Personal Moral Autonomy, Responsibility and Choice: Do We Know What Our Cultural Discourses Are Doing to Young People’s Mental Health?

  • Philippa Donald


Neoliberalism has its roots in the post-enlightenment project of autonomy, freedom, and responsibility. We are each individual, unique selves, existing autonomously and independently of the particular contexts we find ourselves born into. We have the capacity to shape our thoughts and feelings, to make choices, to take responsibility for ourselves. The natural state of human beings is to be free, to be able to make choices according to preferences, to be able to steer our own ships, follow our own dreams and aspirations. Above all we must be true to ourselves—authentic, honest, sincere; these are the virtues of the twenty-first century. If we fail to have the life we want, it is our own fault—we have not made the right choices and are continuing not to make the right choices. In this chapter, I outline some of the ways in which this entrenched, twenty-first century, Western liberal ideology undermines and subverts mental health and, in particular, the mental health of children and adolescents.


  1. Appelhans, B., Whited, M., Schneider, K., & Pagoto, S. (2011, August). Time to Abandon the Notion of Personal Choice in Dietary Counseling for Obesity? Journal of the American Dietetic Association, 111(8), 1130–1136.CrossRefGoogle Scholar
  2. Arcelus, J., Mitchell, A. J., Wales, J., et al. (2011). Mortality Rates in Patients with Anorexia Nervosa and Other Eating Disorders: A Meta Analysis of 36 Studies. Archives of General Psychiatry, 68(7), 724–731.CrossRefGoogle Scholar
  3. Caplan, P. J., & Cosgrove, L. (2004). Bias in Psychiatric Diagnosis. Lanham, MD: Jason Aronson.Google Scholar
  4. Davies, W. (2015). The Happiness Industry: How the Government and Big Business Sold Us Well-Being. London: Verso.Google Scholar
  5. Edwards, R. B. (1981). Mental Health as Rational Autonomy. The Journal of Medicine and Philosophy, 6(3), 309–322. Reidel Publishing.Google Scholar
  6. Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2004). Affect Regulation, Mentalisation and Development of the Self. London: Karnac.Google Scholar
  7. Gauthier, D. (1986). Morals by Agreement. Oxford: Clarendon Press.Google Scholar
  8. Hume, D. (2008). Treatise of Human Nature (Hardback ed.). Charleston: Bibliolife.Google Scholar
  9. Lafrance, M. N., & McKenzie-Mohr, S. (2013). The DSM and Its Lure of Legitimacy. Feminism and Psychology, 23(1), 119. Sage.Google Scholar
  10. NICE (National Institute for Clinical Excellence). Accessed August 4, 2018.
  11. Rawls, J. (1972). A Theory of Justice. Oxford: Oxford University Press.Google Scholar
  12. Rowe, J. M. (2011). Perspectives on Mental Health Care in the UK: Neoliberalism, the Family and Self-Management. Kindle edition, John Michael Rowe; 1 edition (5 July 2011). ASIN: B005AXXIQK.Google Scholar
  13. Smith, P., Cowie, H., & Blade, M. (2015). Understanding Children’s Development (6th ed.). Hoboken: Wiley.Google Scholar
  14. Sonnenville K., Micali, N., et al. (2012). Common Eating Disorders Predictive of Adverse Outcomes Are Missed by the DSM-IV and DSM-5 Classifications. Paediatrics, 130(2), e289–e295.Google Scholar
  15. Sumner, L. (1981). Abortion and Moral Theory. Princeton: Princeton University Press.CrossRefGoogle Scholar
  16. Taylor, C. (1989). Sources of the Self: The Making of the Modern Identity. Cambridge: Cambridge University Press.Google Scholar
  17. van der Kolk, B. (2014). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. City of Westminster: Penguin Books.Google Scholar
  18. Verhaeghe, P. (2014). What About Me? The Struggle for Identity in a Market-Based Society. Melbourne: Scribe Publications.Google Scholar
  19. Wampold, B. E., & Imel, Z. E. (2015). The Great Psychotherapy Debate. The Evidence for What Makes Psychotherapy Work (2nd ed.). Abingdon: Routledge.CrossRefGoogle Scholar
  20. White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. New York: W.W. Norton.Google Scholar
  21. Winegard, B., & Winegard, J. C. (2011). The Awful Revolution: Is Neoliberalism a Public Health Risk? Dissident Voice, April 19. Accessed September 9, 2017.

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Philippa Donald
    • 1
  1. 1.Child, Adolescent and Systemic PsychotherapistLondonUK

Personalised recommendations