There's something wrong with you, forever.
On womanhood and the spectre of personality disorder.
In order to be diagnosed with Borderline Personality Disorder (or Emotionally Unstable Personality Disorder, BPD/EUPD), patients must meet at least five of the following criteria:
Frantic efforts to avoid real or imagined abandonment
A pattern of unstable and intense interpersonal relationships characterised by alternating
between extremes of idealisation and devaluationIdentity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating) (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5)
Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper,
constant anger, recurrent physical fights)Transient, stress-related paranoid ideation or severe dissociative symptoms.
75% of people diagnosed with Borderline Personality Disorder are women.
Typically, mental illnesses take time to diagnose. Months, if not years, spent weighing up different options, exploring different possibilities, following different pathways to different explanations . After all, the mind is a complicated thing. The patient is a complicated thing. I am diagnosed in a single 45-minute assessment. I am twenty-two and being asked to recall fourteen. Or I am fourteen, not envisioning twenty-two. Either way the doctor, male, makes a judgement call. Either way, I am female. This is the first time I meet with adult mental health services. The experience is at once violating and impersonal - the doctor has questions that must be answered, but I do not get to ask my own. The doctor would like to know what happened. Something has almost always happened. But it is not the happening that is sick. It is not the tragedy that we will diagnose. The illness lies in how I survived. How I did so the wrong way.
The cure once was to suck the womb out through a straw. Eels, for the blood. The very essence of a thing. Women cannot be trusted with anything, especially their own anatomy. When you say every man is a room closing in, out comes stethoscope or speculum. Speculative diagnosis. The doctor says Borderline Personality Disorder and I hear a door slam somewhere inside of me. The doctor says Borderline Personality Disorder and I close my eyes to the colour of a bruise. The doctor says Borderline Personality Disorder but I am not listening - the sun coming through the window in such a way that must be deliberate. Divine.
Women with Borderline Personality Disorder are Damn Sexy, Right?! - jezebel.com.
The agreed treatment in the United Kingdom for someone with Borderline Personality Disorder is twelve months of Dialectical Behavioural Therapy, which takes place within a group setting. To begin with, there are six of us - five women, and one man. Before our first session begins, our psychiatrist hands each of us a contract. In order to receive treatment, we must agree to follow a certain set of rules, the first of which is: ‘patients do not form confidential and/or romantic/sexual relationships with each other.’ Once we have signed them, we are asked to turn to the person next to us and memorise five facts about them before sharing with the group. I want to ask how we define confidential. What do we consider romantic? Which elements are safe to share, and which break rules? One day, one of the other patients comes in with two black eyes. Nobody asks anything - this would be the wrong kind of knowing. We can bear witness to the violence, but to reach out to its root would be too intimate. Would see us being asked to leave.
Personality
noun
The combination of characteristics or qualities that form an individual's distinctive character.
Disorder
noun
A state of confusion.
Each week begins with a check-in. Each woman sounds like an echo. We’ve been timing how long it takes to burn the marrow from the bone. Bending ourselves out of sex. We’ve been sitting patiently for IVs, telling the nurses we have ways of coping when we are haemorrhaging memory, being denied the simple pleasure of forgetting. Our psychiatrist asks the one man in the group what do you do, when you are feeling down? And he says I treat myself to some chocolate. The rest of us laugh, and laugh, and laugh, turning to each other, giddy at the idea of sugar as a cure. Up to 54% of patients with Borderline Personality Disorder also meet the criteria for an eating disorder. Nobody asks why we are laughing. We are laughing because we know appetite is its own superpower. That if it gets really bad, that feeling down, we can disappear any time we want. There we go again - so female, so inescapably women.
If the hysteric was a damaged one, the borderline woman is a dangerous one. - Mary Ann Jiminez: Gender and Psychiatry, Psychiatric Conceptions of Mental Disorders.
Dialectical Behavioural Therapy was developed by Marsha M Linehan in the 1980s, and relies on, among other components, ‘skills training’, using The Dialectical Behavioural Therapy Workbook. The book lists ways to cope with distressing situations - which include being ‘shouted at by your boss’, or being ‘upset that your daughter is leaving home’. The solutions offered are simple. So simple. If only we’d considered them sooner - how well we could be by now. ‘Wash the dishes’. ‘Polish your jewellery’. ‘Clean your bath tub’. The workbook suggests that if you need distracting from your thoughts, you ‘create sexual fantasies involving you and someone you know or someone you would like to know. Try to think of as many details as possible.’
I would like to know the protocol for coming out of a flashback. For finding my way back into my body when I’m occupying an absence. Which page of the workbook will tell me how to return to myself when the locks have been changed. I want to know how much jewellery I would need to polish before I can stop finding other people’s names in my mouth, forcing my teeth from out of my gums. But just as in my assessment, there is no room for questions of my own within group therapy. Women with Borderline Personality Disorder who question their own treatment, who do not ‘comply’ with mental health professionals are labelled ‘treatment-resistant’. If we continue to engage in the behaviour that contributed to our diagnosis in the first place, we are ‘manipulative’. Our sickness a self fulfilling prophecy, an inescapable fate - a cycle in which your illness deems you manipulative. So, if the dish washing, the bathtub cleaning, the sexual fantasies do not suddenly see us unshackled from our personality disorders and the pain that accompanies them - we must, again, be at fault.
Six months into the twelve-month course, funding is pulled, and the skills training group is cancelled.
How do we determine which personalities are disordered? What is the benchmark of a correct woman? How must we speak about ourselves in order to avoid pathology? I am twenty-five when another man, a different man assigns me a new diagnosis. Over the phone, he tells me I meet the criteria for Complex Post Traumatic Stress Disorder. Initially, I am relieved, to find myself with a language that feels appropriate to talk about myself in. But quickly I begin to wonder, again - why must I carry the burden of a name for the things that have been done to me? I ask if this means Borderline Personality Disorder will be removed from my records. No, he says. Perhaps this is not a new language at all, but a surplus. Another way of saying what was always said. No, he will not remove my Borderline Personality Diagnosis. And so, I cannot erase my history, just as I had no say in its creation. Instead, it must follow me around as my present. Close, and determinative, as breath.
Hi Cherry Femme readers. How are we? I wrote this essay in 2022, but I think 2024 - seven years on from my initial diagnosis - I finally feel capable (rather than just ready) of talking about un/wellness, womanhood, and CPTSD. I initially set out today and began writing a recap on 2024 but I couldn’t write my way out of a central point of health, un/wellness, cyclicality. so I re-visted this piece and have published it instead. I have also recently regained the rights to my first poetry publication, Ways of Coping, which is on the same topic and which I’ll be re-editing and publishing in the ways I always wanted it to be. I’ll see you in a few days for an end of year post, but for now, I hope you can forgive the re-publishing of this essay.