Miriam A Marvin
Deviant Minds
Sociology 360
Professor Williams
Borderline personality disorder: the name itself insinuates that the personality of the patient diagnosed is somehow flawed. This disorder has been laden with sever gender bias from the very first study around the 1970's. This disease carries a package of assumptions which are taken as the absolute truth, when in all actuality they are nothing more than skewed half truths perpetuated by societal misconceptions and disdain of the unknown and different. All mental health disorders carry a different level of stigma as they are focusing on the mind, and any deviance of the mind can not be trusted and those damn "crazy people" must be kept at a safe distance from all of us "normal" people. Borderline personality is a grossly misunderstood disease, one which has symptoms/manifestations which are only amplified by societies negative reactions. It would be idealistic for the stigma surrounding this disease to decrease over time, but this has yet to occur. While there are various treatments for this disorder and the prognosis for those diagnosed has become much more positive over time, the only real winner in this situation is the pharmaceutical companies raising their quarterly profits.
The first published theory of borderline personality disorder (BPD) was written by Mahler in 1971, and was quoted as follows by Nadine Nehls PHD: "the disorder was a developmental arrest that occurred during the process of separation and individuation." This implies that BPD somehow impedes upon the individuals maturation process and they are then an incomplete person. Just a few years later, Masterson (as quoted by Nehls) stated "....the mother of a person with borderline personality disorder was herself a borderline." With the assumption that BPD is based upon the genetic make up of the mother, it also stands to reason that more women would then be diagnosed with this disorder. This disorder first appeared in the 1994 DSM-IV, and since it's publication there was a noticeable rise in diagnoses of this disorder across all data compiled and available.
The symptoms of this disorder are best described by the DSM, as quoted by Hall-Flavin, MD:
- Intense fears of abandonment
- A pattern of unstable relationships
- Unstable self image
- Impulsive and self-destructive behaviors
- Suicidal behavior or self injury
- Wide mood swings
- Chronic feelings of emptiness
- Inappropriate anger
- Periods of paranoia and loss of contact with reality
This author went on to state that "A diagnosis of BPD is usually made in adults, not children or adolescents. That's because what appear to be signs and symptoms of BPD may go away with maturity" (Hall-Flavin 2012). Just glancing at the list of symptoms it becomes quite clear why this disease has been considered so deviant. All of the behaviors which make up the disease are already considered deviant by main stream society. These symptoms are also more commonly feminine personality traits, which by societal standards makes the males diagnosed with this disorder that much more deviant.
Information about this disease is spread by the medical community and the internet. Just using Google, millions of articles, blogs, and research documents are available expressing a variety of view points. The medical professionals making the diagnoses are the main source of information on this disease as it is their statistics which are later used to form numbers and data used for polls. In this way, the medical profession has a great deal of influence over the process of information gathering on BPD. While some researchers for a pool of various persons diagnosed with BPD, those persons are still operating under the belief of their practitioners beliefs about their disease. How the information is given to them and what they are told can greatly impact how the patients view themselves. Think for a moment, if they were treated by a psychologist who firmly believed BPD was caused by a childhood trauma. The patient would then begin searching their past for any event which would validate their psychologist's beliefs as this would be necessary in order to progress in therapy/treatment. When this patient then participates in a study, they are still perpetuating their doctors beliefs and opinions more than their own. In this way, the medical field as a whole maintains a choke hold on the mental illness data, as well as the ebb and flow of information.
Stone (1990) as quoted by Nehls (1997) stated "... nearly one third of the population of people with borderline personality disorder reports a serious dysfunctions over a long period of time." Because the characteristics of this disease are quite severe, the sick label seems to go hand-in-hand. Throughout all of the various sources, there was a lack of any which did not assume that all persons diagnosed with BPD are sick as well. The number of inpatient cases which are considered severe are not helping this in any way. The mental hospitals and treatment facilities maintain the perception that those with BPD are sick, as well as the diagnosticians asserting the criteria for the disease itself. There is an entire system of various persons and health care facilities devoted to maintaining that those with BPD are sick.
The group who benefits the most from this disease are the pharmaceutical companies. For every person diagnosed with BPD, there are generally a great deal of various psychotropic medications prescribed to treat the disorder. These various companies are greatly invested in making a profit from various mental illnesses. According to Bitch Media, "...the pharmaceutical industry ... spends an estimated 2.5 billion annually on reaching the public through advertising "(2011). If this industry is willing to spend billions on advertising alone, consider how high of a profit margin is required to just such an expenditure. Another group who stands to gain from this disease are the scientists investigating and studying the disease. Each discovery lends a great deal of notoriety and respect to the scientist. This can lead to greater advancement in the field as well as their employment outlook/prospects. The patients may benefit some, if they are able to obtain disability benefits and insurance coverage for treatment.
