Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity
Sami Timimi
Vintage, 2026, £12.99
Many years ago, through my then day job, I encountered the ideas of professionals who challenged the dominant account of serious mental health problems. It was wrong, they argued, to see these problems as caused by one or more of a collection of discrete mental illnesses. The term “schizophrenia”, for instance, now describes a quite different set of symptoms from those it did when it was coined in the 19th century, and despite all the advances made in neuroimaging, physical signs that would allow schizophrenia to be securely diagnosed remain as elusive as ever. And homosexuality ceased to be a mental disorder in the US in 1973, not because of any scientific discovery, but because of a vote among psychiatrists. Of those eligible to take part, 21 per cent said it was a disorder, 32 per cent said it wasn’t and 47 per cent failed to return their ballot paper.
Because the charge is often made, it’s worth emphasising that critical professionals don’t seek to minimise the suffering of people diagnosed with mental illness. What is true is that they are more likely to look for the causes in people’s life experiences, such as abuse, discrimination and poverty. They find the most useful question to ask a new client is not “What’s wrong with you?” but “What’s happened to you?” They also recognise that the treatments often prescribed, from psychoactive medication to electroconvulsive therapy, are not without distressing side-effects.
These critical mental health professionals are a heterogeneous group, but it’s fair to number the psychiatrist Sami Timimi among them. He writes well about what he calls the “mental health industrial complex (MHIC)” – which is in part what we used to call Big Pharma – and how it affects society:
Problems that are socio-political can easily be converted into problems that are psychological. The devastating consequences of discriminations, together with the persistent and pervasive inequities in society, are turned into mental disorders that need mental health care rather than political action. The diminishing boundaries for normal also mean that, over recent decades, the MHIC has continued to benefit from billions in revenue through individualising and psychologising mental suffering.
Where Searching for Normal will be controversial for many is that Timimi includes conditions like ADHD and mild autism in this analysis. Again, he is not denying people’s problems: one of the best things in the book are his case studies of young patients. (They are composites to protect individual clients’ confidentiality) They bring home that each person’s difficulties and suffering are different and that giving a patient one, two or half a dozen diagnoses – and some do receive that many – tells you little about them or what is likely to help them.
Yet it is undeniable that both ADHD and mild autism are fluid concepts. ADHD has gone from a condition affecting small boys, whose symptoms sounded very like a list of those things about children that most irritate adults, to one found in both sexes and in adults as well as children. And, in online discourse though not psychiatric manuals, from one characterised by inattention to one that can equally well be characterised by paying too much attention. Who, we need to ask, is to say what too much attention is? The neurodiversity movement promised more acceptance of differing personalities, but it too often seeks a medical diagnosis for anyone who differs from an ever-narrowing and ever more stereotypical idea of what is “neurotypical”.
I was pleased to see that in looking at alternative frameworks for helping people, Timimi commends the Power Meaning Threat Network, which was published in 2018 by a group of clinical psychologists and service-user campaigners. He describes it as providing “a way of helping people to create more hopeful stories about their lives and the difficulties they have faced or are still facing, instead of seeing themselves as blameworthy. Weak, deficient or ‘mentally ill’.” It has its roots, to return to my old day job, in a project I once helped to initiate.
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