It is perhaps wise to begin by saying I’m not in my most forgiving mood, right now. Little Juniper is going through a growth spurt and night times aren’t quite as peaceful as they were a week ago. (Sleep, we will be reunited again before long, promise.)
In a way, I’m not entirely sure where to begin. Choice is such a weird concept. At least, that one word encompasses a massive range of behaviours. Choice is everything from deciding what to have for breakfast in the morning (porridge with honey, in case you were wondering), deciding whether or not to make a big purchase (the shoes will be here tomorrow), to deciding whether or not to have surgery (we had some good times, tonsils, but I wasn’t sad to see you go). Choice is the big, the little, the moral and the tasty. When it comes to mental illness, choice is, I believe, a grey area. Admittedly a really big and squidgy grey area.
When I think of choice and mental illness, there’s one thing in particular that comes to mind: Mr. Juniper coming into the living room and admitting he had ingested something in a quantity that is generally regarded as unhealthy. In years before, it would have been any one of the countless occasions he was roughly bandaged up. I won’t go into the visual details, I simply can’t. But how I felt? Anger, frustration, and the need to know why. And it’s in pleading “Why?” that I know I’m expecting him to have had a choice in what he had just done. When I say, “You couldn’t be bothered to take the whole lot?” I am saying, “It’s okay,” but the undertone of, “Why?” is there, too. If I’m asking why, I’m asking why he chose to do what he did.
That question of why isn’t an attempt to deny him what is beyond his control, to deny that he’s mentally ill. That “why” comes from a place of anger and a place of distress. No matter what, I’m his partner first and caregiver second. No matter what compassion and knowledge I have, in the moment that I’m questioning why he has chosen to hurt himself, I’m trying to deal with the man in front of me who is injured, and who needs medical care. I’m questioning how he can come to be in that position. And that’s when I remember it isn’t a choice. He doesn’t want to be in that position. He doesn’t choose to be hurting. It’s that for so many years, it has been the only coping mechanism he’s had. He isn’t choosing to be mentally ill. He’s simply trying to survive. And when he’s standing in front of me, I come to realise that choice and survival can sometimes be hard to distinguish from each other.
Yet in the same breath, I think there is a kind of choice. The kind called compliance. But even that comes with conditions. Mr. Juniper chooses to go to his therapy sessions, to see the GP and the psychiatrist. He chooses to take his medication as prescribed. He is choosing to be compliant with his treatment plan. Except, I’m not sure if that can be called choice. If he didn’t comply with the treatment plan that everyone has agreed upon, he could get to a point where his choice not to comply resulted in him becoming a danger to himself, at which point choice would be removed. He would have to be sectioned; a choice that could be mine, among others. His choice to comply is his choice not to have choice removed. Why, hello Yossarian, it does sound like a Catch-22, doesn’t it? Nobody puts the pills in his hand when the world and his mind get to such a point that there seems like no other option, but I have been the one who has put the pills in his hand when it comes to the daily medication routine.
So is there choice in mental illness? I guess I would say a very hesitant, “Yes,” in so much as I think there can potentially be a choice to survive but a more comfortable, “No,” in that mental illness is so much more than black and white choices. But above all else, the most important choice with regard to mental illness is how we choose to treat those with mental illness. (The answer is as human beings.)