Three Ways of Transgressing a Borderline Personality Disorder Diagnosis

This article was originally submitted for my journalism assessment under the heading: 'Disobedience, Divergence or Disorder? 3 Ways of Transgressing a Borderline Personality Disorder (BPD) Diagnosis (and how to write about it as a defiant journalist).'


The following is a recent diary entry from an Australian mental health worker:

I want to write, like Francoise Heritier’s ‘The Sweetness of Life’, on what life is to a person diagnosed with borderline personality disorder. Of flowered trees just visible in the pre-dawn light. A comforting musicale of birds tempering the space where jetskis and light traffic will eventually come as a reminder that we are not alone. That people are about, living their lives, however that makes sense to them. No longer asleep. Content to carry on. And, of how I contemplated suicide again last night in the emptiness of all that seems to be going on right now.

I want to assure people that they are not thoughts I need to control. That they are as meaningful as any other. That there’s nothing to fix, change or heal here. That I’m simply having the experience of this moment. But they don’t understand and they don’t ask questions. They just worry I’m going to kill myself or be depressed and that makes them uncomfortable… because they care about me. I get that. But it doesn’t really give me the space to be who-what-how I am. It doesn’t locate me. It doesn’t honour the possibility that there is more going on here than a simple case of crisis that needs to be managed. By focusing exclusively on those two points on the map, labelled suicide and depression, no-one sees what truly or what else exists for me.

When my loved ones do it, that’s an intimacy. When society does it, through a psychiatrist’s actions or an employment rejection or by delimiting access to financial support and material gain or as a consequence of the academic performance framework, in all the places where I don’t have a platform to offer an(other) interpellation, then what recourse do I have except to be disobedient?

More than that, a focus on two points among so many ultimately criminalises my nature. It says, “hey you with the different scaffolding and the non-compliant cosmology, get back here and learn to behave like everyone else who fits into a typical construct or risk being medicalised, medicated, othered, isolated and excluded, not to mention failed, fired and fettered”. Which, like all attempts to criminalise rather than contemplate, drives it underground. But that’s not happening in the moment.

In the dark, being with, I’m just present. Surrendered to the truth that there is often something else going on. Even when it seems like I’m at an end. Acquainted with my process, I suspect that my suffering has purpose. Allowing whatever thoughts and feelings need to be - how it would hurt my husband, my father and my friends to see me go; a vague recollection of wisdoms on what to do with thoughts that come in the middle of the night - and the plethein of now rocks me back to sleep.

For one who, like the writer, exists on both sides of the treatment table, the striking aspect of the debate over borderline personality disorder is the patent lack of genuine curiosity. The type of curiosity actor John Noble talks about when selecting roles,

“I always approach characters sympathetically. I mean this is actor talk really, but I never judge them, and I always try and work out what’s put them in the place they’re in, and behaving the way they do,”[1]

and paleoecologist Conrad Labandeira attaches to good science,

“To be a really good scientist one has to understand things that are even beyond your immediate interest. It’s all part of the same ecosystem. To really understand any one part of it I think you need to understand the entirety of how organisms interrelate and how they associate with one another not only in the fossil record but also what’s going on today. And the two - the fossil record and what’s going on today - eliminate each other, and help us really to understand how the past works,”[2]

epitomised in T. S. Eliot’s often quoted poem, Little Gidding,

“We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.”[3]

A curiosity wherein one willingly fails to know or, perhaps more accurately, succeeds to unknow, so that all that one has come to expect can be put aside in order to explore what might otherwise be left unseen. The kind of curiosity one suspects scientific discovery to be informed by; processual and unassuming, alive and breaching.

Until now, such abject curiosity was more commonly found in the humanities[4] and social sciences[5], those places prepared to engage in less privileged forms of knowledge and to seek differently. Advocates, such as O’Riley, whose research methodology “troubles the ‘right to know’,” and whose work emerges from the act of “thinking against oneself so as to engage in the ‘regeneration’ of knowledge versus the ‘generation’ of more and better for the western knowledge project,” do more than simply ask questions.

Theirs is a focus on hypothesis-generating rather than hypothesis-testing. A mode of processual and ontological curiosity that necessitates declarations of self-awareness where the very notions of “self” and “awareness” can be brought into question. And it is from this place, this curious endeavour, that the writer invites one to explore the wholeness of a borderline personality disorder diagnosis. Beginning with institutional psychometry[6].

The conventional psychiatric view is that there is no need for reform of the diagnostic category; the belief being that patient recovery is only possible if the pathology can be treated and the patient learns to regulate their emotions to such as extent that they no longer present as unstable.

