There is a rich canon of literature in the social sciences, medical anthropology, and critical psychology which deals with various aspects of psychiatrization, but mostly using different terminology and against different theoretical backgrounds. Also, this literature usually targets a micro-level [e.g., ethnographic case studies on the effects of psychiatric diagnosis (38–40)] or is unspecific to the field of psychiatry (e.g., research on medicalization, pharmaceuticalization, see below). Yet, as discussed in the introduction, there is empirical research from the medical field that points at various developments within psychiatry (e.g., research on drug safety, prescription rates, overdiagnosis, and overtreatment), based on numerous sources and levels of data from different domains and disciplines. Both fields of discourse are rarely brought into productive contact with each other. This may result in conceptual research which tends to neglect empirical data of the criticized psychiatric discourse itself and then again in medical research which does not specifically aim at a theory-based interpretation of its own findings in the light of larger social, political, and cultural developments.

Methodologically, this article is a conceptual paper which focusses on theoretical considerations and theory development. Its intention is neither to prove empirically that psychiatrization exists nor to speculate in whichever ontological sense this could be true. In line with Grant & Booth's typology of reviews, it can be considered as “critical review” that “goes beyond mere description” to produce “a hypothesis or a model, not an answer,” and which can serve as a “launch-pad” for further conceptual, but also empirical research [(41), p. 93]. Drawing on a diverse literature base on various aspects of psychiatrization, this article aims at mediating between the plurality of disciplines, concepts, and available data. It intends to contribute to a synthesis of the discourses within medical and social sciences, which are not only heterogeneous but stand in a tradition of being perceived as incommensurable.

Given that psychiatrization is a highly diverse, ambiguous and in itself transdisciplinary research object with fuzzy edges, a systematic literature review covering the multitude of disciplines involved was not feasible. Instead, literature was selected with regard to content and by focusing on the most influential authors and most quoted theoretical contributions surrounding psychiatrization over approximately the past 25 years. Drawing on this rich corpus of literature, an overarching, yet preliminary, model is proposed, which integrates the main actors, drivers and sub-processes of the field into a larger framework that eventually aims at setting the stage for further transdisciplinary research.

Given that the main body of research literature focusses on the Global North, the emphasis of this article will necessarily lie on how psychiatrization manifests in industrialized countries where established psychiatric services already exist. However, despite the limitations of our approach, psychiatrization in low and middle income countries will remain an equally important topic for any kind of further research.

The term “psychiatrization” is first mentioned in psychiatric literature in the year 1983 by Dušan Kecmanovic, who briefly discusses psychiatric labeling of social phenomena or of deviance from existing norms (42). Within the last years, a range of popular criticism about certain aspects of psychiatry's expansion has been mostly interested in the soaring use of psychotropic medication or the inflation of diagnostic categories in the context of DSM-5, which appeared in 2013 (36, 43–46). However, more ambitious empirical and theoretical scholarship with an explicit focus on psychiatrization as higher-order process, aiming at an overarching theory or presenting a comprehensive model is rare.

For instance, the sociologist Nikolas Rose examines reasons for and interpretations of the inflation of some psychiatric diagnoses and related treatments, but without using the term psychiatrization or attempting to systemize his findings under a different term. Instead, he concludes by advocating a more complex approach to understand the growth of these diagnoses in the broader context of Western societies and their cultural developments (47). The rich work of philosopher of science Ian Hacking puts an emphasis on how psychiatric classification interacts with society, but without focusing on the expansion of psychiatry as a whole, e.g., by considering quantitative data, or developing a more unified model. However, Hacking compellingly shows how psychiatric taxonomy can deeply change the identity of the targeted persons, who, in return, react to the provided description by various degrees of embracement or resistance, which then creatively re-shapes the classifications (“looping effect”) (48, 49). Hacking also claims that classification has the power of literally “bringing into existence” the classified objects, thus “making up people” and creating “ecological niches” for new ways of existence as a certain kind of person (50, 51).

Furthermore, there is some ethnographic research detailing a few of psychiatrization's mechanisms at work in specific countries and groups worldwide (38–40, 52–54). Theoretical and experiential accounts of psychiatrization are also evident in psychiatric user and survivor scholarship, the burgeoning area of Mad Studies (55–57), and, of course, the classic anti-psychiatric literature of the 1960s and 70s (58–61). Recently, there have been several campaigns and publications addressing medical overdiagnosis and disease-mongering in general but lacking a special focus on psychiatry (62–66). Conceptually, psychiatrization unfolds as a co-production of various psy-disciplines (psychology, psychotherapy, psychoanalysis) from which mostly synergistic processes of dispersion of psy-knowledge, concepts, and vocabulary are derived (67). It shares many features with various current or preceding concepts and theories that are grounded in a plethora of disciplines:

(1) The conceptual framework of medicalization has been mainly coined by social scientists, among them Irving Zola, Peter Conrad, and Ivan Illich (68–74). Medicalization is understood as the process of defining and treating problems as medical that formerly had been perceived as non-medical, and thus expanding medical jurisdiction into new realms.

