Hear Me Out… Maybe There’s No Such Thing as Mental Illness
I know.
This sounds ridiculous.
It sounds dismissive, anti-science, and even dangerous.
Hear me out.
I’m not saying that your lived experience of depression, anxiety, or PTSD isn’t real. I’m saying that mental illness is one of the most misleading phrases in modern healthcare. The word mental illness assumes that suffering originates in the mind. But over the last several decades, neuroscience, developmental trauma research, genetics, endocrinology, immunology, attachment, and the emerging field of psycho-neuro-immunology have steadily dismantled the assumption that mental illness is in the mind. Yet, we still use this phrase, which convinces us that suffering lives inside the mind while distracting from the brain, nervous system, immune system, endocrine system, genetics, attachment, trauma, development, relationships, environment, culture… We’ve taken one of the most complex interactions in human biology and reduced it to a single adjective: Mental.
What if we’ve been putting fundamentally different human conditions into the same bucket because they all affect thoughts, emotions, and behavior?
We’ve Been Calling Everything Mental
Imagine going to your primary physician with chest pain and the doctor saying “you have chest illness” while a cardiologist says “your arteries are blocked”. Which explanation is useful? Psychiatry does the equivalent of saying “chest illness”. It groups together experiences that arise from fundamentally different biological and developmental processes because they all happen to affect the brain.
The brain is an organ. Every thought has a brain, every emotion - a nervous system, every attachment - a physiology, every stress response - hormones. Every developmental experience changes neural circuitry, every traumatic experiences changes the body. So what is mental about mental illness?
When the brain changes, so do thoughts, emotions, memory, identity, and behavior. That doesn’t necessarily make the problem “mental”.
We Have Been Sorting Apples, Giraffes, and Planets into the Same Basket
ADHD, Autism, CPTSD, Bipolar, Schizophrenia, Gender Dysphoria, PMDD, OCD, Panic Disorder, GAD, Depression, Borderline. These are not one thing. They do not arise from one mechanism, and they do not respond to one treatment. They do not even belong in the same branch of biology. Imagine calling asthma, diabetes, Parkinson’s and lupus “body illness”. That’s absurd, yet we do that with the psychological equivalent every single day. But let’s unpack this…
CPTSD is the nervous system
ADHD/Autism is neurodevelopment
Bipolar/Schizophrenia is neurological
Gender Dysphoria is hormonal/chromosomal
PMDD is hormonal/immunological
Everything else might be a manifestation of trauma through a different nervous system function.
None of this is just mental.
Recent Research from the American Psychological Association Says…
That complex trauma (Complex PTSD) is the “transdiagnostic factor” and the “causal ecosystem” of most diagnoses (APA, 2024). Strangely, CPTSD continues to evade formal DSM inclusion, despite being represented in the International Classification of Diseases Version 11 (ICD-11). What they’re saying is what Pete Walker has been saying for a while, that “mental illness” symptoms are manifestations of underlying trauma, which comes from a dysregulated nervous system and is not primarily mental but a whole body process. Trauma is a nervous system condition. Dysregulated nervous systems function on one of four ways —> They fight, flight, freeze, or fawn. Each of these 4Fs can be mapped to different DSM diagnoses.
If that’s the case, then are the DSM diagnoses real, or more superficial manifestations of specific type of nervous system responses to complex trauma? The DSM is great at describing patterns, but it sucks at explaining why those patterns exist. A diagnosis tells us what someone experiences, but not what caused it.
Now, you might be thinking, well not everyone has experienced significant big traumas in their life. True, but recent research conducted by my colleagues and I consistently find that emotional abuse and emotional neglect continues to cause worse complex PTSD symptoms than physical or sexual abuse, because it distorts the sense of self. This means, parents that love their children but cannot emotionally attune to them or don’t show up for them for the difficult conversations can actually give their children complex PTSD. This is primarily due to lack of co-regulation, which is necessary for healthy neural development and integration that contributes to stable sense of self, emotion regulation, and attachment security necessary for healthy relationships (see how this maps to the DSO symptoms of CPTSD?)
What This Means is That Most “Mental Illness” is Actually a Whole Body Nervous System Condition Responding to Perceptions of Chronic Threat.
Anything that might map to a 4F could be understood through a Complex PTSD lens. And then there are a few other DSM conditions that cannot be better explained by trauma. These include the following:
Attention Deficit Hyperactivity Disorder
Autism
Bipolar
Schizophrenia
Gender Dysphoria
Premenstrual Dysphoric Disorder
What we Know About ADHD and Autism
They are neurodevelopmental conditions where executive function, sensory systems, attention, and communication develops differently. Once again, this is a whole body phenomenon, and it emerges from birth. Much of the suffering that comes from being neurodivergent is related to living in environments that misunderstand, pathologize, or fail to accommodate different needs.
