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 2022, June 26 from https://www.healthyplace.com/blogs/recoveringfrommentalillness/2014/04/guilt-shame-and-responsibility-in-mental-illness
Author: Mike Ehrmantrout
I firmly believe that cannabis can help patients with bipolar disorder. Consult a medical cannabis doctor today.
The question of responsibility and accountability is in intrigued correlation on daily psychiatric work up. Indeed, person with any mental disorder have got limited ability to be responsible to their behave and actions. But this fact didn't means that they are completely free from their abnormal activity during interpersonal relationship. In this context, it ought to prepare the fact that restricted responsibility of mentally ill person is misunderstanding and abused from professional and laic community, as well. Furthermore, the institions of responsibility and accountability isn't the same category with any psychiatric entity. It might be responsible even any person suffer from any mental disorder and vice versa. Therefore, it ought to examine closely each case distinctly, and thoroughly. However, the issue of accountability must give expert's report from specialist of mental health, such are clinical psychiatrist, clinical psychologist and so on. As it is known , each mental disorder has got on own specific course and repercussion that are in close relation with guilt, shame, responsibility and accountability of mentally ill patients that aren't rigid absolute attribute. They should perceived and elaborated in context of respective psychosocial condition and sociocultural values and norms of social milieu. The above psychological and legal parameters should be in correspondence with the meaning, massage and provocative factors of incrimination act. mentally ill person should be protect from legal and informal discrimination by honored and sincere mental health care institutions.
My partner of a year is mentally unstable and we know the doctors don't have it right. They are saying depression and ADHD but honestly it's more than likely a personality disorder, bipolar or something else and it's been very hard on me. After the first 3-4 mths after we met and even though I knew he was a little off (who isn't?) he proceeded to contact a woman he had met the previous year and decided to tell them we were in an open relationship, this after we pledged our love and were very happy! He told me about it after I confronted him and said hey, it's your choice but haven't we already gotten so far? He agreed and said he loved me and only wanted to be with me. Then several mths pass and he's on my computer and he forgets to log off, and I see all this activity on Craigslist, posting and resonding to ads for bondage and all kinds of weird stuff and I confronted him. I knew he wasn't consistent with his ssri and he was unstable, but when I confronted him he said that I was holding him back but the next minute he was begging for forgiveness. I knew it was mental illness but his actions seemed conscience to me and the lying was deliberate. Fast forward, he swears he will regain my trust and I get us both tested and we were both negative for everything thank god and I thought it was over. But nope, 3-4 mths later and I see a text and look up the number and it's the same girl - he said he was having a sexual relationship with her the whole time and here she was thinking he was free and clear after he was committed to me! And then it comes out there's someone else - - woman barely out of her teens who he is getting ego strokes from and I actually mesaage both of them - they didn't know about me and we were all so shocked he could pull it off. I discovered he gave one of them presents I had gifted him and I lost it. Mental illness or not, that was deliberate and since then he's been swearing up and down he's faithful. The whole time this was happening I was trying so hard to get him treatment, we have an incredible relationship despite it all, he is very supportive of me and my own severe physical health issues, and I feel incredibly connected to him on a spiritual level, but I'm exhausted. He has sworn that he he loves me, every time he misses even one day of his ssri he's messed up for 2* weeks and afterwards he apologizes profusely and tells me how in love with me he is etc etc, !75 here we are again tonight with a suspected missed dose, his disappearmxe again and me running around with his brother trying to find him, only to have him ignore me and avoid me as well. I feel guilty trying to hold h accountable but no one can tell me he has zero control. I grew up with my Father being MI and I get it on many levels, heck I'm ADHD and have a TBI to boot, but I feel the need to have some pride and dignity and tell him to shove it, at least to the point he sees how I've suffered and regardless of his MI there has to be some kind of limit.
slippery slope. yes, MI can put people in a condition where they are out of control and do regrettable things - but if the MI is not able to be controlled by medication and therapy then periods of out of control behavior is normal for the afflicted person - as such, the person should be put in care - for the protection of themselves and for others. My brother is mentally handicapped and is only a danger to himself, but he has lived in an institution for most of his life and the people there are really his family - they understand each other better than ordinary people and have more to share with each other - I suspect the same would be for people with MI. in fact it would seem that the attempt to classify oneself as ''normal'' is delusional and harmful. Unfortunately, except for Veterans with PTSD there is very little available for sufferers at low cost.
