
This essay will attempt to outline some of the challenges psychiatry and reliance on the biomedical model to treat mental health poses to mental health patients. I will also attempt to outline some activists who opposed the psychiatric paradigm and the different types of activism available to people who wish to change how mental health is treated and managed. Finally, I will look at a way forward and what could be achieved through activism and healing and empowerment of the patient or those who experience mental health difficulties.
Firstly, psychiatry relies on the Biomedical model when treating mental ill health, it believes that mental ill health is caused by “faulty brains” and chemical imbalances which must be treated and managed with medication. It believes these illness’s have a biological basis much like epilepsy or any other disease and it must be treated by a psychiatrist who is a doctor who has done additional training in order to be able to diagnose the illness’s and prescribe medications to manage it. Psychiatry is the primary method of treating mental ill health in the UK. This means many people who feel their health issues are caused by social and psychological or even spiritual reasons don’t necessarily get treatment and healing for those issues.
Overall is their evidence for a purely biomedical perspective? Certainly, in the past about 60 years ago the chemical basis for mental ill health was considered factual and evidence based. In the 1950’s “there were two revolutionary new drug treatments. The introduction of chlorpromazine in Paris in 1952 “… the synthesis of haloperidol in 1958 swiftly followed. In 1952, Max Lurie in Cincinnati first coined the term antidepressant after a trial that investigated isoniazid for tuberculosis. The first tricyclic antidepressant, imipramine, was launched in 1958, with amitriptyline hard on its heels in 1961.” (Burns, 2020) These drug treatments took the world by storm and in 1959 the Mental Health Act tightened up measures for compulsory treatment of mental health patients. The public was generally under the impression that mental health disorders were biological and based on chemical imbalances. Then, following this in the 60’s came the first of the anti-psychiatrists. They were known as R D (Ronnie) Laing, Michel Foucault, Erving Goffman and Thomas Szasz. These men dared to see mental health troubles from a very different lens that actively challenged the chemical imbalance theory looking at the very real social and psychological reasons certain individuals get diagnosed, they published popular books about their findings and were active speakers on the topic.
In addition, 50 years of intense scientific study into the chemical basis of disorders such as depression failed to prove that it was in fact caused by a chemical imbalance and was not due to an imbalance of serotonin as previously thought, leaving psychiatry in a position where it was not actually scientifically proven and/or evidence based (Moncrieff, 2014 cited by Vicary and Mallon 2024)
There is no biological test for these disorders, diagnosis being made purely by the observation of different behaviours, signs and symptoms. So, it cannot be measured in the same way as any other disease which has a biological basis and indeed there is no real evidence a diagnosis exists on a biological and chemical basis as psychiatry claims.
So why then in the UK, is psychiatry still classed as the main and most reputable treatment for mental health issues? Why is it so many people accept their diagnosis and think that to become well is to take and be compliant to a prescription of psychiatric drugs? While it is true many people have found the medications helpful, and that is why they continue to take their medications, a large portion of the mental health population has never recovered enough so they can return to work and live fully functioning lives again despite their medications. Many service users are simply excluded from mainstream society and are instead maintained while still unwell and experiencing side effects and secondary health issues from their medications, on health-related benefits, often isolated in their homes or put into specialist shared houses as supported living.
Compliance with their diagnosis and psychiatric drugs may also be considered the only option and service users may feel they have no other choice or that the professionals must know best. In the UK, psychiatry is actively forced on patients with compulsory treatment in hospitals, with being detained under the Mental Health Act. It is considered by the powerful authorities that medication and forced treatment is the best and most vital option to help these patients despite lack of evidence and other forms of treatment may not be employed. Another challenge people with mental health conditions face are they may be traumatised by the compulsory, forced and often heavy-handed hospitalisations and administration of psychiatric drugs. I have lived experience of this in the UK and it is experienced in psychiatric hospitals across the world (Kennedy, 2021 cited by Samra,2024) There’s a serious power imbalance between the patient and the psychiatric system which deems individuals unwell and must be treated with methods that are not backed up by serious science and it must be very difficult to form a helping or therapeutic relationship with someone and build trust while forcing them to comply. Service users often have no choice on how they are treated and if they refuse treatment can lose their liberties and come under the complete legal control of mental health services.
