Ever had a therapy session where it seemed like the therapist didn’t understand you? Maybe you’ve been dealing with mental health challenges for a while and have tried various therapies, only to hear the same advice repeatedly: Improve your boundaries or Just think positively. Many individuals experiencing mental health issues often feel that their care solely revolves around their personal choices or personality, disregarding the influence of their environment, relationships, or social concerns on their mental well-being. Consequently, they often feel isolated, blaming themselves for their struggles instead of recognizing them as normal responses to difficult life circumstances.
This focus on individual responsibility is common in U.S. mental health care, where treatment often follows advice from major organizations like the American Psychological Association. But psychology (the study of human thoughts, behaviors, and feelings) isn’t the only factor in mental health. While brain chemistry can be relevant in some cases—like with severe disorders such as schizophrenia—it’s rarely the only factor. Even when biology plays a role, something in the environment, like stress or trauma, often “triggers” the symptoms. This aligns with a concept introduced by Engel in his article “The Need for a New Medical Model: A Challenge for Biomedicine,” (1977). He argued that mental health care needs a new model—one that doesn’t just look at the individual but also considers the impact of social and environmental factors.
Understanding the Influence of Social Environments
In reality, a person’s social and physical environment is often a bigger factor in mental health than brain chemistry alone. In their book, A Sociology of Mental Health and Illness (5th ed.), Rogers and Pilgrim explore how external factors like family issues, work stress, and money problems can all impact a person’s mental well-being (2014). These sociologists (experts who study society and social behavior) argue that if we ignore these outside factors, any mental health care model risks being too simple and, honestly, not very effective.
The Biomedical Model’s Shortcomings
One major issue with mental health care today is the biomedical model, which sees mental health issues as isolated within the person, separate from outside influences. According to Barney in “Limitations of the Critique of the Medical Model,” this model falls short because it doesn’t consider how social factors—like relationships, social class, and work conditions—can create or worsen health problems (1994). This narrow focus often leads people to think their struggles are due to personal flaws, rather than recognizing how their environment impacts their mental health. When mental health care encourages people to blame themselves, they may end up feeling like something is inherently “wrong” with them, instead of seeing the bigger picture.
Individual Blame vs. Environmental Harm
Marina Morrow critiques the narrow focus of therapists who attribute problems in toxic environments, such as unhealthy relationships or stressful jobs, solely to individual shortcomings like a “lack of boundaries.” In her article, Critiquing the ‘Psychiatric Paradigm’ Revisited: Reflections on Feminist Interventions in Mental Health, she argues that this perspective overlooks the broader social and political factors affecting individuals, particularly those navigating issues of power or privilege, and fails to help clients recognize the toxic behavior surrounding them.
This perspective is problematic because it subtly shifts the blame onto the victim, implying they’re somehow responsible for the abuse they’re facing. Morrow points out that traditional therapy has often been shaped by a privileged perspective, which means it may not fully understand the experiences of people from marginalized (socially or economically disadvantaged) backgrounds. When therapy doesn’t take into account these external influences, clients may end up feeling like their suffering is their own fault because they’re “not good enough” at setting boundaries. However, most abusers don’t respect boundaries at all, so no matter how clear the victim is, it’s the abuser’s actions that are the problem.
The Role of Capitalism and Western Individualism
The values of capitalism (a system that prioritizes individual success and profit) and Western individualism (a focus on the individual rather than the group) only complicate this issue. Capitalism often suggests that everyone is responsible for their own success or failure, which feeds into the idea that everyone is solely responsible for their own mental health. Rogers and Pilgrim argue that this mindset overlooks structural inequalities, like income disparity and social class differences, creating a system where those at the top benefit from the struggles of those at the bottom. These issues can even show up in families and relationships, where traditional power imbalances often go unchallenged.
Morrow also critiques capitalism’s role in mental health care, especially through the pharmaceutical industry (the business of creating and selling medicine). This industry often promotes the idea that mental health issues come down to “chemical imbalances” or genes, which sidesteps the discussion of how harmful environments or social systems contribute to mental illness. By focusing only on biological factors, the industry depoliticizes mental health concerns—meaning it separates these issues from the societal structures that play a big role in causing them.
