Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity 
Dr Sami Timimi, Fern Press, £25

WITH mental health, particularly of young people in our society, a hot topic of conversation, Dr Sami Timimi’s new book offers a refreshing and radical view as a counterpoint to the mainstream narrative and the increasing medicalisation of mental health.

Challenging mainstream shibboleths, especially scientific ones, can be a Quixotic enterprise but Timimi takes up the knight’s lance with alacrity. He has been an NHS consultant in child and adolescent psychiatry since 1997 and has a wealth of hands-on experience. This is his sixth book and he has also made numerous contributions to medical journals. His book is written in a clear and accessible way for a general readership.

While he doesn’t proclaim himself as such, his approach to psychiatry is one of a Marxist bent, in that he looks at the subject holistically and recognises the dialectical interplay of factors, particularly social, class and cultural, on everyone’s mental health.

Modern Western medicine, particularly as practised in the United States, is very much based on seeking the causes of illness in the individual. Searching for the magic bullet for every healthcare issue is the much-favoured method of approach adopted by Big Pharma because in this way huge profits can be made.

Viewing health and the treatment of illness as much a social as an individual issue will involve public investment in prophylactic measures and social services, but this approach is not lucrative for the medi-care industry. 

Timimi argues that “what the public is being told about mental health is misleading and may be harming our collective sense of well-being.” Mainstream mental health ideology is a culture of pathologising, labelling and medicating, he says, and there has never been a generation of young people so colonised at such a young age by mental health propaganda. The ballooning number of “disorders” like ADHD, autism and anorexia are evidence of this.

Timimi maintains that it is not possible to make a meaningful psychiatric “diagnosis” in the same way that you can for physical illnesses, which are concrete. Psychiatric “diagnoses,” he argues, will always be subjective.

“The primary task of a psychiatric assessment in the mainstream model of practice is to enquire about, notice and analyse ‘symptoms’ to arrive at the correct ‘diagnosis’,” Timimi says. On this basis, a treatment plan will be developed, but such treatment “will usually involve medication and/or specific therapies. And while this process will not ignore other aspects, such as family history, relationships, social situation etc, they become secondary concerns sitting in the shadow of the primary task of discovering the ‘correct’ diagnosis so that the ‘correct’ treatment can be given.” 

Timimi believes psychiatry needs to move away from the idea of just seeing and treating the individual. “Most of the important decisions that affect children’s lives are not made by them but by various people in caring relationships with them,” he says. “There are material contexts, social, historical, cultural and relations contexts which need to be considered.”

What mainstream Western medicine ignores is the idea that society itself — particularly one where rampant capitalism reigns supreme and in which genuine and supportive communities have been or are being destroyed — could be one of the chief causes of mental health problems.

“These days, practice in child and adolescent mental health has been expunged of the curiosity and openness of a developmental and contextual backdrop, in favour of ‘treatment pathways’,” he writes.

Although Timimi takes a somewhat extreme position against the medicalisation of mental health, he bases his arguments on solid practice and research. His book is certainly provoking, questioning and revelatory.