Does ‘mental illness’ exist? I have taken as my title one of my least favourite questions. Although often posed to critics of psychiatric practice like myself, it actually makes very little sense. In unpicking it, I hope to show that we have better ways forward than the current, largely unchallenged understandings of emotional distress which do not reflect reality – either in terms of the evidence, or in terms of people’s lives.

The question really needs re-phrasing in two parts. If we framed the first part as ‘Do people really experience extreme forms of distress such as suicidal despair, hearing hostile voices, crippling anxiety and mood swings?’ then of course the answer is yes. As a clinical psychologist who has worked in the field of mental health for over three decades, and as a human being who is not immune from distress myself, I know this very well. But my answer to the implied second part ‘Are these experience best understood as “mental illnesses”?’ is a definite no. The concept of ‘mental illness’ obviously exists, as do the concepts of witches, ghosts and God – but the idea that the very real experiences subsumed under this term are best explained as medical disorders does not have, and has never had, any evidence to support it.