (1998).
51. Hacking I. Making Up People. In: Heller TL, Sosna M, Wellbery DE,
editors. Reconstructing Individualism. Stanford, CA: Stanford University
Press (1985). p. 222–36.
52. Lakoff A. Pharmaceutical Reason: Knowledge and Value in Global
Psychiatry. Cambridge, Cambridge University Press (2006).
doi: 10.1017/CBO9780511489150
53. Mills C. The Psychiatrization of poverty: rethinking the mental
health-poverty nexus. Soc Personal Psychol Compass. (2015) 9:213–22.
doi: 10.1111/spc3.12168
54. Cohen BM. Passive-aggressive: M¯
aori resistance and the continuance
of colonial psychiatry in Aotearoa New Zealand. Disabil Global South.
(2014) 1:319–39. Available online at: https://disabilityglobalsouth.files.
wordpress.com/2012/06/dgs-01- 02-06.pdf (accessed May 19, 2021).
55. Burstow B, LeFrançois BA, Diamond S. Psychiatry Disrupted: Theorizing
Resistance and Crafting the (R)evolution. Montreal: McGill-Queen’s
University Press (2014).
56. LeFrançois BA, Menzies R, Reaume G, editor. Mad Matters: A critical reader
in Canadian Mad Studies. Toronto, ON: Canadian Scholars Press Inc, (2013).
57. Russo J, Sweeney A. Searching for a Rose Garden: Challenging Psychiatry,
Fostering Mad Studies. Monmouth: PCCS Books (2017).
58. Goffman E. Asylums: Essays on the Social Situation of Mental Patients and
Other Inmates. New York, NY: Anchor Books (1961).
59. Foucault M. Madness and Civilization. A History of Insanity in the Age of
Reason. New York, NY: Random House (1965).
60. Szasz TS. The Myth of Mental Illness: Foundations of a Theory of Personal
Conduct. New York, NY: Harper & Row (1974).
61. Cooper D. Psychiatry and Anti-Psychiatry. London, Tavistock/Paladin (1967).
62. Preventing Overdiagnosis: Winding Back the Harms of too Much Medicine.
Available onlineat: https://www.pre ventingoverdiagnosis.net/ (accessedMay
19, 2021).
63. ABIM-Foundation Our Mission. Available online at: http://www.
choosingwisely.org/about-us/ (accessed at: May 16, 2020).
64. BMJ’s Too Much Medicine Initiative. Available online at: http://www.bmj.
com/too-much- medicine (accessed at: May 16, 2020).
65. Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical
industry and disease mongering. BMJ. (2002) 324:886–91.
doi: 10.1136/bmj.324.7342.886
66. Moynihan R, Cassels A. Selling sickness. New York, NY: Nation Books
(2005). doi: 10.1037/e514562004-001
67. Klein E, Mills C. Psy-expertise, therapeutic culture and the politics of
the personal in development. Third World Quart. (2017) 38:1990–2008.
doi: 10.1080/01436597.2017.1319277
68. Zola IK. Medicine as an institution of social control. Soc Rev. (1972) 4:487–
504. doi: 10.1111/j.1467-954X.1972.tb00220.x
69. Conrad P. Medicalization and social control. Annu Rev Sociol. (1992)
18:209–32. doi: 10.1146/annurev.so.18.080192.001233
Frontiers in Psychiatry | www.frontiersin.org 9June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
70. Conrad P. The shifting engines of medicalization. J Health Soc Behav. (2005)
46:3–14. doi: 10.1177/002214650504600102
71. Conrad P. The medicalization of society. On the Transformation of Human
Conditions into Treatable Disorders. Baltimore, John Hopkins University
Press (2007).
