We're Out of Time - Is Psychiatry Overdiagnosing Normal Life? | Dr. Patricia Casey

Episode Date: October 6, 2026

Are we turning normal life struggles into mental illness and teaching people to see themselves as broken?Dr. Patricia Casey, professor emeritus of psychiatry at University College Dublin and author of 14 books, joins Richard Taite to question how modern psychiatry defines and treats mental health.Dr. Casey explains why grief, stress and sadness are often healthy responses rather than illnesses, what adjustment disorder really is and why it's so often misdiagnosed, why checkbox screening tools can be misused, and how she decides when medication is appropriate and when therapy or a "wait and see" approach comes first. They also discuss trauma and substance misuse, the role of insight and acceptance in recovery, and why listening to music has always helped her through difficult times.This conversation is for general information and is not medical advice. Nothing discussed is a diagnosis or a recommendation to start, stop or change any medication. Consult a licensed clinician about your own care. If you or someone in your family is in crisis, call or text 988 in the United States to reach the Suicide and Crisis Lifeline. In an emergency, call 911.The "We're Out of Time" podcast dives into the issues America can't afford to ignore, from addiction and mental health to parenting, resilience, and hope. Hosted by Richard Taite, founder and chairman of Carrara Treatment Wellness & Spa and chairman of 1 Method Centers, the show cuts through the noise with raw truth, real stories, and life-changing conversations. From former addicts and wellness experts to celebrities, athletes, musicians, and influencers, we ask the questions no one else will, educating, empowering, and demanding answers.We're Out of Time is consistently ranked #1 in Mental Health on Apple Podcasts, a 2025 Signal Award winner (Best Video Podcast Guest), and a 2026 Webby Honoree in Health, Wellness & Lifestyle podcasts. New episodes every Tuesday.

In a specialty that has no biological markers that we can use for the most part, except for dementia, we need to be really, really judicious in how we label people, because labels stick with people and they tell people something about who they are and the kind of people they are. So we mustn't mislabel them. If someone has a problem with substance use disorder, please call one call placement. That's 8888-8-3-1-1581. And if we can't help you, we'll make a referral to someone who can. Please, we're out of time.

One Call placement is affiliated with Carreira Treatment, Wellness, and Spa, and One Method Treatment Centers. Before we start the conversation today, I want to deliver a personal message. Every day, families across America lose someone they love to an overdose. That's why I've partnered with the CDC Foundation through their cope. community overdose prevention efforts campaign and committed to matching every donation dollar for dollar up to $25,000. I've spent my life helping people recover from addiction, but if we can get to the place of prevention first, this would help save so many more lives. I hope you'll join me in supporting the CDC Foundation's overdose prevention work at cdcfoundation.org slash cope.

Thank you from the bottom of my heart. Today on We're Out of Time, I'm joined by Dr. Patricia Casey, Professor Emeritus of Psychiatry at University College, Dublin, consultant, psychiatrist, and author of 14 books and more than 120 peer-reviewed papers. She also serves as editor of BJ Psych Advances and is a leading voice questioning how modern psychiatry defines and treats mental health. Her work takes a closer look at adjustment disorder, overdiagnosis, and whether we've begun to medicalize normal human emotions and life experiences. Professor, are we overdiagnosing people and turning normal life struggles into mental disorders? In other words, are we helping people or are we teaching them to see themselves as broken? I absolutely agree with the latter part of what you said. I think we are teaching people to believe that they have illnesses and that they're vulnerable

and that they're not resilient when it should be the other way around. And now that doesn't mean, and I don't want your listeners or you to get the impression that I don't believe there are vulnerable people that exist because there are lots of them. It's your bread and butter. It's my bread and butter. There are people with mental illnesses and with addiction and all of that. But I think there are a cohort now that are being over-diagnosed, over-medicalised, and are given very serious diagnosis. I mean, being diagnosed as being on the autistic spectrum, I think is quite a serious diagnosis.

