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(Michael Koval/Emerald)

One of the most difficult parts of struggling with mental illness is hearing the sentiment from others that you are actively choosing to be unhappy. Many are quick to assume that those with depression are merely choosing to be “lazy” when they are unable to maintain their home living spaces, manage their work responsibilities, or handle basic tasks like scheduling doctor’s appointments and returning phone calls. Others believe that those with anxiety are merely choosing to avoid stressful social situations rather than push through.

And, of course, the solutions to mental illness are cast as choices too. People with mental illness are supposed to “fix” themselves by making simple choices — choosing to make friends, choosing to practice self-discipline, choosing to be happy. But when you’re the one actually struggling, these suggestions are about as helpful as telling someone with a broken femur that they should just choose to get up and walk around on it.

You just need a change of attitude, we say. Have you tried meditating?

Yet, despite the harmful way that choice is usually weaponized as a form of victim-blaming, learning to make good choices is extremely crucial to living better with a mental illness. In fact, I have found that recognizing both my choices and my lack of choices has been one of the most transformative skills I’ve developed through therapy. I think it’s important for those struggling with depression and anxiety to “reclaim” a feeling of choice and agency when so much of life feels out of control.

Part of this problem is our cultural tendency to ignore the real conditions of people’s lives. While it’s normal to look at real conditions when one is physically ill — of course we can see on a scan that a bone is broken — it’s altogether too common to ignore environmental and biological factors that contribute to illnesses like anxiety and depression.

As a result, when we use the narrative of choice to shame those who suffer, we implicitly tell those people that it is their fault they cannot control the conditions of their lives. We tell students it is their fault they cannot control the incredibly stressful sink-or-swim meritocracy that forces them to live in a constant state of anxiety. We tell poor people struggling with depression that it is their fault they cannot control economic factors like wage stagnation, loss of opportunity, and overwhelming debt; or accompanying environmental factors like food insecurity and poor nutrition, lack of economic mobility, housing instability, and workplace abuse. We tell people of color that it is their fault they cannot control the systemic racism that leads to constant, profound emotional distress; we tell women that it is their fault that they cannot control their feelings of low self-worth in a world that constantly belittles them, despite the fact that depression is twice as common for women as men; and we tell queer and trans* folks that they are at fault for being three times as likely to experience mental illness when they could just look on the bright side and know that “it gets better.”

What’s worse, we often internalize these victim-shaming narratives. At that point, you begin to blame yourself for your mental illness — to feel as if every struggle you face is the result of a bad choice made somewhere along the way. When others mistreat you, you begin to think it must be your fault; that the only way to fix the situation is for you to make some kind of better choice — maybe to apologize or just not “mess up” next time — rather than to recognize that perhaps someone else is responsible for the bad choice or judgement. You start to believe that every bad thing that happens to you is the direct result of an action on your part.

On the other hand, if you are constantly told you are making choices but it never feels as if you are, you might start to believe that you actually have no choices whatsoever. You might start to think that you are inherently broken or defective and therefore people will always hate you, or think of you as a burden. You will always feel overwhelmed and you will always be unhappy, regardless of what choices you make.


We need a better approach.

We don’t necessarily have to treat individual choice as if it is all-or-nothing. It seems that those struggling with mental illness constantly feel as if we have zero choice, and those not suffering feel as if we have all the choice in the world. The reality is somewhere in between. Sometimes we have no meaningful choices that could alleviate our painful feelings — trying to worry less about your debt isn’t going to make it go away. On the other hand, sometimes we can make choices that alleviate painful feelings. You can choose not to stalk your ex’s new partner’s Instagram page, and you can choose not to obsess over old photos of yourself when you were skinnier.

The important thing is learning to differentiate between moments when you have meaningful and achievable choices; when you have no choices; when your choices have been taken away; and when you are only in partial control. Once you are able to mentally identify where you stand, you can begin to dedicate your energy towards the achievable things and away from the unachievable things that you usually just feel badly about. Monitoring your own activities from day to day and determining which patterns exacerbate your negative feelings can be a useful way to approach this problem.

If you are lucky, once all those little daily choices feel more manageable, your larger non-choices ultimately do too. This is especially important if you, like me, sometimes get overwhelmed by everyday responsibilities. While I might not be able to fix my whole life in a day, I can probably convince myself to make one better choice each day. Maybe I choose to stop using Facebook for a few weeks because it makes me feel inadequate. Maybe I choose to invite a friend over because I’m lonely but too anxious to leave the house. Maybe I choose to care for myself after a hard week by cooking a meal, or doing my laundry, or taking a long hot shower.

Or maybe the only choice I can manage is to put on a TV show to distract myself, rather than spending my whole night getting worked up about something beyond my control. Maybe I just choose not to think about something difficult until I have the mental space to process it. That’s a choice too.

You can’t learn to manage your illness better until the word “choice” stops feeling like an accusation. If we are going to develop a more tolerant society, we should all be paying more attention to the important distinction between using choice as a weapon, and offering choice as a tool.

PhD student/fist-shaker. My research fields include contemporary US politics and culture, feminist studies, and theory & praxis—with an emphasis on the role of power in discourse. I also teach writing at the University of Oregon.

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