Book Review
The Unfragile Mind: making sense of mental health
by Gavin Francis (Profile Books, 2026)
“Our minds are not brittle or rigid, they are dynamic, resilient and adaptive: they are not fragile but unfragile. Their capacity for change is part of their very nature.” With these inspiring words, the GP author of this beautifully written and thoughtful book sets out his stall. And while I expected to agree with his argument, I was still surprised by how much I learned as well. (For instance, newest research from 2024 shows that 85 per cent of untreated depressions resolve on their own within a year. And, after a year of treating young children with stimulants for ADHD, the only ongoing effect may be to stunt their growth.)
Francis sets the scene with his own first unsettling adolescent acquaintance with fierce anxiety, how it descended and lifted, giving him a lived experience of the pliability and suggestibility of the human mind, and how what happens there cannot be parcelled off as separate from what is happening with the body. Having studied medicine, he chose to enter general practice because it would enable him to engage with the universal mental states that don’t warrant psychiatric intervention: “Our mental states are where we live; they filter every experience and sensation”.
This position underpins his scepticism about the validity of labelling mental conditions and the inclusion in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of categories constituting risk of developing particular states of mind: “We’re all at risk of all sorts of things – it’s a shift that, if extended further, could find pathology in all of us. … If I had one ambition for the twenty-first century, it might be that we human beings become more tolerant of uncertainty, more comfortable with paradox, more compassionate and open-hearted about the fuzzy edges of the categories we try to impose upon the world.”
Thus his view that a diagnosis of autism is warranted only if there are significant impairments causing distress: “When a mental state is said to affect around 3 per cent of the population, as autism now does, it has moved from being something best understood as a disorder into the territory of a common manifestation of the ways humans think, feel and exist.” This doesn’t mean that he disregards the milder manifestations, just that these manifestations can better be managed as part of general human difference.
As a GP, he may be an outlier, in terms of engaging with mental states, whatever a patient brings to his surgery. (Seven glorious pages of realistic ‘dialogue’ enact gently moving a patient away from wanting medication for their ‘bipolar’ to their embracing the idea of learning how to get difficult feelings under control.) He is concerned with the complexity of being, within family life, community and culture, and the diverse ways people respond to the challenges and obstacles that they encounter.
Having started by exploring how we have arrived at the thinking that predominates in psychiatry today, cycling through the different trends in psychiatry (from chemistry to networks) and the contribution of brain scanning (pros and cons), he goes on to explore in compassionate detail what he encounters daily as a doctor, and the many ways that people across cultures make sense of their difficulties “in thinking, feeling and being”.
He is at pains to point out that the ‘categories’ of anxiety, trauma and so-called personality disorders, mania, depression, psychosis, addiction and neurodiversity, each of which has its own chapter, “are not discrete but flow into one other in patterns that vary for each person” and are manifestations writ large, sometimes too large, of what makes us all human. For instance, as he eloquently describes, “Heightened irrational fears are the price we pay for our magnificently social minds, which excel at second-guessing the intentions of others, but can easily slide into being overcautious, protective and paranoid”.
In keeping with his understanding of mental illness as a feature of the human condition, the book is full of stories, threaded through with relevant findings from research that inform his perspective. He not only recounts with utter humanity the experiences of individuals but also the stories of those who have added to – or maybe addled – our understanding of the mind. For Francis (as for those of us in the HG world), whatever the labels used for mental distress, it is really all about relationships – difficulties in forming or maintaining them for a variety of reasons, including struggling to manage emotions, inability to interpret others’ intentions, or withdrawing from or damaging them because of overwhelming life circumstances. He ends with a wonderfully uplifting section on really matters in life – all the seemingly simple things that expand our awareness, enabling us to value connection and appreciate what’s around us.
Reviewed by Denise Winn