Every Sunday I read Randy Cohen’s column, The Ethicist, in the New York Times. Cohen settles moral dilemmas with humor and common sense. This week’s ethical conundrum: A mentally ill neighbor.

The writer moved into an apartment in a small town. A woman with schizophrenia lives across the street: “She regularly accosts me, shouting insults with apparent lucidity…Other locals treat her as a harmless nuisance, speaking to her as if she were a child, but I’d feel awkward doing that since she is twice my age. How should I respond to her?”

Cohen’s response began: “Assuming your amateur diagnosis is correct, you should respond courteously and briefly. As you know, you should not chide someone mentally ill for her rudeness.” (I added the bold.)

God bless you Randy Cohen. Just for emphasis, let’s allow Randy say it again: “As you know, you should not chide someone mentally ill for her rudeness.” And one more time, Randy, because you make it sound so common sensical: ”As you know, you should not chide someone mentally ill for her rudeness.”

Nor should we ridicule, berate, deride, ignore or shame someone mentally ill for his/her rudeness. However, it seems like we have a caste system for mental illness and our etiquette depends upon the position a specific a mental illness holds within that system. Often it is easier to pardon rudeness when the person is clearly psychotic and delusional. But how do we treat – how should we treat – the obnoxious alcoholic, the panhandling addict, the “lazy” person with depression or the boiling diatribes and vengeful behavior of those in the throes of their mania?

Good question. Hey, I am as guilty as anyone. I cannot tell you how many times I have “chided” an obnoxious drunk – even though I am an alcoholic. Until I experienced, and was finally diagnosed, with depression I berated others – especially those with dysthymia – as weak and lazy. And apparently I – little Ms. Bipolar – must have  missed – or wasn’t paying attention – during the Sunday school lesson on “Judge Not Lest Ye Shall Be Judged.” But the delusional rages or mutterings of someone with schizophrenia I self-righteously forgive.

Even more disturbing, until I admitted I have alcoholism and was diagnosed with depression and bipolar, I offered no help – which brings me to the rest of Cohen’s column. Cohen consulted two experts. One suggested contacting the government agency that handles mental health to request help from a social worker.

Another expert suggested that the neighbor ask himself why he felt so awkward and whether treating the woman as a child or in any other way “is helpful to keep her at bay.” Ironically, treating her like a child may be “unwittingly and paradoxically elicit her most upsetting behavior.”

There is no happy ending or right answer. The writer moved. I’m still here, wondering what I would do.

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    Last reviewed: 10 Aug 2009