Research Seminar Series 2020
Presenter: A/P David Butt
When: 12th June 2020
Functional Linguistics in the treatment of Borderline Personality Disorder: the Conversational Model and aspects of complementary practice across linguistics and psychiatry.
Borderline Personality Disorder is a devastating condition. B.P.D. disables intimate relations and social connections. It dramatically constricts the living of life. Yet, paradoxically, it can emerge in some apparently ‘high functioning’ individuals. The checklist of descriptions in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) is suggestive of the controversies that have surrounded the clinical status of the syndrome: for example, its typical overlay of other disorders; and its relation to “dissociation”. Patients have, in an unfortunate proportion of cases, been classified as intractable, and sent round and round service and medical providers.
A deeper interpretation of BPD comes from the Conversational Model of Psychotherapy, first developed in the U.K. during the 1970s by Robert Hobson (1920-1999) and Russell Meares - Emeritus Professor and previous head of the unit at Cumberland Hospital. This model of treatment, which has been carefully tracked for its measurable outcomes, addresses the patients in relation to a “painful incoherence”, a disaggregation and emptiness of the “self”: a failure in the construction of the sense of person. An inertness at core.
Many aspects of the Conversational Model refine insights from the founders of neuroscience and psychiatry – Hughlings Jackson (1835-1911); Ribot (1839-1916); Janet (1859-1947); and the consolidation of ideas put forward by William James (in 1890; 1892; and 1902). All emphasized the “co-ordination” and cohesion issues that are fundamental to the brain/CNS. Jackson, for instance, saw mental disorders as a breakdown of the levels of evolutionary development in the brain, and he was probably the first to theorise the “self’ as an organic concern within a modern medical context. In the second part of my discussion, using James’s contrast of representations of the “duplex self” (ME vs. I), along with the writings of Meares (2005:Ch.9; 2012:206) and of Damasio (2010:46ff), I will elaborate linguistic aspects of the self as biological and personal “value”.
But the presentation will first exemplify various tools from functional linguistics which have already proven effective in sharpening diagnostic concepts; in offering measurements of ‘improvement’ or of dissociation/incoherence; in characterising the therapeutic interaction as a distinct register; and in capturing the shared interactive techniques of practitioners (noting that this sharing is maintained in the context of a variety of professional and personal styles). The increased clarity around professional techniques has been important for patients, and also in the medical training supervised each year through Westmead and Cumberland Hospitals, and through annual conferences here and overseas.
While there are interpretive benefits from just carefully distinguishing subject, theme, and actor within the grammar of clauses, and from measuring cohesive ‘harmony’ across a patient’s discourse, what may be most surprising is how the collaboration has opened up new aspects of linguistics and semiotics for the linguists in the research project (viz. previously our NHMRC funded project “The discourse correlates of the Conversational Model…” 2005-2008). Of particular significance are the concepts around child language development, interpersonal meaning, semantic theory, intonation and voice quality, register theory, narratology, and the ways in which the specific systems of a grammar may be a catalyst for new meaning potential.
Psychiatry/psychotherapy and linguistics are both a polyphony of science, of craft (a techne/ τέχνη of Classical Greek philosophical debate), and of artistic insight in relation to meanings. We share the challenges of ‘hermeneutic’ sciences – how to interpret the often ambivalent messages delivered by Hermes - the winged god of language; the ‘soul guide’ or “psychopomp” in Greek; but also a ‘trickster’ or maker of mischief.
[After the talk, a pdf of the slides, with references, will be available if you email me individually. Please note, parts of the transcript material may be confronting. I plan to minimize this aspect and warn listeners along the way.]