A question I've been pondering lately:

At what point should a person with a mental health condition and/or an addiction problem be held accountable for their actions?

For example, a person with bipolar in a manic state will do and say incredibly hurtful things to their loved ones...how much of that is disease and how much of that is allowing the disease to take over? How many times should a loved one accept the "I'm sorry" once the manic state is over?

About 10 years ago I had a definite stance on this issue...I was engaged to marry a man with addition problems, something I did not figure out until way too late...and then I was stuck...no need to give gory details as the point is that I finally concluded that my ex-fiance could haveexercised some control over his addiction but just did not want to exercise that control.

Ultimately, I held him completely responsible for his actions.

I now have a friend who has recently been diagnosed with bipolar, and since I am not romantically invested in this friend as I was with my fiance, I am examining my prior beliefs of "he just did not want to exercise control".

Of course I understand that every person is different, and that no sweeping statements can be applied to all people with MH and addiction issues. But what is your general sense about this topic?

There's a guy in my classes who's got serious mental problems... not sure what exactly they are, but it put him in hospital at least once (breakdown), and he trembles from time-to-time. I seriosuly think he's a Columbine waiting to happen. Violent dude as well... kickboxer, tells us stories of pummelling guys in the ring with great glee.

Anyways... my point is: by his own admission, the reason why his brain is almost completely devoid of seratonin is because he mucked around with speed quite a lot some years ago.

Most of my classmates seem to think: "don't feel sorry for him, he brought it upon himself".

I agreed for the longest time. But then recently a friend of mine (who has mild depression herself) said: "well, how do you know he wasn't born with something and self-medicated?"

I guess that's true as well. I don't know, and it's very much possible.

"Self-medication" was the excuse/reason my ex gave me for his inability to put down a botttle of beer.

But there are a lot of people who are born with MH conditions who do not self-medicate".

It is all so sticky...

My sister has been diagnosed with depression for several years now and her relationship with me and my parents has been seriously affected by it.

She has been in hospital for two times after overdose of pills because she has tried to stop the medication, she felt that under the influence of her medication she was nothing but a lie.

In the last year she has accepted that, at least for now, she simply cannot do without the medication, it's something vital for her ability to relate to other people and feel better about herself.

I don't blame her for the incredibly unjust and innacurate things she has told me, but they really hurt.

The self-medication explanation kind of loses its cogency once the person doing it uses it (why not see a doctor and get the necessary medication), and how in the world does it apply to alcohol?

No one's born alcoholic... with maye the exception of the Irish.

This is bad, but this thread reminds me of Sunday's Family Guy. Peter was diagnosed as "mentally retarded." So he just started behaving even worse and blaming it on the retardation.

Obviously, that went to extremes, but I think once people know what their problem is, a lot of us have a prediliction to milk it. To stop caring if we behave well or how we treat our loved ones, because treating people properly and living a decent life is hard. It's much easier to not try and say, "oh look, I'm depressed. I can't help it."

Meanwhile, a lot of people who care seek help, work hard on their treatment, and end up living a very normal life.

This is right on the money. Very true.

When my sister was really bad, and had tried suicide once, her psyciatrist told us to agree with whatever she said, I really wanted to tell her how wrong she was but I'm sure that at that time it would have the opposite effect.

When depression becomes such a serious debilitating disease patience is a key word to try to save someone we love.

I know there are people who try to milk it, like B said, but others really have given up on life.

This is what really gets me pissed about my friend. He won't take care of himself...won't take his meds, won't go to therapy appt's, and then when he calls me suicidal, I can't do a thing but talk him down and then wait for the manic-depression cycle happen all over again.

But is it his fucked up brain chemistry telling him, "You don't need meds or therapy"?

Is it wrong of me to want to scream at him for being so hurtful and selfish? Is he being hurtful and selfish or is he just being bipolar?

And about this:


Alcohol is a popular "self medication" for those w/MH issues---it is widely available and legal. It makes you "forget" all manner of anxiety and stress...but unfortunately it is a depressant and it only makes things worse.

It's not wrong to want to do that, but it's probably unproductive to really do that. A lot of people in this group have great friends that push them, reflect their behavior and statements back to them, and keep them on task with treatment/meds.

