Accountability in Mental Illness

[Cavernio]

Is someone with a mental illness responsible and/or accountable for their actions?
Are they sound of mind? Should one interfere with someone who has mental illness when they are self-harming even if the mentally-ill person does not want help?

I'm coming at this topic from the perspective of someone whose suffered from one my entire adult life, and who has recently really felt a paradigm shift within myself about this whole thing.
I recently came back from 10 days hospitalization where I have been put on mood stabilizers for the first time instead of antidepressants, and since getting out I have been delving into the realm of bipolar disorder.
I never thought I was bipolar. I have deduced for myself that I probably experience hypomania and rarely full-blown manias, but the depression is deep and the hypomania is more often than not a 'happy' manic. My past few months have been hell.

The paradigm shift I am developing, and testing the waters of fully adopting this way of thinking, is that I am not actually accountable for the worst of my behaviors when I have them because I am not actually in control. It's like I'm on auto-pilot.
I have never truly considered myself 'insane' as such though, until coming home from my hospitalization just recently. Now I think I am. And it's so obvious to me that it's coming from inside my body, and is not the world around me that triggers things. I experience body temperature fluctuations, mental tiredness that doesn't mesh with physical restlessness or vice versa, episodes of highs or lows can last hours to days, but never seem to have a reason for them.
But then one of the therapy groups that I went to while staying in the psyc ward gave a handout that was basically saying the best way to get through strong emotional experiences was to just allow them to happen, watch them as they go by. Don't try to change them. And it was sort of like the nail on the coffin lid for me. The best advice I'd heard the entire 10 days, the most helpful, was 'stop trying to change it'.
Why would this therapy, above so many other things that pretty much work with altering it or changing it somehow, work at all if it were not true that I do not actually have control over myself? Like, goddamn I've had problems for 15 years, and I keep struggling and trying to control and not let things take over, but nope, that doesn't matter at all.

It makes me actually yearn for days when institutions were around because at least then you weren't at all accountable for your actions. But now mental illness is like, being rested on the head and shoulders of the person who has it. Paradoxically this view is being held through while strongly touting the adage that mental illness is a disease that one is not in control of. But no, If they person wants it enough, they'll change, because they'll do enough therapy, try enough meds, they'll stick to it, they'll struggle everyday. But all I hear is, if they're sane enough, they can stave off the insanity. If they're not sane enough, they can't but are still being told to.

[Luvox]

As someone relatively new to the psych ward scene (last 5 years, in and out), I feel the only people who can't be held accountable are those born or inflicted with intellectual disabilities. Everyone else; regardless of their illness/instabilities, should be.

If they're harming themselves or those around them, despite how "insane" they (or others) might deem themselves to be, somewhere in that brain of theirs lies the knowledge to make a more informed and sensible decision.
Take yourself for example.
Despite how much you say the illness has made life hell, at least you're capable of a sound enough state of mind to identify the problem, you still possess inherent decision-making skills. If you're capable of at least that, you're more than capable of being held accountable for your actions. If you're simply incapable of fathoming the repercussions of your actions or just your actions in general, I'm not saying you should get a free pass, just more leniency.

I'm someone who suffers from a number of illnesses, and regardless of how much they may be impeding my ability to make a rational decision, I still have the knowledge ingrained to know what I'm doing is/isn't right. Even if that knowledge isn't present at the time. It's our responsibility as risks to back the fuck up when things aren't working up there, attempt to identify the problem, and try to do the right thing based on experience. Unless you're a small child, you have that experience.

[V-Ormix]

Yeah I think it makes sense that if you can even ask/are aware of the question, that should be a testament to the direct link of ones cognitive capacity to have a border-line. (basically what luvox is saying)

I think it's safe to say to not worry more about weather or not your accountable more than the actions and decisions that you make.

I personally would never trust a "doctor" drugging me up to "fix" my problem... best not be to quick to rule out the physical world and the sense of space that can be had around you.

[klimtkiller]

depends whether the person is trying to do something about the illness. if they know they do bad things due to their mental illness, but don't try to seek medication, then i think they are accountable. if they have tried everything, or are unable to try/get medication for any reason, but still have the illness, then i don't think they are accountable.

