No More Normal: Mental Health in an Age of Over-Diagnosis, Dr Alastair Santhouse, Granta, £18.99.

The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far, Dr Suzanne O’Sullivan, Hodder Press, £22.

Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity, Dr Sam Timimi, Fern Press, £19.65.

At a time when concern about poor mental health is at an all-time high, a quiet but compelling counter-movement is gaining traction. Three new books – No More Normal by psychiatrist Alastair Santhouse, The Age of Diagnosis by physician and neurologist Suzanne O’Sullivan, and Searching for Normal by psychiatrist Sami Timimi – make an uncomfortable but necessary argument: we are turning life itself into an illness.

Alastair Santhouse’s No More Normal begins with a bold claim: ‘We are not getting sicker; we are attributing more to sickness.’ While addressing the increase in psychiatric diagnoses specifically, his observation encompasses the tendency to medicalise ordinary human experiences. In recent decades, conditions like ADHD, autism, depression, and anxiety have seen dramatic diagnostic increases, a trend that also concerns both other authors. Timimi notes that between 1998 and 2018, autism diagnoses in the UK surged by 787 per cent. He argues that we are increasingly transforming emotions like unhappiness and behaviours such as social awkwardness, previously considered normal aspects of personality or life’s challenges, into clinical disorders requiring professional intervention.

Santhouse examines how language has evolved over time. ‘Trauma’ originally referred only to physical injury and was adopted slowly in psychiatric contexts – so slowly that it wasn’t even used to describe psychological suffering during the First World War. ‘Frankly’, declared an expert witness testifying about shell shock in 1922, ‘I am not prepared to draw a distinction between cowardice and shell shock.’ Today, the term is applied much more broadly. Santhouse describes a case involving a woman experiencing deep distress following a family member’s death, not because she suffered from clinical depression or trauma, as might be suggested today, but because she was going through the natural process of grief. While labelling life’s inevitable challenges as ‘trauma’ may appear empathetic, he contends it ultimately does more harm than good by reclassifying normal human experiences as health abnormalities. This approach, he argues, diminishes individuals’ capacity to develop coping mechanisms and resilience, while discouraging communal, non-medical responses to what are essentially universal aspects of human existence.

Even within the domain of biological diseases, diagnosis combines science with artistry, as Suzanne O’Sullivan skilfully illustrates. With both compassion and precision, she explains diagnostic processes and their effects on patients across various conditions, including Lyme disease, Long Covid, cancer, autism and ADHD. She examines Huntington’s disease, an inherited, incurable neurodegenerative disorder where modern genetics, neuroimaging, and molecular biology enable diagnosis with complete certainty before symptoms appear, revealing that the implications of receiving such a diagnosis are far from straightforward.

In a thoughtful chapter, O’Sullivan presents two patient stories that demonstrate how knowledge of an incurable future condition, one that might remain dormant for a decade, serves as both compass and weight. This foreknowledge can empower individuals to make deliberate life choices, informing decisions about having children, genetic testing of embryos, professional pursuits, and living arrangements. However, this same awareness can also cast shadows, transforming one’s sense of self and outlook on possibility. A diagnosis, or even its mere prospect, may come to define a person completely. They might experience illness psychologically long before physical symptoms emerge, their future narrowed by the burden of what they’ve learned.

O’Sullivan argues that with many conditions, we are experiencing both over-detection and an expanding definition of disease. She illustrates how borderline issues increasingly receive definitive diagnoses, while ordinary variations in human behaviour become reclassified as pathological. First, not everything constitutes a disorder: aging, poor sleep, changes in sex drive, and menopause aren’t necessarily problems requiring clinical intervention. Second, she doesn’t suggest that all diagnoses, including those for autism or cancer, are wrong. Rather, she raises the possibility that for milder cases, the harm of labelling may outweigh any potential benefits.

