Academic journal article South African Journal of Psychiatry

De-Stigmatising Manipulation: An Exercise in Second-Order Empathic Understanding

Academic journal article South African Journal of Psychiatry

De-Stigmatising Manipulation: An Exercise in Second-Order Empathic Understanding

Article excerpt

A vast range of behaviours are labelled with the term 'manipulation', both in clinical and non-clinical situations. This word is used to stigmatise morally wrong ways of interacting, lumping together bullying, intimidation, physical violence, building special relationships, corruption, creating divisions, conning and lying, deceiving and threatening.[1,2] Manipulativity, although not an official diagnostic criterion for borderline personality disorder, is often used by clinicians to deplore the way in which these persons interact with others. Manipulation in people with borderline personality disorder is deemed deliberate and morally blameworthy rather than ill. Also, it is considered maladaptive since it reduces the other person's empathy towards the manipulator, undermining his/her desperate search for relationship and attention. Thus, manipulation is a term that tends to be over-inclusive and is affected by conceptual cloudiness and conflating moral values with clinical judgement.

Potter (p. 109) proposes a working definition of 'manipulativity' that can be summed up as follows: [1] it is a behaviour that dramatises the manipulator's needs/emotions in ways designed to target a perceived vulnerability in the other, in order to effect desirable responses by the other in an indirect way, although the other feels/thinks that the manipulator is overdoing his/her own need/emotion, s/he (the other) feels trapped by them.

This definition highlights the alloplastic purpose of manipulativity: producing a belief in, or action by the other.

In this article, I attempt to show that this is only one side of the coin, and shed light on a complementary aspect of manipulative behaviour: manipulation can serve an epistemic, rather than alloplastic, pragmatic motif-the attempt to establish contact with the other in order to achieve a more distinct experience and representation of the other.

An antipathetic behaviour

Imagine the following situation: a woman in her forties, hospitalised in a surgery ward of a general hospital, behaves restlessly, and is impatient, irritating and complaining. She attacked a nurse with no apparent reason when she tried to give her medication, refuses drugs, makes a fuss, asks for special treatment, etc. Nurses say that the patient is over-demanding, continuously looks for attention, and tries to manipulate them. Some qualify her behaviours as 'acting out', saying that she behaves thoughtlessly and impulsively.

You, as a psychiatrist, are asked to interview the patient. During the interview you exclude all sorts of disorders of consciousness (e.g. lowered, clouded, narrowed or expanded consciousness) and orientation (in time, place, situation, etc.), as well as psychotic phenomena (e.g. delusions, hallucinations). Feeling more at ease, at a given point the patient tries to clarify: 'Nobody wanted to explain to me what was going on. I could not understand what they were doing to me. Everything so obscure. I felt nervous, worried about that. I just wanted to know. Do I have the right to know and to decide? Or should I go away?'

During the staff meeting that follows your interview with the patient, you try to shed light on the motivations of the patient's behaviour, and on the staff's interpretations thereof. What is the purpose of this behaviour, if any? What is it about?

The first reaction is deeming her behaviour 'irrational', 'illogical', and 'unmotivated', thus 'incomprehensible' and 'almost crazy'. The majority, after a further reflection, suppose that her intention is 'manipulating', 'controlling', 'manoeuvring' the others. Someone more softly assumes that she tries to 'persuade' the nurses to act the way she wants. As to her innermost reasons to behave like that, some conjecture that it is because of her 'need to dominate' the others. A doctor speaks of 'sadism'--she needs to get pleasure from harming the other. Someone speculates that she may be driven by her 'fear of the other' and her 'need to control' the other who is supposed to be harmful. …

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