‘Borderline Personality Disorder’, the Failure of Psychiatry and Emergence

By Jacqueline Gunn, PsyD and Brent Potter, PhD

Authors, Borderline Personality Disorder: New Perspectives on a Stigmatizing and Overused Diagnosis (Praeger, November 2014)

When you are reading our book, be prepared to challenge your view of what is called “borderline personality disorder” and even the way you see all so-called psychiatric ‘disorders’.

This is what we have done as co-authors. We sound a little strong at times, but we really believe in what we are presenting.

We take you through exactly why we take this approach, give you historical context and also explain some experiences with real people who are suffering. To this end, client’s stories at the end along with a few narratives written by clients themselves along the way. We stick faithfully to the experiences themselves rather than upon theoretical constructs and other abstracted materials. Our approach is not experience-near, but experientialist; we don’t hypothesize, abstract, nor construct theories from human experience.

Here’s the overview of the journey that’s in store in our book. The fields of psychiatry and so-called scientific, evidence-based psychology are as aware of their historical-environmental context as a fish is to its being wet—they are oblivious; the most obvious and necessary context eludes them. You’ll notice in every book you pick up on ‘borderline personality disorder’, that the authors assume that it is a psychiatric syndrome / disease as outlined in the clinical literature. None of them even look at the basic assumptions or historical, cultural and environmental contexts wherein the supposed syndrome or disease was invented. You read this correctly: All of the mental illnesses outlined in the diagnostic guide for psychiatrists and other mental health professionals, the Diagnostic and Statistical Manual of Mental Disorders (DSM), are inventions. Said differently, there is no biological evidence for any one of the disorders outlined in the DSM. There is no blood test, mouth swab, hair sample, biopsy, spinal tap, x-ray, brain-imaging, nor any other sort of “We’ll have to send this off to the lab,” way to diagnose or confirm psychiatric diseases. Zero. The contents of the DSM are constructed by committees of professionals, most with financial ties to the psychopharmaceutical industry, and then voted upon.

That the diagnoses are diseases and/or syndromes reflecting a chemically imbalanced or otherwise defective brain organ is a ‘given’. Yet the fields of psychiatry and natural science psychology proceed as if their hypotheses, perspectives and diagnoses are facts, like wind or gravity. And like wind or gravity, diseases just happen. If brain diseases are like other medical diseases, they happen independent of other factors. They simply are due to this or that neurochemical mishap and there is no need for any further investigation or thinking outside the realm of biology. When varieties of human distress are understood as diseases, critical thinking is off the hook. The phenomena are decontextualized, stripped of context and any meaning outside of biological hypotheses.

It makes sense that clinicians, for the most part, accept this ‘given’. Psychology students today learn that psychology is the study of human behavior which, in turn, is the exclusive product of the brain organ. Brain organ events produce human behavior. The DSM categorizes anything that is considered defective or maladaptive in such happenings. These are so ‘given’ in the education and training of mental health professionals that the presuppositions and contexts are entirely ignored. These diagnoses are accepted as facts. Every clinician, for example, knows that it is commonplace for clinicians to simply refer to a client by his or her diagnosis; “the schizophrenic,” “the one with major depression,” “the borderline” or, sometimes, “the borderliner.” While it is impossible to stand outside our cultural-historical context, it is possible to examine some of the history, context and philosophical assumptions inherent in our worldview.

This is one of the major challenges and accomplishments of this book: sticking descriptively with the phenomenon itself without lapsing into established opinions, ideas and long-held understandings. We also do not deny that various, typically expressed, forms of distress exist. People do become distressed, sometimes in long-standing ways. What is often labelled as mental illness varies in degree, but not kind, from what everyone experiences.

This work stands out as distinct from all other books written on ‘borderline personality disorder’ and other so-called psychiatric diseases. We do not assume that BPD is what is outlined in the DSM and the literature on psychopathology. At no time do we refer to it as a diagnosis or psychiatric disease. This is why you will repeatedly see ‘borderline personality disorder’ in single quotation marks. It isn’t a thing, like a disorder residing solely in the brain organ of an individual. An individual only takes up possibilities disclosed to him or her by the cultural-historical environment. To say otherwise would be to say that the individual creates them out of nothing which, of course, would be absurd. Since distressing states of mind are variations of common human experience, they are expressed in typical ways. For these reasons, we do not consider ‘borderline personality disorder’ in a decontextualized fashion.

