The 4th annual Rabinowitz Symposium in medical ethics was a huge success! It was titled, "Disordering Personalities? Psychiatric Diagnosis and Moral Responsibility."
The first talk, by philosopher 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.
Next, medical anthropologist Rebecca Lester (Washington University), described some of her experiences working in an eating disorders clinic. 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.
Finally, forensic psychotherapist Gwen Adshea (Broadmoor Hospital, UK), spoke about 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.
The lively interdisciplinary audience took full advantage of each discussion period, and the interchange continued into the final period, which focused on moral implications of trying to identify proto-personality disorders 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.