Articles: Did You Hurt Yourself?
By Katherine Morris
Philosophy, Psychiatry, & Psychology - Volume 10, Number 1, March 2003, pp. 23-24
PEOPLE WITH BORDERLINE PERSONALITY DISORDER (BPD) frequently deliberately injure themselves, to the extent that "the diagnosis [BPD] rightly comes to mind whenever recurrent self-destructive behaviors are encountered" (Gunderson, 2001, 54) quoted by (Potter, 2003, 1). How are we to understand this puzzling and disturbing behavior?
Situating her approach to this question within a general framework that sees the body as a "text" that requires "interpretation," Potter deliberately avoids answering this question in the way we might expect. It is doubtful, she argues, that every act of self-injury has a meaning, and a fortiori doubtful that every such act has the same meaning. Her discussion includes a section, informed by medical anthropology, in which she attempts to distinguish pathological self-injury of the sort that occurs with BPD from such culturally acceptable (or at least culturally understood or tolerated) body modifications, such as tattooing, scarification, and body piercing. It also includes a section in which it is suggested that the meaning of some self-injurious behavior may indicate cultural rather than individual pathologies (e.g., the "commodification" and "objectification" of women's bodies in Western culture). The principal issue for her, however, is how a clinician is to work out the meaning of a particular individual's self-injuring behavior when it does indeed have an individual meaning, and the prerequisite for doing so, she argues, is the cultivation of a virtue she terms giving uptake.
The general tenor of her argument seems to me to be admirable: the issues are dealt with subtly and with ethical, anthropological, and philosophical sensitivity. There are nonetheless a number of questions I want to raise.
The Framework
It is of course fashionable in certain quarters these days to speak of the body as a text. One might, however, wonder to what extent this metaphor is illuminating. After all, texts, one might think, are by definition linguistic; yet part of the point here is precisely to move away from the narrow "speech-act" focus of "traditional philosophical analyses of communication" (Potter 2003, 1-16).
The point of the metaphor according to Potter is to "suggest that the body, like other mediums of communication, must be interpreted and that its meanings are not given or inevitable" (Potter 2003, 2). Again, however, this invokes a number of fashionable but questionable ideas: an easy reliance on the difficult idea that "how we experience the world is shaped by our conceptual scheme" (Potter 2003, 3), a structuralist account of signification (Potter 2003, 3), and the concomitant notion that all communication involves interpretation, indeed that the listener (or observer) "relies on linguistic and other conventions [End Page 23] to infer meaning" (Potter 2003, 4). As a general account of communication this seems to me to be wildly off the mark: we very seldom interpret others' words, we very seldom "infer their meaning." The supposition that we always do is the direct consequence of the externalizing of the relation between "signifier" and "signified" that constitutes the heart of structuralist linguistics. 1
Now, it may well be that the sort of self-injuring behavior that is the focus of Potter's essay precisely does require interpretation. Insofar as it is expressive behavior (and again Potter is right to question whether it is necessarily always such), it seems to be importantly different, in just these respects, from many other forms of expressive behavior. In the first place, it is different (in just these respects) from the culturally tolerated forms of body modifications discussed in section 2; for members of the culture in which body piercing or tattooing is acceptable or tolerated, such behavior is understood without the need for interpretation. In the second place, it is different in just these respects from natural expressions (e.g., moaning as an expression of pain). And in the third, it is different in just these respects from the expression of thoughts in (at least nonmetaphorical) language (which, one might add, is all the more reason not to think of the body as a text). If this is right, then Potter should, I submit, ditch the controversial general framework and go straight for the question: "How are we to understand what (if anything) is expressed by this or that BPD individual's self-injuring behavior?"
"Giving Uptake" as a Virtue
Austin uses uptake to refer to the ways in which an audience must respond for an utterance to count as this or that speech act (e.g., a threat). Potter extends Austin's notion to incorporate an acknowledgement of social conventions and power relations that may interfere with uptake; in this way, a woman's attempt to express anger may not succeed in doing so if men "hear" it as shrill bitchiness or "cute." Potter then outlines five "communicative maxims that guide giving uptake," modeled on Grice's conversational maxims; these include "Approach discussions of self-injury with the principle of charity" and "Take a critical and reflective stance toward your own conceptual framework." She finally argues that giving uptake is a virtue, and indeed one of especial importance and relevance to clinicians.
From one point of view there is little to disagree with here, although one wonders what Austin would make of these extensions of his (surely nontechnical) term uptake; additionally, Potter's conception of virtue is not the only possible one. (Could one see it as an Aristotelian virtue? Its defect would be a certain style of arrogance; what would its excess be?) From another, I cannot help thinking that it makes rather heavy weather of what is essentially a simple and uncontroversial point—even if not always attended to by clinicians (or indeed the rest of us). What these sections stress is, very simply, the (moral as well as epistemic) importance of listening to the patient if one wants to understand what she is expressing by her self-injuring behavior.
Still, perhaps I am being unfair here. Listening is a difficult skill and being reminded of what is involved in it may well be salutary. Likewise, being reminded of its conceptual connections with trust, respect, and open mindedness cannot hurt either. If this essay succeeded only in doing these things, it would be worthwhile.
--------------------------------------------------------------------------------
Endnote
1. This framework may be part of what leads her to this solecism: "we make mistakes in our interpretations of signs all the time, including mistakes about gender. Signifiers for gender are like signifiers for Santa Claus—although sense making—neither refers to anything real." (Potter 2003, 4). How then is the notion of a mistake to get a grip?
Reference
Potter, N. 2003. Commodity/Body/Sign: Borderline Personality Disorder and the Signification of Self-Injurious Behavior. Philosophy, Psychiatry, & Psychology 10:1-16.
