Book Review

Searching for Normal

by Sami Timimi (Fern Press) £25.00

This book is suffused with vibrant warmth and common sense as it delivers solid ideas for doing things utterly differently to preserve our collective mental health. There will be those who don’t like it. Timimi pulls no punches about his disbelief in an explosion of ADHD, autism, neurodiversity, gender dysphoria, etc, giving sensible – and sensitive – reasons to explain his thinking, all of it underpinned by decades of working with young people as a highly empathetic consultant psychiatrist.

It is the explosion in these ‘conditions’ that Timimi questions, not whether associated behaviours exist. He starts the book with 15-year-old Ibrahim, diagnosed as autistic at age 6, who has significant learning difficulties, little language and, now, challenging behaviour, the reason that his school has referred him to Timimi. After a few months, he is discharged, his behaviour much improved. What was it that helped? “Well that’s the thing about mental health care,” says Timimi. “You can’t really tell. Perhaps it was the passage of time; perhaps it was that the parents felt listened to; perhaps he was settling into his new home [the family had moved around the time the behaviours developed]; perhaps it was a better understanding of the effects of puberty (which I spent some time talking to his parents about); perhaps it was the school knowing he was being seen that helped them feel less burdened about trying to solve this problem. Perhaps it was discovering that he was good at riding a bike and seemed to really enjoy it.”

Timimi firmly believes that politics and subjectivity inevitably play a part in any kind of healthcare but is bothered by the fact that, in mental health, there is nothing concrete to base it on. “It’s not definable in a causal way in the same way as a fracture in the arm, diabetes or even migraine. And yet this is the way we talk about mental health and illness, as if we know what sort of ‘thing’ this is and assume that it exists within a person regardless of their context. If you hear that one in four of the population is possessed by, or will be possessed by, a mental disorder, be wary.”

We have got into a situation where describing and then naming states or behaviours means the behaviour is apparently causing itself, he says. Thus Marlon does this because he has ADHD; Jeannie is feeling low because she has depression. Indeed, he feels that the very use of the word ‘disorder’ at the end of a ‘diagnosis’ (he calls psychiatric diagnoses ‘brands’, some more popular than others) is a futile attempt to create a boundary separating mental illness from mental health. As he points out, no doctors talk of diabetes disorder or asthma disorder.

As he works his way, chapter by chapter, through the fashionable diagnoses of our times, Timimi starts each with a story that illustrates someone presenting with psychosis, self-harm, ADHD, gender dysphoria, etc), goes on to explore what is known or thought about that ‘condition’ and then comes back to the case, to describe how he and his team worked with that person, and the outcome. (In his humility, he rarely takes credit for the countless lives he has helped change for the better.)

He introduces the ‘elastic band effect’ to describe how woolly psychiatric diagnoses can expand indefinitely in response to social forces (“science can’t trump marketing”). Thus the ‘explosion’ in cases of autism, ADHD, depression, etc, which he recounts the histories of – including the dodgy research procedures or results interpretation used to justify medication. He even fears that ‘trauma’ is becoming another form of mental health expansionism, fitting with “the cultural trend to notice our vulnerability more than our resilience”, and that lack of wellbeing – a now ubiquitous, albeit completely abstract, term – is perceived as correlating with mental illness.

Of course Timimi gives much space to dissection of the spread of autism and ADHD diagnoses, as he has researched and written much about this before and is horrified by the huge increase in numbers of young people arriving in his consulting room with these labels. While admiring neurodiversity activists for what they have done to move autism perception from disorder to difference, he still fears that behind it is an imposed feeling of ‘not being good enough’ which needs challenging rather than made acceptable as a result of a ‘brain state’: “Autism, like any other psychiatric diagnosis, is not a diagnosis but a brand as confused and unstable as the culture that created it and the lives it was meant to liberate.”

He offers a long discourse on “the mental health industrial complex”, in which he is scathing about the political and big business underpinnings of this particular service industry, which promotes and sometimes even takes over the very ideas which appear to be grassroots-generated. Ultimately, neoliberal capitalism leaves the individual at fault, not the system, he argues.

The book ends with a heartfelt plea for the rehabilitation of emotions. They are natural but now we seem to be suspicious of them and need to regulate them. Things can be different and Timimi ends with hope of how. This is a fantastic, thought-provoking, even uplifting read because, whatever your views on Timimi’s position, his genuine, caring humanity cannot be doubted.

Reviewed by Denise Winn