A name, a label

That should help. Give something to hold on to. Provide an explanation. But what if that same label then locks you into a system that mainly thinks in terms of being ill, fighting symptoms and normalising functioning?

The present mental health system is built on a foundation in which the disease model is central: mental distress is seen primarily as a disorder, a defect in the brain, a treatable condition. And understand me well: that model has its value. It is not wrong to want to relieve distress. And it is logical that professionals look for explanations that offer something to hold on to and that are measurable. But what if that model has become too dominant? What if it starts to hinder instead of help?

From ‘treatment’ to guidance in living

There are by now enough indications that people with severe mental health problems often do not get better from the disease model, but more ill. Not necessarily through ill will or wrong treatments, but simply because the model is too limited. It focuses on symptoms, is directed at risk management, and meanwhile forgets something essential: life itself. The model says: first you have to be cured before you can live. Whereas people often recover precisely by being allowed to live again, with ups and downs, with their sensitivities and talents, not in spite of them.

Think of models such as salutogenesis (focused on what promotes health, not what causes illness), risk reduction (tackling the context that makes you ill, or really taking your lifestyle seriously), developing resilience, making meaning, spirituality. These are the basic conditions for recovery, not soft side issues. Those models start from the question ‘what do you need in order to live, in your own way?’ and not from ‘what is wrong with you?’

A different voice: expertise by experience

And then there is the movement of experts by experience, for forty years an alternative voice within mental health care. People who have been through deep valleys themselves and who, instead of sticking a label on that, say: I have had to learn to live with my vulnerability. And you can learn that too. By discovering step by step who you are, what affects you and what works for you, and not by fighting symptoms.

They see mental distress as a kind of existential lesson, a radical question about life, and not as a defect. And that makes it a learning model. The question becomes ‘how do I shape my life with what I have been through?’ in place of ‘how do I become normal again?’ That is fundamentally different from the common idea that recovery equals being ‘symptom-free’.

The neoliberal trap: being ill as the only escape

There is something else. Our society is becoming more and more measurable, more engineered, more driven by performance. You have to recover quickly, work again, perform, be happy. And if that does not work? Then being ill is sometimes the only accepted reason left for not having to take part. But that also makes being ill a social survival mechanism. And then it suddenly becomes tricky: we help people to ‘function again’, while the question may be much more fundamental: do I actually want to function in a system that is destroying me?

PsychosisNet: tilting, not rejecting

Let us be clear: the disease model does not have to go. Diagnoses can be helpful, treatments can save lives. But they must serve the person, not the other way round. A diagnosis should be a temporary aid and should not become someone’s identity. Treatment should follow what someone needs in order to get a grip on their life again, and should not steer it.

At PsychosisNet we start from mental variation, neurodiversity, and the fundamental right to walk your own path. We assist people in living, not in ‘normalising’. Diagnosis and treatment are welcome, but always in a serving role, as a means and not as an end. Because every person is more than their DSM code. And because mental distress may well be the most difficult, but also the most human thing there is.

Jim van Os

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

Want to read more?

Blogs by Jim van Os can be read here

Did you know that PsychosisNet regularly posts new content?

Online tests 
Compare antidepressants tool
Compare antipsychotics tool
Podcasts
Books