The Psychiatrist Who Says You're Approaching Mental Health Backwards
Most of us talk to ourselves like harsh prosecutors. Here's how to become your own best friend instead.
The Big Idea: Mental health isn’t just about diagnosing problems and fixing deficits. It’s also about recognizing the strengths, values, and capacities that are already alive inside you.
Why It Matters: Many of us move through life driven by ambition, distraction, anxiety, or the pursuit of comfort. But according to psychiatrist Paul Conti, lasting well-being comes from balancing those drives with something larger: the desire to contribute, connect, and help life flourish.
Try This Today: Write down three things that are already “going right” in your life—not achievements, but qualities: resilience, curiosity, kindness, persistence, honesty. Then ask yourself how you might build from there instead of starting from self-criticism.
These ideas come from What's Going Right: A Powerful New Method for Optimizing Your Mental Health by Paul Conti. Conti is a psychiatrist and president of Pacific Premier Group, a comprehensive mental health clinic, and has been featured on leading podcasts including those hosted by Andrew Huberman, Tim Ferriss, and Mel Robbins. Read on for 5 of his big ideas.
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1. Begin with what’s going right.
This suggestion comes across as backward to a lot of people. That’s because the field of mental health has been built, almost entirely, on a deficit model.
The dominant framework—the Diagnostic and Statistical Manual of Mental Disorders (DSM)—is literally a 1,120-page compendium of what can go wrong with a human mind. The DSM has offered a lot to the field, but its unintended legacy is a myopic culture of mental health stuck to what’s broken, what’s missing, and what needs to be fixed.
What I’ve seen across decades of clinical practice is that this approach misses something essential. Every person who has ever sat across from me, no matter how much they were struggling, brought something right, healthy, and good into that room with them. Usually, a lot of courage and curiosity. A capacity for honesty that most people would find difficult under far easier circumstances. Relationships that have survived adversity. Resilience that’s been earned, not given. And often a clear sense of what they want their life to look like, if only they could figure out how to get there.
By focusing on what’s going right, I’m not asking anyone to pretend that hard things haven’t happened or that suffering isn’t real. Real pain deserves real attention. But I am suggesting that the best place to start addressing your mental health isn’t in cataloging what’s gone wrong—it’s in identifying what’s already going well for you and building from there. Not because it’s more comfortable, but because it’s more effective.
When you begin with your strengths, existing capacities, values, and fundamental drives, you’re working with the grain of who you already are rather than fighting against some imagined ideal of who you (or others) think you should be.
Understood this way, mental health is less about repair and more about optimization. You don’t need to be broken to benefit from it. You don’t need a professional diagnosis to ask meaningful questions about your own life. And you don’t need a therapist in the room to begin. You need honesty, a willingness to look inward with some regularity, and—perhaps most importantly—the conviction that what you find there is worth taking seriously. Because it is.
2. Know what’s driving you.
Imagine that you’re driving a car, but the car is you: it’s the same vehicle you’ve been piloting your entire life. You know the roads you’ve taken and the ones avoided. You’ve had your share of breakdowns and stretches of smooth highway. Now ask yourself: What’s fueling this vehicle? What’s in the tank? The nature of what drives you determines not just how far you go, but whether you arrive anywhere worth being.
Every human being is driven by three fundamental forces: assertion, pleasure, and generation.
Assertion drive: This is the part of you that wants to influence your life and the world. It’s what gets you out of bed in the morning, makes you set goals, and provides the energy it takes to change things. At its best, the assertion drive produces ambition, persistence, and the kind of healthy competitiveness that pushes you to grow. When it runs unchecked, however, it tips over into dominance, control, and the belief that your needs deserve to override everyone else’s. You’ve met people for whom assertion has become their primary mode of existence, and you’ve probably noticed that spending time with them is exhausting.
Pleasure drive: This is the part of you that wants to enjoy life and feel good. This drive is the source of gratification, relaxation, connection, and relief. When the pleasure drive is balanced, it makes sure your life is worth living while also keeping you grounded. But when this drive gets off kilter, it fosters avoidance, overindulgence, and the pursuit of comfort at the cost of everything else. Many of the addictive behaviors I’ve treated over the years represent a pleasure drive that’s been commandeered—often in response to pain—into something that provides short-term relief while dismantling long-term well-being.
Generative drive: Of the three, the generative drive has been widely neglected by mainstream psychology. This is the part of you that wants to make things better for yourself, for the people you love, and for the world beyond your immediate circle. The generative drive is also behind creativity, learning, altruism, and the impulse to leave something of value behind. It’s what makes a person run into the surf to save a stranger caught in a rip current, not because it’s rational, and not because it feels good in a simple hedonic sense, but because something in them cannot choose to do otherwise.
Understanding which of these drives is running the show on any given day, and whether the three are in balance or at war, is one of the most clarifying things you can do for your own mental health. Most of us spend our lives toggling between assertion and pleasure, with the generative drive showing up only in glimpses. This book gives you tools to change that ratio.
3. Activate your generative drive.
My maternal grandmother wasn’t a therapist, philosopher, or self-help author. She grew up in a cramped row house in New Jersey, never received a formal education, and probably never thought of herself as remarkable in any way. But Grandma Grace—born Maria Gracia, daughter of Italian immigrants—was one of the most mentally healthy people I’ve ever known. The older I get, and the more patients I work with, the more clearly I see why.
