Is Compliance a Measure of Mental Health?
Much of mental health treatment operates, to a significant degree, on the assumption that compliance equals mental health. I distinctly remember when I was in so-called mental health treatment as a teenager, both programs that I went to operated this way. And there was indeed much that you had to comply with - endless rules, orders, constant evaluation and surveillance, having to demonstrate that you thought the way that the staff did, and more. This compliance with these programs was a very tall order, which you had to meet or else they would continue to deem you as “unwell”.
I remember some kids would more brazenly display noncompliance. They kept breaking the rules and they didn’t show up in the way they were expected to. What ultimately happened was they would be kept there longer. The way the programs worked was that in order to move through them and graduate, which meant that they deemed you were “well”, you had to move through different levels within each program. And if you broke any of the major rules, you would move down to the bottom of the program again and have to work your way back up. They would tell our parents that we were “unwell” and have to stay longer, often getting them to take out loans to do so because they couldn’t afford the exorbitant fees. The assumption was this would cure you of your “mental illness”. Looking back on it now, this assumption is obviously beyond ridiculous and it’s outrageous that any mental health authority was in a position to do this to teenagers and families. But they were the authority and you just had to go along with it.
This entire farce was based around the idea that obedience to the mental health professionals was equivalent to mental health itself. Now for me, I had a very strong feeling that the more I obeyed them, the more compliant I was, and the more I went along with what they said and bought into their ideas, the weaker, more broken, and less mentally healthy I became. So my own internal source of healthyness turned out to be diametrically opposed to their idea of mental health. But, again, they were the authority on the matter. I didn’t have a PhD, a license, training, or continuing education credits. They were the authority over my mind and life, they made sure I had no agency, and so I had to go along with them.
My experience was that the mental health profession was just one of several interlocking systems that equate healthiness with compliance. And interestingly, noncompliance with some of these other systems will get you sent to the mental health system for treatment. For example, I was non-compliant as a teenager within my family system, which I perceived as being painful, where I’d been dying inside for as long as I could remember, and which very clearly had intergenerational trauma. I was also non-compliant within the school system, which I found to be insufferable and as I became an adolescent, was increasingly convinced that it wasn’t actually good for me. It didn’t help me develop myself intellectually, emotionally, or creatively. It seemed to be more about obedience training than helping you become a well-rounded, empowered individual who is intellectually and creatively prepared for life in our world, and who can help sustain (or build) a democratic and consensual society. Because I perceived these systems as broken, was pained by them, and therefore was somewhat non-compliant, I was deemed mentally ill by those systems and the mental health profession.
This is an issue that psychologist Bruce Levine has spoken about which is that many of the people labeled mentally ill in our society are really just, as he puts it, anti-authoritarian. They question the legitimacy of authority and they are pained by coercion. Because of this, they may be emotionally reactive, have behavioral disturbances, engage in substance abuse, etc. And that the mental health system is more about controlling them and maintaining the status quo, rather than helping to meet people’s real needs or offering genuine support. This perspective really spoke to me because it got me wondering; maybe what got me into trouble, and therefore labeled as mentally ill, were really just positive qualities that didn’t fit into these particular systems. Positive qualities like a strong sense of self, passion, strong connection to my own feelings, etc. And so if these attributes don’t fit into these systems, then these systems must be broken, on some level. Maybe these systems were authoritarian. Maybe the people in charge of them lack self-awareness and depth. Maybe there's a lot of denial of the dysfunction occurring.
As I mentioned, I got into trouble for being noncompliant and then labeled as mentally ill, and according to the entities of the MH system I experienced, the way back to “mental health” was compliance - compliance with the MH professionals, with my dysfunctional family system, with the school system. And they literally believed that noncompliance was a “risk factor” for things like substance abuse problems. But of course, from my perspective (and it's really clear to me now), compliance with the harmful, backward systems I was stuck in was the real “risk factor”. If you are stuck in a painful family system, then complying with it, obeying it, and staying stuck in it will harm you and therefore mean that you’ll need to find ways to cope with the pain involved.
This pattern in the mental health system of compliance being central to its conception of mental health I think shows up in many different places - certainly in so-called mental health treatment for youth. But also my understanding is that addiction programs often, if not mostly, operate this way. A lot of basic therapy I experienced also operated this way - where if you don’t submit to the therapist, they pathologize you for it. If you accept their interpretations and ideas then you are considered healthy.
And I think we also see it with things like the labeling of millions of kids with ADHD. Cases of ADHD are often really just noncompliance with the school system more than anything else, or at least is to a significant degree. I think a lot of what these ADHD symptoms are is kids rejecting the school system - rejecting having to sit still for so long, rejecting having their lives controlled to such an extreme degree, rejecting having their minds put under such mechanical control, rejecting having their true needs and interests disregarded. We forget the fact that the school system is a relatively recent and quite radical social engineering project.
As MH professionals focus on compliance, they neglect and force us to neglect, what might be true sources of mental health. Which is where the real value for us is. If a kid is noncompliant with the school system, we don’t typically think very deeply about what their real needs might be. If they are labeled with ADHD, we don’t realize that the broken system they are being jammed into is harmful to their mental health. Or if there’s conflict in a family system, we don’t think about how everyone could work on transforming themselves and that system. We just focus on modifying (i.e scapegoating) the individual that’s pained by the broken system and therefore making noise about it.
One of the effects of this is it reduces self-awareness. We tend to assume that mental health treatment will, by definition, increase self-awareness. This isn’t necessarily the case at all. In my experience, it often radically reduces self-awareness. And this makes sense because if compliance is seen as a measure of mental health, then you can’t inquire into what’s actually wrong with your environment and what you might truly need and want. Because then it would look like you are “unwell” or not “improving”.
