Nurture before responsibility: self-in-relation competence and self-harm

Kong, Camillia (2018) Nurture before responsibility: self-in-relation competence and self-harm. Philosophy, Psychiatry and Psychology 26 (1), pp. 1-18. ISSN 1071-6076.

Abstract

Borderline personality disorder (BPD) is a disorder that affects mainly women and often manifests itself through self-injurious behaviour and suicide attempts. The perception that these patients are themselves to blame for their self-destructive behaviour is a common reaction when clinical practitioners are faced with this behaviour. Recent philosophical work has tried to reconceptualise the responsibility of personality disorder patients (i.e. Pickard’s responsibility without blame). In this paper I problematise the focus on responsibility as a conceptual and therapeutic approach to deliberate self-injury in BPD. I suggest that this thin, content-neutral account of responsibility fails to properly consider the complex phenomenology of BPD selfhood and self-harm. Instead, I forward an alternative model based on a thick account of responsibility to examine in more detail the social formation of substantive content of the will. The paper explains how borderline is a disorder of the self-in-relation, which tracks the socialising, relational factors that contribute to the development of a dysfunctional BPD selfhood premised on self-punishment, self-abnegation, and self-loathing. Moreover, the framework lends itself to an alternative normative standpoint to self-harming behaviour in individuals with BPD which focuses on the therapeutic nurturance and validation of emotion and needs, prior to the treatment of individuals as responsible agents. I explore how such a standpoint is applied in Schema-Focused and Dialectical Behavioral Therapy treatments of BPD.

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