Pub Date : 2023-07-31DOI: 10.1332/147867321x16878111260082
David W. Jones, Jo Lomani
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Pub Date : 2023-07-26DOI: 10.1332/147867323x16881441383633
Wren Aves
The healthcare experience of many people carrying the label ‘borderline personality disorder (BPD)’ is one of exclusion, discrimination and neglect. The letters ‘BPD’ replace our very humanity, trampling our right to receive evidence-based, appropriate, lawful and compassionate care. Within mental health services our pain, distress, unusual experiences and self-harm/suicidal actions have been reconceptualised as ‘behavioural’ issues, encouraging the promotion of punitive and cruel responses from professionals in an attempt to discourage us from seeking help. ‘Responsibilisation’ narratives, which prioritise personal independence over all else, legitimise institutional neglect. We are told suicide is a choice we have the capacity to make, while care is actively withheld to avoid us becoming dependent on support. Despite the rising suicide rates of people labelled with a personality disorder diagnosis in the UK, our risk continues to be downplayed; rewritten as a risk of death by ‘misadventure’; and accepted by services and coroners as a justifiable outcome of so-called ‘less is more’ care plans. This article explores the current mental health service landscape in which prejudice and stigma direct ‘BPD’ care through the creation and maintenance of clinical mythology, which despite its popularity across healthcare teams, is not supported by ongoing research findings and recommendations.
{"title":"Dispelling myths and challenging neglect in ‘borderline personality disorder’ healthcare: a lived-experience perspective","authors":"Wren Aves","doi":"10.1332/147867323x16881441383633","DOIUrl":"https://doi.org/10.1332/147867323x16881441383633","url":null,"abstract":"The healthcare experience of many people carrying the label ‘borderline personality disorder (BPD)’ is one of exclusion, discrimination and neglect. The letters ‘BPD’ replace our very humanity, trampling our right to receive evidence-based, appropriate, lawful and compassionate care. Within mental health services our pain, distress, unusual experiences and self-harm/suicidal actions have been reconceptualised as ‘behavioural’ issues, encouraging the promotion of punitive and cruel responses from professionals in an attempt to discourage us from seeking help. ‘Responsibilisation’ narratives, which prioritise personal independence over all else, legitimise institutional neglect. We are told suicide is a choice we have the capacity to make, while care is actively withheld to avoid us becoming dependent on support. Despite the rising suicide rates of people labelled with a personality disorder diagnosis in the UK, our risk continues to be downplayed; rewritten as a risk of death by ‘misadventure’; and accepted by services and coroners as a justifiable outcome of so-called ‘less is more’ care plans. This article explores the current mental health service landscape in which prejudice and stigma direct ‘BPD’ care through the creation and maintenance of clinical mythology, which despite its popularity across healthcare teams, is not supported by ongoing research findings and recommendations.","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"2008 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90281385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-12DOI: 10.1332/147867323x16871713092130
D. Jones
This article suggests that to appreciate some of the conundrums that surround ‘borderline personality disorder’ (BPD), we need to understand more about its history and the contexts and cultures in which it arose, consolidated and proliferated. Previous work on the development of personality disorder diagnoses (Jones, 2016) points to their emergence and shape being determined by the interaction of a multiplicity of forces including the needs of distressed individuals and communities; the manoeuvring of professional groups seeking to provide solutions to that distress and the cultural, public and media representations and responses to those problems and the proposed solutions. This single article can only begin to outline some of the key issues and will focus on the emergence of the diagnosis within the discourses of psychiatry. As we will see in the case of BPD, like other, so-called, disorders of personality, there are connections to major social changes; in particular to some of the anxieties raised by urbanisation and industrialisation and later processes of deindustrialisation and their impacts on people’s lives and identities. The article argues that significant roots of the diagnosis can be traced back to major fault lines in the discipline of psychiatry and unresolved questions about its own borders. Is psychiatry a branch of the medical profession or is it a cross-disciplinary endeavour that centres the mind as an object of study and treatment, which cannot merely be located in the individual but is instead immanently connected to the social and cultural world?
