When Mental Health Becomes the “Bootstraps”: A Positive Systems Perspective on Gen Z and Mental-Health Care

By Dr. Bob. Carey

A recent article in The Globe and Mail described the experience of a young woman in her twenties living in Fredericton. She earns just under $50,000 a year, which she considers a reasonable income for where she lives, yet approximately $500 each month goes toward therapy and medication related to her mental health. She explained that without these supports, she has difficulty sleeping, eating properly, and functioning well enough to work. For her, mental-health care is not an optional expense or something she turns to only when things become particularly difficult. It has become part of what allows her to maintain her everyday life.

What I found particularly interesting was the way she described the difference between her generation and previous generations. Older generations, she suggested, were often encouraged to pull themselves up by their bootstraps. For her and some of her peers, therapy and medication have become the bootstraps of their generation.  It is a simple observation, but I think it raises some important questions about the way we understand mental health, resilience, and personal responsibility. Are younger people actually experiencing more mental-health difficulties than previous generations, or are they simply more willing to recognize those difficulties and seek help? Are the circumstances in which young adults are beginning their working lives different enough that we should expect their experience of stress to be different? And perhaps most importantly, what does it tell us when an increasing number of people come to see professional mental-health support as an essential part of maintaining their ability to function?  These questions are not particularly easy to answer, and I suspect that there is no single explanation. It is quite possible that several things are happening at the same time.

One of the central ideas underlying the Positive Systems Approach is that human behaviour and emotional well-being do not develop in isolation. Individuals are continually interacting with the systems around them, and those systems include family relationships, friendships, schools, workplaces, communities, physical environments, economic circumstances, and the broader social environment. Biological and developmental factors are also part of this picture, as are personal history, temperament, coping skills, and previous experiences.  When someone experiences anxiety, depression, emotional dysregulation, or another mental-health difficulty, our natural tendency is often to look inward and ask what is happening within the individual. We may ask what diagnosis best describes the difficulty, what treatment might be appropriate, or whether medication or psychotherapy could help. These are important questions, and in many circumstances, they are essential ones. At the same time, they only provide part of the picture.

The Positive Systems Approach encourages us to widen the lens and become curious about what is happening around the individual as well. What pressures are present in the person's environment? What relationships are available to provide support? How predictable is the person's daily life? Are there opportunities for meaningful activity and social connection? Is the workplace supportive or stressful? Are financial pressures creating a persistent level of uncertainty? Are there family or community resources that could help but are currently unavailable?  None of these questions suggests that the individual has no responsibility for their own well-being. Rather, they recognize that individual responsibility always operates within a larger context. The ability to cope with stress depends partly on the skills and resources a person brings to a situation, but it also depends on the demands being placed upon them and the resources available within their environment.

This is one reason I am cautious when I hear discussions suggesting that younger generations have simply become less resilient. It is certainly possible that some young people may struggle with coping skills, emotional regulation, or tolerance for frustration, just as people have at every point in history. At the same time, we should be careful about assuming that an increased willingness to seek help represents a reduction in resilience. In fact, in some respects, the opposite may be true.  Previous generations experienced anxiety, depression, trauma, relationship difficulties, and other forms of psychological distress, although the language used to describe these experiences was often different. In many families and communities, there was considerable pressure to keep emotional difficulties private. Seeking psychological help could be associated with stigma, weakness, or the belief that a person should simply learn to manage their problems on their own.  The fact that a young adult is now more likely to say, “I am struggling and I need some help,” may therefore represent an important change in our understanding of mental health. It does not necessarily mean that younger people are less capable of coping. It may mean that they have become more comfortable recognizing when their existing coping strategies are no longer sufficient.   At the same time, it would be equally simplistic to conclude that nothing has changed except our willingness to talk about mental health.

The broader environment in which many young adults are beginning their adult lives is also different in important ways. Housing costs have increased substantially in many communities, the cost of everyday necessities has placed additional pressure on household budgets, student debt can make financial independence more difficult, and employment can be uncertain, particularly for people attempting to establish themselves early in their careers. These circumstances certainly do not affect everyone in the same way, and many young adults manage these challenges very successfully. Nevertheless, they represent part of the environmental context in which development and adult functioning are occurring.

