The Disease Model of Psychiatric Care Has Failed. Now What?

In 1980, the American Psychiatric Association (APA) adopted a disease model for diagnosing and treating major psychiatric disorders when it published the third edition of its Diagnostic and Statistical Manual. The story that was then told to the public, in the U.S. and to the global public, was that schizophrenia, depression, and other major disorders were caused by chemical imbalances in the brain. A second generation of psychiatric drugs came to market that was said to be safer and more effective than the first generation and to fix those chemical imbalances and thus was like insulin for diabetes. In countries around the world, the public organises its thinking around that narrative of significant progress.

However, as a critical review of the scientific literature reveals, it was a false narrative. The biological causes of major psychiatric disorders remain unknown; psychiatric drugs induce the very chemical imbalances that were hypothesised to cause psychiatric disorders, and over the long term, there is substantial evidence that the drugs cause more harm than good. Public health outcomes in mental health have plummeted in the past 40 years, too.

All of this leads to the moment at hand: we need to create a new narrative for thinking about psychiatric disorders and how to treat them best. Choice Theory is an example of a practice that can help society and psychiatric practitioners do just that and, in the process, promote a profound “paradigm shift” in psychiatric care.


Open dialogues as humanistic practice: Mobilises the resources of individuals and families to be ‘cured’ of severe crises

Open dialogue has provided a new way of helping people in the most severe mental health crises. In several studies, the outcomes have been about twice as good as in treatment as usual. The main idea is to meet with whole human beings instead of focusing on symptoms. People are met immediately together with their families and other relevant persons in their social network. The aim is to create an intense process in dialogues to tolerate uncertainty. A new human view is created, in which we see the human mind as relational and embodied. Sharing emotional experiences is a healing experience.