{"title":"A history of borderline: disorder at the heart of psychiatry","authors":"D. Jones","doi":"10.1332/147867323x16871713092130","DOIUrl":"https://doi.org/10.1332/147867323x16871713092130","url":null,"abstract":"This article suggests that to appreciate some of the conundrums that surround ‘borderline personality disorder’ (BPD), we need to understand more about its history and the contexts and cultures in which it arose, consolidated and proliferated. Previous work on the development of personality disorder diagnoses (Jones, 2016) points to their emergence and shape being determined by the interaction of a multiplicity of forces including the needs of distressed individuals and communities; the manoeuvring of professional groups seeking to provide solutions to that distress and the cultural, public and media representations and responses to those problems and the proposed solutions.\u0000This single article can only begin to outline some of the key issues and will focus on the emergence of the diagnosis within the discourses of psychiatry. As we will see in the case of BPD, like other, so-called, disorders of personality, there are connections to major social changes; in particular to some of the anxieties raised by urbanisation and industrialisation and later processes of deindustrialisation and their impacts on people’s lives and identities.\u0000The article argues that significant roots of the diagnosis can be traced back to major fault lines in the discipline of psychiatry and unresolved questions about its own borders. Is psychiatry a branch of the medical profession or is it a cross-disciplinary endeavour that centres the mind as an object of study and treatment, which cannot merely be located in the individual but is instead immanently connected to the social and cultural world?","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"3 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72922929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-12DOI: 10.1332/147867321x16869242475575
Cassandra Lovelock
This article draws on the lived experience of the author to discuss the Black mixed-raced experience of being diagnosed with borderline personality disorder (BPD), particularly in relation to the BPD symptom of troubled identities. This article argues that what psychiatry pathologises as a troubled identity within BPD is actually an everyday experience for a mixed-race person growing up between cultures. This article goes on to discuss Black mixed-race people’s identity through a lens of performativity, how this presents and is weaponised in psychiatry, and why it is important for psychiatry to understand Black mixed-race identities.
{"title":"Are you borderline or did you grow up without a racial identity? Black mixed-race identity disturbance and an unstable sense of self","authors":"Cassandra Lovelock","doi":"10.1332/147867321x16869242475575","DOIUrl":"https://doi.org/10.1332/147867321x16869242475575","url":null,"abstract":"This article draws on the lived experience of the author to discuss the Black mixed-raced experience of being diagnosed with borderline personality disorder (BPD), particularly in relation to the BPD symptom of troubled identities. This article argues that what psychiatry pathologises as a troubled identity within BPD is actually an everyday experience for a mixed-race person growing up between cultures. This article goes on to discuss Black mixed-race people’s identity through a lens of performativity, how this presents and is weaponised in psychiatry, and why it is important for psychiatry to understand Black mixed-race identities.","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80680311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.1332/147867321x16869242230927
_ _
A personal account of the inability to discard the borderline personality disorder (BPD) diagnosis decades after it has been applied. The impact of a BPD diagnosis continues long after discharge from treatment services. The author seeks a route map out of BPD labelling but there is no process to follow.
{"title":"Serving life due to borderline personality disorder","authors":"_ _","doi":"10.1332/147867321x16869242230927","DOIUrl":"https://doi.org/10.1332/147867321x16869242230927","url":null,"abstract":"A personal account of the inability to discard the borderline personality disorder (BPD) diagnosis decades after it has been applied. The impact of a BPD diagnosis continues long after discharge from treatment services. The author seeks a route map out of BPD labelling but there is no process to follow.","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"90 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89187752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.1332/147867321x16862340840414
Hattie Porter
Research indicates transgender people are more likely to be diagnosed with a personality disorder than cisgender people. While this interrelationship is complex and multifaceted, this article discusses the disproportionate rates of personality disorder diagnosis in transgender people as rooted within social and historical contexts; suggesting transgender people are not more likely to have a personality disorder, rather they are more likely to be diagnosed with a personality disorder. Transgender identities have historically been framed as a manifestation of mental illness as opposed to an identity and inherent aspect of personhood. This is argued to confine understanding of transgender identities to the parameters of pathology, silencing and marginalising transgender communities. I suggest the disproportionate rate of diagnosis of personality disorders in transgender people is an extension of this historical pathologisation. Clinician bias may contribute to inappropriate diagnosis of personality disorders in transgender people due to personal values and unfamiliarity with transgender experiences. However, bias is also more deeply rooted within the construct of personality disorders itself, which appears to inherently pathologise deviation from rigid gender norms and expectations. This has implications for the ethical and ontological basis of the diagnostic construct.
