The medical model of care reduces women’s experiences into problems they are expected to manage themselves. This is failing us, writes Emma Hamilton

woman pensive

Emma Hamilton is a Northerner who aspires to live in a warmer climate, spending her time writing and walking barefoot on sand

Emma is our guest blogger for February

Borderline personality disorder (BPD), also known as emotional unstable personality disorder (EUPD), is a mental health condition most commonly (about 75%) diagnosed in women.

I have seen both during my career as a social worker and in my personal life that this particular diagnosis is highly stigmatised both within and outside of mental health services. It is constructed around a narrative of impulsive, self-destructive behaviour; unstable mood; difficulty in relationships and dissociation, a process whereby a person disengages from themselves and the present. This is a coping mechanism that protects them from perceived or actual pain in their life.

BPD was long thought of as a lifelong condition; one that didn’t respond positively to treatment. Therefore people with the diagnosis were “historically confined…to the margins of healthcare systems”.

More recent research around the condition has reported a 75% rate of childhood sexual abuse in BPD patients. Would it not seem logical that a young child who has been abused will later have trouble trusting people, causing difficulty in their relationships? Would it not be logical that they experience mood changes if triggered by something that reminds them of those experiences? Would it not cause patterns of behaviour where a child may blame themselves for how they are feeling and therefore feel the need to punish and hurt themselves?

The difficulty with our healthcare system is that the field of mental health is dominated by the medical model. This model is essentially reductionist in that it evaluates the set of symptoms a person is experiencing and then labels them as a problem within that individual. There is little acknowledgement of environmental and personal experiences that may cause particular symptoms. Essentially, the patient is blamed for not being able to cope.

So why are so many women being diagnosed with this stigmatising label? Is it because women are more likely to come forward for help? Is it that more girls than boys experience childhood abuse? Or is it that there is a bias within the mental health field to more readily diagnose women with a personality disorder rather than, for instance, post-traumatic stress disorder?

I believe it’s a combination of all those factors.

A BPD diagnosis can be a very depressing label. To be told you have a disordered personality — that you are not “normal”— can be life-changing. I have known many women diagnosed with the condition and there are common threads throughout their experiences: doctors not enquiring about or listening to their life stories, being told they need to change their behaviour and then everything will resolve itself and being treated as a drain on resources because they present in highly-distressed states which the clinician believes they should just manage themselves.

All these experiences compound the feeling that these women are not worthy of care; are not people in their own right beyond their diagnosis. That must be a very familiar feeling for those who have experienced trauma at the hands of someone more powerful than them.

To add to this stigma, women with this condition find their chances in life curtailed. Nicola writes on The Time To Change blog:

Since the age of 18, I have always worked or been in full time education, or both. I am an exemplary employee – never take a sick day, I can interact with people in a professional manner, I have a wealth of knowledge, skills and experience which makes me invaluable – and yet, in the past 6 months, my employer has banned me from taking any shifts and the university where I was undergoing teacher training has informed me that I am not allowed to continue on my course because of this condition

Is this not societal oppression of women who have experienced trauma in their lives? If the healthcare professionals we all turn to when in need are framing a set of coping mechanisms used by these women as permanent and inappropriate, is that satisfactory? I think not.

Thankfully, the effects of trauma are being now beginning to be recognised as research is done and campaigners and activists work to highlight the issue. But is medicine catching up? Is the medical model of mental health best serving those diagnosed with EUPD/BPD, or would a more holistic model offer more hope?

It’s time to build on the recent work around understanding the effects of trauma. It’s time to move away from the victim-blaming model of psychiatry. It’s time to support vulnerable women who are simply using maladaptive coping techniques because they have never been valued and supported to create ways of coping with life stressors in a more constructive way. If we recognise that childhood abuse and trauma at any stage of life can be overwhelming then we can — as a society — begin to create more nurturing, inclusive models of support: models that do not confine survivors to the lifelong stigma of a psychiatric diagnosis.

Image by Isaac Holmgren, from Unsplash. Used under Creative Commons Zero licence.

Image is of the back of a woman’s head as she looks out the window onto a carpark. The scene feels moody and pensive.