Feminism, psychiatry and Mumsnet

[OnceThereWasThisGirlWho]

This started as a reply to a post on another thread (not a thread started by me). I don't want to upset anyone by theorising in a support forum so am posting my ponderings here.

My brain is not at optimal functioning to rephrase everything, so here is part of my reply:

"OP is understandably and justifiably frustrated and distressed and some posters are seeking to justify shoddy treatment and the smoke-and-mirrors operation of MH services. Which obviously makes the OP more frustrated and distressed.

It baffles me that an online community which appears to encompass thoughtful discussion, criticism of existing power structures/services/wider system, and has many strong feminist viewpoints/posters, should be so lacking in any kind of understanding support about how crappy the mental health system can be. Or, dare I say it, any kind of vaguely antipsychiatry/survivor movement type experiences/thinking/feeling."

At this point I realised this was a discussion to be had elsewhere. Personally, I have found it immensely helpful to look at alternative ways of viewing things to the narrow medical model of psychiatry. To realise that others have similar experiences of the system, similar criticisms or frustrations or alternative viewpoints encompassing the wider context. Even if I am very distressed, talking to someone who understands generally ends up in a lot of dark humour and discussion of the sociopolitical context. Especially helpful when things like gender role expectations, male on female violence and control, and issues around poverty and homelessness form part of the issues.

To be honest, if someone had started talking to me about the things I now agree with (including feminism!) in the past, I would have been polite but inwardly patting them on the head, trying not to dislodge their tinfoil hat. So I do understand others not understanding in general... but so surprised to see it on Mumsnet, where issues are normally pulled apart with alternative viewpoints argued.

I hope I'm making sense, and hope this is the right place to ask...

Once: On BPD, Dana Becker: "...borderline has become the most pejorative of all personality labels, and it is now little more than shorthand for a difficult, angry female client certain to give the therapist countertransferential headaches."

The reference is Becker, D (2000) When she was bad: Borderline personality disorder in a posttraumatic age American Journal of Orthopsychiatry 70(4):422-32

If you would like to read the original article and are not able to get hold of it, let us know. We will be able to get it to you, if that sort of thing interests you.

(Countertransference is the collective term for the feelings evoked in the therapist when the therapist is working with the client. It's a fancy word for "feelings that one person has when they are in a relationship with someone else", where that relationship is the therapist-client relationship. In this language, the feelings that the client has when they are in a relationship with the therapist are transference. I did not write the labels, let alone label the two sets of feelings differently. Thus the comment that the client gives the therapist countertransferential headaches comes with the understanding that the client is doing no such thing. The two people are relating, and it is the words countertransference and transference that reinforce the power imbalance in therapy.)

(Between you and me, I pride myself on my ability to drive my therapists nuts, but that is because I am manipulative, you see...)

(That was a sort-of in-joke, so please accept my apologies if it comes across wrong.)

A simple guide to avoid receiving a diagnosis of Borderline Personality Disorder.

This is amazing. Thanks to BrokenGirl fro sending me the link.

My personal favourite is "Talk with enthusiasm at the idea of being abandoned. Relish the idea whether it’s real and/or imagined." (For the luckily uninitiated, "fear of abandonment" is a BPD symptom.)

My sense of humour was my saving grace until that one time it was described as pathos, which has the same linguistic root as pathology

I am not sure that the headaches are countertransferential, to be honest. They might just be headaches.

Anyway, this is not a competition nor a race to the bottom of any sort. I liked that link. I can imagine it being put together

Erm, also Erin, I dont usually have strong emotions as such. More just an ongoing grinding despair and lethargy. It's only if the memories are particularly strong or someone is being controlling/horrible to me - and I've got better at walking away from the latter.

I could do with some kind of supportive social contact day-to-day, just being accepted as "me", rather than something for "exteme" moments. The suicidal feelings I have relate to ongoing hopelessness, not a spur-of-the-moment thing. Sorry I'm not trying to be awkward, and I'm not criticising just explaining.

