Responsibility and the Neurotic Patient

Although the question of responsibility comes up all the time, a definitive answer to the question “Who is responsible?” is as elusive as the shifting sands. This is not surprising when we become aware that the word responsibility has many meanings. We may engage in attempts to resolve the question without being conscious that we are talking on different levels and therefore cannot agree. While this may raise doubts as to whether the matter of responsibility can be resolved, an attempt must be made to clarify our investigation of this field.

The matter of responsibility obviously plays an important part in our lives. Proof is not necessary. We analysts accept as patients only those who we feel will be able to assume part of the responsibility for entering into a trusting relationship, so essential do we consider it to a favorable outcome. Yet Dr. Voth of the Menninger Clinic states that a patient's poor motivation, his dishonesty, and his unwillingness to change are the doctor's responsibility.¹ Dr. Conn of Illinois is quoted as saying that it is the patient's responsibility to get better and that the burden should be placed upon him.² Such contradictory pronouncements lead to confusion.

Moreover, the medical model for the treatment of emotional disorders is being attacked. Some sociologists state that the environment alone is responsible for mental ills. There is a group of doctors who insist that psychotic criminals should be tried and judged for their offenses without the consideration of psychiatric testimony.^{3, 4} The fact that the question of whether or not psychotic criminals should be held responsible for their deeds is again being discussed indicates that the McNaughten principle of 1843,⁵ which demonstrates contempt for the power of the emotions, is currently in vogue in certain circles.

Yet before we can aver that criminals are responsible for their deeds, we must answer the question “Are we responsible for our acts?” The terms themselves need