Psychiatrist Derek Summerfield is passionate about social justice and about avoiding torture.1 Derek and I—even though I am a specialist in internal medicine, not a psychiatrist—are both members of the Critical Psychiatry Network based in the UK, which strives to improve psychiatry and to make it less harmful
Derek wrote an eloquent article in the BMJ eight years ago about the epidemic of depression diagnoses,2 which is still highly relevant. Nothing has changed for the better. I therefore reproduce the text here in italics, with my comments in plain text
NHS antidepressant prescribing: what do we get for £266m a year?
This “epidemic” of depression lets the neoliberal political and economic order off the hook
The Royal College of Psychiatrists and the media routinely state that there is an “epidemic” of mental disorder—one in four people in the UK, with three in four said not to get the treatment they need. These disease mongering assertions have been recycled for so long that they have become unexamined societal truisms
The criteria for psychiatric diagnoses are so broad that most of us could easily get one or more diagnoses.3,4 When I lecture, it never fails that between one quarter and one half of the audience test positive for ADHD, for example. I tell them not to worry, as my wife, one of my daughters and myself also test positive, and as some of the most inspiring and dynamic people I have ever met test positive
The pandemic of psychiatric diagnoses is so frustrating that I wrote the article, “Are psychiatrists more mad than their patients,” and responded in the affirmative, based on my analyses:5
”As psychiatrists’ beliefs in what they are doing are in contrast with the science, this makes psychiatry a pseudoscience, a kind of religion. If you want more evidence that most psychiatric leaders are delusional, just read their guidelines and textbooks, which I have done. My Critical Psychiatry Textbook is freely available …”
It is noteworthy that the psychiatrists’ predominant idiosyncratic beliefs are not shared by people considered sane—the general public. And the great majority of psychiatric patients do not have delusions whereas most psychiatrists have. I therefore believe I have proven that psychiatrists are more mad than their patients.”
Most concerningly, I documented that the madness among psychiatrists is increasing.5
We are apparently wading knee deep in “mental disorder,” yet psychiatry has not confronted the philosophical problem of defining just what we mean by “mental disorder.” Barring categories arising directly from physical disease (for example, dementia), there is no conceptual agreement about when a person “really” has a mental disorder, only the constructed agreement inherent in the methodologies that psychiatry has adopted (1)
If there are sufficient phenomena, at sufficient threshold, a mental disorder is declared to exist. This is a kind of alchemy. If to have a mental disorder is to have some measure of incapacity, how could one in four UK citizens be thus afflicted and society still keep going as it does? (2). The psychiatric field is making claims it cannot justify. I am not talking about a minority with severe or recurrent psychiatric problems, often needing inpatient care
When the medicalisation of everyday life and the commodification of “mind” is professionally endorsed and taken up by wider culture, the language of psychological deficit is inserted into the public imagination. People come to see themselves not as stressed, but as “ill,” with negative emotion recast as a mental health problem (3)
Child and adolescent psychiatrist Sami Timimi, also a member of the Critical Psychiatry Network, published a superb article in 2025 in the Globe and Mail, a Canadian newspaper: “When mental-health diagnoses become brands, the real drivers of our psychic pain are hidden.” Sami carefully explained how he arrived at his painful conclusion: “You see there is a truth that we (in the mental-health business) hope no one will notice—we literally don’t know what we are talking about when it comes to mental health.”
I noted in my comment on Sami’s article that neurodiversity is a meaningless concept used by psychiatrists to impress the public about how knowledgeable they are but it just means that all people are not the same.6
What people should realise is that it is part of being human to have difficulties that can be handled better if we don’t give people psychiatric diagnoses and drugs. Difficulties often have a cause that has nothing to do with being ill, e.g. poverty, trauma, inadequate housing, social injustice, marital problems, discrimination, exclusion, bereavement, unemployment, and financial insecurity. Life is not easy, but if you have difficulty coping with its challenges, you can easily get one or more psychiatric diagnoses.
