What is mental health today - psychiatry, neuroscience and society in the twenty first century

In this lecture, I will describe the new ‘territory’ of mental health that is taking shape today, in the light of a number of developments: a debate about the extent of mental ill health in Western and non-Western societies and the individual and social consequences; the hopes for neuropsychiatry, and the possibilities and difficulties facing neurobiologically based diagnoses and treatments of mental ill health; the emerging logic of early diagnosis and intervention (both in the early years and in ‘the aging brain’); and the rise of movements of psychiatric service users demanding their own say in the services that are provided for them, and the debate over the new obligations of ‘recovery’. I will characterise this new ‘territory’ in terms of two dimensions. : (1) where a focus on the external space of everyday life and of the expert management of mental health ‘in the community’ meets a focus on the internal space of the brain and the ambitions of the experts of the neuromolecular gaze; and (2) where the language of the user’s voice, rights and ‘recovery’ meets the language of the national and global ‘burden’ of mental disorder and policies to alleviate that ‘burden’. These lines of tension define the new territory of mental health and shape the new relations, alliances and conflicts, between neuroscientists, psychiatrists, users and policy makers. I will illustrate this by discussing: (a) ‘disorders without borders’ – the apparent epidemic of mental disorder; (b) neurochemical selves – the rise of psychopharmacology and its contemporary troubles; (c) the road to DSM 5.0 – the search for biomarkers and the question of the aim of psychiatric diagnosis today; and (d) the new politics of mental health and especially debates over screening, prediction, early identification and intervention.