Are we responsible?

I was recently in a discussion group that was asked about responsibility for actions. This group happened to be a group of young mental health students. Their responses regarding responsibility were chilling as they seemed to understand that one is responsible for his actions but they could not understand how mental illness impairs the ability to judge. This was my response.

What do you think?

After reading the responses submitted here I am scared. I am a practitioner in the mental health field. I am an ADHD coach. Furthermore I have been diagnosed with ADHD and use a multi-modal approach for treatment. This includes pharmacology, exercise, yoga, prayer, massage and coaching. I am not always responsible for my behavior. What could that mean? If I drink and drive did I choose to get behind the wheel? Of course. However my choice was affected by a lack of filtering through the normal executive functions located in the pre-frontal cortex.

Thank God I have never made that choice but I have clients that have. If there is guilt it’s in not treating the ADHD. As a rule people with ADHD like to take risks. They like to start fights with their spouses. They like to drive fast. All of these are due to a need to increase the amount of hormone in their PFC. When we are super stimulated we feel normal. We can focus and concentrate because our PFC is on. This is what my meds. do for me. I don’t have to chase stimulus all day, every day in order feel like my brain is working.

One client I have has a child with ODD as a co-morbid disorder with his ADHD. He is in the 2nd grade and whenever he is slightly provoked he will lash out. Children or adult it does not matter. When in line with another child he may have his toe stepped on and then bam he will hit the kid. Is he choosing to do this? I don’t believe so. I believe that this very bright child has a neurological disorder that meds and other therapeutic means will help to control. At some point he may have control or not but one can not say that he is choosing the wrath that comes upon him when he reacts.

A very famous study shows that when leaving a child in a room with a marshmallow and giving instructions to leave it alone a child with ADHD will respond differently. When leaving the room the adult states that if you leave the marshmallow alone that you will receive more upon my return. Non ADHD children are very successful at waiting as they grasp the point and can control themselves to wait to receive the bigger prize. Children with ADHD were almost wholly unsuccessful at waiting and immediately ate the marshmallow. They consistently understood the benefit of waiting but they could not.

Finally ADHD is about 40% hereditary. That is to say that about 40% of kids with ADHD have a parent with ADHD. That is much higher than most disorders. To immediately suggest that these children are completely responsible for all of their actions is to not understand the nature of mental illness. None of us volunteer to end up with the negative aspects that befall us based on our maladaptive behavior. However we do look to the mental health community to understandingly assist us in getting to normal. That is helping us to achieve all that we can.

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