The article analyzes how cultural and social factors influence psychiatric disorders and how the concept of mental health is changing in modern society, with a focus on young people.
It builds on Foucault’s account of the historical link between ‘madness’, psychiatry, and the asylum, and asks how this story should be updated for the mid-20th century onward.
central idea: the “social imaginary” around mental health is shifting, reshaping concepts, discourse, and practices, and may relate to an apparent rise in mental health problems among the young.
Two key contributing strands are identified:
changes in representation and discourse about mental health
fractures in social solidarity interacting with socio-political-economic-environmental stressors (e.g., rising intergenerational wealth inequalities; accelerating climate concerns)
question addressed: is there a real increase in mental health problems among youth, or is the rise largely a reflection of changing representations and social conditions?
the article also emphasizes the biopsychosocial approach as essential for understanding population-level mental health trends.
Cultural influences: Foucault’s story to the mid-twentieth century
Well-established that culture and social determinants shape psychiatric disorders (urbanization, unemployment, overcrowding, lack of green spaces).
Culture determines what is considered normal/abnormal, potentially creating disorders through socially approved behaviors.
Foucault’s narrative: in the Middle Ages madness was interpreted through Christian notions of sin/redemption; during the Renaissance madness is depicted as excess passion and ambiguity about who is mad or who has expertise; the Enlightenment frames madness as deficit or absence of meaning, leading to social exclusion and management by mad-doctors in asylums, i.e., the birth of modern psychiatry.
Question posed: how should Foucault’s story be updated for post-mid-20th-century changes (e.g., decarceration, community care)?
The authors take Foucault’s idea of socio-cultural meaning of madness and examine its extension to the present, particularly how social spaces (space vs. place) and the social imaginary shape mental health concepts.
Apparent rise in mental health problems among the young
In the UK and other Western democracies, there has been substantial growth in demand for child and adolescent mental health services and rising prevalence of common mental health problems (anxiety, depression).
UK data (NHS Digital, 2018): steady rise in prevalence among 5–15-year-olds from 9.7% (1999) → 10.1% (2004) → 11.2% (2017). Emotional disorders rose from 4.3% (1999) → 3.9% (2004) → 5.8% (2017).
2017 surveillance shows prevalence increases with age: from 5.5% among 2–4-year-olds to 16.9% among 17–19-year-olds; emotional disorders are the most common category overall.
Important caveats:
increases are hard to attribute to a single cause; best evidence is descriptive epidemiology (What/Who/Where/When) with limited causal inference (Why).
breakthroughs in genetics/neuroscience do not yet explain population-level prevalence or service demand without considering environmental interactions with the brain and gene expression.
A broad biopsychosocial perspective is recommended to understand causes and mechanisms.
Changes in representations of mental health problems
The authors organize shifts into four areas: Terminology, Prevalence, Case definition, and Expertise.
Terminology: What should we call it?
The field has experienced a terminological struggle aimed at reducing discrimination, stigma, and social exclusion.
From the 1960s onward, terms shifted from “mental illness” to “mental disorder” in ICD/DSM; distinctions emerged between “serious mental illness” and “common mental health problems.”
The term “mental disorder” remains in ICD/DSM, though both acknowledge terminology challenges.
Today, “mental health problems” is common in everyday language; in some non-health contexts, “distress” is more frequently used.
In practice, young people in London may describe themselves as experiencing “mental health” problems, without the older qualifier like “disorder.”
Implication: language reflects shifting boundaries between “madness” and “us,” affecting stigma, policy, and service access.
Prevalence: How much of it is there?
Debates exist about how high prevalence estimates should be, and whether overdiagnosis or overprescribing is occurring.
The public and professional discourse splits the population into a perceived dangerous minority (over there) and the majority (us). The possibility that a large portion of the population has mental health problems challenges traditional boundaries.
Debate context: balancing concern over overdiagnosis/overmedication with the need for parity with physical health services (parity of esteem).
Illustrative concerns: skepticism about large lifetime prevalence estimates (e.g., “are we all nuts?”) reflects stigma and political sensitivity.
Case definition: What is it?
DSM/ICD work provides symptom lists and syndromes; however, definition of mental disorder is theoretical and has practical consequences for access to treatment.
The Diagnostic Manuals standardize syndromes but do not by themselves define “mental disorder.”
A key conceptual point: distress and impairment are central to defining a case; distress is intrinsic to common problems like anxiety/depression and impairment determines when help is sought and when something is regarded as clinically significant.
Thresholds of distress and impairment (clinical significance) influence prevalence estimates and clinic attendance.
