Self and identity in borderline personality disorder: Agency and mental time travel

Abstract

We consider how conceptions of the self and identity from the philosophical literature can help us to understand identity disturbance in borderline personality disorder (BPD). We present 3 philosophical approaches: connectedness, narrative, and agency. We show how these map on to 3 different ways in which the self can be temporally extended. The connectedness approach is dominant in philosophy, and the narrative approach has been used by psychiatry, but we argue that the lesser‐known agency approach provides a promising way to theorize some aspects of identity disturbance in BPD. It relates the 2 diagnostic criteria of identity disturbance and disinhibition and is consistent with evidence of memory deficits and altered self‐processing in BPD patients.

Reasoning, evidence, and clinical decision‐making: The great debate moves forward

“…The paper by Tania Gergel and Eduardo Iacoponi also examines the dominant philosophical models of continuing identity over time, noting that they all depend upon “some notion of fundamental stability,” and thus seem to be “a poor fit for the trajectory associated with psychotic disorder.” This explains the common conception of psychosis as “loss of selfhood.” The authors, however, prefer a different approach, treating “the transitions which accompany psychotic disorders” as presenting “a challenge to conventional and philosophical notions of selfhood” and thus seeking “an alternative model of identity to use in this context.” Their approach seems in line with the methodological point in our opening comments, that it is legitimate to hold theories to account for making sense of practice, which in this context means enabling practitioners to help patients make sense of their own experiences. Adopting a pragmatic stance which resonates with the arguments of other contributors to this section Gergel and Iacoponi find there are strong reasons to avoid the option of simply judging psychotic disorders as “bringing about a loss of selfhood.” They accept that some individuals with psychosis are prepared to “posit a self/illness separation” as a way of managing the condition, but they note that even for those individuals, “it was still they themselves who experienced the psychotic state and must somehow integrate these experiences into their self‐concept, no matter how distinct this state might be from their non‐psychotic self.”…”

“…Natalie Gold and Michalis Kryatsous examine philosophical approaches to the self to assess their ability to help our thinking about identity disturbance in BPD . They argue that models of the self based on continuity, including narrative identity, need to be supplemented by a notion of agentic identity, explaining how it connects impaired self‐processing to both memory deficits and disinhibition.…”

“…In this edition, we present an array of up‐to‐date analyses of the problems of reason in practice, addressing a diverse range of healthcare contexts and methods, considering policy decisions as well as specific instances of clinical reasoning . Contributors discuss the nature of practical wisdom, the relationship between reasoning, emotion, intuition, and evidence, and the sense in which EBM is (or is not) a “modern” scientific enterprise, in the light of considerations of the relationship between science, context, and culture .…”

“…Contributors discuss the nature of practical wisdom, the relationship between reasoning, emotion, intuition, and evidence, and the sense in which EBM is (or is not) a “modern” scientific enterprise, in the light of considerations of the relationship between science, context, and culture . The edition includes important sections on mental health, where questions ranging from epistemic injustice to psychiatric nosology and validity are analysed—discussions given both specificity and depth via a range of papers from a significant conference on how we conceptualize a number of psychiatric disorders . There is also a significant section on causal reasoning, publishing papers delivered to a recent gathering of the CauseHealth collaboration .…”

Interdisciplinary workshop on “mental disorder and self over time”

“…In this paper, we summarize the talks and responses, giving a flavour of the discussion and drawing some general conclusions. Five detailed papers, each based on one of the presentations given at this workshop, also appear in this issue, and 3 papers on the workshop theme have appeared in the previous philosophy thematic . A podcast is available on the website of the Self‐Control and the Person group, at http://www.selfcontrolandtheperson.weebly.com/podcasts.…”