Abstract
One of the most common ways of characterizing patients diagnosed with borderline personality disorder is that they are manipulative. Clinical usage of the term varies widely but clearly carries a pejorative meaning. Furthermore, behaviors that look similar to those called manipulative in clinical contexts are not called manipulative in broader society. It is crucial to become clear on what manipulation is, because studies show that carers routinely perceive BPD patients as manipulative and so have less empathy for them. In this paper the concept of manipulativity is clarified and its scope narrowed by distinguishing it from a number of related concepts, and a number of reasons why manipulating others is morally objectionable are suggested. I argue that, while some BPD patients may be manipulative, much of their behavior can and should be understood in a different light. Moral and clinical values are conflated in carers' judgments of manipulativity, and clinicians and researchers need to clarify when and why manipulative behavior is dysfunctional, and when it is merely morally wrong. Separating these two domains will enable carers to be more empathetic and less blaming of their patients' behavior.
Nyquist Potter, Nancy. (2006). What is Manipulative Behavior, Anyway?. Journal of personality disorders. 20. 139-56; discussion 181. http://dx.doi.org/10.1521/pedi.2006.20.2.139
Key Notes
"[Makes an example of sex workers and flight attendants manipulating their client's emotions and the use of emotional labour (regulating their own emotions to "perform" context appropriate service)] In other words, I am arguing that some forms of behavior that might appear to be manipulative involve complex negotiations of people in social roles, or are entered into with an implicit understanding[...] Con artists are called manipulative, but their interactional relation is different. What distinguishes this case from the examples above is that the con game can only work if the victim is ignorant of what is truly occurring[...] his case does seem to fit the general idea of manipulation as bad means to achieve one’s ends, but I will argue later that deception and manipulation are analytically separate concepts."
"Recall that, in clinical literature, one type of behavior that counted as manipulative was patients who threated to make official complaints if they were not treated the way they thought was right. But consider this type of behavior in another context[...] Protests and strikes occur when people are experiencing injustice or a violation of their rights and other forms of redress are unavailable. When power imbalances exist and the more powerful party refuses to negotiate in good faith, the less powerful may threaten other actions such as strikes or protests. Are threats always manipulative? A threat to strike may simply be the next move in a frustrating attempt to be taken seriously. In our society, we do not ordinarily talk about threats to strike as manipulative (although employers might frame it that way). Furthermore, it’s not clear that attempts to claim a right to be treated fairly should fall into the category of “intent to harm.”
This example raises the question of why BPD patients who are similarly less powerful and need pathways to ensure fair treatment are called manipulative when they threaten to take advantage of those securities. Bowers (2002) argues that, while some complaints are justifiable and for good cause, others seem to be done spitefully or over trivial matters[...] Putting Bowers’ ideas together with the above argument, I would say that manipulativity in patients who threaten to make official complaints would not consist in the activity per se but in a cluster of other issues that must be viewed in context, such as what a particular patient’s motives are, what events preceded the complaint, how dysfunctional the patient is, and so on. In other words, the act of threatening to make an official complaint does not entail manipulativity any more than the act of threatening to strike does."
"There appear to be two problems in the use of the term manipulation. One is that, even in the restricted domain of clinical contexts, the class of behaviors is over-inclusive[...] With such a range of behaviors, the primary message seems to be a negative judgment—vague in content but powerful in effect. Clinicians use the term as a superordinate category under which morally wrong ways of interacting are included. But lumping all these behaviors together is not therapeutically useful, because it doesn’t allow for differentiation between kinds of behavior that vary among BPD patients. Furthermore, moral wrongdoings (such as lying) are distinguished from other kinds of wrongdoing (such as being divisive) both in moral theory and in ordinary language; the action, intention, and type of harm done are part of the evaluation of what makes each action wrong, and the identifying features of each of these moral wrongs are importantly different. So it is a mistake for clinicians to group all these behaviors under a general heading of manipulativity.
