The Scarlet Label (Borderline Personality Disorder)

By Brent Potter PhD

The diagnosis Borderline Personality Disorder (BPD) strikes fear and loathing in the hearts of most mental health providers. It is unquestionably one of the most stigmatizing and overused diagnoses in existence. Often diagnosing someone with this label is a clinical punch in the gut to the client and also a means of communicating warning to other clinicians. It is the 21st century version of the scarlet letter.

In Borderline Personality Disorder: New Perspectives on a Stigmatizing and Overused Diagnosis, Jacqueline Simon Gunn and I outline the history of attitudes about the (perceived) feminine gone awry. We show that current diagnostic conceptions do not bespeak a psychiatric disease of chemically imbalanced brain organs, but are the logical outcome of long-standing attitudes about women through history. We do not deny that there are patterns of experience typical of emotional chaos and we demonstrate that men too suffer from distress presently labeled as ‘borderline’. In order to stick with the experience itself, contemporary humanistic and psychodynamic views are presented as ways of re-visioning BPD. We also present clinical material to reflect lived experience of working with people struggling with some of the issues outlined. These clinical narratives are presented also to provide the clinician, both new and experienced, with concrete ways of taking up and relating to the experiences of those distressed. It is our hope that someone suffering from intense emotional states will find, without stigma, his or her experience reflected accurately in the book’s pages. If what is outlined in these pages seems to resonate with behavior of a friend or family member, we hope this provides insight, a more open path to compassion.

I am proud to say that we worked with a number of non-psychiatric resources and received permission to compile and put into print a directory, Wellness and Recovery Resources. The reason for doing so is based upon Jacquie’s and my belief that there is no cookie-cutter solution for folks interested in recovery and wellness. As Jung said, “A shoe that fits one person pinches another; there is no recipe for living that suits all cases.” Unlike many of our colleagues, neither Jacquie nor I believe that psychotherapy is the answer for everyone. Don’t get me wrong, it proves to have amazing and often life-saving benefits for some people. So too does 12-step programs but, again, it’s not for everyone. More often than not, the path of recovery / wellness – I prefer to simply call it ‘life’ – involves a number of activities that are tailored to the individual. Sometimes it’s nutrition, exercise, group or community involvement, education, employment / different employment, etc. etc. It usually takes some trial and error to find the combination that best suits one.

In any event, it’s time to return to the individual in cultural context without engaging in the binary thinking that presently plagues our times. The form of distress often labeled as ‘borderline’ is neither a disease nor a choice. This holds true for every form of distress, not just BPD. Varieties of psychological distress are almost always the result of protracted developmental stress and/or trauma. The individual always is living in historical-cultural context. It is necessary to understand both unto themselves and in terms of how they interact. If done successfully, we see so-called ‘borderline’ people contextualized—extremely hurt, traumatized people set up against 4,000+ years of a derogatory cultural narrative of feminine madness. Again, staying away from simplistic binary thinking, it is important to note too that this kind of distress does, more often than not, cause much suffering in the lives of those in the person’s life. A good analogy may be someone in active drug or alcohol addiction. This person too has suffered a lot during his or her childhood and suffers too the same burden of essentially being kicked out of culture, dehumanized. It is also true that the addict’s behavior negatively impacts the lives of many others. Such things are difficult, complicated, painful. And yet, we must avoid the temptation to run to moralistic, literalistic, scientistic, binary thinking. To do so circumvents true understanding and the opportunity to work towards wholeness.

Clearly, a volume of books could be written on any number of these and related topics. Our hope is that this book provides some more context and contact with the human person behind the label. Unlike most insurance companies and practitioners we believe that there is hope, always, both for suffering individuals and also the culture wherein such damage is incurred.

I want to thank Beyond Meds for the invite to write this brief piece. Beyond Meds continues to be my favorite blog and has been so for quite a while. I also welcome correspondence via email (brentpotterma@yahoo.com) and on Facebook.

Jacqueline Simon Gunn, Psy.D. is a Clinical Psychologist in private practice in Manhattan, a freelance writer and author. She is the former Psychology Internship Training Director and Clinical Supervisor of The Karen Horney Clinic. Gunn is bold and irreverent in her storytelling – she likes to ‘tell it like it is.’ Using wit and guts in straight-forward narrative style, Gunn’s writing shows her readers that fact-is-stranger-than-fiction. And she hopes by baring truths her readers may find some inspiration along the way.

Dr. Brent Potter is a psychotherapist and wellness specialist with 20 years of direct clinical service. He is the Director for the Society for Laingian Studies. Brent is the author of numerous articles whose topics include: innovative and effective mental healthcare models, analytical psychology, humanistic psychology, existential-phenomenology, psychoanalysis, the psychotic register of the mind, character and personality disorders, chemical dependency and child / adolescent mental health concerns.His first book, ‘Elements of Self-Destruction‘ is out via Karnac Books and he has three forthcoming books.