There is also challenges to mental health service users around the labelling and diagnosing of themselves with a disorder. These diagnosis or labels often carry significant stigma and may leave people feeling unhappy about themselves or may lead them to being excluded or treated differently in society. As previously mentioned, there is no biological test for a mental health disorder and it is instead a judgement based on the opinion of society, family members and mental health professionals. Who decides who is acting abnormally or not? Normality can also vary from culture to culture – in a secular society someone who is hearing voices or experiencing visions of hell or the voice of God may be labelled with schizophrenia whereas in a religious or shamanic culture they may be labelled as a prophet or shaman and trained for their gifts. There have also been those activists influenced by Foucalt who concluded “mental illness is simply a convenient label to remove uncomfortable and supposedly deviant individuals unable to contribute economically” (Burns, 2020)
To address this power imbalance and aid those individuals diagnosed with a mental health condition and have come under the care and control of the psychiatric team often against their wishes, there has been the need for activism. Activism is where groups of people work together to effect change. In the case of the mental health system changes could include changes on who gets diagnosed as mentally unwell and why, changes to the narratives people have around their experiences and struggles, what is classed as a mental health problem or not, how mental health patients are handled and their power status and role in society, changes in who gets detained, for how long and why and changes in how mental ill health is managed and treated. Activism can also include trying to change public opinion and attitudes both in terms of stigma and prejudice and exclusion of those deemed mentally unwell, and also on what sort of treatments the public should expect from their health service should they or a relative become unwell or diagnosed with a mental health condition.
Activism can be done in a variety of different ways but can be broadly put into two different types conventional actions and radical actions (Johnston and Gulliver, 2022 cited by Jones 2024) Conventional actions are those which are legal and use standard processes and institutions in society such as writing to an MP or attending a peaceful protest or making a You Tube video whereas radical actions tend to be illegal such as occupying a building or blocking a road.
Successful activism can include Franco Basaglia’s reforms of Italy’s psychiatry where he rejected the medical basis of diagnoses and the exclusion they fostered. In 1978 Italy passed Basaglia’s law banning admission to mental hospitals and required them all to close. (Burns, 2020)
Another successful form of activism was the removal of homosexuality from the Psychiatrists DSM, Diagnostic and Statistical Manual of Mental Disorders, the bible for diagnosing mental disorders. To achieve this activist employed both conventional and radical activism lobbying the APA to declassify homosexuality, in 1973 homosexuality was finally no longer considered a mental disorder. (Jones, 2024b)
Current forms of conventional activism could include the popular You Tube Channel by Lauren Kennedy which until recently was called “Living Well with Schizophrenia” – in this channel Lauren has put herself and her story into the public domain where she has been managing a diagnosis of schizoaffective disorder. On her channel she has highlighted many concerns such as her experience with forced medication (Kennedy 2021 cited by Samra 2024 to reducing stigma of the disorder by talking about the issues and being a popular You Tube celebrity while also having a mental health diagnosis. She has also recently started highlighting other potential avenues of treatment instead of relying on psychiatric drugs, with her exploration of medical keto, to the end where she has been able to come off all her psychiatric medications and now manages her symptoms with this diet and the help of her keto coach. Her activism has helped shift public opinion on what someone with a mental health disorder looks acts like, fostered dialogue on the issue in her comments section, influenced professionals and has inspired many people living with mental health disorders to live better lives.
Activism can be paid or unpaid – activism that is paid may be undertaken by mental health organisations such as Mind or Rethink Mental Illness lobbying the government on behalf of their members or undertaken by Experts by Experience’s employed by Health Boards to implement change from within the health service using their lived experience and use of the services as a guide. Employed peer mentors and therapists with the dual role of having lived experience while also working within the health system can also utilise change from within the system. Unpaid or voluntary activism may be done by service users or by concerned friends or relatives and carers either individually or by forming grass roots organisations and movements such as the psychiatric survivor’s movement. The skills and talents of people with mental health conditions may be employed in activism such as using the arts and creativity to conduct craftivism, the art of gentle protest by creating beauty and a better world through engaging with others, inspiring thought and fostering dialogue with crafts and creativity, (Corbett, 2016)
Alternative forms of treatment also need to be promoted and discovered which may better address the human needs of those with mental health struggles, looking at the very real social and psychological and spiritual reasons for their difficulties. Support networks could be better built up and communities fostered so people are less isolated in dealing with their issues with experienced peer mentors guiding and facilitating growth and healing processes which empower the patient rather than subduing them. The Recovery College Model which is peer lead and service user developed and run could be a definite way forward as could looking at alternative ways of viewing mental health difficulties such as the Power Threat Meaning Network which addresses power imbalances and encourages people to form more hopeful narratives where they create different stories of their lives with a more hopeful future on why they experienced difficulties rather than purely see themselves as “mentally ill” or through the lens of a diagnosis or disorder.