Reframing Boundaries and Victim-Blaming
Consider how damaging it is to tell someone in an abusive relationship that they “should have set better boundaries.” Abuse is ultimately about the choices and actions of the abuser, not the response of the person being abused. Rogers and Pilgrim emphasize that mental health issues are often symptoms of bigger social and relationship dynamics. So even if the person had set boundaries, that wouldn’t guarantee safety, because abusers, by nature, don’t respect boundaries. Focusing on the victim’s supposed flaws takes the blame off the abuser and reinforces a cycle where the victim ends up blaming themselves.
For people stuck in toxic relationships, workplaces, or family dynamics, the primary solution is often to leave the situation. But that can be incredibly hard, due to financial limits, social pressure, and practical challenges. Engel argued for a model that recognizes these social barriers to health. Telling someone to simply “stand up for themselves” or “be more assertive” isn’t just unhelpful—it can actually make them feel worse. Therapy should remind people that their self-worth isn’t dependent on their ability to “fix” a toxic environment, nor should they feel they have to shoulder the blame for harmful actions they didn’t cause.
Practical Tips for Reclaiming Self-Worth and Building a Path to Safety
Recognizing that mental health is shaped by more than just individual responsibility can be empowering, especially for those who have been made to feel at fault for circumstances beyond their control. By acknowledging the role of social and environmental factors, we can begin to understand our struggles with more compassion and clarity. But this awareness is only part of the journey. For those who find themselves in challenging situations—whether in toxic relationships, oppressive work environments, or difficult family dynamics—knowing how to separate self-worth from external harm and plan for safety is essential. The following tips offer practical ways to navigate these situations, reminding us that no one is bound by their current circumstances, and that there are steps to create a safer, more supportive path forward.
1. Shift the Blame: Separate Yourself from the Problem
- Remind Yourself: Harmful situations aren’t your fault. Your worth isn’t defined by others’ actions.
- Recognize What’s Yours and What’s Not: Reflect on what you are and aren’t responsible for; others’ behaviors are not within your control.
2. Find Support and Validate Your Strengths
- Connect with Safe People: Trusted friends, family, or support groups can help you see the bigger picture and feel less isolated.
- Remember Your Positive Qualities: List strengths others appreciate about you, and revisit them when feeling stuck.
3. Create a Basic Safety Plan
- Prepare Essentials: Keep copies of important documents in a safe spot. Set aside emergency funds if possible.
- Arrange Emergency Communication: Set a code word with a trusted contact for help, if necessary.
4. Practice Small Boundaries
- Start Small: Practice saying “no” or setting limits in non-threatening situations to build confidence. For example, politely decline an invitation to a casual event you don’t want to attend, or tell a colleague you can’t take on an extra task this week. These small steps will help you become more comfortable setting boundaries in bigger situations over time.
- Take It Gradually: Boundary-setting is a process. Each small step strengthens your self-worth.
5. Build a Life Beyond the Harmful Situation
- Engage in Enjoyable Activities: Create a fulfilling “outside world” through hobbies, friends, or new skills. This could be taking up a new hobby like painting, joining a fitness class, or reconnecting with friends who support and uplift you. These activities provide emotional relief and remind you that there is more to life than the harmful situation you’re in.
- Envision a Positive Future: Visualize a life of freedom and safety, and remind yourself it’s possible. You can envision your ideal life by creating a small vision board or journaling about a future where you’re free from harm and surrounded by positive people. This reminder can help you keep moving forward, even on hard days.
Reframing Self-Worth: Healing Without Reinforcing Individualism
True healing requires looking beyond individual-centered approaches and recognizing the ways that relationships, social expectations, and environmental factors impact mental health. Everyone deserves respect, safety, and support, regardless of how assertive or “strong” they are. A supportive approach to mental health should reassure people that their value isn’t dependent on how well they meet society’s standards of resilience.
When mental health care focuses too much on individual responsibility, it can leave people feeling stuck in toxic situations, thinking they must change themselves to escape. But well-being doesn’t come from internalizing blame; it comes from understanding how harmful environments affect us and creating conditions that allow real change to happen. As Engel put it, we need a new model—one that blends individual, relational, and societal views for a truly balanced approach to mental health.
