I got thinking about this after reading a post on SkinnyHobbit – to what extent are we responsible for bad behaviour during active episodes of mental illness?
The short answer is that we’re 100% responsible, in that there’s really no other person to lay blame upon. Perhaps a more meaningful question would be how much control we have over our behaviour in the context of illness. To peel back another layer, we can consider looking at the degree of responsibility we have when well(ish) to prevent the illness from deteriorating to the point that it affects our behaviour.
Probably the worst acting out I did in the context of illness happened the day before my first psychiatric hospitalization. I was fighting with a friend, and ended up throwing a large rock through his window. Is that something I would ever have contemplated doing in other circumstances? Absolutely not. Was it his fault? He was being an ass, but no, I can’t blame it on him. Was my judgment impaired? Absolutely.
Another problematic incident was at a work team-building retreat. At the time I was holding myself together, but just barely. Alcohol was acceptable at these team retreat, so I brought an amount of booze I knew I should have no problem handling when spaced throughout the day and mixed with food. Unfortunately, it was enough to be the straw that broke the camel’s back, and I went into drunken meltdown mode. I decided I was going to drive myself home, despite being barely coherent. Coworkers had to physically restrain me. Someone drove me home and I sobbed the whole way. Was this normal behaviour for me? No. Does this fit my moral code of never driving while impaired? No. I had taken what I had thought were reasonable steps to ensure moderate alcohol consumption that would leave me sober by the end of the day. But was I responsible? Yup.
Sometimes when I’m depressed I’ll go through phases of being highly irritable. The last big blowup was a couple of years ago, when I started shouting and swearing at a friend of a friend in a public place. I knew I was irritable, but my best friend at the time was playing a musical gig, so I felt obligated to be there. In this case I do hold my friend a little responsible for not releasing me from my friendly duties when she could tell I was about to blow. Still, it was me who did the yelling and swearing.
None of these examples are things that I would ever even contemplate doing when in a clear frame of mind. The first example I wasn’t receiving treatment yet, but the other two examples occurred while I was on medications, and trying the best I could to manage a difficult illness. Sure, I could have made different decisions, but hindsight is 20/20.
So, how responsible are we for our behaviour when ill? Sure, we’re responsible, but when judgment is seriously impaired, there’s limited control over our behaviour and limited ability to exercise the higher level thinking that would normally shut that mess down.
What I hope is that the people around us are able to distinguish between that responsibility and lack of control. After all, when the shit hits the fan they’re likely the ones with relatively clear judgment; us, maybe not so much.
My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses. It’s available on the MH@H Store, as well as Amazon and other online retailers.