Did You Hurt Yourself?

PEOPLE WITH BORDERLINE PERSONALITY DISORDER (BPD) frequently deliberately injure themselves, to the extent that "the diagnosis [BPD] rightly comes to mind whenever recurrent self-destructive behaviors are encountered" (Gunderson, 2001, 54) quoted by (Potter, 2003, 1). How are we to understand this puzzling and disturbing behavior?

Situating her approach to this question within a general framework that sees the body as a "text" that requires "interpretation," Potter deliberately avoids answering this question in the way we might expect. It is doubtful, she argues, that every act of self-injury has a meaning, and a fortiori doubtful that every such act has the same meaning. Her discussion includes a section, informed by medical anthropology, in which she attempts to distinguish pathological self-injury of the sort that occurs with BPD from such culturally acceptable (or at least culturally understood or tolerated) body modifications, such as tattooing, scarification, and body piercing. It also includes a section in which it is suggested that the meaning of some self-injurious behavior may indicate cultural rather than individual pathologies (e.g., the "commodification" and "objectification" of women's bodies in Western culture). The principal issue for her, however, is how a clinician is to work out the meaning of a particular individual's self-injuring behavior when it does indeed have an individual meaning, and the prerequisite for doing so, she argues, is the cultivation of a virtue she terms giving uptake.

The general tenor of her argument seems to me to be admirable: the issues are dealt with subtly and with ethical, anthropological, and philosophical sensitivity. There are nonetheless a number of questions I want to raise.

The Framework

It is of course fashionable in certain quarters these days to speak of the body as a text. One might, however, wonder to what extent this metaphor is illuminating. After all, texts, one might think, are by definition linguistic; yet part of the point here is precisely to move away from the narrow "speech-act" focus of "traditional philosophical analyses of communication" (Potter 2003, 1-16).

The point of the metaphor according to Potter is to "suggest that the body, like other mediums of communication, must be interpreted and that its meanings are not given or inevitable" (Potter 2003, 2). Again, however, this invokes a number of fashionable but questionable ideas: an easy reliance on the difficult idea that "how we experience the world is shaped by our conceptual scheme" (Potter 2003, 3), a structuralist account of signification (Potter 2003, 3), and the concomitant notion that all communication involves interpretation, indeed that the listener (or observer) "relies on linguistic and other conventions to infer meaning" (Potter 2003, 4). As a general account of communication this seems to me to be wildly off the mark: we very seldom interpret others' words, we very seldom "infer their meaning." The supposition that we always do is the direct consequence of the externalizing of the relation between "signifier" and "signified" that constitutes the heart of structuralist linguistics. ¹

Now, it may well be that the sort of self-injuring behavior that is the focus of Potter's essay precisely does require interpretation. Insofar as it is expressive behavior (and again Potter is right to question whether it is necessarily always such), it seems to be importantly different, in just these respects, from many other forms of expressive behavior. In the first place, it is different (in just these respects) from the culturally tolerated forms of body modifications discussed in section 2; for members of the culture in which body piercing or tattooing is acceptable or tolerated, such behavior is understood without the need for interpretation. In the second place, it is different in just these respects from natural expressions (e.g., moaning as an expression of pain). And in the third, it is different in just these respects from the expression of thoughts in (at least nonmetaphorical) language (which, one might add, is all the more reason not to think of the body as a...