What is Sanism (or Mentalism)?


Mentalism or sanism describes discrimination and oppression against a mental trait or condition a person has, or is judged to have.

This discrimination may or may not be characterised in terms of mental disorder or cognitive impairment. The discrimination is based on numerous factors such as stereotypes about neurodivergence, for example autism, learning disorders, attention deficit hyperactivity disorder (ADHD), foetal alcohol spectrum disorders (FASD), bipolar disorder, schizophrenia, and personality disorders, specific behavioural phenomena such as stuttering and tics, or intellectual disability.

Like other forms of discrimination such as sexism and racism, mentalism involves multiple intersecting forms of oppression, complex social inequalities and imbalances of power. It can result in covert discrimination by multiple, small insults and indignities. It is characterised by judgements of another person’s perceived mental health status. These judgments are followed by actions such as blatant, overt discrimination which may include refusal of service, or the denial of human rights. Mentalism impacts how individuals are treated by the general public, by mental health professionals, and by institutions, including the legal system. The negative attitudes involved may also be internalised.

The terms mentalism, from “mental”, and sanism, from “sane”, have become established in some contexts, though concepts such as social stigma, and in some cases ableism, may be used in similar but not identical ways.

While mentalism and sanism are used interchangeably, sanism is becoming predominant in certain circles, such as academics, those who identify as mad and mad advocates and in a socio-political context where sanism is gaining ground as a movement. The movement of sanism is an act of resistance among those who identify as mad, consumer survivors, and mental health advocates. In academia evidence of this movement can be found in the number of recent publications about sanism and social work practice.

Mentalism tends to be referred as mental disability, distinguishing itself from ableism, which refers to physical disability.


The term “sanism” was coined by Morton Birnbaum during his work representing Edward Stephens, a mental health patient, in a legal case in the 1960s. Birnbaum was a physician, lawyer and mental health advocate who helped establish a constitutional right to treatment for psychiatric patients along with safeguards against involuntary commitment. Since first noticing the term in 1980, New York legal professor Michael L. Perlin subsequently continued its use.

In 1975 Judi Chamberlain coined the term mentalism in a book chapter of Women Look at Psychiatry. The term became more widely known when she used it in 1978 in her book On Our Own: Patient Controlled Alternatives to the Mental Health System, which for some time became the standard text of the psychiatric survivor movement in the US. People began to recognise a pattern in how they were treated, a set of assumptions which most people seemed to hold about mental (ex)patients regardless of whether they applied to any particular individual at any particular time – that they were incompetent, unable to do things for themselves, constantly in need of supervision and assistance, unpredictable, likely to be violent or irrational etc. It was realised that not only did the general public express mentalist ideas, so did ex-patients, a form of internalised oppression.

As of 1998 these terms have been adopted by some consumers/survivors in the UK and the US, but had not gained general currency. This left a conceptual gap filled in part by the concept of ‘stigma’, but this has been criticised for focusing less on institutionalised discrimination with multiple causes, but on whether people perceive mental health issues as shameful or worse than they are. Despite its use, a body of literature demonstrated widespread discrimination across many spheres of life, including employment, parental rights, housing, immigration, insurance, health care and access to justice. However, the use of new “isms” has also been questioned on the grounds that they can be perceived as divisive, out of date, or a form of undue political correctness. The same criticisms, in this view, may not apply so much to broader and more accepted terms like ‘discrimination’ or ‘social exclusion’.

There is also the umbrella term ableism, referring to discrimination against those who are (perceived as) disabled. In terms of the brain, there is the movement for the recognition of neurodiversity. The term ‘psychophobia’ (from psyche and phobia) has occasionally been used with a similar meaning.

Social Division

According to Coni Kalinowski (a psychiatrist at the University of Nevada and Director of Mojave Community Services) and Pat Risser (a mental health consultant and self-described former recipient of mental health services), mentalism at one extreme can lead to a categorical dividing of people into an empowered group assumed to be normal, healthy, reliable, and capable, and a powerless group assumed to be sick, disabled, crazy, unpredictable, and violent. This divide can justify inconsiderate treatment of the latter group and expectations of poorer standards of living for them, for which they may be expected to express gratitude. Further discrimination may involve labelling some as “high functioning” and some as “low-functioning”; while this may enable the targeting of resources, in both categories human behaviours are recast in pathological terms.

