The Complexity of Responsibility
The Complexity of Responsibility
Issue 36 – September 2013Authors: Philip Houghton (email@example.com) and Steven Coles (firstname.lastname@example.org)
- People often do not know why they act the way they do
- A judgement of responsibility can limit how we understand a situation and its complexity
Implications for practice
- We need to consider power and resources when we think of responsibility
The use of responsibility in clinical work1Moral and ethical judgements about people’s behaviour are at the heart of the field of mental health. One of the reasons people receive a psychiatric diagnosis is due to their behaviour being judged to be different from what is currently expected in a particular society. For example, a person who is not performing their usual roles and activities, and is not reciprocating in relationships will often receive a diagnosis of depression. Or a person might be given a diagnosis of schizophrenia, if what a person says and does are interpreted as not making sense in the current context, particularly if the person is unable to give a culturally acceptable explanation for their behaviour. When someone is labelled with a psychiatric diagnosis, we often limit our judgement of how responsible someone is for their actions. How responsibility is judged in mental health services is complex and varies according to diagnosis. Within clinical work judgements are often made as to whether something is “illness” or “behaviour”. An example would be the difference between someone who describes hearing voices, who acts on them and smashes a window; versus someone who struggles with rejection smashing a window, when a staff member does not arrive for an appointment. In the first instance we are likely to see the person as not being entirely responsible for their actions, whereas in the latter we would see the person as being in control and as responsible. Is this fair a judgement of responsibility? In their own ways, both people were responding to internal experiences that were not of their own choosing: the first a voice, the second a feeling of rejection. The judgement of being responsible, or not, is important as it can lead to different forms of care and empathy towards each person. But what underlies our judgments of responsibility? Our understanding of the immediate context of the behaviour has a large influence on the judgements we make. In the example above, the presence of voices can lead us to make a decision that the person had less control of their actions. In the absence of anything obvious in the immediate context, the common conclusion is often that the person could, and should, have acted in a different way. This may lead to statements such as “the person just needs to take responsibility for their actions”. What does this statement mean in practical reality? Are such statements neglecting the complexity of why people act the way they do? Even if we accept someone does need to take more responsibility, how are they going to achieve this? What is the responsibility of services in helping the person achieve this?
Why is the concept of responsibility limited?What is often missing from our analysis of behaviour is a wider perspective on what influences why we act in a certain way. Within the modern era we have come to highlight concepts such as personal autonomy, responsibility and our ability to think through situations and act based on our cognitive appraisal. Yet we need to remember that our bodies and brains have developed over millions of years to survive and reproduce, not think through situations logically. Such instincts and brain structures have not been replaced, but have been added to by the higher functions of language and conscious thought. Furthermore, our brains develop based upon our experiences of life, and our feelings and ability to act in the world our shaped by the society and culture we live in. A further difficulty of using the concept of responsibility in relation to behaviour is the fact that we have very limited awareness of why we do things. Much of what drives our behaviour is outside our conscious awareness, and even if it isn’t, the sheer enormity of possible influences beyond us can severely restrict what we choose to do at any point in time. For example, many of us regular try to eat more healthily and exercise more. Yet cast your mind back to the last time you supposedly could have done more exercise, or eaten more healthily but you didn’t. Why not? In such situations we may well just react rather than act based on a logical analysis. Furthermore, we are more likely just to react when frightened, isolated or highly distressed. Indeed such feelings may well activate responses which are fundamental to our survival instinct.
PowerRather than just apply the concept of responsibility with its somewhat binary outcome of yes / no, we would argue for a more sophisticated analysis of behaviour based on the power that a person has, in any given situation to act in different ways. For the individual these relate to factors such as: material resources (e.g. money, work, education); home and family life (e.g. love life, partner); social life (e.g. friends, leisure); and personal resources (e.g. our appearance, intelligence). Every option in a given situation is simply not available to us, and even those that might be will be more or less likely to happen based on our current level of power and influence. An analysis of power can be applied to behaviour seen within clinical practice. By examining how much power a person has (or does not have) to act in various ways gives us a more sophisticated analysis that is ultimately more compassionate. Rather that simply placing responsibility on the person to change (or on ourselves to change them), we can try and understand some of the forces that make change difficult, not just for our clients, but for all of us. On occasions someone might have the power to act in a certain way and choose not to, however, we often vastly inflate a person’s ability to choose to act in a certain way. Sometimes, even often, we or the person themselves may not be able to enhance their level of power sufficiently to broaden the behavioural choices available to them, but rather than blame ourselves or them for lack of progress, we can try and understand their behaviour within the constrained human bodies and worlds we all inhabit.
Final CommentsPerhaps the idea of responsibility is at times culturally necessary and can be pro-social, if it means we think about our responsibilities towards each other and the responsibility of people, groups and organisations in positions of power towards those with limited means of influence. What we need to be mindful of though is the fact that when we use the idea of responsibility, we are using a moral, rather than a clinical concept (though this is the case for much of mental health work). Further, the idea of responsibility is problematic, particularly when applied to those with limited power and resources. In these circumstances we need to consider pragmatically what the most useful course of action is, including an awareness of our own limitations of influence, so as to support a person’s development.
- Smail, D. (2001). The Nature of Unhappiness. London: Robinson. (pp. 406 – 435)
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