Women and mental health services

I'm finding this thread fascinating and am really learning a lot from the experiences that have been shared here. I agree that psychiatry and mental health services provision is very gendered, and I think the pp who described EUPD as just a new term for Hysteria has it spot on.

I think BPD/EUPD is a feminst issue and it's just the latest name for Hysteria. It's a very gendered diagnosis.

I have been diagnosed with Avoidant PD, or Anxious PD as it's known in the UK. That isn't really a matter of gender, as most people aren't even aware of it. It doesn't seem to affect the support I recieve and it appears that Avoidants are largely viewed with sympathy and occasional annoyance as we tend to just be reclusive, socially awkward and socially inept sad sacks who don't like to rock the boat. Unfortunately there are no NICE guidelines for treating this PD. I've heard a lot about people with BPD getting shoddy treatment from CMHTs. That's really shit IMO.

I also have a diagnosis of Bipolar 1. I have had really good treatment all in all, especially when you consider the state of the NHS and funding issues. The professionals I've seen have all been kind and compassionate - apart from one locum psychiatrist who was a complete arse. He was a semi retired bloke and he was very sexist.

However, I didn't experience sexism from the other psychiatrists I've seen. I have a male care coordinator/CPN and he's a really nice bloke. He's in no rush to discharge me. They haven't pushed me into becoming 'normal' and into female roles, because frankly, that's not going to happen. I have a severe manic and depressive bipolar episode every 18 months to 2 years (even on meds) and struggle with AvPD the rest of the time.

However, I have a really supportive husband and there's no abuse going on, so I can't comment on how they'd handle it if there was.

I'm just sorry that so many people have had negative experiences. On the whole I think my CMHT has done a good job with the resources on hand, apart from that wanky locum psychiatrist. I have a lot of respect for them.

There are nhs services that offer long term psychotherapy (in nhs terms 1-2 years)for bpd (and other pds), but it does vary nationally. The cassell hospital in richmond and the tavistock in London both do. But I agree there are not nearly enough and everywhere is facing cuts. But not everyone will like or feel helped by these services either.
I feel mental health provision for men is actually worse than it is for women.

BPD is indeed a feminist issue. They are too quick to dish that diagnosis out and then refuse to help women who have it.

This has been a subject on my mind for a while now.

My personal experience was similar to others here. After a decade of depression I built myself up to approach the GP. I had been really bad for the 18 months before that due to the birth of my youngest and some really shitty circumstances.

He was ridiculously patronising. But medication was given based on a 5 minute conversation. I went away feeling confused. I always knew that my MH issues were mostly, if not entirely, caused by situations in my life but treating the symptoms was more important than treating the cause?

I took the first prescription and yes, they numbed me. But I couldn't bring myself to go back to get more. So I found a private therapist and accepted that I was going to be skint for the foreseeable if I was ever going to get better.

That therapist halved her fee at the first appointment and she went on to change my life. Just being able to talk and be heard and feel understood and respected felt like a miracle. It wasn't just that. I had to make some massive changes in my life. But sge supported me through it.

I have always had an interest in Psychology, and I hope that someday I will be a therapist and help someone else the way she helped me. I am working towards that now.

But lately I have been becoming a bit...deflated? The issues mentioned om this thread are all around me and they seem so ingrained. Children are being socialised into these patterns and really the MH services are coming too late. Feminism is a dirty word. Feminists are crazy, men hating, bra burning lunatics. There are men who actively despise women.

I am actually considering whether I am strong enough to go into the NHS and work in an environment that does nothing to challenge these issues, and actually might be perpetuating them.

I am rambling on now...but this is a very interesting thread OP.

That's interesting Fallon.

This is a very interesting book about feminist historian Barbara Taylor's experience of needing proper long term help. Really long term. (Actually it's just a review of the book but the book is very interesting and a challenge to the system we have now)
www.theguardian.com/books/2014/jan/30/last-asylum-barbara-taylor-review

I was working on acute wards in the 90s and early 2000s. I'd say about 25% of the service users who had admissions under a section of the MHA had a diagnosis of BPD (PD not bipolar).