I've tried to set up this debate so as to not be a personal "what do I do?" sort of thing, so if you will all be patient with this next part--

I have done exactly what you suggested, B: reflected his behavior and statements back to him, and I have expended an enormous amount of energy trying to get him to take his meds and go to his therapy appt's.

Despite all my efforts, he continues to destroy himself...both by not taking care of his physical self (he won't sleep or eat or wash for days when manic) and by not taking care of his mental self (by not working with his doctors to find a good combo of meds).

He is such a good friend when he is even keeled...which is unfortunately becoming more and more rare with each passing day. I'm not willing to put up with his abuse, but I am not willing to let him go. There has to be a way to help a person like this...

In the end, you can't take responsibility for his actions. You can push. You can push again, but he's got steps he has to take on his own.

Keep being honest. Keep pushing. Eventually you'll hit a window, and you'll get in. But don't blame yourself for not being able to run his life.

Wise words. Practical? We'll see.

Back to an objective debate:

People with MH conditions have a disease of the brain. How can they ever be held accountable for their behavior? Would you blame a person with Rhuematoid arthritis for their lack of mobility and constant state of pain?

Just as there is a whole spectrum of disabilities, there is a whole spectrum of expectations of individuals with those disabilities. I don't know how you can answer those questions on anything but a case-by-case basis.

I have problems with the mental health industry in this country due to close personal experience. The doctors I called on all had the best in mind but the real problem was that most of the time they were so pressed for time they just threw medication at the problem. While medication is necessary in most cases, it isn't the be all and end all of treatment. You have to change your behavior! There's no way you can continue to live your life physically the same way and mentally the same way. Often it's a radical change but it's needed.

Here's the real problem, I could walk into any psychs office and be diagnosed with whatever mental health issue I wanted. Most of the times the docs have a diagnosis before you're even finished talking. Right now it seems bipolar is a popular disorder. It's en vogue.

Are we just taking the human condition and assigning it a phony name? Isn't everyone depressed and everyone manic at some points in their life?

I agree that bipolar is a Dx that is assigned quickly and with little thought/investigation all too often. Doctors take so little time with each patient, and the pressure to see as many patients as possible is overwhelming.

But there is a true disorder manic depression, and in my friend, I can actually hear him cycle through moods over the telephone (and in his emails, too). It is scary to listen to, and it is scary to know what is coming once his voice starts to change like that mid-conversation (sometimes it happens mid sentence).

In my ex, I think his addiction was mostly learned behavior (his mom was a Rx drug addict).

But how does one ever really know?

With people with true MH conditions, how does one separate the disease from the person?

It's fear.

can you clarify?

unfortunately, in my experience this is right on. my b/f's ex was diagnosed as bi-polar, and just from anecdotal evidence plus what I've seen myself she's also what they call a "borderline personality." this has expressed itself in episodes of public, vulgar, insulting shrieking at "loved ones" (at their kids in front of friends is my favorite ), and she excuses her behavior by saying she "just can't help herself."

however, she has proven time & again to be manipulative and to use emotional blackmail (on my b/f & especially on her kids) at the drop of a hat, so it's extremely hard to feel any compassion whatsoever. she's tried all that with me & found out quickly I can't be blackmailed (a visit from the sheriff helped), and she's lost most if not all of her old friends.

I used to try to feel compassion but now my feeling is that this is something she could control if she cared about anyone else more than her immediate needs. it makes me feel like such a bitch but at the same time I can't argue with my instincts.

so the question is: if her bi-polar symptoms were more controlled, would she indulge in her need to manipulate & blackmail those closest to her? if she cared about her kids as much as she says she does, wouldn't she try harder to control her bi-polar symptoms, wouldn't she at least stick with one therapist instead of going from one to the other cuz they all end up saying things she doesn't want to accept?

edit to add: if she's as "sick" as she says she is, how come the threat of another visit from the sheriff, the threat of having a harassment protection order on her record keeps her from coming to my house anymore? I would think that would be irrelevant to her if she was as out-of-control as she acts with her kids.

this isn't really rhetorical; any insights would be cool.

ps: great thread topic, genxgirl.