The sound of lifting heavy baggage

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baggReblogged from a psychologist who writes about Borderline Personality Disorder in a non-judgmental way. This is so important, and I thank the author for this nuanced view of the psychological challenges people with BDP face.
 
 
 
Friday, 20 September 2013

Borderline personality disorder: Abandon the label, find the Person

 
Steven Coles
 
In 1980 the mental health industry invented a new diagnostic label, one of many, for the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III). The American Psychiatric Association (APA) presented DSM III to the world as a scientific revolBorderline Personality Disorder Awarenessution in psychiatric understanding. If people suffering emotional distress had accepted the APA’s statements about the new manual, they would have rejoiced that such a wealthy and powerful organisation had put its energies into making sense of psychological suffering. The vast majority of people receiving one of these new labels had experienced great trauma – sexual abuse, extreme life events and repeated abuses of power. Quite a progressive move by the APA then: understanding the effects of power on people. Psychiatrists could show care, understanding, and perhaps even provide a sense of solidarity to people who were marginalised. Unfortunately, in 1980 the APA willed Borderline Personality Disorder into being. The APA’s idea of empathy and understanding led to vast numbers of survivors of abuse being labelled as disordered individuals.
 
In many ways the diagnosis of BPD is an easy target for criticism and satire. The diagnosis of BPD is defined by a series of social and moral judgements, applied to people who have been traumatised and dressed up as a medical problem. If we had a friend who revealed to us after years of secrecy and shame that they had been repeatedly sexually abused as a child, our first response is unlikely to be “your personality must be really disordered – no wonder I’ve felt like rejecting you”. Instead we would show care, be amazed at their survival and probably feel anger at the perpetrators of abuse – basic common sense and decency. Sadly when it comes to psychiatric diagnosis good sense does not prevail. The survival of psychiatric diagnoses is in many ways an astonishing feat of magic; its supporters have woven a spell that repels good sense, compassion, logic and evidence.

There are multiple problems with a diagnosis such as BPD. Here I want to highlight just one: it locates the problem within t08d0ab8d1b1a5435a32a3e5134150cd2he individual. ‘BPD’ hides disordered environments, misuse of power and perpetrators of abuse. The following quote from Suzi, someone who received the label, makes the point better than I can:

 
‘I cannot understand how the vast majority of perpetrators of sexual violence walk free in society; whilst people who struggle to survive its after effects are told they have disordered personalities’ (Shaw & Proctor, 2004, p.12).
 
Think about the implications of that for a second. It’s accusing us of failing to recognise the abuse of power in society, of colluding in suffering. People are traumatised and hurt in many ways. For some there are obvious damaging events involved, for other people the circumstances are more complex and subtle. The flow of power is usually crucial in each. Unfortunately, the way in which we offer mental health services can lead us to ignore life circumstances and power. An understandable reaction to a horrifying life experience is converted into an illness, which a person is held responsible and rejected for having.
 
If that doesn’t paint a pretty picture of mental health services what are the alternatives? Perhaps a little good sense might help here. We need to support people to make sense of their distress in relation to their life experiences and circumstances – survival strategies in the face of disordered environments. People need to be offered practical support and guidance, as well as compassion and care. It seems unnecessary to grab at the concepts of illness, treatment and disorder, when we can talk with people using ordinary language. Our conversations need to honour people’s survival and strengths against the odds, as well as their difficulties and needs. When supporting people who have experienced high levels of abuse and are struggling in life, workers need space, supervision and time to reflect on and cope with their own feelings, and to consider the most useful ways to help. People should not have to accept a label and the attached baggage to receive support.
 

There are multiple problems with a diagnosis such as BPD. Here I want to highlight just one: it locates the problem within the individual. ‘BPD’ hides disordered environments, misuse of power and perpetrators of abuse. The following quote from Suzi, someone who received the label, makes the point better than I can:

 
‘I cannot understand how the vast majority of perpetrators of sexual violence walk free in society; whilst people who struggle to survive its after effects are told they have disordered personalities’ (Shaw & Proctor, 2004, p.12).
 
