Guest: Dr. Sami Timimi from Lincoln, UK

Introduction & Welcome

Lianne Castelino: Welcome to Where Parents Talk. My name is Lianne Castelino.

Our guest today is a consultant child and adolescent psychiatrist. Dr. Sami Timimi is also a psychotherapist with the National Health Service in the UK and an author. His latest book is called Searching for Normal: A New Approach to Understanding Mental Health, Distress, and Neurodiversity.

Dr. Timimi joins us today from Lincoln in the UK. He’s also a father and a grandfather. Thank you so much for taking the time.

Dr. Sami Timimi: Thank you so much for inviting me.

What Concerns You Most About How We Diagnose Mental Health in Young People?

Lianne Castelino: What concerns you most, Dr. Timimi, as you look out at the current landscape as it relates to how we are diagnosing mental health – particularly when we’re talking about young people?

Dr. Sami Timimi: Well, there are many things that are concerning, but it starts with some fundamentals.

We’re talking about things and we’re calling them psychiatric diagnoses which, in medical terms and in strictly classification terms, they are not diagnoses.

And there are a lot of consequences that happen when you treat something as if it’s a diagnosis – as if you’ve got an explanation for your experiences or your child’s experiences or behaviours, which in fact are not an explanation but a description – and a particularly bad one at that.

So, for example, if you go to the doctor with a cough, you don’t expect them to go through a checklist of symptoms and at the end say, “You’ve got recurrent cough disorder” and add the word “disorder” at the end.

You’d expect them to listen to your chest, perhaps order a chest X-ray, take a sputum sample – because there could be many different reasons for that cough.

A real diagnosis points towards possible causes and influences treatment. It goes beyond what the patient can imagine because it reveals a physical process.

But in mental health we talk as if we’re dealing with something very similar.

We imagine that a diagnosis of, say, attention deficit hyperactivity disorder explains why a child is struggling with attention.

We treat ADHD as if it is a diagnosis, so we assume the reason the child is struggling with attention or impulsivity is because they “have ADHD”.

But then you have to ask: How do you know it’s ADHD that’s causing that?

The only answer is: “I know it’s ADHD because they have poor attention.”

That’s a circular argument.

We have a description of behaviours and we’re using that description as if it causes itself – like saying the pain in my head is caused by a headache.

There are many consequences to confusing description with diagnosis.

Consequences of the “Disorder” Label

Dr. Sami Timimi: First, it assumes there’s something wrong – we add the word “disorder”.

It implies the behaviour or experience is abnormal and shouldn’t be there.

In medicine, when we call something a symptom, we try to get rid of it or reduce it.

That shapes intervention – especially medication.

There’s been a huge increase in psychiatric medication in young people.

Long-term studies show these drugs are associated with many side effects and do not lead to long-term improvements.

People are being exposed to medication of dubious long-term value that causes a lot of harm.

The Developmental Perspective We’ve Lost

Dr. Sami Timimi: As a traditionally trained child psychiatrist from the mid-1990s, the core ideas were systemic and developmental.

The one constant in life – especially childhood – is change.

The one thing I can predict with absolute certainty is that every child I see is going to change – their body, interests, friendships, relationships, tastes, thinking, emotions – everything.

Putting psychiatric labels on children risks fixing the idea that there is something broken inside them that is lifelong (we now call ADHD, autism, etc., lifelong conditions).

It persuades parents and young people to think in a non-developmental way and closes down openness to change.

It focuses attention only on what’s “wrong”, so people notice less of what’s going well and miss the changes that are happening.

That was a long answer, but it’s only the tip of the iceberg.

This is a huge problem we’ve created.

How Did We Get Here? The Cult of Diagnosis

Lianne Castelino: Certainly the way you lay it out… [full response acknowledging]. Your book, Searching for Normal, has been described as “An antidote to the cult of overdiagnosis.” How do you think we got to this place?

Dr. Sami Timimi: I think that quote is wrong. I’m challenging the cult of diagnosis, not overdiagnosis.

The problem isn’t overdiagnosis; the categories themselves are the issue.

Psychiatric categories are subjective.

There are no chest examinations, no X-rays, no blood tests, no microscope for thoughts.

We are meaning-making creatures.

The framework we use to understand experiences shapes how we respond to them – and that is incredibly powerful.

Sociologists have known for decades about the power of labelling.

When you internalise a label, it further shapes your experience.

We’ve put normal struggles – anxiety, low mood, difficult behaviours – into a medical “symptom” framework where the goal is suppression or elimination.

Growing up is tough. It always has been.

