Introduction to Ethics Phil 140 @ Binghamton University, Sp '11


Borderline personality disorder: Denial vs. acceptance and the choice of therapy

People seek therapy for various kinds of reasons. Some may wish for a more fulfilling life and choose therapy as an opportunity for self actualization, others may be struggling with mild depression or relationship problems, and yet others have more serious disorders that interfere with their ability to function in life. All patients who seek help realize that they are struggling in one way or another but the type of treatment and the goal of therapy varies in these different situations. Among the most difficult to treat are personality disorders because they are, by definition, firmly established ways of coping with the world and reacting to stressful situations that are detrimental to the well-being of that person. People with borderline personality disorder have a difficult time expressing appropriate emotions and, therefore, maintaining relationships. Two important issues arise, though, when considering the approaches taken by therapists in dealing with patients with such a disorder. Should a person who has been diagnosed of a certain disorder accept that diagnosis even if they disapprove of being labeled and placed into a specific category? Furthermore, is it then that person’s responsibility to attend therapy? From a deontological perspective, the diagnosis and treatment should be accepted because they follow maxims that can be universalized. For a person with emotional difficulties, deontology is the best ethical theory that resolves these issues because it gives that person an objective standard upon which to judge his options without the interference of his emotional volatility.

Deontology is the ethical theory that places emphasis on duties and obligations. At its core, it recognizes each individual person as the law-maker and law-abider of his own legislative world. This principle, however, does not validate the idea that a person can act in any way he wishes at any given moment. The rules and consequential actions that this person creates are only morally acceptable if they follow the categorical imperative, which states that (1) any maxim acted upon by the person should be capable of becoming a universal law, (2) in the process of creating and abiding by maxims, others should be treated as ends and not as mere means, and (3) this person should view himself as the source of moral law. Hence, a person should conduct himself in accordance to maxims that he believes can and should be followed by everyone else as well (Kant, Groundwork: Moving from popular moral philosophy to the metaphysics of morals, Part II, paragraph 20). When contemplating a moral dilemma or choosing between various options in life, it is the person’s responsibility to recognize what maxim he is acting from and whether this maxim can be universalized. By following the deontological code, each person holds an objective view towards what is right and wrong and recognizes that his subjective situation in life and personal emotions can lead him astray from acting morally. In contrast, by acting from subjective personal desires, a person often opts for short-term satisfaction at the price of long-term content and often uses other people for his own advantage. Deontology, however, offers a consistent principle upon which a person can trust to lead him in the right direction.

The denial of a diagnosis is equivalent to the denial of psychology as a respectable and true science. So if a person denies his diagnosis, then his maxim could be stated as such: no diagnosis made by a mental health professional is valid and, therefore, no person needs to seek or be given treatment for mental disorders. We can automatically see that this maxim could never be made a universal law because it would disqualify the diagnosis and treatment of all mental disorders, ranging from those that present with suicidal tendencies to psychosis. All mental hospitals should then release their patients, suicidal beliefs stemming from mental “abnormalities” should be disregarded, and no thought should be given to mental stability in court rulings. Because such a maxim could never be made into a universal law, it would instead be morally correct to accept the label and acknowledge the fact that there is a problem. More importantly, it is the person’s responsibility to seek treatment for his disorder even if he may find it uncomfortable at first. If suicide is not an acceptable option according to deontology because it would promote the maxim of self-destruction, which certainly cannot be universalized, then the same applies for mental disorders. If a person chooses not to receive treatment, he is choosing a path of self-destruction, albeit less extreme, and such a maxim cannot be acceptable.

In “Incest Survivors and ‘Borderline Personality Disorder’”, Nicki writes an intimate account of her own struggles with emotional problems as well as her negative experiences with doctors and her positive reactions to support groups. She disagrees with the label of personality disorder and claims that she did not find the consolation she was looking for in therapy. Nicki believes that labeling someone with a personality disorder is equivalent to laying all the blame of irrational behavior on the patient instead of considering the unique and difficult life experiences of each person (Nicki: Incest Survivors and “Borderline Personality Disorder”, paragraph 6).  She explains her repulsion against labeling by asking “What confident and self-loving person would accept thinking of himself/herself as having something inherently wrong with his/her most basic self?” (paragraph 7). Instead, she advocates for support groups as an alternative way to deal with one’s problems. Nicki felt most comfortable in a support group where she could relate to the experiences and concerns of others.

Therapy, however, is not meant to provide consolation as much as it is supposed to teach the patient certain coping skills. While support groups are a great opportunity to meet other people with similar experiences, they are not an alternative option to treatment. Support groups offer a nurturing and safe environment where the person can feel safe and understood but they do not teach that person how to control their emotions, deal with stress and change, and how to manage relationships. Support groups can also be more effective if the person can apply the social skills learned in therapy to the group environment.

