Wednesday, February 29, 2012

Responsiblity or Pathology?

How's my mental health today?

It probably depends on who's diagnosing me. Or what I'm trying to excuse or justify!

Last week I heard a newsbrief mention of an RCMP officer charged with a number of infractions including drunk driving and leaving the scene of an accident. The defense strategy employed by his lawyer was to justify/excuse the officer's behaviour due to his "suffering" from an addiction and PTSD.

As an advocate and activist working to reduce the stigma and negative public perception of mental illness I was always angered by stories like this. I still am - even though I stepped away from those roles 4+ years ago.

The bottom line is that mental illness and addictions SHOULD NOT, and MUST NOT be used to excuse deliberate choices and behaviours.

I have a mental disorder, I am not responsible for that - I certainly did not ask for it, or desire it in any way, shape or form. I have no control over that. I am, however, responsible for how I respond to my reality. It IS my responsibility to educate myself about my condition, the danger signs, and what I need to do about them. I am responsible to do those things in my power that will help me stay as healthy as possible. If my doc prescribes meds or other treatments - it is my responsibility to comply with the treatment plan. If I disagree with the treatment plan, it is my responsibility to negotiate another approach with my physician.

If I deliberately choose to ignore and/or not comply with the treatment plan, I cannot use my illness as an excuse for any resulting mishap or catastrophe. Nor should I be allowed to use that justification.

One of my first jobs in mental health was with a mental health crisis service that was  located in a building that also contained a number of emergency housing services and addictions treatment programs. I was a smoker at the time, and while getting my nicotine fix one day (in front of the building) I overheard a conversation between 2 young men. One was telling the other about his intention to go out and score some crack later that evening. The other responded, quite incredulously, "What are you doing? You're in a treatment program! Why mess that up?"

The response: "I can't help myself. I have an illness."

Such a crock! Making deliberate, destructive plans are not a symptom of an illness or addiction. Cravings and urges are - but not the conscious choice to satisfy those urges and cravings. The second young man was still giving the pathetically "ill" guy an earful when I left to return to work.

This story is unfortunately too common in our culture and society. How often do we see and hear the "I'm not responsible", "I have an illness", "I have an addiction", "I was drunk" justification for destructive incidents where someone got hurt or even killed?

(The overuse of early childhood victimization through social injustice, poverty, family dysfunction, etc as justification for continued destructive adult behaviour is a whole other rant).

I don't deny that there are tragedies that occur as a result of illness which victimize both the injured party and the "perpetrator". In those instances the illness is clearly the cause of the calamity (and I will speak up loudly in defense of the afflicted in these circumstances).  Those situations are far more rare than defense lawyers would have us believe.

In my opinion (and many others) the social sciences have played a significant role in this trend to pathologize bad choices and behaviours and the subsequent use of this pathology as justification for these behaviours and choices all in the hope of avoiding responsibility for inevitable destructive outcomes.

The list of psychiatric disorders is expanding at an amazing rate. It appears that more and more socially and culturally undesirable behaviours, character traits, eccentricities and personal beliefs (including religious) - are being labeled as some kind of disorder. The spectrum of acceptable social norms is shrinking and everything outside of that spectrum is quickly pathologized and given a psychological or psychiatric label. (I'm not talking about clearly blatant criminal behaviour).

During my years working in mental health I had the opportunity to meet some very interesting people, including individuals whose driving passion was their involvement in the anti-psychiatry movement. While a few were rabidly over-the-top, many presented some fascinating, legitimate, articulate arguments.

Some were even entertaining. The ones that amused me were the stories and parables that mocked the practice of analyzing and pathologizing everything. The first link below will take you to one of my favorite anti-psychiatry discourses. For Winnie-the Pooh fans, here's a whole new slant on your favorite characters.

Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne

Even general medicine gets ridiculed.

Medical Mysteries of the 100-­Acre-­Wood

Responsibility or Pathology?

It's time for more honesty - we need to call behaviours and choices exactly what they are!

If it's clearly deliberate, intentional, especially driven by selfishness - it's not justifiable or excusable as the result of illness.

Sin is sin - not an illness!


A bit crude - but it makes the point!

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