Seeking Critical Approaches to BPD and Psychiatric Diagnosis

Shared with creative commons license (Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0)); Original photograph attributed to Nico (https://www.flickr.com/fraublucher); changes made: cropping to square dimensions.

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.

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?

– Rachel Rowen Olive, Sept 2019, “We can discuss mental health care responses, but leave my personality out of it.” Mental Health Today

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.

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