Rob Ford's recent attempts to causally link his improper behaviour with his addiction problems has lead to some hair-pulling on the part of columnists and bloggers alike. For example, Andrew Coyne of the National Post recently fretted over the use of the term 'disease' to describe addiction, as it might then allow people a free pass in terms of accountability.
Indeed, many people have been commenting -- rather furiously -- that Rob Ford is side-stepping proper responsibility for his actions by assigning blame solely to his "disease."
The whole affair has raised a difficult and perhaps uncomfortable series of questions -- such as, can addiction and mental illness be used to avoid accountability?
Trying to answer this type of question inevitably leads us to the free will versus determinism debate. Are we free to make our choices in life, or are our decisions forced upon us by factors such as genetics, biology, psychological history, etc.
Part of the problem is trying to conceptualize what it even means to exercise personal choice. If there are factors that influence the decision, is it still free? At what point do things like biology and genetics make me a prisoner of my own decision-making process? Can a disease force someone to make mistakes?
The free will - determinism debate is least helpful when you feel compelled to choose one or the other. It is more helpful to acknowledge that our thinking and behaviour are influenced by many things, but influenced is not the same as determined. For example, if you were in a major car accident last month, your choice of whether to drive on the highway is being influenced by changes in the brain that have occurred as a result of the accident (ex: the presence of traumatic memories). However, you may choose to drive anyway for reasons that are specific to you (ex: a personal desire to fight fear).
The ability to acknowledge shades of grey and judge accordingly is very important when it comes to understanding the decisions of those with addictions and mental illness.
If a mother is suffering from chronic depression, to say that she is freely choosing to spend less time with her children and more time sleeping is ridiculous. Many factors are guiding and influencing her thoughts and actions. Similarly, when someone has an addiction, there are likely biological, genetic, psychological and even social and cultural factors that influence their craving, thoughts and behaviours.
So does this mean that the depressed mother and the addict are completely without blame?
No, it does not. There is an important distinction to be made between explanations for behaviours and excuses for behaviours.
An explanation helps us understand why a decision was made -- what were the various factors behind this choice. An excuse is an act of pardoning or forgiveness for one's mistakes. So, we can explain why someone acted in a particular way, but that does not necessarily excuse the behaviour.
The more influence that external factors have on one's decision-making, the less accountable they should be, but rarely do we have zero input into our own decisions. In fact, it can be helpful to use a continuum -- say, a scale from 0 to 100.
On this type of scale, 0 would equate to situations where you have essentially no choice or control and 100 would equate to total self-determination. The vast majority of choices are going to fall somewhere between these two end points.
For example, imagine someone with mild depression, good social support (ex: family and friends) and access to psychological treatment. We might say that the depression is having some influence on decision making, but on a scale from 0 - 100, deciding whether to sleep in bed or spend time with children is in the 75-85 range (significant, but not perfect self-determination). This contrasts drastically with a single parent with no support and chronic, severe depression. In this case, the person's level of self-determination may fall within the 20-30 range.
In this scenario, it is clearly easier to criticize the first person and sympathize with the second person. However, this does not mean the second person is not at all accountable. There remain some things within their control (ex: seeking assistance through public services) and that is where they must be accountable.
Which brings us back to Rob Ford and other people with addictions. Whether one considers addiction to be a disease or not is a matter of debate. The issue of accountability is, for the most part, separate from this debate -- whether psychiatry or medicine labels something as disordered is not relevant. Only knowing the degree to which the problem limits our ability to make choices that are consistent with our values is relevant.
In the case of someone like Rob Ford, he may have very little control over his cravings for alcohol, and this is where he deserves sympathy. In a culture where everyone has something -- coffee, cigarettes, marijuana, shopping, alcohol, need for approval, etc. -- it shouldn't be too hard for us to sympathize with someone dealing with a dependence problem.
However, as a man who has good financial resources and who is capable of accomplishing significant person goals (remember, this is someone who was elected mayor to one of the largest cities in North America), he has considerable, personal influence over the treatment of this problem (ex: access to treatment).
Likewise, Mr. Ford's potential susceptibility to addiction was not the only factor that determined whether he used drugs or drank alcohol -- such decisions are not 100 per cent genetically or biologically determined. Also, alcohol leads to inhibition -- not to personal beliefs. The types of offensive things the mayor was caught uttering are separate from the substances. There are certainly things (ex: beliefs about homosexuality) that were and are within his control, and thus to which he must be held accountable.
His offensive behaviour may be partly explained, but in no way is it fully excused.
The choices we make are not entirely our own -- there are too many psychological, cultural, social, biological (and other things that end in "al") factors that influence our thinking and behaviour. For a good understanding of this issue, I would recommend Dr. Steven Pinker's book The Blank Slate- - which makes a clear, although perhaps a bit too forceful =- case for determinism and how our lives are influenced by these factors. Knowing how each of us comes to make the choices we do can promote sympathy and empathy -- both for ourselves and for others.
So, we can feel sympathy for Rob Ford and the difficult road ahead, but we are all in the same boat. We all have vulnerabilities and life circumstances that push and pull on our ability to think and act.
It is a bit like riding in a boat on the sea -- the waves will push you around and pull you in certain directions, but you still have paddles in your hand. And for this reason, we must all take some responsibility for our boat's direction.
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