The discrimination can be so fundamental and unquestioned that it can stop people truly empathising (although they may think they are) or genuinely seeing the other point of view with respect. Some mental conditions can impair awareness and understanding in certain ways at certain times, but mentalist assumptions may lead others to erroneously believe that they necessarily understand the person’s situation and needs better than they do themselves.

Reportedly even within the disability rights movement internationally, “there is a lot of sanism”, and “disability organisations don’t always ‘get’ mental health and don’t want to be seen as mentally defective.” Conversely, those coming from the mental health side may not view such conditions as disabilities in the same way.

Some national government-funded charities view the issue as primarily a matter of stigmatising attitudes within the general public, perhaps due to people not having enough contact with those (diagnosed with) mental illness, and one head of a schizophrenia charity has compared mentalism to the way racism may be more prevalent when people do not spend time together throughout life. A psychologist who runs The Living Museum facilitating current or former psychiatric patients to exhibit artwork, has referred to the attitude of the general public as psychophobia.

Clinical Terminology

Mentalism may be codified in clinical terminology in subtle ways, including in the basic diagnostic categories used by psychiatry (as in the DSM or ICD). There is some ongoing debate as to which terms and criteria may communicate contempt or inferiority, rather than facilitate real understanding of people and their issues.

Some oppose the entire process as labelling and some have responded to justifications for it – for example that it is necessary for clinical or administrative purposes – as the way a person may justify the use of ethnic slurs because they intend no harm. Others argue that most aspects could easily be expressed in a more accurate and less offensive manner.

Some clinical terms may be used far beyond the usual narrowly defined meanings, in a way that can obscure the regular human and social context of people’s experiences. For example, having a bad time may be assumed to be decompensation; incarceration or solitary confinement may be described as treatment regardless of benefit to the person; regular activities like listening to music, engaging in exercise or sporting activities, or being in a particular physical or social environment (milieu), may be referred to as therapy; all sorts of responses and behaviours may be assumed to be symptoms; core adverse effects of drugs may be termed side effects.

The former director of a US-based psychiatric survivors organization focused on rights and freedoms, David Oaks, has advocated the taking back of words like “mad”, “lunatic”, “crazy” or “bonkers”. While acknowledging that some choose not to use such words in any sense, he questions whether medical terms like “mentally ill”, “psychotic” or “clinically depressed” really are more helpful or indicative of seriousness than possible alternatives. Oaks says that for decades he has been exploring the depths of sanism and has not yet found an end, and suggests it may be the most pernicious ‘ism’ because people tend to define themselves by their rationality and their core feelings. One possible response is to critique conceptions of normality and the problems associated with normative functioning around the world, although in some ways that could also potentially constitute a form of mentalism. After his 2012 accident breaking his neck and subsequent retirement, Oaks refers to himself as “PsychoQuad” on his personal blog.

British writer Clare Allen argues that even reclaimed slang terms such as “mad” are just not accurate. In addition, she sees the commonplace mis-use of concepts relating to mental health problems – including for example jokes about people hearing voices as if that automatically undermines their credibility – as equivalent to racist or sexist phrases that would be considered obviously discriminatory. She characterises such usage as indicating an underlying psychophobia and contempt.


Interpretations of behaviours, and applications of treatments, may be done in an judgmental way because of an underlying mentalism, according to critics of psychiatry. If a recipient of mental health services disagrees with treatment or diagnosis, or does not change, they may be labelled as non-compliant, uncooperative, or treatment-resistant. This is despite the fact that the issue may be healthcare provider’s inadequate understanding of the person or their problems, adverse medication effects, a poor match between the treatment and the person, stigma associated with the treatment, difficulty with access, cultural unacceptability, or many other issues.

