We are living through what is routinely described as a mental health crisis. Rates of psychological distress are increasing. Suicide remains a leading cause of death for many age groups. Young people report unprecedented levels of anxiety and despair. Entire communities are grappling with housing insecurity, economic instability, climate catastrophe, family violence, racism, and social isolation.
The dominant response has been to expand psychiatric intervention. More diagnoses. More screening. More treatment pathways. More mental health literacy. More awareness campaigns.
Yet the crisis persists.
This should force us to ask a difficult question: what if the problem is not that we have failed to identify enough mental illness, but that we have come to understand human suffering through the wrong framework entirely?
At the centre of that framework sits the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document that has become so embedded within contemporary culture that many people assume it simply describes objective medical realities. The DSM is presented as a scientific catalogue of mental disorders, a neutral tool used to identify and classify illness. In practice, however, it functions as something much larger. It shapes how distress is understood, who is considered rational, whose experiences are believed, who receives support, and who becomes subject to surveillance, intervention, and control.
The DSM does not merely describe suffering. It produces particular ways of thinking about suffering.
Psychiatric diagnoses are often discussed as though they are equivalent to diagnoses in other areas of medicine. The comparison is misleading. There is no blood test for depression. No brain scan that confirms borderline personality disorder. No biological marker that distinguishes one person with schizophrenia from another person who hears voices but has never entered a psychiatric system. The categories contained within the DSM are based largely on clusters of behaviours, emotions and reported experiences that have been organised into diagnostic frameworks by committees of experts.
This is not to suggest that suffering is not real. The pain people experience is often profound. The question is whether the psychiatric categories used to describe that pain reveal something fundamental about the individual, or whether they tell us more about the society in which that suffering emerges.
The DSM encourages us to look inward for explanations. It asks what is wrong with a person rather than what has happened to them. It directs attention towards individual pathology while obscuring social conditions. Distress becomes evidence of disorder rather than a response to circumstances.
When a woman experiences despair after years of domestic violence, psychiatry asks whether she meets diagnostic criteria. When an Aboriginal person struggles under the ongoing weight of colonisation, dispossession and racism, psychiatry asks whether their symptoms fit a recognised disorder. When people become anxious in the face of unaffordable housing, insecure employment, climate collapse or social exclusion, psychiatry translates those experiences into clinical language.
The conditions remain intact. The person becomes the problem.
This is where psychiatry sits uneasily alongside public health. Public health has long recognised that health outcomes are shaped by intermediate social determinants: housing, income, education, safety, community connection, discrimination, and political power. We understand that poverty, although a symptom of other causes, produces illness. We understand that racism produces illness. We understand that violence produces illness. Yet when it comes to emotional suffering, we frequently abandon this analysis and retreat into individual explanations.
The result is a strange contradiction. We acknowledge that social conditions produce distress while simultaneously treating that distress as evidence of individual dysfunction.
Psychiatric abolition begins by rejecting this contradiction.
To argue for the abolition of the DSM is not to deny suffering, nor is it to romanticise experiences that can be terrifying, overwhelming or life-threatening. Rather, it is to challenge the assumption that human suffering is best understood through diagnostic classification. It is to question why psychiatry has become the dominant authority on experiences that are often social, political, and relational in nature.
This becomes particularly important when we examine the consequences of diagnosis.
The DSM is often imagined as a benign clinical document. In reality, diagnoses travel. They move beyond consulting rooms into schools, workplaces, courts, child protection systems, housing services, prisons, and welfare agencies. Diagnostic labels influence whether parents are considered competent, whether workers are considered reliable, whether witnesses are considered credible, and whether individuals are considered capable of making decisions about their own lives.
Most significantly, psychiatric diagnosis remains one of the few mechanisms through which liberal democracies routinely justify the removal of liberty without criminal conviction.
People can be detained indefinitely because they are assessed as mentally ill. They can be medicated against their will. Restrained. Secluded. Subjected to forced treatment orders. Their refusal can itself become evidence of illness.
No discussion of the DSM can be separated from this reality.
The manual does not simply categorise experiences. It authorises interventions. It provides the language through which coercion becomes framed as care.
This relationship between diagnosis and power is not accidental. Psychiatry has always been shaped by political and cultural assumptions. Homosexuality appeared in earlier editions of the DSM as a mental disorder. Women have historically been diagnosed in ways that reflected prevailing expectations about femininity and obedience. Across different periods and places, psychiatric diagnosis has been deployed against dissidents, activists, racialised communities, and those whose behaviour challenged dominant social norms.
These examples are often dismissed as unfortunate mistakes of the past. Yet they reveal something more fundamental. They demonstrate that psychiatric diagnosis is never simply scientific. It reflects prevailing ideas about normality, productivity, reason, and social order.
The question is not whether psychiatry has been political. The question is whether we are willing to acknowledge that it remains political.
An abolitionist approach requires us to imagine a different response to suffering. One that does not begin with diagnosis and coercion but with material conditions. What would happen if we approached distress as information rather than pathology? What if anxiety was understood as a signal about insecurity rather than evidence of disorder? What if despair directed us towards questions of housing, violence, poverty, and exclusion rather than neurotransmitters?
Psychiatric abolition is often caricatured as abandoning people who are struggling. In reality, it asks why the wealthiest societies in history have become so reliant on diagnostic categories while consistently failing to provide the things people need to live well. Safe housing. Meaningful relationships. Community belonging. Economic security. Freedom from violence. Cultural connection. Collective care.
These are not alternatives to mental health. They are the foundations of it.
The DSM asks us to locate suffering within individuals. Psychiatric abolition asks us to locate suffering within relationships, institutions, histories, and systems of power. One approach seeks better classification. The other seeks transformation.
If public health is genuinely political, then we cannot continue treating distress as though it emerges independently of the world people are forced to inhabit. We must be willing to ask whether the mental health crisis is, in fact, a crisis of housing, inequality, colonialism, violence, alienation, and abandonment.
And if that is the case, then the future lies not in refining diagnostic categories but in building a society that requires fewer of them.