Let’s Start A New Conversation: What if the Entire Treatment Conversation is Built on Incorrect Foundations?

July 7, 2025

Simon Bratt, Author & Strategic Leader in Mental Health & Substance Use 

Tom O’Connor, Editor & Publisher

Topic

If incorrect information is the foundation of a treatment conversation, it can have serious and potentially devastating consequences for the patient. 

Simon Bratt authored the following:

Let’s be honest: we’ve spent years—decades, even, focusing on what’s “wrong” with people. We assign them labels, discuss disorders, establish risk categories, and implement compliance rules. If you work in this field, you know the drill: someone turns up in pain, and before you know it, we’re reaching for the same old toolkit—harm reduction advice, medication, maybe a referral if you’re lucky.

But here’s the uncomfortable question: what if the problem isn’t just how we treat people, but what we think we’re treating in the first place?

What If Substance Use Isn’t a Disorder?

It sounds radical, but stick with me. What if substance use, at least for a lot of people, really isn’t a disorder at all? What if it’s a survival strategy, a way of coping with trauma, poverty, or just too much pain to handle? Seen like that, the “problem” isn’t in someone’s brain or body. The problem is what’s happened to them—and what’s happening around them.

What If “Mental Illness” Is More About Wounds Than Malfunctions?

We talk a lot about chemical imbalances and broken brain circuits, but let’s face it. So much of what gets called “mental illness” is actually about being wounded by loss, by exclusion, by relentless stress. These aren’t just abstract ideas. If you work on the front line, you see it every day. People aren’t malfunctioning—they’re carrying the weight of stuff most of us would struggle to survive.

Maybe the System Isn’t Broken—Maybe It’s Doing Exactly What It Was Built For

We like to say the system’s broken, but sometimes I think it’s doing its job just fine—if the job is to sort, control, and manage. We set up endless hoops—eligibility checks, risk assessments, compliance rules—but who are these really for? Do they help, or do they keep people out?

What Would Happen If We Asked Better Questions?

So here’s my pitch: what if we started with pain, not pathology? What if we looked at the context—the poverty, the trauma, the lack of safe housing—rather than blaming people for not “engaging” with services that weren’t designed for them in the first place? What if we cared less about labels and more about dignity?

Ask Better Questions

It’s Not Just About Tweaking the System

Don’t get me wrong—reform is essential. But if we don’t rethink the whole foundation, we’re just rearranging the furniture. We need to take a serious look at what suffering and survival truly entail. That means ditching the blame game, challenging the idea that people are just collections of symptoms, and listening to what people say they need.

So, perhaps it’s time for a more significant reset. Not better labels—better questions. Not more compliance—more humanity.

What do people need to recover? That may not be another diagnosis. Another risk assessment may not be possible. Maybe just a chance to be heard, a bit of dignity, and a system that’s willing to meet them where they are.

Ready to start that conversation?

Additional Information For You

According to Outside Research:

Substance Use Disorder

Substance use disorder is a complex disease:

• It is defined as a problematic pattern of substance use that affects a person's brain and behavior, leading to an inability to control drug use despite the harmful consequences.

• It is considered a chronic condition, and like many other chronic diseases, treatment is available and recovery is possible. 

  
  

Factors like trauma, poverty, and emotional pain can play a significant role:

• Trauma: Experiencing trauma, such as abuse, neglect, or violence, can alter brain development and make it harder to manage stress in healthy ways. People may turn to substances to cope with difficult emotions or traumatic memories.

• Poverty: The stress and challenges associated with poverty, such as financial insecurity, lack of access to healthcare, and social support, can contribute to increased vulnerability to substance abuse.

• Psychological Pain: Individuals struggling with emotional pain from mental health conditions like depression or anxiety may use substances to self-medicate and temporarily numb their pain. 

  
  

Coping Mechanism: Substance use can be seen as a dangerous coping mechanism that provides temporary relief or escape from complicated feelings. However, it often exacerbates existing problems and can lead to a cycle of dependence and addiction. 

While substance use disorder is diagnosed as a medical condition, recognizing the contributing factors like trauma, poverty, and emotional pain is crucial for understanding its complexities and developing effective treatment strategies. Treatment often needs to address both the substance use itself and any underlying issues to promote long-term recovery. 

Mental Illness

The statement, “Mental illness” is too often a social and relational wound misread as a biomedical malfunction," points to a critical debate in the understanding and treatment of mental health conditions. 

Arguments supporting this view often highlight the significant impact of social and environmental factors on mental well-being:

• Social Determinants of Mental Health (SDoMH): These include factors such as poverty, discrimination, inadequate access to healthcare, housing insecurity, and adverse childhood experiences. These conditions can profoundly shape an individual's mental health outcomes.

• The Social Model of Disability: This perspective argues that disability (including mental health conditions) is often not solely a consequence of individual impairment but rather a status imposed on individuals by societal structures and attitudes that create barriers and disadvantages.

• Stress and the Environment: The social and environmental conditions in which people live and work can significantly influence their mental health by impacting stress levels and overall well-being. 

