From Blame to Balance: Rethinking Mental Health Through Systems

Long before psychology emerged as a science, early theories like the four humours explained human behaviour and emotional states as the result of internal imbalances. Rooted in Ancient Greek medicine, this model proposed that blood, yellow bile, black bile, and phlegm each governed temperament and health. If someone was irritable and aggressive, they were believed to have too much yellow bile — a “choleric” temperament.

Treatment focused on restoring internal balance, such as through bloodletting or changes in diet. The issue — and the solution — was believed to lie entirely within the individual.

As medicine advanced, this view evolved into the medical model, which dominated psychology from the 19th century onward. This model introduced diagnostic categories based on observable symptoms. For example, if someone experiences low mood, fatigue, and loss of interest for more than two weeks, they may be diagnosed with depression. If the symptoms persist for over three months and interfere significantly with daily life, it may be classified as major depression. Each diagnosis corresponds with a standard treatment — usually medication, therapy, or both. While this model brought structure and consistency, it remained centred on the identified patient, assuming the problem was located inside the person.

Then came a major shift. Systems theory, introduced by thinkers like Ludwig von Bertalanffy and Gregory Bateson, looked at mental health and systems. It offered a new lens: it suggested that individuals cannot be fully understood outside the context of the systems they live in. A system is any interconnected group where change in one part affects the whole — families, schools, communities, workplaces. Systems theory emphasises that behaviour often emerges not from an isolated flaw in a person, but as a response to the dynamics of the system they’re part of.

Psychology embraced this shift through family systems theory, particularly in the work of the Milan Systems Team, led by Mara Selvini Palazzoli. Their Milan Systems Theory rejected the idea of an isolated problem residing in one individual. Instead, they asked: What function is this behaviour serving within the system?

Take, for example, a mother and a daughter with anorexia. Why does the daughter have anorexia? Is it because she has an over-controlling mother? But if your daughter was sitting in front of you not eating and slowly killing herself, you might also become over-controlling.

So where did it start? With the mother? With the daughter? Or in the family? Perhaps the original issue was conflict between the mother and the father. The child witnessed this tension during dinner and stopped eating due to stress. Her weight loss drew praise at school, reinforcing the behaviour. As she became sicker, her parents stopped fighting and focused on her — finally operating as a team. The child unconsciously learns: if I want my parents to get along, I need to stop eating. When things improve between her parents, she eats more. But when the original issues return, so does the fighting — so she stops eating again. The system begins to stabilise itself around the child’s pathology, and her behaviour is reinforced within the family dynamic.

If we take this child out of the family system — put her in a hospital, teach her new coping strategies, build her up with therapy — she may get better. But if she returns to the same unchanged system, her progress begins to erode. Eventually, the same dynamics will trigger the same behaviour, and the symptom returns.

A helpful metaphor: imagine placing a piece of wood in a body of water. The current moves the wood — it cannot resist. The water is the system; the wood is the person. Now attach a motor to the wood and give it fuel. That’s therapy — building self-awareness and coping skills. For a while, it can go against the current. But eventually, the fuel runs out. Without changing the current itself — the system — the original direction reasserts itself.

This reflects a core principle in systems theory: homeostasis. Systems tend to resist change and return to a previous state of balance — even if that balance is unhealthy. Without altering the system, it will unconsciously work to restore old patterns.

This approach aligns with what is known as first-order systems theory, where the therapist observes and analyses the system from the outside. Later developments introduced second-order systems theory, which acknowledges that the therapist becomes part of the system simply by interacting with it — highlighting how deeply interwoven these dynamics are.

In short, people can only sustain new behaviours if the system they return to supports those changes. True and lasting transformation requires more than individual effort — it requires a systemic shift. The question is no longer, “What’s wrong with this person?” but “What needs to change in the system so this behaviour no longer needs to exist?”

What Can We Do?

Some systems can be changed. Sometimes we can bring awareness, insight, and new patterns that shift the entire dynamic. Other times, we must exit the system altogether — whether that means leaving a toxic workplace, stepping back from a harmful social group, or setting boundaries within a family.

In most cases, systems become healthier when they are open to feedback, flexible to change, and exposed to outside influences and new knowledge. Rigidity, isolation, and secrecy are often signs of systemic dysfunction. Healing comes when a system allows light in.