The Patient is Unresponsible

“This patient has no responsibility,” the resident said.

Interesting, I thought. Responsibility. Not a word I heard often anymore, at least not since high school, when I was occasionally accused of lacking it.

So what did this young psychiatrist mean exactly – no “responsibility”? Depending on cultural norms, I suppose there could be 2 broad definitions of the word.

Definition 1. Responsibility: To “take ownership of your actions,” a phrase that has become tainted with its use by television psychologists and talk show hosts, and Britney Spears.

Definition 2. Responsibility: To fulfill one’s obligations and duties.

To fulfill one’s duties. Is that a sign of psychological health? After all, the existentialists would argue that duty and obligations are ultimately decided by family, community, and society; therefore to fulfill your duty is to give up your intrinsic freedom, to bow to external social forces and expectations.

By this logic, an irresponsible person would be considered more psychologically evolved than the responsible person.
Put another way: If duties are dictated by social structures, and responsibility means fulfilling your duties, then to be irresponsible is actually a sign of psychological health.

But that’s clearly not true: The irresponsible person – someone who endangers other people by his actions – is not completely healthy. And the responsible person – someone who fulfills his or her duty, who does only what society and culture and subculture expect – is not at the highest level of psychological functioning either.

So, what is healthy responsibility then? And how to define it so different psychiatrists can agree upon its absence or presence in a person?

Well, what if the definition of “duty” was expanded to include not just obligations to a few people, but to all people?

In other words, a responsible person looks out for his own, but also for those who are not, he knows that although he is an individual, he has a responsibility to the world, he thinks about immediate as well as long-term consequences of his actions. To paraphrase some great man, the responsible person acts locally and thinks globally.

“In what way does the patient have no responsibility?” I asked the resident, ready to launch into a lengthy discourse.

“She is not responsible to time, place, or person, not even responsible to painful stimuli,” the resident replied, with characteristic confidence. “The patient is unresponsible.”

“Oh, ” I said. “You mean, the patient is unresponsive.”

Disclaimer: A work of fiction. Any resemblance to anyone alive, or deceased is purely coincidental.