What are we missing?

We talk about mental health more openly than ever before. There is greater awareness, more diagnoses, more treatment options, more medications, more psychological therapies, and more digital mental health platforms.

And yet, despite all this attention, something remains deeply unresolved.

Are we actually becoming mentally healthier, or simply better at recognising distress?

Perhaps the more important question is: what are we missing?

This question is at the heart of my Beyond Diagnosis series. In earlier articles, including my exploration of Borderline Personality Disorder, I have questioned whether a diagnostic label always captures the person behind the symptoms.

A diagnosis can be useful. It can give us a language. It can help clinicians communicate, identify risk, guide treatment and open the door to support.

It does not tell us everything about the person sitting in front of us.

And increasingly, I believe we need to ask whether our mental health systems are sometimes looking at the symptom while missing the ecosystem in which the symptom has developed.

What happened to us?

The COVID-19 pandemic did not create every mental health problem. But it exposed, intensified and accelerated many vulnerabilities that were already present.

But the pandemic ended. The psychological consequences did not simply vanish with it.

Many people returned to work, school and ordinary routines, but to a world that had changed.

Perhaps we should therefore stop asking only one question, and begin asking another.

Connected, and increasingly disconnected

We have never had so many ways of communicating.

And yet many people feel profoundly alone.

A person can receive hundreds of messages and still have no one to call when they are frightened.

A young person can have thousands of followers and still feel unseen.

A couple can live together and still experience profound emotional isolation.

A family can share the same house and inhabit completely different emotional worlds.

So, when loneliness becomes depression, should we treat only the depression?

Or should we ask: where did the connection go?

The continuous struggle to survive

For many people, life has become an almost continuous negotiation with uncertainty.

We tell people to practise mindfulness. To sleep better. To exercise. To think positively. To manage stress. All of these may help. But there is a deeper question.

What if the person is not simply failing to manage stress? What if their life has become chronically stressful?

There is a difference.

When anxiety becomes the language of uncertainty

Anxiety is often treated as something happening inside the individual. But anxiety can also be a response to a world that no longer feels predictable.

This is why I believe we need to move beyond one question, and also ask another.

And what about our children?

Perhaps this is where we should become particularly uncomfortable. Mental health difficulties are appearing early in life, and the evidence tells us that childhood and adolescence are critical periods.

So, when a child is struggling, what exactly are we assessing? The child? Or the environment around the child?

Because the child may be carrying:

A child cannot always tell us what is wrong. Sometimes behaviour becomes the language of distress. And sometimes what appears to be a disorder may be a child's attempt to communicate:

"Something is not right."

That does not mean every childhood mental health condition is caused by the environment. It means we should not examine the child in isolation from the environment in which the child is developing.

The danger of stopping at diagnosis

Imagine someone comes to us with depression. We diagnose depression.

The diagnosis may still be correct. But it may not be enough.

This is the distinction I mean by Beyond Diagnosis. I am not arguing that diagnosis should be abandoned. Far from it. Diagnosis has an important place in mental healthcare.

But diagnosis should be the beginning of understanding, not necessarily the end of it.

The person is multidimensional

A human being is not simply a brain producing symptoms. These dimensions continuously interact, and the boundaries between them are not as neat as our diagnostic categories sometimes suggest.

Instead of asking only what disorder this person has

Beyond diagnosis does not mean beyond science

Looking beyond diagnosis does not mean rejecting modern psychiatry, psychology, neuroscience or evidence-based treatment. It does not mean replacing diagnosis with vague explanations. And it certainly does not mean assuming that every mental health problem has a single hidden cause.

Rather, it means recognising that good clinical understanding may require more than one lens.

Integration does not weaken science. Done properly, it can deepen our understanding of the person.

From treating symptoms to understanding people

Perhaps the next evolution of mental healthcare is not simply about creating more diagnoses. Perhaps it is to become better at understanding the human being behind the diagnosis. The future may require us to move from one sequence to another.

Because recovery is not always the same as symptom disappearance.

A person may stop having panic attacks and still feel profoundly disconnected from life. A person may no longer meet the criteria for depression yet still have no sense of purpose. A person may manage their anxiety and still live in an environment that continually breeds insecurity.

Perhaps successful mental healthcare should therefore ask not only one question, but two.

Perhaps there is another question that conventional mental health discourse rarely asks. We ask what has happened to the body. We ask what has happened to the mind. We ask what has happened to our relationships, families, work, finances and environment.

But what has happened to our relationship with ourselves? And beyond that: what do we actually mean by the Self?

For generations, we have often assumed that greater external fulfilment will bring greater internal fulfilment.

And yet, despite unprecedented material and technological possibilities, many people continue to experience anxiety, emptiness, loneliness and a sense that something is missing. Perhaps we are beginning to discover the limitations of external solutions to internal questions.

Perhaps this is where the conversation needs to become deeper.

Neti, Neti. Not this, not this.

There is an ancient Indian inquiry expressed through these words. In the Upanishadic tradition, this is an inquiry into the nature of the Self, questioning whether what we ordinarily identify with is the entirety of who we are.

The Advaita Vedanta tradition takes this inquiry further, toward the recognition of Ātman and Brahman as non-dual reality. Whether one accepts this as metaphysical truth, explores it as contemplative philosophy, or simply treats it as a profound question, it introduces something rarely addressed by diagnostic thinking: the question of consciousness itself.

Modern psychology asks us to understand the mind. Vedic Psychology invites us to investigate something more fundamental: who is the one experiencing the mind? That is a very different question.

Beyond the symptom. Beyond the diagnosis. Beyond the mind.

This does not mean abandoning psychiatry. It does not mean rejecting psychology. It does not mean replacing evidence-based treatment with spirituality. Rather, it suggests that the human being may need to be understood at several levels simultaneously.

Diagnosis can help identify a condition. Psychology can help us understand the mind. A multidimensional approach can help us understand the interaction between the person and their wider life. And Vedic Psychology invites us to ask an even deeper question: who is the person behind all these layers?

Perhaps these are not competing approaches. Perhaps they represent different levels of inquiry into the human experience. And perhaps the growing dissatisfaction with purely external definitions of success and wellbeing is, for some people, becoming the beginning of an inward journey.

I do not claim that this transformation is universal or inevitable. But I believe the question is worth asking. Because perhaps the future of mental healthcare will not be found simply in discovering more diagnoses. Perhaps it will also require us to develop a deeper understanding of what it means to be human, and what consciousness means within that experience.

We have become increasingly sophisticated at naming mental health conditions. But perhaps our next challenge is to become equally sophisticated at understanding human beings.