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Mental health is complex. The brain is an intricate structure that we don’t understand well. And when it interacts with culture, relationships, life experience, stressors, trauma, and all the other usual and unusual parts of life, we’re bound to encounter complexity.

There’s a movement to classify all mental health problems as brain disorders. And to some degree, these advocates aren’t wrong. All of human life is experienced by the brain. We can’t usually identify individual anatomical changes that distinguish one mental disorder from another, but there’s little pushback against the idea that the brain is at the center of our experience.

Brain-based explanations of mental health may also reduce some forms of stigma. And at the same time, we all have a natural tendency to be skeptical of recovery from brain-related deficits.

For example, we know that opioid use disorder (the clinical term for people who continue to misuse substances like heroin, morphine, or oxycodone despite negative consequences) can be convincingly modeled as a chronic, relapsing brain disorder. And at the same time, there are concrete behavioral changes that people can make to recover from opioid use disorder. 

My patients with opioid use disorder absolutely benefit from medications that stabilize the brain-based opioid system, just like someone with diabetes benefits from medications that stabilize blood sugar. At the same time, we can be so much more empowering by exploring behavior and providing coaching on ways to better manage the problem. For opioids, that might include education, changing contacts, identifying cravings, managing triggers, approaching trauma, and so much more. For diabetes, these interventions often fit the same mold. But to say “this is an insulin resistance problem” or “this is a brain-based opioid system problem” without saying “and I want to help you find ways to overcome this” sets people up for suboptimal outcomes. 

Like anything else in life, there are things we can change, and things we cannot. We can reduce stigma by normalizing the things we cannot change. And at the same time, we can empower each other emphasizing the depth, breadth, and reality of effortful improvement. Because at the end of the day, there is always some way we can improve our lives by changing our behavior.