A Conversation With a Friend
In 1998, while in a psychiatric hospital, a friend of mine was verbally attacked by a nursing assistant. It was a stinging, remorseless attack. One, she claims, that was completely unprovoked. She was told that she was undeserving. A ‘waste of resources’. Ironically, she was sitting in the same room as a woman who had once tried to burn her boyfriend to death and a man who had a history of violent behaviour. This nursing assistant was looking for an easy target and, like any self-respecting coward, he selected the easiest target in the room.
And the reason he chose her to focus his pent-up aggression on was her diagnosis. She was, according to her consultant psychiatrist, ‘suffering’ from Borderline Personality Disorder.
If you should ever find yourself in need of psychiatric treatment there are two words you should dread hearing: ‘personality disorder’. Somebody once gave me this definition of a personality disorder: ‘the patients the psychiatrists dislike the most.’ For many this diagnosis is the kiss of death. It is a catch-all term that psychiatrists use when they can’t quite work out what is wrong with you. It is also used to define what they used to call moral insanity or maybe character defects. ‘Personality Disorders’ are often more value judgements than diagnoses. In a world with limited resources they are not usually a priority. Society is arranged hierarchically and this is replicated in psychiatry and mental health nursing. Some are regarded as less ‘deserving’ than others. Psychiatric patients with personality disorders are the ‘undeserving mentally ill’. This is a view unashamedly endorsed by some prominent psychiatrists and some have even advocated the denial of any kind of treatment.
One issue that is rarely addressed is that many ‘sufferers’ of personality disorders have endured severe trauma. Many have been abused. There is a clear and extensively documented correlation between a history of abuse and personality disorders. Did their flawed personalities contribute to their original abuse? Perhaps they invited childhood sexual abuse, physical abuse, domestic violence. Perhaps they asked for it. There is little acknowledgement that these people are products of their histories. They are detached from their context, a strangely superficial stance for people attempting to understand how people’s minds work to adopt.
The claim that personality disorders are untreatable has been refuted but media coverage of the issue does not reflect this. For many in the media experts are infallible. There is an unwillingness to admit that they may be wrong. The truth is that everyone is fallible and psychiatrists are more fallible than most. All medicine is to some extent an art and psychiatry is more of an art than most.
Many also seem to forget that personality disorders do not preclude the possibility of co-morbid disorders. The system rejects them not because they are likely to harm others but because they are not. They are maligned because they are easy to malign. They are complex and difficult to treat. In a profession enslaved by the pharmaceutical industry those who do not respond to medication are ‘untreatable’. They serve as mirrors to the fallibility of psychiatry and ‘the medical model’ and that is why they are hated.
Addendum: http://bjp.rcpsych.org/cgi/content/full/180/2/110
http://www.iop.kcl.ac.uk/departments/?locator=600
And a little inhouse catfight between medical specialisms on the subject of self harm can be found here. Entertaining stuff. One wonders how, given the frequency with which they fight amongst one another, they ever get around to treating anybody.
So Sick of Drowning 