I was reminded of this recently with a patient I was treating. This patient had experienced minimal response to medication changes, and I had suspected from the beginning that life circumstances were the primary drivers of her depression. She wanted to focus on medication, but agreed to try making small behavioral changes to improve her life. At each visit, she failed to make any changes and would ask for a different medication.

I felt a little frustrated. Medications are helpful for many people, and at the same time, they aren’t a substitute for a mentally healthy lifestyle. 

I felt stuck with this patient going into our most recent visit. The medication I had prescribed had been predictably ineffective. The tiny behavioral change we had agreed upon didn’t happen. But she felt much, much better. And in discussing the change, she noted that the psychotherapist on our team had broken the stalemate by asking her to do one simple thing: keep a journal of how she felt each day.

This simple measurement made her realize that certain situations contributed to her depression. It made her realize that she had some control over her mood. And it also helped her recognize that overall, things weren’t as bad as she had thought they were. Even though she hadn’t changed a single behavior, she suddenly felt empowered and hopeful. 

Measurement doesn’t always have such profound effects. And measuring the wrong things may be misleading and even harmful. But if you are struggling to make a change in your life, a good first step may be to start measuring the problem. Build that habit first. It may help you learn what you need to change.

It’s a simple principle that bears repeating. But there are some relevant counterarguments that are worth addressing.

Another option to improve your mental health would be to wait and change nothing. You can do this if you wish, and there is a chance that things will get better without extra effort on your part. But more likely than not, you’ll continue repeating the same patterns until things get worse.

(As an aside, choosing to accept things as they are is very different than choosing to do nothing. Acceptance is an active process that is often foundational for change. We often achieve only cursory acceptance: we deny the full weight of the situation; identify problems and yet brush aside consequences; or we fail to explore the parts of our problems that could actually be changed. Change accelerates when we wholeheartedly accept that we have been doing the best we can with the motivation, skills, habits and biases we have, and that we need to try harder, be more motivated, and learn to do better. Acceptance and change are siblings; they don’t need to be rivals.)

Others might question the cardinal rule by stating that someone else might be the problem, and you can ask them to change. Of course you can, but it doesn’t invalidate the cardinal rule. Your influence can only come by changing the way you interact with other people. You decide what you do. They decide how they respond. You don’t get to choose their reaction.

In a healthy relationship, influencing another comes through mutual respect, example, kindness, honesty, open communication, occasional frankness, patience, and forgiveness. Positive interactions are much more likely to help someone discover and act upon their internal motivation than criticism and negativity.

Force isn’t a great option. There are a few exceptions. Parenting young children. Protecting someone from truly dangerous behavior. Individuals and societies have important duties to rarely use force. But the line between wise use of force and abuse will always be debated. And when you get this wrong–and you will–you risk resentment and backlash. Let your default be patience, kindness, and gentle persuasion. Control rarely works.

There’s so much more to be said. But the basics are clear. Choose to do something that makes your life better. Start small, but start.

It’s a dumb joke, and I’ll let you suffer through it. But first, let’s talk about relationships.

Every relationship is more than just two people. There is an unspoken middle ground called the relationship system, a constantly evolving construct defined by the interactions between two people. In other words: how I act influences you, and how you behave affects me. Relationship systems have a memory, and past events color how we see each other. A good relationship system can produce trust, shared experience, and so much more. And when people have problems with each other, it’s usually best to start looking at flaws in the relationship system before trying to find fault in either party.

How do you improve a relationship? You have some control over your own behaviors, a little control over the relationship system, and absolutely no control over the other person.

To strengthen relationships, it helps to understand what I call the cardinal rule of mental health: your only real option to improve any situation is to change your behavior. That doesn’t mean that everything is your fault. It’s an acknowledgment that you wait for something unexpected to happen, change your approach, or leave. But you’ll never, ever, be able to force real change in someone else. You can ask them for change, support them, antagonize them, or even cut them off. No one strategy works in every situation. And yet all reasonable options start and end with you.

I’m not trying to minimize the capacity for change in others. I am fundamentally optimistic about our capacity to improve, despite the very real forces of ambivalence and habit. There are reasons why we do what we do, and reasons we want to do better. A good therapist digs deep to uncover motivation, but they can’t build on something that isn’t there. It’s rare outside of therapy to have the permission, skill, and safety to probe others this way. Instead, you get to decide if you can tolerate what’s happening right now.

That is the textbook definition of a boundary: “you can’t do this to me and expect our relationship to continue as it is.” How do you enforce a boundary? By changing your part in the relationship. You don’t have the power to do anything else.

How many psychiatrists does it take to change a lightbulb? How many people does it take to have a positive influence? One. But some small part of the lightbulb has to want to change itself. You don’t have to spend the rest of your life clinging to lightbulbs that refuse to budge.

The current iteration of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–a mouthful we lovingly abbreviate as the DSM-5–contains 22 chapters, each containing multiple mental health disorders.

For many of these problems, there are textbooks, conferences, and fierce debates. Expert conversations can quickly switch from sub-nanometer-sized medication to the history of human civilization. Mental health influences–and is influenced by–nearly everything in our environment. 

It’s easy to get lost in the complexity. 

In this blog, I’ll be taking complicated ideas and breaking them down into easily understandable chunks. And in my opinion, the smallest piece of useful information is a mental health model. 

Models are simplified descriptions of complicated ideas. They can be nuanced enough to fill books or simple enough to be captured by a single phrase. Some are backed up by hundreds of studies, while others have only theoretical support. No model is perfectly accurate, and even well-supported models may not be very useful.

But trying to talk about mental health without clear models is a fool’s errand. When I’m working in the clinic with someone, my mind is rapidly testing models to see if they fit my observations. A model that matches the problem often leads to a specific solution. And if that solution doesn’t work? We re-examine the model until we find one that fits better.

Because ultimately, the most important model is the one that works. And if you and I can keep finding models that fit that goal, our mental health may just get a little bit better.