Psychiatry must be clear: most mental illness is not due to brain abnormality

As Huda recognises, critical psychiatry aims to improve practice. This acknowledgement may indicate that critical psychiatry has at least moved on from anti-psychiatry, which Martin Roth^{Reference Roth1} condemned as ‘anti-medical, anti-therapeutic, anti-institutional and anti-scientific’. Huda accuses critical psychiatry of not fully taking on board the evidence against some of its views. His critique is not dissimilar to Anthony Clare’s critique of anti-psychiatry^{Reference Clare2} or Awais Aftab’s promotion of integrative and critical pluralism as a variant of critical psychiatry.^{Reference Aftab3} The claim being made by Clare, Aftab and Huda is that mainstream psychiatry is not really as damned as critical psychiatry makes out. As I’ve often said – for instance, in 2022^{Reference Double4} – critical psychiatry seeks to move on from the reductionism and positivism of much of modern psychiatry. Similarly, I’ve often said that psychiatry needs to move on from a system based on a ‘disease’ model of primary mental illness. Despite Huda, I do think mainstream psychiatry is as damned as critical psychiatry makes out. Quite simply, most mental illness is not due to brain abnormality. This is not what most people hear from psychiatry and has consequences for their understanding and treatment of their mental health problems.