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.
Yes, I do definitely see that society has a duty to protect society at large and also protect the sufferer from harming themselves. I also agree it can be a slippery slope. But it's still necessary for society to see and accept that mentally ill people are statistically not dangerous to others. This is another stereotype from mental health stigma that must be debunked.
I became delusional, thought I was in the Witness Protection Program, and took off upstate in my car. Days later, I got pulled over by the police. They told me to wait, but I pulled out and off I went. They caught up to me, I pulled over and they arrested me.
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?
Mostly, mental diseases are demonstrated by uncontrolled behave in daily functioning of mentally ill person. On the other hand, this misconduct in personal and psycho-social relationship has got ruinous consequences on life performances both to respective psychiatric patient and its social environment. You are right, when mention the fact that many person abuse with this ascertainment, in order to justify their antisocial and impulsive activities. Let's observe the distinguish between mental illness that destroy our global life functioning and impulsive interpersonal discrepancies of person with disocial disorder. Two above mention entities have got specific psychiatric course, clinical manifestation, therapeutic and prognostic characteristics. In order to soften common misconception on public opinion to mental pathology it should implement last one achievements of neuro science in clinical psychiatry, strictly and without any improvisation. This work-out should be the mission of whole mental health system by supportive protection of society. Otherwise, we shall face with many primitive and macabre attitudes on mental illnesses.
My bipolar 27 year old son lives with me and as much as I try to be understanding to his illness I still feel so overwhelmed. Especially when I see his weight climbing, his lack of motivation. He does take his meds, keeps regular visits with his therapist. Is it too much to feel he also needs a support group?
Hi Madesole. It sounds like a support group would be important for your son. I don't think it's too much to ask, given that you are watching out for him. Try to find one in your area that is specific to bipolar if you can. A good place to start would be to ask your son's therapist for a referral. Your son is fortunate to have you there helping him.
I like Susan's comment... MI or not, diagnosed or not... All brains and bodies function differently and everything from psychosis, schizophrenia, aspergers spectrum through to self harming, depression and anxiety have ALL been categorically identified as NOT just about brain function or chemical "imbalance" but about diet, lifestyle, mindset, hormonal function, gut health etc etc and effective treatment is always going to include unpacking beliefs and priorities and actioning those priorities for optimal wellness everyday (for all in the community not just those with a diagnosis) as well as implementing a routine to integrate full body/brain health. Agree big picture should always be assessed before judgement of any kind however if I am in a relationship with a man or woman who repeatedly strays but is remorseful and self loathing and attributes it to an MI episode of some sort... At some point I have to set a boundary and accept that unless he she is committed to doing all he can to manage said MI then I would have to take care of myself first.
I am wondering how you all keep away from the law. Perhaps none of your manic episodes have resulted in illegal activities? My son is 16 with Bipolar 1 and has been in the juvenile justice system since 14. It seems that every time he comes home from a treatment facility he falls into that social media trap and says whatever is on his mind and someone calls the police or his probation officer and he is in trouble again. That being said, we live in a tiny town and my poor son's name and problems have been all over the papers. I just wish there was a better solution for juveniles. The justice system seems to be the only mental health system for kids in this country.
Unless I am suffering psychosis, I am responsible for my behaviors. I know what I need to do to control my MI, and everyday I have that choice-take my meds or not, stay in bed or not, participate in my recovery or not. When I'm manic, for whatever reason, I want to do things that have consequences-do I disregard those consequences, or do I make a hard choice to not do that? If people without MI make choices that bring on negative consequences, we hold them accountable. If I want to be treated like anyone else with any other illness, how dare I play the "mental illness card" to duck responsibility? And YES IT IS HARD. But we've got to own all facets of our diseases he good, the bad, and the ugly. And the really really hard.