Mentalism may lead people to assume that someone is not aware of what they are doing and that there is no point trying to communicate with them, despite the fact that they may well have a level of awareness and desire to connect even if they are acting in a seemingly irrational or self-harming way. In addition, mental health professionals and others may tend to equate subduing a person with treatment; a quiet client who causes no community disturbance may be deemed improved no matter how miserable or incapacitated that person may feel as a result.

Clinicians may blame clients for not being sufficiently motivated to work on treatment goals or recovery, and as acting out when things are not agreed with or are found upsetting. But critics say that in the majority of cases this is actually due to the client having been treated in a disrespectful, judgmental, or dismissive manner. Nevertheless, such behaviour may be justified by characterising the client as demanding, angry or needing limits. To overcome this, it has been suggested that power-sharing should be cultivated and that when respectful communication breaks down, the first thing that needs to be asked is whether mentalist prejudices have been expressed.


Mentalism has been linked to negligence in monitoring for adverse effects of medications (or other interventions), or to viewing such effects as more acceptable than they would be for others. This has been compared to instances of maltreatment based on racism. Mentalism has also been linked to neglect in failing to check for, or fully respect, people’s past experiences of abuse or other trauma.

Treatments that do not support choice and self-determination may cause people to re-experience the helplessness, pain, despair, and rage that accompanied the trauma, and yet attempts to cope with this may be labelled as acting out, manipulation, or attention-seeking.

In addition, mentalism can lead to “poor” or “guarded” predictions of the future for a person, which could be an overly pessimistic view skewed by a narrow clinical experience. It could also be made impervious to contrary evidence because those who succeed can be discounted as having been misdiagnosed or as not having a genuine form of a disorder – the no true Scotsman fallacy. While some mental health problems can involve very substantial disability and can be very difficult to overcome in society, predictions based on prejudice and stereotypes can be self-fulfilling because individuals pick up on a message that they have no real hope, and realistic hope is said to be a key foundation of recovery. At the same time, a trait or condition might be considered more a form of individual difference that society needs to include and adapt to, in which case a mentalist attitude might be associated with assumptions and prejudices about what constitutes normal society and who is deserving of adaptations, support, or consideration.

Institutional Discrimination

Offensive and injurious practices may be integrated into clinical procedures, to the point where professionals no longer recognise them as such, in what has been described as a form of institutional discrimination.

This may be apparent in physical separation, including separate facilities or accommodation, or in lower standards for some than others. Mental health professionals may find themselves drawn into systems based on bureaucratic and financial imperatives and social control, resulting in alienation from their original values, disappointment in “the system”, and adoption of the cynical, mentalist beliefs that may pervade an organisation. However, just as employees can be dismissed for disparaging sexual or ethnic remarks, it is argued that staff who are entrenched in negative stereotypes, attitudes, and beliefs about those labelled with mental disorders need to be removed from service organisations. A related theoretical approach, known as expressed emotion, has also focused on negative interpersonal dynamics relating to care givers, especially within families. However, the point is also made in such views that institutional and group environments can be challenging from all sides, and that clear boundaries and rights are required for everyone.

The mental health professions have themselves been criticised. While social work (also known as clinical social work) has appeared to have more potential than others to understand and assist those using services, and has talked a lot academically about anti-oppressive practice intended to support people facing various -isms, it has allegedly failed to address mentalism to any significant degree. The field has been accused, by social work professionals with experience of using services themselves, of failing to help people identify and address what is oppressing them; of unduly deferring to psychiatric or biomedical conventions particularly in regard to those deemed most unwell; and of failing to address its own discriminatory practices, including its conflicts of interest in its official role aiding the social control of patients through involuntary commitment.

In the “user/survivor” movement in England, Pete Shaughnessy, a founder of mad pride, concluded that the National Health Service is “institutionally mentalist and has a lot of soul searching to do in the new Millennium”, including addressing the prejudice of its office staff. He suggested that when prejudice is applied by the very professionals who aspire to eradicate it, it raises the question of whether it will ever be eradicated.[25] Shaughnessy committed suicide in 2002.

