Brokering authenticity: Borderline personality disorder and the ethics of care in an American eating disorder clinic.

Publisher: University Of Chicago Press Country of Publication: United States NLM ID: 0421035 Publication Model: Print Cited Medium: Print ISSN: 0011-3204 (Print) Linking ISSN: 00113204 NLM ISO Abbreviation: Curr Anthropol

Publication: Chicago Il : University Of Chicago Press
Original Publication: Chicago.

Ethics, Medical* ; Psychiatric Department, Hospital*; Borderline Personality Disorder/*therapy ; Feeding and Eating Disorders/*therapy ; Managed Care Programs/*ethics; Adult ; Borderline Personality Disorder/complications ; Borderline Personality Disorder/diagnosis ; Borderline Personality Disorder/psychology ; Feeding and Eating Disorders/complications ; Feeding and Eating Disorders/diagnosis ; Feeding and Eating Disorders/psychology ; Female ; Humans ; Psychoanalysis ; Risk Factors ; United States

This paper examines the moral work of a controversial psychiatric diagnosis--Borderline Personality Disorder--in an American eating disorder treatment center in the era of managed mental health care. Based on fieldwork at this clinic spanning more than 6 years, I consider how clinicians invoke aspects of Borderline Personality Disorder in everyday conversation, in a practice I call "borderline talk." I argue that borderline talk emerges in response to being caught between contradictory models of the subject entailed in managed care and psychodynamic discourses. Specifically, borderline talk enables clinicians to endorse a formulation of the subject that, although considered pathological, provides them with a clear path of ethical action in otherwise ethically ambiguous situations. These kinds of everyday ethical negotiations percolate throughout the American health care system and are key mechanisms through which notions of economic expediency become entangled with concepts of the healthy subject. As clinicians struggle out a course of action between competing ethical imperatives, they also struggle out the workability--and failures--of various articulations of the subject within contemporary American cultural ideologies of health and pathology.

Date Created: 20091016 Date Completed: 20091117 Latest Revision: 20191111

20240104

10.1086/598782

19827330