  

  Stress

Critiques of an overemphasis on the biomedical model include:

• Minimizing Psychosocial Contributions: The biomedical model, by focusing heavily on biological factors, may downplay the vital role of social and psychological factors in the development and experience of mental disorders.

• Neglect of Treatment Innovation and Outcomes: Some argue that a predominantly biomedical focus has led to a lack of innovation in treatments and less favorable long-term outcomes for specific individuals.

• Potential for Mislabeling: In some cases, physical symptoms or distress resulting from social and environmental stressors might be misattributed solely to mental illness, potentially leading to misdiagnosis and inappropriate treatment. 

  
  

However, it's essential to recognize that a purely biomedical model is also a valid perspective in many instances:

• Mental Illness as a Medical Condition: The American Psychiatric Association defines mental illnesses as medical conditions affecting emotion, thinking, or behavior. They are viewed as treatable, similar to other medical conditions like heart disease or diabetes.

• Biological Basis of Mental Illness: Research increasingly points to the involvement of genetic predispositions, brain chemistry, and brain structure in mental illnesses. Certain severe mental disorders, like schizophrenia and bipolar disorder, are considered to have a clearer biological basis.

• Biomedical Interventions: Medications and other biological treatments can be crucial for managing symptoms and promoting recovery, particularly in cases of severe mental illness. 

  
  

In conclusion, while the statement “Mental illness” is too often a social and relational wound misread as a biomedical malfunction" highlights an important issue regarding the societal and environmental influences on mental health, it's essential to adopt a nuanced view that acknowledges the complex interplay of biological, psychological, and social factors in mental health conditions. A balanced perspective that considers the diverse experiences and unique needs of individuals is crucial for effective diagnosis, treatment, and support. 

Overall Treatment Based Upon Incorrect Information

If the foundation of a treatment conversation is based on incorrect information, it can have serious and potentially devastating consequences for the patient. 

Here are some potential scenarios and the consequences:

1. Misdiagnosis and Delayed Diagnosis:

• Wrong Treatment: If a misdiagnosis occurs, the patient may receive treatment for a condition they don't have, leading to unnecessary side effects, complications, and delayed treatment for their actual condition.

• Worsening Condition: Delayed diagnosis can result in the condition worsening, making treatment more difficult or less effective. In severe cases, such as cancer, a delay can have life-threatening consequences.

• Reduced Treatment Options: As a condition progresses due to a delayed diagnosis, treatment options may become limited.

• Physical and Emotional Trauma: The physical effects of untreated or worsening conditions are often compounded by emotional distress, anxiety, and a loss of trust in healthcare providers. 

  
  

2. Poor Communication and Misinformation:

• Misunderstandings: If information about a patient's condition, symptoms, or test results is not effectively communicated between providers or between providers and patients, it can lead to misunderstandings, incorrect assumptions, and diagnostic errors.

• Reduced Quality of Care: Ultimately, poor communication can lead to a reduction in the quality of care provided and adverse patient outcomes.

• Increased Risk of Medical Errors: Communication failures during patient handovers or in general healthcare interactions can lead to the wrong treatment or procedure, incorrect medication administration, or delays in essential tests and treatments.

  
  

3. Impact on Patient Outcomes:

• Adverse Health Outcomes: Medical misinformation, even about seemingly innocuous topics, can lead to adverse health outcomes. Studies have shown correlations between believing misinformation and refusing evidence-based treatments, leading to increased mortality rates.

• Reduced Trust in Healthcare Professionals: Inaccurate or misleading information can erode patient trust in healthcare providers and the healthcare system as a whole.

• Financial Burdens: Misdiagnosis or delayed diagnosis can lead to additional medical

  bills, lost income, and costs associated with long-term care, creating significant financial strain. 

  

  Financial Burdens

  
  

4. Ethical Considerations:

• Informed Consent: Flawed information can lead to inadequate informed consent, as patients may not fully understand the risks and benefits of a proposed treatment plan based on inaccurate information.

• Patient Autonomy: If the foundation of treatment is built on incorrect information, it can undermine patient autonomy and their ability to make informed decisions about their healthcare. 

  
  

To mitigate the risks of incorrect foundations for treatment conversations:

• Ensure Accurate Diagnosis: Healthcare providers must conduct thorough patient evaluations, order appropriate diagnostic tests, and interpret test results accurately.

• Improve Communication: Clear and effective communication between healthcare providers and between providers and patients is crucial for reducing the risk of errors and ensuring informed decision-making.

• Promote Health Literacy: Educating patients on how to identify reliable health information and critically evaluate online sources can help them make informed decisions and avoid misinformation.

• Emphasize Patient Perspectives: Healthcare providers should prioritize patient perspectives and actively engage patients in their care to ensure treatment plans are tailored to their individual needs and values.

  
  

  

  Foster Trust

  Foster Trust: Building strong doctor-patient relationships based on trust and open communication is essential for patients to feel comfortable sharing information and asking questions. 

Simon Bratt can be reached at his website (https://www.through-the-cracks.com/) or by email at s.bratt@me.com.

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