The right to self-determination is sacred in our culture; the law protects a person’s “right” to be homeless, to be mentally ill without treatment, or to live in a home that is dangerous and uninhabitable if that person refuses help. Because these legal and cultural protections parallel our continuing lack of adequate services, I worry that we have learned to tolerate the intolerable. When people refuse assistance, it is easy to default to, “It’s her choice.” But the concept of informed choice is multi-layered and elusive.
What does the word “no” really mean? I know what it’s like to sit face to face with people who reject assistance or who cannot participate in what is offered for reasons that are difficult to understand. When a person asks me for assistance then refuses my help or throws a hundred road blocks in my path each time I take a step towards that assistance, something inside me doesn’t believe that the “no” I am hearing is an informed choice. I can’t accept that this fragile, flailing person grasps the implications of refusal or has weighed the various outcomes carefully and rationally.
I do understand that “no” is often the sound of fear, the echo of loss, the last stand of selfhood. As irrational as it may seem, compromising one’s freedom for the sake of safety can feel like a violation. Dignity is inseparable from self-determination. Although a person is asking for help, accepting assistance can be experienced as a painful loss of autonomy. Refusal becomes the default response.
Older adults developing health-related deficits feel caught in this dilemma. People living in poverty face multiple humiliations at every turn. Those with mental illness are often not able to move beyond their fears born of mistrust. In these contexts, “no” is not so much a choice as it is an expression of the person’s internal state.
Paradoxically, those who say “no” are most often the people who return again and again. Although they come to us with real problems, I don’t think that “solving the problem” is what they want at heart. What I hear is a genuine bid for connection- a request for someone to be truly present with them in their experience. There’s a desire for someone to listen from a deep place to the story that is being told and to refrain from judgment. After all, each one of us has our own narrative that forms the structure of who we are regardless of whether that narrative makes sense to others or not. “No” is not an invitation to close the door, although, in a world of limited resources, it can be very seductive.
The most difficult part of social work is accepting the unacceptable. It is painful to watch fellow human beings struggle in situations that can be mitigated. For our clients who refuse in the midst of reaching out, we can sometimes only offer a hand. The power of that hand should never be underestimated.
By Lani Scheman
Lani is a Geriatric Care Manager in the Aging in Place program. She has worked with a variety of populations for over thirty years. Lani is a longtime resident of Capitol Hill, living with her partner Scott and a Chesapeake Bay retriever. She is interested in just about everything but has a special passion for literature, photography, book arts and the beauty of the natural world.
Feature photo by martin.
