Understanding trauma: how women’s distress is wrongly medicalised

// 10 February 2017

woman pensive

Emma Hamilton is a Northerner who aspires to live in a warmer climate, spending her time writing and walking barefoot on sand

Emma is our guest blogger for February

Borderline personality disorder (BPD), also known as emotional unstable personality disorder (EUPD), is a mental health condition most commonly (about 75%) diagnosed in women.

I have seen both during my career as a social worker and in my personal life that this particular diagnosis is highly stigmatised both within and outside of mental health services. It is constructed around a narrative of impulsive, self-destructive behaviour; unstable mood; difficulty in relationships and dissociation, a process whereby a person disengages from themselves and the present. This is a coping mechanism that protects them from perceived or actual pain in their life.

BPD was long thought of as a lifelong condition; one that didn’t respond positively to treatment. Therefore people with the diagnosis were “historically confined…to the margins of healthcare systems”.

More recent research around the condition has reported a 75% rate of childhood sexual abuse in BPD patients. Would it not seem logical that a young child who has been abused will later have trouble trusting people, causing difficulty in their relationships? Would it not be logical that they experience mood changes if triggered by something that reminds them of those experiences? Would it not cause patterns of behaviour where a child may blame themselves for how they are feeling and therefore feel the need to punish and hurt themselves?

The difficulty with our healthcare system is that the field of mental health is dominated by the medical model. This model is essentially reductionist in that it evaluates the set of symptoms a person is experiencing and then labels them as a problem within that individual. There is little acknowledgement of environmental and personal experiences that may cause particular symptoms. Essentially, the patient is blamed for not being able to cope.

So why are so many women being diagnosed with this stigmatising label? Is it because women are more likely to come forward for help? Is it that more girls than boys experience childhood abuse? Or is it that there is a bias within the mental health field to more readily diagnose women with a personality disorder rather than, for instance, post-traumatic stress disorder?

I believe it’s a combination of all those factors.

A BPD diagnosis can be a very depressing label. To be told you have a disordered personality — that you are not “normal”— can be life-changing. I have known many women diagnosed with the condition and there are common threads throughout their experiences: doctors not enquiring about or listening to their life stories, being told they need to change their behaviour and then everything will resolve itself and being treated as a drain on resources because they present in highly-distressed states which the clinician believes they should just manage themselves.

All these experiences compound the feeling that these women are not worthy of care; are not people in their own right beyond their diagnosis. That must be a very familiar feeling for those who have experienced trauma at the hands of someone more powerful than them.

To add to this stigma, women with this condition find their chances in life curtailed. Nicola writes on The Time To Change blog:

Since the age of 18, I have always worked or been in full time education, or both. I am an exemplary employee – never take a sick day, I can interact with people in a professional manner, I have a wealth of knowledge, skills and experience which makes me invaluable – and yet, in the past 6 months, my employer has banned me from taking any shifts and the university where I was undergoing teacher training has informed me that I am not allowed to continue on my course because of this condition

Is this not societal oppression of women who have experienced trauma in their lives? If the healthcare professionals we all turn to when in need are framing a set of coping mechanisms used by these women as permanent and inappropriate, is that satisfactory? I think not.

Thankfully, the effects of trauma are being now beginning to be recognised as research is done and campaigners and activists work to highlight the issue. But is medicine catching up? Is the medical model of mental health best serving those diagnosed with EUPD/BPD, or would a more holistic model offer more hope?

It’s time to build on the recent work around understanding the effects of trauma. It’s time to move away from the victim-blaming model of psychiatry. It’s time to support vulnerable women who are simply using maladaptive coping techniques because they have never been valued and supported to create ways of coping with life stressors in a more constructive way. If we recognise that childhood abuse and trauma at any stage of life can be overwhelming then we can — as a society — begin to create more nurturing, inclusive models of support: models that do not confine survivors to the lifelong stigma of a psychiatric diagnosis.

Image by Isaac Holmgren, from Unsplash. Used under Creative Commons Zero licence.

Image is of the back of a woman’s head as she looks out the window onto a carpark. The scene feels moody and pensive.

Comments From You

Bippyone // Posted 11 February 2017 at 3:39 pm

First of all I would like to thank Emma Hamilton for her insightful and accurate article on the plight of women who experience trauma.

Childhood sexual trauma in particular is the cause and brings about overwhelming anxiety emotions in adulthood and this as a result is treated by psychiatrists with medication and the person is considered to have these negative feelings lifelong when in actual fact a more holistic approach and one to one talking therapy has been proven to help and aid recovery.

Psychosis and delusions are I do not believe to be an illness as such and I believe are a phenomenon that there is very little known about even today although supporters of modern day psychiatry would disagree and say it is a chemical imbalance.

So many women experience sexual trauma and so many woman seek help from the only people possible which are their family, friends and doctors. Therapists also have a large part to play but on the NHS they are a rarity. CBT is not the only therapy known about. I personally have been having existential therapy for the past three years and I would say I shall never look back. But once entangled in the web of patient and labeled with a mental health diagnosis it is very difficult to break free.

It seems so unjust and so unfair that because we suffered childhood trauma the trauma in adulthood should continue despite keeping head above water and the blame culture of mental ill health decides our fate.

Recovery to psychiatrists is a dirty word but there are insightful people working hard to change this. And I am grateful.

There are psychiatrists, nurses, health workers and others in Finland who use the Open Dialogue Approach to young people who experience psychosis for the first time and they are having 80% success rate and these youngsters are going back to school and college and work. Making complete recovery with no drugs or ECT ever used on them. To me this is inspiring and Nick Puttman is introducing training within the NHS which is a huge step forward for those suffering severe mental illness.

For all those others who do not experience psychosis but who have overwhelming post traumatic feelings there should be no labeling and the choice of treatment granted for everybody. Talking therapies should be available first a foremost for people on the NHS before drugs and hospital are ever prescribed.

Talking therapies work. Whilst drugs disable people for life. I know at the age of 17 if I hadn’t been sent to my family GP who sexually assaulted me also and I had been given existential psychotherapy then my life would have been a completely different picture.

It is being discovered that the long term affects of labeling and drugging and also shocking people does not work and has never worked for people.

Jaakko Seikulo and others in Finland have proved their family orientated person related approach does work. And this is the way forward.

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