I've found it very hard, and hopeless, the way MH teams and others try to cram everything into a "crisis" narrative, with everything focussed on getting through the moment rather than a realistic plan for the future (this is where lay people start ramping up the drama calling ambulances/police and things if you try to talk to them). But there's no support from anyone in a sort of low-key everyday way. I cant talk to anyone about it all. MH team seem convinced I'm fine but periodically hit crisis; in reality I'm struggling every day, pushing myself just to shower or eat, and sometimes I call them just to remind them I'm not getting any better and feel rather hopeless because I have no support or treatment. Then they want to know what's "caused" the "crisis"!

Yes. I understand, and I believe you.

I can tell you what worked for me but it may not work for you. It took me time, multiple crises, and quite a lot of swallowing my pride and accepting that I was going to have to do things that I did not want to do, and also trying out loads and loads of things and then holding firm when I made decisions that other people did not agree with in terms of support, but it can be done. I am aware every day of how lucky I am in as much as I have resources to draw upon when I am well and I systematically go about putting things in place so that I know what to do in a crisis. It was me who had to drive all of this and I feel fortunate that I have been able to do it. Last year I found out what it is that happens when one forgets to do such a thing. It was not pretty. Do not recommend.

I love to plan though. Always have. Always have a plan. If the plan fails, make a new plan.

"Controlling"

My plans just consist of ordinary life plans... doing Open Uni and stuff. I just really miss having real friends. Trying to get support from MH services is actually really disheartening and draining, tbh I just stay in touch via crisis team occasionally because I am worried about evidence for benefits. That's really hard actually. Knowing at any minute all plans are dashed if my income goes. I have some savings to tide me over until the end of the uni year but the hovering shadow of destitution is really difficult to live under.

Yes. The income thing is really, really shit. It is as if the benefits and MH systems were deliberately constructed such that the worst off people would kill themselves out of it

I do like conspiracy theories - paranoid, you see.

What are you studying with OU? I am in awe of anyone who can study with OU. Do you get to connect with people through that? I find the set-up difficult to imagine. I can barely make it through a Coursea course. I have done 1.5 of them and am about to fall behind on one.

I'm studying Social Psychology. One course in, so far.

I think connections probably depend on how many others in you local area are doing the same thing and you might study together etc. Otherwise it's just meeting up for the occasional tutorial or discussing the work online, which also depends on the others doing the same course.

What are you studying? I fell behind last year but managed to catch up. I was about 3 weeks behind so worked out if I did 1.5 weeks' work each week, I could catch up in 6 weeks... so it felt more manageable. Did have to get an extension on one TMA though.

I agree re. the benefits situation. Often wonder the same... Though I think its mainly just people without a clue who really do believe in all the behavioural bullshit. For eg. someone could look at my situation and be VERY critical, think I needed a kick up the backside etc. But if you knew me you'd know how much I struggle and am doing what I can to make things better. Whilst I've been off work I've learnt new skills and challenged myself but they wouldn't know that, or care, as I'm no more employable.

Disability benefits for MH are very all-or-nothing. My income after rent/council tax was 2.5 times what it is now, when I got PIP. Ludicrous, no middle ground. (Used to being poor, I saved a fair bit). Plus they could have funded several years of intense psychotherapy at the right time, which would have saved thousands in the long run...

Hmm just recalculated - make that almost 3 times what my income is now!

It is bizarrely counter-intuitive, the way that the pieces do or do not join up. I tell myself a quote I once read about Jung when the writer was essentially trying to account for the anti-Semitic themes in Jung's writing which went along the lines of "even the greatest genius is born at a particular time in a particular place".

I do find intensive psychotherapy funny as well. I wonder whether in two hundred years time they will be going "and they used to think it would help people, if they sat in a room and talked to each other, and one of them paid the other one, and there were a lot of tissues involved."

OP your knowledge of how mental health professionals see women with BPD ( it's not even called that anymore , but FB groups like BPD World insist on using that term themselves) .

A lot of what you are saying is very outdated.

This diagnosis is nothing about putting blame back on individuals .

Women aren't assessed in terms of whether they wear make up?!!!

The article you mention is a comic dig at mental health professionals - many of us have seen & read this.

