This paper probes the format and underlying assumptions of insight conceptualizations and assessment procedures in psychiatry. It does so with reference to the oftenneglected perspective of the assessed person. It delineates what the mental steps involved in an insight assessment are for the assessed person, and how they become affected by the context and dynamics of the clinical setting. The paper examines how expectations of compliance in insight assessment tools and procedures extend far beyond treatment adherence, to compliance with diagnostic language and the assessment relationship. Such compliance can be ethically problematic and not in line with human rights standards, notably the Convention on the Rights of Persons with Disabilities. Most importantly, it can be counterproductive in supporting an individual to gain better insight in the sense of self-knowledge. The paper concludes with guidelines for a new approach to insight. This new approach requires taking into account currently neglected components of insight, in particular its relational and social dimensions, through which a person's insight operates and develops, and through which it could be supported. Concretely, this would mean removing the condition of compliance and reflecting on the influence of the clinician-patient relationship and assessment situation on insight.
Human subjectivity, ethics, autonomy, gender -from a psychoanalytic perspective, doesn't everything start with the mother? Studying the maternal (the mother, the child, and their relational attachment) becomes a starting point for understanding both subjectivity and autonomy. It could be argued that being an autonomous adult means precisely that mothering is no longer needed. But if we understand autonomy as a process that takes into account relational unconscious dynamics and their entanglements as the way through which one also attempts to know oneself, then providing a space for the other's separate and autonomous living which was once a part of maternal provision, continues to represent what we all need from the other, and the very process through which we also relate. Maternal studies could be described beyond the study of the actual mothering of a child, as the study of the way we relate and separate, and, in our adult life, the way we negotiate and re-enact our selves through the puzzling unconscious and fantasy roles of mother, child, self and other, as well as all third terms that intervene between them.Maternal studies, in a broad understanding of the term, is somewhat the 'mother' of all (other) themes in psychoanalytic and psychosocial studies; the idea of the maternal breaks free from the mother-child couple as if needed as a resource and means to live our life as adults; that is, as supposedly autonomous subjects.'Prior to sexuality as the unacceptable there was helplessness. Dependence was the first thing, before good and evil ' (Phillips 1988, p.7). The maternal, I think, is evoked as the answer to human dependence -doesn't it signify a highly specific and perhaps indescribable ('unacceptable') stance that involves taking care of another person, someone utterly dependent and vulnerable, a child? And can this stance be separated from a wish (demand) for such mothering, and our identifications with such a child? Doesn't the image of the mother evoke the image of the child in an (uncomfortable) reversal of Winnicott's famous statement about there being no such thing as a baby (without a mother)? Feminist theorists have been critical of classic object-relational psychoanalytic developmental theories that persistently focus on the perspective of the child. But we might be able to explore what this persistent perspective as an ideal can tell us of mothering as an expression of the wished-for-mothering that each of us would perhaps like to have received, and incite a theory of what we are able to do with this wish, in order to find
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This paper proposes thatautonomyandintimacyare understood as processes linked and co-created through one another. Stressing the socio-historical embeddedness of both notions, recent perspectives from feminist philosophy and psychoanalysis insist that autonomy is thought of within the concept of the self as relational; that is, entrenched in close relationships with others, lest a seemingly irreconcilable split is created between autonomy and intimacy as related to desire.Paying attention to the conditions of intimate relations and desire for the other, this paper looks at how autonomy is in actuality always entangled with intimacy, which influences a person’s identificatory and subjective states. Intimacy is discussed as a process of encounters with the other that begins with initial fantasy, and moves towards a continuous mutual negotiation of shared reality with the intimate partner. The importance of the feeling of ‘entitlement’ for both subjects in intimate relationship is highlighted.The suggested model is informed by relational psychoanalysis and Judith Butler’s theory of subjectivity and uses psychoanalytic case studies and film storylines, adopting assumptions of a fantasising subject created and continuously formed through a medley of discourses as well as in excess of them. Intimacy is shown as a complex play of fantasy and reality, where the other is at the same time a support and fracture of one’s fantasy. Some ways of how this could be used to think about autonomy are proposed.
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