The psychiatric survivors movement has been described as a feminist issue, because the problems it addresses are “important for all women because mentalism acts as a threat to all women” and “mentalism threatens women’s families and children.” A psychiatric survivor and professional has said that “Mentalism parallels sexism and racism in creating an oppressed underclass, in this case of people who have received psychiatric diagnosis and treatment”. She reported that the most frequent complaint of psychiatric patients is that nobody listens, or only selectively in the course of trying to make a diagnosis.

On a society-wide level, mentalism has been linked to people being kept in poverty as second class citizens; to employment discrimination keeping people living on handouts; to interpersonal discrimination hindering relationships; to stereotypes promoted through the media spreading fears of unpredictability and dangerousness; and to people fearing to disclose or talk about their experiences.


With regard to legal protections against discrimination, mentalism may only be covered under general frameworks such as the disability discrimination acts that are in force in some countries, and which require a person to say that they have a disability and to prove that they meet the criteria.

In terms of the legal system itself, the law is traditionally based on technical definitions of sanity and insanity, and so the term “sanism” may be used in response. The concept is well known in the US legal community, being referred to in nearly 300 law review articles between 1992 and 2013, though is less well known in the medical community.

Michael Perlin, Professor of Law at New York Law School, has defined sanism as “an irrational prejudice of the same quality and character as other irrational prejudices that cause and are reflected in prevailing social attitudes of racism, sexism, homophobia, and ethnic bigotry that permeates all aspects of mental disability law and affects all participants in the mental disability law system: litigants, fact finders, counsel, and expert and lay witnesses.”

Perlin notes that sanism affects the theory and practice of law in largely invisible and socially acceptable ways, based mainly on “stereotype, myth, superstition, and deindividualization.” He believes that its “corrosive effects have warped involuntary civil commitment law, institutional law, tort law, and all aspects of the criminal process (pretrial, trial and sentencing).” According to Perlin, judges are far from immune, tending to reflect sanist thinking that has deep roots within our culture. This results in judicial decisions based on stereotypes in all areas of civil and criminal law, expressed in biased language and showing contempt for mental health professionals. Moreover, courts are often impatient and attribute mental problems to “weak character or poor resolve”.

Sanist attitudes are prevalent in the teaching of law students, both overtly and covertly, according to Perlin. He notes that this impacts on the skills at the heart of lawyering such as “interviewing, investigating, counseling and negotiating”, and on every critical moment of clinical experience: “the initial interview, case preparation, case conferences, planning litigation (or negotiation) strategy, trial preparation, trial and appeal.”

There is also widespread discrimination by jurors, who Perlin characterizes as demonstrating “irrational brutality, prejudice, hostility, and hatred” towards defendants where there is an insanity defence. Specific sanist myths include relying on popular images of craziness; an ‘obsession’ with claims that mental problems can be easily faked and experts duped; assuming an absolute link between mental illness and dangerousness; an ‘incessant’ confusion and mixing up of different legal tests of mental status; and assuming that defendants acquitted on insanity defences are likely to be released quickly. Although there are claims that neuroimaging has some potential to help in this area, Perlin concludes that it is very difficult to weigh the truth or relevance of such results due to the many uncertainties and limitations, and as it may be either disregarded or over-hyped by scientists, lawyers or in the popular imagination. He believes “the key to an answer here is a consideration of sanism”, because to a great extent it can “overwhelm all other evidence and all other issues in this conversation”. He suggests that “only therapeutic jurisprudence has the potential power to ‘strip the sanist facade’.”

Perlin has suggested that the international Convention on the Rights of Persons with Disabilities is a revolutionary human rights document which has the potential to be the best tool to challenge sanist discrimination.

He has also addressed the topic of sanism as it affects which sexual freedoms or protections are afforded to psychiatric patients, especially in forensic facilities.

Sanism in the legal profession can affect many people in communities who at some point in their life struggle with some degree of mental health problems, according to Perlin. This may unjustly limit their ability to legally resolve issues in their communities such as: “contract problems, property problems, domestic relations problems, and trusts and estates problems.”

