[âLike other personality disorders, BPD has a notoriously low reliability level even by the generally poor standards of the DSM, and even within the profession is considered by many as yet another âwastebasketâ category (though as Bourne (2011: 76) ruefully remarks, the ambiguity of such personality disorders makes them particularly useful in policing deviance in the new century). One member of the DSM-III task force stated at the time of constructing BPD that âin my opinion, the borderline syndrome stands for everything that is wrong with psychiatry [and] the category should be eliminatedâ (cited in Decker 2013:199). The chair of the task force, Robert Spitzer, admitted with the publication of DSM-III that BPD was only included in the manual due to pressures from psychoanalytically oriented clinicians who found it useful in their practices (Spitzer 1980: 31â32). Such practices have been documented by Luhrmann (2000: 113) who describes psychiatristsâ typical view of the BPD patient as âan angry, difficult womanâalmost always a womanâgiven to intense, unstable relationships and a tendency to make suicide attempts as a call for help.â Bearing significant similarities to the feelings of nineteenth century psychiatrists towards hysterics, Luhrmannâs (2000: 115) study reveals psychiatristsâ revulsion of those they label with a personality disorder: they are âpatients you donât like, donât trust, donât want ⌠One of the reasons you dislike them is an expungable sense that they are morally at fault because they choose to be different.â Becker (1997: xv) reinforces this general view of the BPD label when she states that â[t]here is no other diagnosis currently in use that has the intense pejorative connotations that have been attached to the borderline personality disorder diagnosis.â A bitter irony for those labelled with BPD is that many are known to have experienced sexual abuse in childhood (Ussher 2011: 81), something they share in common with many of those Freud labelled as hysterical a century earlier; a psychiatric pattern of depoliticising sexual abuse by ignoring the (usually) male perpetrator, and instead pathologising the survival mechanisms of the victim as abnormal (Caplan 1995: 237).
By the mid-1980s, the hysteria diagnosis had disappeared from the clinical setting while BPD had become the most commonly diagnosed personality disorder (Bourne 2011: 76). BPD is now the most important label which psychiatric hegemony invokes to serve capital and patriarchy through monitoring and controlling the modern woman, reinforcing expected gender roles within the more fluid, neoliberal environment. Nevertheless, as Jimenez (1997: 163, emphasis added) reminds us, the historical continuity from hysteria to BPD is clear:
Both diagnoses delimit appropriate behavior for women, and many of the criteria are stereotypically feminine. What distinguishes borderline personality disorder from hysteria is the inclusion of anger and other aggressive characteristics, such as shoplifting, reckless driving, and substance abuse. If the hysteric was a damaged woman, the borderline woman is a dangerous one.
The overemotional, needy housewife of the nineteenth century had been replaced at the end of the twentieth century by Glenn Close in the film Fatal Attraction (1987)âan out of control, irrational, aggressive (if unknowing) victim of womenâs liberation. As the DSM-5 (American Psychiatric Association 2013: 664) states of the BPD sufferer,
Easily bored, they may constantly seek something to do. Individuals with this disorder frequently express inappropriate, intense anger or have difficulty controlling their anger ⌠They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil.
BPD asserts a moral code on the neoliberal woman, defining the limits of her independence in line with dominant, expected gender roles in the twenty-first century. Thus, the introduction of such categories to the DSM is far from accidental. In contrast, Jimenez (1997: 166â167) insightfully states,
It was related to the social and cultural gains women achieved in the 1970s, when many middle-class women moved into the public sphere, increasing their independence and reshuffling gender roles. These personality disorders define the mentally healthy woman as one who is renewed and energized by social change and no longer dependent on men, but neither angry nor aggressive. According to the criteria, a woman who is mentally healthy restrains her sexuality and does not use her new powers to manipulate men. Together, these diagnoses demonstrate psychiatryâs ability not only to respond to changes in gender-role arrangements, but to limit their impact.
Personality disorders such as BPD serve as the latest versions of supposed scientifically valid medical classifications with which to police and control womenâs behaviour in neoliberal society. As Ussher (2011: 81) has reiterated, it is a historically persistent form of social control of women that powerful forces in society have considered deviant: As the outspoken, difficult woman of the sixteenth century was castigated as a witch, and the same woman in the nineteenth century a hysteric, in the late twentieth and twenty-first centuries, she is described as âborderline.â All are stigmatising labels. All are irrevocably tied to what it means to be a âwomanâ at a particular point in history.â]
bruce m.z. cohen, from psychiatric hegemony: a marxist theory of mental illness, 2016