[Cavernio]

Originally Posted by Luvox

As someone relatively new to the psych ward scene (last 5 years, in and out), I feel the only people who can't be held accountable are those born or inflicted with intellectual disabilities. Everyone else; regardless of their illness/instabilities, should be.

If they're harming themselves or those around them, despite how "insane" they (or others) might deem themselves to be, somewhere in that brain of theirs lies the knowledge to make a more informed and sensible decision.

You're making the assumption that knowledge leads to ability to then control oneself. But we know that this isn't always the case. Take the extreme example of how this is not always the case: Someone in a coma who is aware of their surroundings can still not interact with them. Clearly awareness is not the only necessary part of the process of free will, but your argument only holds if it is.

Now, you could potentially argue that there is nothing inherent in mental illness that prevents free will that is on par with being paralyzed or in a coma, but that, again, would be a different argument.

[Cavernio]

Originally Posted by V-Ormix

I think it's safe to say to not worry more about weather or not your accountable more than the actions and decisions that you make.

This makes no sense. Clearly situations have happened in my life that have made me perceive that I am not actually in control of my actions and decisions for large-enough periods of time that I'm actually questioning it.

I personally would never trust a "doctor" drugging me up to "fix" my problem... best not be to quick to rule out the physical world and the sense of space that can be had around you.

I personally think this is a childish perception of life and mental illness, one that is wrong and which causes a lot of harm. Really, EVEN IF mental illness were ENTIRELY environmentally based, there would still exist the question about what constitutes mental illness, and there would still mandatorily be heavy intervention from the outside world in attempts to 'fix' the person. That we know that this isn't even the case is actually -good- news.

[Dynam0]

Your belief in total lack of self-control is what perpetuates same. Change your beliefs and you change your life.

[lurker]

i feel like luvox's post doesn't distinguish clearly enough between those who have their mental faculties unimpeded by their illness and those who are too lost in their mental illness to distinguish their delusions from reality
you're not going to give a fuck about common sense if you think everyone is an agent acting against you (talking mainly about schizophrenia here) and while more intelligent people tend to be more able to cope with delusions of that magnitude it doesn't take any particular level of "intellectual disability" to convince oneself of that sort of situation

[Luvox]

I'm not touching that coma comparison

Originally Posted by lurker

i feel like luvox's post doesn't distinguish clearly enough between those who have their mental faculties unimpeded by their illness and those who are too lost in their mental illness to distinguish their delusions from reality
you're not going to give a fuck about common sense if you think everyone is an agent acting against you (talking mainly about schizophrenia here) and while more intelligent people tend to be more able to cope with delusions of that magnitude it doesn't take any particular level of "intellectual disability" to convince oneself of that sort of situation

You're too right, my opinions were biased towards my specific illnesses (or maybe just myself in general). I do feel where you're coming from though, my meds just restricted my ability to think about the situations when I actually need them.

I can't count the times I've been committed or arrested because I was getting delusions of reference from external stimuli (that's a lie, the answer's 8). I don't blame the illness though, I blame myself for the way I handled the situations. In the end it's my actions and my own inability to discern whether or not what I hear and see is actually real.

illness is a hurdle, not a barrier. Unless they've got a neurodegenerative disease, people are capable of identifying their triggers and placing failsafes to ensure their safety and the safety of others. For example, I go to sleep every most nights expecting any number of neighbours to storm my house and kill me in my sleep, the news tells me there's public outrage and people are pissed with me, I expect a shitstorm everytime I close my eyes.
You know what I do? Every sensible step to ensure the sounds I'm hearing are absolute. I don't watch TV, I keep my windows closed, and I take every step to ensure I'm not disrupting those around me, does it help me sleep? no. but at least it gives me confidence that my delusions are my own. I'm able to make these decisions to help myself distinguish from what's real and what's not; and in turn make the most sensible decision based on what's left

I don't know where I'm going with this but just some insight on someone who literally isn't sure he's in the same reality as everyone else most of the time.
I feel like if I can overcome my problems, she can overcome hers. Or at least learn to control them

