“The stark reality for the vast majority of people in the non-Western world, transcending everything, is poverty. Currently one quarter of the global population lives in near destitution and 3.5 million children die of starvation annually. What is ‘mental health’ in this broken social world?” (Summerfield, 2012)
IN recent years, mental health has been attracting a lot of attention — globally as well as in Pakistan. Terms like ‘anxiety’, ‘depression’, ‘trauma’, ‘neurodivergence’ and ‘well-being’ frequently come up for discussion on public forums and social media.
In Pakistan “increasing awareness and decreasing stigma” about mental health has become quite fashionable. Telepsychiatry, helplines, online platforms for connecting with psychologists and counsellors are making mental healthcare much more accessible to people.
On the surface, all this seems promising, but it begs a deeper question: are we medicalising human suffering and distress in ways that obscure its social origins? A new book, provocatively titled Searching for Normal by Dr Sami Timimi, a child and adolescent psychiatrist and psychotherapist in UK’s National Health Service invites us to consider precisely this: how we understand and conceptualise distress, what are its root causes and how we respond to it.
Timimi describes a global mental health system in which distress and behavioural differences are increasingly framed as medical disorders requiring diagnosis and treatment.
Rather than viewing emotional suffering as a natural response to adverse social and economic conditions, we are encouraged to see it as a pathology — something inside the individual that needs fixing. Timimi calls this a “mental health industrial complex” (much like the military-industrial complex) and highlights how diagnoses, therapies, medications and self-help markets form a complex network of interests that benefit from ever-expanding definitions of illness.
Over the last few decades, the number of psychiatric diagnostic labels has multiplied exponentially — from attention-deficit hyperactivity disorder (ADHD) to autism spectrum disorders to new stress and trauma classifications. While some help guide support for genuinely disabling experiences, they are also cultural constructions rather than discrete biological entities with clear tests, like diabetes or tuberculosis. Timimi points out that psychiatric diagnoses are not grounded in objective biomarkers but in symptom clusters that vary across cultures. What counts as a ‘disorder’ is shaped by cultural and economic forces, not just science.
The dramatic rise in the diagnosis of ADHD and autism in recent years, Timimi observes, is linked to incentives and structures of profit-making, wherein market forces, pharmaceutical interests, and diagnostic expansion intersect. We are already seeing a similar trend in Pakistan as people are increasingly self-diagnosing based on checklists freely available on the internet and asking to be put on medication. This is not only pathologising, but is reducing complex social realities into ‘conditions’ to be treated.
The medical model of mental health thrives on individualisation of systemic problems.
This is not to deny the reality of suffering or a criticism of therapy or to be psychiatric care per se. Distress is real and suicide, self-harm, anxiety and depression affect individuals and families deeply; some individuals benefit from clinical support, and severe psychiatric conditions exist and deserve compassionate, evidence-based care. But when ordinary distress — sadness after loss, anxiety during economic struggle, restlessness in adolescence — begins to be treated as a diagnosable disorder, we must ask how we understand and respond to that suffering. Should mental healthcare be primarily about diagnosing and treating individuals or also about reshaping the social world in which they live?
A mental health strategy that focuses on treating symptoms with medication and therapy, that ignores the conditions that produce those symptoms, also ignores prevention. It forces mental health professionals to treat symptoms without improving the lives of people in meaningful ways. Societies facing economic hardship do not need more medicalisation; they need jobs, food, housing, safety and security.
The medical model of mental health thrives on individualisation of systemic problems. Focusing on individual self-management, self-care, or ‘fixing the chemical imbalance’ in the brain deflects attention from collective and structural solutions, including human rights, economic reforms, and social and economic justice.
Timimi’s book urges us to view people not through the lens of pathology with the goal of returning them to a vague ‘normal’, but to ask what is “normal in a broken social world?” It means taking an approach that goes beyond “raising awareness, decreasing stigma or including mental health in primary care” and to also focus on social welfare, education and economic opportunity. It suggests that schools, workplaces, mosques and neighbourhoods should be part of a collective mental well-being ecosystem, not just referral points to clinicians.
For Pakistan, this has important implications, as social determinants — poverty, unemployment, violence, widespread disparity, social and economic injustice, institutional corruption and lack of social protections — are powerful drivers of distress. Research shows that inequality and insecurity are strongly linked to poor mental health outcomes. In communities affected by conflict, natural disasters or chronic poverty, emotional suffering is often a response to external conditions, not an internal defect. Framing this distress as a mental abnormality diverts attention from policies that should address their root social causes.
Importantly, it forces us to question how we conceptualise distress in countries like Pakistan and whether we are conflating distress with clinical states of depression and anxiety. If distress is framed primarily in clinical terms, then we seek a medical solution — medications or counselling/ therapy (or both) — while people continue to battle the same social conditions that caused their distress in the first place.
A humane, contextual approach to mental health acknowledges that suffering is often a response to lived conditions — poverty, violence, marginalisation — much more than some chemical imbalance in the brain. It calls for policies that address these conditions upstream, while also providing care that is compassionate, culturally grounded, and socially informed.
There is need for broadening our vision — thinking of mental well-being not as a product of individual pathology, but a reflection of societal conditions. Only then can we move towards creating a society where healing is shaped by justice, solidarity and care.
The writer is a consultant psychiatrist.
Published in Dawn, January 12th, 2026
