In the past few decades, public discourse regarding mental illness and drug use has been centered on a conceptualization of these problems as “illnesses like any other.” This focus on brain disorder was well intentioned; the hope was that this would replace moral blame and therefore encourage people to seek treatment. However, there are unintended consequences of promoting the illness model and there are alternative ways to conceptualize these problems that have advantages not only for individuals but for society.
Where have we missed the mark? When the notion of “illness like any other” is highly promoted, it can reinforce a sense that an individual is a passive victim of some pathology that needs to be addressed and remedied. People may come to believe that they’re too broken to do anything to improve their health. They may be inclined to expect someone to fix the problem before they begin their recovery. By reinforcing a patient’s internal sense that they are a passive victim of addiction we may diminish the person’s sense of agency; it is important for individuals to realize that, while it is extremely difficult, they need to be active partners with others in seeking recovery.
This does not imply that we return to blaming people when they find the road to recovery to be extremely challenging. Rather, we approach them with love and compassion; we acknowledge with them that overcoming addiction and mental health challenges is extremely daunting. Treatment may be more successful if we expand our care to consider how trauma, poverty, housing, employment and the larger social fabric leave some people feeling like they have no hope or a role in our society.
Medical and mental health professionals need to accept our own limitations. As psychiatrists we are most successful when we position our knowledge on a more equal level with our patients and acknowledge what we don’t know. When we bring humility to our conversations with our patients, those open exchanges can be healing. We may not be able to “fix” everyone we see because substance abuse is more than just a “glitch” in their brain. People are using substances like opioids to manage the pain of life. Sometimes, the pain people experience are understandable reactions to life adversity.
By being humble medical professionals, we can begin a conversation with the patient to learn about them, how they got there and how they make sense of this addiction. We might do better to just be with a person and tolerate some of the sadness and difficulty in their life. Health care is all about relationships and building human connection – and treating substance abuse is no different.
Sandra Steingard, MD, chief medical officer at Howard Center