The second problem is that a mismatch exists between the meaning of the term in everyday settings and in clinical settings[...] In ordinary life, many similar behaviors are not called manipulative. Is this mismatch warranted? Are all of us more manipulative than we think—and, if so, what would that finding indicate about the ordinary person’s mental health? Or are BPD patients being held to a higher standard of behavior and interaction than are others?
Most people occasionally deceive, are indirect about what they want, disguise their true feelings, and intimidate others (Goffman, 1952). But BPD patients are routinely characterized—pejoratively—as manipulative. "
"Another approach to distinguish between everyday and pathological manipulativity is to identify what forms of manipulativity are dysfunctional or maladaptive[...] To call BPD manipulativity maladaptive, though, merely pushes the question back: why, and when, is manipulativity maladaptive? If I am right that behavior that is called manipulative in clinical settings is condoned, expected, or not even noticed in nonclinical settings, we need to have a noncircular way of identifying pathological manipulation."
"Why are patients viewed through a lens of dysfunctional manipulation rather than seen as participants in tacitly understood social interactions, or engaged in a type of persuasion, or as making a move in a negotiation? The reason is that clinicians are as likely to perceive manipulative behavior based on preconceived notions of BPD patients as they are to base judgments on clear and objective perception. That is, their perceptions may be based on stereotypes of BPD patients."
"Research by Bowers (2002) returned similar responses: nurses were virtually unanimous that these patients are to blame for their behavior. The nurses reason that, unless a patient is deluded or hallucinating, or confused or muddled, the patient knows what she or he is doing and is therefore responsible for those actions."
"This discussion thus points to three questions. (1) Are clinicians seeing something objectively real in BPD patients? (2) Is that behavior best described as manipulative? (3) Given the pejorative use of the term when referring to BPD patients, manipulative is being used to convey strong disapproval. But what is wrong with patients manipulating their clinicians and staff? The second half of this essay considers possible answers to this last question and shows how moral values and values of psychological well-being are conflated."
"As I indicated earlier, we cannot rule out the possibility that patients perform complex negotiations in their relationships with clinicians and that those interactions are socially encoded in the patients’ view. Are patients manipulative in all contexts? Or is manipulation a sociological phenomenon that occurs particularly in response to clinicians? Are patients enacting a social role that is common among people who experience themselves as relatively powerless? Answers to these questions would be fruitful in evaluating manipulative behavior."
"Inappropriateness in behavior suggests social ineptness, not necessarily dysfunction. And inappropriate behavior is sometimes the outcome when someone is challenging conventions and norms that are subjugating. Perhaps Lotta is actively resisting (in the political sense) the patient role as subservient, compliant, and subjugated. All this behavior could turn out to be dysfunctional for Lotta, but one encounter is insufficient to assess her. In order to know whether Lotta is dispositionally and pathologically manipulative, more time in interactions with her is needed, more context needs to be developed, and more attention to clinicians’ perceptions and assumptions needs to be paid.
The question I have been addressing is whether clinicians are justified in taking a pejorative and judgmental stance towards BPD patients. While a violation of norms for relationship might provide an explanation of why clinicians react negatively to BPD patients, it doesn’t provide warrant for sweeping labels of manipulativity or the negative attitudes that are entailed. Such attitudes do not satisfy therapeutic and moral norms that clinicians are expected to follow: namely, that clinicians need to develop empathy for their patients’ suffering and distress. When clinicians view patients’ primary character as morally objectionable, it’s difficult for clinicians to feel empathy and for patients to either receive or elicit it."
Note from PDV!: This entire article is a great read and does much to address how to define manipulation and how it is used and why even manipulation might be morally objectionable. I wish that they had carried through the idea that people diagnosed with BPD are held to a far higher standard into the second part of the study, holding the examples of "manipulative behaviour" within the literature under scrutiny because the examples offered really really fall short in my opinion, and indeed I think the behaviour of clinicians is often far more manipulative than any client could be as they act from a position of power. I also have some qualms with the idea of "pathological manipulation" as I'm of the belief that calling somebody manipulative is an inherently moral judgement of behaviour that is an obstacle to actually providing support for a person's underlying needs. This is much better addressed by Keir Harding's article Why are people with Personality Disorder so manipulative?
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