Chapter

Self-injurious behavior

Nancy Nyquist Potter

in Mapping the Edges and the In-between

Published on behalf of Oxford University Press

Published in print June 2009 | ISBN: 9780198530213
Published online February 2013 | e-ISBN: 9780191754388 | DOI: http://dx.doi.org/10.1093/med/9780198530213.003.0006

Series: International Perspectives in Philosophy & Psychiatry

Self-injurious behavior

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Clinicians are often at a loss to understand the actions of individuals who self-injure. Many find that it is difficult to talk about self-injury in a way that allows the patient a role as interpreter of her own signs (Favazza 1996; Himber 1994). ‘Ross and McKay (1979) found that only after conceding that they did not understand self-mutilation were counselors then able to suspend clinical judgment and allow the young women to explain their behavior’ (Zila and Kiselica 2001). Being a good clinician involves not only therapeutic skill and ethical commitments, but also an adherence to good epistemic practices. To be epistemically responsible is to seek out knowledge, acknowledging the limitations of our individual and professional body of knowledge. It is to ask ourselves questions about who gets to count as knowers and to work toward egalitarian knowledge production and attitudes toward variously positioned knowers. It is to resist prevailing psychiatric discourse when its power to pathologize is uncalled for. I say more on this issue in Part II of the book. For now, I just emphasize the importance of clinicians’ approaching patients with a degree of epistemic humility.

BPD patients, the population relevant to our examination, need much guidance in order to work through their many difficulties and suffering. But they also need to be encouraged to see themselves as would-be knowers. And to do this, they must be the ones to say what they mean to communicate (or not) about their behaviors that look like self-injury. This does not mean that whatever they say must be right (see 5.2 above), but that the discursive power that silences women in many ways must be shifted to the patients to some degree.

Chapter.  6747 words. 

Subjects: Psychiatry

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