Voices of Riverbend: Rethinking Mental Illness Through the Lens of Reward Posted on February 19, 2026February 19, 2026 by Paul J. Brown, Chief Medical Officer When most people think about mental illness, they imagine sadness, anxiety, or troubling behaviors. As a psychiatrist, I often see something deeper and potentially more helpful: problems in how the brain experiences reward. Our brains are designed to guide us toward what matters—relationships, purpose, pleasure, and hope. When that internal “reward system” is working well, it helps us learn from experience, stay motivated, and recover from stress. But when it’s disrupted, people can become stuck in states that look very different on the surface, yet share a common root. Depression, for example, is not simply feeling sad. Many people with depression describe a loss of pleasure, motivation, or meaning. Things that once mattered no longer register. Mania can be the opposite problem: the brain’s reward system is turned up too high, attaching enormous importance to ideas or actions that others might see as risky or unrealistic. Psychosis can involve the brain assigning meaning or urgency where it doesn’t belong, making the world feel confusing or threatening. Seen this way, mental illness is less about “weakness” and more about misfiring signals. The brain’s internal GPS is giving poor directions. This perspective matters because it changes how we respond. Instead of asking, “Why won’t this person just try harder?” we ask, “What signals is their brain sending them right now?” That shift leads to compassion, patience, and better care. At Riverbend Community Mental Health, our work is built around this understanding. Medications, therapy, structure, and human connection all help recalibrate the brain’s reward system over time. Progress is often gradual, and setbacks happen—but recovery is real. For our community, this lens also reduces stigma. If mental illness is a disorder of brain signaling rather than character, then seeking help becomes an act of strength, not failure. Your support—whether through donations, advocacy, or simple understanding—helps us provide care that is thoughtful, evidence-based, and deeply human. When we help someone rediscover meaning, motivation, and connection, we are not just treating illness. We are helping their brain find its way home. Paul J. Brown, MD, is a board-certified psychiatrist and Chief Medical Officer of Riverbend Community Mental Health Center. He provides clinical and strategic leadership across outpatient, inpatient, and crisis services, with a focus on quality improvement, systems integration, and evidence-based psychiatric care. He also serves as Chair of the New Hampshire Suicide Fatality Review Committee and previously held a faculty appointment at the Geisel School of Medicine at Dartmouth.
