The 5th annual Rabinowitz Symposium in medical ethics was held Friday, April 13, on the topic "Disordering Personalities? Psychiatric Diagnosis and Moral Responsibility." The first talk, by philosophy professor Nancy Potter, University of Louisville, focused on oppositional defiant disorder, with discussion of radicalized attributions of defiance in the school system, concerns about motivations for diagnosis and treatment, and the possibility of a virtue of defiance. Psychiatrist Jonathan Metzl, Vanderbilt University, provided comments.
Next, medical anthropologist Rebecca Lester, Washington University, St. Louis, described some of her experiences working in an eating disorders clinic, first as an ethnographer and later as a therapist. Lester analyzed common treatment of "difficult" patients, and considered how diagnoses such as borderline personality disorder alter therapists' thinking about the necessity of engagement with a patient, sometimes based on unfounded assumptions about manipulative behavior. She also offered interesting insights into internal family systems therapy, which treats each individual as a collection of internal parts with their own identities and desires, and requires individuals to recognize and address the internal conflicts between these parts of self. Professor Ingra Schellenberg, UW philosophy, bioethics, and humanities, offered comments.
Finally, forensic psychotherapist Gwen Adshead, Broadmoor Hospital, UK, gave a talk based on her work doing therapy with individuals who have committed violent crimes and been sentenced to life in a locked psychiatric facility. Her focus was on the ways in which individuals diagnosed with personality disorders can come to develop a stronger sense of agency and make sense of their actions. Lorna Rhodes, UW Anthropology, offered comments.
The lively interdisciplinary audience filled each discussion period, and the interchange continued into the final period, which was a panel discussion that focused on moral implications of trying to identify proto-personality disorders (as with oppositional defiant disorder) in children; the effects of managed care on the diagnosis and treatment of personality disorders; the difficulties of identifying and understanding patient manipulation; and the danger of value-laden psychiatric diagnoses.