You can find the original article at this site: Garbage Can Diagnosis: The Borderlining of America's Women
by Stevie Redfield
Borderline Personality Disorder is a recent development about which the public has been bombarded with so much new "information and innovative ideas", that we tend to think of it as a real disorder, with clearly defined causes, symptoms, and treatments. This is not the case. A little research into the subject reveals a darker truth-one that insurance companies and pharmaceutical giants don't want you to know.
Borderline Personality Disorder(or BPD as we know it) is a recent phenomenon having come into vogue alongside HMO's and managed health care, as well as the newest wave of psychiatric wonder drugs such as Prozac and Ritalin. Prior to the 1980's, the National Alliance of Mental Health used the diagnosis 'borderline' (as separate from 'personality disorder') to describe a patient who was more than neurotic, yet not full-blown psychotic. It was assumed that, without intervention and treatment, such a patient was in danger of developing a psychosis, and so 'borderline' patients were taken seriously and treated with individualized combinations of antidepressant, anti-anxiety, and anti-psychotic medications, as well as one-on-one therapy. It is interesting to note that this diagnosis was often concealed from the patient being referred to under such euphemisms as 'mixed disorder'.
The Big Change
In the 1990's, 'borderline' was added to the newly-published DSM IV's list of 'personality disorders', and the term took on a new and darker meaning.
As a personality disorder, 'borderline' remains undefined. It has, however, picked up a list of 'criteria'�all of which is ambiguous and open to interpretation (such as 'a history of intense interpersonal relationships') or includes most of the public (such as displays of anger ranging from sarcasm to violence to adult tantrums). Using this criteria, anyone whose case cannot be managed quickly, profitably, and comfortably, is in danger of being given this diagnosis.
Prior to the release of the DSM IV, 'borderlines' were a mix of men and women from various walks of life. In the 1990's, most borderlines tended to be women, and most tended to be women with lower incomes. This striking change in population has come about for reasons that have nothing to do with disorders of the personality. Women in this country are socialized from birth to a particular way of dealing with relationships, anger and aggression, and acceptance or non-acceptance of the body. To reject this socialization is to incur the strong disapproval of all but the most ardent feminists. To accept it, and at the same time be in need of mental health care, is to have a personality disorder. Clearly, when it comes to health care, the situation is, at best, biased against women.
Who Is In Danger?
Depression, unlike BPD, is and has long been a well-established clinical disorder. Much of the criteria used for diagnosing BPD is widely known to indicate major illness such as schizophrenia and bipolar disorder. The criteria used to diagnose BPD is wide-sweeping, and people with major mental illnesses are misdiagnosed as 'borderline' everyday.
If you or someone you know suffers from any form of mental illness that cannot be treated quickly and with ease, then you are in danger. Directly (as from medical misdiagnosis, continued illness, suicide, etc.) or indirectly (as from suicide survivorship or ongoing contact with someone whose day-to-day functioning is impaired due mental illness). The diagnosis of BPD is routinely given to patients(especially women) with symptoms ranging from obsessions, to hallucinations, to crippling anxiety, to depression, to violence, to suicide. Moreover, the diagnostic rule of meeting six or more of the criteria�as is true with other fad diagnoses such as Attention Deficit Hyperactive Disorder in children�is routinely discarded. Patients meeting just one of the criteria listed are being 'rediagnosed' as borderline everyday.
Once BPD is 'diagnosed' in this manner, any underlying condition tends to be discarded completely, and costly medications and therapies discontinued. Trials of medications to find the right combination and dosage are a thing of the past, as it has been decided that 'this disorder does not tend to respond to medication'. BPD is 'treated' by short term(and often forced) enrollment in a classroom-like(and 'cost effective') behavior modification program. These groups are by no means 'group therapy', nor are they any other form of therapy. Though they are sometimes accompanied by an equally short stint with one-on-one counselor(who reinforces group skills), they are just as often not accompanied by any private counseling or therapy at all, nor by any form of medical intervention.
A big part of what these groups teach, is 'distress tolerance'(i.e., suffering in silence). Moreover, this is popularly taught through use of a technique called irreverence, which consists of responding to 'manipulative behavior'(such as suicide attempts, self-starving, angry outbursts, violence, withdrawal, etc.) with something outrageous and aloof, thereby not reinforcing the behavior. An example of this is when one suicidal patient was told, "If you want to jump off a building, go to New York or L.A�the tallest ones are there". The message in this technique is, "I don't take you a bit seriously, and if you're going to do something dangerous I dare you to go through with it." Since it has been decided that suicide is disproportionately high in BPD patients, and since suicide profits no one and benefits no one, the motive for popular use of this technique remains a mystery.
But What Can We Do?
We can do a lot of things. We can gain knowledge, use our voices to speak for those who are often too ill to speak for themselves, and use our tax dollars and our votes. Because it is we who are the loved ones and friends of those who need mental health care, and it is we who sometimes need such care ourselves. Public awareness in the past has affected the fad misuse of such things as shock treatment, Valium, and Ritalin�and public awareness in the present can affect the fad misuse of the BPD diagnosis.
For further information, contact SAVE (Suicide Awareness Voices of Education), 7317 Cahill Rd., Suite 207, Minneapolis, MN 55439