Abstract

The Virtue of Defiance and Psychiatric Engagement argues that defiance sometimes is a virtue even for those with mental illnesses. It also argues that defiance is sometimes mistaken as a sign of mental disorder when it may have other, reasonable explanations. This book offers a nuanced and complex look at defiance, taking seriously issues of mental disorders while also attending to social contexts in which defiant behaviour may arise. Arguments are presented for how to understand defiance as different from noncompliance, resistance, and other related concepts, and how defiance is related to living a life with a realistic understanding of a flourishing life and its limits in our everyday world. A framework for differentiating different forms of defiance is offered, and a realistic picture of phronesis—practical reasoning—is presented that makes room for clinicians as well as patients to assess the degree to which defiance is reasonable. The concept of intersectionality as it related to child development is worked through to highlight some of the challenges clinicians face when interpreting defiant behavior. Particular attention is given to issues of race and gender as factors that need to be considered when evaluating defiant behavior as reasonable, virtuous, bad, or symptomatic. Those who work with defiant patients are invited to engage in different ways with defiant people so as to better understand and respond to those who express that defiance. This involves the learning to cultivate what the author calls the virtue of giving uptake. Because giving uptake is difficult to do well, the author employs theoretical work on epistemic resistance—resistance that, despite thoughtful and well-intended--clinicians may grapple with in being responsible knowers and that can impede their understanding and responsiveness to those who are, or seem to be, defiant. Practical applications for psychiatric engagement are threaded throughout this book through case studies and personal narratives.