Responsibility

How much are mentally ill people responsible for their actions?  I should think every family that was ever touched by mental illness must have struggled with this.  Whether it's the addict lying or stealing to get their hit, a very public loss of control, or an attempted (or successful) suicide: in each case, how much could the individual have changed their behaviour?  Is the illness completely in charge, or did they have any sort of choice?  Are they being selfish?

We have been thinking about this a lot in the family this week, after Julie's self-harm incidents last week while I was recovering from a major operation.   It is very hard to address this head-on without getting tangled up, pity and sympathy for her competing with frustration and anger.  If she cannot exercise any control then what plans can she ever make for the future?  But if she can exercise any control, then what was she thinking of, putting us all through what happened last week? 

The truth must lie somewhere between two extremes: one extreme Julie being totally controlled by the illness, the other Julie being completely in control.  The illness puts her under great pressure, and she has to exercise great self restraint to resist it.  To resist she has to do a sort of mental arithmetic, to work out whether or not it is worth giving in.  On the one side is the immediate relief of self-harm (and this must include the excitement of recent incidents involving ambulances and police), and on the other is the damage that it does, literally (to her body) but also to her prospects, and her relationships with other people.  And the bit of the equation that is not very well represented is the damage it does to her family and support network, the people closest to her, those most hurt and bewildered by what she does.

Sometimes children do things that shock us, as parents.  Then there has to be that stern conversation: you don't kick/bite/mock.  How can it be that they don't know that these things are wrong? we ask ourselves.   We may feel angry and offended by their behaviour.  But a two year old doesn't instinctively know that the pleasure of sinking teeth into an enemy is wrong: they have to be told.  And as children grow up they don't suddenly acquire adult-style empathy.  Plenty of us at 18 were cheerfully unaware that we were hurting our families deeply, whether it was rolling home drunk, getting into bed with the wrong people, or casually tossing out religion.  Julie self-harms.  At 18 you are invulnerable - no amount of paracetamol will damage your liver, no cut however deep ever gets infected, nobody pays for your mistakes - and your family are made of Indian rubber.  They write you a blank cheque of love and support and never experience hurt or despair or resentment at the things that you do.

There has to be a conversation.  Not an easy conversation, and not something that can be finished and done with in one conversation: it has to be part of a whole process of discussion, and support. Yes, we support you completely because we love you, but you are damaging us.  We are not going to reject you, but you have to look at our suffering as well as your own.  We know life is hard for you and you feel as if you only have energy enough for yourself, but to progress from this dark place, you have to put us back into the equation.