The consequences are manifold and far-reaching. The broadening of diagnostic categories can render those most severely affected effectively, as O’Sullivan puts it, ‘invisible’. Autism is a compelling example. Individuals with significant needs, such as those who are non-verbal or unable to function without intensive support, now find themselves competing for attention and resources alongside Instagram influencers who identify with the condition but live markedly different and independent lives. Additionally, as the definition of autism expands from a narrowly defined, relatively homogenous group to a more inclusive and heterogeneous one, researchers increasingly struggle to determine why autism occurs, or how best to support those affected. If the goal of diagnosis and support is to anticipate and meet an individual’s specific needs, that task becomes far more difficult when the population expands so dramatically and diversifies.

In a brief historical passage, Santhouse references Erving Goffman’s 1960s asylum studies, where the sociologist documented patients’ experiences. Their days were characterised by monotony and aimlessness, lacking distinction between work and leisure. They made no decisions and pursued no goals. One can’t help concluding that we’re creating something similar – transforming society into an asylum and everyone into such patients.

The word patient derives from the Latin verb pati, meaning ‘to suffer’. It shouldn’t be something to aspire to. Yet all three authors suggest it may be becoming exactly that. Each has encountered patient-driven diagnosis in their practice. While increased patient knowledge and the ability to challenge medical authority represents progress – as O’Sullivan demonstrates, doctors historically have dismissed symptoms of legitimate conditions – scientific expertise should still carry greater weight. They note the trend of people, particularly youth, actively pursuing diagnoses. For some, it becomes an identity comparable to being a goth or a punk. This represents both a bottom-up phenomenon – individuals seeking diagnosis – and top-down medicalisation by healthcare systems and professionals. However, adopting an identity centred on illness can impede recovery, creating incentives to remain unwell.

While the American social psychologist Jonathan Haidt has gained considerable public attention by attributing rising mental health issues primarily to smartphone use and the decline of unstructured play in childhood, these three doctors point to more complex and fundamental factors. Both Timimi and Santhouse somewhat simplistically implicate capitalism, and the pharmaceutical companies who manufacture and profit from drugs. Such explanations fall short of illuminating why health conditions have become central to personal identity formation in contemporary society. This stands in stark contrast to previous eras, when occupational roles or political affiliations served as primary identity markers.

Santhouse delves deeper, offering several insightful ideas about why this cultural shift has occurred. He observes shortcomings in traditional forms of socialisation and perceptions of adult authority. For example, when children are slow to concentrate or fidget, rather than instructing them to pay attention or address the behaviour directly, adults increasingly defer to medical categories. They step back from what might previously have been considered routine discipline or guidance, allowing diagnoses to explain away behaviours they feel uncomfortable addressing. He observes that conceptions of the human condition itself – what we can withstand and manage – are evolving. O’Sullivan similarly urges us to accept life’s messier, less-controlled aspects. Perhaps also traditional coping mechanisms that people historically relied upon, whether religious faith, community bonds, or artistic expression through poetry, have diminished in modern life, creating a vacuum that medical explanations now occupy.

For some time, the expansion of diagnoses, particularly in mental health, has fuelled a polarising and largely unproductive debate. One side argues that increasing diagnostic rates reflect indolence or deliberate avoidance of responsibility; the other maintains that such conditions were always prevalent but previously unrecognised, and that questioning this narrative demonstrates a lack of compassion and kindness. Neither position accommodates nuance, and the discussion has become more personal than constructive. These works, grounded in professional experience and rich with examples and case studies, initiate a dialogue that transcends these limiting extremes.

Regarding solutions, Santhouse contends that sometimes a clinician’s most powerful intervention is simply reassuring someone that their experience falls within normal parameters. O’Sullivan astutely notes that we expect too much from medical professionals, and the remedies for our current malaise must emerge from beyond clinical settings. These authors persuasively argue that while genuine suffering warrants support, greater well-being might come not from expanding medical categories but from adjusting our expectations of normal human experience, with all its inevitable discomforts, challenges, and variations. The path to healing lies not in multiplying diagnoses, but in rediscovering our capacity for resilience and meaning-making outside the medical framework.