I write this piece on the eve of 75 years since the birth of modern psychopharmacology and 50 years since the discovery of Prozac, once touted as a miracle drug to treat depression. Before the advent of DSM-III and the arrival of Prozac, cases of mental disorders were limited. However, with the introduction of more and more drugs, the incidence and severity of mental disorders have skyrocketed.

The World Health Organization (WHO) estimates that 1 in 8 people globally—i.e., 970 million or 12.5 per cent of the world’s population—live with a mental disorder today. In the US and UK, the percentages are 23.1 and 25 respectively, while the proportion of Indians suffering from mental illness at any given time is 16 per cent.

The consequences of the rapid growth in mental illness are immense. According to the WHO, the burden of mental health problems in India is 2,443 disability-adjusted life years (DALYs) per 100,000 population. It also estimates the age-adjusted suicide rate per 100,000 population as 21.1.

Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD) are the most common mental health conditions. As per WHO estimates, 280 million people globally suffer from depression, 304 million from anxiety disorders, 40 million from bipolar disorder, and 24 million from schizophrenia.

Over the past three decades, the global burden of mental disorders has seen a steep rise. According to The Lancet, between 1990 and 2019, global DALYs due to mental disorders significantly increased from 80.8 million to 125.3 million.

A few pressing questions arise at this juncture:

I will attempt to answer these questions a little later. Suffice it to say, for now, that after the discovery in 1975 of fluoxetine—the first SSRI, marketed under the tradename Prozac—and its projection as a “miracle drug," the following consequences ensued:

Prozac was sold as a “magic pill" to treat depression and other mental ailments including anxiety disorders. But was it? The editorial of the May 2025 edition of the prominent medical journal The Lancet sums it up succinctly: “But 50 years on from landmark developments in drug treatment (with the arrival of Prozac) that were the cause of so much hope, we remain a long way from providing the level of care that so many people need, and this need continues to demand the attention of the scientific and medical communities."

I begin with a brief account of the DSM—the so-called psychiatric bible—and its controversial role in the proliferation of mental illnesses. The DSM first appeared in 1952 as a crisp 32-page document when the Committee on Nomenclature and Statistics of the American Psychiatric Association (APA) published the first edition, DSM-I.

From those original 32 pages, the manual expanded to 494 pages in DSM-III, culminating in 1120 pages in the latest version, DSM-5-TR (Text Revision).

DSM-I bore a distinct Freudian imprint. It also drew from the seminal work of eminent European classifiers of the late nineteenth and early twentieth centuries—German Emil Kraepelin and Swiss Eugen Bleuler. Everything changed in 1980 with the publication of DSM-III.

DSM-III marked a significant shift: the classification of mental disorders moved from “aetiologically defined illnesses" to symptom-based “categorical diseases." This was ostensibly done to create a more standardised and reliable framework for diagnosis. Ironically, DSM-III ushered in an era of medicalisation and chemicalisation of mental illness. It contributed to an exponential rise in diagnosed mental illnesses, broadened the scope of psychiatric intervention, and fuelled a dramatic surge in the sales of psychotropic drugs.

The result? From fewer than 100 classifications of mental illness in DSM-I, the number swelled to more than 220 in DSM-5-TR—pathologising a wide range of human emotions and behaviours. The latest addition to this list is “prolonged grief disorder."

Moreover, despite eight iterations of the DSM over seven decades, its diagnostic system—based solely on consensus among contributors—continues to suffer from a lack of both reliability and scientific validity. DSM diagnoses are based on agreement over clusters of clinical symptoms, not on objective laboratory measures.

Unsurprisingly, in 2013, Dr Thomas R. Insel, then Director of the National Institute of Mental Health (NIMH), announced that the agency would no longer fund research based on DSM criteria. Insel cautioned that the DSM’s supposed precision and reliability had been overstated for decades: “While DSM has been described as a ‘Bible’ for the field, it is, at best, a........

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