Growing Good Mental Health with Choice Theory

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

By Nancy Buck -November 15, 2022

Thought Provoker:

How do you define good physical health? Do you know what to do to develop, improve and maintain your physical well-being?

How do you define good oral and dental health? Do you know what to do to develop, improve and maintain oral and dental health?

How do you define good mental health? Do you know what to do to develop, improve and maintain good mental health?

During the psychiatric rotation of my undergraduate nursing program, I read William Glasser’s Reality Therapy: A New Approach to Psychiatry (1965). At that moment I knew this was going to be my area of specialty. All of Glasser’s subsequent books, lectures and especially the work I was fortunate enough to do with him have influenced my entire professional career and personal life.

I worked for decades as a psychiatric nurse in traditional psychiatric settings, using the medical model where diagnosing and medicating people was considered to be “best practice.” This is still true today, despite the lack of evidence to support this protocol. People did experience temporary relief of their symptoms and upsets, but never quite returned to a medication free life, or a vibrant and happy one.

Most of these folks developed “side effects” from the medication they were taking, which were often just as bad and debilitating as the original mental and emotional distress that brought them to treatment to begin with. For some, this led them to seek help from a different health care provider. This often led to a different diagnosis, with new medications prescribed.

Rarely were the previous medications discontinued. It was not unusual for me to see patients with more than one psychiatric diagnosis, taking as many as 25 or more medications, and still complaining of unhappiness and unpleasant symptoms.

This is what was considered best practice. Today this is still what is considered best practice. The noteworthy changes that have occurred in the 48 years of my career in mental health include: new, and different medications, and a change in the terminology from “mental illness” to “mental health,” but still without defining what mental health is. There is no information given or discussion about what a person can do to develop, improve and maintain their own good mental health. It’s worth noting that changing the name from illness to health has had no effect on the negative social stigma associated with mental health. Added to the problem is the pharmaceutical industries’ false advertising that medication can “fix a person’s broken brain,” as if that defines mental illness.

What if we changed the mental health paradigm altogether, making it more consistent with the paradigm shift that has occurred for physical and dental health? What if our best practice taught all people what mental health is, and taught people what to do daily to develop, improve and maintain their mental wellbeing? What if we could start right now Growing Good Mental Health?

In 2005 Glasser wrote a small booklet entitled Defining Mental Health as a Public Health Issue. Today, in 2022, because of the COVID-19 pandemic, the entire world finally understands that personal mental health is also a public health issue.

Yet we still have not defined what mental health is.

Most six-year-old children in the US can tell you what to do to get into better physical shape. The same is true for dental health. I personally know a few elementary teachers who ask their students to brush their teeth after lunch before they go out for recess.

Imagine an eight-year-old, or an eighth grader, or a junior in high school or college knowing what to do to develop, maintain and continue to grow their own good mental health. Imagine them understanding that their negative experiences create a negative change in their mental health. Imagine that they know what steps to take to improve it. Imagine that they know and accept that there may be times when more help is needed, that they know who to reach out to, and that help is available to them, not something to be stigmatized by or hide from.

The worldwide COVID-19 pandemic brought about significant changes in people’s lives, including an awareness of the disruptions, disturbances, and changes in their mental health. Because of my interest in the subject, I set a Google search for “mental health as a public health issue,” and the number of alerts I started receiving increased significantly and continues to this day.

For me, COVID has created an opportunity and a call to action. (More on that later*)

Choice Theory Psychology Explained

William Glasser is the founder of Choice Theory psychology, an internal control psychology. In fact, Glasser, along with Albert Ellis, created the original CBT (cognitive behavioral therapies): Choice Theory by Glasser and Rational Emotive Behavioral Therapy by Ellis.

Choice Theory is a psychology based on internal motivation. as opposed to external motivation which is the model most individuals and organizations operate from. Internal motivation means that the external world provides us with information, but does not make us do anything; behavioral choices are inspired from within and every individual has the power to control only themself. This allows us to take responsibility for our own life, happiness and choices. Knowing this also allows us to stop the exhausting process of attempting to control other people’s decisions, lives and choices. The only person whose behavior we can control or change is our own.

Choice Theory explains that we choose our behaviors in an attempt to meet one or more of our five genetic psychological needs: safety and security; love and belonging; power; freedom; fun. From birth we begin creating internal pictures of what we want, our quality world pictures, because these things, people, relationships, and experiences satisfy one or more of our needs.

Our daily lives are composed of a constant series of self-evaluative cycles, comparing what we want and need with our perception of the world. When there is a difference between what we want and what we perceive we’re getting, we are driven to behave, in an attempt to effect change. Thus, all of our behaviors are purposeful. But all behavior, although purposeful, may not be effective. And even purposeful and effective behaviors may not be responsible. Responsible is defined as a person’s ability to meet their need without interfering with another person’s ability to meet their needs.

Attempting to control another person’s behaviors is almost always irresponsible, leading to damage in the relationship.

