There was a time when you could simply be hot-tempered. Now you have BPD.

Or you could break into tears at a sunset. Now you have bipolar disorder.

Or you could be an introvert, left exhausted by social interaction. Now you have social anxiety disorder.

Or you could be a daydreamer, always drifting off. Now you have ADHD.

Or you could feel paralyzed by hopelessness about the state of the world. Now you have depression.

Or you could have a painful history of bullying at school. Now you have PTSD.

The number of ways one can be sick has exploded — both the number of diagnoses and how expansive each one has become.

Nearly a quarter of Americans are diagnosable with a mental disorder in any given year. Over a lifetime, the number rises: according to a recent estimate, up to 86 percent of people will meet the criteria for a mental disorder at some point in their lives.

This has almost nothing to do with the advance of science. It has little to do with greater education and awareness. It has to do with a system that is designed to reinterpret increasingly vast swaths of human distress — or sheer deviation from the norm — as symptoms of illnesses, to be diagnosed and fixed.

The pathologizing tendency has colonized our inner lives.

This conquest of our inner lives cuts us off from our own selves — from our deepest impulses, desires, and dreams — and replaces them with a list of diagnoses, each requiring its own specialist to “heal.”

Purpose, Not Pathology

A core insight drives everything I write: purpose, not pathology.

The kinds of problems that we describe as mental disorders aren’t disorders. They’re strategies. Adaptations. Signals. Understanding what they’re trying to say is the key to a better life.

Depression is a great example of how, when we start seeing purpose rather than pathology, things start to change.

Since the 1980s, doctors have told us that depression is a chemical imbalance or brain disorder — one to be rectified with pills. Just as one takes insulin to manage diabetes, one takes SSRIs to manage depression. This is the philosophy that was handed to me as a troubled teen during a six-week psychiatric hospitalization.

But over the last twenty years, a new vision has unfolded — one that psychiatry’s disease model overshadows. Depression isn’t a symptom. It’s a signal. It’s your mind’s wake-up call that something in the world isn’t right and needs more attention.

Think about what depression does. It saps our motivation. It dulls our capacity for pleasure. It is your brain’s way of saying, “f**k this. I’m done.”

It could be a career path. It could be a relationship. It could be a life goal. Depression is an inner prompt to reflect on the course of your life, identify where it’s taken a wrong turn, and decide how to correct it.

Now, think about what actually happens when a doctor or therapist tells somebody that their depression is a brain disorder or a cognitive dysfunction — one that can be fixed by drugs or therapy.

Suddenly, my problems stop being problems in the world. They become problems in my head. The problem is no longer: my job is demoralizing, but I can’t leave it because finances are too tight. It’s: I have a chemical imbalance that prevents me from enjoying life.

The problem isn’t: I’ve been building this relationship for years, but my partner won’t reciprocate, and I think we need a clean break. It’s: I have intimacy issues due to unprocessed trauma.

The problem isn’t: I chose a prestigious, high-paying career, even though I wanted to be a musician, and now in my forties I constantly mourn those lost opportunities. The problem is: some inner dysfunction prevents me from being satisfied with life.

When we see our problems as problems in the world — and not in our heads — we have the tools to solve them: pursue a new job, end a relationship, start a band with some friends.

Recent evidence suggests that even telling someone that their depression is a functional signal, rather than a dysfunction, makes that person feel more optimistic about getting better, and less shame about sharing their depression with others.

Psychiatry – the branch of medicine that treats illnesses of the mind – has trained us to think it can’t be that simple. Isn’t depression a serious brain disorder that requires specialized expertise to fix? The evidence shows otherwise. Depression often evaporates when we make exactly those positive life changes (see here and here).

The same principle – purpose, not pathology – applies to a wide range of mental health problems, including borderline personality disorder, hearing voices, anxiety, ADHD, and autism. It applies just as well outside the clinic – to occupational burnout, to “trauma responses,” to whatever we’re currently calling the ordinary problems of being alive.

Naming the Problem

How did our culture fall into the grip of this pathologizing tendency? How did we allow mental disorder categories to expand and multiply until they now cover the vast majority of the world’s population?

That story begins with psychiatry. Throughout the 20^th century, there have been doctors who believed that mental illnesses were best seen as brain diseases to be treated with physical remedies – the so-called “biomedical paradigm.” That tradition gave us electroconvulsive therapy, insulin coma, lobotomy, and eventually our current arsenal of drugs — antipsychotics, mood stabilizers, antidepressants — each enthusiastically marketed as a miracle cure for the underlying problem.

Naturally, advocates of the biomedical paradigm were also preoccupied with classification, labels, and diagnoses. After all, if I experience heart palpitations, I go to a doctor and expect a diagnosis – a name for the underlying disease. Why shouldn’t we treat mental health problems the same way?

