Is Borderline Personality Disorder real? Is the use of that term as a label or diagnosis damaging? It is certainly a highly contested construct. This blog post contains my notes on a Huffington Post UK article: “Borderline Personality Disorder – A Diagnosis Of Invalidation” by Dr Jay Watts. 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. In a spirit of learning, I am always happy to engage with and learn from (respectful) comments. I am not, however, setting out to make my own commentary on the psychiatric system separate from the author’s.
Language and labels – some points from the article
The diagnoses of Emotionally Unstable Personality Disorder (EUPD) and Borderline Personality Disorder (BPD) tend to be used interchangeably. These are constructed as a syndrome characterised by things like a fear of abandonment, unstable relationships, extreme emotional turbulence, rage and disconnection.
BPD is sometimes reduced to the manifestation of negative and destructive behaviours such as being manipulative and hostile. These are then seen only in their effect on, say, psychiatric staff or on the system such as causing conflict and wasting resources. The language “manipulative”, “argumentative” and “hostile” used of a woman who committed suicide on a psychiatric ward is both symptomatic of this position and of 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, a means to stabilise their thoughts about themselves or a means to access services. However, the article makes the case that language and labels are powerful, as 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.
Borderline Personality Disorder – is it real?
So is Borderline Personality Disorder real?There have been attempts to challenge these ideas, such as feminist critiques of the validity of such diagnoses; and government intervention. Would a re-construction help; or just produce different but still unhelpful constructs and language? Changing the label risks simply choosing a new term that carries an amount of value judgement equal to that now arguably built into the whole ‘personality disorder’ mind-set and terminology.
Going forward, it is important to recognise that feelings and behaviours such as hate, love, rage, destruction and manipulation are present in all of us to some degree and that BPD is a larger-scale manifestation of these. Our therapeutic approach must take into account the consistent link between this and childhood abuse, neglect and trauma.
Further work required on the original blogpost:
- 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
“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