There is A LOT of extremely positive work going on for women who have these particular difficulties.

"Appearance" is very often about facial expression, ie reactive or flat, whether that person appears severely self neglected through depression, whether they appear fatigued or full of energy. Absolutely nothing to do with judgments on how a woman presents herself.

Apologies, NoMudNoLotus. I am not laughing at you at all.

OP your knowledge of how mental health professionals see women with BPD ( it's not even called that anymore , but FB groups like BPD World insist on using that term themselves).

I am aware the name has officially changed to Emotionally Unstable PD in the ICD (but not DSM). But it's still called BPD in various places including my local MH services.

A lot of what you are saying is very outdated.

Good - could you let the MH professionals know?

This diagnosis is nothing about putting blame back on individuals.

See above.

Plus the entire name being a "personality disorder". How can you possibly argue that is not blaming individuals? Telling them their personalities are at fault! "Emotional Dyregulation Disorder" might be ok.

Perhaps, like so much to do with MH services, it's a postcode lottery? I also have a theory that because of the severe funding issues in services, staff enter an emotionless "just doing my job" mentality in which they can do awful things/judge people harshly, way beyond what they as a human would normally do. They have to follow really strict criteria about who is allowed help and what kind of help, and turn away the "least ill"; so to them someone who doesn't fit the narrow service definition but still keeps asking for help is a stressful nuisance. If there was the funding and actualy therapy and support services to refer people too they might engage better with people instead of keeping them at arms length and discharging them asap.

Women aren't assessed in terms of whether they wear make up?!!!

It wasn't me who brought that up, but taking care of your appearance is something that is noticed and used (hopefully within context) to help ascertain your mental state.

The article you mention is a comic dig at mental health professionals - many of us have seen & read this.

Eh? What are you getting it?

There is A LOT of extremely positive work going on for women who have these particular difficulties.

Good - any links? And why is there no service round here?

And if you're thinking about DBT - please tell me you mean full DBT not the stage one "don't let your distress show" only DBT that seems to be all the NHS offers... Please if you know the secret let me know how to get trauma informed therapy to work on the underlying issues!

Actually, Lotus, there's something else - I wonder what you think about it? You say things have changed with the treatment of EUPD/BPD. However, it's only 9 years since they stopped excluding these people from services. So when I approached services 6 years ago; things could still have been pretty bad. Certainly services would be full of staff who'd got used to a certain judgement of people and turning them away. (That is not going to change overnight.) So perhaps I'd be much better off if I'd been referred into services for the first time now, rather than 6 years ago, iyswim.

And I had approached services for the very first time about 12 years ago; when things were bad. It was horrendous - they didn't tell me why I wasn't allowed help. Basically I'd developed a thing where I felt overwhelmed and panicked and in so much pain inisde, as a result of something happening. When the thing stopped happening the weird reaction carried on in relation to other triggers. I had assumed I'd get some counselling to deal with the original thing and unpick how stuff affected me (I was also in an abusive relationship, but was encouraged to believe everything wrong was me ). The lack of support meant I was very alone with some difficult times which also later affected me.

I carried on, thought I was fine, things seemed to be going well then I broke down - different symptoms this time, more a hopeless depression, dissociation, and memories and nightmares (largely involving the years when I'd tried to get help before). But services can't admit they did anything wrong so my horror and overwhelmedness (?) at the time is ignored, even though it's seriously affected me. I can't seem to come to terms with what happened. From my POV the way services operated felt like being taken to A&E after an accident and having them refuse to treat your injuries - even pretend you weren't injured, or shouldn't be injured - and ending up permanently disabled as a result. It's impossible to talk any of this through with most NHS staff though, despite the judgements made about me and subsequent decisions and events making me feel helpless, trapped and frightened. The re-writing of reality literally drives me mad.

Anyway, so 12 years ago judgements were made, which is going to affect future judgements from staff who read the notes 6 years later in more enlightened times. And then I'm passed from pillar to post and still don't get treatment for a further 6 years, so I become some sort of hopeless case in their minds due to struggling for so long, and here we are.

Now tell me you wouldn't feel pretty fucking depressed in this situation?

