The issue of mental illness affects every community and every neighborhood. In some cases, as we have seen with recent tragedies, mental illness has led a few afflicted individuals to seek to hurt and kill others, including little children. In addition to the question of how the law should address cases such as these, there is also the question of how, doctrinally, we are to understand the moral agency of those with mental illness from the standpoint of the Restored Gospel. Furthermore, how are we to understand our moral obligations to those with mental illness, and also to those who might be hurt by those with mental illness, including our own selves. How do our readers, especially those who have had experience in this area, view the accountability of those with mental illness, and the responsibility of those interacting with them as family or as those with stewardships that intersect with the lives of those who are mentally ill?


Full Citation for this Article: Editorial Board (2013) "Readers' Puzzle for Spring 2032: Mental Illness and Accountability," SquareTwo, Vol. 6 No. 1 (Spring), http://squaretwo.org/Sq2ArticleReadersPuzzleSpring2013.html, [give access date]

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COMMENTS: 7 Comments

I. Anonymous

This particular "puzzle" is very personal for me. I was born with schizoaffective disorder. This is a combination of paranoid schizophrenia and clinical depression. I was first diagnosed at the age of 31. However, I've had feelings that there was something wrong with me (psychologically) since early adolescence.
The term "mental illness" covers a wide range of pathologies with an even greater range of severity. Hence, my experiences as a mentally ill person are strictly my own. I have no formal training in psychology or other medical fields, or legal scholarship. However, I do have a Bachelor's degree in biology and am well versed in the genetics and biochemistry of the issue.
Heavenly Father is ultimately the judge of us all, mentally ill or no. It is not "meet" (proper) for us to try to specify everyone's level of accountability for their actions. Fortunately It is also not required of us in order to help people with mental illness. We can deal with the problem without tying ourselves up in knots about accountability. To those who have mentally ill loved ones who have committed grievous acts, remember that the mercy of God is available to all and that He appreciates our efforts to minister "unto the least of these" despite our own shortcomings.
My illness does not turn me into a robot, though it certainly does affect my ability to deal with stress and focus my thoughts. Even in the depths of the psychotic break that precipitated my diagnosis I had an ability to think and make decisions. That is one of the reasons I sought treatment.  Now (years later) I am responsible to take my medication, go to my therapy appointments and watch myself.
This site is dedicated to discussing modern social problems. Hence, I can only assume that one of the primary intents of this "puzzle" is to deal with mental illness within a legal context. I view that as independent of the accountability issue. For those who disagree, I would like to remind them that we support the concept of governance and law even if the source of those laws is secular in nature. I would also like to remind them that Jesus was not hostile towards the civil government of his time (Rome) despite its many imperfections.
We need better treatment and diagnosis of mental illness in the world. However we also need to appreciate the difficulty that occurs when trying to draw the line between normal and abnormal. I suspect one of the problems is that people with mental and emotional problems stemming from substance abuse are reluctant to acknowledge how much their substance abuse has damaged their brains and affected their behavior. In seeking to normalize their own behavior, they must necessarily normalize the behavior of a lot of other people. Regardless, the fields of psychiatry and psychology have a long way to go.
I'm concerned that the modern legal system encourages prosecutor's to deny any evidence, however compelling, of mental illness. This is because an insanity ruling often makes it difficult to place someone in a secure location. I agree that normal prisons are often not well equipped to "rehabilitate" people with mental illness. Therefore, we need to use high security treatment facilities for mentally ill people who have committed grievous crimes. Compulsory treatment for mentally ill people needs to be brought back into society. Leaving severely mentally ill people "free" to wander around, sleep under viaducts and lose extremities to frostbite is hardly compassionate.
A final note: If I ever murder or rape someone, I want to be executed. I would view this as "putting me out of my misery". I certainly cannot speak for all mentally ill people. However, leaving me alive to possibly commit further grievous crimes in the future would not be merciful, it would be abusive to myself and others.