Conceptual formula (illustrative):
extCaseness=1extifD≥D<em>c and I≥I</em>c; otherwise 0,
where $D$ = distress, $I$ = impairment, and $Dc$, $Ic$ are clinical cutoffs.
Expertise: Who can help?
Foucault’s mid-20th-century narrative placed psychiatrists as “mad-doctors” overseeing madness elsewhere (the asylum).
Freud’s influence introduced a counter-movement emphasizing listening to madness, leading to a broader array of therapies.
Since then, there has been diversification of professionals and modalities: psychotherapy, counselling, online therapies, self-help apps.
The modern landscape features multiple sources of expertise and care settings, with growing emphasis on access and patient-centered care.
Distinguishing real vs. apparent rate rises
In infectious disease epidemiology, real rises can be confirmed by laboratory tests; apparent rises may reflect better detection, access to services, or help-seeking.
For mental health, there is no simple laboratory test, so distinguishing real prevalence increases from apparent ones relies on careful interpretation of self-reports, service data, and contextual factors.
The authors argue that changes in social representations, help-seeking behavior, and diagnostic practices can produce apparent rises, while real and/or meaningful increases in distress may also occur in relation to social changes.
Socio-technological changes
The scope of tech use—especially social media—has accelerated dramatically and may shape well-being in youth.
Orben (2020) reviews multiple syntheses and finds: evidence is methodologically limited, effects may be small, causality direction is unclear, and individual differences matter.
Internet gaming disorder is cited as an example of a new psychiatric presentation possibly linked to sociotechnological shifts.
Sociocultural group fractures, anomie, post-truth
Social cohesion is theorized as a protective factor against stress; Durkheim’s concept of anomie describes breakdowns in social regulation and the experience of excessive freedom or uncertainty, contributing to anxiety/depression risk.
The last few decades feature fractures in social solidarity—cultural conflicts (culture wars), post-truth politics, and epistemic instability in public discourse.
The authors discuss: how youths navigate competing claims about truth, facts, and normative beliefs in a landscape of rapid information exchange and political polarization, often amplified by social media.
Hypotheses for youth: growing up in a world with contested beliefs about what to trust, what will happen, and how to plan for the future can be stressful and destabilizing.
Durkheim’s anomie is framed as occurring during substantial social changes or economic cycles; today, the authors link it to epistemic norms and a broader “post-truth” environment.
Specific stress factors affecting the young
The authors focus on two social stressors that may contribute to rising anxiety and depression among youth, while acknowledging other factors (e.g., substance use) exist but are outside the scope here.
Increasing intergenerational wealth inequalities
Economic hardship is linked to health through chronic stress and perceived lack of control, contributing to health inequalities (Marmot; WHO).
Economic downturns can negatively impact population mental health; the 2008 financial crisis had documented effects, with parents’ difficulties affecting children’s mental health and risk of negative experiences.
In the UK, young people anticipate less stability in housing, employment, and finances relative to their parents, which may elevate distress and anxiety about the future.
Mechanisms include parental transmission of worry and societal messages about downward mobility.
UK 2017 data (NHS Digital, 2018) illustrate income-based disparities and group differences:
overall rate of mental disorder in 5–19-year-olds: 4.1% (lowest) to 9.0% (second highest) with a peak at the 9.7% category and a slight drop to 9.0% in the top quintile;
broader pattern shows the sharpest increase between the top two income levels: 4.1%,6.3%,8.3%,9.7%,9.0% across quintiles (1=lowest, 5=highest) (NHS Digital, 2018).
Ethnic group variation observed in UK data (2017): White British ~14.9% vs Black/Black British 5.6% and Asian/Asian British 5.2%, suggesting differential exposure or resilience patterns across groups.
Hypothesized pathways: wealth gaps provoke downward or upward expectations among youth; the highest-resource families may preserve status, while others face rising insecurity; the resulting anxiety about future resources and opportunities can contribute to distress.
The section emphasizes that the pattern may reflect both real distress and altered reporting, help-seeking, and diagnosis in the context of social inequality.
Climate change and other concerns
Geopolitical determinants shape mental health risk; a global survey of Generation Z (Amnesty International, Ipsos MORI, 2019) asked youth to choose up to five top issues from a list of 23.
Global priorities: climate change cited by 41%; pollution by 36%; terrorism by 31%; climate change ranked fifth in national concerns (e.g., corruption, pollution, economic instability, income inequality featured higher in some contexts).
The finding underscores that young people perceive climate change as a defining contemporary challenge, which may contribute to psychological distress, eco-anxiety, and a sense of threat about the future.
Conclusions
Since the mid-20th century, mental health concepts have shifted from a sharp boundary between madness and ordinary life (asylums) to a more porous, “mental health problems” within the social fabric.