Courage and Agency in Mental Health

Building habits of endurance

Photo by Marcel Strauß on Unsplash

At the end of On Getting Out of Bed, I claim that “while we may hesitate to call getting out of bed ‘courageous,’ it is undeniably true that day-to-day life demands a great deal of courage.” I think anyone who has suffered from a mental affliction can resonate with this sense of the courage needed to live. Sometimes it hits spontaneously. You wake up one morning with a gargoyle of anxiety or depression sitting on your chest. Sometimes you are triggered by discrete events throughout your day. Sometimes it’s just the accumulation of days of weeks of months of mundane struggling against your own mind and fearing that there is “no end, but addition.”¹ And so to get up and continue on with your life is an act of courage. But what precisely does it mean for it to take courage to get out of bed and face the day despite mental suffering? In what sense does it involve the virtue of fortitude? To develop habits of courage with mental health is to learn to endure for the good of God, neighbor, and life.

Aquinas distinguishes between two forms of courage: attack and endurance. Attack sounds like what we typically think of when we think of courage: a firefighter running into a burning building, a police officer tackling a suspect, a soldier firing upon an enemy, and so on. But endurance is passive: the WWI soldier in the trenches enduring bombardment, boredom, and disease. Our cultural tendency is to equate “courage” with attacking. Consider how many heroes and superheroes in film and literature of the modern era display their courage through attack rather than endurance. And so I think some readers may have scoffed a little when they read those words in my book, because they were conditioned to think of courage only in terms of attack. And what’s so courageous about getting out of bed? What are you attacking, your coffee? But interestingly, Aquinas describes endurance as “the chief act of fortitude”! He says that “endurance—that is, standing fast in the face of danger—is a more important act of fortitude than attacking.”²

When you choose to engage with life regardless of your anxiety or depression you are altering your brain by telling it with your body that it ought to feel better because you are acting better. And you are showing your brain that it can “stand fast in the face of danger,” whether that danger be the threat of continual depression, social embarrassment, higher anxiety, the possibility that nothing will change, or a million “What ifs?” that may haunt your imagination. The danger you feel may not be rational, but the emotions will be, and to overcome that requires courage to endure the fear that would ask you to shrink away from the challenge of life and fold in on yourself until you are very small, very tiny, very alone, and very helpless.

To endure requires habits of courage. It will be the case that if you begin making excuses for yourself and allow yourself to give in to fear and not “stand fast in the face of danger,” it will be harder to stand fast tomorrow when faced with fears. But it is also the case that if you choose to stand fast today, it will be a little easier tomorrow.

Practically we can do this by making micro-decisions: The choice to literally get out of bed. The choice to get dressed. And so on. Particularly important are decisions to care for yourself and your wellbeing. Specifically I have in mind the choices to shower, to dress nicely, to eat a healthy meal, to drink water, to go for a walk and get sunshine, to pray and read the Bible, and to talk to other people (face-to-face, ideally). There’s good evidence that the choice to exercise can alleviate mental distress in many people. Caring for ourselves, in an act of selfless self-preservation is a choice we make to endure the suffering prudently. Of course, there will still be fluctuations, days, even weeks where things get difficult. And sometimes there will be no explanation for why the depression or anxiety has returned. But if you have exercised that virtue of courage, you will be able to endure these fluctuations with minimal disruption to your life. You’ll discover, if my own recovery has taught me anything, that the times of disruption are fewer and farther between and no longer last as long or are as intense.

That last paragraph may have struck you wrong. There’s a lot of language of “choice” in it, and many times when you are suffering from mental health challenges you don’t feel like you have much or any “choice” in life. Let me be clear that I’m not saying that you can choose whether to be depressed or anxious. My point is that you can choose what to do despite being depressed or anxious. This is the argument I made in On Getting Out of Bed, and it has rubbed some readers the wrong way. I am sympathetic to their concerns. I know, personally, how debilitating mental health challenges can be. Trust me, I do. I know what it’s like to feel stuck and helpless. But I also know that agency is a tricky thing. Once we stop believing we have agency, we stop trying to have agency. If we surrender choice to live a full life to a mental condition, then we will never have a full life. But if we insist that we have a choice, it will be difficult, and we will have to endure, but we’ll be able to work toward recovery. As I have argued before, the first step in recovery is desiring to recover—and that’s a choice you have agency over!

I understand that there are severe cases of mental health issues in which choice is minimal and the person needs serious medical intervention. I’m not trying to minimize those cases by suggesting they could just choose their way out of their suffering. Instead, I’m merely suggesting that for most of us, our experience of mental suffering is one in which we do have a choice of how we will act. Not how we will feel, but how we will respond in action to that feeling. And that is what we are responsible for. That is where endurance comes into play.

We choose to endure danger because we believe that there is some greater good that calls us to endure it. As I will discuss in Re-Collecting, courage is not thrill-seeking. It’s not someone who risks danger for the sake of risking danger. That’s rashness, a vice. Courage is risking danger for the right reasons, for what you know to be good. In the case of mental health, we risk our fears and anxieties because we know it honors God, we know it encourages our neighbor, and we know that this life is a gift from God for us to enjoy and therefore it is good for us to enjoy it. This is the argument at the heart of On Getting Out of Bed.

We do no harm to the virtue of “courage” by suggesting that every day life can often require a great deal of courage. As Aquinas argued, endurance is the better part of courage, and endurance is precisely what mental health challenges call for. We may squirm, as some of my critics have, under the language of agency and “choice,” but we remain agents in the world, and in surrendering our agency to a condition we surrender ourselves. We can of course admit that it is hard to resist the pull of anxiety or depression, but that is different than saying we have no agency, that we are helpless and hopeless. A difficult task is something to be endured. An impossible task can never be endured. If you believe you have no agency in your recovery and in your mental health, you will struggle to endure. But with God’s help, and the aid of professionals, and the support of good friends and caring family members, and the choice to endure, we can.

1. The Dry Salvages, T.S. Eliot

2. STII-II Q. 123 A.6