NoMudNoLotus

You wrote that a lot of the OP's information is outdated. Are you able to give us a little insight into where you are coming from? For example, are you a mental health professional yourself? You referred to "us" ("many of us have seen and read this") which leads me to infer that you see yourself as a MH professional. Do you mind posting what your profession is?

The article you mention is a comic dig at mental health professionals

It suggests to me that you feel dug at. The article is far from a comic dig. It was published in Clinical Psychology Forum, a publication available to members of the Division of Clinical Psychology, a division of the British Psychological Society which promotes the professional interests of Clinical Psychologists across the UK. The article itself represents a nuanced understanding of the us-and-them nature of psychiatry.

The services in my area use the term Personality Disorder, including reference to the term Borderline Personality Disorder. If the term is outdated, why did the Division of Clinical Psychology of the BPS publish this article in their publication? I feel confused about this. Language takes time to change. As Once implies in her writing, people who have been previously excluded from the system on the basis of their diagnosis are now able to seek help and treatment again. In the time since then and now, what has changed? Whilst the patient and the circumstances of the patient may or may not have changed, they were previously not able to access to services, and now they are. The same is true of other psychiatric diagnoses. For the patient, this can be confusing.

Whilst the patient and the circumstances of the patient may or may not have changed, they were previously not able to access to services, and now they are.

Unless staff read the notes and judgements made by previous professionals in the "crazy bitch not our problem" days of yore not so long ago . It's weird how professionals rush to tell us it's all different now and they're not judgemental etc etc blah blah, but they're the ones who don't seem to working with a clean slate and go by what some misognynist shrink wrote over a decade ago.

I was allocated one person... erm I was told she was my care co-ordinator, she was told she was allocated to me specifically to "do DBT skills" ... anyway she made a point of saying she hadn't read my notes because she wanted to avoid any pre-judgement. I appreciated that, and she did seem to understand what my actual problems were, and generally empathise (and totally understood social context etc). However, once she had access to my notes that started to change. Also, her hands were tied tbh, because she was supposed to be doing something specific with no scope for different approaches or re-evaluating what the problem actually was.

Now I think of it, it whole situation was a perfect example of the lack of transparency and accountability that has frustrated me with services. Basically this woman, an occupational therapist iirc, repeatedly told me she'd got involved because she'd been asked to do DBT skills (I didn't ask her, she just kept stating it). When I tried to find out from the nurse (and team lead) who'd assessed me, why they'd decided DBT, or just tried to understand or explain anything, I got the blanket response (from this nurse) "It's a team decision". Who the team was I didn't know and they wouldn't tell me. Eventually a friend asked her, calmly brushing aside each new wave of obsfuscation until she finally admitted the "team" consisted of herself and the occ. therapist. Who had only got involved after the DBT decision had been made, obviously. So basically she was making decisions all on her own and passing them off as "team decisions" that she couldn't possibly explain!

[Fwiw I'd try DBT if done properly (skills groups, indivdual therapy, and "phone coaching"), largely because I am fascinated and want to see what it's like.]

I came across the attached recently. This is an excerpt from The MRCPsych Study Manual - Third Edition. The MRCPsych is the professional qualification awarded to a doctor who has completed the relevant training and exams to become a member of the Royal College of Psychiatrists. This study guide is relatively outdated (2006); however the 2000 edition (second edition) says much the same thing and from what I can work out many of the psychiatrists who treated me would have been awarded MRCPysch on or before this date, although the examinations themselves change over the years so I hope that this attitude is outdated now, but I do not by any means feel certain about it.

The attached except is on how to look like a psychiatrist for the purposes of the clinical part of the examination as it was in 2005 (Patient Management Problems, PMP). It strikes me as sinister. The whole book contains various derogatory language about psychiatric patients and notes on how to come across as if you were a competent professional in order to pass the exam. I have no idea of the regard with which such study guides are held - it could well be that the Royal College of Psychiatrists does not approve of them, for example. Nonetheless this is a book that was written and edited by practising clinicians. I was at the cavalier attitude towards other people's distress; it is as if the patients are not people.