Sunday, November 27, 2022

Yet Another Problematic Example of the Medical Model of Mental Health

Was working this week on an article about the concept of setting personal boundaries. While doing research on the topic, one of the top web search results I found was this one-pager FAQ sheet. It was developed in 2006 by and is hosted on a UC Berkeley website.

The second sentence about personal boundaries says this...

"A person with healthy boundaries can say “no” to others when they want to"

Note the heavily lifting done by the word can. If you can, you're healthy. If you can't, you're unhealthy. As I've pointed out numerous times over the years*, the barriers preventing a person from being able to say "no" effectively might originate from any or all of factors including..

- Issues with self

- Issues with community 

- Issues with broader society  

 People in positions of low power are disempowered from saying no effectively. They don't have the luxury of privilege. They are at high risk. Saying "no" sometimes isn't just ineffective - it can be downright dangerous. More dangerous than the already existing harm from the "no" being ignored. It could risk physical or emotional abuse. It could result in getting fired from a job. It could risk smaller but still impactful microaggressions. And these are often people who do not have the privilege to just go somewhere else when these things happen (which is a topic deserving it's own article).

Do we call these people "unhealthy"? Are the poor "unhealthy"? Are marginalized people of any or all kinds "unhealthy"?

I hope it feels uneasy thinking about that. We may identity these people as "in distress". But I don't think "unhealthy" is the correct term. Maybe, on some technical level, health does not imply cause. Mental health professionals I've interacted with rely on this technicality a lot. Technically, they say, they know and account for social factors. In practice though...

The term health, in contexts like this, is often solely linked to and heavily implying that the issue is an issue with self. That you are unhealthy and that the tools of psychotherapy and relationship advice are all that is needed to fix you and solve the problem - in this case the problem of boundary violation.

Instead of calling boundary violation "unhealthy", call it what it is - boundary violation. 

Begin with a much more explicit separation of experience from cause, which is often not currently done. Put another way, I argue that, in practice, when professionals say "you are unhealthy" what they are also saying is "you are the problem". 

Much like medical disease, we center the problems within the self. And we focus solutions at the level of self. Not the environment. Not the community. That, in my estimation, is one of the key aspects (not the sole one, but a major one) of what it means to discuss the medical model of mental health and why it's problematic.

All the tools of emotional and relationship aid are aimed at what the individual is not currently doing and what they could/should be doing differently. Which, put another way, is telling them that they are doing it wrong and that we need to correct and fix them until they do it right. Being corrected and fixed is sold as the key to freedom from distress.

I am not opposed to the notion that individual-focused self-change strategies sometimes help. But when it becomes the only thing we talk about, it's a massive problem. Because no, individuals are not the sole and only source of their own problems and distress. Period.

*A tool I developed for helping map out causes between self, community, and society is The Accountability Triangle, available here

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