Being diagnosed as having a major depression, as DSM-5 calls it, is a big deal. And I think we need to be terribly careful about how we make the diagnosis, the process we go through, and the terminology we use. And for example, a lot of people say, I suffer with depression. But of course, depression isn't in itself a diagnosis. It's a symptom that may reflect a depressive illness, or it may reflect sadness and being fed up,

or it may be secondary to delusions or secondary to anxiety, but yet language is used very loosely in psychiatry. I wouldn't want to comment about psychology in this regard, because it's not my bailiw it, but certainly in psychiatry. And I suspect that maybe psychology is just as loose with its language, but I leave that for you to comment on it. So I think we need to be careful. about the whole process.

And I am very concerned about the use of screening tools and schedules, you know, tick boxes, the Beck Depression Infantry or any of the others. There's a range of them. And they're very useful for research. And that's what they were designed for. But now they're being misused greatly, I think. And at the moment now, I'm frequently discontinent. continuing medication on people because they will have been prescribed for the wrong reasons.

Like people who are bereaved get prescribed antidepressants, you know, pretty quickly. Now, grief can turn to an illness. There's no doubt about that. But for most people, it's a normal, it's a healthy response to a major loss. That's exactly right. If somebody who you love dies, you can expect to feel sad. Yes, indeed, are indeed lesser than human beings. Animals, if people are lonely and isolated and have an animal that they lose,

they can be very devastated and very, very, very distressed by it. But it's not, it's not the thing that makes an illness whereby you would say somebody has a psychiatric illness and they need an intervention, be it medication or indeed psychology as well, you know, psychotherapy. And because I believe that there's an overuse of both. both medication and psychotherapy. And I do think that's, that's, that is giving young people the wrong message about their own innate resilience. I need clarity around, uh, uh, the therapy, right?

Whether it's with a psychologist or an MFT or an LCSW is irrelevant. Okay. I'm the most over-therapized person. I know. I go three days a week. I've been doing it 20 years, right? I do it because my life is great, but I want it better. And I want to be the best version of myself.

And sometimes I need containment through the week, right? That's what I use it for. I think it's how elegant people deal with their stressors so that they're not creating wreckage. Let me know how you feel about that. I think that there's probably an underestimation of your resilience and the resilience that most people have. Most stress is a normal thing in life. We all have it.

I mean, I feel stressed when I was coming into town today in traffic that I thought might get in because the farmers and truck and hauliers are holding up all the roads. I get stressed if I have a very worrying patient whom I'm having difficulty treating and worried about. I get stressed. I get stressed if any of my family become ill. I worry about them. But I don't feel that I need the indulgence

of attending a therapist about it because I'm not sure the therapist could tell me anything that I can't do myself. But you're a different animal. You're like one of the smartest people on the face of the earth in this regard. So who the hell is going to? So you made an executive decision that was correct.

Yeah. Yeah. There's a word in Irish called plow mossing. It's when you get lots and lots of compliments that you feel you don't deserve. But I think there's a bit of that going on with you, Richard, your plum assing. No, that's not true.

I typically get TV doctors and TV therapists and celebrity doctors and celebrity therapists. And now I've got somebody in front of me who's done 120 peer reviews, written 14 books, is a legit professor. Emeritus. Well, thank you. I mean let's just know who let's just recognize who who we are yeah okay we're not going to move on until we acknowledge who we are as human beings well yes I mean I I've worked hard for what I've got I love every minute of it I wouldn't do anything different I'm I'm not a perfect psychiatrist I do refer people for psychotherapy I'm not decrying psychotherapy and I I want to make that clear but I think that

people, for example, in Ireland now, if somebody goes to their general practitioner, you would call them a family practitioner, they go to their GP, their general practitioner and say, look, I'm a bit depressed, I'm a bit low in mood, I'm not eating well, I'm not sleeping well, and I'm kind of feeling anxious. They will get put on an SSRI antidepressant and then will get sent off to a counsellor or a therapist of some sort. Now, I think we start at the wrong end of the stick when we don't try to find out, well, is there a cause for this? It might be a perfectly normal set of symptoms that the person is experiencing in the circumstances. And what can you do to help that? Are the symptoms interfering with their day-to-day life or with their relationships, their interpersonal relationships? You know, what is the impact of all of this on them? I don't think we pay enough attention to that because if we did, a lot of these people wouldn't be sent anywhere. It's a phrase.

