Why Do We Use Personality Disorder Diagnoses Anyway?
June 29th, 2007 |
This post is a promised follow-up to a post from two weeks ago called, “Do you believe ‘Personality Disorder’ diagnoses are pathologizing?“ I was motivated to finish it this morning when I read a passionate comment posted by Jeana in response to the above mentioned article. The comment can be found here, but for the sake of getting others into the spirit in which I finished this post, I will copy it here:
“I need to rant…I am so tired of therapists and doctors labeling clients PD then in essence giving up on them. I had a recent incident with a client that I have worked with for 6 months. She attempted to get more help by entering a day treatment program for her ED and was told by the MD, who had only read her chart that “with her PD and SI, [she was] too severe for the program.” Of course the client calls after 3 hours of Binging and Purging saying “What PD???” Uggg!! I talked to the MD who was cold, lacked compassion, and in my opinion was irritated by the client! Well, if you think she is PD (x3 BTW) then the last thing you should be is irritated. I can recall working in several inpt. tx centers as a mental health tech before I got my MA and hearing the staff talk poorly about the patients, esp. the BPD ones. If someone walked in with a BPD dx, you might as well hang a target around their neck! Where is the COMPASSION? If BPD is so difficult to manage as a therapist, imaging how hard it is for these people to live with! It is not a choice…neither is bulimia, binge eating or anorexia BTW. If you are burnt out, get out! I love my job!”
Although I don’t know a great deal about the history of psychiatry and psychology, and there are many others more qualified than I to answer this question, I’ll give you my armchair analysis. I believe the “Personality Disorder” label evolved out of the common struggle experienced by early mental health care providers trying to help folks who were deeply wounded and defensive. It’s true that deeply wounded and defensive people can be very difficult to work with, especially when we get our own defenses and wounds triggered. And there is a lot to get triggered by. People with “PD” constellations may self-harm, attempt or feel suicidal, shift from idealizing their therapist to devaluing their therapist, get angry, become overwhelmed by parts of themselves which harbor great emotional needs, expect people to take care of them, quit therapy, and just as quickly beg their therapist to take ‘em back. This is the short list. If we haven’t felt worthless, hopeless, and inadequate prior to working with such a person, it’s likely we will when we do. This highlights the importance of doing our own work so that we can do our best to stay calm, curious, and compassionate in the face of nearly anything.
But because the early history of mental health care was occupied by many people who hadn’t trained in the art of self-soothing, staying calm and compassionate in the face of these kinds of provocations was not the norm. Rather, the first generations of mental health care providers probably felt dumbfounded, confused, at a loss of what to do, and, if some were already harboring burdens, they probably felt powerless and inadequate. Others may have gripped tighter to their theories and preconceptions to avoid feeling powerless and inadequate. I believe that it’s reasonable to believe that a portion of these early pioneers did feel powerlessness, worthlessness, and inadequacy, and protected themselves from falling into the abyss of these feelings by leaning heavily on labeling, judging, and evaluating people, sometimes as hopelessly and fundamentally flawed. Pathologizing, I believe, grew partly out of an attempt to place control over the uncontrollable and reduce feelings of inadequacy, fear, and hopelessness.
Now that new generations of mental health providers have trained and developed in an environment and attitude dominated by the “pathological and deficient model,” the tendency to pathologize is practically unconscious. Many don’t realize the impact of their words, labels, and attitudes, and many know of no alternative.
Thank goodness for my heroes, those brave clinicians, who didn’t take it personally when their clients regressed, raged, rejected, blamed, or insulted them. Those that stayed curious and open eventually learned that even the most wounded, degraded, and abused individuals have the capacity to access their own Self energy and can heal their exiled traumas without relying on years of advice giving, skill building, or high doses of medication. People have the resources needed to transform themselves from within, and healthy therapy helps people to access these resources.
Noah :)
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