Nancy Potter

I think that Hanna Pickard and I are in agreement that the dichotomy between ‘having’ and ‘not having’ control and conscious knowledge should be rejected. Personality disordered (PD) service users, like the rest of us, have degrees of not knowing and knowing, controlling and not controlling, such that pinpointing exactly when assignment of responsibility should enter into judgments of service users is murky and difficult. This position includes both metaphysical and epistemological issues in that it is a separate question whether or not we can know someone is responsible from the question of whether or not someone is responsible and to what degree. Because Pickard focuses on metaphysical questions, I raise some ..

This chapter sets out several views of empathy that draw not only on psychology's literature but on philosophical and psychiatric writings. Empathy is a set of complex concepts involving perception, emotion, attitudinal orientation, and other cognitive processes as well as an activity that expresses character traits and, hence, one of the virtues. In other words, an examination of the philosophical and clinical literature reveals empathy to be not one unified concept but instead a set of related characteristics and qualities needed to be an ethical and therapeutically effective clinician. To this end, the chapter offers reasons as to why empathy is important to clinical work: empathy is both epistemically and ethically necessary to good social relations and, in particular, clinical relations. It then distinguishes empathy from a related concept called "world"-traveling and situates its relevance to therapeutic relations. Finally it brings these ideas together by highlighting Iris Murdoch's ideas of "just vision" and "loving attention."

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 33-35 [Access article in PDF] In the Spirit of Giving Uptake Nancy Nyquist Potter IT IS BOTH WONDERFUL and daunting to now be in the middle of a dialogical exchange on the messy and difficult topic of self-injury and how ethically to interact with patients who self-injure. It is wonderful that authors such as Carolyn Sargent have contributed very helpful examples from the discipline of anthropology that expand the ideas I have been grappling with. And it is daunting to begin to sharpen and correct my thoughts along the lines that the commentators suggest. In the spirit of giving uptake both to the praise and the criticism I have received, I first situate the "Commodity/Body/Sign" article in the context of my larger project and then focus on one problem area: my claim that giving uptake is necessary to ethical healing practices. Giving Too Much Uptake to the Dsm Rob Woolfolk is right that borderline is diagnostically imprecise. But what initially caught my interest in this personality disorder was its pejorative connotations. I will mention my favorite example, which comes from a past chairman of the psychiatry department at New York University that "borderliners are the patients you think of as PIAs—pains in the ass," (Medical World News 1983). Why are the patients who exhibit the behaviors associated with borderline personality disorder (BPD) so disliked, I wondered? Who are these patients, and what are they doing that brings upon themselves such rejection? My investigation, in other words, has been focused on behaviors and their meanings, using a philosophical lens to examine underlying assumptions. I completely agree with Woolfolk and Carolyn Sargent that much more analysis needs to be done on BPD, and I am eager to do it. It is true that I do not take up larger questions about the gendered nature of this diagnosis in general (Sargent, Woolfolk), nor do I challenge the validity of the diagnosis in this article (Woolfolk). In my view, that larger project must be held in abeyance until more philosophical probing on a number of other issues is done. Hopefully, my book-length project will benefit from continuing guidance from these authors.I focus first on self-injury for two reasons. First, it is the most common symptom for which people with BPD come to clinical attention (Gunderson 2001, 22). Second, of all the behaviors associated with BPD, self-injurious behavior is the kind that people most tend to dig in their heels about when its status as pathological is questioned. Gunderson cautions that "because the diagnosis of BPD underscores a serious, long-standing mental health problem, the diagnosis should not be offered too readily to anyone who cuts or otherwise self-mutilates" (2001, 23). I add to that caution that we ought not too readily assume that self-injury is pathological: Lynne Cox (2003) swam to the Antarctic Peninsula in water temperatures of 32° Fahrenheit and with 25 foot waves; she suffered nerve damage and numbness in her extremities. Self-injurious behavior? [End Page 33] Pathological? Cox trained for two years to accomplish this feat. In problematizing self-injury, I raise questions about some associations and assumptions we make. Calling into question the whole taxonomy requires looking at symptoms, behaviors, and criteria as a whole, and that cannot be done until systematic analysis of concepts such as self-injury, impulsivity, identity disturbance, and manipulativity are undertaken. To put things in terms of Woolfolk's reasonable criticism that he wishes I would "give less uptake to the framers of the DSM-IV," I appreciate that point. But I do think that those of us who are not ourselves clinicians must do our research carefully and proceed conservatively rather than attempting to tear a house down that may not need to be condemned. Methods and Morals Woolfolk says that the concept of uptake is "familiar and central" to therapy; Katherine Morris says it is "simple and uncontroversial"; Sargent says it is "unexceptionable"; and Christa Krüger says it may be "very difficult if not more or less doomed...

This essay examines the relationship between nonviolence and trustworthiness. I focus on questions of accountability for people in midlevel positions of power, where multiple loyalties and responsibilities create conflicts and where policies can push people into actions that reinstate hegemonic relations. A case study from crisis counseling is presented in which the management of the case exacerbated previous violence done to a biracial female. The importance of resistance to dominant ideology is scrutinized.

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.