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Sam Thompson on the Diagnosis Debate

On the future of mental health

Eric Maisel
Source: Eric Maisel

The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.


Interview with Sam Thompson

EM: You used to work in a “think tank.” Can you tell us a little bit about what a “think tank” is and specifically how think tanks can help us “shift the paradigm” with respect to the current, dominant paradigm of “diagnosing and treating mental disorders”?

ST: These days I spend most of my time as a clinical psychologist in the NHS, but for a number of years I worked in academia and in the policy world, mostly for nef (the new economics foundation).

“Think tanks” come in many different shapes, sizes and political persuasions! At their best they can bridge the gap between academia and policy. Academics too often assume that once they’ve published their research in a journal, that dissemination is taken care of. Meanwhile, policy-makers often work under multiple, competing pressures and don’t have time to trawl academic journals looking for evidence. Thinks tanks can play a useful role in drawing out key messages from the academic literature, making arguments publicly and therefore – to some extent – influencing the terms of debate.

At nef, colleagues and I tried to connect social and economic policy with findings from positive psychology about what makes life go well. In the UK, at least, I think we had a hand in helping to broaden understanding of mental health away from just a focus on disorder. For instance, the UK has led the way in developing measures of national wellbeing, something that we had argued for extensively.

EM: You’ve written about the “diagnosis debate.” Do you have any thoughts about “alternatives to diagnosis” and what might improve upon or replace the current DSM/ICD model?

ST: My views on the DSM/ICD model have been strongly shaped by my practice as a clinician. Put simply, I’m yet to come across a clinical situation where a psychiatric diagnosis has helped me understand what’s going on, or what to do about it.

As a psychologist I focus on formulation – that is, collaborating with clients to work out what causes and maintains their problems. In my experience, a thoughtful and lightly-held (in the sense of being flexible and open to revision) formulation renders diagnosis completely unnecessary. Indeed, I work mostly with children and families whose needs are complex; in this context a diagnosis can be actively unhelpful because it locates the “problem” so firmly within one individual (usually the child), shutting down alternative avenues for exploration.

That said, I try to meet people where they are. Some people find medical explanations helpful, and if that’s the case I don’t see it as my role to argue them out of identifying with the diagnoses that they have been given by others. But I always hope to create space for multiple ways of understanding problems.

EM: If you could wave your magic wand, what would you like to see changed with respect to the current UK mental health care system?

ST: The National Health Service is unique in the world and is a source of great pride for many people in the UK. Historically, however, NHS mental health services have been poorly funded compared to their physical health counterparts. In recent years there has been growing recognition of the social and economic costs of mental distress and calls for a renewed focus on mental health, but true parity is still a long way off.

Whilst more funding would help, ultimately I would like to see greater emphasis on primary prevention. We actually know a good deal about how to reduce the incidence of mental health problems: providing early years parenting support, increasing opportunities for secure employment, tackling discrimination and stigma, reducing personal debt, reducing isolation of the elderly, and so on and so on. The difficulty is that intervening in most of these areas is not within the remit of mental health practitioners!

So, I would like to see psychologists and other mental health professionals become more politically engaged. Recently, for instance, I’ve been involved with Psychologists Against Austerity, a group of psychologist and therapists who are concerned about the mental health impact of recent social and economic policy in the UK. We've had some success in putting mental health onto the political agenda.

EM: You have a background in music and a love of music. Do you have the sense that music can perhaps “heal” emotional and mental distress?

ST: I read music as a first degree but (fortunately, with hindsight) realised pretty quickly that I wasn’t going to be good enough to make a career playing, and so I got stuck into the academic side. In fact, that was my route to psychology! I took a couple of courses with Professor Ian Cross and got interested in how we listen and make judgements about what we hear, and ultimately went on to write a PhD on the psychology of performance evaluation.

I haven’t been involved with music professionally for a decade or more, but I still play regularly and find making music with others incredibly energising. On the other hand, when I need comfort and space there’s nothing better than a few hours alone with my guitar (hand-made for me by the wonderful Brook Guitars). So music certainly has a big part in managing my emotional distress! Whether there is anything special about engaging with music compared to, say, art, or poetry, or dance, I’m not so sure. From a psychological perspective, I suspect the common ingredients have to do with active participation, sharing experiences, and gaining a sense of mastery.

EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?

ST: There’s a role for therapy and medication, but I think the foundations of good mental health are more basic and everyday. Years ago, colleagues and I were asked to contribute to the government’s Foresight Project on a Mental Capital and Wellbeing. This “horizon-scanning” exercise reviewed research on mental health and wellbeing to make predictions about the challenges facing the UK over the next 50 years. We took the academic reviews and developed some simple, evidence-based messages about how to stay mentally well, the Five Ways to Wellbeing: Connect, Be active, Take notice, Keep Learning, and Give.

In the West we often tend to think of mental health as something that happens inside people’s heads. What I like about the Five Ways is that they invite action in the world, rather than retreating into introspection. If a loved one was struggling, I’d encourage them to look at the Five Ways and be curious as to what they could do differently in their lives day-to-day, not just how they could think differently.


Sam Thompson is a clinical psychologist in a specialist child and family service at the Tavistock Centre in London. As an academic and policy analyst, Sam has published on public mental health, wellbeing and critical approaches to psychology.


Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at, visit him at, and learn more about the future of mental health movement at

To learn more about and/or to purchase The Future of Mental Health visit here

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