Guilt, Shame, and Responsibility in Mental Illness
When should the symptom-induced guilt and shame end and responsibility in mental illness begin? Chris T. (actual person, name changed) has been diagnosed with bipolar disorder. One of the ways his bipolar manifests is hypersexuality. This symptom drives Chris to act out sexually. He's a married man and over the years has had two extramarital relationships. He has come perilously close on more than one occasion to losing his entire family. Chris feels guilt and shame. He doesn't deny responsibility in his mental illness, but his wife is torn apart because of his actions.
Millie, Chris's wife says,
The question of balancing the mental illness with responsibility and accountability is not just an abstract question to me. It's many intensely personal questions I've struggled with so much in my relationship with my husband. I've actually felt guilty for being mad at him, because I know the bipolar affects so much of it. But at the same time, I rage against that idea, because his behavior has caused me so much unbearable pain.
Chris says he also struggles with guilt. "I always hear this stuff in my head. You didn't act like that because you're bipolar. You're just an unfaithful jerk." He explains that he is constantly going back and forth in his mind. "I'm afraid to accept that it's partly my illness because I'm afraid of being the type that just makes excuses for everything."
We all know mental illness affects our behavior in so many ways. We also know that mental illness is not a choice people make.
Where Does Responsibility In Mental Illness Begin?
Where does mental illness end and responsibility and accountability begin? Does the fact that I have a mental illness serve as an excuse for bad behavior? And if it does not, where do we factor the person's illness into the equation, while attempting, simultaneously, to hold the individual accountable for his actions?
The mentally ill brain is damaged and disordered (Why Can’t People Accept the Evidence of Mental Illness?). And, like most things in life, there is no easy, black-or-white answer to these questions. There are nuances always, mostly because each person and situation are different, and may call for a different approach.
The questions must be asked on a societal level and on a personal level. Society has a duty to hold people accountable when their actions are a threat to society. Most mental health issues are acknowledged as a problem in the brain. Research has borne this out (Brain Damage From Bipolar Disorder). Now, I ask you, is it fair and just to blame a person for behavior caused by a malfunction in the person's brain? Behavior the person most likely would've never engaged in but for the brain problem?
It's rather like a person having a horrible seizure in public. If the person destroys any property or hurts another person, what's likely to happen? Nothing, probably, because we recognize the person is not fully in control. This person has a health issue, which causes him to have these terrible seizures, and that's why the damage was caused. It is neither fully fair nor just that mentally ill persons are not given that same level of understanding.
In the end, of course, we can't use our illnesses as an excuse. However, we do have every right to expect that our health condition will be fully considered in determining what, if any, consequences we will face.
Ehrmantrout, M. (2014, April 16). Guilt, Shame, and Responsibility in Mental Illness, HealthyPlace. Retrieved on 2019, August 19 from https://www.healthyplace.com/blogs/recoveringfrommentalillness/2014/04/guilt-shame-and-responsibility-in-mental-illness
Author: Mike Ehrmantrout
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As to the justice system - as long as you have not harmed someone else they may release you, however if you harm someone else, the justice system will have to institutionalize you as long as you remain incompetent and present a risk to others (or yourself). Can you see that too?
Having read Dr Amen's book on his use of SPECT brain scans, I would say they certainly sound worth looking into for anyone with a personality disorder - there could be physical components that are hard to diagnose.
Two months later I was found incompetent to stand trial, and was released from jail. The law did not judge me responsible for my actions. Praise God! Jail was miserable and I was thankful to just leave and go home.
When psychotic, delusional or even manic you do things that you would not normally do. Thank God the justice system sees this. Why can't we?
I appreciate your comments and in no way to I feel rebuked. I do believe it's important for everyone involved with mental illness to understand that it affects everyone in the family and can precipitate illness in other members. Your suggestion for better self care are welcome, because it's so easy to fall into inertia when so mentally exhausted.
I want to point out that I am my son's mother! His father is very much involved with his life, though we have been divorced for 42 years, and he takes some of the pressure off of me when he can. I follow this site regularly and thank all of you who make it so meaningful.
My 44 year old son suffers from schizoaffective disorder complicated by alcoholism and a plethora of other disorders: generalized anxiety, PTSD, to name two. He lives with me, and that presents me with a number of challenges, some of which I think I fail to meet.
He is being treated by a talented and loving team which includes a psychiatrist, a therapist, an addiction counselor and a peer counselor. Clozaril was the best thing that ever happened to him, but his WBC dropped after a month of therapy and it was discontinued. When the drug was stopped, he had a psychotic episode that ended in his second suicide attempt in three months.
Now he’s on Maintaina with oral supplementation until the parenteral drug takes effect. He is also on lithium, Prozac and Xanax. He is not psychotic but has rapid mood cycles that send him into a sine curve of mood swings throughout the day. He’s flying high and within an hour he is weeping. He has little impulse control and seems oblivious to the world around him, so self-absorbed is he.
My challenge is to support him without sapping my own emotional energy. He does not know the meaning of a closed door, though I have told him gently many times that my closed door means I am unavailable. When he interrupts me while I am showering or using the bathroom, I try to be patient and understanding, knowing that he is driven by his disease. He is obsessed with his appearance and looks to me for continuous affirmations about how he looks and asks me constantly how I think he's doing. He lives in the past, and cannot bring himself into the present except in superficial ways. He knows his behavior is hard on me. He tells me that several times every day and expresses guilt about it, but it never changes. Facebook has taken a little of the focus off of me, and I am grateful for that.
The whole process is taxing for me.
I, of course, have a therapist of my own, but she doesn’t live with us. I feel beaten down by my son’s disease. How do I survive without losing myself into his illness? I am a retired nurse, which helps. I am also a writer, which also helps because I can express my feelings on paper and not out loud. Having said that, I feel as though I am drowning in my son’s illness. Knowing that his behavior is driven by his illness does not make it any easier for me to deal with it. It's exhausting in every way.
First, let me say that you sound like an amazing dad. I get what you mean by a note from the other side. However, the way you treat your very ill son tells me you're on our side! :) At the same time, we should probably refrain from creating an "us versus them" mentality. Please don't take that as a rebuke of any kind C.J, because it certainly is not. I just thought I should say that because I want to feel important. :) But words can't describe the exhaustion I hear in your comment. You asked, "How do I survive without losing myself into his illness?" Such a poignant question. I simply don't know the answer. I do know that what you're doing inspires me and awes me, to be honest. I would think self-care would obviously be critical in your situation. So I'd say use your self-care techniques you know help you. I might suggest you expand your self-care. For example, if you use exercise for self care, ramp it up. Join a gym. If reading's your thing, expand the time you give yourself to read. Those are just two small things you could do. I apologize if those things seem trite. They were just examples anyway.
You said you feel you are "drowning" in your son's illness. So what could save you from drowning? A life preserver? Rescue personnel? Swimming lessons? Only you know what those things might be for you. It sounds like your situation might be beyond things like these, but maybe it could help, if only a little bit. Maybe you could try reestablishing some boundaries with your son, if you think that would help. I suggest support groups might be something to look into. Maybe you've tried all of these already and they didn't work.
I'd just like to say thank you for loving your son the way you do. And thanks for being an example of what we who are ill crave.
God is taking care of me now.