writing a response

© 2011 by The Johns Hopkins University Press

­­­­­­­­­­­­­­­Oh­Blame,­Where­Is­ Thy­Sting?

Nancy­Nyquist­Potter

I­ think­that­Hanna Pickard and I are in agree- ment that the dichotomy between ‘having’ and ‘not having’ control and conscious knowledge

should be rejected. Personality disordered (PD) service users, like the rest of us, have degrees of not knowing and knowing, controlling and not controlling, such that pinpointing exactly when assignment of responsibility should enter into judgments of service users is murky and difficult. This position includes both metaphysical and epis- temological issues in that it is a separate question whether or not we can know someone is respon- sible from the question of whether or not someone is responsible and to what degree. Because Pickard focuses on metaphysical questions, I raise some epistemological points, as well as moral and cul- tural ones. It is important to remember that when Pickard says that ‘so long as one knows what one is doing, one is responsible for one’s behavior to the degree that one can exercise choice and control over it,’ she is making a metaphysical point about whether or not a service user is responsible for some behavior (2011, 212). This is precisely the question, but one might wonder what evidence exists that would indicate that PD service users do have an ability to control and choose behav- iors among various options. For example, I agree with Pickard that ‘reduction [of capacities] isn’t extinction’ (2011, 213), but what about those with impulse control disorder? Although it is no easier to determine the parameters of that problem than the more general one of conscious knowledge and

control over one’s behaviors, it at least raises the possibility that some PD service users do not have the ability to control some of their actions because of impulse control disorder (cf Potter 2009 for an analysis of impulsivity.)

As Pickard notes, holding someone responsible means treating him or her as accountable or an- swerable for his or her behavior (p. 215). In this paper, I emphasize the point that accountability does not necessarily lead to or entail blame. On her analysis of blame, Pickard distinguishes (among other things) between expecting an account- ing, on the one hand, and making judgments of blameworthiness, on the other. My remarks are meant to expand on these ideas, focusing on (a) the conditions for judgments of blameworthiness with respect to PD service users and (b) the no- tion of entitlement and the characteristics of the ‘sting’ of blame.

Considerations­and­ Conditions­of­Blame

The cluster of concepts in moral philosophy that includes blame, blameworthiness, responsibil- ity, accountability, pardon/excuse, and mitigation stands in need of analysis even though philoso- phers and others have been doing so for over two thousand years. The idea of responsibility without blame is a captivating one because it opens up the possibility of holding others accountable without engaging in blaming in the vernacular (accusatory,

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‘stinging’) sense of the term. Considerations of accountability and blame include:

• factual/descriptive features of behavior (what was the action, who actually performed it, who was the target of the action, if anyone);

• legal aspects (what does the law say about actions like these, does the service user understand the legal implications of his or her actions);

• moral aspects (what obligations if any were violated, what consequences follow from the action, does the service user understand the moral implications of his or her actions);

• cultural contexts (how do culturally-inflected as- sumptions, biases, and stereotypes play into judg- ments of the action, what cultural values are embed- ded in the action); and

• epistemic features (what can we say we know about the person’s intentions, how well do we truly under- stand his or her capability to make voluntary and informed choices).

These considerations are not a stage theory; woven throughout any consideration of accountability and blame will be questions of context and epis- temology.

Conditions for judgments of blameworthiness also exist. Edwards, for example, in a discussion of mental illness (2009) argues that the appropriate- ness of blame depends upon three things:

1. The fairness of attributing moral responsibility; 2. The effects that withholding responsibility will have

upon the broader ethical system; and to answer these questions, we need to know

3. The details of the dysfunction itself.

Although these metaphysical conditions are right, as far as they go, they do not offer enough of a framework—because fairness does not just depend on the details of dysfunction, but also on whether or not the lens we are using is a just one; and because Edwards’ three conditions are not enough—we need another consideration, and that is an epistemological one: how accurate is the interpretation of behavior? How accurate is the attribution of wrongdoing, or deviance, or defi- ance? My point is that, when we are considering the metaphysical questions of responsibility, we cannot accomplish this task properly unless we also take into consideration that we sometimes are making attributions based on stereotypes, assumptions, and biases that skew our epistemic

standing. These two types of considerations are distinct analytically, but in practice, we are answer- able to skeptics of our claims to knowledge about whether or not another is responsible and to what degree. If our aim is to attribute blameworthi- ness appropriately, then we need also to include an epistemic condition that holds us accountable for unreflective assumptions and unfounded ste- reotypes. Expanding on Edwards’ framework for moral responsibility in the face of mental dysfunc- tion, then, we should ask, “Why do we excuse behavior in some cases of schizophrenia but not in pedophilia?” And “Why would something like Borderline PD typically fall under a similar kind of blame to pedophilia but not schizophrenia?” Are we importing distorted beliefs and perspectives into our assessments of PD service users?