The psychotherapeutic community, however, has arranged itself along a spectrum including organisations which support, promote and advocate for borderline personality disorder, and the loose-knit group of professionals seeking to have the diagnosis abolished.

In this case, the former rarely seek to justify their position. The legitimacy of the diagnosis is taken as a given. A fact most readily evinced in the vision, mission and/or aims of such organisations which commonly encourage a positive culture around BPD, access to timely, responsive and appropriate care for people with BPD, support for clinicians and researchers in this field, and better recognition of the disorder. Whereas the latter take their profession to task with a focus on challenging and invalidating the diagnosis. A project undertaken through an examination including but not limited to profession-centred vested interests, epistemic injustice, iatrogenic harm, normality, and treatment.

But what is borderline personality disorder?

There is no singularly satisfying universal answer to that question. There are only the places that curiosity can take you, this time working back and forth between contestation and convention.

From Hysteria to Borderland

Feminist interpretive analysis identifies BPD as an extension and expansion of hysteria, the first mental disorder attributable to women. Dating back to Ancient Egypt, hysteria, according to this perspective, played a continous role in the pathologisation of women up until it’s removal from the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) in 1980. An impressive 4,000 year history.

It has not gone unnoticed among Feminist writers-researchers-practitioners-theorists that as hysteria became obsolete the “borderline” diagnosis began to take its place. Whereby, norms of selfhood, of gender and madness intersect to re-establish “a dangerous symbolic mobility[7]” on the “frontier between men and chaos[8]”. In other words, femininity itself is seen not only to occupy the borderland between cultural order and madness, but is ultimately used by those variously patriarchal-hegemonic-neoliberal institutions such as psychiatry and medicine to define and exemplify the very nature of deviance, disorder and perversion. Therefore, to be deviant is to be woman.

But not just any woman. One must first be seen as emotionally distressed… and to feel angry… numb… abandoned… invisible… uncertain or empty. The kind of feelings, behaviours and expressions brought about by experiences of sexual, emotional and physical abuse, neglect during the formative years, the natural processes of adolescence, and wider social vulnerabilities now faced by a “flexible” workforce in an ecologically “challenged” environment. Except, harken the Feminist voices, the medicalisation of these “symptoms” seeks to internalise the larger causes of distress and make the “client” responsible for managing their “emotional dysregulation”, rather than acknowledging socio-political injustices and advocating for changes at the appropriate levels of society-government-law.

From a feminist perspective, it’s akin to having your home wiped out by a tornado and being told by your psychiatrist that your subsequent distress and poverty and inability to be entertaining at dinner parties are all characteristics of a personality disorder that you can be taught to regulate as long as you don’t get angry (because your whole world has been turned upside down and you have nowhere to go) or turn up late to appointments (because your car is three states away lodged in an oak tree and the bus, held up in construction traffic, was late) or forget what day your appointment is on (because you’re worried about your daughter’s cough that keeps getting worse and there’s no money to send her for treatment) or feel insecure about your place in the world (because your job disappeared along with the building it was in) or start to question who you are and what you want out of life (because, you know, the shit hit the fan) or exhibit any other “emotionally unstable” signifiers.

To better illustrate their point, here are a couple of real-world examples where “research” and “professionals” medicalise what Feminist scholars recognise as social and political issues:

“[A] person with BPD may make your life quite difficult until the situation resolves itself. […] Research by Mount Sinai psychiatrist Antonia New and colleagues (2012) suggests that people with BPD have difficulties in understanding their own, and other people’s, emotions, in ways that land them in relationship trouble. […] If you’re an individual who has this diagnosis, the findings point to a possible way that you can gain insight into your own experiences with negative feelings. By gradually acknowledging them, people with BPD may be able to accept not only these feelings but also gain greater self-awareness and acceptance.” — Susan Krauss Whitbourne Psychology Today, 2012

“No matter how severe a mental health condition is, there is always a way out - once a person is given the correct support and structure to enable them to take responsibility for their own condition and move on into the world.” — Sheri Jacobson Harley Therapy Counselling, 2013

At this point, it might be helpful to break out a little convention so that one can get to grips with some of the rigour Feminist and historical analyses have found so offensive.

Nature and Reason

For the (largely American) psychiatric profession, the fact that the DSM-III was both the site of the removal of hysteria/hysterical personality and the introduction of the borderline personality diagnosis does not represent a shift in gender ideologies but rather a consequence of the review process. The same process of literature and supporting data assessment required to validate the construct of each personality disorder is also applied to the development of the document itself. A document that is developed and published by the APA since 1952, grounded (since DSM-III) on empirical evidence, and recently (DSM-IV and 5) revised to address cross-cultural issues.

