Should I blame myself for my mental illness?

When it comes to mental illness, we as a society has a tendency to place the blame on the patient. This is evident even in the way people talk to those who are struggling – “Be strong! Try a little harder! You just need to smile more!” There is often an unspoken assumption that mental illness is a failure of character, or worse, a choice to wallow in misery. As a result, psychiatric patients carry not only the burden of their disease, but also a deep sense of shame and guilt, which in turn, breeds more anxiety and depression.

So, are patients to blame for their mental suffering? Genetic epidemiologists estimate that the heritability of major depression, as well as various anxiety disorders to be around 30%–40% (Sullivan et al., 2000). Meanwhile, heritabilities of bipolar disorder and psychotic disorders tends to be even higher. Genetics, which we have no control over, play a significant role in one’s mental illness. Therefore, it makes little sense to blame the an individual for having a certain mental illness.

But genes aren’t the entire story. An individual is the product of the interaction between their genetic makeup and environmental factors. While we have little control over early environmental factors, we do gain increasing amounts of control as we grow and become more aware of our surroundings. For example, we could leave situations the are harmful to our physical and mental wellbeing, set boundaries with people who are toxic and abusive, take care of ourselves by getting the right amount of sleep and exercise, and when needed, take appropriate medications to reduce debilitating psychiatric symptoms. We are not powerless to make changes. 

As a psychiatrist, I work with my patients to develop an understanding of their illness from biopsychosocial perspectives so that they can be freed from shame and self-blame. But just as importantly, I help patients develop tools that they can use on a day-to-day basis to manage their symptoms, so that they can live in the present and progress in their journey towards recovery.