As a clinical psychologist, David van den Berg witnesses daily how the mental healthcare system confines people within diagnoses. Now that he has been appointed as a special professor at Vrije Universiteit Amsterdam, he wants to challenge this rigid approach. „Someone is given a borderline diagnosis, but in reality, they have debts, an unstable home situation, and unresolved trauma. We apply a label but fail to address the real problem.”

A woman locks herself in her room for an entire weekend at a mental health institution. The staff describe her as 'psychotic' and struggle to reach her. When David van den Berg arrives at work on Monday morning and speaks with her, he discovers a different reality. She believes she is in danger because the police told her she needed to come with them 'for her own safety'. In her mind, this confirmed her fears: 'You see? They are going to kill me. The only safe place is here, in this room.'

„It was a confronting case from my early years as a psychologist,” says David van den Berg, sitting in his office on the third floor, overlooking the HMC hospital in The Hague. „But the core of the problem remains the same. We observe behaviour, assign a DSM label (a classification system for mental disorders, ed.), and fail to ask the most important question: why is someone reacting this way? The person disappears behind the diagnosis.”

„I don’t see myself as a typical professor."

You were recently appointed as a special professor of clinical psychology at VU. In your inaugural lecture, you initially wrote that you never wanted to become a scientist and found professors rather odd.

„(Laughs) I don’t see myself as a typical professor. What I wanted to emphasise is that professorship was never a goal in itself for me. I see science as a means to improve healthcare, not as a way to put myself on a pedestal. And to be honest? I feel uncomfortable with the status that comes with it. The robe, the hierarchy... that’s just not my thing. But I have also learned that if you completely reject it, it becomes even more awkward. So, I try to own it without losing myself in the process.”

You argue that the current mental healthcare system, with the DSM as its main reference, has exceeded its purpose. What do you mean by that?

„That we confine people within diagnoses that say little about their real problems. Take someone who seeks help for severe panic attacks. Instead of mapping out their life story during the intake, they are primarily asked about the presence or absence of various symptoms. A week later, they are told: 'You have an anxiety disorder.' Great, a label. But perhaps that anxiety stems from debt, a toxic relationship, loneliness, or childhood abuse. That reality is not properly addressed in the current system."

„The problem is that we treat the diagnosis, not the underlying cause."

„The problem is that we treat the diagnosis, not the underlying cause. I regularly see people with five, six, or even seven different DSM classifications. All these labels, yet I still have no idea what is truly going on with them."

You advocate for a complete overhaul of mental healthcare. What does the system need, in your opinion?

„To start with: more equality in conversations. A simple question like, ‘What do you think is maintaining your problem?’ could make a difference. Instead of immediately searching for a disorder, we should explore a person’s life story and patterns over several sessions. We then select one primary goal and evaluate progress after six to eight weeks before adjusting the treatment plan accordingly."

„This approach places the therapist and patient on equal footing, giving the patient more responsibility and control. The doctor in the white coat no longer assumes an authoritative position deciding on treatment but rather acts as a guide, accompanying the patient on their journey for a while."

„The doctor acts as a guide, accompanying the patient on their journey for a while."

„During treatment, we can still utilise the DSM, existing therapies, and medication—not everything needs to be discarded. But currently, some people are prescribed antidepressants as the sole treatment. Yet, antidepressants are not truly 'anti-depressants'; they suppress certain symptoms but do not necessarily address the root of someone’s problems. Likewise, schema therapy, which focuses on patterns, is not the right fit for a man who has not told his wife about his sex addiction and debts. That simply won’t work."

„Additionally, care should be more practical and less bureaucratic. If someone with PTSD cannot attend therapy because their bicycle is broken, we provide a bicycle. That is not healthcare or therapy, but it helps nonetheless."

„Mental health fluctuates, and everyone struggles with themselves at times."

Does this mean we need to change how we view mental health issues?

„Absolutely. We often see mental health as something static: you are either ill or healthy. But it is dynamic. Mental health fluctuates, and everyone struggles with themselves at times. The problem is that we still approach psychological issues as something internal—a brain problem that can be solved with a diagnosis and treatment—while social context plays a massive role. Anyone can experience difficulties at some point in their life. Anyone who faces financial troubles, loneliness, stress, physical health problems, or a lack of social support."

But doesn’t this perspective lead to budget cuts? If everything is fluid, when does someone qualify for care?

„That is indeed a risk, but every pound invested in good mental healthcare pays off significantly. People can work, reliance on benefits decreases, and absenteeism is reduced. A bigger issue is that much of the current funding goes towards mild problems. Our friends with stable jobs and mild stress often see a psychologist for a year, while those with severe issues wait a year for help. That needs to change."

„But during my final internship in mental healthcare, I realised there is plenty of development work to be done right here in the Netherlands."

Given the strained healthcare budget, does this new approach not lead to higher costs?

„We have been applying this method for a year and a half, and we are already seeing positive results. Patients report that they finally understand what is happening to them. These insights lead to greater engagement and a more active approach, which is expected to result in faster recovery and, ultimately, shorter waiting lists."

What motivated you to enter mental healthcare and shape your research in this way?

„After my studies, I initially wanted to go abroad and do volunteer work. But during my final internship in mental healthcare, I realised there is plenty of development work to be done right here in the Netherlands. I was shocked by how many people were truly struggling, being passed from one service to another, stuck in a system they couldn’t escape."

„I quickly learned that I should never become desensitised to how difficult life can be for some people. It is tempting to think: 'That’s just the way it is.' But I refuse to accept that as normal. My drive is not only to improve mental healthcare but also to change the way we think about psychological problems. At the same time, I have also realised that I need to appreciate small victories—that way, I can keep going until retirement."