The DSM-5 is one of several schemes used to classify for the purpose of psychiatric diagnoses. Others include:
    1.    The International Classification of Mental and Behavioural Disorders 11 (ICD-11) entrusted to the World Health Organisation (WHO) since its sixth version in 1948,
    2.    The Chinese Classification of Mental Disorders (CCMD-3) written in both English and Chinese first published in 1979 then revised by the Chinese Society of Psychiatry (CSP) in 1981,
    3.    The National Institute of Mental Health’s Research Domain Criteria (RDoC) project launched by the National Institute of Mental Health (NIMH) in 1980,
    4.    The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders,
    5.    Practice Guidelines of the Asian Federation of Psychiatric Associations (AFPA) founded in 2005, the World Psychiatric Association (WPA) established in 1950, and Indian Psychiatric Society (IPS) founded in 1947, and
    6.    The Latin American Guide for Psychiatric Diagnostic (GLDP)
Not all of these psychiatric bodies recognise borderline personality as a disorder, and those that do tend to differ in how they classify and diagnose the condition. A full report on the differences is beyond the scope of this article but a summary of the DSM-5 and ICD-11 entries for BPD should suffice.

The DSM-5

According to the DSM-5, “The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits.” More generally:

“Personality disorders are associated with ways of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in many aspects of life. They fall within 10 distinct types: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality, narcissistic personality disorder, avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.” — APA DSM-5 Personality Disorders

The set of criteria that must be met in order to diagnose BPD:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.

b. Self-direction: Instability in goals, aspirations, values, or career plans.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilites.

b. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.

B. Pathological personality traits in the following domains:

1. Negative Affectivity, characterized by:

a. Emotional liability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

c. Separation insecurity: Fears of rejection by –and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.

d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.

2. Disinhibition, characterized by:

a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.

b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.

3. Antagonism, characterized by:

a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual's developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or general medical condition (e.g., severe head trauma).

With this latest publication, personality disorders (PDs) have been moved from multiaxial to a single axis system. According to the APA, previous versions presented PDs as Axis II to reflect “inadequate clinical and research focus” and therefore “to ensure they received greater attention”. Since the APAs Personality Disorders Work Group’s review of approaches to PDs, both a categorical (standard) and trait specific (alternative) model have been submitted. That is, the inclusion of an “alternative DSM-5 model for personality disorders” in the section referred to as “Emerging measures and models” allows its official use by those who are interested, while the virtually unchanged DSM-IV diagnostic system for PDs has been sustained in the main section of the DSM-5. The decision to do so informed by “several scientific and clinical committees that the American Psychiatric Association (APA) had established to review all proposed changes in the diagnostic manual [who] felt that there was not sufficient evidence at the time to validate the proposed new personality disorder model and to establish its clinical utility[9]”.

The ICD-11

Just as the DSM-5 streamlined PDs into a single axis, the ICD-11 no longer uses different ‘types’ of PD. Instead, PDs take up a single dimensional construct, classified according to the following four levels of severity: personality difficulty, mild personality disorder, moderate personality disorder and severe personality disorder.

“Severity is determined by the extent to which the disorder affects an individual’s interpersonal relationships, performance of occupational and social roles, and risk of harming themselves or others. Clinicians may then additionally choose to optionally classify the personality disorder according to five dimensional domains: negative emotionality, disinhibition, dis-social, anankastic and detached.” — Barnicot & Ramachandani, 2015.

Recent case studies have shown successful application of the ICD-11 PD classification with the proviso of further investigation to determine usefulness among the diversity of practitioners across WHO member countries.

Resistance to Treatment

Feminist scholar, Dana Becker, objects to the increasing number and type of symptoms attributed to an increasing number of women for various ailments under the guise of a borderline personality disorder diagnosis. She says that diminishing “a central defining feature” and any core symptoms, BPD becomes a “catchall or wastebasket category”. A sentiment taken up within the resistance movement where BPD has become known as the dustbin diagnosis.

Being such a flexible and indiscriminate category is not the only point of contention here. Much of the growing exception to a BPD diagnosis has to do with issues of stigma and harm not sufficiently accounted for within psychiatric and psychotherapeutic policy and practice. Although a plethora of papers on stigma exist, and both psychiatric and psychotherapeutic bodies are sympathetic to the seriousness of the issue, the weight of professional interest only extends as far as calls for more compassion and awareness. A position the resistance movement find insufficient and ultimately untenable since women are dying, being denied emergency medical care, being re-traumatised after surviving sexual, physical and emotional abuses, and denied the right to exist and experience their reality (as women).