If anything, I think it's less likely that someone with a diagnosis of PD is admitted to hospital now. Because it's hard for anyone to be admitted now and because the admissions that were had back in the day for people with PD were often lengthy but not particularly helpful in a lot of cases.

People with PD may have been technically excluded due to semantics around language but they were not being excluded from services.

I am uncomfortable with much of what is said on this board. And I absolutely consider myself a feminist. I think that mh services are struggling terribly and in times of cut services and social inequality, mental health is also suffering terribly.
I think sometimes it is hard to help people to feel better, despite all the best will in the world. Sometimes it is just hard. However I do agree that pd is a feminist issue (or rather people issue as feminist issues are issues for women and men) but women are more likely to get this diagnosis while men are more likely to be diagnosed with asd/ adhd and end up in the criminal justice system/ committing suicide. The reasons for this are complex but I do feel uncomfortable with how bpd can get overused for women. I also agree that there should be more long term talking therapy around. And there is now evidence for it e.g.: www.bpc.org.uk/news/publication-landmark-psychoanalytic-psychotherapy-depression-study
It is however expensive and measuring 'outcome' for constellations of difficulties such as complex self sabotage, repeated abusive relationships, trauma etc are not as straightforward as measuring outcomes for other types of nhs treatment.

I was psychotic at the time I was in an abusive relationship, and one of the things advised was to move out of the house I shared with him.

BPD was considered for me at one point, but the label was removed and bipolar decided upon, for various reasons.

When I was considered to be BPD, which was a label I had for several months, I don't think I was treated any differently in terms of kindness. They were reluctant to put hospitalisation on the table, as data has shown that hospitalising people with BPD just leads to continued admissions and a negative cycle appearing. I was told this at the time and they worked with me on an outpatient basis. There was a significant focus on supporting me, but keeping strong boundaries in place. I was told about DBT and advised to buy a book to get started. I was also referred to a service that does some kind of DBT based therapy, but my diagnosis changed before I could get there.

My diagnosis changed because I moved back to my home town and was re-assessed when in crisis again. As said, there were reasons bipolar was more appropriate, mainly because my symptoms only occurred during a mood episode, and medication resolved the mood episodes.

When I was diagnosed bipolar, my psychiatrist would occasionally do me a favour, like drop me at the station after an appointment (in her car) so I could go to work. This only happened about once, but my understanding is that this would not be appropriate for a patient with BPD, because it would blur boundaries, and destabilise the relationship.

The books I read about borderline and DBT, when I was thought to have BPD, mentioned traditional therapy for BPD. Apparently it's unsuitable because patients end up retraumatised from going over trauma, and often go through a cycle of devaluation/putting their therapist on a pedestal and wanting constant contact, so it ultimately doesn't do any good. The therapist ends up feeling drained and useless, and cannot give the person what they want.

BPD is a feminist issue.

Hotmail - I think that MH services are possibly gendered in their response but I think that's often to the detriment of men. And I promise I'm not a 'what about the menz' person.

I think it's much more acceptable for women to be distressed and less so for men - this contributes to the higher suicide rates in males.

And a PP said anger may be more acceptable for men - I don't think it is. In my experience, traumatised women who self-harm or 'act out' are more likely to be diagnosed with depression, PTSD or (if other DSM criteria is present, BPD) but men are much more likely to be assessed as having a substance misuse disorder or an antisocial PD.

The referring to you as Mum thing is probably due to lazy HCPs who can't remember your name but when you're talking about a report about a child, GPs and lots of other HCPs won't/don't have the time to read a 5+ page report so it's safer and makes more sense to refer to you as Mum rather than 'Hotmail' which may lead some readers to not immediately know who that is.