Edit: If you're wondering it's a mix of psychosis and anxiety. changes my feelings, behaviour and tricks me into thinking everyone is talking about me behind my back. If you've got a paranoia deficiency I'd definitely recommend 5 stars

double edit: this is probably more of a chit-chat post then a critical thinking post, I don't really know if divulging my weaknesses contributes in any way. But the point is: you don't have to let it control you.

if it can be controlled, you're accountable. Even when it's not controllable, you're still accountable. Someone needs to take responsibility for things, and if you're the reason for those thing then accountability falls on you. I'd say the same to anyone. mentally disabled dude shits his pants? their fault. rapist can't stop raping? his fault. everything we do or have done is a product of who we are, our actions are ours and ours alone.
If we wanna use cavernio logic; it's not the rapists fault blame his hormones. it's not the retards fault blame his parents.

It all comes down to control (which most people are capable of to some degree), regardless of your illness.

This thread should probably be titled "I can't control myself, validate my decision to let the sickness win"

Originally Posted by Cavernio

I am not actually accountable for the worst of my behaviors when I have them because I am not actually in control. It's like I'm on auto-pilot.

this mentality is toxic. Learn to control yourself.

Sorry if I'm being blunt, but I've seen countless people more fucked than you and even they were able to learn some self-restraint.

[lurker]

for some reason i interpreted your first post as meaning that you worked in a psych ward and now i feel really stupid

[Luvox]

don't feel stupid, "psych ward scene" was a dumb phrase to use. It would've been much clearer if I wasn't trying to be a hip little shitlord. Sorry for that

[rushyrulz]

The mentally handicapped should be held accountable for their actions to an extent. Instead of using a mentally handicapped person, let's say we're talking about a very drunk person. It is probably excusable for the drunk person to give someone an unsolicited slap on the ass, where it is not excusable for them to go and rob a bank...

Mental illness comes with an added layer of empathy and forgiveness, and it can be scientifically backed. But is not, by any means, the get out of jail free card some people think it should be.

[Cavernio]

You don't know the level of my self-restraint. But suffice it to say that under duress I have less self-restraint than when not. We all do. Where the difference lies is the magnitude of that duress and how often it happens. And yes, this whole thing borders on fatalism. I don't have an inability to know what reality is or isn't, but I do have an inability to control my emotions. And again, the most useful thing I've ever been told is 'don't try to control your emotions'.
We are not coming at this from the same place at all. Your paranoia, your emotions, are a direct result of thoughts. All you need to do assert what is real or not, not saying this is easy or that it's pleasant. My moods are not the result of any thoughts though. They just are. It is a physiological reaction.
Secondly, you're assuming your thoughts are the direct connection to your actions. Thought leads to action. I beg to differ. One's physiological arousal that is far closer to your actions than your thoughts. Thought leads to arousal leads to actions. You actually have an out that I don't have; I can't think my way out of my moods.

Lastly, I don't understand why there -needs- to be someone held accountable for something. Why is this necessary? Yes there is the safety of people around us, and it makes sense that in order to get to the bottom of it we need to find the cause to properly protect the public and properly train criminals to not do it again. At the same time though, we don't expect wild animals to behave in ways that fit into society. We don't hold animals accountable for their actions. Why do we always hold people accountable for theirs? Just because it makes things easier for society to think that everyone has self-control, that doesn't actually make it so. Would we not benefit more from having a -real- perspective of what's going on in the world around us instead of assuming something because it's easier that way? We can still do all sorts of things to people even if we don't think it's their fault.

Lastly, why do you think that in the past people weren't held accountable for their actions if they were mentally ill? Clearly there has been a societal shift in thinking. And yes, this is absolutely a societal shift in thinking and is far from some sort of 'absolute' Luvox is making it out to be. We also like to blame individuals for things like getting cancer now too though.

It's like there's this perception that we'll think of ourselves as lesser beings or something. Guess what, if you're paralyzed and you keep trying to walk you're not going to be able to walk and you're just going to put yourself through pain every single time you try to. There's serious negative consequences for trying to control what is beyond one's control which then leads to negative stigma because society believes a falsehood of what's possible.

[Cavernio]

Originally Posted by rushyrulz

The mentally handicapped should be held accountable for their actions to an extent. Instead of using a mentally handicapped person, let's say we're talking about a very drunk person. It is probably excusable for the drunk person to give someone an unsolicited slap on the ass, where it is not excusable for them to go and rob a bank...