{"title":"It’s not my sense of self that’s unstable, it’s the world’s sense of me: the harms of the construct of ‘personality disorders’ towards transgender communities","authors":"Hattie Porter","doi":"10.1332/147867321x16862340840414","DOIUrl":"https://doi.org/10.1332/147867321x16862340840414","url":null,"abstract":"Research indicates transgender people are more likely to be diagnosed with a personality disorder than cisgender people. While this interrelationship is complex and multifaceted, this article discusses the disproportionate rates of personality disorder diagnosis in transgender people as rooted within social and historical contexts; suggesting transgender people are not more likely to have a personality disorder, rather they are more likely to be diagnosed with a personality disorder.\u0000Transgender identities have historically been framed as a manifestation of mental illness as opposed to an identity and inherent aspect of personhood. This is argued to confine understanding of transgender identities to the parameters of pathology, silencing and marginalising transgender communities. I suggest the disproportionate rate of diagnosis of personality disorders in transgender people is an extension of this historical pathologisation.\u0000Clinician bias may contribute to inappropriate diagnosis of personality disorders in transgender people due to personal values and unfamiliarity with transgender experiences. However, bias is also more deeply rooted within the construct of personality disorders itself, which appears to inherently pathologise deviation from rigid gender norms and expectations. This has implications for the ethical and ontological basis of the diagnostic construct.","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"38 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87370212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.1332/147867321x16872536791817
Nina K. Fellows
The purpose of this discourse study is to deconstruct how a journal article published in Early Intervention in Psychiatry, ‘Sexuality and sexual health among female youth with borderline personality disorder pathology’ (Thompson et al, 2017), constructs the sexuality of young women diagnosed with ‘borderline personality disorder’. The methodology used was Foucauldian discourse analysis, following Hook’s (2001) recommendation to re-situate a text within its socio-political location and among its material correlates, as well as analysing its intra-textual discursive features. The process of analysis involved repeated close readings of the text by Thompson et al (2017), with a focus on binary oppositions within the text, and the power/knowledge nexus in which it is situated. The analysis identified three key discourses at work in the text: the discourse of the academy, the discourse of dichotomy, and the discourse of ‘borderline’ sexuality, which contains a conceptually unstable paradox concerning female ‘borderline’ sexual agency. The consequences of these findings, their historical context, and implications for practice and classification are discussed.
