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Title: 'Emerging severe personality disorder' in childhood : the reification and rhetorical functions of a proposed developmental disorder
Author: Clark, Dawn
ISNI:       0000 0004 5357 5166
Awarding Body: University of Roehampton
Current Institution: University of Roehampton
Date of Award: 2014
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This research employed Discursive Psychology and some Foucaudian concepts to explore discourses concerning proposals for ‘Emerging Severe Personality Disorder’ (ESPD) to interrogate potential ‘effects in the real’ for patients, clinicians and approaches to psychological interventions. The constructivist review of literature explores reification processes in propositions for ESPD in a brief reconsideration of historical ‘personality disorder’ discourses with a particular focus towards UK policy. This traces ESPD’s inextricable links to revival of the ‘psychopathy’ construct via invention of the ‘psychopathy checklist’, policy-makers ‘Dangerous and Severe Personality Disorder’ (DSPD) terminology and the ‘interventionist imperatives’ in youth justice driven by the Crime and Disorder Act (1998). Fourteen interviews highlighted rhetorical strategies by which practitioners worked up their epistemological entitlements to use ESPD appropriately by undermining entitlements of others. Some demonstrated autonomy by refusing to use the term ESPD at all. Other practitioners positioned those ‘outside mental health’ as potentially misusing ESPD while erroneously reifying it themselves as a formal ‘diagnosis’ or something that children ‘are’. Associated repertoires concerned iatrogenic or exclusionary ‘effects in the real’ linked to frustration at being ‘forced’ by the government to work with the ‘untreatable’. Ideological dilemmas arose throughout, most notably where practitioners who were concerned the label ESPD could exclude children from treatment discursively excluded ‘high-risk’ older children with beliefs ‘early intervention’ only. This saw children subject positioned similarly to their historically assumed ‘untreatable’ adult counterparts with ‘personality disorder’ diagnoses rather than being ‘at risk of’. A final ideological dilemma arose for practitioners as many believed in ‘early intervention’ but conceded that risk prediction in psychiatry was unreliable and could lead to over use of ESPD, with potentially damaging outcomes. The review and analysis are discussed in terms of bringing about a new version of ESPD’s reification with emphasis on encouraging further discussion concerning potential objectification of future ESPD category recipients, assumed ‘prognosis’, advances towards clinical intervention and issues regarding possible further exclusion from services or residential care. It is argued studies with a discursive focus can investigate labelling concerns in ways which positivist methodologies in the medico-legal approach fail to and that this embraces counselling psychology’s historical aims towards ‘social justice’ in its (assumed) critical approach to psychopathology which, (if it has one at all) is consistently tested in this current political climate of ‘evidence-based practice’.
Supervisor: Dubowski, Janek ; Moon, Lyndsey Sponsor: Not available
Qualification Name: Thesis (Psych.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available