Introduction
This blog post contains my notes on the following article about borderline personality disorder. found on Huffington Post UK.
“Borderline Personality Disorder – A Diagnosis Of Invalidation”
by Dr Jay Watts in Huffington Post UK (2016/17)
It contains elements of my own interpretation, rather than trying to faithfully reproduce the article. I make these notes to reflect on and improve my own counselling and psychotherapy practice. But I am not setting out to make my own commentary on the psychiatric system separate from the author’s. In a spirit of learning, I am always happy to engage with and learn from (respectful) comments.
The challenge to Borderline Personality Disorder in the Huffington Post
What is going wrong?
The Huffington Post article highlights how psychiatric staff sometimes use a BPD diagnosis to demonise the person they are trying to help. This is not deliberate, of course, but a by-product of how BPD has come to be understood.
Borderline Personality Disorder (BPD) is constructed as a syndrome characterised largely by noticeable strong feelings and behaviours. These include a fear of abandonment, unstable relationships, extreme emotional turbulence, rage and disconnection from other people. The same is true of Emotionally Unstable Personality Disorder (EUPD). There is a large overlap between the diagnoses and health professionals sometimes use them interchangeably.
However, BPD is sometimes reduced to the manifestation of negative and destructive behaviours such as being manipulative and hostile. Framing BPD this way allows helpers to locate their experiences with ‘helpees’ primarily in terms of their effect on themself and ‘the system’ of which they are part. The helper slips into blaming the helpee for causing conflict or wasting resources.
By this stage, the helper has lost empathy for the person they are there to help. But the relationship between ‘helper’ and ‘helpee’ has been show to be one of the most transformative factors. And empathy is a critical aspect of this. Without empathy there can be no real understanding or capacity to help. The potential to help is now significantly reduced.
Dr Watts’s article cites the case of a woman who committed suicide on a psychiatric ward. Staff described her as “manipulative”, “argumentative” and “hostile” . It also demonstrates how our choice of language helps to continually re-create and reinforce it. The fact that staff feel backed up by medical science helps to legitimise this.
Language and labels: for better or worse?
Some people find a medical diagnosis or label stigmatising. Others find it comforting as an explanation of how they feel. It can feel like a good starting point for understanding themselves when this has previously seemed impossible. In that way it can help to stabilise one’s thoughts and feelings about oneself. Sometimes a person sees it as a means to access mental health services.
However, the Huffington Post article makes the case that language and labels associated with BPD are powerful. This is shown in the following examples.
- Humanly – the language of EUPD / BPD can shut down our humane response, as we only see and set out to manage negative behaviours, forgetting their underlying causes and that we are here primarily to help the person.
- Psychologically – Our sense of ourselves is constantly re-adjusted through absorbing how others experience and react to us. So, if we are characterised as manipulative and needy, that can reinforce our self-hate.
- Psychologically – What is implicitly read into or – sometimes wrapped into – a diagnosis of BPD may echo or reproduce the attacks (and neglect) of critical or abusive care-givers people in the person’s past who unwittingly helped shaped his or her behaviours. This is likely to reinforce and not resolve behaviours associated with BPD. This is relevant not just in providing therapy but also in how medical systems can potentially provoke such behaviours and then punish the person (patient) for them.
- Medically – the label of ‘BPD’ can (a study shows) lead to staff assigning a poorer prognosis to a person to someone than when they are just given the presenting issues.
Is Borderline Personality Disorder real?
BPD is an increasingly contested construct. Nowadays, its definitions lie in formal classifications of ‘mental disorders’ found in psychiatric manuals. Really there are only two. These are firstly the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. And secondly the World Health Organisation’s International Classification of Diseases (ICD). Huffington Post sits at the liberal end of the media spectrum. So, it no surprise that we can find in its pages a challenge to the definition of Borderline Personality Disorder.
There have been attempts to challenge these ideas. These include feminist critiques of the validity of such diagnoses; and government intervention. Would a re-construction of BPD help? Or just produce different but still unhelpful constructs and language? Simply changing the label won’t help if the new one build in the same amount of value judgement. Arguably, the whole ‘personality disorder’ mind-set now has so much built-in negativity that we need to start from scratch. It is questionable whether the ICD reclassification of personality disorders will achieve this.
BPD and trauma?
Feelings and behaviours such as hate, love, rage, destruction and manipulation are present in all of us to some degree. This is true even if we don’t recognise them. It may be that people diagnosed with BPD are feeling a wider range of these and/or more strongly than most of us. What gets labelled as BPD can be regarded as outward manifestation of these.
The Huffington Post poses BPD as a response to trauma
The Huffington Post article takes an increasingly common view as to the origin of what is labelled as Borderline Personality Disorder. What is called BPD is actually a response to previous trauma. This might be childhood abuse or neglect but equally might not be something quite so easily recognisable.
If we are helping someone deal with a trauma response, our therapeutic approach must reflect this. Recognising ‘disorder’ as a trauma response, alters the profession stance towards the person who faced trauma. It becomes easier to maintain empathy for a person we are trying to help. And to help them manage the feelings that are driving the outward expressions of those. That is especially important if a helper is sometimes feeling a person’s anger directed at them.
Further work required
- Look at responses to this Twitter thread, especially other viewpoints, for example that some people find receiving a diagnosis very helpful and a starting point for feeling better or initiating the change they seek.
Sources
“Borderline Personality Disorder – A Diagnosis of Invalidation” by Dr Jay Watts. Published: 26/09/2016 16:57 BST | Updated 27/09/2017 10:12 BST. Retrieved: 08 March 2018. http://www.huffingtonpost.co.uk/dr-jay-watts/borderline-personality-di_b_12167212.html