本话语研究的目的是解构发表在《精神病学早期干预》杂志上的一篇文章，“边缘性人格障碍病理女性青年的性行为和性健康”(Thompson et al, 2017)，如何构建被诊断为“边缘性人格障碍”的年轻女性的性行为。使用的方法是福柯式的话语分析，遵循胡克(2001)的建议，将文本重新置于其社会政治位置和材料相关性中，并分析其文本内话语特征。分析过程涉及汤普森等人(2017)对文本的反复仔细阅读，重点关注文本中的二元对立，以及它所处的权力/知识联系。分析确定了文本中起作用的三个关键话语:学院话语，二分法话语和“边缘性”话语，其中包含一个概念上不稳定的悖论，涉及女性“边缘性”性代理。这些发现的后果，他们的历史背景，并对实践和分类的影响进行了讨论。
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Pub Date : 2023-07-05DOI: 10.1332/147867323x16863891304659
Astrid Fly Oredsson
I argue that the inappropriate anger criterion for borderline personality disorder (BPD) is likely to contribute to gender bias in the diagnostic process. In its current form, the inappropriate anger criterion is vaguely formulated, providing close to no guidance on to how to distinguish inappropriate from appropriate anger. Further, recent work in moral psychology highlights that the inappropriate anger criterion can be understood and applied in wide range of ways, none of which are required nor excluded by criterion. Moreover, research on public administration and management gives us reason to suspect that the criterion’s ambiguity coupled with the working conditions characteristic of healthcare settings is likely to increase the risk that clinicians will rely on stereotypes in their assessments of the appropriateness of anger. Specifically, various empirical studies point to the existence and widespread influence of gender stereotypes whereby anger is associated with men. Women who display anger are seen as underconforming to prescribed gender roles and, therefore, abnormal. Thus, we have good reason to think that women’s anger will more often be thought inappropriate than men’s, in general and in psychiatry.
{"title":"Women ‘out of order’: inappropriate anger and gender bias in the diagnosis of borderline personality disorder","authors":"Astrid Fly Oredsson","doi":"10.1332/147867323x16863891304659","DOIUrl":"https://doi.org/10.1332/147867323x16863891304659","url":null,"abstract":"I argue that the inappropriate anger criterion for borderline personality disorder (BPD) is likely to contribute to gender bias in the diagnostic process. In its current form, the inappropriate anger criterion is vaguely formulated, providing close to no guidance on to how to distinguish inappropriate from appropriate anger. Further, recent work in moral psychology highlights that the inappropriate anger criterion can be understood and applied in wide range of ways, none of which are required nor excluded by criterion. Moreover, research on public administration and management gives us reason to suspect that the criterion’s ambiguity coupled with the working conditions characteristic of healthcare settings is likely to increase the risk that clinicians will rely on stereotypes in their assessments of the appropriateness of anger. Specifically, various empirical studies point to the existence and widespread influence of gender stereotypes whereby anger is associated with men. Women who display anger are seen as underconforming to prescribed gender roles and, therefore, abnormal. Thus, we have good reason to think that women’s anger will more often be thought inappropriate than men’s, in general and in psychiatry.","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"106 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85337435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-05DOI: 10.1332/147867321x16861569580196
R. Hart
Created in response to the question ‘Whose borderline is it anyway’. The aim of the written word and associated graphical expression is to explore the experience of disassociation as someone who has been given the label of borderline personality disorder. More accurately, my experience of disassociation as a response to complex trauma triggers. Highlighting the compounding impact of the fear an individual experiences from a complex history of trauma and the fear of judgement associated with the diagnosis.
{"title":"Whose borderline is it anyway? The frosted vortex – MY world, THEIR label","authors":"R. Hart","doi":"10.1332/147867321x16861569580196","DOIUrl":"https://doi.org/10.1332/147867321x16861569580196","url":null,"abstract":"Created in response to the question ‘Whose borderline is it anyway’. The aim of the written word and associated graphical expression is to explore the experience of disassociation as someone who has been given the label of borderline personality disorder. More accurately, my experience of disassociation as a response to complex trauma triggers. Highlighting the compounding impact of the fear an individual experiences from a complex history of trauma and the fear of judgement associated with the diagnosis.","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"15 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80772052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.1332/147867321x16861559264945
E. Reynolds
A personal reflection on the diagnosis of borderline personality disorder.
边缘型人格障碍诊断的个人反思。
{"title":"The mirror stage: a reflection on borderline personality disorder","authors":"E. Reynolds","doi":"10.1332/147867321x16861559264945","DOIUrl":"https://doi.org/10.1332/147867321x16861559264945","url":null,"abstract":"A personal reflection on the diagnosis of borderline personality disorder.","PeriodicalId":29710,"journal":{"name":"Journal of Psychosocial Studies","volume":"11 12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79582660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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