The thing about such subjective criteria is that it allows the diagnosis to function as a kind of “other” category: if we don’t understand the reasons for your emotions and we don’t know how to help, then your personality is the problem.– Rachel Rowen Olive, Sept 2019, “We can discuss mental health care responses, but leave my personality out of it.” Mental Health Today
The “Borderline” in “BPD” reflects the diagnosis’ history as a “not otherwise specified” box; it originated as a descriptor for those patients not viewed as mad enough for long-term institutionalisation, but who did not improve under psychoanalysis, and so were seen as occupying the border between psychosis and neurosis.
Women, queer people, autistic people, trauma survivors: many people with this diagnosis are in several of these groups. Yet often we see separate narratives that “BPD” is a valid diagnostic category, but x group are being wrongly placed in it. Relatively few join up the dots and ask: if all these groups are being misdiagnosed with “BPD”, how many people would be left with those groups removed?
I recently read this article and thought FINALLY! – after asking some fellow psychiatric survivors for resources I’ve found some critical approaches to BPD.
Ever since my new psychiatrist suggested I would fit the diagnostic criteria for this disorder, I have been reliving the trauma of misdiagnosis as a pre-teen. Was I depressed? Anxious? Psychotic? Did I have PTSD? Was it BPD all along? Or was I just a sensitive kid with different learning and emotional needs who was given powerful psychiatric drugs that made me want to kill myself? Whose narrative has authority, and whose expertise can I trust? It’s overwhelming.
I have serious reservations about this diagnostic category and the way it is used to dismiss entire communities of vulnerable people who fall through the cracks of traditional medical-model style care. As I continue to study critical approaches to borderline, I’ll endeavour to share my findings and insights here. For now, as I start collecting articles and scratching the surface of the critical scholarship that already exists, it feels incredibly validating to see these reservations about borderline diagnosis voiced eloquently here.