Fallonjamie thank your for your post. I am going to think about it.
My general reply would be, if it is difficult to trust the MH services, how can any one get help? Do you at least agree that in general MH services are gendered in their response (from the moment of pregnancy I noticed that I lost all my degrees but became referred to in 3rd person as 'mum') and that has a really deleterious effect on how women engage with the support, if any, which is offered?
Samuel Pepys, the diarist had to have a gall stone removed this was pre anaesthesia, anti biotics etc. He embarked on a pre operation friendship with the surgeon which lasted for months and by the time he had the operation, he trusted him so much, that I am sure that helped him survive a pretty dangerous operation.
Without trust, it is so difficult for any positive outcome to arise from any intervention.

Thadius that is appalling.

I agree with previous poster about ridiculous expectations and demands placed on new mothers. Dd1s birth was the most terrifying and medically traumatic event of my life, but I was just expected to get on with 24 hour care of a colicky newborn. I'll bet a lot of money those countries you've cited have far lower levels of pnd.

In relation to my dh's severe mental illness I've been patronised and looked on as neurotic when expressing concerns about his changing moods to doctors. Only after he almost succeeded in committing suicide have docs started actually listening to me

I dont agree that men are 'allowed' to be angry. Anger in men is often conflated with abuse and threatening almost as default.

I do however completely agree with what the OP and others are arguing.

Having been in military situations of sleep deprivation where low level hallucination, talking to yourself and dreaming whilst awake, as well as using aggression to keep going are joked about and seen as linked to the physical conditions, and similar when sailing, the same effect in a home or hospital situation caused by poor sleep or a desire to stay awake or thoughts racing when you are fucking knackered are seen as not only seen as low ' mental heath ' but also 'memtal illness' when it isn't.

Army training for officers consciously avoids high level teaching when physical exhaustion is highest, because they know you lose visualisation, high level thinking emotions, and multitasking , and simple skills go last.

So women having no emotions left during childbirth or other times of exhaustion is normal and predictible.

I also agree that because emotions are nearer to the surface/more acceptable/ the social currency /the entire operational sphere (i am struggling to explain what i mean..something like emotion is 'real' to a lot of women in a way that isnt always there in men, and that actually 'mental health' is really emotional health and/or understanding and that how you feel underpins all of it. This is how i think medicalisation of emotions does affect women more. once drugs and self-labelling enter the equation, you then get predictible 'mentally ill' behaviour that traps people.

Music Poetry art literature history religeon all explain dark thpughts grim times ghosts from the past helping or hindering and tend to tie those elements within a coherent human personality, so why we are mow calling these things 'disorders' amazes me.

Hotmail - because I see the very different posts by the OP when she can barely form a sentence and they're often deleted as she is threatening suicide.

And it is clear that she is in crisis and needs help but local MH services know her and say they cannot offer help because they feel she has a BPD and until she is willing to work with that, anything they offer is pointless and won't help.

And when OP is feeling less desperate she posts very intelligent threads on here where people tell her MH services don't give a shit, don't have the expertise, are labelling her wrongly or are discriminating against her or the patriarchy is gearing MH services against women.

I don't think that helps. And I'm not being a bitch. I've spent many hours on numerous threads trying to help OP as have many others. It isn't helping. She is still unwell and desperate and won't get the help she needs till she develops some insight and is willing to work with services.

hotmail124 thank you. I am very lucky with the family support I have but i worry about people who have no family and friend support experincing some of the treat I have from mental teams. If I were alone I don't know if I would still be here.

My DH couldn't understand why I was upset with the cpn for just taking his word. I explained it was because without seeing me or the things she was asking about she had no proof the children were safe with me etc.. and I felt like she was happy just to take his word with no evidence because he was a respectable business man in a suit.
What of he were lying?
What if he were abusive?
How could she possibly know the children were well care for?

I don't think these threads help you at all With great compassion Fallonjamie I don't think that is for you to decide. We all have the right to choose our own paths, and this thread is fascinating and clearly a bit threatening to some. Perhaps you should ask yourself why you would need to write such a post? Warm good wishes.

human understanding, kindness and giving someone the space to feel heard AtrociousCircumstance beautifully put.
A fantastic thread, thanks OP.