My previous post criticized Nancy Nyquist Potter’s Mapping the Edges and the In-Between: A Critical Analysis of Borderline Personality Disorder (2009) for lack of methodological clarity. In this post, however, I would like to extract what I think is the most interesting part of her book, her suggestion that there is a specific virtue of “giving uptake”—and that this virtue is particularly important to clinicians working with patients with BPD. She develops this argument in Chapter 8 but also foreshadows it in Chapter 2, “The Problem with Too Much Anger.”
Consider first the concept of virtue in the Aristotelian tradition of moral philosophy, in which Potter positions herself. An ethical virtue is an excellence of human character, a settled disposition to do the right thing, in the right way, at the right time, and for the right reasons. In contrast to the Kantian tradition, with its stern insistence on human reason over and against “pathological” determination by the emotions, Aristotle holds that virtue involves the “having” of emotional reactions and reactions of pleasure or displeasure, as well as practical reason. In contrast to much of modern moral philosophy, especially utilitarianism, Aristotle is at pains to remind us that ethics is not geometry; each type of inquiry has its own degree of precision, he says in Nicomachean Ethics, book I, and we cannot expect a mathematical level of precision in morals. Instead, having a virtue is a matter of having a kind of balance (which Aristotle unfortunately, to the confusion of all first-year philosophy students, calls a “mean”) between extremes of vice. For example, a courageous or brave person has a disposition to perform acts of courage in the right way, at the right times, and for the right reasons, and the courageous person “has” (this is the ancient Greek way of talking, but it is echoed in many contemporary languages, such as French) their fear neither too much nor too little, and about the right things, etc. There is a difference between courage and cowardice (too much fear, fear about things that one should not fear), but also a difference between courage and recklessness or rashness. For Aristotle, having a virtue is both good for others and for oneself; it is a way to bring harmony to our complex nature as beings endowed at the same time with reason, emotions, and appetites.
The doctrine of the mean applies not just to emotions, but also to actions. For example, generosity is a proper balance in the giving of external goods, neither too much (wastefulness) nor too little (stinginess). Similarly, if I understand correctly what Aristotle means by the virtue of truthfulness, he recognized long before the 1970s fad of honesty rolled around that one can be too “honest” with others.
Let’s turn now from virtue in general to the idea of a specific virtue of giving uptake. A brief detour is needed here through the concept of uptake in ordinary language philosophy. Once again, J.L. Austin is the inspiration here, by way of feminist philosopher Marilyn Frye on anger. In brief, Austin’s chief concern was to develop a philosophy of language that would move beyond the view that the proposition or statement is the fundamental logic unit. Statements are, more or less, the kinds of linguistic expressions that can be true or false, such as “The cat is sitting on the mat.” Austin pointed out that we do things with words, i.e., we carry out actions; we do not just assert predicates of subjects. When we do things with words, we can fail in ways other than simply failing to say something true. If I say that the cat is on the mat and the cat is not on the mat, I have said something false. But if I say, “I find you guilty on all counts,” and I lack the vested institutional authority to issue guilty verdicts, then what I have said is not false; rather, it does not come off. For my speech act to come off, it must be acknowledged and recognized by qualified others.
What Frye contends is that this analysis of speech acts also applies to the emotion of anger. Like verdicts, promises, orders, christenings, pronouncements of marriage, warnings, apologies, and concessions, anger can come off or fail to come off, depending on uptake. In “A Note on Anger,” Frye points out the “tiresome truth” that women’s anger is often treated as hysteria or craziness. And she draws an analogy with Austin directly: “Being angry at someone is somewhat like a speech act in that it has a certain conventional force whereby it sets people up in a certain sort of orientation to each other; and like a speech act, it cannot ‘come off’ if it does not get uptake” (in Politics of Reality, p. 87).
