I am part of a group preparing materials on living with chronic suicidal thoughts. We group members are made up of mental patients like me, family members of sufferers, and specialized clinicians. As I’ve written about before, as a Recovery College project, our task will be to create a “course” that interested parties can “study” online. So far, we’ve had three online meetings. I think it’s going well.
What I wanted to write about was a concept that was introduced during the second meeting. It was new to me and struck me as being of great importance. This is the notion of the dignity of risk. The idea is that, if a person’s support group (whether official, as in a clinical setting, or informal, out in the world) “rescues” a mentally ill patient from all genuine risk, the group thereby robs the patient of dignity.
A “normal” adult, in the everyday course of things, will constantly undertake tasks where they can fail; and such that they thereby suffer some bad consequences. Indeed, neurotypical folks regularly do things that could have very serious consequences – consequences such as getting hit by a car, being knocked over into traffic on one’s bike, getting serious food poisoning, etc. Living with such risk is simply part of being a grown up. In contrast, we don’t allow infants to even attempt the genuinely risky.
What’s the difference between the “normal” adult and the small child? Among other things, it’s that the former can be trusted to make reasonable choices about which risks to incur, whereas the baby can’t make wise decisions on its own. Now consider, in this context, attempts to save people like me from failure – whether that be just serious failures, or even the modestly risky. On the one hand, protecting folks like me is an understandable impulse, based in level-headed concern for the mentally ill person’s welfare. People who love me ipso facto want to protect me from harm. On the other hand, to shield a loved one from all risk, even all serious risk, is to literally infantilize them. It can be, in short, a way of robing the patient of their dignity as responsible adults.
Respecting a person’s dignity thus brings with it allowing that person to take serious risks. I have been pondering this realization for days, on two fronts.
First, there’s obviously a question of balance hereabouts. Pondering the first, part (a): there’s the dimension of how mentally ill the person is at the time. Speaking for myself, when I’m really bad, I simply can’t be trusted to make appropriate choices. In fact, my decision-making has sometimes been so irrational that it’s been necessary to lock me up. In such scenarios, maybe infantilizing is the right stance. Pondering the first, part (b): there is the dimension of how big the risk is, and how large the consequences of failing. As an example, given that an overdose of Nortriptyline would be fatal, it likely makes sense for my family and friends to dispense that medication to me only a week’s worth at a time. Arguably the resulting harm to my dignity is worth it. (It was precisely in the context of a potential for suicide that our working group touched on the dignity of risk, by the way. When should we protect a loved one who is running the risk of “failing” in the sense of killing themselves? How suicidal is too suicidal to let them be? That’s a really tough question.)
Second, I’ve been thinking about the dignity of risk in relation to another phenomenon, namely my on-going “upwards spiral”. Part of the reason I’ve been improving, I think, is that I have felt confident enough to take on more challenging tasks; I’ve succeeded in those; and this has made me even more confident; which has encouraged me to take a still bigger risk; etc. Such a positive spiral inevitably brings along with it, however, the possibility of failure, even major-league failure.
If our little group figures out precisely how to balance autonomy versus potential failure, I’ll be sure to share the result here! Meanwhile, I’ll keep pondering the dignity of risk.
