This is our chosen title as a campaigning group of women survivors and mental health workers. We started to meet over four years ago because of our concerns about women and the diagnosis of Borderline Personality Disorder BPD .
We meet monthly in Leeds for discussion and debate; we’ve also been involved as a group in collating information about the impact of this diagnosis on women, organising an open day for women given the diagnosis, and presenting women’s experiences to interested workers. Our latest big achievement was the Women at the Margins conference held on International Women’s Day, 2004. Our current plans are to set up a support group for women with this diagnosis, to create a web site and to plan a direct campaign.
Why Women at the Margins? Because women given this diagnosis become marginalized as a direct result of it. BPD has always been a diagnosis of exclusion from mainstream mental health services, women are marginalised and stigmatised within services by descriptions such as manipulative, attention-seeking nuisances. Women arc punished – sutured without anaesthetic in A&E; marginalized in society – women have their children removed, and fall between benefits – often unable to claim disability benefits but too distressed and stigmatised to work.
Women already marginalised by society are further stigmatised by BPD. Some are already institutionalised and abused by mental health and criminal ‘justice’ systems, have experienced unemployment, poverty and homelessness. Women are often lesbians, lone mothers, and other women who, in different ways, have ‘failed’, or maybe succeeded in refusing to live up to cultural, moral and normative expectations of what it is to be a woman in this society. Kalikhat suggests in this issue that it is difficult to find a home where we are not marginalized. As Sam Warner further argues in this issue, there is little if any cross fertilisation between feminist and radical mental health groups. As a matter of urgency we should examine and consider the appalling situation of these women, particularly in the current political climate.
Until recently, most people would never have heard of Personality Disorder or BPD specifically. However, these days it is likely to ring a few more bells in the general population as a result of media coverage of:
- Government proposed legislation on ‘Dangerous and Severe PD’, which proposes to detain people deemed suitable for this diagnosis before any crime has been committed, and without the need for the current criteria for detention under the Mental Health Act.
- The recent focus on ‘mad, bad’ women and their association with this diagnosis.
- The media fascination with self injury.
- A growing focus on PD diagnosis, as a growing market in medication and therapy cashes in on treating human expressions of emotion.
As a result, BPD comes weighted with negative associations – manipulative, dangerous, extreme, confusing – are they or aren’t they disordered?
So why is BPD a women’s issue? Throughout history, society has created multiple categories for women who do not fit into society’s norms and expectations. Just on the basis of diagnostic prevalence alone – 75% of those diagnosed with BPD are women (DSM IV 1997: 652) – BPD is a gendered diagnosis. We argue in ‘Women at the Margins’ that the diagnosis of BPD is the latest manifestation of society’s attempt to explain away the strategies which some women use to survive and resist the oppression and abuse they experience, by describing these strategies as symptomatic of a disturbed individual. BPD is a feminist issue.
It is a feminist issue when women who overcome their fear to disclose their experiences of childhood sexual abuse are called “attention- seeking” and “manipulative” (see ‘Why cut up?). It is a feminist issue when women are visited in hospital, and people who care for women are shocked and appalled at the conditions (sec ‘Two flew over the cuckoo’s nest’). It is a feminist issue when as a result of being given this diagnosis, women are told they are “virtually unemployable” and a “risk to other people” (see ‘Jo’s story’). It is a feminist issue when women who have survived abuse at the hands of men are given the same diagnosis as serial rapists and murderers (see ‘Suzi’s story’). It is a feminist issue when women are incarcerated and have their children removed as a result of this diagnosis (see ‘Sylvia Hurts’). It is a feminist issue when Black women arc labeled for having emotional responses to the experience of racism (sec ‘Paying the price for not fitting in’. It is a feminist issue when “victims of criminal savagery beyond understanding which will reverberate through their lives awake and asleep, as long as they live” are locked up “until you grow out of it” see ‘Truly Photographic Memories’).
We will not rest until the answer is not to prescribe DBT, the therapy currently most publicized and seemingly popular with workers, misguidedly being presented as the ‘benign’ response to BPD. Instead, it plays right into the agenda of the label, accepting it wholeheartedly along with the implication that women with BPD are damaged creatures who need to be saved by the professional and taught how to be more ‘appropriate’. Again. DBT depoliticises and personalizes the real issue. The real issue is the pervasive abuse of women and girls in this society, coupled with the continued silencing and invalidation of women’s experience.
However, there are hopeful responses. Rape Crisis (see ‘Breaking the silence around sexual violence’) honour and support the ways women have survived sexual violence. Some workers do work to support women in respectful ways, without judgment or blame, within real, honest and self-aware relationships (see ‘Disordered Boundaries’). Women with this diagnosis are getting together, challenging their stigma and supporting each other. We hope that this issue and our continuing work with Women at the Margins will encourage women (and men) to get together to act out of anger and hope.
Special edition on BPD: Bullshit Psychiatric Diagnosis: Women and Borderline Personality Disorder. Put together by Women at the Margins. Edited by Clare Shaw and Gillian Proctor.
Clare Shaw (survivor activist and poet)
Gillian Proctor (activist, Clinical Psychologist at North Bradford PCT and honorary lecturer at Bradford University’s Centre for Citizenship and Community Mental Health
N.B. thanks a lot to Carole A. Bressington for her helpful suggestions for this editorial.
- Jo’s Story
- BPD under the Microscope: Gillian Proctor and Clare Shaw
- Suzi’s Story
- Truly Photographic Memories: Carole A Bressington
- Breaking the Silence around Sexual Violence – Monica Hill
- Two Flew Over the Cuckoos Nest – Terri Shaw
- Why Cut up? –Tamsin Walker
- Sylvia Hurts
- Disordered Boundaries – Gillian Proctor
- Paying the Price for Not Fitting in Kalikhat
- Feel the Fear but do it Anyway – Pauline Bispham.
- Radical Politics from the Women’s Movement to Mad Pride – Sam Warner
- Poetry – Maggie Baker and Jackie Hagan