Breathlessness is far broader than a physical symptom. It affects people’s mood, self-esteem and social links and often involves feelings of guilt and shame. Breathlessness can also be a symptom of a range of mental disorders, such as panic and anxiety disorders. There is also blame directed at people who suffer from breathlessness as result of past behaviour, such as smoking. Smokers often also blame themselves for becoming ill or think they deserve to be ill. These types of thinking – self-recrimination, blame and the ensuing guilt – can make things worse for the ill person who is already suffering breathlessness. In this blog post, philosopher and therapist Professor Hanna Pickard introduces a new way to think about these issues.
The Responsibility without Blame Project
provides a free, interactive, and accessible e-learning for anyone interested in thinking about our ideas of responsibility and blame. It grew out of my own experience working in a Therapeutic Community and is designed to help staff – as well as friends and family – work and relate more effectively with people with personality disorder or complex needs. But the idea of Responsibility without Blame has the potential for much wider relevance.
The key idea in the Project
is that we can get caught between two equally unhelpful mindsets when someone’s actions cause them or others harm.
Sometimes we step in and “Rescue” a person by denying that they had choice or agency. If they couldn’t help doing it, then they’re not to blame, and we treat them as worthy of care despite the harm caused.
Sometimes we “Blame” a person because we see them as having choice and agency. But since their actions caused harm, we may then judge them harshly and treat them as not worthy of care.
Both these mindsets stop us from supporting the person to make better choices and do things differently. A Rescue mindset is disempowering. But a Blame mindset is rejecting and punishing. I call this The Rescue-Blame Trap.
The key to escaping The Trap is to distinguish our ideas of Responsibility and Blame. Very crudely, responsibility is about the other person, and whether they have choice and agency. Blame is about us, and how we choose to respond when a person’s actions cause harm.
With this distinction in hand, the possibility of treating someone as responsible but maintaining care and indeed compassion comes into view. This enables us to support the person to do things differently in future, rather than getting stuck blaming them for the past.
Of course, it is not always easy to do this in practice. But the e-learning is designed not only to help people understand these ideas better, but also to develop this practical skill, by inviting them to learn interactively and to reflect on how these ideas apply to their own experience.
In the course of working on the The Responsibility without Blame Project, I talked about it with patients in the Therapeutic Community where I worked. They helped me realise that The Rescue-Blame Trap applies just us much to ourselves as to our attitudes towards other people.
When we do things that we recognise as harmful we can get stuck in either a Self-rescue or a Self-blame mindset. Sometimes we pity ourselves or think of ourselves as helpless. Sometimes we are incredibly hard and punishing on ourselves. This is the Self-Rescue and Self-Blame Trap. It is something that we all face at some point in our lives: when we have made choices that we come to regret. Whichever side of the Trap we are in, we are stuck in a place that blocks us from making changes that we may desperately want and need to make.
The key to escaping the Self-Rescue and Self-Blame Trap in our own case is the same as with other people. We need to adopt a Responsibility without Blame stance towards ourselves. This allows us to acknowledge our own power of choice and agency and work to do things differently in future, but at the same time, to show ourselves kindness and compassion, and not beat ourselves up for the past.
Although the e-learning is designed to help people work and relate more effectively to others, you can also use it as a tool to work on your relationship with yourself, and it ends with a short Module about The Self-Rescue and Self-Blame Trap. If you are a person who is struggling to come to terms with some of your past choices, I hope it may offer you a new way of seeing things, and hope for the future.