Neither of those things is excusable. Furthermore they chose to get drunk in the first place or were otherwise themselves drugged or colluded into doing something they didn't want to do.

[Luvox]

I've approached this wrong. I wasn't saying you need to keep your emotions in check I was saying you need to control the actions those emotions lead to. That's where the accountability lies. No body has control over the thoughts and feeling their brain produces, but it's still their responsibility not to exhibit uncharacteristic behaviour due to it. You're more than welcome to be happy/sad/whatever, but it's when you're experiencing these emotions that you need to realise the things you do and the things you say, fall solely on you. No matter how unwell you are.

Also, you shouldn't compare the ideas of a single person to a societal shift in thinking

Or compare the mutation of cells to someone with thought/emotional disorders

And you keep comparing this to physical infirmity (cancer, paralysis), as though they're even remotely related and I don't understand why. Last I checked emotion was influenced by neurotransmitters and hormones, chemical changes.

"Lastly, why do you think that in the past people weren't held accountable for their actions if they were mentally ill?"

Because it was stigmatized and those who suffered from mental disorders weren't considered as human as the rest of them. That's where the societal shift is. I don't know if you're aware, but human rights are a thing now. Everyone's for the most part "equal".

[V-Ormix]

Originally Posted by Cavernio

This makes no sense. Clearly situations have happened in my life that have made me perceive that I am not actually in control of my actions and decisions for large-enough periods of time that I'm actually questioning it.

I personally think this is a childish perception of life and mental illness, one that is wrong and which causes a lot of harm.

Originally Posted by Cavernio

I personally think this is a childish perception of life and mental illness, one that is wrong and which causes a lot of harm. Really, EVEN IF mental illness were ENTIRELY environmentally based, there would still exist the question about what constitutes mental illness, and there would still mandatorily be heavy intervention from the outside world in attempts to 'fix' the person. That we know that this isn't even the case is actually -good- news.

Clearly situations have happened in you're life that have "made" you perceive "that" you are not "actually" in control of you're actions and decisions for large-enough periods of time that you actually question it.

Originally Posted by rushyrulz

The mentally handicapped should be held accountable for their actions to an extent. Instead of using a mentally handicapped person, let's say we're talking about a very drunk person. It is probably excusable for the drunk person to give someone an unsolicited slap on the ass, where it is not excusable for them to go and rob a bank...

Mental illness comes with an added layer of empathy and forgiveness, and it can be scientifically backed. But is not, by any means, the get out of jail free card some people think it should be.

Furthermore they chose to get drunk in the first place or were otherwise themselves drugged or colluded into doing something they didn't want to do.

[Cavernio]

Originally Posted by Luvox

you shouldn't compare the ideas of a single person to a societal shift in thinking

Why not? There has been a shift in a societal way of thinking and my thinking right now is wondering about what the past's perceptions of mental illness was.

Or compare the mutation of cells to someone with thought/emotional disorders

And you keep comparing this to physical infirmity (cancer, paralysis), as though they're even remotely related and I don't understand why. Last I checked emotion was influenced by neurotransmitters and hormones, chemical changes.

Last I saw both of these are under the category of 'human physiology'

"Lastly, why do you think that in the past people weren't held accountable for their actions if they were mentally ill?"

Because it was stigmatized and those who suffered from mental disorders weren't considered as human as the rest of them. That's where the societal shift is. I don't know if you're aware, but human rights are a thing now. Everyone's for the most part "equal".

So you think that accountability is a purely human trait then?


And why AREN'T you touching on the coma example of someone who's aware but not in control? Do you know what causes comas? What if a coma is merely the extreme end of a physiological state that starts off as something akin to depression? Do you know that I've had an MRI to rule out visible neurodegeneration to explain what has happened to me? Do you -honestly- think that size is lesion is important in determining a person's accountability? Like, neurodegenerative diseases show symptoms long before they're detectable using current day instruments, most of them. Mental illness, what we have, is a disease whose current methods of measurement are unable to detect with accuracy what the impairments we will have will be. That is all. We have behavioral proof that we have illness.

Do you know that there are mental illnesses that, as part of their definition, include -poor impulse control- as key defining symptoms?