The frequency with which I hear the question,
“How do I know whether that is my child acting out, or whether
it is something to do with his/her diagnosis?” is only matched
by the thorniness of the issue itself. Fine lines exist between explanation
and excuse, responsibility and blame, or empathy and permissiveness.
I believe my TS can be an explanation for my behaviour, but it is not
an excuse. I should not be blamed for my symptoms, but I am required
to be responsible for them. It is important for me to be granted accommodations
and an understanding borne of informed empathy for my condition, but
people should not make the mistake of ‘lowering the bar’
on me and becoming permissive, because I would only sink to their expectations.
In any given situation, to ask, “Is the disorder
to blame or not” isn’t, it seems to me, the best approach
to take. Doing so implies that if some neurological condition IS to
blame, then the person is NOT, and (s)he thus escapes from any finger-pointing
and consequences. No wonder people want to capitalize on that –
sign me on too! The problem with this manner of thinking is that the
more we learn about genetics and neurology, and the environmental factors
that exert influence upon our genetics and neurology, the more we will
be able to explain ALL of our thoughts, feelings, and actions within
these terms. This leads to a slippery slope: at some point isn’t
everything we do, and everything we are, a product of our genetics,
neurology, and environment? Since none of these factors are under our
control, we quickly come to the untenable point where NONE of us are
ever responsible for ANYTHING we do!
We obviously need another option then: after all, “My
right to swing my fists in the air ends where your nose begins”,
regardless of whether I have Tourette Syndrome, hyperactivity, or tickets
to the next Rolling Stones concert. So, here’s my stab at it:
“Individuals with TS and its associated disorders
may indeed experience symptoms that are involuntary and/or beyond their
control in nature. This fact is not questioned, and indeed can be assumed.
However, we do not have the right or the ability to differentiate between
volitional acts and symptomatology in individual cases. Furthermore,
it would not be appropriate nor would we be even entitled to assign
guilt based on such distinctions. Instead, it is my position that a
person's responsibility lies in recognizing his/her limitations and,
in situations where his/her symptomatology could result in criminal
actions, implementing appropriate preventative accommodations (such
as avoidance of the situation). If, knowing his/her potential for criminal
action, (s)he fails in appropriately accommodating to a degree within
reasonable expectation, then regardless of whether the actions were
a result of symptomatology, responsibility (including legal culpability)
? In other words people with 'leaky brakes' may or may
not be able to control their actions, and so guilt (for example criminal
guilt) should not be determined based on this question. A person CAN
control knowing whether their symptoms could lead to unfortunate actions
in certain situations, though. A person can also control whether or
not they then avoid or preventively alter that situation. Guilt CAN
be determined based on these questions. Put another way, a blind man
is not to blame for his lack of eyesight. He IS, however, to blame if
despite being blind he knowingly gets behind the wheel of a car and
hurts someone as a result.
I suggest implies the following: if you did it, then you are responsible
for it. That part, at least, is simple. The only complicated part is
deciding how your accountability is going to look.
consider the following objective situation: we see a boy put his hand
through a classroom window. On the basis of this information alone we
can be clear and united in our chorus: that is an unwanted, undesirable,
and unacceptable scenario. We can also all agree that it was the boy
who broke it; he therefore is responsible for the scenario. Now let’s
add colour to this black-and-white canvas by offering some potential
explanations for this behaviour we just saw.
• The boy is antisocial, and is engaged in a power
struggle with you.
• Another boy dared him to do it.
• It was an involuntary movement borne of a condition such as
TS or epilepsy.
• The boy was in the midst of a neurological rage.
• He learned from an abusive, authoritarian father that breaking
things is how a person displays anger.
• He is an outfielder on a baseball team and was trying to catch
where the situation gets dicier, because depending upon the explanation
you choose you may alternatively feel anger, pity, protectiveness, embarrassment,
helpless fear at how to respond, simple concern as to whether the child
is alright, or nothing at all – some of these outlined scenarios
elicit an emotional reaction, but others need not.
also where the situation, at a promptly-called parent/teacher interview,
gets pointedly uglier as different individuals interpret, explain, and
sometimes unnecessarily add emotion to this initially objective situation
based on their own training, life experiences, beliefs, biases, or emotional
frame-of-mind. At base, remember, we still just have a child breaking
glass around other children; this detail can easily get lost in the
ensuing melee, however, as conflicting interpretations of the event
lead to clashing ideas of how to impose accountability onto this child.
we already decided above that the child is responsible for the behaviour.
None of the various possible explanations suggested above reject the
notion that it was this child’s arm which came crashing through
the glass. To debate this point is needless. The real issue, and the
million-dollar question that needs to be asked, is ‘what is the
best way to ensure that this situation doesn’t happen again’.
answer the question of accountability, then, we need first to be open-minded
about ascertaining the true reason the window got broken in the first
place. We need to be prepared to reject our first-blush appraisal of
the situation, and to rethink our position in light of new information
our list above leads to many possible avenues to show accountability.
For instance, if this was a purposeful and malicious act, then the question
of how to prevent this situation in the future may be refined into ‘what
is the best way to punish this child’? If this was epilepsy, the
question is refined into, ‘what is the best medication for flailing
arms’? And if the boy was lunging to catch a pop-fly when he broke
the glass, the question becomes “where should we move the ball
diamond to”? All of these are ways of being accountable, but match
the most appropriate style of accountability to each situation. One
would not get particularly far, for instance, sending the child with
epilepsy to a Children’s Aid social worker. No amount of analysis,
cajoling, parent-threatening or behavioural attributions will make a
difference: you’d better prepare yourself for more showers of
glass, because in applying the wrong explanation to the situation we
got our solution all wrong.
same reason, suspending a child after a neurological rage episode also
does not get you very far, and so is a bad idea. Not because the rage
is not his responsibility and he should not be held accountable –
this is not the issue remember – but because suspension isn’t
going to ensure that this situation doesn’t happen again. It applies
the wrong TYPE of accountability. Collaborative problem-solving or symptom
negotiation or treating other comorbid disorders or learning to anticipate
and avoid over-stimulating experiences for the child WILL allow you
to put away your broom and dustpan though. Not because you’ve
given in and let someone else win or get away with anything. But because
you discovered the true issue behind the broken glass, and laid it to
rest. Remember, the key to rage is that it never WAS personal to begin
with. Save yourself some time, headache, heartache, burnout, emotion
and stress, then, and don’t be the first to TURN it personal.
You’re only muddying the water on what can be a much simpler,
more objective, fix.
B. Duncan McKinlay, Ph.D., C.Psych.