Mental Illness: Disease or Choice?

Is it true that Dr. William Glasser's Choice Theory doesn’t believe in mental illness? Of course not! However, that is what many believe and some don’t give his ideas credence because they think he is wrong about that. This article is my humble attempt to explain exactly what Dr. Glasser means when he says he believes in mental health, not mental illness. This article should be particularly helpful to those of you who work in the helping professions or those of you with family members who have been diagnosed with any type of mental disorder.

I'm asking you to take a journey with me into the realm of possibility. What if what we believe about mental illness is wrong in much the same way people in Columbus’ day believed the world was flat? And if it’s possible our conceptualization about mental illness is wrong, then it logically follows that perhaps we need to look at treatment differently.

My goal in this issue is not to change your mind about what you think and believe, but merely to present another possibility. Take a journey with me 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. I’ll start with total behavior. Glasser says all behavior is total, meaning it consists of four inseparable components—your actions, your thinking, your feelings and your body’s physiology. All of these components occur simultaneously, even when you are more aware of one of them.

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, once you learn how, you can direct your thoughts from unwanted topics to healthier ones.

When we want something we don’t have, we are driven to create a 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 in our body’s chemistry causes the unusual behavior or thinking. But what if the “crazy” behavior and thinking over an extended period of time 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?

And what about those diagnoses that don’t have a known chemical imbalance? What about Post Traumatic Stress Disorder or Dissociative Identity Disorder. These are groups of symptoms that develop during a serious 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 basically 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 works for them to get 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. Why would someone choose such thoughts and behaviors?

Currently, there is a concept I hear more and more in psychology called secondary gain. Mental health professionals are recognizing that there often is some pay off 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 gains, 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 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 become hard wired and therefore repeated, 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. 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 understand now how symptoms can develop out of satisfying some need the had, then treatment becomes a matter of teaching them more responsible ways of getting those needs met.