From a systems perspective, these conditions are worth considering because chronic background stress can influence many aspects of functioning. A person who is uncertain about where they will live, whether they can afford their expenses, or whether their employment will continue may be carrying a level of cognitive and emotional load that is not immediately visible to others. That does not mean that financial difficulty inevitably produces a mental-health disorder, nor does it explain every instance of psychological distress. It is simply one factor among many that can influence how a person experiences the world.

This becomes particularly interesting when we think about two individuals who appear to have very similar personal characteristics but who are living in quite different circumstances. Both may be intelligent, motivated, and psychologically healthy, yet one may have stable housing, supportive relationships, predictable employment, and a sense of financial security, while the other may be dealing with uncertainty in several of these areas simultaneously. We could ask which person has better coping skills, but the Positive Systems Approach encourages us to ask another question as well: what is each person's environment asking them to cope with?

That distinction has been important throughout my clinical work. When we focus exclusively on the individual, it can be tempting to assume that the solution must also reside entirely within that individual. We teach coping skills, recommend strategies for managing anxiety, prescribe medication when appropriate, or provide psychotherapy. All of these interventions can be valuable. But sometimes the difficulty is also being maintained by something outside the person, and unless we understand that broader context, we may find ourselves repeatedly treating the consequences without fully understanding the conditions contributing to them. The issue of access to mental-health services provides a good example of this.

The Globe and Mail article also raised concerns about the way some employee benefit plans provide considerably greater coverage for medication than for psychotherapy or psychological services. The reasons for this difference are complex, and medication and psychotherapy are not interchangeable forms of treatment. For some individuals, medication may be an essential part of maintaining psychological stability and functioning. For others, psychotherapy may be particularly helpful in developing coping strategies, understanding patterns of behaviour, working through difficult experiences, improving relationships, and learning how to respond differently to stress.  The systems issue is therefore not whether medication or psychotherapy is the “right” approach. It is whether people have access to the combination of supports that is appropriate for their particular circumstances.

Mental health rarely rests on a single intervention. In the same way that physical health is influenced by many interconnected factors, psychological well-being is often supported by a network of relationships, routines, activities, skills, and environmental conditions. Sleep, nutrition, physical activity, social connection, meaningful work, financial stability, relationships, recreation, and access to appropriate professional care can all contribute to a person's ability to remain psychologically well.  The young woman described in the article seemed to recognize this herself. Alongside therapy and medication, she spoke about maintaining a healthy diet, caring for her pet, and structuring her life in ways that helped her remain balanced. These details may seem relatively ordinary, but they illustrate something that we sometimes overlook when we talk about mental health. Stability is often created by many small and interconnected supports rather than by a single treatment.

This is also where I think our understanding of resilience deserves some reconsideration.  Resilience is sometimes described as an individual's capacity to withstand adversity and continue functioning despite difficult circumstances. There is certainly an important place for developing personal coping skills, emotional regulation, problem-solving abilities, and confidence. At the same time, resilience does not necessarily mean doing everything alone.  Children are often more resilient when they have supportive adults around them. Students tend to manage challenges more successfully when schools provide predictable environments and meaningful relationships. Adults dealing with difficult circumstances frequently cope better when they have people who can provide emotional or practical support. In each of these situations, resilience is partly an individual characteristic, but it is also supported by the systems in which the person lives.

This is why I would hesitate to describe therapy or medication as evidence that someone is not resilient. For some people, accessing professional support may actually represent a thoughtful recognition of what they need in order to function well. Knowing when to seek assistance can itself be an important coping skill.  At the same time, we should be careful not to assume that every increase in mental-health treatment necessarily represents an increase in psychological health. Greater openness about mental health is generally a positive development, but there is another possibility that deserves consideration. If family connections, community relationships, workplace supports, and other informal sources of support become less available, professional mental-health services may increasingly be asked to fill roles that once belonged partly to the broader social environment.  In that situation, the growth in mental-health care may tell us something not only about individuals, but about the systems surrounding them. This is an important distinction because it changes the question we ask. Rather than asking simply, “Why are so many young people struggling?” we might also ask, “What is happening in the environments in which young people are trying to establish their lives?”

