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Harvey Jacobs, PhD, Brain Injury Professional magazine (page 2 of 3) Page 2 of 3
Choice and Responsibility
This brings up several issues, the first of which is the timeless free will vs. determinism – personal responsibility debate. This debate generally argues between free will, noting that people make unexpected choices in light of overwhelming odds, so behavior cannot be determined and by making choices people are responsible; vs. the concept that much of our behavior is determined by the many prevailing variables that effect it, even if we don’t understand them all. This side of the argument often notes that while we clearly cannot always accurately predict the weather, few of us would ignore the environmental and climatological factors that produce it. Subsequently, if any part of our behavior is determined, can we be responsible for such behavior since it was the product of a wide range of variables, many of which were beyond our control and hence not of our choice or responsibility?
Sorry, I don’t have an easy answer on the free will vs. determinism debate, though I lean towards determinism as part of the overall equation. What we don’t know about ourselves as a species and how we fit into the “big picture” far exceeds what we do know – sort of an existential agnosia.
The concept of personal responsibility may also be more accurately framed in terms of situational accountability. This account focuses on the “rules for the road” that a person may be expected to follow in a given situation as well as their ability to do so. For example, nobody cares if I sing in the shower because they can’t hear me. On the other hand, if I sing in the library I could get in trouble given their basic rules of being quiet and respecting the ability of others to concentrate. If you want to drive you better be able to handle all of the variables involved on the road, or stay off; and if you don’t stay off you may get pulled off by your friendly state trooper (for the benefit of the rest of us). Play golf at putt putt? No problem. Play golf on the PGA circuit? Only if you’re a big dog.
Clearly situational accountability varies with the task, community, culture, heritage, orientation, etc. and the aforementioned examples are relatively simplistic compared to actual daily life challenges. However, situational accountability establishes the skills and abilities a person is expected to bring to the table, the supports or assistance they may expect in the situation and the criteria for evaluating performance and continued membership in a given setting. When someone is “not appropriate,” we are saying that they are not following the expected rules or properly using available resources within the setting. Problems can clearly arise when a person’s judgment of their abilities and expected rules differ from that of other members of the immediate community.
Facilitation
If you accept the relationship between changes in behavior as a function of changes in variables that effect behavior, it then follows that “adverse” behavioral change is a warning sign that something is out of balance. A person is not “misbehaving” but “reasonably” behaving to a different set of salient factors.
Theoretically, by addressing the aberrant factor(s), the behavior of interest will also change. Practically, however, it is not always so easy. The contributing factors may not be readily identifiable, accessible or amendable for change. For example, we still can do woefully little to repair actual neurological impairment. A person with poor self-awareness may insist that they are capable of driving when others disagree, not understand why comments they made in a social setting upset someone else, or not even realize that they made a disparaging comment. Pre-morbid issues that were not successfully addressed prior to the brain injury may remain prominent. There is likely to be disagreement and possible conflict among parties in such situations. Still, this approach will be effective more often than not, especially with newly developing challenges. It also helps to understand that the person in question is usually doing the best they can in such situations within the information and abilities that they possess.
At issue, however, is the concept of not fixing something unless it is broken. This is simply too costly and detrimental when considering behavioral challenges following brain injury. By the time behavioral challenges garner professional attention they are usually at a crisis level where the urgency of the immediate situation typically obscures the initial point of focus. As a result, we too often equate behavioral intervention with stopping or preventing dangerous or highly irritating behavior rather than facilitating personal competency that would have likely avoided the problem in the first place.
It is just as easy, if not easier to identify proactive skills and abilities that facilitate individual success and the factors that support such behaviors. Obviously if we can operationally define challenging behaviors and identify the salient factors that facilitate such behavior, we can also operationally define proactive behaviors and identify the salient factors that promote functional competence.
This type of approach offers multiple benefits to the person of focus as well as others in their world. Nothing breeds success like success and people who have plans, tools and supports to negotiate life’s daily challenges are less likely to “melt down” or disrupt the lives of others. There is greater likelihood for success, even in difficult situations, when relationships are built on support and respect rather than confrontation. Building honest and positive relationships is often cited the single most important approach to curbing “problem” behaviors. It is also easier and more economical to do things with the wind at your back than to fight on oncoming gale.
Consider the “typical” behavior plan that extensively identifies the aberrant behavior and the steps suggested to stop the problem behavior. Somewhere near the bottom of that plan there will be a brief statement to the effect of: “and socially reinforce the person when they act appropriately.” Unfortunately, little thought is given to what is socially reinforcing to the person or exactly what “appropriate” constitutes. When the plan’s focus is on stopping rather than supporting, we fail to articulate the structure and supports required for success. As a result many people quickly relapse into problem situations. Staff is just as vulnerable, especially when the focus of their training is on the “can’ts” and “shouldn’ts” rather than the possible. They become enforcement officials rather than coaches and mentors.
From Brain Injury Professional, the official publication of the North American Brain Injury Society, Vol. 5, Issue 4. Copyright 2009. Reprinted with permission of NABIS and HDI Publishers. For more information or to subscribe, visit: www.nabis.org.
Brain Injury Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society. Brain Injury Professional is published jointly by NABIS and HDI Publishers. Members of NABIS receive a subscription to BIP as a benefit of NABIS membership. Click here to learn more about membership in NABIS.
Harvey Jacobs, PhD,
Harvey E. Jacobs has a long history of serving people seeking opportunity who are challenged by disability following neurologic, psychiatric, developmental, medical or physical impairments. Throughout his career, Dr. Jacobs has worked on-staff, in administrative roles, academic positions and as a consultant to numerous facilities (medical, rehabilitation, community, assistive living programs and nursing homes) in the United States and abroad.
Dr. Jacobs’ current interests include behavioral rehabilitation for neurological, psychiatric, medical and developmental disorders; brain injury; severe behavior dysfunction; rehabilitation outcomes research; vocational rehabilitation; family systems; staff training; and community integration. Throughout his practice, Dr. Jacobs has worked with diverse ages, ranging from pediatrics to geriatrics. He has a special interest in organizational and systems management relative to developing and operating comprehensive programming in both business and clinical settings.
He is also a partner in Lash and Associates Publishing/Training which creates practical educational and training materials for care providers, direct care staff and other people assisting people who experience disability.
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