I argue that the way we assign blameworthiness and responsibility to Borderline PD service users is not fair, for two reasons. First, it is not accurate, because we can be mistaken about what counts as manipulativity (Potter 2006). And it is not fair inaccurately to saddle people with responsibility (with or without blame) for being manipulative (or for knowingly and deliberately being disrespectful of boundaries, like regularly exceeding the session time limit). This is not to say that we always are skewed in our attributions, but that we need to recognize the way that epistemic considerations play into metaphysical ones and that, sometimes, our practical body of knowledge can be culturally inflected (such as in the ways we determine who is and is not manipulative and when we praise or blame manipulativity). The caveat here also allows that it will be accurate sometimes, say, to hold someone responsible to some degree for her behavior in exceeding the time limit. My point is just that we may be inaccurate in our attribution of deliberate and disrespectful behavior—that we ought not assume that behavior is deliberately disrespectful without critical reflection into the service user’s perspective, the clinician–service user relationship, and the cultural influences on the clinician’s interpretations.

Second, it is discriminatory in terms of gender. For example, as I argue in Potter (2009), there is ample evidence that women’s and men’s anger are met with quite different responses such that

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the criterion of ‘inappropriate or intense anger’ needs to be socially contextualized when making attributions of responsibility. That is, we need to know what norms govern the distinction between appropriate and inappropriate anger and, I argue, those norms are unfairly gendered and applied in judgments of women’s anger. In the words of Iris Murdoch: “As moral agents we have to try to see justly, to overcome prejudice, to avoid temptation, to control and curb imagination, to direct reflec- tion” (1970, 40). The responsibility of clinicians, in working with BPD and other PD service users, is to develop a just vision whereby they bring to bear the considerations of accountability and blameworthiness and the conditions of judgment that preserve fairness and accuracy in all their complexity and cultural context. The ‘sting’ of blame, therefore, may come from a sense of un- fairness, inaccuracy, and injustice in the blaming. Service users who experience gender discrimina- tion from clinicians may feel unfairly ‘slapped in the face’ and respond with indignation at what is experienced as unjustified unequal treatment. Their anger, then, can fuel future blaming based on (probably unconscious) assumed gender differ- ences about appropriate anger, and a destructive dynamic may ensue.1

A condition for appropriate blame on a cli- nician’s part, on Pickard’s account, is that the blame be detached as opposed to affective. Af- fective blame carries with it the ‘sting’ of blame, on her view, because it is constituted by feelings such as hate, anger, resentment, disgust, and sad- ness, and attitudes such as disapproval, dislike, disappointment, and contempt, together with a feeling of entitlement to these various feelings (Pickard 2011, 218). Note that the emotions and attitudes listed are ‘reactive’ or ‘negative’ and that they are part of the larger set of ‘affective’ emotions and attitudes that include kindness and empathy. Pickard wants to hold to a fairly strict dichotomy between affective and detached blame in the domain of clinical work. The reason is that affective emotions are associated with negative or reactive ones. My suggestion is that such a posi- tion compromises the larger domain of affective engagement as it applies to empathy. As Bennett Helm (2010) argues, when it comes to evaluative

attitudes, the divide between reason and emotion, judgment and feeling, cannot be sustained. When we make value judgments (about people), we al- ways and necessarily also are making what Helm calls ‘felt evaluations’—evaluations grounded in what and who we care about and love—the emphasis being on ‘feeling’ that plays a constitu- tive role in our relationships with others (includ- ing our ‘judgments’ about them). Furthermore, Helm says, love and friendship (and, I would add, the therapeutic alliance) cannot adequately be understood unless we reject the individualist conception of persons. Persons are fundamentally social, and part of what this means is that our affective states and our capacity to care for and to be intimate with others (two different things) must be given central place in any philosophical conception of the self. Helm cites David Velleman, who holds that love inhibits our tendencies toward self-protection whereby we can draw ourselves in and close ourselves off from being affected by the other. “Love disarms our emotional defenses; it makes us vulnerable to the other,” Velleman says (Helm 2010, 26). That openness to the other is a good thing, I would argue; in fact, it is necessary to being empathetic toward others, including PD service users. Empathy is both cognitive, in that it involves beliefs and imagination, and affective, in that it involves feelings and emotions (see Pot- ter [2002] for an analysis of empathy). Empathy is a virtue, with a mean and two extremes, and just as it is possible to have too much empathy toward others, it is possible to have too little. Borderline PD service users especially tend to elicit negative, blaming attitudes from clinicians. As Pickard rightly points out, such attitudes are not helpful to the treatment of PD service users. Yet detached blame seems the wrong goal, for the most part; detachment impedes the quality of relationship, the engagement with another as a fellow human being, and the sense of a therapeutic alliance—that clinician and patient are working together toward some common ends. Besides, if what is meant by detachment is the maintaining of emotional boundaries, then detachment is compat- ible with affective commitments toward the other. Although Pickard writes that ‘compassion and empathy push the negative emotions constitutive

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of affective blame aside’ (Pickard 2011, 230), I hold that empathy does not require that we not experience affective blame—the two can, and often should, go together. I emphasize this point because I worry, as does Pickard, that a detached stance might undermine the clinician’s ability to empathize with his or her service user because empathy does require emotional engagement. I would urge Pickard not to dichotomize between reason and emotion, and between detached and affective blame, if the point is to associate detached blame with ‘non-judgmentalism’ and affective blame with ‘entitlement,’ where blame seems to get its sting from.