2. Ralph C. Hancock

A few years ago I found myself struggling to finish a book on The Responsibility of Reason while a person as close to me as my own flesh and dearer to me than my own life had very simply lost his reason.  Some readers will know all too well that I am not exaggerating: there are mental afflictions that very simply and entirely remove a person from the common world we together inhabit, a world in which we negotiate our way through a common-sense understanding of reality that is truly common, that is, a shared sense of a structured and overall quite predictable world that in its basic elements is very solid and reliable, despite differences of opinion and interpretation which may exercise and amuse us at the margins.  Now I find myself making light of philosophical and religious differences I in fact hold to be of momentous importance, and by the discussion of which, not incidentally, I happen to make my living.  But this is my point, precisely: when confronted with the a person you know intimately and love very much, but with whom you no longer share even the most basic sense of an ambient reality, the differences of interpretation within this reality seem pretty small.   The person in front of you is perfectly conscious, even vividly, excessively conscious, but no longer inhabits the world you inhabit.   How can you relate to such a person?  How can you counsel and serve a person in such a condition?  What does it mean to love such a person?

If I had achieved clear and distinct answers to such questions, you couldn’t afford me, and I would be too rich and famous (or too spiritually exalted) to be writing these lines.  There are no clear answers.  This is one of those limit-experiences that teaches us more about our human condition than we can formulate in propositions.  Our whole existence presupposes that we are, in the classic, generic sense, “rational beings”  -- not rationalist philosophers, or quasi-autistic scientific nerds like the character on “The Bing Bang Theory,” but beings who make their way in the world by speech, understanding, and accountability.   Severe mental illness undermines this presupposition, and throws us back on spiritual resources beyond merely human categories.  What can be more profoundly humbling, not to say shattering, than to realize that our very identity as reasonable, responsible selves depends on an equilibrium in our brain chemistry that proves to be quite fragile?  Our human essence is not in our hands, not within our control.  It is a gift, and there is no reason to know it is permanent.

How responsible are we then?  As responsible as we can be.  Aristotle taught, or insinuated, that the truly morally responsible person takes responsibility for more than he or she may be responsible for.  I can always argue that my passions, instincts, inherited traits, childhood traumas, etc., as well as a chemical imbalance, relieve me of responsibility.  Anyone can always plausibly make such a claim.  But to be human is to assume responsibility, to nip a very justified anger in the bud, for example, and to be the co-agent of forgiveness and of grace.  Accountability is always a miracle, a gift, and yet we must strive to be open to it and, in a way, worthy of it.  We must be open to the judgment that condemns our irresponsibility – and yet (this is part of the miracle of grace), full of compassion for the irresponsible.  For the capacity to judge whether another person’s brain chemistry allows them to be accountable is very far indeed beyond our powers.

We are responsible for being rationally accountable, and at the same time for confessing the limits of rational accountability.

But this still leaves the question, how are we to respond, to counsel, to serve those who, temporarily or (God forbid) permanently have no access to the common world that provides the touchstone of rational accountability?  We must try to give reasonable counsel, addressing the person’s natural humanity, in case this might have some effect.  But in cases of serious mental illness, by definition such appeals will be in vain.  And so our relation to that person must be grounded in a faith and a hope that are painfully disconnected from the concrete reality of the distorted personality whom we encounter face to face. 

What does it mean to love in such a situation, in which the loved one is more absent than present, in which the empirical presence of the person is in fact a disturbing, even gruesome caricature of the actual person to be loved?  Clearly this task exceeds the limits of our reasonable responsibility, and cries out for some light beyond the natural.  Let me try to share a least a glimmer of such light, as I received it one day, as I was peering into the abyss of this dilemma: how to love a person who, at least at this moment, seems to lack the most basic quality of humanity, that is, contact with the real world and rational accountability?  My answer came in a luminous inspiration, which I’m afraid I must ridiculously degrade in the telling, but which I will offer to you anyway, in case it provides a useful clue to something we can only see through a glass, darkly.

Here was my answer, which has never left my heart since the miraculous moment it entered it:  You, Ralph Hancock, are blessed to have this person to love.

That puts accountability in a whole new light, doesn’t it?


3. Rachel Zirkle

Honestly, I do not know how to assess the accountability of the mentally ill. I think it is often very difficult to even be aware of mental illness in others if we don’t already know of the condition or the signs. It wasn’t until a dramatic tipping point when I was growing up that I came to find out someone extremely close to me suffered from depression. Over and over again I asked myself, how could I have not have known? Could I have helped had I known? Would the outcome have been different? I saw first hand how the inability to cope or to think rationally impairs decisions and choices in a way that someone who is not suffering from such incapacities cannot fully understand. It was my first lesson on the intricacies of mental illness – it isn’t something you shake off or get over. It is indeed an illness, perhaps more stealthy than the outward ailment, and often requires both medication and supervision.