72. Conrad P. The medicalization of mental disorder. In: Aneshensel CS, et
al., editors. Handbook of the Sociology of Mental Health,2nd Edn. Springer,
Dordrecht (2013). p. 61–73 doi: 10.1007/978-94-007-4276-5_4
73. Conrad P, Potter D. From hyperactive children to ADHD adults:
Observations on the expansion of medical categories. Soc Probl. (2000)
47:59–82. doi: 10.2307/3097135
74. Illich I. Medical Nemesis. London: Calder & Boyars (1974).
doi: 10.1016/S0140-6736(74)90361-4
75. Clarke A, Shim J, Mamo L, Fosket J, Fishman J. Biomedicalization:
technoscientific transformations of health, illness, and U.S. biomedicine. Am
Soc Rev. (2003) 68:161–94. doi: 10.2307/1519765
76. Fox NJ, Ward KJ. Pharma in the bedroom. . . and the kitchen. . . .The
pharmaceuticalisation of daily life. Sociol Health Illn. (2008) 30:856–68.
doi: 10.1111/j.1467-9566.2008.01114.x
77. Abraham J. Pharmaceuticalization of society in context: theoretical,
empirical and health dimensions. Sociology. (2010) 44:603–22.
doi: 10.1177/0038038510369368
78. Healy D. Pharmageddon. Berkerley, LA: University of Virginia Press (2012).
doi: 10.1525/9780520951815
79. Jenkins JH, editor. Pharmaceutical Self: The Global Shaping of Experience in
an Age of Psychopharmacology. Santa Fe: SAR Press (2011).
80. Rose N. Neurochemical selves. Society. (2003) 6:46–59.
doi: 10.1007/BF02688204
81. Gordo Lopez A, De Vos J. Psychologism, psychologising and de-
psychologisation. Ann Rev Crit Psychol. (2010) 8:3–7. Available online
at: https://thediscourseunit.files.wordpress.com/2016/05/arcp8full.pdf
(accessed May 19, 2021).
82. De Vos J. From Milgram to Zimbardo: the double birth of postwar
psychology/psychologization. Hist Hum Sci. (2010) 23:156–75.
doi: 10.1177/0952695110384774
83. Sommers CH, Satel S. One Nation Under Therapy: How the Helping Culture
is Eroding Self-Reliance, New York, NY: St Martin’s Press (2005).
84. Furedi F. Therapy Culture: Cultivating Vulnerability in an Uncertain age.
London, Routledge (2004).
85. Haslam N. Concept creep: psychology’s expanding concepts of harm and
pathology. Psychol Inq. (2016) 27:1–17. doi: 10.1080/1047840X.2016.1082418
86. Bauman Z. Liquid Modernity. Cambridge: Polity Press (2000).
87. Jorm AF. National surveys of mental disorders: Are they researching
scientific facts or constructing useful myths? Aust N Z J Psychiatr. (2006)
40:830–4. doi: 10.1080/j.1440-1614.2006.01901.x
88. Wakefield JC, Schmitz MF. The challenge of measurement of mental
disorder in community surveys. In: Pilgrim D, Rogers A, Pescosolido B,
editors. The Sage Handbook of Mental Health and Illness.New York, NY: Sage
(2011). p. 26–48. doi: 10.4135/9781446200988.n2
89. Wakefield JC. DSM-5, psychiatric epidemiology and the false
positives problem. Epidemiol Psychiatr Sci. (2015) 24:188–96.
doi: 10.1017/S2045796015000116
90. Batstra L, Frances A. DSM-V further inflates attention deficit
hyperactivity disorder. J Nerv Ment Dis. (2012) 200:486–8.
doi: 10.1097/NMD.0b013e318257c4b6
91. Pratt LA, Brody DJ, Gu Q. Antidepressant Use Among Persons Aged 12
and Over: United States, 2011–2014. NCHS Date Brief No. 283 (2017).
Available online at: https://www.cdc.gov/nchs/data/databriefs/db283_table.
pdf#4 (accessed May 16, 2020).
