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Questions of Method: Nancy Nyquist Potter on BPD

I picked up Nancy Nyquist Potter’s Mapping the Edges and the In-Between: A Critical Analysis of Borderline Personality Disorder (2009) with great interest, for, as far as I can tell, it is the only book-length work by a philosopher on BPD. Potter states, moreover, that she worked for five years as a certified crisis counselor, sat in on a treatment team while writing the book, and observed psychiatrist-patient interactions, so the book promises to avoid the usual pitfalls of abstraction and irrelevance to practice that philosophy suffers from. Unfortunately, I found the book mainly disappointing, on two counts. First, it became quickly clear that it was mostly a pastiche of previously published journal articles and book chapters (see the Acknowledgements page, which mentions 10 previous publications). Second, and more interestingly in my perspective, the book suffers from inadequate reflection on methodology, which, in turn, drives what I think is a questionable choice of subject matter. In what follows, I will focus on this latter problem.

Potter’s reflections on method are confined to a short introduction. She states that hers is “the prevailing analytic philosophical approach, with the added component of doing philosophical field work” (p. 9). The first part of this sentence refers, I take it, to conceptual analysis, which, classically speaking, means clarifying the meaning of concepts, that is, offering rigorous definitions. For example, I might undertake an analysis of the concepts cause, democracy, law, racism, explanation, or health. Conceptual analysis is not lexical definition; it is not trying to tell us how people use words. Analysis is, rather, normative: it aims to establish the proper scope of a concept, its extension (what it refers to) and its intension (the features that go along with a concept). A good illustration of this kind of approach in philosophy of psychiatry (or, really, philosophy of medicine, but it is quickly imported into philosophy of psychiatry) is Christopher Boorse’s extensive argument for a definition of health as “normal species functioning” (for an overview of the debate here, see this). 

The other half of the quotation, however, takes us in a different direction—“philosophical field work.” The reference here is to the ordinary language philosophy of J.L. Austin and, more pointedly, to his “Plea for Excuses” (1956). Austin is often associated with the movement of “ordinary language philosophy” in mid-twentieth-century British philosophy. Put very crudely, he shared with his contemporaries the belief that language holds the key to intractable philosophical problems, but he thought that philosophers should, shockingly, look at how people actually use words. (Of course, the extent to which he pioneered this approach is much overstated.)

In the passage where Austin introduces the term philosophical field work, he has this to say: "we are using a sharpened awareness of words to sharpen our perception of, though not as the final arbiter of, the phenomena" (as reprinted in Philosophical Papers, p. 182). The expression “philosophical field work” is meant both as a statement of method—go out and do field work, look at how people use words!—and as a reframing of the Problemstellung, the problematic of traditional philosophy—let's use field work to shift inquiry away from sterile, abstruse, scholastic debates about, say, Free Will, and towards ordinary ways of reasoning and reaching consensus about whether, say, a certain set of circumstances amounts to a genuine excuse for what looks like bad behavior.

This is all great, in my opinion, but how does one actually do such philosophical field work? Austin hardly tries to formulate the method of philosophical field work in the way that, in contrast, qualitative researchers might. There are no protocols, no coding procedures, no “grounded theory” or the like. Rather, he offers three suggestions for doing field work, in descending order of reliability: read the dictionary, look at the law (especially case law), and consider what psychology and anthropology have to say.

Let’s return from this detour: how does the idea of philosophical field work apply to borderline personality disorder? Presumably, what Potter means is that she will do philosophical field work with an eye to conceptual clarification for the main concepts she deals with in her book: identity disturbance, excessive anger, relationship boundaries, impulsivity, self-harm, manipulativeness, trust, empathy, and uptake.

What is missing in both Potter and Austin, though, is a sense of how one is to go out and get a rigorous and comprehensive view of the field, how one is to do serious field work rather than just tourism or tagging along. Moreover, Potter goes on to say that she is going to avoid historical questions about how the concept of BPD arose (p. 11). I think this is a serious mistake, for Potter is depriving herself of a mechanism analogous to the case law that Austin so favors: the complex social practice whereby definitions of BPD were proposed and conflicts adjudicated. We are not just dealing with ordinary language, whatever that is, when we talk about, say, the diagnostic criteria for BPD. We are talking about a specialized vocabulary developed by researchers and clinicians, albeit a vocabulary that interacts with and is hardly removed from other fields of discourse. I just don’t think, then, that you can make sense of the BPD construct without an eye to its conceptual genealogy. To borrow from Arnold Davidson, who has done crucial work to marry Foucault-style philosophical genealogy with analytic concerns about conceptual analysis, we need to look at concepts in their sites.

With all of this being said, I think the entire notion of approaching BPD from a "philosophical field work" perspective has much going for it. It suggests a goal, conceptual clarification, while avoiding the more scholastic pitfalls philosophy of psychiatry can fall into. 

In subsequent posts, I may discuss how I think these methodological problems play out in Potter's conceptual analysis of self-harm or self-injury. I may also look at the article she cites by K.W.M. Fulford on Austin and philosophy of medicine.

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