Accommodations can be difficult. Not only for an individual with a disability to identify what accommodation would be relevant or helpful for them, not only convincing whoever to implement the desired accommodation, and not only ensuring that the accommodation continues over time and doesn’t lead to resentment or punishment for the person with a disability. Here is an additional wrinkle – sometimes desired or needed accommodations conflict. What one PWD needs to accommodate her disability could not only not help another PWD, but might actually exacerbate their disability.

Let’s take an example: smoking. For some PWDs, especially those with mental illness, smoking can help ameliorate their symptoms, calm their anxiety, even help some with restoring neurochemical imbalances. The rates of smoking among people with mental illness tend to be much higher than the general population, in which about 20% of people smoke. Here is a chart of smoking rates among PWDs with mental illness:

There are lots of theories why people with mental illness smoke. At a recent meditation seminar, the instructor was modeling deep breathing techniques for relaxation and stress reduction. He pointed out that the deep breaths, with an exhale longer than the inhale, breathing from the abdomen, exactly mimicked the breathing of a smoker while inhaling from a cigarette and exhaling smoke. I know people who took up smoking intentionally and specifically in order to help regulate breathing during panic attacks – they report that the 5-7 minutes of regulated breathing during one cigarette is enough to get them through a panic or anxiety attack.

Nicotine, the active ingredient in cigarettes, also acts as a stimulant on the brain. Some report enhanced attention, focus, and concentration, which can be helpful for people with attention or focus problems caused either by their disorders or the medications that treat them. As one study reports: “Certain thinking patterns are affected in schizophrenia including sustained attention, focused attention, working memory, short-term memory, recognition memory and even processes that are preattentive (eg reflexes). Some studies have suggested that there may be improvements in these areas after treatment with nicotine.” Those authors theorize, as have many others, that “it may be that patients “self medicate” to remediate the chemical imbalance in the brain (dopamine hypofunction in the pre-frontal cortex) which may help with certain difficulties with thinking tasks involving this PFC area and might explain why there is smoking persistence in schizophrenia.”

On the flip side, of course, there are many PWD for whom being around smokers or smoke will exacerbate their disabilities and a necessary accommodation is an atmosphere free from smoke. People with asthma and other respiratory problems or people with allergies and chemical sensitivities could be seriously harmed by being around smoke or people who are smoking, and could require an accommodation to be free from smoke exposure.

This sets up the possibility that there could be two PWDs – let’s say one with schizophrenia and one with severe smoke allergies – who require accommodations that are directly conflicting with each other. These situations are much trickier for me than when a PWD is requesting an accommodation that an employer, business, government, or other entity is saying is too difficult or expensive to implement. In those situations, I believe the accommodation rights of the PWD should trump that concern in the vast majority of cases. But handling issues of conflicting accommodations can be much more complicated, because the rule of “you must accommodate PWDs” doesn’t give us any guidance on how to proceed.

This is just one example of desired or needed accommodations that can directly conflict, but there are many others. How do you think these situations should be handled? Have you run into conflicts like this in your own life?

Note: discussions of conflicting accommodations – including the example discussed above – can become very charged and very personal, as readers and commenters may have personal preferences or needs on which accommodation to implement. Please be respectful of the needs of other PWDs in this comment thread. Specifically, comments that imply or state that smokers are inherently evil or people who don’t smoke are inherently intolerant (or similarly bright line rules) will be deleted.