x Abu Dhabi, UAEWednesday 17 January 2018

When does self-harmful behaviour demand intervention?

Sooner or later it's question everyone has to ask: when is it right to interfere in the private lives of others and limit their freedom to make their own decisions?

Over the last few weeks, I've found myself in a bit of a quandary. When is it right to interfere in the private lives of others and limit their freedom to make their own decisions?

Sometimes, it's obviously necessary to do so: to exert control over an immature child, as one example; a driver who insists that a passenger wears a seat-belt is another clearly justified case.

There are also plenty of occasions when it's right to offer advice, even forcefully, to an adult who is planning to embark on a course of action that would place his or her life at risk.

This issue came up this month after the tragic death of a hiker at the Stairway to Heaven hiking trail in Ras Al Khaimah. Experienced outdoorsmen lined up to warn novices not to tackle the climb.

Similarly, a responsible guide would warn someone not to attempt a dangerous traverse across a rock face without the proper experience and equipment, or not to try to swim across a channel with a strong current. This is just common sense.

The situation that I am facing, however, is rather more complex. In this case, it is becoming apparent that a person - a friend - is losing (or has already lost) the ability to make appropriate decisions because of a decline in mental faculties.

In such scenarios, people are faced with the choice of simply allowing people to make decisions that will ultimately be harmful to themselves, or of intervening, perhaps against their will or without their knowledge.

Such a choice is by no means easy, although I suspect that it is one frequently faced by people with older friends or relatives who are beginning to suffer from the onset of conditions such as Alzheimer's disease.

How does one determine when it is right to intervene to help someone whose mental capacity is declining, particularly when the person in question probably does not recognise the decline and may resent the interference?

A friend of mine in Britain has been dealing with such a problem for nearly a decade, as her aged mother has gently slipped into benign senility, increasingly forgetful and unaware of her surroundings. Fortunately, she's not aware - most of the time - of what is being done to safeguard her.

That may not always be the case, and the person affected may be aware and violently object. An old friend of mine has recently begun to display what appears to be a rapid deterioration in his ability to act and to think in a logical way.

What was once a very lucid and analytical mind has become, as a result of years of alcohol abuse, one that is increasingly focused on obsessive schemes that - to me and to others - appear to be completely illogical, with minimal chance of ever being achieved.

This has been coupled with a series of delusions and implausible conspiracy theories. This, by itself, doesn't really threaten my friend's welfare. These delusions can be humoured and, indeed, some of his ideas are rather funny.

The next stage, however, is one that has been well-documented in medical studies about alcoholism. My friend has slid into paranoia, believing that several attempts have been made to kill him. To external observers, it's obvious that he's in real need of psychiatric help.

But my friend lives in the United Kingdom, where such help can be provided only if he seeks it himself, which he refuses to do, or if he is detained by the police and obliged to undergo treatment.

Can I and other friends and relatives seek to intervene, although it would be against his will and undoubtedly construed as another conspiracy? There is no question that we believe treatment is in his own best interests and indeed essential.

We've tried in various ways to do so, unsuccessfully so far. I hope that if the time ever comes when I'm in a similar situation, my friends will do the same for me.


Peter Hellyer is a writer and consultant who specialises in Emirati culture and heritage