In an interview, Executive Clinical Director of Spectrum - providing services for people with severe personality disorders - Professor Sathya Rao acknowledges that the name BPD is “unhelpful, confusing and invalidating”. Alternatives include Complex Trauma Disorder (CTD), Complex PTSD, Emotional (Dys)Regulation Disorder, Complex Attachment Disorder, or Gunderson’s Disorder (after the clinician who identified it). He goes on to say that “when we study the history of psychiatric nosology, we see that BPD originally came from Hysteria. Hysteria was split into Conversion Disorders, Dissociative Disorders, Somatoform disorders, Somatization disorders, BPD and Histrionic Personality Disorder. The nosological confusion surrounding BPD reminds us of the confusion we had with Hysteria in the past.[10]”

Links between childhood trauma (including abuse and attachment difficulties) and BPD are also addressed in the interview as part of the discussion on reclassification.

“[C]hildhood trauma is a significant risk factor for BPD but trauma in itself does not seem to cause BPD. Trauma in the presence of biological predisposition is likely to cause BPD. Therefore, the conceptualisation of BPD as a Complex Trauma Disorder or Complex PTSD, while a useful way of reducing stigma, does not seem to be completely helpful in understanding the full range of BPD presentations. Similarly, Emotion Regulation Disorder is also unsatisfactory as not all BPD patients have significant emotion dysregulation.” — Professor Sathya Rao

Professor Rao identifies mental health workers as the biggest stigmatisers of BPD, and BPD is itself a highly stigmatised and misunderstood disorder, suggesting that clinicians might better conceptualise BPD and its treatment with the following analogy:

“Imagine the car to have hypersensitive accelerators (Amygdala-emotional system of BPD patients) and very poor brakes (cortical control over Amygdala). It is as though BPD patients are driving such a car.

“No wonder their driving is erratic (their lives). They may be unsteady in driving (unstable emotions). Even a very mild touching of the accelerator speeds up the car (hyperemotional state) and can make it go off balance (BPD crisis). Because of poor brakes (poor cortical control over Amygdala) they find it hard to control the car especially when the accelerator is very high.

“The idea here is that anyone who is made to drive such a car with hypersensitive accelerators and poor brakes will drive erratically and may crash now and then and even go through amber or red lights. It is not the personal weakness or the faulty character of the driver. The problem is the car that has faulty accelerator and brakes.

“The task for the clinician is to be a driving instructor for the person driving such a car and teach them to drive that car carefully and learn the skills to handle the accelerator very gently and use the brakes fully and be more careful on the road.

“The demand here is that the clinician is required to sit in the passenger’s seat and play the role of the driving instructor sharing the risks along with the patients. If the driving instructor (clinician) is fearful and anxious they may become overly critical and careful and not let the driver learn how to drive (e.g. admissions to hospitals, excessive reliance on medication prescriptions). The instructor needs to be very validating and gently guide the driver and teach the skills to drive.”

What Professor Rao seems to be suggesting is that clients will be better served once BPD is seen as a genuine mental illness and not a behaviour. The argument being that BPD as a condition of the brain means the patient is less likely to be viewed as at fault. The problem with this conceptualisation, according to the abolitionists, is threefold.

First, “reducing complex emotional issues to medical labels explains nothing and fails to empower people[11]”. Second, a patient’s ability to manage their emotions, their interpersonal relationships and self-harm and suicidal urges continue to operate as part of the illness and therefore are discredited without any investigation into how or what value these aspects might play. And third, “BPD is a dodgy construct, replete with problems of construct validity and reliability, [especially since] the diagnosis fails to predict what treatment will work, and prognosis[12]”.

Outraged by the continuing criminalisation of femininity, Professor Jillian Mary Ann Jimenez writes in her article ‘Gender and Psychiatry: Psychiatric Conceptions of Mental Disorders in Women, 1960-1994[13]’ that where hysteria “offered women of earlier eras normative guideposts,” BPD transforms the damaged hysteric woman into “a dangerous one”. Furthermore, by pathologising these ways of being in the world, whether coping mechanisms or natural eccentricities, a BPD diagnosis prevents anyone from locating themselves as wholly valuable. A person becomes a patient and this particular type of patient becomes identified with their BPD constructed behaviours, the most damaging of which include being labelled untrustworthy, manipulative and cruel as demonstrated by this excerpt:

“Helen Millard […] was found hanging last year, on a day where she had been seen to tie ligatures around her neck […] She was left alone because she was considered to be “manipulative” and “needy” [and that] attending to her would reward her “attention-seeking” behaviours. [Even after Helen’s death, her key nurse] felt able to dismiss Helen in a formal statement as “manipulative” and “hostile”.” — Dr. Jay Watts, Transformations-the Journal for

Psychotherapists and Counsellors for Social Responsibility (PCSR)

Although, in the face of stories like Helen’s, the damage of discrediting a person is only one of the potential harms abolitionists object to, the disrepute of a BPD diagnosis is no small thing. Epistemic Injustice, a term coined by Miranda Fricker, and its subtype Testimonial Injustice are just two of the ways academic writing has come to legitimise such harms. Beyond stigma, epistemic injustice identifies the medicalisation of “women who dissent, who disobey, who resist […] as if these reactions were signs of pathology”, as an abuse of professional power, and the result of social iatrogenesis.

