I’d been on the psychiatric ward less than an hour when the first person said it was ’not the right environment’ for me.

It was the duty doctor, doing the intake paperwork. He wasn’t wrong – traumatised, suicidal, and autistic, being trapped on the third floor of a hospital, next to a building site, was hell. But the number of times this exact phrase was repeated by effective strangers over the next ten days was remarkable.

From a quick glance at my notes, or after a brief conversation, what was it that made staff put me so squarely in the ’not for here’ box? Why did they all talk about ’the ward environment’ as if it were fixed and unchangeable, something whose harm could not be mitigated? I believe the answers lie in longstanding prejudices around the increasingly euphemised diagnosis of borderline personality disorder.

There is significant debate over whether those of us with this dreaded diagnosis – the validity of which many of us dispute – should ever be admitted to hospital. NICE guidance and related reports stress that it should always be a last resort. In theory, this is because of the harm it causes us. I don’t want to pretend that this harm is insignificant, it isn’t. Hospitals are often the source of large-scale iatrogenic harm.

However, I have to wonder why the response to this harm is to say, ’we shouldn’t admit these people’ instead of ’how can we make wards less hellish for them?’. Given the wealth of evidence of how much clinicians frankly dislike us, I have my suspicions about the answer.

Who, then, do staff think these hospital wards, with their banging and beeping and total indifference to suffering, are right for? When I push this question, the answer I typically get is that they are for people in acute psychosis or mania who, it is heavily implied, mostly need medicating back into normality.

I have never been psychotic or manic, so I won’t presume to know what is best for those who are. But I do know that the ‘borderline’ in borderline personality disorder stems from the idea that we are the ones all treatments make worse. In the early 20th century, a (false) distinction was made between psychosis (or true madness), and neurosis (or emotional difficulties, not insanity). While psychosis was viewed as being solved by locking people away in asylums, neurosis was seen as being amenable to psychoanalysis and other talking therapies. We ‘borderlines’ were thought to straddle this dichotomy. As a result, we were – and still are – defined by nobody knowing what to do with us, (re)traumatised by both analysis and incarceration.

The consequences of this distinction are wide-reaching, but in the context of the psychiatric ward, this is how it screws us over: it makes staff act as though emotion-driven suicidality and displays of distress are trivial. It’s like those of us who are ’just’ suicidal are wasting their time, and best off out of there as soon as possible.

At the same time, it assumes that people experiencing acute psychosis or mania have no emotions other than those wrapped up in their delusions or hallucinations. Nothing in the infamous ’ward environment’ is seen as worth improving because treating psychotic patients like human beings with a need for peace, connection, or empathy won’t help them anyway (it feels unethical to write about other patients here, but my experience does not bear these assumptions out).

Ultimately, improving ward environments is only ever going to be about harm minimisation. I don’t want to go into hospital, and I wish they didn’t exist (although I believe we have a long way to go in building alternatives before that is feasible). I want actual community care based on something other than restriction. But, in the meantime, I believe that harm is worth minimising. It breaks my heart that the closest thing to safety the current system lets us imagine is things like keeping our phone chargers in the nursing station.

I’m tired of this diagnosis and its euphemisms making it so easy for systemic harm to be individualised and pushed back onto patients, as though it’s our fault they are hurting us. And I am so, so tired of ward clinicians who have the power to minimise harm pretending there’s nothing they can do.

Rachel Rowan Olive is a survivor researcher, illustrator and writer living in London. You can find her art at etsy.com/shop/rachelrowanolive and follow her on social media @rrowanolive.

This is a sample article from the Autumn 2023 issue of Asylum Magazine (30.3).  To read more, subscribe to Asylum Magazine.