There’s a passing quote in Rachel Aviv’s recent article “The Edge of Identity” (The New Yorker April 2, 2018) that stopped me short.

In 2008, Hannah Upp, a vivacious, engaging woman, experienced a dissociative fugue. Fugue is the medical/psychological term for an extended, complete identity lapse. Hannah ‘disappeared’ in New York City. She triggered newspaper headlines and a widespread search, her image popped up on several retail video cameras around the city, and she was finally ‘discovered,’ twenty days later, floating in New York Harbor.

Four years later, in Kensington, Maryland, Hannah ‘disappeared’ again. Another search. This time she was found in a creek.

After Hannah’s second fugue, some wondered if perhaps Hannah might benefit from wearing a chip implant; the Maryland police suggested an ankle bracelet similar to the ones designed for people under house arrest. Hannah did not want anything like that and her mother, Barbara, honored her decision. “She’s living it, and she needed to have the freedom to make choices.”

That’s the quote that gave me pause. Really? A young woman who has endured two disappearances, suffered personal danger, and caused all sorts of heartache among family, friends, and emergency personnel, can decide against identifying technology that could assist in another fugue simply because she needs the freedom to make choices? If Hannah can choose not to take precautions against another fugue, do we—society—have a responsibility to intervene and require her to do so? If she refuses reasonable safeguards against a foreseeable disaster, are we responsible to sound the alarm and search for Hannah the next time she goes astray?

Which, of course, she does.

Hannah’s third fugue occurs on St. Thomas, just after Hurricane Irma hit in 2017. Her third search includes three Coast Guard helicopters, several boats, and extensive human resources, conducted amidst the chaos of disaster relief. Her official search gets called off only as Hurricane Maria approaches. But her mother Barbara moves to Saint Thomas indefinitely and continues to look for a daughter who has never been found.

Where do we draw the line between people who blamelessly deserve societal support, and those who contribute to their own downfall?

Surely we should provide support for children with Type I diabetes. How about adults with Type II diabetes exacerbated by poor diet?

We should rescue scientific expeditions on Mount Everest that encounter extreme conditions, but should we rescue clueless day hikers who wander beyond their abilities?

How about my friend Bob, who endured a brain tumor that left his balance precarious? He’s fallen several times in his apartment, even blacked out, yet he refuses to wear an emergency call button. When he inevitably falls again, are we compelled to expend unlimited resources to his resuscitation, or are we allowed to hold back, since he shuns reasonable precautions?

We humans are expert at destructive habits. What is our responsibility to treat addicts who relapse after multiple rehabs? Heavy smokers? Chronic gamblers? The dividing line is rarely clear. Most misery istriggered by a combination of personal action and cultural conditions. Folks with Type II diabetes are not 100% responsible for their condition; they may be unaware of better dietary choices, and healthier food is both more expensive and more difficult to access.

Americans hold individual freedom paramount. We may restrict individuals for the stated objective of protecting others (we require parolees wear an identity bracelet), yet we don’t demand that individuals protect themselves (Hannah was not required to wear one). We establish certain obligations that serve everyone’s health and safety (drivers license and insurance to drive a car), yet are lax on others (user ID on hand guns). Our fixation on so-called individual rights over societal responsibility is so strident as to become self-centered, borderline narcissistic.

Hannah’s story is tragic; her condition arbitrary as it is bizarre. The article focuses on her deep empathy and caring. Yet it doesn’t even mention the obvious flip side. By refusing to do whatever she could to minimize the impact of her fugues, Hannah brought all manner of distress on others. We will never know, if Hannah had agreed to technical monitoring, whether it would have helped us find her when she went wandering on St. Thomas. We only know that her third fugue was predictable, that she did nothing to mitigate it, and that society condoned her decision.