92. Drescher J. Out of DSM: depathologizing homosexuality. Behav Sci. (2015)
5:565–75. doi: 10.3390/bs5040565
93. Beeker T, Witeska-Młynarczyk A, te Meerman S, Mills C. Psychiatrization
of, with and by children: drawing a complex picture. Glob Stud Child. (2020)
10:12–25. doi: 10.1177/2043610619890074
94. Scott S. The medicalisation of shyness: from social misfits to social fitness.
Sociol Health Illn. (2006) 28:133–53. doi: 10.1111/j.1467-9566.2006.00485.x
95. Wakefield JC. The DSM-5 debate over the bereavement exclusion:
psychiatric diagnosis and the future of empirically supported
treatment. Clin Psychol Rev. (2013) 33:825–45. doi: 10.1016/j.cpr.2013.
03.007
96. Bandini J. The medicalization of bereavement: (Ab)normal Grief in the
DSM-5. Death Stud. (2015) 39:347–52. doi: 10.1080/07481187.2014.951498
97. Horwitz AV. The DSM-5 and the continuing transformation of
normal sadness into depressive disorder. Emot Rev. (2015) 7:209–15.
doi: 10.1177/1754073915575401
98. World Health Organization. mhGAP Intervention Guide for Mental,
Neurological and Substance Use Disorders in Non-Specialized Health
Settings. (2010). Available online at: https://www.who.int/mental_health/
publications/mhGAP_intervention_guide/en/ (accessed at: May 8, 2020).
99. Dua T, Sharma A, Patel A, Hanna F, Chowdhary N, Saxena S. Integrated
care for mental, neurological and substance use disorders in non-specialized
health settings: rising to the challenge. World Psychiatr. (2017) 16:216–7.
doi: 10.1002/wps.20430
100. Watters E. Crazy Like Us: The Globalization of the American Psyche. New
York, NY: Free Press (2011).
101. Kirmayer LJ. Psychopharmacology in a globalizing world: the use
of antidepressants in Japan. Transcult Psychiatr. (2002) 39:295–322.
doi: 10.1177/136346150203900302
102. Applbaum K. Educating for Global Mental Health. The Adoption of SSRIs in
Japan. In: Petryna A, Lakoff A, Kleinman A, editors. Global Pharmaceuticals.
Ethics, Markets, Practices. Durham; London: Duke University Press (2006). p
85–110. doi: 10.1215/9780822387916-004
103. Foucault M. Abnormal: Lectures at the Collège de France,1974–1975. New
York, NY: Picador (2003).
104. Miller P, Rose N. Mobilizing the consumer: assembling the
subject of consumption. Theory Cult Soc. (1997) 4:1–36.
doi: 10.1177/026327697014001001
105. Applbaum K. Pharmaceutical marketing and the invention of the medical
consumer. PLoS Med. (2006) 3:445–7. doi: 10.1371/journal.pmed.0030189
106. Ignaas D, van Hoyweghen I. A new era of medical consumption:
medicalisation revisited. Aporia. (2011) 3:16–21. Available online at: http://
hdl.handle.net/1854/LU-1852744 (accessed May 19, 2021).
107. Barsky AJ, Borus JF. Somatization and medicalization in the era of managed
care. JAMA. (1995) 274:1931–4. doi: 10.1001/jama.1995.03530240041038
108. Emanuel EJ, Fuchs VR. The perfect storm of overutilization. JAMA. (2008)
299:2789–91. doi: 10.1001/jama.299.23.2789
109. Singh I. Doing their jobs: mothering with Ritalin in a
culture of mother-blame. Soc Sci Med. (2004) 59:1193–205.
doi: 10.1016/j.socscimed.2004.01.011
110. Hande MJ, Taylor S, Zorn E. Operation ASD: philanthrocapitalism,
spectrumization, and the role of the parent. In: Burstow B, editor. Psychiatry
Interrogated. Cham: Springer International Publishing (2016). p. 81–101.
doi: 10.1007/978-3-319-41174-3_5
111. Epstein SG. Patient groups and health movements. In: Hackett EJ,
Amsterdamska O, Lynch M, Wajcman J, editors. The Handbook of
Science and Technology Studies,3rd Edn, Cambridge, MIT Press (2008).
p. 499–539.
