Mapping the Edges and the In-between A critical analysis of Borderline Personality Disorder

by Potter, Nancy

• ISBN13: 9780198530213
• ISBN10: 0198530218
• Edition: 1st
• Format: Paperback
• Copyright: 2009-09-28
• Publisher: Oxford University Press

Summary

Borderline Personality Disorder (BPD) is a diagnosis given to ten percent of all those seen in outpatient mental health facilities and twenty percent of those seen in inpatient psychiatric units. This is a significant number of people in the Western world. However, many of the core concepts and symptoms that underlie this diagnosis are questionable. Many of the attitudes and actions of carers are based on assumptions about those with BPD that cry out for analysis, with both cultural and gender norms interacting with clinical diagnosis and treatment, to the detriment of both carers and patients. This book considers how we diagnose BPD, looking at the key constructs: idendity disturbance, inappropriate or excessive anger, unstable relationships, impulsivity, self-injurious behaviour, and manipulativity. It starts by looking at the cultural and gender assumptions and norms behind BPD, drawing upon philosophical, clinical, anthropological, and sociological literature. Combining philosophical analysis with clinical experience and patients' writings, it clarifies the constructs so that the reader can understand the messiness and complexity that frames this diagnosis and treatment. After examining the current state of these constructs and their effects on carer/patient interactions. Part II sees an application of virtue theory to therapeutic treatment with BPD patients. It looks at three virtues that are particularly important for clinicians and other carers to cultivate when working with BPD patients: trustworthiness; the virtue of giving uptake, and empathy. It argues that, in their absence, not only are clinicians' attitudes harmful to patients, but also that the status of the diagnosis is actually compromised. Mapping the Edges and the In-Between presents a compelling argument that Borderline Personality Disorder needs to be approached in a new light--one that will benefit patients.

Author Biography

Nancy Potter is a professor of philosophy at the University of Louisville and a core faculty member of the university's Interdisciplinary M.A. in Bioethics and Medical Humanities. Her research ranges from virtue ethics to philosophies of peace and to mental health and illness. She has had considerable volunteer clinical experience with people in crisis, sex offenders, and people who come to hospital in need of psychiatric care. She also works in the local community to advance medical ethics. Nancy Potter is the author of the monograph 'How Can I Be Trusted?' and two edited anthologies. She is the president of the Association for the Advancement of Philosophy and Psychiatry.

Table of Contents

Introduction	p. 1
What is it? Who has it? Axis II and the Cluster B personality disorders	p. 1
The hand-in-hand philosophical and clinical work to be done	p. 3
Flourishing and suffering	p. 7
Methodology	p. 7
The structure of the book	p. 10
What this book is not	p. 11
Acknowledgements	p. 12
Identity disturbance and the self	p. 17
Statement of the problem	p. 17
The Western construct	p. 18
Boundaries	p. 19
Boundaries, the self-other relation, and the concept of alterity	p. 22
What is 'identity disturbance?'	p. 25
Problems with the constructs	p. 27
Conclusion: The pain of identity troubles	p. 33
The problem with too much anger	p. 35
Vignette	p. 35
What is anger?	p. 35
Anger, extremes, and dispositional anger	p. 37
The doubling effect of injury on anger	p. 38
What impedes giving uptake to real-time anger?	p. 40
Anger and gender norms	p. 43
Conclusion	p. 45
Rocky relationships	p. 47
An example	p. 47
Intimacy, connection, and repair	p. 49
Belongingness, home, and desperate love	p. 52
Relationship norms and expectations	p. 56
Critiques of norms-and expectations as they relate to BPD	p. 59
Conclusion	p. 62
Impulsivity, spontaneity, and deliberation	p. 63
An example	p. 63
Constructs in need of conceptual analysis	p. 63
Clinical definitions of impulsivity	p. 65
Deliberation	p. 66
Impulsivity and willing	p. 69
Spontaneity and the good life	p. 73
Impulsivity, gender, and sexuality	p. 76
Conclusion	p. 79
Self-injurious behavior	p. 83
The scope of the problem	p. 83
Meaning-making and responsibility: Part one	p. 85
Signs and culture	p. 86
When is self-injury an act of communication? What is it communicating?	p. 89
Situating self-injury	p. 90
Commodity/body/sign	p. 95
Conclusion	p. 97
What's wrong with being manipulative?	p. 99
Introduction to the problem	p. 99
An example	p. 100
Conceptual cloudiness	p. 101
Implication for clinicians and BPD patients when the concept of manipulativity is employed	p. 105
Two initial difficulties in evaluating putative manipulation	p. 106
Morality and mental illness	p. 114
Conclusion	p. 115
The trustworthy clinician	p. 119
Introduction	p. 119
From trust to trustworthiness	p. 120
Crash course on virtue theory	p. 123
Some dispositional features of trustworthiness	p. 127
An example to work with	p. 134
Conclusion	p. 137
Communicative ethics and the virtue of giving uptake	p. 139
An example	p. 139
The concept of uptake	p. 140
Applications to BPD patients	p. 152
Uptake and anger	p. 155
Conclusion	p. 157
Situating empathy in our lives	p. 159
Introduction	p. 159
What's at stake	p. 159
Empathy as a concept, empathy as a virtue	p. 168
Virtues of the virtue	p. 175
Conclusion	p. 176
References	p. 179
Index	p. 193
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