Grandma Grace lived almost entirely from her generative drive. She spent her spare hours knitting blankets, scarves, and sweaters—not to wear them herself, but to give them away. She knew there was always someone nearby who needed one. During World War II, she worked a factory job and sent money back to her family in war-torn Italy. When she encountered a neighborhood girl who wasn’t receiving what she needed at home, she simply stepped in—providing love and support for years, without fanfare, without expectation of return.
Grandma Grace helped raise my siblings and me with the same quiet consistency. I sometimes wonder whether I would have made it through the harder stretches of my youth without her.
Generative drive is not something I invented. It is a biological reality, a fundamental human capacity present in every one of us, as basic to our nature as the drives toward assertion and pleasure. The evidence is everywhere: in the parent who stays up all night with a sick child, in the stranger who picks up litter in a park they’ll never visit again, in the artist who labors over work they may never be paid for, in the scientist who spends a career pursuing knowledge that won’t benefit them personally. We aren’t simply selfish creatures who occasionally act generously. We are creatures for whom generosity, creativity, and care are as natural as breathing.
What blocks the generative drive is usually some combination of unexamined fear, pain, and habituation to the other two drives. People whose lives are organized primarily around assertion often find it difficult to let their guard down enough to give freely. People whose lives are organized primarily around pleasure often mistake short-term comfort for flourishing. The generative drive requires a longer view and a larger container. It asks you to tolerate discomfort, invest in the future, and find meaning in contribution rather than control or gratification.
Activating your generative drive doesn’t require heroism. It can start as small as a handwritten note to someone who’s struggling, a decision to learn something challenging and new, or ten minutes of honest self-reflection at the end of the day. Grandma Grace didn’t wait for ideal conditions. She worked with what she had, and she used it to make things better.
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4. Become your own best friend.
Think about the best friend you’ve ever had: the one who would tell you a hard truth with kindness, who could hold your worst moments without judgment, who knew how to ask the right question at exactly the right time. Now ask yourself: Do I ever treat myself that way?
For most people I work with, the answer is no. In fact, most people speak to themselves in ways they would never speak to someone they loved. The inner voice they bring to their own struggles is not the voice of a thoughtful friend but the voice of a harsh prosecutor—cataloging failures, doubting intentions, and usually coming to the most unflattering interpretation of any ambiguous situation.
This matters tremendously because self-inquiry is one of the most powerful tools we have for building and sustaining mental health, as long as our inquiry is conducted with curiosity and compassion. When I encourage patients to examine their lives, the ones who make the most meaningful progress are never the ones who are hardest on themselves.
Self-inquiry involves checking in regularly with your structure of self, function of self, and drives. It also means asking honest questions about what you find. Not to criticize yourself, but to understand yourself. This distinction changes everything. When you judge yourself for being anxious, you typically get more anxious. But when you become curious about your anxiety—when it started, what triggers it, what function it’s been serving—the resultant understanding usually calms you down and offers you leverage.
One useful entry point into this kind of self-inquiry is to notice the gap in your function of self between your behaviors and your strivings. What you actually do, day to day, tells you a great deal about what you believe about yourself and what you think you deserve, as opposed to what you consciously aspire to.
When these two things are aligned, life tends to flow reasonably well. When they’re in conflict, that gap is precisely where some crucial work lives. A person who says they want to build closer relationships but consistently avoids vulnerability isn’t being inconsistent because they’re weak-willed. Something inside of them has decided that closeness isn’t safe. Getting curious about that—kindly, without self-condemnation—will shift everything.
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5. Change your life narrative.
Here is an exercise I return to again and again: write two versions of your own life story. Not a polished autobiography, just a page or two describing who you are and how you got here.
Write the first version through whatever lens comes naturally, without editing. Then write a second version, deliberately told through the lens of your generative drive. This second version will highlight your resilience, hard-won lessons, capacity for connection, the ways you have shown up for the people who needed you, the moments when you did the right thing even when it was difficult, and so on.
I did this exercise myself. The difference between my two versions was alarming. The first began with dysfunction, loss, and my brother’s suicide. The second began with my grandmother (who modeled simple goodness and profound kindness) and my parents (who, despite their struggles, built successful careers and raised children), with a winding path toward medicine that was driven by love rather than ambition, and a career that has given me the privilege of sitting with people in some of the most important moments of their lives. Both versions of my life narrative are true. But they have very different effects on the person reading them, not to mention the person living them.
The stories we tell ourselves about our lives are not neutral recordings. They are active forces that shape how we see ourselves, what we believe we deserve, and what we’re willing to attempt in life. A life narrative populated primarily by failure, loss, and inadequacy creates a particular kind of salience—it primes you to see evidence of those things in new situations, to interpret new information negatively, and to approach challenges with a pre-formed expectation of defeat. A life narrative that honestly acknowledges difficulty while also accounting for strength, learning, and connection creates something remarkably different. It doesn’t deny pain. It contextualizes it.
The goal of a well-constructed life narrative isn’t happiness—it’s benevolent accuracy. Most of us have been carrying around stories that are selectively edited in favor of our failures, because shame and self-criticism are louder and stickier than pride and self-compassion. The invitation here is to correct that editorial bias: to “take in the good,” as psychologist Rick Hanson puts it, with the same seriousness that you’ve been taking in the difficult and the painful.
Over time, it’s possible to view your life with kindness, an embodied sense of peace, contentment, gratitude, and delight. Not because life becomes easier with time, but because you finally have the full story available to you.