Over or under diagnosis? The challenge of responding to mental distress in contemporary society

In psychiatry, psychology and mental health more broadly, an enduring conceptual puzzle of interest to scholars has been the way some behaviours or clinical presentations are constructed as criminal or deviant while others as a psychiatric condition or illness. It has been argued that these distinctions are socially constructed along gendered lines with men more likely to be criminalised and women more likely to be diagnosed as mentally ill. In these two talks, we present the dichotomy from a different lens. The first talk considers the thorny issue of “overdiagnosis”, using population level data to examine which groups are more or less likely to be over- or under-diagnosed. Here, gender features as one aspect of inequality but age and sexual orientation are more significant as risk factors. In our second talk we present work from the health and social care frontline supporting a group of disadvantaged women assessed to be failing in their role as mothers, leading them to be stereotyped as 'bad mums’ but who face a catalogue of disadvantage. These women have tended to be left without any therapeutic assessment of mental health needs, let alone diagnosis or treatment for psychological symptoms. When mental health assessment and diagnosis is used with this population, it tends to be to question their ability to parent, and not with a focus on their needs. In this sense, these talks together challenge the assumption that the “mad or bad” dichotomy is primarily concerned with gendered stereotypes.

About the speakers

Susan McPherson is Professor of Psychology & Sociology and Deputy Director of the Institute for Public Health and Wellbeing at the University of Essex. From 1998-2007, she worked at the Tavistock & Portman NHS Foundation Trust in psychotherapy evaluation, routine outcome monitoring and as a research psychologist in the Psychotherapy Evaluation Research Unit co-ordinating the Tavistock Adult Depression Study (a randomised controlled trial of psychodynamic psychotherapy for treatment resistant depression). She also previously worked as a researcher at the London School of Hygiene and Tropical Medicine and at Kings College London. From 2006-2024, she led research training for the Doctorate in Clinical Psychology at the University of Essex and is currently Deputy Director of the Institute for Public Health and Wellbeing. Her research spans medical sociology, psychology and disciplines concerned with mental health and social welfare including critical approaches to diagnosis and evidence-based practice.

Danny Taggart is Reader in Clinical Psychology, Programme Director for the Doctorate in Clinical Psychology and Divisional Lead for Psychological Therapies at the University of Essex. He worked at the Independent Inquiry into Child Sexual Abuse from 2019-2022 where he was the principal psychologist and clinical lead for the Truth Project. He has worked as an advisor to the Northern Irish Historical Institutional Abuse Redress Board, the Scottish Child Abuse Inquiry and Redress Scheme, the Jersey Care Inquiry Citizens Panel and the Mother and Baby, Magdalene Laundry and Workhouse Truth Recovery process in Northern Ireland. His current research is focused on survivor participation in non-recent institutional abuse inquiries, the ways that childhood trauma impacts engagement with public services, and what value survivor testimony has in both facilitating recovery from trauma and creating change in institutional practices. He also works in the area of family separation in the context of child removal, in both contemporary family justice settings and in cases of non-recent institutional abuse.