“It’s Not My Fault!” Blame, Responsibility and Mental Health

(4 minute read)

One of the nicest things that psychiatry has done is to try to help us stop blaming ourselves for our psychological problems. We’re told that our depression is a result of an imbalance of chemicals in our brain. Our anxiety an overactive amygdala and a fight-flight-freeze response that’s out of kilter. Our distractibility and restlessness is a brain disorder called ADHD. Whether or not these are true is beside the point. The cause of the problem has been located in our biology, not our character.

Suddenly, it’s not our fault. Hooray! We can tell ourselves, our friends and family that it’s not because we lack willpower, or are lazy, or overthink, or are just foolish, or have a character flaw. The doctors have spoken, and there is Something Wrong With Our Brains. There is as much shame in having any of these psychological problems as there is in having a broken leg. And just as with a broken leg, there are medications and treatments that can be applied to fix us. What a relief.

So far, so good. Unfortunately, this pretty picture now starts to break down. The medical profession is a lot better at fixing broken legs than they are at changing the way we feel and behave. If you’ve read my previous blogs (here, here and here) about the topic, you’ll know the effectiveness of the psychiatry profession is a good deal closer to the age of blood-letting than it is to Star Trek. Some of their drugs are no more effective than a sugar pill, but unlike sugar, will offer a slew of unpleasant side effects. Others are highly addictive and can be life threatening over time. And still others cause such awful side effects that after taking them for a long time, consumers can no longer function in society and may even kill themselves. (See Tardive Dyskinesia and Akathisia.)

You might argue “Sure, the drugs may not be ideal, but they’re better than nothing, and anyway, it’s got to be good for your mental health to know that your problems are not your fault — that it’s your brain’s chemicals and structures that aren’t working well.”

On the surface, that seems a reasonable argument. Let’s test it: If being diagnosed and medicated was a good thing for us, something that helped us shed blame for our problems and feel better, one would expect that the western world would be experiencing increasing levels of happiness and mental health. The numbers tell a different story: In 1987 in the United States there were 1.25 million adults receiving a payment from the government for disability due to mental illness. In 2012 that number had more than tripled to 4.2 million. In the same period of time, spending on psychiatric drugs increased by 3,750%, from US$800 million to US$30 billion. Lots of diagnoses, huge amounts of medication and the result: lots more people who are too mentally ill to function in the workplace. If all the diagnosing and medicating was working, you’d expect fewer people to be disabled by mental illness. Something is very wrong with this picture.

The psychiatric profession and the pharmaceutical companies certainly bear their share of responsibility for selling us psychoactive drugs which, while they have their uses, are to various degrees ineffective, addictive and harmful. But even their basic premise — that our problems are not our fault because they lie in our brain chemistry — may be harmful, strange as that may seem.

Here’s the dark side to being told our problems are not our responsibility. Being diagnosed with a “Disorder” hands over power to the medical profession. We’re no longer responsible for getting ourselves out of our depression, or reducing our anxiety, or focusing on our work. Someone has to help us, usually with a pill. We’re no longer in control of our lives, no longer responsible for our problems, and no longer searching for solutions. The doctor will give us something to make us feel better. And only he (it usually is a ‘he’) can help us.

In effect, we give up. Our problems seem beyond us, and it’s only the medical profession that can rescue us. Our greatest weapons in our battle against our problems are our optimism, our creativity and our determination. Taking those away only to turn to a medical establishment that has little or nothing to offer us is equivalent to surrender. Here’s an example:

Linda didn’t recognize that her relationship with her husband was in trouble. All she knew was that she was feeling sad and tired much of the time. Her doctor told her she was depressed and prescribed antidepressants. A year later she was still feeling sad and tired. And because the marital relationship was still in trouble, the root cause of her sadness and exhaustion had not been dealt with.

Had Linda not been seduced by the idea of a pill that would solve her emotional problems, she might have spent more effort trying to understand what was going on in her life that could make her feel this way. Perhaps her parents, friends, or a therapist could have pointed out that her husband was treating her in a way that would make anyone unhappy.

So if the psychiatrists are wrong to absolve us of responsibility and put the blame on brain chemistry, does that mean we should take the opposite tack? Am I advocating that we tell unhappy, anxious, struggling individuals that their own “weakness” is responsible for their problems? It seems that these are the only two choices: It’s either our fault, or it’s not our fault.

But there is a third way. The psychiatrists are right to say that it’s not our fault. But it is our responsibility to get better. Perhaps we are depressed because of our terrible childhood, anxious because we overestimate threats, unable to sit still and concentrate because that’s just the way we’re built. We didn’t ask to be saddled with these problems. But they’re ours, and we now have to figure out a way to fix them the best we can so that we can at the very least muddle our way through life.

This is a difficult concept to accept: That it is our job to fix ourselves even though it isn’t our fault that we have the problems we have. It goes against the grain of a “You broke it you fix it” mentality that underlies western culture. And yet it makes sense. The things that have happened to us in our life have interacted with the type of personality we have to create the problems we live with. Bad stuff happens, and blaming ourselves, our DNA or our parents resolves nothing. However, the response of the medical profession — essentially “There, there you poor thing, it’s not your fault, so take this pill and you’ll feel better” — tells us that our optimism, creativity and determination are meaningless. It takes away our agency, our control over our own lives.

That’s important, because the need for control over our lives seems to be hardwired into us, as any parent of a two year old can tell us. Just the very fact that we are in control makes things feel less awful. Two examples: First, for therapy clients, the knowledge that we have made an appointment to see a counsellor makes a sizable percentage of us feel better, even before we attend our first session. The simple fact that we’ve taken the first step toward addressing our problems is enough to help us. Second, the ability to control the amount of pain medication received makes hospital patients reduce the amount they actually take. Knowing that the amount of pain they’re going to feel is within their control makes the pain more bearable.

So when the medical establishment tells us it’s not our fault, in the long term they make us feel worse, not better. We must remember the first part of the message — that we’re not to blame for our problems. But we must ignore the second part — that the doctor will help us. It’s not the responsibility of the medical profession to fix us. It’s our responsibility. And we not only own that responsibility, we also own the tools, the strength, the ability to ask for help, and the capability to make ourselves better.