The group who stands to lose the most in these diagnoses are the patients themselves. There are many social stigma surrounding all mental illness, but BPD has received an especially bad reputation. This may be in part to the severity of the diagnostic criteria used, as well as the symptoms being deviant themselves. Those persons also have to try and sort out the affects of having the disease. If a newly diagnosed patient were to try to obtain information about the disease, there is an overwhelming amount of information and opinions. Just imagining the effect of a misdiagnosis lends a very uncomfortable feeling. Allen Frances was quoted as saying "Anticipate the worst. If something can be misused, it will be misused. If diagnosis can lead to misdiagnosis and over-treatment, that will happen" (2010). This would seem to indicate that there are many people with a diagnosis of BPD who do not actually have the disease. Because there is such a small margin of positive aspects to having this diagnosis, it would seem that there are many persons who have been handed a plate of struggles and difficulties and then expected to fix the problem they were given.
There is one group who is the most heavily represented in having BPD: Women. Across multiple research, the number remains approximately 77% (Bjorklund Ph.C 2006). Because many of the symptoms of this disease are typically female characteristics, it is not surprising that this disease is more prevalent in females. Horsfall, as quoted by Bjorklund, stated " gendered assumptions are embedded in psychiatric knowledge and that BPD is essentially a gendered construct arising from a psychiatric classification system that is itself a social construction." This speaks volumes, as there is no way state that even the diseases themselves are a result of the socially constructed beliefs and practices shaping society.
The stigmatization of BPD is no different from any other mental illness. As Wyckoff stated, "...Some research has suggested that emphasizing the science behind mental illness- that it's a brain disorder and not a defect in character- could be powerful enough to help shake the stigma of the condition. But a study just published online by the American Journal of Psychiatry found that isn't paying off all that well"(2010). Despite efforts to enlighten society to the facts of mental illness, very few are willing to acknowledge the validity of the argument. It would seem that because changing and challenging the deep set beliefs of society is such a great challenge, many chose to simply believe the assumption that all mentally ill persons are dangerous, deviant, and less than the default group. There is also a lot of assumptions that the person who is sick is simply faking it.
BPD is a very complex mental illness, with just as many opinions regarding best treatment practices as there are patients. The social constructs and stigmas surrounding this illness make things that much more difficult, as there is very little social tolerance for this illness. There are many factors which play a role in the over diagnosis of this disease, the most prevalent of these being the greed of pharmaceutical companies. This disease has been made out to be scary and horrible, when in actuality it is only scary and horrible for the person dealing with the disease. It leads to the question: If there was no corporate gain to be had from this illness, how different would the disease and the patients with this disease be treated?
Word Count: 1594
References
Bjorklund, Ph.C., RN, CS, PMHNP-BC, P. (2006). No Man's Land: Gender Bias and Social Constructivism in the Diagnosis of Borderline Personality Disorder. Issues in Mental Health Nursing, 27(), 3-23.
Wyckoff, W. B. (2010, September). Despite Deeper Understanding of Mental Illness, Stigma Lingers. NPR Blogs, (), . Retrieved from http://www.npr.org/blogs/health/2010/09/17/129937437/still-a-stigma-for-mental-illness
Nehls, PhD, RN, N. (1997, January). Borderline Personality Disorder: Gender Stereotypes, Stigma, and Limited System of Care. Issues in Mental Health Nursing, 19(), 97-112.
Hall-Flavin, Daniel K. (2012, January). Borderline Personality Disorder - A Clinical Perspective.
Facing The Facts. Mayo Clinic. Retrieved from:
http://bpdfamily.com/bpdresources/nk_a103.htm
Smith, s.e. (August 2011). We're All Mad Here: Pharmaceutical Advertising and Messaging About
Mental Illness. Bitch Magize.org. Retrived from:
http://bitchmagazine.org/post/were-all-mad-here-pharmaceutical-advertising-and-messaging- about-mental-illness
Spiegel, Alex (December 2010). What's A Mental Disorder? Even Experts Can't Agree. Retrieved from:
http://www.npr.org/2010/12/29/13407384/whats-a-mental-disorder-even-experts-cant-agree
