This work examines the concept of trust in the light of virtue theory, and takes our responsibility to be trustworthy as central. Rather than thinking of trust as risk-taking, Potter views it as equally a matter of responsibility-taking. Her work illustrates that relations of trust are never independent from considerations of power, and that asking ourselves what we can do to be trustworthy allows us to move beyond adversarial trust relationships and toward a more democratic, just, and peaceful society.

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. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a shift (...) in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

This article critically examines Louis Charland’s claim that personality disorders are moral rather than medical kinds by exploring the relationship between personality disorders and virtue ethics. We propose that the conceptual resources of virtue theory can inform psychiatry’s thinking about personality disorders, but also that virtue theory as understood by Aristotle cannot be reduced to the narrow domain of ‘the moral’ in the modern sense of the term. Some overlap between the moral domain’s notion of character-based ethics and the medical (...) domain’s notion of character-based disorders is unavoidable. We also apply a modified version of John Sadler’s “moral wrongfulness test” to borderline and narcissistic personality disorders. With respect to both diagnoses, we argue that they involve negative moral evaluations, but may also have indispensable nonmoral features and, therefore, classify legitimate psychiatric disorders. (shrink)

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.". (shrink)

I discuss pedagogical issues that concern incest survivors. As teachers, we need to understand the ways in which the legacy of incest variously affects survivors' educational experiences and to be aware that the interplay of trust, knowledge, and power may be particularly complex for survivors. I emphasize the responsibility teachers have to create classrooms that are inclusive of survivors, while raising concerns about the practice of personal disclosure and assumptions about trust and safety in the classroom.

This paper raises questions about who counts as a knower with regard to his or her own memories, what gets counted as a genuine memory, and who will affirm those memories within an epistemic community. I argue for a democratic epistemology informed by an understanding of relations of power. I investigate implications of the claim that knowledge is both social and political and suggest ways it is related to trust. Given the tendency of epistemology to draw lines that discriminate unfairly (...) against some, it is vital that efforts to create democratic epistemologies be sensitive to the potential for exploitation. Standards of credibility often favor members of dominant groups, and our ontological commitments may intersect with patterns of domination. While acknowledging difficulties in evaluating what counts as credible claims to memories, I argue that one’s engagement with clients must be mapped onto the larger moral and political domain. (shrink)

We are thankful for the opportunity to reflect more on the difficult problem of the relationship between moral evaluations and the construct of personality disorders in response to the commentaries by Mike Martin and Louis Charland. We begin by emphasizing to readers that this important problem is complicated by the different perspectives of the various disciplines involved, especially, philosophy, psychiatry, and psychology. Incredulity, anger, and dismay are among the reactions we encountered in discussions of these issues, especially with some mental (...) health professionals. Strong reactions on either side of a disciplinary divide occasionally present barriers to a dispassionate discussion of the topic. .. (shrink)

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... (shrink)

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. (shrink)

IN THINKING ABOUT the wonderfully helpful comments by Eric Cassell, Suzanne Jaeger, and Deborah Spitz, I find myself grappling with three central questions: How reliable a guide is world traveling? What kind of knowledge can be obtained by world traveling? and, What are the goals of treatment such that world traveling might be thought to serve a purpose? These questions arise from the insights, criticisms, and cautions the commentators provide, and I will weave together possible answers from ideas drawn from (...) the commentaries. (shrink)

Fostering shame in societies may not curb violence, because shame is alienating. The person experiencing shame may not care enough about others to curb violent instincts. Furthermore, men may be less shame-prone than are women. Finally, if shame is too prevalent in a society, perpetrators may be reluctant to talk about their actions and motives, if indeed they know their own motives. We may be unable accurately to discover how perpetrators think about their own violence.

This case consultation offers three cases that illustrate a collaborative consultation model for psychiatric ethics that we have developed in outpatient clinic and in emergency psychiatry over the last 10 years. After we present these cases, we discuss three points of interest: 1) the characteristics we found to be important to our collaborative project, 2) the benefits of an integrative approach, and 3) ways that our collaborative moral reasoning developed our awareness of and sensitivity to ethical issues. We end by (...) raising some topics on which commentators could engage.Potter began working with El-Mallakh more than 10 years ago. Her impetus was that she was writing a critique of the criteria used in borderline... (shrink)

