The dilemma of accountability

In a previous job I dealt with a patient who was in chronic pain, had various mental health issues and was mildly developmentally delayed. Faced with numerous problems, this patient tended to become desperate, demanding and even somewhat aggressive and abusive when he didn’t get what he needed.

I found that there were two ways I could see him:

  1. As a victim of their circumstances acting out impulses that everyone would feel and few would be able to control in their situation.
  2. As responsible for their own actions.

For the most part I was drawn towards option 1, and I guess insofar as either option seems “correct” to me now it is option 1. To regard this person as fully culpable, when almost anyone would be driven to do the same as them in their desperate circumstances, would be monstrous.

But option 1 isn’t perfect. When you think of someone as not responsible for their own actions you risk infantilising them, and that can undermine self-confidence as surely as getting stuck into them.

I’m certainly not the first person to observe this dilemma, and I don’t have a general solution- I don’t think there really is one. At least giving  name and concept to the dilemma makes it explicit, and maybe that form of explicitness makes it easier to think about and recognise these kinds of situations.

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