112. Scott WJ. PTSD in DSM-III: a case in the politics of diagnosis and disease.
Soc Probl. (1990) 37:294–10. doi: 10.2307/800744
113. Young A. The Harmony of Illusions: Inventing Post-Traumatic
Stress Disorder. Princeton NJ, Princeton University Press (1995).
doi: 10.1515/9781400821938
114. Barker K. Self-Help literature and the making of an illness identity:
the case of fibromyalgia syndrome (FMS). Soc Probl. (2002) 49:279–300.
doi: 10.1525/sp.2002.49.3.279
115. Barrett D. Illness movements and the medical classification of pain and
fatigue. In: Packard RM, Brown PJ, Berkelman RL, Frumkin H, editors.
Emerging Illnesses and Society: Negotiating the Public Health. Baltimore, MD,
Johns Hopkins University Press (2004). p 139–70.
116. Rose SL. Patient advocacy organizations: institutional conflicts of
interest, trust, and trustworthiness. J Law Med Ethics. (2013) 41:680–7.
doi: 10.1111/jlme.12078
117. Patel V. Where There is no Psychiatrist. A Mental Health Care Manual. Royal
College of Psychiatrists, Glasgow: Bell and Bain (2003).
118. Bauman Z. Globalization. The Human Consequences. Cambridge: Polity
Press (1998).
Frontiers in Psychiatry | www.frontiersin.org 10 June 2021 | Volume 12 | Article 645556

Beeker et al. Psychiatrization of Society
119. Crouch C. Post-Democracy. Cambridge: Polity Press (2004).
doi: 10.1093/0199259402.003.0007
120. Piketty T. Capital in the Twenty-First Century. Cambridge MA: Harvard
University Press (2014). doi: 10.4159/9780674369542
121. Klein N. This Changes Everything. Capitalism vs. the Climate. New York, NY:
Simon & Schuster (2014).
122. Castner SA, Williams GV, Goldman Rakic PS. Reversal of antipsychotic-
induced working memory deficits by short-term dopamineD1 Receptor
stimulation. Science. (2000) 287:2020–2. doi: 10.1126/science.287.5460.2020
123. Reilly JL, Harris MSH, Keshavan MS, Sweeney JA. Adverse effects of
risperidone on spatial working memory in first-episode schizophrenia. Arch
Gen Psychiatr. (2006) 63:1189–97. doi: 10.1001/archpsyc.63.11.1189
124. Faber G, Smid HGOM, van Gool AR, Wiersma D, Van Den Bosch
RJ. The effects of guided discontinuation of antipsychotics on
neurocognition in first onset psychosis. Eur Psychiatr. (2012) 27:275–80.
doi: 10.1016/j.eurpsy.2011.02.003
125. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson
BT. Initial severity and antidepressant benefits: a meta-analysis of data
submitted to the Food and Drug Administration. PLoS Med. (2008) 5:e45.
doi: 10.1371/journal.pmed.0050045
126. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective
publication of antidepressant trials and its influence on apparent efficacy. N
Engl J Med. (2008) 358:252–60. doi: 10.1056/NEJMsa065779
127. Read J, Cartwright C, Gibson K. Adverse emotional and interpersonal effects
reported by 1829 New Zealanders while taking antidepressants. Psychiatry
Res. (2014) 216:67–73. doi: 10.1016/j.psychres.2014.01.042
128. Fava GA, Gatti A, Belaise C. Withdrawal symptoms after selective
serotonin reuptake inhibitor discontinuation: a systematic review. Psychother
Psychosom. (2015) 84:72–81. doi: 10.1159/000370338
129. Livingston JD, Boyd JE. Correlates and consequences of internalized stigma
for people living with mental illness: a systematic review and meta-analysis.
Soc Sci Med. (2010) 71:2150–61. doi: 10.1016/j.socscimed.2010.09.030
130. Chang CR, Bassman R. Psychiatric diagnosis and the power of names. J
Humanist Psychol. (2019) 59:1–23. doi: 10.1177/0022167819852786
131. Georgieva I, Mulder CL, Whittington R. Evaluation of behavioral changes
and subjective distress after exposure to coercive inpatient interventions.
