As a psychologist, my focus is on mental and emotional health. I help people put words to the struggles they have been experiencing and to initiate change they have been looking to make. As I hear people discuss mental health and specific mental disorders, such as depression, anxiety, bipolar disorder, and a variety of other conditions, mental illness is often spoken about as if it is a choice. Someone can either stop being anxious/depressed/some other mood if they try harder; or they have no right to be mentally ill because they have everything good happening in their life. Do people choose to be mentally ill? Is mental illness within their control?
First, let’s define mental illness. Mental illness is an illness that impacts how someone interacts with their environment, more specifically in how they think, feel, and behave in their environment. As with most things in life, there is a degree of impact. It is possible for someone to have poor mental health while not experiencing mental illness. Poor mental health would be periods in which you are anxious, depressed, or stressed, for example. However, you are able to recover from these periods easily and they don’t have a prolonged impact on your overall functioning. Mental illness, by definition, must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. If you are depressed but it is not having a significant impact on your functioning, it would not be considered a mental illness. Instead, it would be a symptom of transient poor mental health functioning.
Mental illness is not a choice. People don’t make the choice to be depressed, anxious, or schizophrenic. Why would they? What benefit would it bring them? Sure, there might be some people that get more attention or time off work when they are mentally unhealthy, but those supposed benefits do not outweigh the consequences of mental illness. If you are someone who has been mentally healthy your entire life, despite various adversities you have experienced, it might be easy to think that someone else should also be able to overcome adversity the same way you did, while not becoming mentally ill. However, they are not you and you are not them.
Mental illness is a disease. It might primarily be centered in the mind but it is no different than a disease of the body. If someone were to be diagnosed with cancer, Alzheimer’s, or a heart disease, would you tell them they choose those physical issues? That they have a choice to get better? Ask them how could they possibly get a terminal or life changing disease when they have everything going for them? I would hope your answer would be no, no you would not ask or expect that from them.
There are a lot of memes and quotes out there that tell you to “choose happiness”. That is great advice, when it is within your control! When it is not within your control, it can be damaging. A mentally ill person can’t choose happiness any more than someone with a broken leg can choose to have it heal. The mind is powerful and we do have many choices in our life, but when it comes to issues with the mind and body, there are many things out of our control. That would be nice though! Will away your injury or mental illness. We have free choice in many things in our life, but some things remain out of our reach.
So, is mental illness within someone’s control? There is no straight forward answer to this question and the best response would be “to some degree”. This would be the same answer if you asked whether someone’s healing broken leg is within their control. There are things they can control to not worsen the issue such as don’t run on it, don’t let your child or pet jump on it, and do all required physical therapy exercises. Despite those things within the person’s control, components of the healing remain out of their control. Someone can’t force their leg to heal or heal faster. You can’t think away your broken leg anymore than you can think away your mental illness. When treating mental illness there are things within the person’s control, such as use of medications and engaging in therapy. Despite that, it depends on the severity of the mental illness. If the person’s mental illness is severe they may not have the ability to make any changes at all. Their mind doesn’t allow them to recognize therapy or medication as beneficial, or they can’t actively engage in their own change. This doesn’t mean the person isn’t trying or doesn’t want to change, it simply means their mental illness is beyond their control.
How we view mental illness impacts how we view the struggles of those with mental illness. If we think of their mental illness as a choice they have made, then we are likely to tell them to just change or work harder at being happy. However, if we understand it as a disease that is, at least in part, out of their control then we can support them through their struggles in ways that work best for them. When you talk about mental illness as if it were a choice, you are placing blame on the mentally ill for the situation they are in. This only acts to worsen their thoughts about themselves. Reduce the stigma of mental health by accepting that it is not something people can just “get over”, but is a disease that they might have little to no control over.