The Mentally Ill Are Just as Responsible For Their Behavior as Anyone Else

Recently, Greta Christina has asked whether the mentally ill are responsible for their behavior.

On the one hand: We cut sick people slack. We don't hold them as responsible for their behavior as we do healthy people. We understand that sick people can't always keep promises; can't always do their share; get irritable; lose their temper. We understand that it's the illness causing this behavior. We get angry at the illness, not at the people. And mental illnesses — including alcoholism and other drug addictions — are illnesses.

On the other hand: There's a limit to that. We cut people some slack if they're sick, but we don't cut them infinite slack. We'd probably cut a sick person slack for losing their temper and snapping at their spouse, but we wouldn't cut them slack for losing their temper and beating their spouse with a tire iron. We would condemn that. And rightly so.

Greta's analysis ends up inconclusive. I empathize with Greta's struggle, but I do not identify with it, mostly because I don't really understand the question. What is meant by holding someone responsible? Is she talking about punishing people for wrongdoing? Moral disapproval? Shaming? Is she talking about responsibility in the personal sense or the collective sense? Mostly, she seems to be asking whether it is justified to get angry at people for exhibiting symptoms of their mental illnesses.

Most of my confusion is due to the lense Greta is using. She seems to be acting under the assumption that people should be blamed for actions that are within their control and absolved for actions that are not. I do not view the world this way.

I do not believe in free will. All of the available evidence suggests that the choices we make are the result of purely physical processes that are subject to the law of cause and effect and the laws of physics just like all other physical processes. When we talk about "making choices," we're talking about a physical process by which our brain is responding to stimulus and outputting commands to the rest of our bodies (and other parts of the brain). The process is fantastically complicated and impossible to fully understand at our current level of neuroscience, but that does not suggest that the process is anything but a physical chain of cause and effect. It often makes sense to treat people (and ourselves) as if free will existed, as the attitudes and expectations that flow from such treatment are often beneficial. However, recognizing that the concept of free will is merely a useful heuristic is important, especially when dealing with moral/ethical questions.

Because I don't believe in free will, it makes no sense to me to distinguish morally between actions that are freely chosen and actions that we are compelled to do by our brain chemistry. Everything we do is compelled by our brain chemistry. Mental illnesses are not distinguished in this way. Mental illnesses are just certain patterns that we've recognized as sub-optimal and (hopefully) developed treatment for. The difference between someone who behaves badly because of mental illness and a person who behaves badly because they are a jerk is merely that the former has treatment options and medical science available to help. Reasons are not excuses, and we should not treat them as such.

Because I don't believe in free will, I attach no objective moral character to people's actions. When talking about optimal ways to behave, I generally use the term "ethics," because I think that it better suggests that I'm talking about a man-made system that has no objective moral character. So if the question is "should we morally judge the mentally ill for their actions?" my answer is no, we should not. We should not morally judge anyone for their actions, because people are all compelled to behave as they do.

If the question is "should the mentally ill be punished for their actions?" my answer is generally that it depends on circumstances. Reward & punishment are two powerful stimuli that can cause people to change their behavior (thogh punishment is often less effective than we would hope). In my mind, it is justifiable to punish someone for one and only one reason - to influence future behavior. So in that sense, whether the mentally ill should be punished for their actions requires an individualized determination of what will be effective. Greata briefly touches on this idea:

And when mentally ill people are held responsible for our behavior ... how does that affect our illness? Does it help, or hurt? When the people we love tell us that we're hurting them and driving them away, when they demand that we see the consequences of our behavior in their lives and in our own ... what effect does that have?

Does it shake us into awareness and insight, help motivate us to take action? Does it shame us into feeling worse about ourselves, make us even less able to see ourselves as worth taking care of? Does it do some of both? Does the answer depend on the person, the illness, the degree of illness, the closeness of the relationship, the day of the week?

To me, this is the ONLY question that matters when you're talking about potentially punishing someone. What will be the effect of the punishment? I am in no way a neuroscientist or a mental health professional, so I can't give a general answer to that question,* but I firmly believe that it's the question that we should be asking when discussing imposing potential punishments.

