A Matter of Choice in Mental Health

Do You Have a Choice or Not?

The idea of ‘choice’ is very interesting and revealing particularly when it comes to mental health problems and especially when it comes to the central idea of whether or not a person actually does, or doesn't, have a choice about the way that they think, feel or behave.

(Also, see Choice Theory here).

If you believe that you have ‘no choice’ in any particular aspect of your life then it is highly likely that you will make very little conscious effort to make a choice or to change anything negatively impacting on your life.

Are there ANY circumstances in which a person truly has NO choice whatsoever?

It seems that the answer to this question depends intimately with what you personally believe and is an excellent indicator of a person’s ability to cope with many of life’s challenges.

Consider the following:

• I’m heavier than I'd like to be because I can’t help myself from eating too much food.
• I can’t stop gambling because I have to make a bet when I’m in the Casino.
• I can’t help it when I get anxious or stressed, it’s automatic.

Are these statements universally 'true'?

Or are they more specifically about person who is making the statement?

• Can a person really eat less food and it be a matter of choice?
• Can a person really enter a casino and simply choose not to make a bet?
• Can a person really choose not to become anxious or stressed about something?

Most people would probably say that in the first two examples that a person DOES have a choice because these are not classically recognised as 'mental disorders' whereas 'anxiety' is a real medical condition - right?

Actually, the view that ANY mental health disorder is some sort of brain disease is very vigorously contested by, on the one side, Psychologists and on the other side, the Psychiatric community.

You can read our post about Psychiatric Diagnosis for more information about this debate.

The Ability to Make a Choice

People generally fall into two distinct camps when it comes to idea of whether a person has a choice or not.

Those who BELIEVE that they have no choice have often ‘learnt’ this thinking style in their early developmental years and in many cases as a 'socially constructed' norm or rule that cannot be questioned.

This might mean, for example, that some people 'unquestioningly believe' in the absolute authority of the medical and psychiatric profession and assume that what they say is fact is fact.

On the other hand, those who believe that they can always choose what they do will have had similar ‘empowering’ experiences in their developmental years or are less prone to be 'swayed' by social opinion or judgement.

So, it seems that the crucial factors leading to the ability to make a choice depends on what you learnt and what you believe.

Crucially, both of these factors can be changed; you can learn new ways of behaving and you can change what you believe.

Direct Action or Avoidance?

Consider the following 'strategies' for dealing with two very prevalent problems that people experience

The best way to stop drinking too much alcohol?

a. Never go near a place where they sell alcoholic beverages (the alcohol is the problem not the person drinking it) - NO CHOICE

b. Learn to take control of your mind and body and stop drinking too much alcohol (the problem is within the person) - HAVE A CHOICE

The best way to lose weight?

a. Have your stomach stapled-up so you can’t get as much food into your body (the problem is with the type and volume of food eaten, or the un-controllable emotions that MAKE a person eat too much) - CAN'T STOP EATING TOO MUCH FOOD - NO CHOICE

b. Learn how to take control of your mind and body and eat less food (the problem is with the person's relationship with food) - HAVE A CHOICE

But just how effective are these two 'a' options?

Will you really be able to reduce your drinking if you never go near a place where they sell alcohol?

Yes, probably, but this more than likely means that you have to limit going outside because alcohol is sold widely and without prohibition.

Can you lose weight if you have surgery to reduce your stomach size?

Once gain probably yes, but it is still possible to overeat even if your stomach is tiny, as in fact it once was before you started overeating.

The problem with these types of solutions is that they require very little effort or responsibility from yourself because what you do is make somebody or something else the solution to the problem.

In effect, what you do is make the open selling of alcohol the problem or you make the surgeon responsible for you eating less.

These types of solutions are known as avoidance strategies and although you may get an initial benefit, the chances are that your personal behaviour will remain the same, or in some cases actually get worse because it’s not your fault if you accidentally come into contact with alcohol, or your get a bit upset and need to eat twice as much food as normal.

In general terms, if you 'locate' the problem you are experiencing as 'outside' of you and your ability to make a choice then thes limiting beliefs will inevitable lead to you diverting your efforts 'externally' rather than focusing on taking responsibility for your own actions.

Structure & Agency

In Psychology these ideas are described by the ideas of 'structure' (also cultural settings) and agency.

Structure refers to the social contexts in which we live our lives.

The nature of the social context in which we grow up has a significant bearing on our ability to act in either a way that equates to 'social compliance' or in a way where we worry less about 'social acceptance'.

Mental wellbeing is inextricably linked to these psychosocial determinants.

Agency refers to the idea of having the ability to be self-determinate in the path that one's life takes.

It is your 'self-efficacy' and is closely related to your locus of control which is one of the key domains we work with during our Tranceformental CBT course.

The greater your sense of agency (within the bounds of your 'structure') the more likely you are to believe that a choice exists.