When I was perceived by psych services to have EUPD (BPD)- and I say perceived because this was never a formal diagnosis; rather, it was the perception of some nurses based solely on their experience of my self-harm- the way I was treated was disgusting. I was occasionally refused treatment, being told that “hospitals are for really ill people.” I was told that “if you were really suicidal, you wouldn’t have told us/ you would have done it by now/ we couldn’t stop you.” I was called an attention-seeker, to my face, by a nurse at A&E. Add to this the pervasive and deep-rooted opinion that being “just” an “attention-seeker” meant that all attention should be withdrawn from me, and we had a real problem on our hands. To me, that problem was the brick wall I faced trying to make myself heard. To them, that problem was me. To them, self-harm was the only tick-box they needed to fill, to slap on me a diagnosis of which I actually had almost none of the other symptoms. And to them, having ticked that box meant that they could rest easy in the knowledge that They Had Done All They Could Do for someone for whom (they assumed) nothing much could be done.
I heard a “joke” once, one of the very unfunny variety. “How do you treat a person with BPD?” “Refer her.” This is offensive in so many ways but it does capture the sense of walking in and out of a revolving door that I experienced, and that I know is experienced on a daily basis by people with a diagnosis of PD. I see this played out on my Twitter feed, on my WordPress reader, and in conversations with people in my day-to-day life.
Someone tweeted recently that the names of personality disorders basically just list things we don’t like (emotional instability, narcissism, antisocial-ness) and create diagnoses from them. I read once, I don’t remember where, a psychiatrist admitting that “diagnosing a person with personality disorder often means there’s something about them that you don’t like, but you can’t put your finger on it.” This is part of why there is such a negative perception of people with diagnosed personality disorders among professionals. It is also why I think it is important to pay attention to the language used when talking about mental health service users. The stigma is in the language.
It’s also not OK to (randomly) decide that a person needs to meet 5 criteria to fit a diagnosis, but then base their diagnosis on just one of those (in my case, this was self-harm, I know others have different experiences).
And please note that I in no way mean to minimise the experiences of people who have a diagnosis of PD, with which they actually agree. I’m not saying that PD isn’t a “real” diagnosis. I only mean that we need to seriously think about how and why PD is diagnosed, and what it means for the individual in reality. If PD is used as an excuse to withdraw help, rather than referring to specialists for help, then it is not a helpful diagnosis. If people with PD continue to be stigmatised because PD is seen as something we (a) can’t change, (b) don’t like and (c) would rather not pay attention to, then we have a serious problem on our hands.
We have a serious problem on our hands.