Difficult Ethical Decisions: To Enable or Not Enable a Loved One in Distress

(June 30, 2017) The Retreat's Clincal Director of the Anna Marsh Clinic, Jilisa Snyder, wrote an Op-Ed in response to a piece written by Richard Davis on the difficult topic of how we interact with and provide support to our loved ones who are struggling.

Snyder's Op-Ed was published by the Brattleboro Reformer on June 30, 2017. Here is a link to the published piece.

Here is the text:

Making Difficult Ethical Decisions

The concept and practice of enabling is a powerful and complicated issue—one that comes up regularly in my work as a clinical psychologist at the Brattleboro Retreat. Enabling has parallel meanings. To enable can refer to our interactions that empower others to develop and evolve. It also includes those well intended or protective actions that unfortunately may contribute to perpetuating or aggravating another person’s problems.

As I read the thoughtful article on this topic by Richard Davis, published in The Reformer on June 15th, I could not help but think how the question of enabling in our own lives, especially when mental illness and/or addiction is involved, is really a catalyst for difficult ethical struggles that Davis aptly describes as “the greyest of grey areas.”

Whenever we struggle with competing needs regarding a situation that holds meaning for us, we face an ethical quandary. Such conflicts may arise with parents, often of young adult children struggling with mental illness and addiction. How much should we help? What would really be effective (if they only knew)? How do we stay aligned with our values, use our resources well, and satisfy our own conscience?

These are all questions asked within the context of bearing witness to the unremitting suffering of someone you love (and for whom you feel responsible) and navigating one’s personal pain and confusion around heartfelt feelings of worry, frustration, guilt, fear, and even anger. What "should" your role be? What is my role at this particular stage of my child’s development? What can I tolerate? What can’t I tolerate? What’s too much…or too little?

I also see this set of dynamics in marital and family situations similar to that of Mr. Davis, in friendships, and among adult children who take on the challenging responsibility of caring for elderly parents. Part of my approach in helping guide clients through such painful quandaries is to remind them (as often as need be) that any angst they are feeling is absolutely normal.

Sometimes a problem solving approach results in a clear directive. Many times though, it does not. Perhaps the situation is simply not under our control, or is unresponsive to our input. Perhaps our efforts and interventions are not helping (or helping enough), or our scope of influence proves sparse in effecting change.

What I always stress with clients is that we do have control over at least one aspect of difficult ethical decisions, and that is the system we use in making our choices.  At the end of the day one can stand strongly with the method from which such decisions have been made, which means part of my work is to guide my clients through a thorough, deliberate, ethical based evaluative and decision making process that accounts for the complexities of their specific situation.

I have found that such an approach offers real sustenance, regardless of the situation’s outcome.  And clients tend to agree. They know they did their best—they deliberated, consulted, and acted from a clearer place within—and therefore are psychologically better equipped to cope with whatever happens. Sometimes this is the only firm ground we can stand on knowing that our decisions may result in a desired or unwanted outcome that we cannot predict or effectively influence.

Mr. Davis stressed this in his piece, wondering if the outcome would have been different had he chosen to leave his spouse. It is natural to wonder about paths that were not taken and will never be known. That does not mean, however, we made wrong decisions.

Lending ourselves to such a decision making process does not erase the experience of grief, sorrow, and sadness of seeing someone you love get stuck or deteriorate.  Loss is grief, and even the most optimal methods will not protect us from emotional pain. Grief is a part of being human, of being whole. It is a package deal that comes with love and connection.

Healing is not a linear process. We take steps forward, backward, and pauses in between where much is unknown and much is at stake. We always hope our efforts will lead to greater health, and many times they do just that.

And when they don’t, the therapist's role is to support someone through their grief, which can be prolonged as the client's “other” continues to not significantly change, and as such may slip away from us, themselves, and health...even as we keep trying to find the right way through. This is part of our shared humanity.

Jilisa Snyder, Ph.D., CRC is the Clinical Director of the Anna Marsh Clinic at the Brattleboro Retreat