This work stands at the crossroads of two current themes in moral philosophy: heightened interest in the topic of trust and renewed interest in virtue ethics. In concurrence with the recent renaissance in virtue ethics, I take the central question in morality to be how we are to become morally good persons. An analysis of trust and failures of trust, therefore, should indicate what is involved in becoming worthy of others' trust as well as indicate when trust and distrust are (...) reasonable. I argue that framing these concepts in terms of Aristotelian virtue ethics provides us with an illuminating and constructive way to think about a topic that has, until recently, been largely ignored in philosophical discourse. ;The theoretical framework provides an analysis of the concept of trust, showing how features of trust lead to an understanding of what is involved in being trustworthy. I argue for the centrality of character to moral theory and explain what trustworthiness would look like in an Aristotelian framework. In doing so, I set out central features of what is required to be fully trustworthy. ;I am concerned, in particular, to articulate and defend a theory of the virtue of trustworthiness that takes into account relations of power. My objective in theorizing about trustworthiness has been to provide a conceptual account which generates practical considerations for the enhancement of trusting relationships by attending to the ways in which social and political institutions and practices intersect with the virtue of trustworthiness. To this end, after setting out the theoretical framework, I examine four particular contexts in which power differentials between and among individuals affect trusting relationships. With each case study, different aspects of trustworthiness will be foregrounded; I identify and clarify the particular issues involved and articulate ways in which variously located persons can become trustworthy. (shrink)

The American Journal of Bioethics, Volume 11, Issue 10, Page 6-7, October 2011.

Theories of humor tend to neglect the role that humor plays in situations of conflict. This paper explores epistemological and political dimensions of humor as it is used by members of disenfranchised and otherwise marginalized groups. Not only can this kind of humor I call "oppositional" aid members of oppressed groups in preparing for conflict; it can also help people's beliefs shift in politically significant ways. Although I think the use of oppositional humor can be very constructive both politically and (...) epistemologically indealing with conflict, I am skeptical about the use of oppositional humor in situations of direct conflict resolution. Nevertheless, I suggest that a type of humor called banter can be productively engaged in by the relatively disempowered when certain parameters are drawn. (shrink)

People do great wrongs to each other all the time, sometimes deliberately, sometimes accidentally. This book looks at how people, communities, and nations can address great wrongs and how they can heal from them - taking into consideration how differences in cultures, histories, and group expectations affect the possibilities for healing.

Sarah Kamens invites readers to consider ways that psychiatry is colonizing, drawing on the concepts of ghostwriting and voice-hearing as mirrored points of haunting in medical regimes. Her article is provocative and engaging, and she is spot on about some of the more concerning aspects of psychiatry. I suggest some ways that Kamens can expand on this work, but my emphasis is on ghostly and emergent voices of service users.I find myself wishing that Kamens would dig deeper into some of (...) the core concepts she employs. Take post-colonialism. Setting aside the fanciful thinking signified by use of the suffix “post”—a term that is used to indicate that we have moved past the practice itself, as in “post-racial society”... (shrink)

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 .. (shrink)

The construct for affiliation in Depue & Morrone-Strupinsky's (D&M-S's) study is restricted to the interpersonal domain. This restriction is not found in other disciplines. It may be necessary in early stages of trait research. But the construct will need to be expanded to speak to the more complex, second-order affiliations of which humans are capable.

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 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 (mis)management of the case exacerbated previous violence done to a biracial female. The importance of resistance to dominant ideology is scrutinized.

We are pleased with the thought-provoking discussion that our article has stimulated. All of the discussants agree that the state of education and infusion of ethical principles and practices into psychiatric decision making is currently suboptimal. The ethical questions raised by the discussants, writ large, have been analyzed, reduced to a seemingly manageable 'core,' or expanded to capture nuance and subtlety, and it is invaluable for clinicians, patients, and others to explore them together.In modern times, where the prevailing Western ethical (...) theories were developed, the aim of ethics was to do the right thing. For example, we ought to aim to maximize overall usefulness based on consequences of actions, or to... (shrink)

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.

Tamara Browne argues that many of the controversies that emerge in the process of revising DSMs could be solved by the creation of an Ethics Review Panel, similar to that of a research ethics committee. Members of such a panel would, in Browne's words, "help inform psychiatric classification". Browne's proposal is important on a number of levels, the most significant one being that it affirms the status of ethics as equal to that of science. An Ethics Review Panel would do (...) more than merely make the processes of scientific and ethical judgments parallel: if Browne's suggestions were followed, it would raise ethical considerations to that of second-order status to scientific judgments in the... (shrink)

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.

Theories of humor tend to neglect the role that humor plays in situations of conflict. This paper explores epistemological and political dimensions of humor as it is used by members of disenfranchised and otherwise marginalized groups. Not only can this kind of humor I call "oppositional" aid members of oppressed groups in preparing for conflict; it can also help people's beliefs shift in politically significant ways. Although I think the use of oppositional humor can be very constructive both politically and (...) epistemologically indealing with conflict, I am skeptical about the use of oppositional humor in situations of direct conflict resolution. Nevertheless, I suggest that a type of humor called banter can be productively engaged in by the relatively disempowered when certain parameters are drawn. (shrink)