Bordering on insanity: misnomer, reviewing the case of condemned women

Abstract

In the UK, there have been calls to develop gendered specific mental health services for women in an attempt to ensure privacy and dignity are achieved as and when women come into contact with services. This is a largely rhetorical policy objective. There are more fundamental factors affecting women's experience of mental health services that need addressing. This paper explores these issues in the context of mental health care for women who have been 'given' the diagnosis of borderline personality disorder (BPD). Borderline personality disorder effects 2% of the adult population, 75-90% of those diagnosed being women. This diagnosis continues to present considerable conceptual and therapeutic challenges for all of those involved in mental health services and it remains a categorical label that evokes a wide range of conscious and unconscious responses in mental health nurses. The paper argues that mental health nurses need to recognize the defence mechanisms involved in working with individuals who are often difficult to work with. It is only when mental health nurses can embrace and acknowledge the person in the context of their life, that the pejorative and disabling consequences of the BPD label can be eliminated, ensuring the individual's story is heard and not that which is often a pre-constituted account accompanying this diagnosis.

Measuring the evidence: Reviewing the literature of the measurement of therapeutic engagement in acute mental health inpatient wards

“…Five common themes were identified as the major barriers to one‐to‐one care: administrative duties, understanding one‐to‐one sessions, control over workload, staff needs, and ward culture (Edwards ). Ward culture and understanding one‐to‐one care are interesting in terms of there being a common belief among mental health practitioners that those who experience serious mental illness are not capable of engaging in therapeutic relationships (Warne & McAndrew ). However, this is challenged by Bentall et al .…”

Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature

“…The conclusions drawn in these studies were that psychiatric nurses perceived those with BPD as 'bad', and other patients as 'ill' (Gallop et al 1989, Fraser & Gallop 1993, Deans & Meocevic 2006, Thornicroft 2007. It is believed by many theorists that the diagnosis of BPD itself has become a pejorative 'label' ascribed to those patients (generally female) who the clinician does not particularly like, and that the use of the term itself needs to be seriously questioned (Fraser & Gallop 1993, Warne & McAndrew 2007. These attitudes can even be taken to the point of explicit segregation, where diagnoses of BPD have become exclusion criteria for some agencies' or programmes' provision of care services (Thornicroft 2007).…”

Personality disorders: illegitimate subject positions

“…It has been argued that the psychiatric model provides nurses with limited treatment options and facilitates feelings of inadequacy, anger and resentment towards clients who have received this diagnosis (Nehls 1998; Krawitz and Watson 1999; Crowe 2000b). Warne and McAndrew (2007) have suggested that categorical labels evoke a wide range of conscious and unconscious responses and that mental health nurses need to recognise the defence mechanisms involved. Feely, Sines and Long (2007) has proposed that diagnostic manuals, which act as points of reference for professionals, encourage healthcare staff to proffer medically related diagnoses and mental health nursing has contributed actively to this process.…”