Nancy Potter

This paper explores the relationship between the bonds of practitioner/patient trust and the notion of a justified lie. The intersection of moral theories on lying which prioritize right action with institutional discretionary power allows practitioners to dismiss, or at least not take seriously enough, the harm done when a patient's trust is betrayed. Even when a lie can be shown to be justified, the trustworthiness of the practitioner may be called into question in ways that neither theories of right action nor contemporary discourse in health care attends to adequately. I set out features of full trustworthiness along Aristotelian lines

Furman and Tuminello raise a central question about people living with mental illness: What kind of life is possible for them? Can one live a flourishing life even when struggling with a mental disorder? The authors draw on research studies to argue that a technique called Applied Behavioral Analysis can improve the lives of children with autism. One study, from 1987, found that 47% of children exposed to ABA attained normal IQ levels, adaptive skills, and social skills, and other studies replicated these results. This is a promising avenue for those living with autism.Furman and Tuminello focus on autism, but their claims, if true, might be extended to other disorders as well; as they note, people...

The Virtue of Defiance and Psychiatric Engagement argues that defiance sometimes is a virtue even for those with mental illnesses. It also argues that defiance is sometimes mistaken as a sign of mental disorder when it may have other, reasonable explanations. This book offers a nuanced and complex look at defiance, taking seriously issues of mental disorders while also attending to social contexts in which defiant behaviour may arise. Arguments are presented for how to understand defiance as different from noncompliance, resistance, and other related concepts, and how defiance is related to living a life with a realistic understanding of a flourishing life and its limits in our everyday world. A framework for differentiating different forms of defiance is offered, and a realistic picture of phronesis—practical reasoning—is presented that makes room for clinicians as well as patients to assess the degree to which defiance is reasonable. The concept of intersectionality as it related to child development is worked through to highlight some of the challenges clinicians face when interpreting defiant behavior. Particular attention is given to issues of race and gender as factors that need to be considered when evaluating defiant behavior as reasonable, virtuous, bad, or symptomatic. Those who work with defiant patients are invited to engage in different ways with defiant people so as to better understand and respond to those who express that defiance. This involves the learning to cultivate what the author calls the virtue of giving uptake. Because giving uptake is difficult to do well, the author employs theoretical work on epistemic resistance—resistance that, despite thoughtful and well-intended--clinicians may grapple with in being responsible knowers and that can impede their understanding and responsiveness to those who are, or seem to be, defiant. Practical applications for psychiatric engagement are threaded throughout this book through case studies and personal narratives.      

This work stands at the crossroads of two current themes in moral philosophy: heightened interest in the topic of trust and renewed interest in virtue ethics. In concurrence with the recent renaissance in virtue ethics, I take the central question in morality to be how we are to become morally good persons. An analysis of trust and failures of trust, therefore, should indicate what is involved in becoming worthy of others' trust as well as indicate when trust and distrust are reasonable. I argue that framing these concepts in terms of Aristotelian virtue ethics provides us with an illuminating and constructive way to think about a topic that has, until recently, been largely ignored in philosophical discourse. ;The theoretical framework provides an analysis of the concept of trust, showing how features of trust lead to an understanding of what is involved in being trustworthy. I argue for the centrality of character to moral theory and explain what trustworthiness would look like in an Aristotelian framework. In doing so, I set out central features of what is required to be fully trustworthy. ;I am concerned, in particular, to articulate and defend a theory of the virtue of trustworthiness that takes into account relations of power. My objective in theorizing about trustworthiness has been to provide a conceptual account which generates practical considerations for the enhancement of trusting relationships by attending to the ways in which social and political institutions and practices intersect with the virtue of trustworthiness. To this end, after setting out the theoretical framework, I examine four particular contexts in which power differentials between and among individuals affect trusting relationships. With each case study, different aspects of trustworthiness will be foregrounded; I identify and clarify the particular issues involved and articulate ways in which variously located persons can become trustworthy

This work examines the concept of trust in the light of virtue theory, and takes our responsibility to be trustworthy as central. Rather than thinking of trust as risk-taking, Potter views it as equally a matter of responsibility-taking. Her work illustrates that relations of trust are never independent from considerations of power, and that asking ourselves what we can do to be trustworthy allows us to move beyond adversarial trust relationships and toward a more democratic, just, and peaceful society.

IN THINKING ABOUT the wonderfully helpful comments by Eric Cassell, Suzanne Jaeger, and Deborah Spitz, I find myself grappling with three central questions: How reliable a guide is world traveling? What kind of knowledge can be obtained by world traveling? and, What are the goals of treatment such that world traveling might be thought to serve a purpose? These questions arise from the insights, criticisms, and cautions the commentators provide, and I will weave together possible answers from ideas drawn from the commentaries.