Think about the implications of that for a second. It’s accusing us of failing to recognise the abuse of power in society, of colluding in suffering. People are traumatised and hurt in many ways. For some there are obvious damaging events involved, for other people the circumstances are more complex and subtle. The flow of power is usually crucial in each. Unfortunately, the way in which we offer mental health services can lead us to ignore life circumstances and power. An understandable reaction to a horrifying life experience is converted into an illness, which a person is held responsible and rejected for having.
 
If that doesn’t paint a pretty picture of mental health services what are the alternatives? Perhaps a little good sense might help here. We need to support people to make sense of their distress in relation to their life experiences and circumstances – survival strategies in the face of disordered environments. People need to be offered practical support and guidance, as well as compassion and care. It seems unnecessary to grab at the concepts of illness, treatment and disorder, when we can talk with people using ordinary language. Our conversations need to honour people’s survival and strengths against the odds, as well as their difficulties and needs. When supporting people who have experienced high levels of abuse and are struggling in life, workers need space, supervision and time to reflect on and cope with their own feelings, and to consider the most useful ways to help. People should not have to accept a label and the attached baggage to receive support.
 
Abuse and misuse of power are social and political issues. We seem to resist asking the questions that flow from this though. Such as why is sexual violence so prevalent in society? How do we prevent people doing horrendous things to each other in the first place? What economic policies decrease oppression and misuse of power in society? Going back to the 20th century, at one point the APA decided people who identified 616557b8644a5f124a2ad7e3964173fathemselves as gay were suffering from an illness. Some of those who were labelled accepted and internalised the label. However due to lobbying and activism this idea was eventually abandoned. It is now time to speak up and say that people in emotional pain, who have suffered and attempted to survive, should no longer be labelled disordered. It is time to abandon the concept of borderline personality disorder and instead find and honour the person.
 
Shaw, C. & Proctor, G. (2004). Suzi’s Story. Asylum (Special Edition: Women at the Margins), 14 (3), 11 – 13. Also reproduced here.
 
Steven Coles is a Clinical Psychologist  and co-editor of Madness Contested: Power and Practice (PCCS Books, 2013). Follow him on Twitter @Steven_Coles_.
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5 thoughts on “The sound of lifting heavy baggage

    Samantha Jane said:
    December 11, 2013 at 04:04

    Reblogged this on both sides of the wall and commented:
    I really like this! I have a lot of issues with the stigma around bpd, and the diagnosis itself. I wish it was taken out of the DSM. Like the highlighted quote, BPD places the problem on the person who experienced the abuse while paying no attention to the reasons behind the issues that person faces… I have yet to meet an individual with a BPD dx that does not have a history of abuse or neglect as a child…

    starkinsanity said:
    December 11, 2013 at 23:40

    Thank you thank you thank you for posting this!!! BPD in my view is a bullshit diagnosis and blames the victims for all they suffered. I am so angry still about my fake diagnosis- I will be getting it to change, and I will be spreading awareness about how damaging this stupid, phony label really is. My personal belief? BPD/EUPD is actually not that. It is a form of PTSD, and as such does not exist.Thank you again for posting this.

    […] The sound of lifting heavy baggage. […]

    The sound of rising water | Mirrorgirl said:
    March 31, 2014 at 07:58

    […] Yesterday I interviewed and talked about the kindness project with several people. I went to a couchsurfer dinner with6 others (for example Kirstine Desian) and they said that it wasn`t usual for a lot of people to come, especially not if alcohol was involved. I was a bit saddened by this. Is this the only way people interact? Another new`s story focused on mental health, and even if many Danish people have psychological issues, it`s still stigma when it comes to mental health. […]

    awax1217 said:
    March 31, 2014 at 12:01

    I work at Legoland and they have a thing there about minifigures. I know I am not suppose to but it gives a child a smile and that is what is important. I buy one mini figure. I do the greeting so sometimes there is just one child in line with his parents and they do not have a minifigure to trade. I explain to them that I can not by the rules of the company give them mine. But I spot a minifigure on the ground and ask the child to pick it up. He can keep it as a gift for cleaning up the park for we do not allow it to get dirty and a minifigure laying there is liter. The parents swear to the secrecy of the con and the child now with a minifigure is beaming for he has one to keep or trade. That smile is worth a lot to me. The price twenty minutes of my time is small in comparison with that. Do not print this for I will lose my job. This is between you and me.

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