Susan Fraser, a lawyer in Canada who specialises in advocating for vulnerable people, argues that sanism is based on fear of the unknown, reinforced by stereotypes that dehumanise individuals. She argues that this causes the legal system to fail to properly defend patients’ rights to refuse potentially harmful medications; to investigate deaths in psychiatric hospitals and other institutions in an equal way to others; and to fail to properly listen to and respect the voices of mental health consumers and survivors.


Similar issues have been identified by Perlin in how children are dealt with in regard to learning disabilities, including in special education. In any area of law, he points out, two of the most common sanist myths are presuming that persons with mental disabilities are faking, or that such persons would not be disabled if they only tried harder. In this particular area, he concludes that labelled children are stereotyped in a process rife with racial, class and gender bias. Although intended to help some children, he contends that in reality it can be not merely a double-edged sword but a triple, quadruple or quintuple edged sword. The result of sanist prejudices and misconceptions, in the context of academic competition, is that “we are left with a system that is, in many important ways, stunningly incoherent”.


A spiral of oppression experienced by some groups in society has been identified. Firstly, oppressions occur on the basis of perceived or actual differences (which may be related to broad group stereotypes such as racism, sexism, classism, ageism, homophobia etc.). This can have negative physical, social, economic and psychological effects on individuals, including emotional distress and what might be considered mental health problems. Then, society’s response to such distress may be to treat it within a system of medical and social care rather than (also) understanding and challenging the oppressions that gave rise to it, thus reinforcing the problem with further oppressive attitudes and practices, which can lead to more distress, and so on in a vicious cycle. In addition, due to coming into contact with mental health services, people may become subject to the oppression of mentalism, since society (and mental health services themselves) have such negative attitudes towards people with a psychiatric diagnosis, thus further perpetuating oppression and discrimination.

People suffering such oppression within society may be drawn to more radical political action, but sanist structures and attitudes have also been identified in activist communities. This includes cliques and social hierarchies that people with particular issues may find very difficult to break into or be valued by. There may also be individual rejection of people for strange behaviour that is not considered culturally acceptable, or alternatively insensitivity to emotional states including suicidality, or denial that someone has issues if they appear to act normally.

Bipolarised: Rethinking Mental Illness (2014)


Bipolarised: Rethinking Mental Illness is a 2014 documentary by director Rita Kotzia.

Challenges conventional wisdom about mental illness and drug therapy through the raw personal journey of a man diagnosed as bipolar.


This documentary is about one man’s personal journey to heal. Diagnosed with bipolar disorder, Ross’ psychiatrist told him he would live with the disorder for the rest of his life and that he would have to take lithium to control symptoms. To Ross, taking the drug daily felt like a chemical lobotomy, leaving him in a foggy, drug-induced haze. Ross ultimately decided to resolve his symptoms outside of conventional medicine. He progressively reduced his use of the psychotropic drug lithium, at an experimental clinic in Costa Rica. What ensued was a self-exploration into alternative treatments to treat his condition and a journey delving into the root cause of his mental breakdown. The film uses Ross’ personal experiences to tell a larger story about medication. It will reveal how we are labelling more and more people with mental illnesses and how, in tandem, we are prescribing more and more toxic psychotropic drugs to treat these illnesses. It weaves together a series of interviews with activists, psychiatrists and other psychiatric survivors who have challenged the status quo as well as recounts some of the alternative therapies Ross uses to maintain his mental, emotional and physical health.


  • Ross McKenzie … Self.
  • David Goldbloom … Self / Professor of Psychiatry.
  • Peter Levine … Self / Writer.
  • Gwen Olsen … Self / Pharmaceutical rep.
  • Charles Whitfield … Self / Psychotherapist.
  • Robert Whittaker … Self / Journalist.

Production & Filming Details

  • Director(s):
    • Rita Kotzia.
  • Producer(s):
    • Noelle Kim Chalifoux … producer.
    • Gordon Henderson … producer.
    • Rita Kotzia … producer.
  • Writer(s):
    • Gordon Henderson … (writer).
    • Rita Kotzia … (writer).
  • Music:
  • Cinematography:
  • Editor(s):
  • Production:
  • Distributor(s):
  • Release Date: April 2014.
  • Running Time: 77 minutes.
  • Rating: TV-MA.
  • Country: Canada.
  • Language: English.