There is a lot of misinformation that leads people astray, in scientific articles, newspapers, TV, radio, and social media. When youngsters look up descriptions of people who say they “have” ADHD on social media, they may be convinced they “have” it too and may even self-diagnose. There is an element of social contagion in this
Moreover, one cannot “have” ADHD, which is just a name for a subjective description of rather common behaviours and therefore cannot explain anything, which many people—including many psychiatrists—falsely believe. It is difficult to explain to people that it is circular evidence and that psychiatric diagnoses cannot attack you like bacteria or a dog can, but I have at least tried.7
As more rere are perceived to be needed, an apparently circular process, a dog chasing its tail. It was clear when I was an occupational psychiatrist that the psychiatrisation of the problems of living frequently perpetuated them (4)
It is very clear that more re, which includes making temporary problems chronic, with a marked increase in disability pensions.3,4
The more that the mental health field promotes its technologies, such as antidepressants, as necessary interventions in potentially any area of life, the more there is a downgrading in collective assumptions about the resilience of the average citizen. Ivan Illich called this “cultural iatrogenesis” (5). To coin an aphorism, the average citizen is as vulnerable or as resilient as the society he is living in expects him to be. To culturally endorse a much thinner skinned version of a person than previous generations recognised does not seem a good idea if we look ahead to the huge challenges facing the world. Society needs to talk less, notmore, about mental health.
Can anyone seriously argue that UK society is healthier and happier as a result of our epidemic of antidepressant prescribing—64.7 million prescriptions in 2016, up from around nine million in the 1990s? (6). Antidepressants cost the NHS £266m (€300m; $365m) in 2016, and these are only the direct costs. In an age of medicalisation, no diagnostic category is more indiscriminately applied than “depression.”
It is far too easy to get a depression diagnosis. The screening test for depression recommended by the WHO was so poor that for every 100 healthy people screened, 36 would get a false depression diagnosis.3,4
David Healy describes the idea that abnormal levels of serotonin were connected to depression as the “marketing of a myth” (8). No consistent defining biological abnormality has yet been found in the brains of people with a diagnosis of depression. Thus the very term “antidepressant” denotes a false specificity
The chemical imbalance hoax turned psychiatrists into real doctors that seemingly could address causes of mental disorders with targeted drugs, just like specialists in internal medicine do when they treat diabetes with insulin.4
This is where it becomes really absurd. Psychiatric drugs are not targeted at all and none of them can cure people. Moreover, there never was a shred of evidence that the hypothesis was true.8 In fact, the truth is the opposite: Drugs create a chemical imbalance in the brain, which is why many people cannot come off them again,9 as the withdrawal symptoms can be severe.10
Antidepressants have non-specific sedative effects, but so far that is all that can be said. Meta-analyses of research data suggest that antidepressants struggle to demonstrate clinical superiority over placebo (8). Regarding a recent review in the Lancet, it is telling that psychiatric academe considers that ratings only one third above placebo, with assessment limited to eight weeks, settle the case for mass prescribing (9)
This review, by Andrea Cipriani and colleagues, got a lot of attention in the media, but it is so horribly misleading that I wrote the article: “Rewarding the companies that cheated the most in antidepressant trials.”11 In addition, the purported benefit was so small that it is considerably lower than the least relevant clinical effect. It is safe to conclude that these drugs don’t work for depression whereas they double suicides and very likely also cause homicides.12-14
My patients’ presentations often bear out the reality that life in the UK is getting harder: the fortunes of the haves and have-nots are diverging, the fabric of the welfare state thins, employment entitlements grow precarious. The Archbishop of Canterbury calls our economic model “broken.” Many people receiving a diagnosis of “depression” might be more authentically seen as carrying generic social suffering. The doctor can do little about the patient’s social predicament, but feels she must do something and so prescribes an antidepressant by reflex. This “epidemic” of depression lets the neoliberal political and economic order off the hook.
It is often overlooked that psychotherapy is much better than doling out pills. It has a more enduring effect in the long run4 and it halves suicide attempts among people at the greatest risk, those admitted after a previous attempt.15 Unfortunately, psychiatry has been so corrupted by industry money,3,4,16 that treatment has become synonymous with pills
Depression has become the dominant idiom of distress in contemporary culture, eclipsing time honoured and more nuanced descriptors—sorrow, unhappiness, despair, gloominess, bitterness, misery. In the process we have lost something that cannot be compensated for by antidepressant prescribing (10). Some rebalancing would be realistic: it could start with the psychiatric field being more honest and less self-aggrandising about the claims it advertises to wider society. “Depression” is the case in point.