(2) Building on these ideas, the concept of biomedicalization (75) describes an intensification of medicalization driven by technological progress in the bio- and life-sciences, whose main vector of expansion is the conversion of health into a commodity and normality into something which has to be maintained or actively produced.

(3) A third line of argument uses the term pharmaceuticalization to point to a growing consumption of prescription- and lifestyle-drugs in many fields of medicine (76–78). More specific to psychiatry, medical anthropologist Janis Jenkins (79) explores how the cultural constitution of the self is influenced by widespread use of psychopharmaceuticals, while Nikolas Rose (80) has coined the expression of “neurochemical selves” for individuals who experience their own emotions as epiphenomena of their brain chemistry.

(4) A fourth theoretical tradition builds on the notion of psychologization (81, 82) or therapeutization (83), seeing psychology as a discipline that shares or better reproduces many of psychiatry's most fundamental assumptions. Yet, unlike psychiatry, psychology does not necessarily make claims about the biological base of mental illness or human behavior in general. Instead it supports the psychiatric epistemology by centering around individualist categories (e.g., individual capacities or deficiencies), and thereby tending to overlook or neglect political and social contexts. In a slightly different sense, psychologization is also used to refer to society's growing interest in individual emotions and psychological mechanisms in general over the last decades, preparing the breeding ground for what has been called a “therapy culture” (84). In a similar vein, it has been argued that many psychological concepts relating to harmful events and negative human experience have undergone semantic shifts within the last years in a way that they now include a broader range of phenomena or quantitatively less extreme examples of already known phenomena. This “concept creep” is hypothesized to mirror society's growing sensitivity toward harm and suffering, but on the other hand, criticized for contributing to further psychologizing and pathologizing normal experiences (85).

Psychiatrization is notoriously hard to define, as psychiatry itself is diverse, comprising rivaling branches with very different views on what causes and defines mental disorders and how to treat them. Also, the boundaries between psychiatry and neighboring disciplines like clinical psychology are often fuzzy and difficult to determine. Synthesizing the aforementioned approaches and concepts, we suggest to define psychiatrization as a complex process of interaction between individuals, society, and psychiatry through which psychiatric institutions, knowledge, and practices affect an increasing number of people, shape more and more areas of life, and further psychiatry's importance in society as a whole. Psychiatrization is an ongoing process which is not monolithic. Like other complex social developments, such as individualization or modernization, it is in itself extremely heterogeneous and appears in multiple, steadily transforming sub-processes (86) (see Figure 1). It can include both material (e.g., growth of psychiatric infrastructures) as well as ideological aspects (e.g., defining a certain condition as disorder) and is rooted in numerous fields and disciplines (e.g., psychology, psychotherapy, etc.). As a whole, psychiatrization reciprocally both causes and reflects the seemingly high incidences of psychiatric disorders and growing mental healthcare utilization.

Although there is some criticism that psychiatric epidemiology might be over-inclusive and biased (87–89), high prevalences and incidences of mental disorders, and even more so, strong evidence for growing service-use based on psychiatric diagnosis indicate that an increasing number of people currently are or are likely to be affected by psychiatry either directly or indirectly. This demonstrates the core feature of psychiatrization: its strong drive toward quantitative expansion (47), which comes into being, for example, through changes in diagnostic practices [e.g., through diagnostic inflation (36, 73, 90)], the growth of the psychiatric healthcare system in many countries or the soaring use of psychotropic drugs worldwide (13, 19, 91). Changes at the institutional or scientific level often correspond with more subtle transformations, such as the infusion of psychiatric terminology into everyday language (e.g., trauma, paranoid) or the interpretation of life events and personal experiences through the lens of psychiatric concepts (e.g., burn-out, depression). Thus, psychiatrization also transforms the life worlds of people without any personal connection to psychiatry.

However, the general psychiatrization of society might also be contrasted with rare examples of de-psychiatrization, which demonstrate that psychiatrization is not a deterministic one-way road. Instead, it is actively negotiated and can sometimes even be openly resisted by professionals as well as by laypeople. The most prominent case of de-psychiatrization might be the de-pathologization of homosexuality and its removal from DSM-II in 1973, showcasing that changing attitudes in society can also result in the rejection of psychiatric labels and normalize behavior, which was previously deemed “sick” or “ill” (92). Also, competing psy-disciplines might sometimes, at least partially, challenge psychiatrization despite sharing some underlying logic, for example, when therapists oppose the pharmaceutical treatment of disorders thought to respond better to psychotherapy.