I tell families I hope reincarnation isn’t real because I wouldn’t want to go through adolescence again.

The world is tougher now – higher expectations, performance culture, pessimism about the future.

Struggling doesn’t mean something is inherently broken inside you.

But the diagnostic framework sets people up to fight against a part of themselves they believe shouldn’t be there.

It turns meaningful experiences (connected to peers, family, life) into meaningless “symptoms” to be eradicated.

If medication helps for a while, you’re set up for a potential lifelong war against yourself.

A different framework could help you understand and live alongside that part – deepening resilience rather than weakening it.

Good therapy helps a person grow, not stay stuck believing part of them is broken.

How Do Parents Tell “Kid Being a Kid” From Serious Struggle?

Lianne Castelino: If we’re medicalising normal childhood behaviours, how should parents differentiate real struggling from just a kid being a kid?

Dr. Sami Timimi: There’s no formula – it’s different for every child, every family.

Some kids have learning difficulties and need extra support.

Some have physical difficulties.

Some are more sensitive, some more intense.

But the pendulum has swung so far that we now see children as fragile – as a disorder waiting to happen.

When I trained in the mid-1990s we almost never used psychiatric medication in children – correctly, because it was harmful and didn’t work at that developmental stage.

Now we medicate hugely.

The idea of “early intervention” is dangerous in mental health.

In cancer or heart disease, yes – catch it early.

In mental health, early labelling creates long-term patients because it locks in a lens that’s hard to escape.

I’ve seen children start with anxiety or ADHD, then collect more diagnoses, more meds, more interventions over years.

At the severe end, young people arrive with anxiety, PTSD, autism, ADHD and are seeking bipolar because nothing “explained” enough.

None of it is the parents’ or young people’s fault – this is what society is selling.

My advice: be very careful about starting down this route.

Even in the severest cases – people who’ve “clocked out” of life – I’ve seen recovery.

Humans have incredible capacity to find hopeful meanings and get through.

Stories of suffering are also stories of survival.

Validate the suffering, but also nurture the surviving part.

And to parents: don’t try so hard.

Good parents feel guilty most of the time – that guilt drives over-intervention.

Sometimes we need to let children cry, let them struggle, be there to pick them up, be patient, not panic.^[1]

Our job isn’t to stop all suffering (impossible) – it’s to help them survive it and grow through it.

Stemming the Tide – The Mental Health Industrial Complex

Lianne Castelino: How do we stem this tide?

Dr. Sami Timimi: There are multiple drivers – that’s why I call it a mental health industrial complex.

There’s a lot of money in medicalising normal experiences.

Social media turbocharges it.

It’s also fed by a failure of politics, especially left-wing politics falling into culture wars.

Diagnosis has merged with identity politics – people now make diagnoses part of their identity.

That hyper-individualises problems and distracts from structural issues: economic crisis, austerity, performance culture, loss of trust in politics.

But wherever there’s a harmful movement, there’s resistance.

I see hopeful alternatives emerging – school projects, community projects, clinics doing things differently.

Some are funded because waiting lists are endless.

With your own children: be patient, resist the constant invitations to pathologise.

I know a mother whose school pushed for autism assessment because her daughter wouldn’t attend.

She fought it, worked with pastoral staff, went through months of hell at home – and now the girl is happily in school. No assessment needed.

People can get through these things.

Final Message to Parents

Lianne Castelino: What is the single message you want parents to take from Searching for Normal?

Dr. Sami Timimi: Mental health services are not always good for your mental health. Beware. Please resist and don’t fall down the psychiatric-diagnosis rabbit hole.

Lianne Castelino: For parents who will turn to Dr. Google next – what’s a reasonable first step if they think their child needs professional help?

Dr. Sami Timimi: Find somebody who works in a relational or systemic way.

Ask them directly: “Do you make psychiatric diagnoses? Do you believe in psychiatric diagnosis?”

Avoid the ones who do.

Closing

Lianne Castelino: Lots to think about on a massive topic we’ve only skimmed.

Dr. Sami Timimi, psychotherapist with the NHS, author of Searching for Normal – thank you so much.

Dr. Sami Timimi: Thank you so much.

Watch the full interview on Where Parents Talk TV. 

References

1. Jureidini, J. (2014). Let children cry. Medical Journal of Australia, 201(10), 590–591. https://doi.org/10.5694/mja14.00917
2. Timimi, S. (2025). Searching for Normal: A New Approach to Understanding Mental Health, Distress, and Neurodiversity. Jessica Kingsley Publishers.