The causes and conditions of what is often labelled as ‘mental illness’ are known. There is no further need to research its origins. Though the literature is unambiguous on this score, it is not popular; that is, it doesn’t further the financial interests of the psychiatric establishment. It is nonetheless true.

It is the aforementioned failures of psychiatry and psychology that demand this book be written. The context provided herein is the story of how the very fields charged with the care of distressed persons came to treat them in such stigmatizing and reprehensible ways. Concurrently, it presents the meaning and experience of people contending with developmental stress and trauma which is often labelled as ‘borderline’.

The fact that this work is heralded as controversial bespeaks the tsunami of energy invested in maintaining and promoting the hegemony of understanding ‘borderline personality disorder’ as is—without context, history, compassion, truth.

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 21^st century version of the scarlet letter or, more aptly, the scarlet label.

‘Borderline’ is to psychiatry as psychiatry is to medicine. Psychiatry’s multiple functional failures—scientistic, misogynistic, literalistic, moralistic, personalistic, pathologizing, Eurocentric, etc.—have sparked interest in what actually works. Most people, these days, have had or know someone who has had a horrible, if not outrightly dehumanizing, experience with the mental health system. Upon this ground of failures, new approaches are emerging, such as the recovery movement.

Recovery, seen as an organic process, experienced some setbacks during the 1940s and 1950s in the US, as the predominant way of contending with psychological distress was institutionalization. Even during the deinstitutionalization, beginning in the 1970s, it was assumed that recovery was not possible from so-called psychiatric diseases. We still see some of this today, unfortunately. Nonetheless, the recovery movement persevered, refusing to adopt the limiting and errant beliefs of the psychiatric establishment. R.D. Laing and his colleagues made substantial headway in establishing therapeutic household that still remain today, such as the Philadelphia Association in the UK. Following R.D. Laing, Loren Mosher was successful in his work at Soteria House. To this day, Soteria houses still exist in various locations. In a similar vein, the consumer and psychiatric survivor movements began taking hold in the 1980s and 1990s and are still quite active to this day. By 2002, the President’s New Freedom Commission on Mental Health solidified a way for a system wide paradigm shift.

Of note in the recovery movement, is the well-resourced and expanding business, Recovery Innovations. The organization constellated around the notion of recovery, from its entry-level employees to its administration. Their international expansion is testimony to the efficacy of its educational, clinical and peer support programs. With this organization, having a recovery story, of some kind, is considered a strength, not a detriment. Their states mission: “To create opportunities and environments that empower people to recovery, to succeed in accomplishing their goals, and to reconnect to themselves, others, and to meaning and purpose in life.” Their service values are hope, empowerment, wellness, personal responsibility, community focus and connectedness. Their organizational values include quality, creativity, friendliness, quality team, cultural competence and financial stability. Impressively, their entire international business operates on a non-hierarchical fashion. They go so far as to have what they call “wellness cities” where all supports are offered in a single setting. The services offered include, but are not limited to, peer support, education, medical services, mental health services, employment and crisis services. The vision of the business “was a transformation in the service delivery system grounded in the belief that people with mental health and substance abuse challenges do recover and move on with their life.” The domains deemed critical to recovery are represented in the services provided: “The principle ingredients of this transformation include hope, education, employment, peer support and self-help.” I present Recovery Innovations, since it is remarkably effective in regards to supporting people through recovery and also being fiscally sound. There are other organizations such as MindFreedom International, The Icarus Project and PsychRights that, in their own ways, participate in and support the recovery movement. And the recovery movement itself a symptom of the surge of interest presently growing out of the failed assumptions of medical model interventions to psychological distress. There are others and it will be fascinating to see what other successful endeavors will arise to replace the fallen juggernaut. This is a great time to be in the field!