I see a lot of comments on mental health sites that are filled with resentment and want accountability from those with serious mental illness (SMI). These come from, I assume, family members or loved ones of the afflicted person. (Maybe therapists, too.)
The comments I’ve seen concerned issues from bipolar mania to schizophrenia. But by far the most common complaint was the person’s noncompliance with medication. “How can I get him to take his meds? He doesn’t think he needs them anymore, but when he doesn’t take them, he slides right back into disruptive behavior. How can I make sure he takes them every day?” What they want is accountability, and what they’re feeling is resentment (among other things).
I accept the fact that my condition will require me to take medication basically forever, and I am about as compliant as one can be. Yet despite that, my bipolar disorder does recur. So do I hold myself accountable for my actions, or can they be explained away by my mental illness?
One thing I can say is that I may not be able to identify a hypomanic mood swing when it happens, but when it does, there certainly are consequences that have to be dealt with. And I’m the one who has to deal with a lot of them, as I’m the one who works with the bills, credit cards, and banking. For example, in November and December, I undeniably overspent. (The holidays didn’t help.) Because many of my online purchases were presents for Dan, he didn’t know all the things I bought or how I paid for them. So, could my behavior be attributed to my disorder? Probably yes.
January rolled around and suddenly I was faced with the fact that hypomania had had me in its grip. The credit card balances are now higher than I like. The bills that I enter on my Google Calendar are that way, too. The bank balance is fluctuating between a-okay and OMG. I’ve been moving money around from checking account to credit cards and from savings account to checking account to try to keep up with the outflow. It’s gotten pretty tight at times, but I haven’t actually overdrawn.
So, did my hypomanic actions cause resentment? My husband has been pretty calm about it all, though he has been rather frustrated by having to ask me whether to use the checking account or a card when making necessary purchases.
I can understand the frustration and resentment of family members and loved ones of psychiatric patients who have to deal with non-compliance and the attending financial, legal, or relationship issues – and even the threat of violence in some cases. This resentment is even more heightened when the person with SMI also has anosognosia, the inability to realize that they are ill and need help. The lack of public supports for both the patients and their families only exacerbates the situation. Parents and grandparents of the SMI sufferers also worry about what will happen when they are no longer able to care for their dependent but know that they can’t manage on their own without going off the rails.
It’s easy enough to say that yes, persons with SMI should be responsible for their actions and should be held accountable. But it’s often not that easy. Family members and caregivers can certainly be tempted to embrace the philosophy of “tough love” when they’ve had to deal with the consequences of the illness by themselves. But realistically that means leaving the patients even more vulnerable to their illness and at risk of homelessness and even worse outcomes. There aren’t easy solutions and, in many cases, no solutions at all.
It’s clear that many of the situations seem – or maybe are – hopeless, unless there would happen to miraculously appear more inpatient treatment centers or maybe Assisted Outpatient Treatment (AOT). But until that happens, families will continue to struggle.
Am I accountable? Yes, but I’m able to be. Was I always? No. In the depth of my major depressive episodes, even less so. But I’ve taken back over the things I was unable to do back then, like the bills and bank stuff. And I’ve apologized to my husband for the things I said when I had some bipolar rage. I’m grateful that I have a “cocktail” of drugs that works, and I take them faithfully. I schedule therapy and med checks regularly. I have sympathy for the families that don’t have those and the people who aren’t capable of doing that.
But do I know a way to increase accountability and reduce resentment? No. Sympathy is the only thing I have to give, and I know that doesn’t make things better.