Examining a society’s mental health policies is a really good way to figure out:
- how much they blame an individual for being sick and
- how much they value a standard human life
People like to believe that the universe is fair. If they do good things, they get good things, whether it comes from God or karma or organizational leaders. If someone is mentally unwell, we like to think there was a sequence of choices they made to get there. They failed to make themselves resilient enough to handle stress; they chose to put themselves in a dangerous situation like signing up to a career that’s exposed to trauma or violence; they neglected to form a balanced diet and exercise routine or practice basic self-care. After all, how hard can it be to just… not do all that?
Eventually though, we observe things like children getting cancer or global pandemics, and we might concede the universe isn’t always entirely fair, but that the inequality still happens for a reason. Perhaps evolution requires that we have ten mediocre men for each great man but we all benefit so long as we know our place; mental illness is often genetic so perhaps some families are simply doomed at birth to live on the margins; many people think that a progressive perspective on mental illness means framing it as another challenge to be overcome through willpower, grit, and ingenuity; others see mentally unwell people as props for their resumes. “I know the real you is still in there!” we’ve seen countless characters scream on screen to a loved one with a mental illness personified by spiritual or supernatural possession. “Here’s an app for your mental health” we’ve seen countless high schoolers vibe code without any professional input.
Many people can’t find the stomach to hold all the rationalizations required for that perspective. A lot of horrible things happen for no clear reason, or if there is a reason, it’s so beyond their understanding that the universe begins to appear much more random than they thought. They have far less control than they imagined. I find that people split into two main personal reactions: they either adopt the mentality of a zero-sum game characterized by “fuck you, I got mine” hyperindividualism or they feel a need to build a strong social safety net with others to at least provide comfort for the suffering that can’t be addressed. The first camp tends to declare war on the second camp because they have no need for anyone preaching the values of redistribution. The second camp tends to keep trying to reconcile with the first camp as part of empathy for the human condition. After a while, the first camp selects for leaders who declare war on the second camp the best, usually through a combination of addicts and psychopaths who can set aside any conscience and concern for rules, while relying on people’s bias towards short-term problem-solving. Give the bully what they want, and they go away. They might come back tomorrow and ask for double, but today you’re safe. You can just keep “doing your job.” So all’s well that procrastinates well, right?
The way this breaks down long-term is that individual health issues compound into systemic public health crises. The burnout of healthcare workers during COVID-19 is a great example that’s still in our living memory. Prior to the pandemic, we already had issues with worker burnout. Researchers like Christina Maslach and Michael Leiter found that burnout varied enormously between organizations rather than individuals, which is in line with the work of those like William Edward Demings who notably said “a bad system beats a good person every time.” Consistently, institutions and their managers seem incapable of moving past the idea that individual performance is the primary determinant of outcomes when most factors determining an individual’s capacity have nothing to do with the individual’s choices. After all, that ends up putting a lot of accountability for a lot of failures in their court, and the solutions end up being more complex than adding resilience, stress management, or work-life balance classes as if the problem people have is being too stupid to assess their own needs. Of course, this mentality trickles down to the rest of society as the required mentality for success.
It’s at this intersection of individual health, systemic policy, and social ideology that you can see a society’s values. Do we care that some people don’t have the agency that others do to live a healthy and fulfilled life? Do we care about trying to make changes in the world that could improve that outcome? Do we foolishly believe that it could never happen to us, so we have no reason to care about it? Do we have the arrogance to think that it’s everyone else’s kid that will get offered and try drugs, but we will be the sole exception as guardians who can enforce a “Just Say No” policy? President Obama’s own drug czar struggled to navigate the mental healthcare system when his son struggled with drugs. President Trump’s brother died of alcoholism which he cites in his motivation to swear off drinking for good.
So given all that, I have given up on trying to make arguments from the position of morality or compassion, or even asking people to think of their kids. It simply isn’t happening, whether it’s because of greed, complacency, or ignorance. I now make arguments from the perspective of effectiveness and cost-savings, because when you point out how someone fumbled those within an organization, jobs might actually be lost. No one likes knowing that they hired someone who cost them money. Not taxpayers or managers.