Steven Coles
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| Borderline Personality disorder: Society's illsdressed up as yours? Picture: MargaritaJP |
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 revolution 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.