Maybe it's an insulting phrase, but it's called watchful waiting. You wait and see what's happened. You don't go rushing into therapy because, as I've said, people are getting the wrong message about their own strength of character. The middle ground that I would look for there is I'm completely on board with you go in, you say you're upset, you're unhappy, you can't sleep, you can't eat, da-da-da-da, right? Obviously, okay, in my world, you don't give somebody psych meds, okay, right away. That's a no-go. I don't believe you should be put on psych meds until you've done the therapy first, right?

And the waiting thing, I get what you're saying. But if they go to a therapist, maybe they can tighten that up real quickly. I don't think it's as simple as that, Richard. Maybe the people that come to therapists in the first instance are very different from the ones that come to psychiatrists. But most of the people that come to psychiatrists will have some physical symptoms accompanying their low. mood. They won't just have low mood in its own because I wouldn't dream of giving somebody on that who just got low mood and was feeling a bit tense. I wouldn't dream of giving them medication in the first instance. But the ones that come, the people that come to me with low

mood will also often have sleep disturbance. They're finding it difficult to function on a day-to-day basis. I look at functional impairment and the functional impairment that can go with depression is quite striking. So if I see somebody who's functionally impaired, who isn't sleeping, who feels worse in the morning, who's losing weight, I wouldn't dream of sending them off to a therapist first off. Absolutely not. I'd be putting them straight on antidepressants. But if they came to me saying, well, look, I'm at home, I'm, I'm, I'm, I'm, I'm, I'm, I'm, I'm, I'm, I'm not getting on with my partner or my, my, my, my spouse. The children are nagging me. Um, what can I do? I wouldn't dream of putting them on antidepressants. I would send them off to a therapist. You and I are completely aligned on this.

That's why I'm glad we dug in. So, so that's it. But there have to be problems that are interfering with them before I think any intervention is necessary. So if somebody is at home, just retired, feeling miserable, that in itself wouldn't cause me any concerns. But the fact that they're rowing with other people, other people are getting on their nerves, they're feeling a bit irritable themselves, that would, and I wouldn't be giving antidepressants for that. I'd be, to a therapist. Exactly. Why is adjustment disorder so often overlooked or misdiagnosed as depression or anxiety? Well, that is changing a little in clinical settings.

The reason for that previously was, firstly, it was viewed with suspicion as a convenient diagnosis that was invented by the APA in order to allow psychiatrists to claim charges for seeing people. because if they said they don't have any diagnosis, they don't meet the criteria for major depression or generalised anxiety disorder or whatever. When they went to their therapists and psychiatrists, they wouldn't be getting any getting paid. So it was regarded with rightly. I mean, in the beginning, I would have thought that this is just a diagnosis of convenience. And that's not how diagnosis should be met. That's illogical. It's not scientific.

You know, it's monetizing symptoms, and I don't think that is a good idea. But then, of course, when it was becoming more respect to because people began to realize that the fact that it's not major depression doesn't mean people have significant symptoms following a major stressor. And, you know, if they have symptoms that cause functional impairment, they certainly need some help. And so it began to be recognized and legitimized within the profession a bit, but there were no drugs involved. And so studies weren't promoted by the pharmaceutical industry, who of course sponsored a lot of the early research and to this day still do. So pharma had no role in it in evaluating the benefits of this diagnosis.

and it fell by the wayside. But recently, I think with more attention being paid to it in DSM, and in fact in ICD 11, now which we work from in Ireland and the UK and Europe, ICD 11 has got completely different criteria to the American DSM, which... How so? Yeah. How so? I think they... There was a very

enthusiastic proponent of adjustment disorder who headed the committee on trauma and stressor-related disorders, and so took adjustment disorder by the horns and really gave it a lot more clout as an individual

disorder with, you know, specific symptoms. And so, so that's made the two, not strictly comparable now. Are we labeling stress as illness too quickly instead of recognizing as, as it just being part of being human? Yes, we are. And there are some people now, in fact, who are labeled with adjustment disorder who actually just have normal stress. So talking about in-betweens, I think adjustment disorder is in between the normal stress and the other stressor disorders like PTSD, for example, are the anxiety disorders. Adjustment disorder sits in the middle there, but now it's been moved too much towards the normal stress range.