Her example (somewhat simplified here for space reasons) involves a woman who goes to a gas station, whereupon the attendant starts fiddling with her car in a way she doesn’t want. She angrily asks him to stop, whereupon he calls her a “crazy bitch” (pp. 87-88). “Crazy bitch” stands in well here as an emblem of refusal of uptake; the attend does not ask for clarification, dispute that he did anything wrong, etc. He does not acknowledge her as angry in the first place. More pointedly, he does not acknowledge the claim-making that is implicit in anger: to get angry, Frye holds, is to make a claim to a “domain” and a claim to “respect.” The claim can be disputed or challenged—but something more extreme is happening here. The attendant is refusing to acknowledge it even as a claim. In this regard, there is a significant moral difference between replying, “Fuck you, I’m not doing anything wrong” and “Crazy bitch!” In short, refusal of uptake is changing the subject, refusal of relevance
To return to Potter, she draws together Frye, Austin, and Aristotle in order now to argue that there is a specific virtue of giving uptake. The domain of this virtue is attending to and recognizing claim-making in a field of asymmetrical power relations (p. 142-143). The dimension of claim-making is crucial: the virtue of giving uptake is not simply the virtue of “active listening.” It is the virtue of recognizing that claims are being made. It is a political virtue of sorts. And with respect to what, in the clinical context, should be given uptake, this is what Potter has to say: “What clinicians need to give uptake about is the patient’s perspective on her self-injurious acts, or her deliberative or impulsive decisional processes, or her anger, and so on” (pp. 144-145). As with any virtue, it is bounded on either end by vices of excess and deficiency. One can give too much uptake or too little. Or, regarding the virtue of excess, one can give uptake in the wrong ways at the wrong times to the wrong people about the wrong things, etc.
What Potter is saying here about uptake sounds to me a lot like the concept of validation. Both DBT and MBT, two of the main treatment modalities for BPD, devote a large amount of space to validation. Indeed, at a certain point in her original treatment manual (1993), Linehan states that one of the main differences between her approach and traditional cognitive behavioral therapy is her emphasis on validation. In her various writings, Linehan defines validation as communicating to someone that their actions, behaviors, urges, emotions, or thoughts make sense and are understandable in light of other features of their life. Communication understandability is not quite the same thing as recognizing a claim, but there is considerable overlap. Indeed, it is hard to see how I could properly communicate to someone that their anger makes sense without communicating that I at least acknowledge they are making a claim. Linehan stresses that validation is not agreement, and, like Potter, stresses that one can validate too much (what she calls “validating the invalid”) as well as too little. It is something of a rendez-vous manqué that Potter says nothing about validation, especially since DBT in particular offers such a rich and nuanced treatment of the topic, with six different “levels” of validation and consideration of such topics as self-validation and recovery from invalidation. Perhaps most strikingly, Linehan’s “biosocial theory” of the etiology of BPD places great weight on the role of childhood “traumatic invalidation” in interaction with biological diatheses. It is truly a missed opportunity that Potter does not engage with this theory.
By way of conclusion, I would like to make two final points. First, this rendez-vous manqué raises larger questions for me about the types of dialogue possible between philosophy and clinical mental health theory and practice. It is as if there are two parallel tracks here, the clinical track, which revolves around the practice and conceptualization of validation, and the philosophical track, which revolves around theories of virtue, emotion, and speech acts. Are these two tracks just two different descriptions of the same thing? More pointedly, should we treat “validation” and “the virtue of giving uptake” as, more or less, synonyms expressed in different languages, equivalent to “star” and “étoile”? If not, then what are we doing when we produce these two different lexicons, when we traffic in these two different conceptual registers? What do users of one set of concepts gain from thinking about the other set of concepts? These are not rhetorical questions. Rather, they raise, from a different angle, the sort of methodological issues about philosophy of psychiatry that I brought up in my previous post.
My second point is simply that there are resources for thinking about anger in Frye that fall out in Potter. I may return to these resources in a further post. In a nutshell, I think Frye ultimately arrives at the realization that anger is really analogous to several different types of speech act. But if that's true, then the account of what we are to give uptake to in anger is inadequate in Potter.
Comments
Post a Comment