In an attempt to better understand Choice Theory psychology, let’s look at the many choices people made during COVID-19. If you were worried about your own health and safety, and the security and survival of others, you probably wore a mask and practiced physical distancing. In fact, these may be things you continue today. You probably quarantined, if possible, for your own protection and the safety of others. Getting vaccinated was never a question for you, you did it to stay safe and healthy even though it was inconvenient and uncomfortable. Because it was important to you, and you chose these things, you never felt your freedom or power were being infringed upon, although you probably felt unhappy about your lack of connection, fun and freedom.

You probably also changed the way you met your needs for love, power, fun and freedom. Suddenly the world was learning and using Zoom for connections, shared holiday dinners, playing new games, going to school and working remotely. It wasn’t the same and yet, because health and safety were your strongest need, alternative methods were found to meet your other needs.

However, if you believed that COVID-19 was not a health and safety issue as reported, you may have done only a few of the above, or none at all. You felt your freedom and power to make autonomous decisions were being imposed upon. No matter what anyone else said to you or threatened you with, you were not going to change your mind or your behavioral choices. Your need for power and freedom were/are more important than your perception of the threat to your health and safety.

Whose position was correct? It depends on what need was most important to you, as well as your quality world pictures, and the way you perceived COVID-19 and the world.

Evaluating the difference between what you want and what you have motivates you to take action, to behave, in order to achieve more of a balance. The practice of Choice Theory involves having an awareness of the choices that will meet your needs, and self-evaluating whether your behaviors are helping you achieve what you want in a way that doesn’t interfere with others doing the same.

Choice Theory involves shifting from an external control psychology, the belief that our behavior (thoughts, feelings, actions and to a certain extent our physiology) is determined by outside forces, such as luck, circumstances and other people, to an internal control psychology, knowing we always have choices and understanding that we direct and are responsible for our choices and resulting consequences.

Definition of Mental Health

My definition is based on Choice Theory psychology. I do not mean to say that this is the only or the best definition, but using this model informs all the work I do with others. I would invite and encourage all practitioners to develop and use their own definition for good mental health, sharing it with their clients so everyone knows and agrees with the goals you are aiming for.

In Glasser’s small booklet, Defining Mental Health as a Public Health Issue, he writes:

As I will now begin to explain, mental health can be accurately described as an entity totally separate from mental illness and I offer the following description: You are mentally healthy if you enjoy being with most of the people you know, especially with the important people in your life such as family, sexual partners and friends. Generally, you are happy and are more than willing to help an unhappy family member, friend, or colleague to feel better. You lead a mostly tension-free life, laugh a lot, and rarely suffer from the aches and pains that so many people accept as an unavoidable part of living. You enjoy life and have no trouble accepting other people who think and act differently from you. It rarely occurs to you to criticize or try to change anyone. If you have differences with someone else you will try to work out the problem; if you can’t you will walk away before you argue and increase the difficulty.

You are creative in what you attempt and may enjoy more of your potential than you ever thought possible. Finally, even in very difficult situations when you are unhappy — no one can be happy all the time — you’ll know why you are unhappy and attempt to do something about it. You may even be physically handicapped and still fit this criteria.

My definition of Mental Health is somewhat simpler: For me to be mentally healthy, my daily objective is to meet my needs for safety, love, power, fun and freedom. When I do, I feel satisfied and content. On those days when I’m experiencing discomfort, anger or frustration, I ask myself: What do I want? What do I need? Which need is not being adequately met and which is driving my discontent? Is what I’m doing now helping me get what I want and need? Can I make better choices about what I’m doing? Do I need to make different choices about what I want?

Sounds simple, doesn’t it? Glasser’s ability to present his ideas in an uncomplicated, straightforward way has always been appealing and it has meant that these ideas can be understood and practiced by anyone, at any age, anywhere. However, putting these simple ideas into practice is very challenging.

There is more to Choice Theory psychology than I have explained here, but this is a good beginning. The more you learn, the more you realize there is to learn and that you want to learn.

COVID-19 presented challenges for all of us, no matter what your circumstances. There are many people in the world who are growing their good mental health and creating a happy life following the tenets of Choice Theory. But has it been working during COVID?

Growing Good Mental Health: Is It Working?

Several colleagues and I started a project in March of 2022 to find the answer to: Is your knowledge and practice of Choice Theory helpful in grappling with the impact this virus has had on your life?

So far, we have received survey responses from people in more than 11 countries, with the majority of people stating that Choice Theory has been valuable or highly valuable. We are continuing to reach out to our international Choice Theory community to get more survey data. And since Choice Theory is being taught in our many Quality Schools around the world, we have plans to create a survey asking similar questions of that demographic.

Our goal is to share the results of our qualitative grounded research with the largest audience possible, and invite people to start GROWING GOOD MENTAL HEALTH. We hope this will be a giant step forward in changing the mental health paradigm in the world.