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Commentary
Neuropsychiatric disorders and the misguided emphasis on individual responsibility in public health interventions
  1. Craig Waldence McFarland1,
  2. Julia Pace2,
  3. Emily Rodriguez3,
  4. Makenna Law4,
  5. Ivan Ramirez5
  1. 1 Harvard University, Cambridge, Massachusetts, USA
  2. 2 Northeastern University, Boston, Massachusetts, USA
  3. 3 Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4 Tufts University, Medford, Massachusetts, USA
  5. 5 Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Craig Waldence McFarland; craigmcfarland{at}college.harvard.edu

https://doi.org/10.1136/jme-2024-110149

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    Neuropsychiatric disorders such as drug addiction, depression and schizophrenia are often centrally implicated in public health challenges. These conditions impact the individuals affected and have widespread implications, contributing to related crises such as opioid epidemic, rising suicide rates and homelessness. Despite their influence, public health interventions frequently emphasise individual responsibility, overlooking the complex interplay of neurobiological and systemic factors that underpin these disorders.

    Current public health frameworks, such as the Nuffield Council on Bioethics’ intervention ladder, prioritise efforts that encourage individual behaviour change. Paetkau critiques this emphasis on individual responsibility, emphasising the need to consider more systemic factors, such as social determinants of health, as targets of necessary intervention.1 We aim to reinforce Paetkau’s critique of the intervention ladder by introducing three neuropsychiatric case studies, each highlighting the limitations of an individual-based framework in addressing psychopathology-involved public health issues. We argue that conditions like addiction, depression and serious mental illness undermine the emphasis on individual responsibility in public health and policy interventions. To this end, neuroscience demonstrates that effective public health interventions necessitate a shift from the long-standing emphasis on individual responsibility towards more comprehensive, systems-level interventions.

    Addiction and the opioid crisis

    Opioid overdose deaths in the USA have sextupled since 1999, with over 100,000 deaths in 2023 alone.2 The opioid crisis has since remained one of the most pressing public …

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    Footnotes

    • Contributors CWMcF, JP, ER, ML and IR were directly involved in the creation of the article. CWMcF, as the lead author, was primarily responsible for conceptualising the main thesis, conducting the initial literature review and drafting the manuscript. JP, ER and ML assisted in the editing of the article and expanding initial ideas, ensuring clarity and coherence in the ideas presented. IR helped in the initial conceptualisation of the main thesis. All authors agreed to be accountable for all aspects of the work submitted.

    • Funding This study was funded by Lester Kissel Grant in Practical Ethics.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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