‘What I see in clinic is never a set of labels’: are we in danger of overdiagnosing mental illness? -podcast

March 6, 2026·26 min·2 clips

A 7,000-year-old Indian epic describes PTSD, revealing mental suffering's timeless nature beyond modern labels.

This episode features an essay by physician and writer Gavin Francis, read by Nuf Uzzalam, which questions modern psychiatric diagnosis. Francis draws from his decades of experience as a UK general practitioner to explore the history and cultural framing of mental distress. He opens by noting descriptions in the ancient Indian epic *Ramayana* that mirror modern post-traumatic stress disorder. Francis cites a 2019 survey finding two-thirds of young people in the UK felt they had a mental disorder, illustrating a perceived epidemic. The essay contrasts the expanding diagnostic criteria in manuals like the DSM-5 and ICD-11 with non-Western views of distress as spiritual or relational problems. Francis describes two contrasting clinical mentors: Dr. M, whose kind, silent consultations fostered healing, and Dr. Q, whose technically correct but impersonal approach left patients unhappier. A surprising claim is that former WHO director Shekhar Saxena would prefer a schizophrenia diagnosis in Ethiopia or Sri Lanka over the West due to better community integration. The 2023 *Nature* review is cited, concluding no convincing evidence supports the serotonin theory of depression. Francis argues that genetic research has found only hundreds of partially implicated genes interacting in baffling ways, complicating a biological model. He states that every mental health problem seen in clinic contains a tendency that, in a different dose or context, could contribute to wellbeing. The essay suggests psychotic illness carries a higher suicide rate than depression. Francis observes that the word "emotion" only gained its current meaning in the 1830s, preceding terms like "humours." He references neuroscientist Charles Sherrington's poetic description of the waking brain as an "enchanted loom." The piece includes a rich list of alternative descriptors for mental states from Clarissa Pinkola Estés, such as "feeling gagged" or "without animation." The tone is reflective and philosophical, blending personal anecdote with historical and scientific analysis. Its style is a crafted narrative essay, read aloud, that advocates for a more humane clinical approach. Listeners interested in the critique of medicalization, the philosophy of psychiatry, and narrative medicine would appreciate this episode. Those seeking concrete mental health advice or definitive scientific explanations might find it too abstract.

As heard by us

A quiet, uneasy look at how diagnosis can help, and also harden, human pain.

This review follows a careful line: it treats overdiagnosis as more than a clinical debate and shows how psychiatry can rename suffering that has long had other names.

Read the full review in PlayNext →

Why you'd press play

For when you want a clear-eyed look at diagnosis, not a fixed-label verdict.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from The Audio Long Read