That question does not imply that society is responsible for every difficulty an individual experiences. Nor does it mean that psychological disorders are simply products of social circumstances. Mental health is influenced by biology, development, personality, relationships, life experiences, and many other factors. A systems perspective is not an attempt to replace one simple explanation with another. It is an attempt to recognize the complexity that already exists.  Perhaps this is one of the reasons that the idea of therapy and medication as the “bootstraps” of a generation is so interesting. It suggests that our understanding of what it means to cope may be changing.

For much of my career, I have seen how easily we can fall into the habit of looking for the problem within the individual. When a child behaves in a way that concerns us, we may ask what is wrong with the child. When an adult is struggling emotionally, we may ask what disorder they have or what treatment they require. Those questions can be clinically useful, but they can also narrow our perspective if they become the only questions we ask.  The Positive Systems Approach encourages a somewhat different starting point. We still look carefully at the individual, including strengths, developmental factors, coping skills, communication, and individual needs. At the same time, we look at the systems surrounding that person and consider how relationships, routines, expectations, environments, and available supports may be influencing what we are seeing.  Sometimes the most meaningful change comes from helping the individual develop a new skill. At other times, it comes from changing the environment in which that skill is expected to be used. Quite often, it comes from doing both.  This perspective also helps us move away from the idea that resilience is something that people either possess or lack. Resilience can be strengthened by supportive relationships, meaningful experiences, opportunities for success, predictable environments, effective coping skills, and access to appropriate assistance. In other words, resilience itself can be understood as something that develops within a system.

Perhaps, then, the generational conversation about “bootstraps” needs to be reconsidered.  The issue may not be that one generation believed in personal responsibility while another has abandoned it. It may be that we are developing a more complete understanding of what personal responsibility actually looks like. Taking responsibility for one's mental health can include learning coping skills, seeking professional help, taking medication when appropriate, maintaining healthy routines, developing supportive relationships, and recognizing when circumstances need to change.  It can also mean recognizing that people do not create their lives entirely on their own.  Families, workplaces, schools, communities, health-care systems, and public policies all contribute to the environments in which people attempt to function. Some of those systems make healthy coping easier, while others can make it considerably more difficult. When we understand this, the goal of mental-health care becomes broader than simply helping individuals manage symptoms. It also becomes about creating conditions in which people have a reasonable opportunity to develop and maintain well-being.

This does not mean that we can create a world without stress, anxiety, disappointment, or psychological difficulty. We cannot, and perhaps we should not try. Struggle is part of being human, and learning to navigate adversity is an important part of development.  What we can do, however, is pay greater attention to the conditions in which that development takes place.  If young adults are increasingly turning to therapy and medication as essential supports, perhaps the most useful response is neither to criticize them for doing so nor to assume that every difficulty reflects a failure of society. Instead, we might become curious about what their experiences are telling us about the interaction between individuals and the systems around them.

The young woman in the Globe and Mail article may have been making a very practical observation when she described therapy and medication as the bootstraps of her generation. Perhaps what she was really describing was an evolving understanding that maintaining psychological well-being sometimes requires support, just as maintaining physical health often does. The Positive Systems Approach takes that idea one step further. It reminds us that those supports do not have to come only from professional services. They can come from relationships, families, workplaces, communities, meaningful activities, predictable routines, healthy environments, personal strengths, and the many other systems that surround us. 

In the end, perhaps resilience is not simply about how strongly an individual can pull themselves upward when life becomes difficult. Perhaps it is also about whether there is something solid beneath them from which they can begin to stand.  That, to me, is one of the more hopeful implications of looking at mental health through a systems perspective. Rather than asking only how we can make individuals stronger, we can also ask how we can create families, workplaces, communities, and systems that make healthy functioning more possible. We may never eliminate the need for personal resilience or professional mental-health care, but we can perhaps create environments in which people do not have to be exceptionally strong simply to remain well.