According to the literature mentioned above and the broad variety of factors for psychiatric expansion that it displays, it is important to keep in mind that the various manifestations of psychiatrization are not under central control or a common endeavor of certain key-players. Their power derives much more from public and scientific discourse or economic rationality than from deliberate actions of specific individuals. This also implies that explanations that mainly focus on the collaboration between psychiatry and the pharmaceutical industry run the risk of scientifically falling short (36, 44). However, in most cases, psychiatrization unfolds in multiple interactions with vectors going top-down as well as bottom-up. This dynamic can also implicate looping-effects in the very sense of Ian Hacking's theory (48, 49).

As a heuristic approximation, relevant protagonists can be classified into agents on the top-level or on the bottom-level. Top-level agents are defined as being either mental healthcare professionals or in other ways professionally tied to the healthcare system, while the agents on the bottom level are “laypeople” from a medical point of view, who do not have a professional connection to (mental) healthcare. A comprehensive model of psychiatrization and any further analysis needs to incorporate these two main levels and the vectors of interaction in between (see, Figure 1). This structure may also serve as a scheme to help characterize single sub-processes of psychiatrization (93).

Processes of psychiatrization are increasingly relevant in the light of a fundamental reorientation of mental healthcare provision in many countries worldwide (e.g., through digitalization, further deinstitutionalization, and the scaling up of community care), which may coincide with ongoing profound political and social changes (e.g., due to economic crisis, climate change, globalization) (86, 118–121). The extent, and dynamics of psychiatrization processes largely depend on the economic situation of a region or country, the structure of its healthcare system or cultural influences. Given the magnitude of these factors, which all include a historical dimension that adds further complexity, a full assessment of context and origins remains a challenge for future research. Also, the effects of psychiatrization are diverse, highly ambivalent, and significantly influenced by the aforementioned local factors. Individuals or groups might well-benefit from aspects of psychiatrization, as the growing mental healthcare system can also increase accessibility and provision of services that are subjectively helpful and medically clearly indicated. Thus, it can be complicated for research to distinguish legitimate attempts to meet real unmet-needs from building up infrastructures which create artificial need or promote pathologization and overtreatment of mental distress, especially in areas with little specialized care for mental disorders.

However, further research about the nuances of psychiatrization is necessary. Besides significant regional differences in its causes and mechanisms, the role of mental health professionals other than psychiatrists or psychotherapists may be a crucial, widely unexplored aspect. Given the trend to the multidisciplinary treatment of mental distress in the Global North, professions such as occupational therapists, social workers, mental health nurses, or rehabilitation counselors deserve a special focus. They may be agents who play an important role in mediating between the top- and the bottom-level of psychiatrization (see, Figure 1). On the one hand, although they do not exert the power of psychiatric diagnosis themselves, they might benefit from psychiatric expansion and their professional (group) interests might be a reinforcing factor. On the other hand, their work may also contribute to preventing psychiatrization or to mitigate its effects, e.g., by avoiding hospitalization or by empowering people in mental distress to overcome crisis without consulting a psychiatrist or psychotherapist. In this context, it will also be an important research question how the growing involvement of mental health service-users as counselors or lay-therapists in psychiatric institutions relates to psychiatrization.

Advancing research on psychiatrization may be important, in the light of its obvious risks on the individual, societal and public health-level: First, on the individual level, negative consequences of psychiatrization may relate to overdiagnosis and overtreatment, e.g. medication adverse effects and harms from long term use (43, 122–128), but may also be about the impacts of labeling and of coercive treatments (129–131). Through pathologization of minor disturbances of well-being, individual variation and numerous life issues, psychiatrization can also co-produce avoidable patient careers, create dependencies on mental health services, and ultimately promote disempowering changes to subjectivity and sense of self (80, 132–134).

Second, on the societal level, psychiatrization may risk to further narrow the range of what is perceived as “normal,” encourage ineffective and short-term medical interventions, prompt individuals to cope with social problems and impede the finding of adequate long-term solutions (67, 134, 135). Such solutions would be situated rather in the realm of politics, where psychiatrization might otherwise be contributing to disguising failed policies.

Third, from a public health perspective, psychiatrization of society runs the risk of establishing widespread inverse care by increasingly neglecting the most severely and chronically ill, when mental health services are tailored to the needs of the mildly ill and borderline cases (18, 136, 137). Accordingly, the relative shortage of psychotherapists and long waiting times for out-patient services in some countries of the Global North may be a direct effect of structurally induced healthcare over-utilization by the “worried well” (138, 139).

Fourth, from a global perspective, psychiatrization could lead to excessive diagnosis and prescription of medication with little monitoring once people are medicated in countries with low and middle incomes, where psychiatrization is to a large degree exerted through task-sharing. In these countries this may also undermine local support systems and promote individualized interventions into poverty (67, 140). Worldwide, psychiatrization could contribute to challenging public health by misallocating scarce resources toward biomedical research and pharmacological treatment instead of strengthening psycho-social interventions (141, 142).