Hi, Susan. Thanks for the comment. Just to be clear, no one is talking about trying to shirk personal responsibility by using the "Mental Illness card." That would be unethical and probably illegal, depending on the situation. In the piece, I was trying to say the fact the person is mentally ill should be considered, that is all. Awesome comment!
I struggle with PTSD and Bipolar Disorder as well as a few minor, related disorders. I was diagnosed roughly 6 years ago. I see a psychiatrist and a therapist regularly. I take my meds regularly. I've read everything about Bipolar Disorder that I could get my hands on. Still, I have a very difficult time distinguishing a difference between which of my actions are affected by my BP Disorder and which are simply me. How can I possibly expect my loved ones to make that distinction?!
Hello, Robert. Thanks for commenting! You make a good point about trying to distinguish between what actions are caused by mental illness and which are just our personality quirks. Honestly, I don't think it's possible. Human beings are just way too complicated. At the same time, if our loved ones know we've been diagnosed, I'd hope they would give us the benefit of the doubt. Let's face it: People who worry about whether their wrong or strange behavior is caused by a mental disorder or not are much less likely to try to use their illness as an excuse for anything. I don't "expect" my loved ones to figure it out, but I certainly do hope they'd at least give me the benefit of the doubt where they can. Another way to see it, too, is that if our loved ones have educated themselves about our illness, they should at least be able to see known symptoms in me and that's a big clue that it's the illness. I hear you, though, about the perplexing nature of the issue. That's what makes this all so fun, eh my friend? :)
For anyone dealing with a child (or parent) trapped in the cycle of schizoaffective disorder, the most maddening part is that the person can be be their old wonderful self one day, and a complete stranger the next day, with no warning of which person will show up day to day
Hi, Jason. Thanks for your comment. I haven't had much experience with schizoaffective disorder, to be honest. I do know that extreme mood swings can be common with many disorders, the most obvious being bipolar disorder. I once sent someone an email in the morning. Then I sent another one to the same person in the evening. The recipient exclaimed, "There's no way the same person wrote these two messages!" So I can definitely relate to that part of it. I'm going to read up on schizoaffective disorder.
Hi again, Mike,
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.
Sorry CJ. You sound like an amazing mom! :)
A note from the other side:
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.
Hi CJ. Thanks for your comment.
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.
Great article, for me Bi-polar was a factor in my marriage, and fatherhood. I am divorced, and have been a good father, but could have been better, financially. There is no way society will understand the deficit of certain minds with Mental Illness. I am older so i can process my life events better. We can not escape what we did, plain and simple. I became a sex addict, I am in Saa now, after I lost what my life was. I believe that society would help us, and themselves by concentrating on how dangerous bi-polar(should be called Manic-Depressive, those of you know what I mean.) is. My driving should have killed me, and my kids, and others. I stole often, then returned often. I did not sleep, so i was more dangerous. I should have got aids, yet i was strong enough not to do the absolute most dangerous while i was married. I would not have sex with my wife for 6 years, i thought this was the only way. My behaviors were always risky. I needed help. I have yet to find a basic support group. What i am saying is the public is scared of us, yet not really doing the right things to help. It is costing everyone in the long run. We need more, better grants so we can have more psychiatrist. They need to spend time talking to us, manic-depressive and listenging out in the field. It took me 5 psychiatrist, and about 10 therapist to get it right. I was actively trying since 23 yrs. nuff said
Thanks for the comment William. There's a wisdom in your words as someone who has experienced many hardships with bipolar disorder. Thanks for being willing to share it with us. I so agree with you that society in general still doesn't get it. I think some try to understand and some don't. The ones who won't try should be rounded up and...just kidding, I promise. I also agree mental health funds could be spent in better ways, but that is way above my pay grade. :)
Thanks for your reply, Mike! You hit the nail on the head--I don't want to be a drain or burden on others, I want to contribute positive things to society. I definitely look forward to reading more!