PEOPLE WITH BORDERLINE PERSONALITY DISORDER (BPD) frequently deliberately injure themselves, to the extent that "the diagnosis [BPD] rightly comes to mind whenever recurrent self-destructive behaviors are encountered" (Gunderson, 2001, 54) quoted by (Potter, 2003, 1). How are we to understand this puzzling and disturbing behavior?
Situating her approach to this question within a general framework that sees the body as a "text" that requires "interpretation," Potter deliberately avoids answering this question in the way we might expect. It is doubtful, she argues, that every act of self-injury has a meaning, and a fortiori doubtful that every such act has the same meaning. Her discussion includes a section, informed by medical anthropology, in which she attempts to distinguish pathological self-injury of the sort that occurs with BPD from such culturally acceptable (or at least culturally understood or tolerated) body modifications, such as tattooing, scarification, and body piercing. It also includes a section in which it is suggested that the meaning of some self-injurious behavior may indicate cultural rather than individual pathologies (e.g., the "commodification" and "objectification" of women's bodies in Western culture). The principal issue for her, however, is how a clinician is to work out the meaning of a particular individual's self-injuring behavior when it does indeed have an individual meaning, and the prerequisite for doing so, she argues, is the cultivation of a virtue she terms giving uptake.
The general tenor of her argument seems to me to be admirable: the issues are dealt with subtly and with ethical, anthropological, and philosophical sensitivity. There are nonetheless a number of questions I want to raise.
The Framework
It is of course fashionable in certain quarters these days to speak of the body as a text. One might, however, wonder to what extent this metaphor is illuminating. After all, texts, one might think, are by definition linguistic; yet part of the point here is precisely to move away from the narrow "speech-act" focus of "traditional philosophical analyses of communication" (Potter 2003, 1-16).
The point of the metaphor according to Potter is to "suggest that the body, like other mediums of communication, must be interpreted and that its meanings are not given or inevitable" (Potter 2003, 2). Again, however, this invokes a number of fashionable but questionable ideas: an easy reliance on the difficult idea that "how we experience the world is shaped by our conceptual scheme" (Potter 2003, 3), a structuralist account of signification (Potter 2003, 3), and the concomitant notion that all communication involves interpretation, indeed that the listener (or observer) "relies on linguistic and other conventions [End Page 23] to infer meaning" (Potter 2003, 4). As a general account of communication this seems to me to be wildly off the mark: we very seldom interpret others' words, we very seldom "infer their meaning." The supposition that we always do is the direct consequence of the externalizing of the relation between "signifier" and "signified" that constitutes the heart of structuralist linguistics. 1
Now, it may well be that the sort of self-injuring behavior that is the focus of Potter's essay precisely does require interpretation. Insofar as it is expressive behavior (and again Potter is right to question whether it is necessarily always such), it seems to be importantly different, in just these respects, from many other forms of expressive behavior. In the first place, it is different (in just these respects) from the culturally tolerated forms of body modifications discussed in section 2; for members of the culture in which body piercing or tattooing is acceptable or tolerated, such behavior is understood without the need for interpretation. In the second place, it is different in just these respects from natural expressions (e.g., moaning as an expression of pain). And in the third, it is different in just these respects from the expression of thoughts in (at least nonmetaphorical) language (which, one might add, is all the more reason not to think of the body as a text). If this is right, then Potter should, I submit, ditch the controversial general framework and go straight for the question: "How are we to understand what (if anything) is expressed by this or that BPD individual's self-injuring behavior?"
"Giving Uptake" as a Virtue
Austin uses uptake to refer to the ways in which an audience must respond for an utterance to count as this or that speech act (e.g., a threat). Potter extends Austin's notion to incorporate an acknowledgement of social conventions and power relations that may interfere with uptake; in this way, a woman's attempt to express anger may not succeed in doing so if men "hear" it as shrill bitchiness or "cute." Potter then outlines five "communicative maxims that guide giving uptake," modeled on Grice's conversational maxims; these include "Approach discussions of self-injury with the principle of charity" and "Take a critical and reflective stance toward your own conceptual framework." She finally argues that giving uptake is a virtue, and indeed one of especial importance and relevance to clinicians.
From one point of view there is little to disagree with here, although one wonders what Austin would make of these extensions of his (surely nontechnical) term uptake; additionally, Potter's conception of virtue is not the only possible one. (Could one see it as an Aristotelian virtue? Its defect would be a certain style of arrogance; what would its excess be?) From another, I cannot help thinking that it makes rather heavy weather of what is essentially a simple and uncontroversial point—even if not always attended to by clinicians (or indeed the rest of us). What these sections stress is, very simply, the (moral as well as epistemic) importance of listening to the patient if one wants to understand what she is expressing by her self-injuring behavior.
Still, perhaps I am being unfair here. Listening is a difficult skill and being reminded of what is involved in it may well be salutary. Likewise, being reminded of its conceptual connections with trust, respect, and open mindedness cannot hurt either. If this essay succeeded only in doing these things, it would be worthwhile.
--------------------------------------------------------------------------------
Endnote
1. This framework may be part of what leads her to this solecism: "we make mistakes in our interpretations of signs all the time, including mistakes about gender. Signifiers for gender are like signifiers for Santa Claus—although sense making—neither refers to anything real." (Potter 2003, 4). How then is the notion of a mistake to get a grip?
Reference
Potter, N. 2003. Commodity/Body/Sign: Borderline Personality Disorder and the Signification of Self-Injurious Behavior. Philosophy, Psychiatry, & Psychology 10:1-16.
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