Combat Stress and The Royal Navy and Royal Marines Charities Partnership to Deliver Mental Health Support

The Royal Navy and Royal Marines Charity has worked in partnership with Combat Stress for many years to support Royal Navy veterans with complex mental health conditions.

In 2020 the RNRMC began a three-year funding agreement with Combat Stress as part of the RNRMC’s Health and Wellbeing Support Programme. This partnership ensures that Royal Navy veterans, like Jim, will continue to receive vital support. Jim had wanted to join the Royal Navy since he was nine years old. When he was 18 that dream came true, but unfortunately his time in the services was not what he imagined.

After joining the Navy, Jim was quickly identified as a promising rugby player and spent much of his time on the rugby pitch. Playing rugby took him to several ships and shore bases over the course of 18 months, but Jim’s life was about to change forever. “In March 1992, after joining the HMS Illustrious, my life was totally changed when I was the victim of a random unprovoked attack shortly after going ashore,” he said. “My attacker, who pushed me through a plate glass window, was later charged with attempted murder. I sustained life-changing physical and mental injuries.
“Due to the nature of my injuries, I had to remain awake, un-anesthetised during surgery and I watched as the medical staff brought a priest in to administer the last rites as they didn’t think I would make it. “But I did, and once my physical injuries were stabilised, I was moved by the Royal Navy to a mental health ward where in June of 1992 I was diagnosed with PTSD. “I spent four weeks undertaking a PTSD awareness course. One element of the course was art therapy and I found painting helped me – in fact, I was encouraged to continue painting and remain busy in order to keep my PTSD at bay. I was also told not to think or talk about my trauma.

“For over 25 years I continued to paint as a way of coping and never spoke about the attack.
“After the course, I was sent back to HMS Dryad, and despite all I had been through, was encouraged to get back to rugby; however, when it came to my first match back, I was convinced I would sustain further injuries and didn’t play. “Shortly afterwards, I was offered a medical discharge which could take several months to arrange, or I could take an honorable discharge based on the exceptional circumstances which would take just 24 hours. I took the second option allowing me to leave as quickly as I could. “I left and got on with life, often travelling extensively with work in order to remain busy. I followed the instruction to keep busy, but I know now this was the wrong choice and wasn’t working.

“I used to relive seeing the priest at the end of my bed at night – just like during surgery. I also used to feel like the blood was pumping out of the scar on my head, just as it did after I’d been attacked. “It was when I was confronted by my daughter, telling me she’d come into my bedroom one night to tell me to turn the telly off that I knew I had to do something. The television wasn’t on –it was me shouting and screaming in my sleep. I knew I used to do this – I had to move into a mess of my own in the Navy because of it – but when I knew it was affecting my family, I decided to do something.”

Jim went to his GP initially and explained that he had been diagnosed with PTSD. However, he didn’t receive the support that he needed. Then in 2017 he reached out to Combat Stress. Finally, Jim started his journey towards recovery. “It wasn’t easy. I was embarrassed to call the helpline. I thought I’d been dealing with my problems but really, I’d just been told to keep busy and push everything to the back of my mind. I felt like a failure.

By working with the specialist team at Combat Stress Jim began to learn management techniques and coping strategies for his mental health issues such as hyperarousal and flashbacks. “I learnt about grounding, mindfulness and did much more art therapy. I received CBT & EMDR treatment which has significantly helped with the reliving. I no longer see the priest. Thanks to CBT/EMDR and the art therapists, I understand why I have these memories and have begun to process them. “I also found the education sessions invaluable – learning about how memories work and how the brain processes them really helped me. The peer support has also played important part of my recovery too, supporting me as I returned back to a Royal Navy shore base and the place of trauma. “Combat Stress also encouraged me to reengage with the veteran community. I hadn’t engaged in anything military since leaving the Navy.