I’ve found that there are questions of agency and moral obligation embedded in these circumstances that don’t really have clear answers, so I am grateful for the gospel that does provide a foundational structure we can trust in. We know through the restored gospel that God loves each of us wholly and equally, and that we are each given a unique set of trials to help shape us in this life. God is the ultimate judge and He knows our minds and our hearts. I think any disability that impairs our agency or ability to make choices is taken into account, whether it be mental or physical. While I do not know how the accountability for tragedies under these conditions goes, I know God does and He will take into account the feelings of those who are hurt, as well as the one who caused it. Whether hurt by another, or by our own inability to intervene when someone we love hurts themselves, we can take comfort in knowing the atonement can heal each of us as we open our hearts to forgiveness.

The scriptures describe our responsibility as family and church members when our lives intersect with those dealing with mental illness. In the New Testament, there is a father who brings his son to the apostles and then to Jesus, seeking a miracle. The father says the son suffers of a “dumb spirit,” (Mark 9:17) and whether that refers to a physical or mental illness, it does not change the meaning of the father’s plea then to Jesus, “if thou canst do any thing, have compassion on us, and help us” (Mark 9:22). The father tells Jesus of how his son has struggled with this disability since childhood, requiring constant supervision to avoid falling in the fire or in the water (Mark 9:22). The Savior then goes on to work a mighty miracle and teach us all the power of faith, yet there is another less obvious lesson in the father’s initial plea. As family members, or in our role as stewards over those who are mentally ill, our responsibility as we strive to be like Christ is to ‘have compassion and to help’ like the father asked and the Savior responded.

The father also highlights an interesting aspect of the reality found in caring for one who is mentally ill in his usage of “us,” instead of “him” – it is a family affair. Many mental illnesses require constant care and attention to protect and meet the needs of the one who is suffering. However, that care and attention also protects others who could potentially fall victim to the impaired judgment and rationale of the mentally ill. Often, tragic accidents occure when mental illnesses go undetected or untreated.

Since the obligation and responsibility of caring for the mentally ill lies primarily with the family, I feel there is much more our government could do to sustain this unpaid caregiving labor. So much more could be done to ease the burdens of helping and caring for the mentally ill before it ever reaches how to deal with tragic cases before the law.  Like Ann Crittenden argued in defense of mothers in The Price of Motherhood and BusinessWeek outlined in the trillions of dollars lost in “wages, social security benefits, and private pensions” for men and women caring for their aging parents, (http://www.businessweek.com/articles/2012-12-03/we-cant-forget-the-unpaid-caregivers), there is more that could be done for those engaged in unpaid caregiving labor. We should progress toward providing a greater safety net and adequate resources for those providing such care. I think our country could also benefit from increased awareness through school programs designed to teach about the signs and various conditions of mental illness. When we understand that mental illnesses are real, we can be better prepared to circumvent potential tragedies and offer compassion and support to those within our networks who need it.


4. Stephen Cranney

Since my early undergraduate social science classes I’ve always viewed the commandment to not judge one another as largely stemming from the fact that we simply don’t know how much of a person’s decision is based on their pure agentic “self” and their circumstances or biological inheritances. If a gene for, say, aggression, runs in a family, and through the roll of the random genetic dice one of the offspring gets, how much is he or she accountable for the untoward actions committed that would not have been committed in the absence of that gene?

We are told that the body + spirit = “soul of man” (D&C 88:15), so I get the sense that the biology aspect isn’t something we simply discard at the end when our true immaterial “self” takes over, especially if our agentic, "true" self has been shaped and molded in reaction to or in complement with the biological impulses we were born with. If somebody with severe ADHD was forced to develop an enormous amount of discipline in order to simply function, how much of that aspect of themselves would be taken away if the ADHD were to abruptly disappear?

I don't know; I’ll readily admit that I’m not sure about the role that biological dysfunction plays into this, especially for those on the extreme end of the psychological dysfunction continuum for whom it could be said have virtually no free will.