Many people find it distasteful to be labeled with a particular disorder. Reasons for this are varying. Some hate the idea of classification because they assume that it ignores their own individual circumstances or life experiences. Others struggle with the idea that there is something clinically wrong with them and may feel insulted. Yet these are all very subjective responses. There may also be people who find relief in diagnosis because they welcome the fact that they are not so unusual, that there are others who share their feelings and experiences, and that there is the potential for treatment and a cure. But even people such as Nicki who automatically assume that a label means that there is something horribly wrong with them will not deny the fact that they seek help because their current situation does not feel right. The stigma attached to the label should not be used to disqualify a professional’s opinion on the types of symptoms exhibited and the kind of treatment approach that would be most effective in dealing with the problem.

Many people who have mental disorders have difficulty understanding, expressing, or controlling emotions to some extent and this is especially true for those with borderline personality disorder. How is a person, who has issues with emotional control, supposed to respond to the highly emotional circumstance of being diagnosed with a disorder and offered psychotherapy as treatment? Even going to therapy sessions can be an intense experience where the patient has to confront his own extreme emotional swings. When faced with the important decision of accepting or denying the truth of a diagnosis and the option of attending therapy, emotions can be a very bad guide. One day, therapy may seem like a gift and offer lots of hope and relief. Another day, it may feel forced and unsettling, maybe even insulting. Because a person with borderline personality disorder is not afflicted with delusions, he does still maintain autonomy over his decisions and a deontological perspective gives the person with emotional issues the ability to exercise his autonomy independent of the influences of his disorder.

Deontology is the best ethical theory to be used by those people suffering from such mental disorders as borderline personality disorder that involve unregulated emotions. Lack of proper emotional control feels overwhelming and disorientating so the person can best exercise his autonomy through an objective deontological perspective. By judging his choices in life based upon self-formed maxims, the person will be more confident in the pursuit of treatment even during an emotional turmoil. He will recognize the necessity and positive role of therapy because he will understand that accepting professional help is something that can be universalized, that no matter the past experiences or present problems, if a professional believes you should be helped, than all those who are advised to do so, should accept the treatment. Thus, the people would be acting on the maxim of self-preservation, fulfillment, and hope instead of self-destruction and denial.


Kant, Groundwork: Moving from popular moral philosophy to the metaphysics of morals, Part II.

Nicki: Incest Survivors and “Borderline Personality Diso


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  1. I agree with the stand that you took with the article and applying Deontology to it. The applications of the ethically theory were very well described and I liked the moral issues that you pointed out from the article. I believe that your use of the first formulation of the categorical imperative most satisfies the solution to the idea of seeking help from therapists and then deciding whether or not people should go to these directed sessions. However, I feel as thought the second formulation could have been applied because you mentioned it when listing the three formulations. As Kant says, we should think of people as mere means, we must consider them as an end, however, this is applied to one’s self as well. We should treat ourselves as ends and not mere means. I think it would have been beneficial to maybe make a connection to the second formulation of the imperative because if we were to use ourselves as means, I feel like a person would not be compelled to go to therapy because there would be no point, when you are using yourself, what’s the point in trying to better the outcome? However, if we view ourselves as ends, then we will wish for the best outcome because the outcomes matter and we must have the right intentions of wanting to help ourselves when we are in trouble. I think going to therapy and taking the step to accept a diagnosis shows good intentions because there lies the intention of wanting to get better and wanting to help yourself.

  2. You hae introduced a very interesting application of deontology to this topic. Your two main moral concerns are very relevent and definitely of much concern when dealing with mentally ill patients. How can we force someone to get treatment for a disorder that is not as concrete as something like cancer? It is difficult to prove the existance of a mental disorder and this is whymany patients have a difficult time accepting their diagnosis.

    A point you bring up is that “the denial of diagnosis is equivalent to the denial of psychology as a respectable science.”
    This came as a new interesting idea to me, I never thought of it this way before. And it is very true according to Deontology and the universal maxim.

    A point that is missing in this paper is the fact that if you are looking at this situation through deontology then the doctors actions should also be looked at through deontology. If a doctor is acting correctly according to deontology he is not causing needless harm, acting to benefit the patient and following the principle of autonomy which in other words means to allow the patient to make his or her own decisions. I feel that if this was included in the paper it would be a stronger argument, however the argument is already very good.

    I enjoyed the analysis of the article, “Incest Survivors and Borderline Personality Disorder” because I found this article very interesting and easy to relate to your topic. I also think it strengthened your argument when you brought up the various moral problems throughout the article such as the true point of a support group.

    Overall this is a very well written paper that displays a very good understanding of Deontology and its application to real life sitatutions.

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