Illness, Responsibility, and Intervention.

In a recent article (Amer. Psychologist, 1961, 16, 69-74; see record 1962-03334-001), Ausubel has questioned Szasz' position that mental illness is a disease process only by virtue of its having been so labeled. While Szasz' position seems to imply that the mentally ill patient is responsible for his behavior rather than being a passive participant in an ego-alien disease process, Ausubel contends that most mentally ill patients should be considered to be victims of a disease process and accorded the same exemption from ethical considerations as is enjoyed by people with any illness. While both positions seem to be well argued, it appears that the authors have neglected a possible alternative to the two extremes of responsibility versus no responsibility in the so-called mental illness (or any other illness, for that matter). The current author suggests that at different points in the longitudinal process we call mental illness, patients' responsibility for their behavior will vary. An analogy we might use in discussing responsibility in mental illness is peptic ulcer. During the preulcer phase when anxiety is the dominant symptom, we can and should hold the individual responsible for learning more effective methods for meeting the stresses of life than he now employs. Similarly, during the postulcer phase, we can and should hold the individual responsible for not utilizing his ulcer for secondary gain. However, during the ulcer phase when the gastric hyperacidity actually erodes the gastric mucosa, the ulcer per se follows physiological laws more closely than it does psychosocial laws. Perhaps this alternate view of patient responsibility during any pathological process will help the helping professions to clarify their responsibilities in the treatment of the "sick" individual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)