“In 2019 I was selected to attend the Cenotaph on Remembrance Sunday. Since leaving Combat Stress, I had further medical support and discovered through a brain scan that I sustained brain injuries as a result of my attack. This injury was contributing to the sensation of blood pumping, but with medication, this is manageable. “What I learnt at Combat Stress has made a massive difference to me. I know now I needed to process my memories, not just bury them or push them away. I owe my life to the team who were on duty at the Royal Naval Hospital Stonehouse – thank you! Also, a huge thanks to Combat Stress for improving my health and knowledge, enabling me to look forward to a better future.”

If you would like to find out more about Combat Stress or how to access their support, please visit their website, or call their 24 hour helpline on 0800 138 1619.


Navy News. (2021) Jim’s Journey Out of the Darkness. Navy News. July 2021, pp.33.

Book: Cracked: Why Psychiatry is Doing More Harm Than Good

Book Title:

Cracked: Why Psychiatry is Doing More Harm Than Good.

Author(s): James Davies

Year: 2014.

Edition: First (1st).

Publisher: Icon Books.

Type(s): Hardcover, Paperback, Audiobook, and Kindle.


Controversial and powerful – a shocking indictment of the pseudo-science at the heart of modern psychiatry.

Developing a Longitudinal Trajectory-Based Approach to Investigating Relapse Trend Differences in Mental Health Patients

Research Paper Title

Differences in Temporal Relapse Characteristics Between Affective and Non-affective Psychotic Disorders: Longitudinal Analysis.


Multiple relapses over time are common in both affective and non-affective psychotic disorders. Characterizing the temporal nature of these relapses may be crucial to understanding the underlying neurobiology of relapse.


Anonymised records of patients with affective and non-affective psychotic disorders were collected from SA Mental Health Data Universe and retrospectively analysed. To characterise the temporal characteristic of their relapses, a relapse trend score was computed using a symbolic series-based approach. A higher score suggests that relapse follows a trend and a lower score suggests relapses are random. Regression models were built to investigate if this score was significantly different between affective and non-affective psychotic disorders.


Logistic regression models showed a significant group difference in relapse trend score between the patient groups. For example, in patients who were hospitalized six or more times, relapse score in affective disorders were 2.6 times higher than non-affective psychotic disorders [OR 2.6, 95% CI (1.8-3.7), p < 0.001].


The results imply that the odds of a patient with affective disorder exhibiting a predictable trend in time to relapse were much higher than a patient with recurrent non-affective psychotic disorder. In other words, within recurrent non-affective psychosis group, time to relapse is random.


This study is an initial attempt to develop a longitudinal trajectory-based approach to investigate relapse trend differences in mental health patients. Further investigations using this approach may reflect differences in underlying biological processes between illnesses.


Immanuel, S.A., Schrader, G. & Bidargaddi, N. (2021) Differences in Temporal Relapse Characteristics Between Affective and Non-affective Psychotic Disorders: Longitudinal Analysis. Frontiers in Psychiatry. doi: 10.3389/fpsyt.2021.558056. eCollection 2021.

Book: Insane Medicine: How the Mental Health Industry Creates Damaging Treatment Traps and How you can Escape Them

Book Title:

Insane Medicine: How the Mental Health Industry Creates Damaging Treatment Traps and How you can Escape Them.

Author(s): Sami Timimi.

Year: 2021.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback and Kindle.


This book digs through the rotten undergrowth which fertilises the mental health industry. The level of failure and deceit is hard to believe. The diagnoses we use are more akin to astrological than medical constructs. We have no medical tests and despite apparent innovations in drugs and therapy, five decades of research has shown no improvement in outcomes from treatment and instead an increase in the numbers categorised as severely mentally ill. Worse, we have convinced the population that they are experiencing pandemics of mental disorders, leading us to fear our ordinary emotions and to scythe away at our natural resilience. There can be no doubt that the mental health industry has caused more harm than good. In this hard hitting book, Dr Timimi, a child psychiatrist with over 30-years-experience as a practicing clinician and researcher, reveals the shocking truth about the unintended harms this industry has caused, both to those in distress and our culture more broadly. He explains how our institutional ideology traps people into becoming long-term patients and proposes a simple theory that explains why more people become long term patients than get better as well as sharing tips on how those caught in this trap can find safe ways back to health and contentment. A revolution in mental health care is inevitable. The current systems have failed and are un-reformable. They will be overthrown. This book will tell you why.

