This is, without a doubt, the most controversial article I have written to date. Yet, it is a controversy rooted in necessity—a challenge to the way we have long conceptualised, diagnosed, and treated mental disorders. The existing models that guide our understanding and care for mental disorders, though groundbreaking in their time, are now misaligned with emerging evidence. And the cost of clinging to these outdated paradigms is not merely academic—it is human lives, suffering unnecessarily prolonged.
*This is a lengthy one today, so go get a nice cuppa–it will be worth it.*
The field of psychology has long tried to place itself on a par with the field of medicine. As such, when the field of psychology finally got its badge as a formal scientific field of study, it eagerly adopted the medical disease model. Consequently, we have come to classify mental disorders as symptom-based syndromes. You know, just like a cold gives rise to a runny nose, sore throat, headaches, and a rise in body temperature, Major Depressive Disorder gives rise to a lack of motivation, insomnia, fatigue, change in eating habits, and social withdrawal.
But what if we have it backwards? What if these symptoms are not merely byproducts but active contributors to the disorder? Take the symptom, insomnia, it is very reasonable to assume that poor sleep (insomnia) causes fatigue, which in turn diminishes motivation, and the resulting social withdrawal can deepen depressive states. This dynamic interplay suggests that symptoms may cause the disorder rather than the disorder being the cause of its symptoms. This is also the core underpinning of the network approach to psychopathology, which posits that mental disorders are the result of the complex interplay between symptoms.
The Myth of Categorical Disorders
Historically, mental disorders have been conceptualised as being categorical in nature—discrete, isolated syndromes producing fixed symptoms. This model assumes that symptoms are non-interchangeable and do not interact. However, modern research (e.g., Borsboom & Cramer, 2013; Kendler, 2010) challenges this view, suggesting that mental disorders arise from the dynamic, causal interactions between symptoms—a paradigm shift made clearer through modern tools like network analysis.
This was exactly this reconceptualisation of mental disorders, combined with the introduction of network analysis as a new psychometric tool, that gave rise to the topic for my PhD research–exploring the interplay between symptoms in personality pathology using the DSM-5’s alternative Personality Inventory for the DSM-5 Short Form. My own findings, alongside those of countless other researchers, forced me to question how we conceptualise, diagnose, and treat mental disorders.
The Missing Link: Metabolism and Mental Health
The story does not stop at symptoms. A critical yet overlooked factor in mental health is metabolism. Several research studies have now evidenced for the link between metabolic dysfunction and higher rates of psychopathologies, such as depression, anxiety, Autism, ADHD, Schizophrenia, and Bipolar Disorder. Studies even suggest that dietary treatments can, in some cases, outperform psychiatric medications in alleviating symptoms.
The mitochondria—the powerhouse of the cell—play a pivotal role here. When these cellular engines malfunction in the brain, the result can be a cascade of over- or underactivation in brain cells, leading to severe mental distress. Dr. Christopher Palmer’s extensive research underscores the view that mental disorders could be better conceptualised as metabolic syndromes.
Why does this all matter? Well, what is at stake is much more serious than academic integrity, it is the effectiveness of our treatments, the validity of our diagnostic tools, and, most importantly, the well-being of those we serve. Misaligned conceptualisations lead to misaligned care. If a patient with severe anxiety caused by a metabolic dysfunction sits across from a therapist and spends years unpacking childhood trauma, that patient’s suffering may persist—or worsen—because we failed to see the bigger picture.
This is not to diminish the transformative power of psychotherapy. On the contrary, I am a strong advocate for its value, why else would I still be practicing the art, right?! However, the power of therapy lies not just in addressing mental suffering. I believe that the strength of psychotherapy lies in its ability to guide individuals towards a better understanding of the self, a journey inward to that of self-discovery, not in treating every symptom as evidence of a disorder.
The Way Forward: Embracing the Grey
In a nutshell, what I am trying to bring across is that we are moving towards what I believe to be, a complete re-conceptualisation and understanding of mental disorders. I want to encourage other researchers, scholars, academics, and clinicians, to adopt a more flexible, integrative approach to mental health. This means considering metabolism alongside psychology, working with symptoms as they present, and questioning the assumptions embedded in our diagnostic manuals. Yes, change is complex and disruptive. It requires a reevaluation of diagnostic systems, insurance claims, training protocols, and more. But complexity should never justify complacency.
We live in an era where technological and analytical advancements allow us to understand mental health more comprehensively than ever before. To ignore these opportunities is not just a missed chance—it is unethical.
If there are better ways to alleviate suffering and help individuals lead meaningful lives, why would we not embrace them? Why would we legalise assisted suicide for treatment-resistant mental illness without first exhausting every avenue of care, including those rooted in metabolic science?
The time has come for a collective shift. We must encourage conversations that challenge traditional views of mental health. We must embrace the nuance of the “grey” and resist the lure of oversimplified, black-and-white narratives.
This is not about discarding medication or psychotherapy but about integrating them into a broader, more accurate understanding of mental health. It is about advocating for research and treatments that prioritise effectiveness over convenience and evidence over tradition.
The stakes are too high for resistance. If we truly care about reducing suffering and empowering lives, then we must align our practices with the truths that science and experience reveal, however uncomfortable they may be.
As our circle of knowledge expands, so does the circumference of darkness surrounding it”
– Albert Einstein
—
If you liked this article, let me know by leaving a comment below. You can also connect with me on LinkedIn, Instagram, and Medium, or join my weekly Newsletter, Lessons from the Couch — where I share nuggets of wisdom, psychological research, personal insights and lessons straight from my therapy couch.