Amy, thanks for your comment. I'm glad the article made you think more about things. I'm glad too that you want to be a positive influence in society. Hopefully, I'll see you back here again. :)
Would a person behave in (such and such) way if the illness were not present/active? In the case of mental illness, the answer is 'no'. The consequences can be determined by people who don't believe mental illness exists, are uncomfortable with mental diversity or who determine that having a mental illness does not supersede the rights of other people, mentally ill or not. It gets complicated because no one exists in a vacuum. What if Millie contracted HIV through her husband's manic indiscretion? Knowing what she knows, maybe Millie is not suited to being married to someone who is sexually promiscuous during their manias. I think it is fair for Chris to have limits and for Millie to have limits. They would both be right. Yes, of course mental illness ought to be a consideration when evaluating the actions of mentally ill people. Of course. There may be other considerations as well.
Thanks for the comment, Margaret. You raise some excellent points. It is indeed complicated (terribly so at times). So many different points of complication. You have to figure out so much in situations like these. For example, is the individual compliant with his treatment plan? Has he been taking his meds on time on target (a little Army jargon thrown in for...I have no idea)? But of course it means taking his meds at the right dosage at the right times. There are so many more facets we could probably argue this for a while. However, I say the benefit of the doubt should be with the mentally ill person. Period. :)
I get psychotic and can't even try Carrie. It sucks when you come back to yourself and start finding out all the awful things you did. They don't care that I don't remember doing anything though... I still get full blame.
Hi Selina.Thanks for your comment. I'm sorry to hear that those around you will not try to understand. It's very hurtful. I feel guilt like "They're right. I don't want to use it as an excuse." It's somewhat of a delicate balance, don't you think?
It's sooooo embarrassing!!! I wish people had the ability to say, that person must feel really awful about what just happened. Not pity, just a little consideration for the person with MI. I have complex ptsd and if I am triggered I put a wall up so high you can't Even kinda get through to me... Of course I try to recognize it before it gets out of hand and I start going into protection mode where I freak out and start yelling. My poor husband :/ he says, I know what it is and I can handle being yelled at. Well that's not fair to him, but I really do try to stop it before I start. Hhhhhhmmmm I don't think he would be as understanding if I didn't try so hard. What about people that are so bad off they can't try????
Thank you Carrie for your comment and your openness. When you talk about the PTSD and how it affects your relationships, my ears perked up because I was literally discussing this very topic with a family member just minutes ago. This family member said, "There's a natural selfishness that goes along with your PTSD that can make it hard to get to know you." We know that emotional numbing could cause this. But yeah, it'd be nice if someone realized that the PTSD symptoms can cause this stuff. Bad thing is, these folks know a lot about PTSD and yet they still don't understand. *sigh* You said, what about people that are so bad off they can't try? There are so many that succumb to suicide or homelessness because they can't try--or they feel as though they can't try. I've felt that way several times in my journey and it's not a good place to be in.
Great website "inability to bond" talks about being labeled lazy. It is a great free website.
I have been shunned, ignored, called crazy, left homeless, and my kids want me to take calculus. I couldn't even feed my own kids when I was diagnosed. I had been sick for 23 years and didn't know it, then flooded and couldn't feed myself.
God is taking care of me now.
Hi Mary. Thanks for your comments. I totally get it how people don't get it. I've had PTSD for years and some people don't understand I have an issue with anger. I guess it's one of those things that unless you've been through it, you just can't understand it. Sad, but human nature, I suppose.
Great article--I wish it was longer! I've asked myself those kinds of questions often. Am I lazy, or is it my depression? Do I expect others to take care of me, or do I really have problems with energy and motivation when I'm depressed?
Hi Amy. Thanks for your comment. I'm glad the article resonated with you. Your comment certainly resonated with me as well. I think most people who have a mental illness feel this way sometimes. It seems the reason you and I think this way is because we have a conscience. We don't want to be a drain to society. We want to contribute positively to our society, but the mental illness just makes things a lot harder. Sometimes we falter, and we get confused and very anxious about it. Then we start beating ourselves up, which of course we don't wish to do. You said you wished the article was longer. We will be revisiting this topic again, I am sure. Keep fighting on!