Entitlement,­Epistemology,­ and­Warranted­Blame

Let me first delineate different kinds of entitle- ment. Pickard asserts that “this feeling of entitle- ment is the key to unifying affective blame,” the kind of blame she urges clinicians to avoid (p. 218). The two more familiar notions of entitle- ment that clinicians might have in mind when they say that PD patients are ‘acting entitled’ are moral entitlement as desert and legal entitlement as claim-right. It is not clear what kind(s) of en- titlement Pickard might be employing, so in this section I expand on Pickard’s work by suggesting some notions of entitlement that might be useful for a framework of blame and responsibility. ‘En- titlement’ in the moral domain typically is used in a pejorative way, and this makes some sense. Are we ever entitled to an apology? Or contrition? No; no one owes us those speech acts or moral attitudes (cf. Potter [2001] for support of this claim).2 In moral philosophy, rights typically are said to have corresponding duties (if I have a right to vote, oth- ers have a duty not to interfere with my exercise of that right, and so on). But the rights/duties correlation does not always hold; we sometimes have obligations while others still have no right to demand that we fulfill that obligation. I may have a duty to provide dinner for my neighbors who are having a medical emergency, but they cannot claim that dinner as their right. Similarly, people may have a duty to act in such-and-such ways (seek forgiveness, act contritely), but having a duty, in

this case, does not imply that someone else has a correlative right. So if my neighbors act like they have a right to receive dinner from me, they are acting ‘entitled’ in the moral pejorative sense.3

But even in the moral domain, claims of entitle- ment are not necessarily pejorative. Robert Nozick is, perhaps, famous for his defense of entitlement to property as a moral stance. Nozick unquestion- ably thinks entitlement is to be understood as a kind of desert. Non-pejorative moral entitlement provides the justification for legal entitlement. Legal entitlement is a claim-right recognized by law as having the further feature of the right to be heard by the law and an entitlement-right legally acknowledged. A claim-right is a right to bring forth a claim to be heard in the courts. That the courts recognize a claim as having sufficient merit to be heard is not evidence that the courts think the claim is justified; that is for the courts to decide. Thus, a claim-right is just a right to make a claim, in the sense that ‘making a claim’ means that somebody is open to considering the claim to a right as being a right. For Nozick, entitlement is secured when it has been properly acquired or transferred. So, for example, if I were to say that I am legally entitled to own the property on Mille Lacs Lake up in Minnesota, I would be asserting that that property, which has been in the family for two generations, is rightfully mine to own. (In this example, I would not have secured this right because I am not entitled to it—there was no legal transfer by way of will or deed to me. So no matter how indignant I might feel that I cannot own that property, I do not have a right to that property.)

We have identified, so far, pejorative moral entitlement, non-pejorative moral entitlement, and non-pejorative legal entitlement. The fourth way that the concept of entitlement is used philosophi- cally is epistemic. Robert Brandom argues that norms for rationality require that we distinguish between two sorts of rational norms: a commit- ment to speech acts by which we put forward reasons to accept something as persuasive or true; and an entitlement by which we ask for or require reasons (2000, 195). Entitlement, therefore, is an epistemic notion whereby we can establish whether or not a person is entitled by reasons to hold the commitments he does. “But for such a

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structure of consequential commitment to count as involving assessments of reasons, there must be in play also a notion of entitlement to one’s commitments: the sort of entitlement that is in question when we ask whether someone has good reasons for her commitments” (Brandom 2000, 43; emphasis in original). Inferential articulation involves, according to Brandom, how concepts are used or employed and whether or not the infer- ences drawn from them are historically, logically, and pragmatically correct. That one is committed to a certain claim must be separated from whether or not one is entitled to that commitment (mean- ing that one has reasons.) For example, clinicians may be committed to the belief that PD service users know what they’re doing unless they are hallucinating and are, therefore, responsible for what they do, but not be entitled to that commit- ment (meaning one’s ‘reasons’ are inadequate).

Asking for reasons and giving them, whether for actions or beliefs or values, occurs only in the context of practices of making and defending claims or judgments (Brandom 2000, 81).

