Mental Illness: Disease or Choice

Many people hear about Dr. William Glasser’s Choice Theory® and conclude that the psychology doesn’t believe in mental illness. Of course, this is not true, and this misinterpretation is why many people don’t give Glasser’s ideas credence. In the following paragraphs, I will attempt to explain exactly what Dr. Glasser means when he says he believes in mental health, not mental illness.

Imagine if what we believe about mental illness is wrong, just as people once believed the world was flat. If it’s possible that our conceptualization of mental illness is wrong, then it logically follows that we need to approach treatment differently. My goal here is not to change your mind; I’m merely presenting another possibility. Let’s journey into an alternative explanation and see where it takes us.

Choice Theory has two concepts that are central to this discussion. One is the concept of total behavior and the other is our creative system. Glasser says all behavior is total, meaning it consists of four inseparable components—your actions, thinking, feelings, and your body’s physiology. All these components occur simultaneously, even when one is taking priority. You only have direct control over two of these components. No matter how hard you try, you will not be able to change your feelings or your body’s physiology without first changing your actions or your thinking. You may not believe you have control over your thinking because sometimes certain thoughts enter our minds unbidden. However, when this happens and you recognize them as unhelpful, you can immediately direct your thinking to another area that is more beneficial for you. It takes practice, of course, and is a skill you can strengthen over time.

When we want something we don’t have, our natural reaction is to create some behavior designed to get us what we want. Sometimes, we rely on behaviors we’ve used in the past that were effective. Other times, we create a new behavior. Whatever our choice, we are choosing the best behavior available to us at the time to get what we want.

When it comes to mental health symptoms, many believe that an imbalance of our body’s chemistry causes the unusual behavior or thinking—but imagine the reverse. Over an extended period, what if the “crazy” behavior and thinking actually causes the chemical imbalance instead? Isn’t it at least possible? Isn’t it exercising that releases endorphins into our blood? It’s not the endorphins that make us exercise. Isn’t it thoughts of bodily harm that releases the chemical adrenaline into our blood stream when we are scared? It’s not the adrenaline that makes us scared, is it? What about those diagnoses that don’t have a known chemical imbalance, like Post Traumatic Stress Disorder or Dissociative Identity Disorder? These are a group of symptoms that develop during a crisis that serve us in that moment. In Choice Theory, Glasser would say they become organized behavior. In neurology, it might be said that neurons that fire together wire together. This means that once we produce a behavior and repeat it over time, it becomes the path of least resistance, and, when confronted with similar circumstances, we will default to our typical way of handling it.

So, if someone has developed a behavior that gets them something they want, then they are more likely to choose that behavior in the future. It is difficult to think of mental health symptoms as having any positive benefit to them. How could someone choose such thoughts and behaviors?

There is a concept in psychology called secondary gain. Mental health professionals have recognized that there often is some benefit for mental health clients in their symptomotology. It might get the client attention. It may abdicate them of daily responsibility. It might get them SSI benefits. They may be able to avoid unpleasant situations and keep undesirables at arm’s length. The list goes on and on. Couldn’t it at least be possible that these are not actually secondary gain, but rather the reason the symptoms developed in the first place? Couldn’t it be that a person learned that being sad got them attention so they developed, perhaps subconsciously, the behavior of depression? Couldn’t it be that a person learns anxiety gets them out of doing certain undesirable things? Once we experience a benefit, the behavior is more likely to repeat and become hardwired even long after it stops being effective.

Once of the criticisms of Glasser’s theory is that no one would actively choose to be neurotic or psychotic or personality disordered, but Glasser never said it was a conscious choice. Most people suffering with mental health disorders are truly suffering, unaware there is any choice in the matter. Our current approach to treatment basically reinforces this image of mental health clients as victims.

I don’t know about you, but I want my clients to know there is a choice. They didn’t know it before. But if they can understand how symptoms develop out of satisfying some need we have, then treatment becomes a matter of teaching them more responsible ways of meeting those same needs.

5 Responses

  1. “Watch your thoughts, they become words;
    watch your words, they become actions;
    watch your actions, they become habits;
    watch your habits, they become character;
    watch your character, for it becomes your destiny.”
    What we think about, we bring about. As a man thinks, so he is.
    Thanks for this clear explanation on how our choices form our future in all areas.

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