If the question is whether we are justified in using a person's mental illness as a substantial factor in deciding what kind of relationship we want with a person, my answer is an unequivocal and emphatic yes. Our relationships with people are not reflections on their moral character or their value as people. All relationships should be absolutely consensual. We can choose to have relationships with people for any reasons we choose. Some of those decisions are better than others, but they are not necessarily a reflection on the virtue of the other person.

I often hear people use mental illness as a reason why they must forgive a person for their actions. The argument is that if a person's mental illness compelled them to behave badly, then it would be unfair to then "punish" that person by changing the relationship (e.g. terminating the relationship, deciding not to see them alone, refusing to interact online, limiting contact to once a week, not inviting them to parties, etc.). I do not like this view, or any view that suggests that our decisions regarding what relationships we should have with people need to be fair. Fairness, in this sense, is a tool used by abusers and manipulaters to coerce people into having relationships that they don't want. It's bullshit.

For instance, if you have a friend who is always late, does it really matter whether their lack of punctuality is due to a mental illness or just garden-variety carelessness? I don't think so. The question for me isn't "why is this person always late?" The question is "how does this person's lateness affect me?" If I can deal with their lateness, fine. If I can't, that's also fine. I don't have to be friends with someone who behaves in ways that bother me, regardless of the cause.

I often point out the absurdity of the social stigma of mental illness by comparing mental illness to physical illness. Greta does this when she points out that "we cut sick people slack." While this is generally true, I don't cut sick people any more slack than I would a non-sick person. If my friend has a physical illness which causes them to, e.g., be unable to leave their house, that's certainly going to factor in to what form our relationship can take. If I really like that person, it might be worth it to routinely travel to their house to spend time with them. Maybe not. Maybe I would decide to only have an online relationship or (shudder) talk on the phone. It's not really "fair" to my friend that our relationship is limited because of their illness, but illnesses aren't fair to anyone, and there is NEVER an obligation to maintain a (non-dependent) relationship that doesn't make you happy, no matter what the reason is. Social relationships are not contracts, and we are all free to leave at any time.

Understanding mental illness is often helpful, not so we can forgive people for their actions, but so we can accurately set expectations. If someone's bad behavior is due to a mental illness, if we make an effort to understand that illness, we can better know what to expect from that person. Some mental illnesses have a bounty of research available that can clue us in on how is best to interact with this person, what sort of communication will be effective, what behaviors can be changed with sufficient motivation, and what behaviors can be expected to continue regardless of effort.

Greta's article revolves around her ambivalent feelings about her father and his alcoholism. To what extent, she asks, was her father responsible for his alcoholism (and his actions that occurred as a result of his alcoholism)? I would never ask that question. To me, nobody is ultimately responsible for their own behavior. The relevant question to me is - how should I treat this person? What kind of relationship would be best for me to have with him? Should we have any relationship? What treatment would allow us to have the best relationship possible? When discussing a personal relationship with someone, these are the relevant questions.

I tend to curate my social circle pretty tightly. If someone does not treat me how I like to be treated, I feel no guilt about excluding that person from my social circles. The cause of their poor treatment of me is not important, only the fact of it. My life is better when I surround myself with people who treat me well and avoid people who treat me poorly, and improving my life is the only reason why I have interpersonal relationships.

Empathy is a good thing. The ability to view your circumstances from other people's perspectives is a skill which we should all develop and improve as much as possible. But sometimes we can go overboard. Sometimes we can allow ourselves to be abused or maintain a relationship that is not serving us well because we feel it would be unfair to hold another person responsible for actions that are a result of mental illness. In a relationship context, focusing on a person's responsibility for their actions is a trap. A much better focus is the effects that a person's action have on you, and whether that's a relationship that you want to have.

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*I am an attorney, and I feel qualified to state that our current criminal justice system is not creating socially beneficial effects, and requires major reforms if it is to achieve its stated goals.