5. George Handley

I won't pretend to have the expertise to comment on legal issues, but from a spiritual and theological perspective, I can say that I am grateful that the LDS church has increased its efforts to help families and individuals understand that mental illness is, indeed, an illness and that it can compromise our abilities to feel joy, to function fully, and to make rational choices. I can only speak personally on this matter, having lost a brother to suicide over thirty years ago. I went through the temple for him shortly afterwards and received a personal confirmation that he not only accepted the ordinances but was growing spiritually in ways I could not imagine, freed as he was from the ailments of a mind and body that were not able to sustain him in this life. This is not to suggest that a doctrine of mercy implies a justification for such violent action. I am sure he was greatly pained by the sorrows he left behind him on those he loved. I later learned that there was a time when the church actively discouraged people from doing temple work for people who had committed suicide. I think we now understand that we are better off not assuming we always know when someone is in their right mind or not. Mercy is called for, and faith in the atonement, which surely covers our sins as well as all of our infirmities of the flesh.


6. Anonymous B

My mother was a paranoid-schizophrenic whose voices told her to be abusive to her two children. I am constantly amazed at the detailed memories my children have of their childhoods; I have had to erase what memories I have of my own childhood or I would be in the grip of PTSD on a daily basis. My mother didn't just lose touch with reality; my mother could be the personification of evil itself. She did evil, horrible things to two innocent children that have had real and long-lasting consequences.

I have had to think long and hard about this issue, and have come to two conclusions. One is that sometimes the most loving course of action you can pursue with a mentally ill person is to get as far away from them as you possibly can. After all, in the eternal scheme of things, which is the greater sin--to have attempted to kill someone's soul, or to have actually be successful in killing their soul? Surely the greater sin is to succeed in destroying another soul. The Holy Ghost finally convinced me that the best thing I could do for my mother's eternal happiness would be to refuse to let her destroy me. And that meant getting away from her and making sure she could never hurt my family as she had hurt me.

The second thing I learned is that while mental illness may be overwhelming and mitigate accountability, I saw with my own eyes the flicker of agency at times where I could detect my mother yielding to the voices. It may have been only a tiny ability to choose that remained with her, but there were times I could see that she chose to yield herself. Because of this experience, I am not sure there is no accountability at all for the mentally ill. I think it may well depend on the person, the stage of their illness, and many other factors. But I am content to leave judgment to the Lord, for only God knows all things.


7. Anonymous Too

I have to say that I am struggling through this issue at the present, and I feel very grateful for the comments posted here. I particularly feel close to the first commenter, Anonymous, as a patient or sufferer and the second commenter, Ralph C. Hancock, as a helper. I relate to Anonymous because my wife also has schizoaffective disorder, but I find the symptoms in the Wikipedia article, and the companion article on its accompanying medication, Risperidone, to more accurately describe my wife's symptoms: Aggression, violent meltdown, perception distortion, delusion (to include paranoia), cognitive disorder, relationship dysfunction, and career dysfunction.

I also find some of Ralph's comments relevant in terms of her being slightly in a different world at times, and difficult to reach most of the time.

She has an advantage over many people who have disorders but don't know it, or are in denial. She sought my help as she brought home prescriptions for me to research on the internet and try to understand what is wrong, but she is also very stubborn, and when we discussed her perception distortions causing problems in our relationship, she totally refused to accept that she had any unhealthy thoughts at all. Her self-awareness of her condition seems to be limited to the violent meltdowns and limited brain stamina that bring fatigue or meltdowns when pushing herself too hard to accomplish something.

Over the years, I have struggled to understand where the line lies between what she is doing because of unaccountable mental illness and what she is doing that is accountable bad behavior, and I can say that to this day I still am not sure, and must echo Anonymous' thought that, "Heavenly Father is ultimately the judge of us all, mentally ill or no. It is not "meet" (proper) for us to try to specify everyone's level of accountability for their actions."

My wife has not done anything grievous such as we see in media incidents, but there have been sufficient violent meltdowns that have escalated to death threats, as well as other behaviors that are harmful and dangerous to me, that have made it impossible to continue our marriage.

I have some unfulfilled blessings, and priesthood counsel that suggests that she may not be aware that she is doing anything wrong and gives hope that we may yet be reunited in the next life.