What we Know About Bipolar and Schizophrenia
These are very strongly heritable, and in fact, have the strongest genetic influences in psychiatry. Thus, we can think of them as primarily a neurological condition, and certain people are genetically preloaded for these conditions. While they may never fully manifest, a trauma or stressor can “activate” the genes, contributing to the full condition. This is the diathesis stress model theory.
What we Know About Gender Dysphoria
Gender dysphoria emerges from feeling as though one’s physical body does not align with their gender identity. Recent research has found biological contributors to gender dysphoria related to hormonal and chromosomal differences across people. Therefore, gender dysphoria is primarily a hormonal and chromosomal condition.
What we Know About Premenstrual Dysphoric Disorder
Recent research in the field of psycho-neuro-immunology, the field that intersects psychiatry/psychology, neuroscience, and immunology, has found significant links between PMDD symptoms, estrogen fluctuation, and histamine intolerance. Research demonstrates that estrogen plays an important protective factor in the immune system, particularly in histamine functioning. When estrogen drops before the menstrual cycle, it no longer regulates mast cells, which allow histamine to overfunction and cause symptom flairs. This flair can manifest as the anxiety, depression, and internal chaos often experienced by people with PMDD. Research suggests that a low histamine diet can have significant positive impact on PMDD symptoms. This emerging research would suggest that PMDD is actually a hormonal/immunological condition, not a mental illness.
Maybe Diagnosis is Describing Survival that Frontiers in Neurobiology Have Yet to Explore
What if DSM diagnoses are not diseases or mental illnesses but descriptions of adaptive nervous system responses or biological functions that interact with stress. In this model, depression can be seen as a nervous system freeze, anxiety’s chronic threat detection primes people to flight (run away) in avoidance or over worry to prepare for the worst. What if intermittent explosive disorder is a fight response for self-protection, and what if borderline or dependent personality disorder is the fawn response that has become so normalized it’s interchangeable from personality characteristics?
What if the real illness is the psychological framework we use to describe human suffering? I know, I’m probably going to get excommunicated from my professional field for this, but what’s life without a little risk I guess? Perhaps the greatest mistake in modern mental health care is believing that suffering begins insight isolated individuals. We never talk about the social determinants of mental health in the DSM, do we? Why? Because that’s against the medical model. But what if suffering is:
Genetic
Developmental
Neurological
Hormonal
Immunological
Cultural
Existential
Spiritual
Maybe the Problem is Language. Maybe the Problem is Pharmaceutical Companies that Benefit From Being Able to Prescribe for Hundreds of Diagnoses.
But medication doesn’t work for trauma or autism. Thankfully, it does work for ADHD, Bipolar, and Schizophrenia. I’m not anti-medication, I’m just anti-corruption and people being treated with things that don’t help them because the underlying issue is not correctly identified.
Maybe we Keep Asking the Wrong Question
It’s not about figuring out what mental illness our clients have. Perhaps it’s about ruling out developmental and/or complex trauma, neurodevelopmental conditions, neurological conditions, hormonal, chromosomal, and histamine conditions. But if we do that, is there anything else left. Is there a true “mental” illness? I can’t find one. The answer to mental health suffering is almost entirely answered by these seven conditions above, and the myriad causes that contribute to their manifestation. None of them are just “mental”.
I doubt the phrase mental illness will disappear - it’s too lucrative. However, I hope the future of counseling continues to move toward a whole-person model that recognizes the inseparable relationship among brain, body, nervous system, relationship, culture, and lived experience. And don’t get me wrong, the myriad diagnostic labels we have are still useful. They point to the type of 4F response people might be having. If trauma is ice cream, then most of the DSM diagnoses are the different flavors. The problem is that we have different treatments for chocolate, strawberry, and vanilla, when they’re all ice cream. We make it more difficult than it needs to be.
I suspect that in fifty years, we will look back on the phrase mental illness much like the way we look at outdated medical theories that explain complex biological systems with overly simplistic ideas. I’m thinking about phenology and blood letting and the humors here. Not because these symptoms that cause suffering aren’t real, but because we realized that they aren’t mental.
Maybe the greatest illusion in the field of psychology is that suffering lives in the mind. Human beings don’t have mental illnesses. They have nervous systems, brains, bodies, relationships, developmental, and neurological systems that shape how they think, feel, experience the world, and survive. Perhaps it’s time the fields of psychology caught up.