Acting with reasons is being entitled to one’s practical commitments. Having this status is being intelligible to oneself and to others. . . .That piece of practical reason- ing explains why one did as one did: what reasons one had. This means that in particular cases one can act intentionally but without reasons. (Brandom 2000, 93; emphasis in original)

Applying Brandom’s analysis of epistemological warrant to questions of whether or not PD service users should be considered responsible for their (bad) behavior, I suggest that here, too, we can see that it is indeed possible for someone to act inten- tionally but lack reasons for his or her actions. Also, clinicians can be intentionally committed to a belief that PD service users act with conscious knowledge and the ability to choose but still lack good reasons for that belief-commitment.

In my view, and based on these expanded ideas about entitlement that go beyond Pickard’s paper, I suggest that justification or warrant for blam- ing a service user for his or her (bad) behavior should at least sometimes involve non-pejorative entitlement. To the extent that I am right, then entitlement (and therefore blame) need not have a ‘sting.’ But that claim also is situated within an

analysis of Pickard’s distinction between detached and affective blame. Pickard’s view is that, to hold PD service users responsible without the sting, clinicians must remain detached when assigning blame to them, in the sense of not affectively blam- ing them. I am interested particularly in her notion of blame without sting, and I agree that the sting without blame should be avoided as it is unhelpful and perhaps even harmful. Still, I want to retain the notion of affective blame without sting, on the grounds that, from a theoretical perspective, the dichotomy between detachment and affective engagement seems artificial and wrong-headed4 and—from a practical, clinical perspective—the therapeutic alliance seems to require affective engagement to be appropriately empathetic and treatment sensitive. Blame can and should be dis- cussed within that context of affective engagement, and affect not bracketed off during appraisals of blame. As I suggested, detached blame with affec- tive engagement are compatible.

The second half of this article has offered an ex- pansion of Pickard’s ideas of entitlement. I realize that they are only a starting point for developing a full account of blame and responsibility regarding PD service users. But my overall point is that, given cultural considerations such as gender discrimina- tion, it is easy to go wrong when assigning blame and responsibility, and part of the problem is in not understanding what entitlement is and its moral, legal, and epistemic aspects. Part of the problem is that, whenever we make judgments of PD service users, we are at risk of importing distorted ideas, assumptions, and stereotypes about those people. So at the end, I return to the conditions for blame that I added to Edwards’ account. Fairness and accuracy require that we attribute blame always being culturally aware and epistemically respon- sible ourselves. And that requires, as Murdoch says, that we develop a just vision.

Notes 1. Note that I am not making the assertion that, if

a service user experiences clinician treatment as inap- propriate, it is objectively inappropriate. There is much to sort out about objective versus subjective claims to injustice in blaming that goes beyond the scope of this article. The point is that gender discrimination toward Borderline PD service users exists and that clinicians

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must be careful to disentangle fair blame from gendered unfair blame.

2. Adequate treatment of this issue is beyond the scope of this paper, but I would remind readers that, although we often do think we are owed an apology, we cannot rely solely on what people believe about what they have a right to, in assessing the status of their moral rights.

3. In addition to those points, PD service users should not be expected to hold all the duties that nonpsychi- atric people hold, because their ability to fulfill duties typically is compromised in at least some ways and to some degree.

4. I recognize the irony of my advocating epistemic entitlement as a condition of warrant—a rationalist epistemology, and at the same time rejecting a hard distinction between detachment and affect. To sort this out would require me to take on Brandom’s rationalism, something I cannot do in this short paper.

References Brandom, R. 2000. Articulating reasons: An introduc-

tion to inferentialism. Cambridge, MA: Harvard University Press.

Edwards, C. 2009. Changing functions, moral respon- sibility, and mental illness. Philosophy, Psychiatry, and Psychology 16, no. 1:105–7.

Helm, B. 2010. Love, friendship, and the self: Intimacy, identification, and the social nature of persons. Ox- ford: Oxford University Press.

Murdoch, I. 1970. The sovereignty of good. London: Routledge and Kegan Paul.

Pickard, H. 2011. Responsibility without blame: Em- pathy and the effective treatment of personality disorder. Philosophy, Psychiatry, & Psychology 18, no. 3:209–223.

Potter, N. 2001. Is refusing to forgive a vice? In Femi- nists doing ethics. Ed. P. DesAutels and J. Waugh, 135–50. New York and Oxford: Rowman-Littlefield Press.

———. 2002. Can prisoners learn victim empathy? An analysis of a relapse prevention program in the Ken- tucky State Reformatory for Men. In Putting peace into practice: Evaluating policy and local and global levels. Ed. N. N. Potter. Amsterdam: Rodopi Press.

———. 2006. What is manipulative behavior, anyway? Journal of Personality Disorders 20, no. 2: 139–56.

———. 2009. Mapping the edges and the In-between: A critical analysis of borderline personality disorder. Oxford: Oxford University Press.