Yet up until the 1970s, advocates of the biomedical model were in the minority. They coexisted — sometimes uneasily — with advocates of other approaches to mental health problems: those who thought those problems represented an understandable response to trauma. Or that they stemmed from repressing your deepest desires. Or that they were a form of revolt against an oppressive social system.

When my dad was diagnosed with schizophrenia in 1973, he was able to find a psychiatrist who agreed not to give him drugs. After several sessions of talk therapy, his problems went away and didn’t return for over a decade. Today, the idea of finding a psychiatrist who’d agree, in principle, not to give you drugs is unthinkable.

In the 1970s, this uneasy coexistence was broken, for reasons I’ve described in my book, The Madness Pill. When it came to mental illness, doctors increasingly embraced the biomedical model. Your mental health problems became the byproduct of a broken brain. They had no further meaning, purpose, or goal. This paradigm shift led to the DSM-III of 1980 – the “bible of American psychiatry” – that soon became the gold standard for the mental health industry as a whole.

But the pathologizing tendency didn’t end with psychiatry. It began to infiltrate the broader society.

Talk therapists, eager to look as “scientific” as psychiatrists, began embracing the DSM and its vocabulary. School counselors adopted the disorder framing to make sense of the ordinary crises of growing up. Human resources departments began diagnosing disgruntled employees with “burnout syndrome” rather than asking whether the job itself was the problem. In the 80s and 90s, the commercial success of drugs like Prozac convinced millions that their problems stemmed from a chemical imbalance.

Today, receiving a diagnosis – or diagnosing yourself – is practically a rite of passage. Almost one in three American college students are on psychiatric medications.

Isn’t Biology Ever the Answer?

I don’t reject the role of biology. The mind is realized in the brain. All of our thoughts, feelings, tendencies, and habits have a basis in our nervous system.

What I reject is the biomedical model — the paradigm I’ve called madness-as-dysfunction. In this view, mental disorders happen when something inside you breaks. The problem isn’t biology. The problem is seeing all mental health problems as symptoms of a broken inner mechanism — a disease, disorder, or dysfunction.

But aren’t some mental disorders diseases? Psychiatrists like to remind us of general paresis, one of the most debilitating mental illnesses of the nineteenth century. People would shut down, grow confused, tune out. Then a group of doctors discovered that general paresis, far from being the result of childhood trauma or forbidden unconscious desires, was a symptom of late-stage syphilis. Better management of syphilis — through public education and the development of drugs like penicillin — made general paresis a thing of the past.

Why are you so certain, a psychiatrist might ask, that the same won’t be true of schizophrenia, or bipolar disorder, or depression, or ADHD, or BPD?

Anything might be true. Maybe scientists will prove that each mental disorder — depression, panic disorder, BPD — rests on a signature brain dysfunction or cognitive deficit.

But the evidence gives us no reason to be hopeful. Every major theory advanced for schizophrenia, depression, ADHD, and so on has been shown false or woefully incomplete. The only mental health issues today that admit of a plausible biological explanation are the clearly neurological ones, like Alzheimer’s disease, which involve a marked deterioration in intellect, memory, and personality.

Nothing’s wrong with having an open mind. If a scientist wants to study the brain aspects of depression, they should. The problem is that the biomedical paradigm has come to dominate our understanding of mental health to the point where it’s almost impossible to see alternatives.

What Are the Next Steps?

If I’m right about how we got here, then psychiatry itself is not going to be the way out.

The way out is going to involve, first, understanding how the pathology script got put into place — and how it stays locked in place — and second, finding better ways to make sense of our problems. It’s to understand their inherent purpose and learn to listen to what they’re trying to say.

That doesn’t mean never take drugs. There are some cases where drugs may help. Suppose I’m depressed because of a structural situation that I can’t do anything to change at the moment, like having to work three jobs to cover monthly expenses. I genuinely feel that all avenues to changing the situation are closed off to me. A course of antidepressants might be useful as a temporary strategy for navigating the difficulty.

But notice that here we’re not treating drugs as a chemical cure. We’re treating them as a temporary support rail we’ll dispense with once we no longer need it — similar to how you might use alcohol or pot to decompress.

It also, crucially, doesn’t mean people should stop taking the drugs they’re prescribed. Getting off a drug requires a thoughtful tapering regime, ideally under the supervision of someone who’s done it before — not necessarily a doctor.

The purpose of Reclaim Your Inner Life is to show exactly how our inner lives have been colonized by diagnoses that alienate us from the deepest parts of ourselves. It also shares timely, practical counterstrategies — tested avenues for understanding what our problems are trying to teach us.