BMC Psychiatr. (2012) 12:54. doi: 10.1186/1471-244X-12-54
132. Von Peter S. ‘Chronic’ identities in mental illness. Anthropol Med. (2013)
20:48–58. doi: 10.1080/13648470.2013.772493
133. Haslam N, Kvaale EP. Biogenetic explanations of mental disorder:
the mixed-blessings model. Curr Dir Psychol Sci. (2015) 24:399–404.
doi: 10.1177/0963721415588082
134. Brinkmann S. Diagnostic Cultures: A Cultural Approach to Pathologization of
Modern Life. New York, NY: Routledge (2016). doi: 10.4324/9781315576930
135. Davies J. Political Pills: Psychopharmaceuticals neoliberalism as mutually
supporting. In: Davies J, editors. The Sedated Society. Cham: Palgrave
Macmillan (2017). p. 189–225. doi: 10.1007/978-3-319-44911-1_8
136. Hart JT. The Inverse care law, Lancet. (1971) 297:405–12.
doi: 10.1016/S0140-6736(71)92410-X
137. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G,
Bromet EJ, et al. Worldwide use of mental health services for anxiety,
mood and substance disorders: Results from 17 countries in the WHO
World Mental Health (WMH) Surveys. Lancet. (2007) 370:841–50.
doi: 10.1016/S0140-6736(07)61414-7
138. Miller D, Acton TM, Hedge B. The worried well: their identification and
management. J R Coll Physicians Lond. (1988) 22:158–65.
139. British Medical Association. Available online at: https://www.bma.org.
uk/news/media-centre/press- releases/2018/february/new-bma- research-
unveils-blindspot- in-mental-healthcare (accessd at: April 05, 2020).
140. Davar BV. Globalizing psychiatry and the case of ‘vanishing’ alternatives
in a neo-colonial state. Disabil Global South. (2014) 1:266–84. Available
online at: https://disabilityglobalsouth.files.wordpress.com/2012/06/dgs-01-
02-04.pdf (accessed May 19, 2021).
141. Dorsey ER, de Roulet J, Thompson JP. Funding of US biomedical
research, 2003-2008. JAMA. (2010) 303:137–43. doi: 10.1001/jama.
2009.1987
142. Dorsey ER, Vitticore P, De Roulet J. Financial anatomy of neuroscience
research. Ann Neurol. (2006) 60:652–9. doi: 10.1002/ana.21047
143. Teddlie C, Tashakkori A. Foundations of Mixed Methods Research:Integrating
Quantitative and Qualitative Approaches in the Social and Behavioral
Sciences. LA: SAGE Publications (2009).
144. Little TD, editor. The Oxford Handbook of Quantitative Methods.
Oxford; New York, NY: Oxford University Press (2013).
doi: 10.1093/oxfordhb/9780199934898.001.0001
145. Krueger RA. Focus Groups. A Practical Guide for Applied Research. London:
Sage Publications (2015).
146. Spradley JP. Participant Observation. Wadsworth, Belmont (1980).
147. Denzin NK, Lincoln YS, editor. The SAGE Handbook of Qualitative Research,
5th Edn. Thousand Oaks, CA: Sage Publications (2018).
148. Cargo M, Mercer S. The value and challenges of participatory research:
strengthening its practice. Annu Rev Public Health. (2008) 29:325–50.
doi: 10.1146/annurev.publhealth.29.091307.083824
Conflict of Interest: The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be construed as a
potential conflict of interest.
Copyright © 2021 Beeker, Mills, Bhugra, te Meerman, Thoma, Heinze and von Peter.
This is an open-access article distributed under the terms of the Creative Commons
Attribution License (CC BY). The use, distribution or reproduction in other forums
is permitted, provided the original author(s) and the copyright owner(s) are credited
and that the original publication in this journal is cited, in accordance with accepted
academic practice. No use, distribution or reproduction is permitted which does not
comply with these terms.
Frontiers in Psychiatry | www.frontiersin.org 11 June 2021 | Volume 12 | Article 645556