Taking responsibility: Toward an understanding of morality in practice. An ethnographic investigation of the social construction of responsibility in the dialectical behavior therapy of women diagnosed with borderline personality disorder
بررسی مردم نگارانه و ساخت اجتماعی مسئولیت در درمان رفتار دیالکتیکی زنان مبتلا به اختلال شخصیت مرزی
Abstract: Although the nursing literature overflows with references to the myriad things for which nurses and patients are de facto responsible, nurses have never explicitly examined the social construction of responsibility in any clinical context. This ethnographic investigation of a unique, 10-bed residential treatment facility for women diagnosed with borderline personality disorder (BPD) sought to identify, describe, and understand the social processes by which a particular mental health treatment community constructed responsibility. Consistent with feminist naturalism and informed by the feminist moral philosophy of Margaret Urban Walker (1998), this study utilized the naturalistic field methodology of Schatzman and Strauss (1973) and incorporated data analytic methods of grounded theory to map, examine, and understand the practices and distributions of responsibility within an intensive residential treatment facility staffed by and for women. This study reviewed and integrated the empirical and philosophical literature on moral responsibility, organized in terms of its forward- and backward-looking dimensions. It selectively reviewed both traditional and feminist philosophical accounts to more deeply understand the socially constructed nature of responsibility in the context of mental health nursing as well as its implications for understanding morality in nursing practice. Ultimately, this study sought to illuminate the concept of \'taking responsibility\' qua moral responsibility and asked what made this notion of responsibility particularly \'moral.\' It found that (a) taking responsibility in this context was a matter of doing dialectical work, i.e., resolving the paradoxes, or synthesizing the dialectical tensions invisibly embedded within the treatment environment; (b) taking responsibility in this setting was a matter of managing the chaos and \"craziness\" not just of individual lives but also the \"craziness\" of the larger mental health system; and (c) taking responsibility in this setting had varieties of form and meaning across multiple dimensions of complex activity, was pervasive in its forward-looking modes, and frequently was unhelpful in its backward-looking modes, i.e.; it did not serve to resolve paradox or synthesize dialectical tension.
Keywords: Health and environmental sciences, Social sciences, Psychology, Responsibility, Morality, Dialectical behavior therapy, Women, Borderline personality disorder