It’s time that we fix a flaw in our mental health model: its denial of personal responsibility.
Mental health is not hard-wired at birth; it’s a set of learned skills. Help is nice, but it only helps if the skills are actually learned.
Today’s “help” is based on the disease model. It sees emotional distress as a disease that experts can treat. Your brain is thus akin to your car: something you don’t tinker with yourself.
The disease model trains us to see happiness as an entitlement. It presumes that happiness is effortless for the “normal” brain. If you are not effortlessly happy, you are entitled to a cure. You learn to expect effortless happiness from the healthcare system.
This view of emotions is biologically false as well as counter-productive.
Our happy brain chemicals (like dopamine, serotonin, oxytocin, endorphin) evolved to do specific jobs, not to flow all the time for no reason. They’re designed to reward survival behavior. They metabolize quickly so you always have to do more to get more. In the state of nature, continual action was necessary for survival, and happy chemicals rewarded that action.
When you expect happiness to come from “the system,” you have less reason to take the steps that would trigger it.
Mental health professionals are well-intentioned and hard-working, but their training often rests on the belief that our society is the problem. This mindset does not see people as responsible for the consequences of their actions, because social injustice is responsible.
This externalizing weakens our focus on internal skill-building. And it undermines the biological mechanism of happiness. The brain is designed to reward you with happy chemicals when you meet a need. When you "get help," you strive to follow this admonition, and it feels good sometimes because helping others meets some of your needs. But your brain keeps doing the job it evolved for. It monitors your needs and sends distress signals when you ignore your needs.
Here's another way to look at it: Children have their needs met by others. Adulthood means meeting your own needs, and those of any children you have. Fortunately, happy chemicals are stimulated by the act of meeting your needs. You miss out on happy chemicals when you decline to honor your own needs. The blame-society mindset trains you to feel burdened by the ordinary demands of adult life.
Animals live with the constant risk of hunger and predation, yet their happy chemicals flow when they take steps to meet their needs. Your sense of well-being rests on your confidence in your ability to meet your needs. The disease model invites you to blame unwanted emotions on externals instead of building your internal power. It suggests that your emotions are not your responsibility. You are deemed responsible for diet and exercise, but not for the habits of mind that trigger happy chemicals.
It’s hard to take responsibility for your brain, of course.
It’s hard for everyone, which is why our self-management skills always need work. It helps to build them in youth when neuroplasticity is higher, which is why societies have historically emphasized the teaching of self-management skills to young people. What will happen to a society that trains young people to think they are not responsible for the consequences of their actions?
No one has a perfect childhood. Each of us faces the world with a neural network built by a random collection of experiences. Neurons connect when rewards or pain are experienced. Children are rewarded for bad behavior sometimes, which wires them to repeat bad behavior. When such behaviors are hard to manage, a “mental illness” diagnosis may be attached to them. That may bring services, but it may not bring what the person needs most: to be rewarded for healthy behaviors and not rewarded for unhealthy behaviors. Dysfunctional incentive structures are hard to change, so it's good to have help. But the disease model and the blame-society model often ignore the incentive structure behind a behavior pattern. They make it taboo to even discuss them.
Medication is attractive when other paths are taboo. If medication doesn’t work, another medication seems like the only hope, and then another. A patient may learn to see themselves as a disease victim rather than as a learner of self-management skills. They may be taught to “manage their disease” and to demand accommodation of their “disease.” They may learn to blame the world for failing to accommodate them adequately. This distracts from the essential task of building healthy habits for meeting one’s needs.
“Help” doesn’t help when it panders to our natural negativity instead of helping us transcend it.
We are fortunate to live at a time when the brain is increasingly well understood. This new knowledge can help us build better self-management skills than our ancestors had. To do that, we must celebrate our responsibility for our own brain instead of abdicating it.
What can be done to fill the personal-responsibility gap in mental health services? What can be done quickly, given the current expansion of services? Perhaps a system-wide training about unconscious bias against personal responsibility. Mental health professionals can be taught to see their patients as managers of their own brains instead of as victims. Staff can be taught to reward desired behaviors and to resist rewarding undesired behaviors. This modest shift in mindset could benefit everyone.