Ogden Nash’s quip implies a perfectly neutral attitude on the part of a professional to the affairs of the people he deals with. Perhaps it is a familiar view of professional people. We need our accountants, lawyers and so on to give us an objective view of our affairs. Maybe that should be what is needed from the caring professions. However, I have argued that within psychiatry carers are particularly disconcerted by the work they do (Hinshelwood, 1999; 2004). In the present paper, I wish to look in some closer detail at these interpersonal processes that occur between carers and those they care for, with particular emphasis on personality disordered people.
This Chapter will take a critical perspective, questioning and problematising the standard approach to care provision based on the consumer model as developed since about 1990 in the NHS. The critique will involve a perspective based on a relational model, in which ‘users’ will be recognised as in relation with their carers, rather than merely objects of care; and indeed ‘carers’ are, equally, in a relationship with their users. In other words the critical position is to focus on ‘users’ in context, and in the relational environment of care. Increasingly the discovery of the notion of compassionate care (DoH Commissioning Board, 2012), has begun to point to the human environment of relationship – the concern, feelings and generally of the psychic pain in providing and receiving care.
Diagnostic terms such as personality disorder, and role assignments such as ‘user’ even, will be used here only in their descriptive sense, and not in the labelling functions that allot persons to professional categories of abnormality or social role. The enquiry in this Chapter is a) whether such a contextualising of persons within relations may add to our understanding of care provision and its problems, and b) if it does so add, what does it lead to in terms of doing things differently.