Borderline personality disorder and institutionalised discrimination
When, aged 17, I found myself at rock bottom and in a fit of absolute despair was admitted to a psychiatric unit. I saw a string of doctors during my time there and various diagnoses were discussed. Bipolar seemed to be the most likely conclusion but, during a particularly erratic and incoherent period in my illness, the term ‘borderline personality disorder’ was mentioned. That scared me. Not in and of itself but because by that point I’d seen how nursing staff had responded to the girls on the unit labelled ‘borderlines’.
The staff seemed to project different meanings onto the behaviours of those with borderline personality disorder. Self harm, for example, was treated with sympathy in people with depression but the girls with borderline personality disorder were often castigated for using it to ‘manipulate’ staff. It also seemed like there was a reluctance to move these girls over from the day unit to inpatient in a crisis situation – a general perception that they were ‘trying it on’. The list could go on; I had a general impression that they were seen as second class patients.
my condition improved and the possibility of me having borderline personality disorder was dismissed
Time went on, my condition improved and the possibility of me having borderline personality disorder was dismissed. I was still left feeling uneasy about the way those girls were viewed but perhaps I’d been imagining it? The girls in question were the only other adolescent girls on the unit so it’s perhaps unsurprising that I paid particular attention to the way they were treated. Yes, perhaps that was it, the nursing staff were professionals after all!
Fast forward ten years and I’ve stayed well enough to finish college and university and to start my career. One afternoon at work was set aside for ‘Mental Health Awareness’ training. I’d silently giggled at the title as for much of my life I’ve been painfully ‘aware’ of mental health!
It seemed a lot like any other training session. Two trainers clicked through a series of slides and delivered basic but reasonably solid information on common mental illnesses. Then a slide came up labelled ‘personality disorders (borderline)’. The trainer looked somewhat disgruntled, ‘Well, we’ve got to talk about this’ she sighed ‘but I’m not sure we should have deal with these people as mental health professionals, we should leave them to the social workers really. I mean, they call it a mental illness but they’re really just being a pain in the arse sometimes’.
The slide remained up and she managed to list a whole host of other prejudicial generalisations
What’s appalling is that my first response wasn’t anger, but shame; was that what a doctor had once considered was the problem with me? Not ill, just a ‘pain in the arse’? The slide remained up and she managed to list a whole host of other prejudicial generalisations ‘They’re the kind of people who turn up pestering the doctor a lot…. You can often tell someone’s borderline because their speech or their clothing will be very weird… when you see ‘bag ladies’ around town a lot of them will be borderline’.
I couldn’t believe what I was hearing! I’d known girls with borderline personality disorder well and none of them were trying to be a pain in the arse, from what they told me they were struggling with extremes of emotion that I can’t even imagine. Their realities were often terrifying with a heightened threat perception or permanent fear of abandonment and they found themselves carried along by extremes of mood that left them feeling powerless and frustrated. None of the things the trainer was telling us rang true. I had no idea of the extent of the prejudice against borderline personality disorder and certainly wouldn’t expect it from mental health professionals who presumably know better.
To my shame I didn’t say anything during the session
To my shame I didn’t say anything during the session. I struck dumb by incredulity and self-consciousness but when I’d had time to gather my thoughts I put in an official complaint. To my even greater shame it may be the case that the staff on the psych unit all those years ago were indeed treating the girls on the unit prejudicially and I looked on and said nothing.
What I find shocking is that, ten years on, the prejudice seems more entrenched than ever and it’s entirely self-perpetuating. People with borderline personality disorder fear speaking out because they’re aware that expressing hurt, anger or indignation can be interpreted as simply ‘being borderline’ and that being labelled non-compliant can affect their treatment. What seems clear is that this attitude is institutionalised, these attitudes have no hope of changing if they are not challenged first from within the professional community. Borderline personality disorder is one of the least visible mental illnesses but one of the most – if not the most - in need of anti-stigma message.