And I don't think that's very, very helpful that people who actually are going through healthy, stressful reactions and proportionate stressful reactions to events are labelled with either adjustment disorder. They would have been labelled with major depression in the past or PTSD if it were a trauma type incident. But now are mislabeled as adjustment disorder. So I think there's a huge problem with labeling anyway. And we see it now with teenagers. They all, you know, hundreds of them are being diagnosed as being on the spectrum or as having ADHD. So there's, there is, for some reason people are wanting diagnoses and labels that differentiates them from people who don't have these conditions. And I'm, I mean, I'm still trying to get my head around it because it's all so new, and particularly the ASD and the autistic spectrum and the gender dysphoria.

We never defined adjustment disorder for the viewers. Can you do that real quickly? Well, adjustment disorder is a condition that occurs. in response to a stressful event. Now, before any of your viewers say, well, I've had major depression in response to a stressful event. In order to meet the criteria for adjustment disorder, you have to have a stressful event. If the symptoms come out of nowhere

and you don't have a stressful event, it's not adjustment disorder, whatever else it is. It's not adjustment disorder. So you have to have ab initio a stressful event. that triggers symptoms like depression or anxiety or anger and can trigger some other symptoms as well. But the interesting thing, and sometimes it can be mistaken for, say, major depression because you can get low mood, you get low mood, but you also get sleep disorder with it. you could have a bit of loss of weight if you're not eating very well.

But the interesting thing is that it happens in a very close time relationship to the stress are like within days or at most weeks, unlike major depression where it can happen a lot, a lot later. And for major depression, you don't even need to have a stressful event to make the diagnosis. That's exactly right. So it's in close, very close proximity to a stressful event. And interestingly, if you prescribe medications like antidepressants, they make no difference. And I have seen a lot of people on long term antidepressants, maybe five ors,

and they've been tried on five or six different antidepressants for their low mood that occurred maybe after their marriage broke up or their relationship broke up. and they're on and they're tried different antidepressants by their GP or by their psychiatrists and they're still not responding and it's actually an adjustment disorder and they respond much better to psychological therapy and I would definitely send them to a therapist do you know who you remind me of in in a little bit I don't know if you know him do you know a doctor by the name name of Daniel Siegel yes okay So I love him. Just love it. A lot of his work is what we do. What we do is based around his work. And what I love mostly about him is he's a psychiatrist.

That doesn't really prescribe medication. Yeah. He's got the outlook that you do. Except I do prescribe medication for people. And he does too. But that ain't his go-to. his go-to is he wants to be mindful about it that's his whole thing and most psychiatrists as you know you walk in you get medication it's like walking into a a barber shop you walk into a barber shop

you get in a haircut okay and it kind of feels like that no yeah i mean i i do prescribe medication quite a bit i i have to say that and i would take medication myself if i had a depressive episode and i give it to family members or ask for them to be given it if any of them were clinically depressed. But because of the overdiagnosis, I'm pretty cautious and I want to be certain that I think they're going to benefit from it. And so that's why I look for triggers. I always think something might be a normal reaction. In the hospital I work in, I see a lot of oncology patients who have got diagnoses of, you know, life, life threatening and life limiting,

possibly life limiting illnesses. And a lot of them will get referred. I see an awful lot of them. And some of them might prescribe antidepressants to, and others I don't. And I suppose it's the art as well as the science one is having to use in this respect. And sometimes if I'm not sure,