Book: A Practical Guide to Mental Health Problems in Children with Autistic Spectrum Disorder

Book Title:

A Practical Guide to Mental Health Problems in Children with Autistic Spectrum Disorder: It’s Not Just Their Autism!.

Author(s): Alvina Ali, Michelle O’Reilly, and Khalid Karim.

Year: 2013.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.


Exploring the relationship between ASD and mental health difficulties, this book offers practical guidance to help parents and professionals recognise and handle co-morbid conditions, and dispels the myth that they are just a part of autism. The authors cover a wide range of common mental health problems experienced by children with ASD, including Obsessive Compulsive Disorder (OCD), anxiety, ADHD, eating disorders, psychosis, stress, tics and depression, and illustrate these issues with case studies. They also provide vital advice in an accessible format and suggest strategies to ease the difficulties which arise from these co-morbid conditions. This book is essential reading for professionals working with children on the autism spectrum and is an accessible and practical resource for parents and carers.

Book: A Guide to Mental Health Issues in Girls and Young Women on the Autism Spectrum

Book Title:

A Guide to Mental Health Issues in Girls and Young Women on the Autism Spectrum: Diagnosis, Intervention and Family Support.

Author(s): Judy Eaton.

Year: 2017.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.


This book addresses the specific mental health needs of girls and young women with autism spectrum disorder (ASD). Looking at the ways autism presents differently in girls than in boys, and the mental health conditions that occur most frequently in girls with ASD, this is the essential guide for clinicians and educators on tailoring interventions and support to meet girls’ needs.

Describing the current assessment process for autism diagnosis, the book explains why girls are under- or mis-diagnosed, leading to later mental health issues. It outlines the types of intervention that are particularly helpful for working with girls to reduce anxiety, improve social interaction skills, and manage self-harm. The book also covers how to manage eating disorders and feeding difficulties, focusing on working with girls with sensory processing difficulties. There is advice on how to deal with the emotional impact on parents, carers and families, and the challenges they face when negotiating appropriate psychological and educational support.

Book: Positive Male Mind: Overcoming Mental Health Problems

Book Title:

Positive Male Mind: Overcoming Mental Health Problems (Positive Wellbeing Series).

Author(s): Shaun Davis and Andrew Kinder.

Year: 2018.

Edition: First (1st).

Publisher: LID Publishing.

Type(s): Hardcover and Kindle.


Mental health problems affect both men and women, in fact, every one in four of us. However, it has been widely accepted for some time that men are much less likely to seek help from a doctor or mental health specialist, as they traditionally expect themselves to be competitive and successful, tough and self-reliant and can find it difficult to admit that they are feeling fragile and vulnerable. This book aims to build on the current progressive movement by supporting men and those that care about them – be that a partner, friend, family member or colleague – by providing insight, advice, and tips on what can be done at a very practical level to make men’s mental health much more positive.

Book: Positive Mental Health: Overcoming Mental Health Problems

Book Title:

Positive Mental Health: Overcoming Mental Health Problems (Positive Wellbeing Series).

Author(s): Shaun Davis and Andrew Kinder.

Year: 2019.

Edition: First (1st).

Publisher: LID Publishing.

Type(s): Hardcover and Kindle.


Whether you work with 10 people, 10,000 people or just yourself, paying attention to mental health in the workplace has never been more important. We all face mental health challenges, regardless of our gender, age or sexual orientation, and too often we can be guilty for taking our mental health for granted. This book aims to build on the current progressive movement around mental health awareness and is in line with current thinking on mental health in the workplace. In this book, the authors provide employees with a resource to develop greater mental health in the workplace and provide employers with a resource to develop greater wellbeing amongst their employees therefore increasing quality, performance, productivity and overall business effectiveness.