Evolution vs Revolution

Mental health at a crossroads

I love music. I love playing guitar. There’s something almost holy about taking a handful of seemingly random notes and stitching them into a pattern that makes someone feel something. Even if it’s just me in my living room. Even if it’s just one chord ringing out clean. It’s magic.

I started early. My dad used to play for my sister and me at bedtime soft, steady, calming. Three or four chords, no more. I learned on his nylon-string classical guitar. Not exactly built for “rock out mode,” but it didn’t matter. I learned where my fingers belonged. I learned how sound can carry comfort. I learned I loved the instrument before I even understood why.

Then I played in bands through high school and college. I got “good,” or at least I thought I did (Thanks, Youtube!), but what kept me coming back wasn’t perfection it was presence. If you’ve ever been on stage, you know the feeling: the noise hits you like a wave. The amps breathe. The room responds. You’re not thinking; you’re actually inside the moment. Time gets weird. Your body knows what to do before your brain can interrupt.

Over the years, I’ve tried to bring music into my professional life, too. I’ve given talks with backing bands. I’ve used music as a metaphor so often it’s basically a part of my professional identity.

Most of the time, music evolves. It builds. It borrows. It responds to the previous generation and becomes more contemporary for the moment. It’s incremental, refining a sound, updating the language, pushing the edges a little farther out.

And then… sometimes something happens that isn’t evolution at all.

Sometimes something breaks open.

Photo by Evgeniy Smersh on Unsplash

Punk did that. So did hip-hop. So did grunge. Whole new rules. New posture. New permission. I came out of my own punk rock cave, a little bit of hardcore, some emo, and a whole lot of counterculture. Musicians here didn’t ask politely to be included. They didn’t wait for approval. They showed up and changed the room.

And the more I work in mental health, the more I think we’re standing in that kind of moment now.

A crossroads.

No, it’s not Steve Vai versus Karate Kid Crossroads levels of dramatic, but it’s real.

War is happening. Technology is surging. Expectations are shifting. Need is rising. People are exhausted, anxious, isolated, overloaded while the systems meant to support them often feel slow, fragmented, and built for a different time. We’re told improvement is coming, that progress is inevitable, that the arc bends toward better.

But here’s the thing: evolution can be painfully slow.

Yes, we can keep making gradual improvements. We can refine processes. We can add features. We can pilot programs. We can publish papers. We can tweak billing codes. We can “optimize.”

But is that enough for the demands of this moment?

Or are we kidding ourselves because “evolution” feels safer than admitting we need change that actually disrupts something?

Because when I look at mental health care, including the basics like access, quality, equity, outcomes, clinician burnout, the gap between what we know works and what people actually get, it doesn’t feel like a situation that calls for gentle adjustment.

It feels like it calls for a revolution. I don’t think it’s a revolution that throws out everything. Not chaos for the sake of chaos. But a revolution that challenges the foundational assumptions we’ve accepted as normal:

Who is the system designed for and who is it not designed for?

Why do we accept mediocrity as the baseline standard of care?

Why do we treat long waitlists, confusing pathways, and inconsistent quality as unavoidable facts of life instead of design failures?

Why is the burden on people in pain to navigate a maze?

The best musicians aren’t just the ones who can read music. They’re the ones who can improvise. They can listen, adapt, respond. They can meet the beat of the moment even when the beat changes.

What’s more metal than a green guitar bursting with lightning?

And the beat has changed.

There’s too much happening in the world to pretend things will just naturally get better if we wait long enough. There’s too much at stake to keep confusing inertia with stability. Too many people are suffering for us to keep calling incrementalism “progress” just because it’s familiar.

This is where leadership matters. Not the kind that hosts panels about innovation while keeping everything the same. The kind that steps forward and says: We can do better than this and we’re going to and here’s how.

So yes: storm the castle. (Metaphorically. Please don’t commit crimes.)

Storm the castle of outdated incentives. Of bureaucratic drag. Of systems that reward volume over outcomes. Of structures that make it easier to deny care than deliver it. Of the quiet, dangerous idea that “good enough” is good enough.

Whether the castle is built around mental health, immigration, climate, peace, war or something closer to home, this is the moment to move.

Evolutionaries wait for conditions to improve.

Revolutionaries create the conditions.

Revolutionaries don’t wait.

They act.