I give a trial of antidepressants, and sometimes I'll be proved right and sometimes I'll be proved wrong but you have to do you know what I love do you know what I love I love that someone who is so research based just use the term it can be a science and an art that is that is that's kind of conflicting right but it's the it's the nuance that is actually required yeah and that unfortunately Richard, I think, has been lost in modern psychiatry at any rate because everybody is ticking boxes. And the former president of the American Psychiatric Association, MacKew, and Slavny wrote a fabulous paper in the American Journal of Psychiatry a few years ago about the tick box approach to diagnosis and how terrible it is. and it happens all the time like major depression the APA are really leaders of this because you know if you have three symptoms for more than two weeks out of a list of 10 you get labelled with major depression and that's how it should be that really isn't you can't be ticking boxes or in PTSD if you've got one symptom from each of the three clusters four clusters they now have you get labeled and that isn't how diagnosis should work. And in a specialty that has no biological markers that we can use for the most part, except for dementia, we need to be really, really judicious in how we label people because labels stick with people and they tell people something about who they are and the kind of

people they are. So we mustn't mislabel them. And that's why I feel so strongly about all the labels that are being thrown about nowadays. You know, you're talking, you just said something very interesting about, let me just paraphrase, objective findings in psychiatry, right? Is that fair to say? Yes, yes, absolutely. Okay. So I think that's changing. I think that's going to change. I think you're going to be able to find objective findings, not subjective findings. It would be great. With the, as AI becomes more learned, if you will, okay, more evolved, okay. I think we're going to get that.

I think we're finally going to get that in your area. You know, it would be great since you're the gatekeeper to make certain we're not BS by that. Yeah. It would be wonderful if that were the case. But I know that when DSM4 was being planned, or sorry, DSM4 was being planned, it was thought that by the time DSM 5 came along, they would have all of the biological markers or lots more biological markers. And that hasn't come to pass. So I hope you're right, Richard, I sincerely do. I hate the DSM, Professor.

I absolutely hate it. I think it's something that is mostly done for billing purposes. So you have a diagnosis to bill. Okay. What are your feelings on that? Yeah. I probably wouldn't have the degree. I'm scared of it as well because some of them,

because mainly it keeps on growing and new conditions keep being diagnosed. that are mainly behavioral like gambling disorder, like sex addiction, you know, there was even, I think there's actually one condition for subclinical depression. So why are you going to make a subclinical diagnosis and call it a diagnosis? So for those reasons, I have concerns at all the new labels that have been added. Unfortunately, ICD-11, which became on. operational just about four years ago is following suit and seems to be inventing labels. Yeah, unfortunate.

And it does affect our resiliency and it does label us to be different. And these things are speed bumps in our life and don't need to be catastrophes. From my own, and I haven't studied this, but from my own clinical experience, I think the trauma of sexual abuse is a big driver of substance misuse of all sorts, certainly in Ireland. It's hugely traumatic and I remember one year when I worked in another hospital which was, which had the busiest emergency department in the country called the Matter Hospital here in Dublin also. I was there for donkey's years like like you were. in your profession. And I worked and we did just a snapshot over a week of all the drug addicts that were seen in the emergency department and something like 80% of them had been sexually abused.

Unbelievable. How much of what we call addiction is actually untreated personality disorder? Oh my goodness. I left the I did investigate I did work in personality disorder research for several years in my life with a very dear friend and colleague of mine called Peter Tyre he's kind of the diet of personality disorder in in the world health organization Europe the UK and I worked with him for a number of years and I just stopped doing it in fact I went to America to a few studies on personality disorder and and we had a reciprocal one in Ireland and people like Alan Francis came over and and big names like that came and attended it but I left the area because it was just going nowhere in terms of of real treatments that are realistic and achievable for psychiatrists on the ground working in busy outpatient public hospital clinics you know the It's all very well to have specialist units for people with complex needs.

But this is just not feasible. So I'm not sure that realistically one can treat personality disorder in the same way that one can treat PTSD or even substance misuse. I think if people, I mean, insight and acceptance of the addiction like you described you have is a huge part of it. I mean, it's really the nub of treating somebody. If they can get or their therapist can get them to the stage of seeing and accepting their addiction. And so that's the basics, the basic approach.