Service users face real challenges with how mental health conditions are currently treated in the UK. While many people do find medications helpful, they are often not “cured” from their disorders and there is very little real evidence for the chemical imbalance theory of mental health. Mental health diagnosis’s do not have a biological test and are based purely on the opinion of professionals and the norms of a particular culture. There is a huge power imbalance in how mental health patients are managed which can be open to abuse and can be perceived of as oppressive rather than helpful. Mental health patients can lose their liberties if they refuse to comply with psychiatric treatment. In the past groups of people who you wouldn’t class as mentally ill today were considered mentally ill such as homosexuals and the same could also apply today for other marginalised groups and those classed as deviant or economically unproductive.
Activism is needed to change the challenges service users face, there have been many successes in challenging psychiatry and changing public opinion from the advent of the ant psychiatrists with their books and public speaking, to Basaglia’s reform of Italy’s psychiatry to popular you tube channel activism by Lauren Kennedy to the work of organisations such as Mind, Recovery Colleges and the Psychiatric survivors Movement. In fact, we can all be changemakers and demand real evidence based and compassionate care for mental health difficulties instead of over relying on an often-oppressive psychiatric system and forced compliance to psychiatric drugs. Current narratives around peoples struggles and what causes them can be challenged.
Mental health patients can be included in the dialogue of what comes next and service users and their carers with their lived experience both in their knowledge of how to manage a crisis and come through to the other side and their knowledge of what it’s like to be on the recovering end of psychiatric care could lead the way in helping to shape the future of mental health services
References
Ambord, N., Burr, C. and Gianfranco Zuaboni (2024) ‘A Glimmer of Hope: The Impact of the Recovery College Bern on Personal Recovery, Well‐Being and Self‐Stigmatisation—A Mixed Methods Study’, International Journal of Mental Health Nursing [Preprint]. Available at: https://doi.org/10.1111/inm.13482.
Burns, T. (2020) ‘A history of antipsychiatry in four books’, The Lancet Psychiatry, 7(4), pp. 312–314. Available at: https://doi.org/10.1016/s2215-0366(20)30106-1.
Cardiff and Vale Recovery & Wellbeing College (2024) Cardiff and Vale University Health Board. Available at: https://cavuhb.nhs.wales/our-services/welcome-to-the-cardiff-and-vale-recovery-wellbeing-college/ (Accessed: 13 March 2025).
Jones (2024a) “Different types of activism”, K243 Mental Health in Society. Available at:Learning Guide 12 Doing: advocacy, activism, mental health and wellbeing: 2.2 Different types of activism | OU online [Accessed 12/03/25]
Jones (2024b) “Removing Homosexuality from the DSM, K243 Mental Health in Society. Available at: https://learn2.open.ac.uk/mod/oucontent/view.php?id=2279892§ion=3.1 [Accessed 12/03/25]
How To Be A Craftivist: The Art of Gentle Protest by Sarah Corbett – YouTube (no date) http://www.youtube.com. Available at: https://www.youtube.com/watch?v=PtHaM7j3Hvg (Accessed: 3 February 2021).
MIND (2024) Mind, the mental health charity – help for mental health problems, Mind. Mind. Available at: https://www.mind.org.uk/.
The British Psychological Society (2018) Power Threat Meaning Framework – The British Psychological Society, http://www.bps.org.uk. Available at: https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework. [Accessed 12/03/25}
Samara (2024)” Psychiatric services across cultures” K243 Mental Health in Society. Available at: Learning Guide 8 Critiques of psychiatry: 2.1 Psychiatric services across cultures | OU online [Accessed 12/03/25]
Vicary and Mallon (2024) “The medical model of depression” K243 Mental Health in Society. Available at: Learning Guide 2 Introducing mental health and mental ill-health: 4.1 The medical model of depression | OU online [Accessed 12/03/25]




