Our Biggest Mistakes When Debating Mental Health

Mental health is a topic of a lot of public debate. As an area that infuses science, politics, philosophy, morality, law, and many other areas, it is easy to see why. These debates and controversies can get heated, which to some degree is unavoidable but, in others, is becoming an increasingly tiresome product of rigid and oversimplified thinking that we would all do well to move on from.

Having been a part of these conversations for decades, there are a few errors I see being made repeatedly in these public discourses. They come from two major and erroneous assumptions.

Wrong assumption #1: Mental health problems are due to mainly one cause.

For decades, the classic nature versus nurture debate dominated the discussion. More recently, new “camps” of people have arrived, who advocate that mental health problems are solely due to any of: trauma, genetics, poverty, brain chemistry, nutrition, parenting, screens, or simply an over-pathologizing of regular human traits and emotions.

For so much of the discussion, elevating one cause means squashing another. Either serotonin is the primary driver of people getting depressed, for example, or it is completely irrelevant. What’s ironic behind these extremely common claims is that good research never supports the one-cause model. Rather, it shows us over and over again that our mental health is a complex soup that develops from a multitude of mutually interacting ingredients, operating at magnitudes that can be different for different people (see assumption 2).

Why we just can’t seem to embrace this thoroughly supported truth is puzzling. Maybe it is just too boring. Maybe it doesn’t get enough clicks or book sales. It’s a real mystery, but what isn’t a puzzle is how this urgent need to promote one cause of mental health at the expense of all others holds us back.

Wrong assumption #2: People are all the same.

We all understand that differences exist between us, of course, but you wouldn’t know it from reading and listening to a lot of the commentary on various mental health-related topics. My bad reaction to a particular medication means that all medications are evil. My mandated treatment that changed my life in a positive way means that we should be doing this for everyone who resists help. The parenting approach that worked for my kids will necessarily work for yours, too. We know that eating a peanut can be a tasty snack for one person and a death sentence for another but, once again, there seems to be this aversion to embracing any kind of complexity or diversity in our thinking.

Tolstoy famously wrote that happy families are all alike, while unhappy families are miserable in their own way. It’s a clever quote, but he didn’t give enough credit to happiness. For those people either with good psychological well-being and for those with major mental health challenges, there are unlimited pathways that could have brought them to that place.

What’s a better path forward?

To make our dialogue on mental health more constructive, we need to fully accept the overwhelming science in front of us. This means acknowledging the complexity that exists when it comes to mental health. It’s fine to continue to advocate for whatever particular areas we feel are important, but we need to stop viewing someone’s advocacy of another area as a threat and instead start viewing it as another piece of the puzzle that deserves consideration as well.

If we can do this, not only will these public mental health debates get less wearisome and contentious but, perhaps more importantly, our policy and clinical approaches will become more effective as we get off the dizzying roller coaster ride between one extreme and another and really get to work in promoting the health of our incredible and wonderfully complicated brain.