Mental health is increasingly at the center of public debate, but with growing attention come new questions. Where is the line between the normal challenges of life and a mental disorder? Why are more and more people losing trust in psychiatry? And what does true recovery really mean? Professor Helene Speyer, a Danish psychiatrist, researcher, and lecturer at the University of Copenhagen, speaks to FAKTI.
- Professor Speyer, in recent years we have witnessed a sharp increase in ADHD (Attention-Deficit/Hyperactivity Disorder) diagnoses among adults. Is this primarily the result of better diagnostic practices, or are we now facing a risk of overdiagnosis?
- Both, and I'd resist being forced to choose. Historically, ADHD, especially in women, was a case of real symptoms dismissed or misread for decades. Correcting that was necessary. But a diagnostic category doesn't distinguish between a genuine neurodevelopmental difference and a nervous system under chronic strain from precarious work, poor sleep, and an attention economy built to fragment focus. My concern isn't that too many people are being diagnosed. It's that we've built one funnel for structurally different problems.
- In your research, you argue that contemporary society places increasingly high demands on individuals. To what extent is psychiatry beginning to turn normal human struggles and difficulties into medical diagnoses?
- In our paper on negative capability and psychiatry's credibility crisis, we trace this to a specific mechanism: a vicious cycle of certainty, where psychiatry's desire to be seen as a "real" medical discipline, the public's appetite for clear answers, and industry incentives all reinforce overconfident etiological narratives. Diagnosis becomes the currency the whole system rewards. Breaking that cycle, as we argue there, means reintroducing uncertainty as a foundational premise and cultivating negative capability — comfort with ambiguity and doubt — both individually and at the level of the field.
- Mental health is being discussed more and more frequently on social media. Does this help reduce stigma, or does it create a new culture of self-diagnosis?
- Both, and they're not really in tension. Visibility has done something decades of stigma campaigns didn't: given people language for experiences they'd otherwise have carried in silence. But that same visibility rewards simple, confident narratives, which is the identical dynamic we describe in the credibility crisis paper — just moved from institutional psychiatry onto a platform optimized for engagement rather than accuracy. Self-diagnosis online is often less a failure of judgment than a hermeneutic gap made visible: people reaching for interpretive resources the clinical encounter never gave them.
- You recently participated in a forum in Sofia, where you raised concerns about institutional injustice in mental healthcare. Where do systems most often fail — in diagnosis, treatment, or the way patients are treated?
- Psychiatry runs on a basic division: the clinician is the one who knows, and the patient is the one who gets known — diagnosed, assessed, interpreted. That division isn't a side effect. It's the load-bearing structure the whole system is organized around: how training works, how legal decisions get made, how records get written, whose account of events counts as evidence.
That's why it's fair to call it epistemic injustice, not just bad bedside manner. Epistemic means it's about who gets treated as a credible source of knowledge. Once someone has a psychiatric diagnosis, their own account of their experience can get quietly discounted — not maliciously, just automatically, because the system is built to treat the clinician's interpretation as more reliable than the patient's own words. A patient saying "I want to stop this medication, it's not me anymore" can get filed away as a symptom rather than heard as a decision.
The key point: a clinician doing this isn't breaking the rules. They're following them. The system doesn't just permit this imbalance, it depends on it to function the way it currently does — diagnosis, treatment planning, legal authority to override a patient's wishes, all of it assumes the clinician's knowledge outranks the patient's. So the injustice isn't a flaw in the system. It's the system's design.
That's also why reforms that just add "more patient voice" on top rarely change anything. They don't touch the underlying rule about whose knowledge counts more. The imbalance stays exactly where it was.
- Many young people today describe anxiety and depression as the "epidemic of their generation." Are mental health problems genuinely becoming more widespread, or is society simply speaking more openly about them?
- Probably both. I'd apply the same lens as the credibility crisis paper: "epidemic" is a certainty-generating word, and certainty is exactly what psychiatry and the public both reach for prematurely. Something in young people's material conditions is very plausibly generating more real distress. But naming it an epidemic imports the logic of infectious disease onto something that spreads through meaning and comparison, not pathogens, and that borrowed urgency can push us toward quick-fix responses rather than sitting with the ambiguity of what's actually happening.
- Artificial intelligence is playing an increasingly important role in medicine. Could AI one day become better than human specialists at identifying mental disorders, and where do the risks lie?
- At pattern recognition on structured data, plausibly. But recovery, the goal of care, isn't only about accurately classifying a disorder. It's about a relationship in which a person's own account of a meaningful life is taken seriously as data, not just symptoms mapped onto a category.
- Why do modern societies appear to be becoming increasingly intolerant of differing opinions, including within medicine and mental healthcare?
- In our recent paper in lancet Psychiatry, on Embracing Dissensus in lived experience research, we wrote that research has too often assumed consensus is the goal, treating disagreement as noise to be resolved rather than data in its own right. I'd extend that claim to psychiatry generally: fields under pressure to look authoritative tend to treat disagreement as something to eliminate rather than something to learn from. Genuine pluralism requires tolerating conflicting accounts without rushing to flatten them into one official narrative, and that's professionally uncomfortable in a field that wants to be taken seriously as science.