Derek suggests that psychiatrists should be more honest and less self-aggrandising. Exactly. I wrote in my article about mad psychiatrists:5
“One type of delusion is grandiosity, which is a sense of superiority, uniqueness, or invulnerability that is unrealistic and not based on personal capability. Many psychiatrists behave in a grandiose way, believing in their infallibility and omnipotence and that they have a special insight no one else has. If you are a patient and disagree, you are called ignorant or in need of psychoeducation, even when your relatives share your views. Or you are told you have a lack of insight into your disease, which is a symptom of your mental illness, a catch-22 situation from which there is no escape.”
Science journalist Robert Whitaker from Boston who wrote two of the most important books ever about psychiatry17,18 and established the Mad in America website has said that in psychiatry, there is a door in but not a door out. We must ensure that there is a door out, most importantly by helping patients taper off their psychiatric drugs and by avoiding long-term drug treatment.4
References from Derek Summerfield’s paper
(1) Ingleby D. Understanding “mental illness. In: Ingleby D, ed. Critical psychiatry. The politics of mental health. Free Association Press 2004:23-45
(2) Summerfield D, Veale D. Proposals for massive expansion of psychological therapies would be counterproductive across society. Br J Psychiatry 2008;192:326-30
(3) Summerfield D. Cross-cultural perspectives on the medicalization of human suffering. In: Rosen G, ed. Posttraumatic stress disorder: issues and controversies. John Wiley 2004:233-45
(4) Summerfield D. Metropolitan police blues: protracted sickness absence, ill health retirement, and the occupational psychiatrist. BMJ 2011;342:d2127
(5) Illich I. Limits to medicine. medical nemesis: the expropriation of health. Marion Boyars 1975
(6) Summerfield D. Depression: epidemic or pseudo-epidemic?J R Soc Med 2006;99:161-2
(7) Healy D. Serotonin and depression: the marketing of a myth. BMJ 2015;350:h177110
(8) Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008;5:e45
(9) Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018;391:1357-66
(10) Wakefield J, Horwitz A. The loss of sadness: how psychiatry transformed normal sorrow into depressive disorder. Oxford University Press 2007
References
1 Bland J. Profile: Derek Summerfield – politics and psychiatry. BJPsych Bull 2017;41:294-6
2 Summerfield D. NHS antidepressant prescribing: what do we get for £266m a year? BMJ 2018;360:k1019
3 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015
4 Gøtzsche PC. Is psychiatry a crime against humanity? Copenhagen: Institute for Scientific Freedom; 2024 (freely available)
5 Gøtzsche PC. Are psychiatrists more mad than their patients? Mad in America 2025;May 6
6 Gøtzsche PC. The pandemic of fake psychiatric diagnoses. Brownstone Journal 2025;Sept 17
7 Gøtzsche PC. Psychiatric diagnoses cannot attack people, but the reification of mental health issues is harmful. Mad in America 2026;March 11
8 Moncrieff J, Cooper RE, Stockmann T, et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry 2023;28:3243-56
9 Gøtzsche PC. Mental health survival kit and withdrawal from psychiatric drugs: a user’s guide. Ann Arbor: L H Press; 2022
10 Davies J, Read J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addict Behav 2019;97:111-21
11 Gøtzsche PC. Rewarding the companies that cheated the most in antidepressant trials. Mad in America 2018;March 7
12 Gøtzsche PC. A story of bad science: How defenders of antidepressant efficacy make their case. Mad in America 2026;July 28
13 Gøtzsche PC. Antidepressants can change peaceful citizens into killers. Mad in America 2026;Aug 15
14 Gøtzsche PC. The illusion of the effects of antidepressants: They don’t work and double the risk of violence against self and others. Gøtzsche’s Perspective 2026;Aug 18
15 Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med 2017;110:404-10
16 Whitaker R, Gøtzsche PC. The pervasive financial and scientific corruption of psychiatric drug trials. Institute for Scientific Freedom 2022;March 23
17 Whitaker R. Mad in America: bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge: Perseus Books Group; 2002
18 Whitaker R. Anatomy of an epidemic, 2nd edition. New York: Broadway Paperbacks; 2015
