Let’s Rethink the Mental Health “Crisis”

The Surgeon General warned of a “mental-health crisis” among young people, adding urgency to long-standing concerns. Campuses are rushing to address these issues, but their efforts may do more harm than good because they’re rooted in the disease model of mental health.

The disease model sees painful emotions as evidence of a disorder. It presumes that happiness comes effortlessly to the “normal,” and “treatment” is the way to get it otherwise.

The disease model began in the 1950s with the first psychotropic drug. Acceptance grew with each new medication, and now the disease model is rarely questioned. It shapes our understanding of our emotions though we don’t notice it the way a fish doesn’t notice water.

Today’s students have grown up with the disease model. They have learned to see emotional pain as evidence that they are broken and need to be fixed. They’re trained to think others are happy all the time and they are missing out. They’re surrounded by dire warnings to “seek help” if they have painful emotions.

It’s not surprising that the Surgeon General’s evidence was entirely based on self-reporting. He pointed to increasing numbers of young people seeking help or reporting distress on survey instruments. All this really shows is that people are interpreting their emotions in the way they’ve been taught.

This alarmism would be fine if it actually helped, but basic biology explains why it doesn’t. The brain chemicals that make us feel good (dopamine, serotonin, oxytocin, and endorphin) are not designed to be on all the time. We’ve inherited these chemicals from earlier animals, and their job is easy to see in animals: they turn on when you meet a survival need. Then they turn off, so you have to keep meeting needs to keep stimulating them. (Complete information is in my book, Habits of a Happy Brain: Retrain your brain to boost your serotonin, dopamine, oxytocin and endorphin levels.)

Our education system is rooted in Rousseau’s model, so researchers tend to find evidence that fits it and overlook evidence that doesn’t.

In short, ups and downs are natural. Our brain is motivated to do things that trigger our happy chemicals, but it’s a challenge to trigger them in ways that are healthy in the long run. It’s a complex skill that we start building from birth and keep building throughout life. This is why emotion-regulation skills have always been prized by human societies.

Emotion-regulation skills build from repetition, like any other skill. It’s nice to have help, but no one can reach into your brain and build them for you.

You are less likely to build these skills if you are told that you have a disorder and “services” will fix it. You don’t build skills when you expect your brain to be fixed the way your car is fixed. Happiness is a learned skill, and unrealistic expectations get in the way.

Good intentions may drive the disease model, but good intentions should allow us to notice when it harms. The risks of behavioral medication are widely overlooked, though evidence has accumulated for decades in titles like Pharmageddon, Psychiatry Under The Influence, and Let Them Eat Prozac. The recent PBS documentary, Medicating Normal, describes severe side effects of popular anxiety, depression, and attention-deficit medication. The pharmaceutical industry dismisses such evidence as “anecdotal,” and academia has mostly followed suit.

The disease model wears the mantle of Science, but it’s based on Rousseau’s philosophy more than it’s “evidence-based.” Rousseau said that happiness is the default state of nature, and unhappiness is caused by civilization. Our education system is rooted in Rousseau’s model, so researchers tend to find evidence that fits it and overlook evidence that doesn’t. We end up believing that unhappiness is caused by “our society,” so it’s society’s job to fix it. We expect the perfect society to deliver universal happiness, and while we’re waiting, we expect the healthcare system to give it to us. These beliefs are treated as Science, but they’re just beliefs. 

If the disease model does harm and is not based on science, why don’t we question it?

You risk being condemned as a “stigmatizer” and a “hater” if you question it. Such attacks often come from “advocacy” groups that are funded by the very companies that supply their medications.

Questioning the disease model threatens your career if you work in the “helping professions.” It bars you from grants and promotions within the therapy-industrial complex. You risk losing your credentials, or failing to qualify for them in the first place. In effect, you have to embrace the disease model to be a member in good standing with the mental health profession. It’s not surprising that little criticism is heard from mental health experts.

But there’s more than self-protection behind support for the disease model. We accept it because it feels true. It explains painful emotions that we cannot explain otherwise. It’s better than models that came before it, like the idea that demonic possession causes painful emotions, or the Freudian sexualizing of children. If we had a better model, things would change. And we are fortunate to live at a time when an alternative is available. The facts are all there but the research is in silos so no one has connected the dots. Let’s start connecting them.

The Inner Mammal Model

Our emotional chemicals are controlled by brain structures inherited from earlier animals (the amygdala, hippocampus, pituitary, etc.). This limbic system cannot process language, so it cannot tell you in words why it releases a chemical. Your verbal brain and your emotional brain are literally not on speaking terms. As Steven Pinker put it, your verbal brain lacks “insider information” about the emotional brain it’s attached to. This is why everyone struggles to make sense of their emotions.

The brain chemicals that make us feel good are not designed to make us happy. They evolved to reward you for action that meets a need. Different needs trigger different reward chemicals, motivating us to meet social needs as well as physical needs. But our dopamine, serotonin, oxytocin, and endorphin come in short spurts, so we have to keep meeting needs to keep enjoying them.

To complicate life further, our brain habituates to what it has. Finding water made our ancestors happy, but unlimited running water doesn’t make you a bit happy today. Our brain saves the happy chemicals for unmet needs. This constant urge for more helped our ancestors survive, but today it’s seen as a moral failing or a sin of capitalism. We have a frustrated treadmill feeling because of the unrealistic expectation that happy chemicals should flow all the time for no reason.

Threat chemicals play a big role in an organism’s quest to meet its needs. Threat chemicals are the brain’s signal to withdraw to avoid harm, just as happy chemicals are its signal to advance toward a reward. Threat chemicals are half of our operating system. They are a natural part of life.

Disappointment triggers threat chemicals, even if you don’t consciously see the disappointment as a threat. When a lion fails to catch its prey, its cortisol surges. The bad feeling helps the lion by telling it to stop investing energy in the failed chase. But hunger triggers cortisol too, so disappointment must feel even worse to send the message. This is why failure is painful. Disappointment feels like a survival threat because it triggers the same chemical. Your conscious brain doesn’t know this, so it presumes you’re really threatened.

There is no royal road to mental health. No one floats through life on an endless stream of happy chemicals. If you expect this, you will be disappointed. But you can build the skill of steering your brain from threat chemicals to reward chemicals. It takes a lot of practice. You will do the practice if you have realistic expectations about your inner mammal.

Realistic expectations about happiness are the best thing we can teach our students.

Loretta Graziano Breuning, PhD, is Founder of the Inner Mammal Institute and Professor Emerita of Management at California State University, East Bay. She is the author of many personal growth books, including Habits of a Happy Brain: Retrain Your Brain to Boost Your Serotonin, Dopamine, Oxytocin and Endorphin Levels. Her books have been translated into twelve languages. Details at innermammalinstitute.org.