Some people would say that certainly in Ireland that if they turn to God through either through the 10 steps or of their own volition, the data system. Others, some others will mention family, but to be honest, it's usually, I would have thought the overarching thing is insight. and acceptance. I would have thought that's the most important thing. And how what achieves that? I don't know. I'm not qualified to say I haven't worked

in addiction, Richard. So I don't know. But I think if people accept it and then I think religion does follow in some form behind that. When I was training to be a psychiatrist, I did my training, I did my medical training in Ireland and then went to the UK.

And the training was three to four years and then you sit if you sit your exams and if you pass them, then you get called an MRC, psych, a member of the Royal College of Psychiatrist. And I remember the day that I got the results of my exam that I had passed and now I was going to go on to the next level of my training. and a professor came to give a talk to the whole all the nurses and all the doctors in the hospital. And it was a big hospital in Nottingham. There were about a hundred people at it. And I sat listening to the talk. And this man now would be very well published and would have been well known internationally. And I thought, oh my goodness, if this man can become a professor, I can easily become one.

because he was an astonishingly awful bad teacher. And so I always remember that moment of clarity. If he can become a professor, I can. And it has stayed with me to this day. And that was a good many years ago. As marijuana becomes more normalized, what concerns do you have about its impact on mental health? I have huge concerns.

And thankfully, the Irish College of Psychiatrists, of which I'm also a member, now has huge concerns as well, because there were attempts to decriminalize it here about two years ago, less even. And the Irish College took a very strong stance. And we're all added among this in the college or most of us. There are huge mental health concerns because we know that in some, people with a vulnerability, it can actually trigger a schizophrenic illness. It doesn't do it in everybody and I don't want to give that message out. But there are people who are vulnerable to schizophrenia, such as people who have a family history of schizophrenia, who themselves are therefore vulnerable. And it can cause schizophrenia in those. We also know that even in the healthy population, it can trigger psychotic episodes that resolve,

but nonetheless psychotic episodes that would bring people into emergency departments and sometimes into short stays in hospital to treat the symptoms. Wrapping up, is there anything else you want to touch on or add? Oh my goodness. I mean, no, we've gone through such a lot, Richard. I'm sort of processing it all and having to process it all quickly. No, there isn't. One thing I should have, it's just an aside.

The one thing has always helped me, in fact, is listening to music. So I really want to just tell your listeners that if they have a problem, just sit down and listen to whatever kind of music you like. Now, if it's highly, triggering music, you know, like heavy metal. I wouldn't be going for heavy metal. But if it's something more restrained or more emotional or whatever, sit and listen to it,

song Requiem Masses, like Mozart Requiem, Vorjax Requiem, Requiem, Requium, Forre's Requiem, most composers wrote requiems and they're wonderful because they're they are said but they all end with a resurrection and they're happy so they mirror what's in the bible about about death punishment you know the last day the day of judgment they all have what's called a DA's ERA, and then they go on to joy when people are reunited in the afterlife. And that's actually the afterlife is what keeps people who have religious beliefs going.

And so the afterlife in music is really very powerful. So I would encourage you to listen to some of the Requiem's Mozart's Requiem. There's even a rock requiem that was written by, oh God, it's gone out of my head now. He's a Welsh composer. He's still alive. He wrote a rock requiem that's absolutely fabulous. Not Hopkins. Anyway, Google Rock Requiem and it'll come up.

Welsh composer, it'll give you the name. Carl Jenkins. Jenkins, Carr Jenkins Requiem is great. It's a modern requiem. But my favourite is Vorjacs, but there are other requiemes. Forays is probably the best known. But requiems take you through the whole range of emotions that you go through when you're grieved. And I can recommend them to listeners.

But even just not even bereavement, just for people who have day-to-day problems, just sit and listen to nice, relaxing music. It changes your state. Anything that changes your state gets you out of that, breaks you out of that pattern. You're going to be, you're going to get relief. Listen, it was beyond a pleasure to have you here today. Thank you so much for taking the time to do this. You traveled two and a half hours to get here.

It's okay. I was talking to God on the way and so it was fine. You are an amazing person. Thank you for blessing all of us here today. Thank you for having me. All right. See you next Tuesday, everybody. We're out of time.

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