- The concept of "recovery" has become one of the leading ideas in modern psychiatry. What does genuine recovery actually mean — the disappearance of symptoms, or the ability to live a fulfilling life despite them?
- This is the central question of our paper with Roe and Slade, "Recovery-oriented psychiatry: oxymoron or catalyst for change?" Recovery is not the disappearance of symptoms. Psychiatry remains rooted in a medical paradigm oriented toward symptom remission, while the recovery movement began as a grassroots social justice movement centered on empowerment and systemic change. We argued these two traditions have real tensions in their values, ontologies, and epistemologies, and that superficial or tokenistic adoption of recovery language, without confronting that tension, does more harm than good. Genuine recovery means building a life you find meaningful, which may or may not coincide with symptom remission, and pretending otherwise is what makes "recovery-oriented psychiatry" sound like an oxymoron in the first place.
- In Eastern Europe, there is still considerable mistrust toward psychiatric care. How do you explain this phenomenon?
- Rising mistrust in psychiatry isn't confined to Eastern Europe — it's showing up from very different directions at once, and that convergence itself is telling.
On one side, movements like MAHA in the US frame psychiatric diagnosis and medication as overreach: too many people medicated, too much trust placed in institutions that don't deserve it. On another side, survivor and service-user movements have been making almost the opposite-sounding complaint for fifty years: that psychiatry doesn't listen enough, that people's own accounts of their experience get overridden by clinical authority. These two critiques often get lumped together as "anti-psychiatry" and dismissed together, but they're not the same thing, and treating them as interchangeable is itself part of the problem.
What they share, underneath the different politics, is the same root complaint: a system that doesn't feel like it's listening. Whether someone is angry that they were medicated against their instincts, or angry that their diagnosis was never questioned, or angry that alternative approaches get no hearing — all of these are, in different ways, epistemic complaints. They're about who gets to be believed.
I wrote about this in a recent paper "Seeking Common Ground: Shared Principles Between Psychiatry and Its Critics". Psychiatry and its critics routinely accuse each other of being unscientific, and that this accusation itself is often what shuts down the conversation before it starts.
That's why listening matters here in a very specific way. Not listening as a nice bedside manner, but listening as the actual mechanism that could reduce the mistrust itself. If mistrust grows because people on all sides feel dismissed rather than argued with, then the fix isn't better arguments. It's making space for disagreement to be spoken plainly, rather than pretending it isn't there or shouting it down as anti-science. A psychiatry that could hold that kind of open disagreement, instead of needing to defeat it, would likely be trusted by more people — not because it changed its mind, but because it stopped needing everyone to agree with it before it would listen.
- If you had to identify the greatest challenge facing mental health in the years ahead, what would it be — technology, social isolation, political polarization, or something else entirely?
- I believe the biggest problem we're facing isn't a disorder to be treated — it's social isolation. And I don't think we can fix it the way psychiatry fixes most things: with more evidence-based interventions, more trials, more ways to include people through medical means.
As I wrote in World Psychiatry, social inclusion is a complex problem, not a treatable symptom. It emerges from how a whole society is organized — housing, work, community — not from a single intervention we can isolate and test. You can't run a randomized trial on belonging.
That's also the argument Jim van Os and I made in Lancet Psychiatry: engaging in life is inherently valuable. A choir, a job, a neighbor who checks in — these don't need to prove they "work" before they count as care. We don't ask people without a diagnosis to justify their friendships with data. We shouldn't ask it of people with one either.
So I think the real task isn't more medicine. It's being brave enough to organize our societies inclusively, and to stop demanding proof for things that are simply good for a human life.
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About Dr. Helene Speyer
Dr. Helene Speyer is a Danish psychiatrist, researcher, and lecturer at the University of Copenhagen. She serves as a Senior Researcher at the Copenhagen Psychiatric Center, where her work focuses on mental illness, patient recovery, and the safe reduction of psychiatric medications.
Education
Doctor of Medicine (MD) – University of Copenhagen, 2008.
PhD in Psychiatry – University of Copenhagen, 2017, with research focusing on psychiatry and mental health.
Academic and Professional Career
Senior Researcher at the Copenhagen Psychiatric Center (since 2022).
Senior Researcher at the Recovery Center within the Mental Health Services of the Capital Region of Denmark.
Associate Professor in the Department of Clinical Medicine at the University of Copenhagen (since 2023).
Visiting Researcher at the Harvard T.H. Chan School of Public Health (2025).
Practicing psychiatrist with extensive clinical experience in the treatment of mental disorders.
Research Activities
Dr. Speyer is the author and co-author of dozens of scientific publications in leading international journals, including: World Psychiatry, JAMA Psychiatry, The Lancet Psychiatry, Psychiatric Services, Psychological Medicine.
She is recognized as one of Europe's leading researchers advocating for a more humane, evidence-based, and patient-centered approach to modern psychiatry, with a strong emphasis on patients' rights and recovery-oriented care.