Mental Health: Focusing Beyond the Individual

This morning Facebook supplied yet another ad for me about mental health services. It was for a behavioral health hospital which was marketing itself as a trusted provider of effective help. 

Seeing that post triggered my continued struggle to declare, for myself and for at least some others, that these services sometimes aren't effective. I wrote them a post, and it's one of my favorite attempts to date trying to unpack and explain critiques of terms such as "health", "behavioral issues", and "effective"....

My Statement in Reply to the Facebook Advert

Effective help needs to also include fixing where people were failed by others/systems. How changes to those areas are what was needed to succeed, and how asking the individual to be solely responsible is a ridiculous and, at times, objectively impossible ask.

"Behavioral health" is an outdated concept. Yes, in some important instances personal change solutions are helpful. But so often it is also, at times, trying to teach people how to be tolerant and accepting of unacceptable situations. That needs to be challenged.

The other personal solution often offered by these institutions is the idea of leaving the unacceptable circumstance. Go away and find success elsewhere. This can work sometimes, but with at least two massive flaws:

1) It lets others/systems avoid accountability for their problematic behaviors

2) It minimized or outright denies the fact that sometimes there is nowhere else to realistically go.

The systems at hand have few to no answers for these issues, and disavow responsibility for addressing them. We need to move beyond the individual and include accountability of systems/others when talking about issues of mental health.

Edit: Follow Up Notes #1

In response to a comment on a social media site...

1) When I say "change others", that absolutely includes the mental health care system. Both at systemic and individual provider levels.

2) Agree with acknowledging the differences between how it could/should be versus how it currently is.

On #2, part of my advocacy is to continue to refuse to hold a view that my current circumstances are acceptable, or even tolerable. A view I hold, that parallels this post, is holding firm to an idea that...

As is, my life is currently intolerable. A important and large portion of why includes the attitudes and designs of people/systems as they currently are. When those change, I will do better. When those don't change, I will continue to be living an intolerable life. I am arguably not empowered to change that until external conditions/attitudes change. I am beyond exhausted of mental health offerings insisting that I am. 

That message seems so intensely absent from so much of modern dialogue on mental health.

Analysis and critique of "you don't have to explain yourself" advice

Ever heard the advice "you don't have to explain yourself"? Was it useful? Did it seem odd?

I've had mixed feelings about it, and certain readings of the phrase strike me as outright misguided. I might not be reading it "as intended". If that's the case, why not phrase the advice more clearly. Below is what goes through my mind upon hearing the phrase, and why it agitates and feels oppressive in my mind as currently written.

Let's start with a reading of the phrase I do find personally agreeable. One sense of the advice above is the idea that you don't always owe others explanations for your actions or behaviors. That you, at least in theory, could or should have a right to say no. I would agree that there are some situations where this works. Situations where there's a tendency toward might be termed "over-owing". Having a cognitive tool for being on the lookout for such situations, and giving a sense of self-empowerment to change those patterns, seems generally useful.

That said...

My critique is this - aren't there at least some situations where we arguably either do outright need to explain self to others?

The phrasing as written, to me, evokes the common myth of modern culture which constantly wants you to believe you are completely and wholly self-sufficient. Which is untrue. Humans are interdependent. No-one is born self-sufficient and the vast majority of us live adult lives relying on human interaction to some extent. Because of this, we are subject to the social structure and power dynamics of that interaction. Those dynamics, at times, will almost certainly ask or demand that you "explain yourself" at times or risk ostracization. Ostracization can, for some, be an immense threat to livelihood. So, instead, we do sometimes feel that we do have to explain yourself. Rendering the idea of "you don't have to explain yourself" a falsehood.

Rephrased as "you sometimes don't have to explain yourself", it's a less problematic phrase. But that's not how it's commonly written.

The above is just one example of situations where you might be outright compelled, and feel choice-less, in needing/having to explain yourself. A second area to explore is the human desire for connection. Mental health teachings constantly warn about the negative effects that extended or prolonged isolation can often cause (note: what counts as problematic isolation versus wanted isolation will vary from person to person). Explaining yourself, when received with respect and not hostility, can be a powerful way to relieve feelings of isolation. So, in that sense, there can often be a strong desire, or even "need", to explain yourself.

Explaining yourself is a path toward acceptance and connection. 

Those desires are, especially for autistic individuals, in low supply. To not explain is to stand by and allow non-acceptance to exist. To be complacent in human interactions that are causing harm. When I hear "you don't have to explain yourself", given the scenario of being harmed, I hear "you don't have to speak up and speak out against being harmed".

The phrase, as written, to me is heard as yet another demand for complacency. It is so convenient for others to refuse to hear, listen, or validate me explaining myself. Telling me I don't have to do it is often untrue, in the sense that not doing so condemns me to further pain, suffering, and isolation.

I understand, very clearly, how that's not what others might image the intended reading or advice of the phrase. I wholly acknowledge that some situations don't require explaining yourself, and the advice works great for that. In the situations where it is required, it's oppressive and harmful advice that implies empowered and positive choice exists where it, in fact, does not.

And yes, I feel compelled to be explaining myself here because I refuse to walk away and let others tell me this advice isn't hurting anyone. It's hurting me, and phrasing it differently would do a lot for seeing and respecting the barriers I face on a daily basis.