As an author and trainer I’ve written enough about mental health to wallpaper a small room. I’ve travelled the length and breadth of the country running courses on personality disorder, and can list the DSM-IV diagnostic criteria while hopping on one leg and loading the dishwasher. I’ve also spent many years working with personality disordered people in secure units, in acute admission wards, in the community. I’ve spent literally hours at a time trying to prevent patients gouging out their eyes, setting fire to themselves or trying to hang themselves with a bath towel, all the while trying to avoid the saliva aimed at my face and blotting out the screaming and shouting with ‘nice thoughts’ about home, family and the post-shift kebab. 

So I know a lot about BPD, then? Er, actually no.
Before reading Siân’s posts I assumed, with the eyes of one who has for many years seen BPD from the ‘professional’ side of the ward or treatment room, that BPD rendered a more or less constant diet of chaos, misery, institutionalisation and sometimes death. Through training and writing I try hard to dispel the idea that all individuals with BPD are manipulative, wildly emotional and self-destructive, but if you’re paid to treat or support people with this diagnosis, it’s always seen as bloody hard work and universally unpopular.
I was keen to hear Siân’s account of her encounters with ‘the system’. I’m certainly no apologist for the many, many faults of a mental health structure which has not so much failed over the years but never really got it’s act together in the first place.
As Siân puts it, we have: “A system that insists that mental illness is no longer taboo but hasn’t yet worked out how to deal with it. Whether through ignorance, lack of funding or wilful desire, it just doesn’t take us seriously.”
And it’s just this sort of voice I wanted readers to hear as opposed to some of the increasingly ‘shouty’ anti-psychiatry stuff spouted on just about any online forum having the words ‘mental’ and ‘health’ in the title. I asked Siân for a service user perspective that might inform and stimulate without stereotyping all mental health workers as a battalion of burnt-out, syringe brandishing stormtroopers whipping out section papers at the mere suggestion of deviation from the cultural norm.
To quote Siân again: “The two sides of the equation – let’s call them ‘the professional’ and ‘the patient’ – ought to be travelling in the same direction, should, really, be striving for the same goal but I would suggest that isn’t always the case.”
No it most certainly isn’t, for reasons that are far more widespread and complex than can be tested on the attention span of our readership. But I’d like to think that my guest blogger has eschewed anti-psychiatry polemic for a considered argument as to where at least some of the problems emerge. Siân highlights a rigid mental health care bureaucracy focussed on crisis management and firefighting, often where an inferno might have been averted with the pre-emptive application of a damp tea towel. And please let’s not have any ‘lack of resources’ argument here. Early intervention can save lives AND money.
At the more individual end of the scale, Siân offers us a glimpse of the ‘piss poor professional’. This is a phenomenon I know only too well as being far too common in the caring professions and about which I’ve guest posted in the Not So Big Society blog.

I probably don’t agree wholeheartedly with everything Siân argues. As a self-confessed science nerd I’m actually quite excited by much of the recent research evidence pouring out of the world’s ever growing collection of CAT and MRI scanners. I would argue argue that neither BPD nor any other mental disorder cannot be explained purely by environmental circumstances or social construction. But like Siân I do believe very strongly that ‘patient’ and ‘professional’ should be travelling in the same direction. So how can we do this?

Only by both sides dropping their weapons and beginning to realise that there is nature AND nurture, that there is medication AND talking treatments, that not anyone wearing an NHS badge is the spawn of Satan and that not everyone labelled as BPD is a spitting, screaming attention-seeking nightmare. A little understanding could go a long way on both sides of the void.
I could go on but let’s save that for another time. To paraphrase Star Trek’s Mr Spock, sometimes the needs of the reader outweigh those of the blogger, so let’s just leave it there and say a very big Thank You to Sian Lacey Taylder.

If you missed Part 1 of our BPD trilogy, it’s here, and Part 2 is here.

Siân is author of The Society of Sin, a Victorian Goth-erotic fiction inspired by her Dorset connections, and is currently in the process of publishing her autobiographical novel Death by Eyeliner. You can find out more about her here.

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  1. Thanks for your perspective, Connor. I did say to you that I didn't set out to damn an entire profession and I hope I haven't done that. I also work as a tutor and the same problem exists in education as in mental health and every other profession – there's good eggs and bad eggs and it's really hard to get rid of the latter.Of course, my perspective of BPD is that of a relatively articulate and educated middle-class professional and in many respects I'm probably not wholly representative of the genre. But I've long since ceased to engage with mental health professionals; I've learned how to manage my symptoms reasonably well and medication's a no-no since I overdosed on Venlafaxine a couple of years ago.And, off the top of my head, I can think of at least two other friends with BPD who have adopted a similar attitude. I can't help making a comparison with the hokum surrounding drug use. There are tens of thousands of people who consume soft and hard drugs on a recreational basis but it's the addicts who grab the headlines and to whom treatment policies are directed. God, I could write a whole book about this subject; I think I'll give myself some time to ruminate on my thoughts then come back with some more thoughts.Thanks for raising the issue and being brave enough to stick your head above the parapet!

  2. Thanks Connor and Sian for a great series on BPD and also for the 'recommended' link to my blog, hopefully there will come a time when the patient and professional are singing from the same hymn sheet and more people wih mental health problems can get the help and support they need to live fulfilling lives :)

  3. Hiya, just wanted to share a thought with you, though I'm commenting very late! I think BPD is often misdiagnosed, or rather, people with understandable psychological problems (from abuse or grief or just a really tough time in life one gets through alone then 'cracks' later with the memories/flashbacks)are often misdiagnosed as BPD. The thing that strikes me, at least in my own unfortunate experience, is that often the prejudice about BPD, the lack of time/funds to treat complex psychological problems, and the way these things impact on professional 'care' and attitudes, actually provoke 'symptoms' of BPD, even in people who probably don't usually fall under the classification. Then this is added to by confirmation bias. What I have observed is that the incredibly frustrating way services treat/ignore someone (and in many cases are actually verbally abusive and definitely neglectful) make them feel angry, desperate, lost, and rejected. This is then interpreted as being ‘manipulative’ (by ‘hurting others feelings’ when they self harm, or self-harming, or even asking for help when their pain is too much), or ‘innapropriate anger’ (I have never seen anger directed at MH services that wasn’t utterly appropriate!), or ‘paranoid thoughts’ (when in fact they are right about being singled out and treated badly by professionals who don’t hide their dislike of them), and these things are then counted as ‘symptoms’ of BPD!Also, having ‘unstable interpersonal relationships’ (because their nearest and dearest are obviously affected by their problems and frustrated at the lack of support) and ‘repeated suicidal thoughts and behavoirs’ (because they are left to rot alone with their pain) are also symptoms in part invoked by services. I do not mean to be personally critical of yourself, you seem like someone who actually bothers to think about patients and what it may feel like for them. However I am critical of the system which means I am recovering from severe depression, along with intrusive memories of my experiences at the hands of services, rather than having had help years ago when I initially realised I needed it. Essentially, I'd have been better off on my own from the start – I'd still have been truamatised by various life events, but I have mainly recovered from them, and what remains is the resulting confusion, fear, inner pain and memories of the way I was 'treated' by those I'd asked for help.

  4. Thanks MyrtleYour comments are very welcome no matter how long after the original post. I can't comment on your individual circumstances but perhaps the main message from your comment is that statutory services are very variable in their responses to complex issues (there are some good guys out there, I promise!) and that self-help groups and the BPD community will become increasingly important in supporting people such as yourself.

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