Implicit in the language and dismissive behaviours of the mental health professional is the means to legitimise a pejorative identity of ‘the patient’ and position professionals as “knowing something about the complicated nature of personality disturbance attributed to such women[14]”; creating an in-group and other dynamic that encourages professional distance, distrust and dismissiveness among other prejudices. Misconduct, abuse and iatrogenesis are serious claims. They amount to hegemony and call into question the legitimacy of psychiatric/medical diagnosis.

In order to apply the type of curiosity introduced at the beginning of this now rather lengthy article, one would need to examine the “notions that inform the rules of diagnostic interpretation in psychiatry” at all stages of the decision-making process - particularly concerning concepts of normality, sincerity and pathology - among other psychology, psychiatric traditions. A task for another day.

In its stead, the writer offers the following tidbits:

“Social iatrogenesis is at work when health care is turned into a standardised item, a staple … or when suffering, mourning, and healing outside the patient role are labeled a form of deviance.” — Ivan Illich, The Expropriation of Health

“Medicalisation is a form of hegemony. Every ideology, in a sense, tries to convince people that their situation is explicable and provides a person who has authority over that situation. So, hegemony is looking for the consent of the dominated.” — Greg Downey, Psychological Anthropology

“Sociocultural effects are causal in the same way that environmental carcinogens, toxins, and bacterial and viral pathogens are. Sociocultural effects do not preclude but rather complement biological modes of causation in sickness and healing. They present a profound challenge to the underlying theory of Biomedicine, because in Biomedicine it is commonly assumed that sickness and healing are essentially biological events in which sociocultural phenomena play at most a secondary role.[15]” — Robert Hahn, Sickness and Healing.

Results of psychiatric research “demonstrate that rejection and physical pain are similar not only in that they are both distressing—they share a common somatosensory representation as well[16] […] and “experiences of social rejection, when elicited powerfully enough, recuit brain regions involved in both the affective and sensory components of physical pain.”

“Autistic people are neurologically divergent, yet approaches to studying autism are framed by neurotypical definitions of being social. Using the concept of intersubjectivity, which conceptualises a variety of ways of socially relating, we investigate distinctive features of how autistic people build social understanding.” Abstract extract from ‘Neurodivergent intersubjectivity: Distinctive features of how autistic people create shared understanding’ (2018) by Brett Heasman and Alex Gillespie.

Summary

Transgression of a BPD diagnosis, it seems, can be divided into three approaches. Disobedience, divergence and disorder.

Disobedience: For those who seek, as the Feminists have and do, to change the deficit of representation in the cultural dialogue, one must become disobedient.

Divergence: For those who seek recognition as divergent and equal, the same way Asperges and Autism have been accepted as legitimate ways of being in the world, one must find ways of making that comparison of greater importance than the current focus upon management of symptoms.

Disorder: And finally, for those who seek to abolish the disorder altogether, one must make visible how it serves all the stakeholders to do so.

Writer’s Final Notes

If transgression is not enough, then what are the alternatives to existing conceptions? If BPD really is a dustbin diagnosis, and women’s dissent is being pathologised, how does one begin and where? As you might have guessed I am the author of the diary entry at the beginning of this piece. On both sides of the therapist's table, and with an unconventional cosmology, I see myself in the unique position of being able to accept that for some, diagnosis and treatment enables them to thrive while others will ultimately perish at its cruel hand, and not find this contradictory.


[1] ‘Fringe: John Noble looks back on his time as Walter Bishop’ by Roth Cornet 6 May 2013 https://au.ign.com/articles/2013/05/07/john-noble-looks-back-on-his-time-as-dr-walter-bishop-on-jj-abrams-fringe
[2] ‘Pure, Abject Curiosity’ Paleoecologist Conrad Labandeira by Smithsonian Education 22 March 2011 https://youtu.be/iTt12UxnUvY?t=94
[3] http://www.columbia.edu/itc/history/winter/w3206/edit/tseliotlittlegidding.html
[4] Cultural studies (particularly cross-cultural works), history, human geography, philosophy (namely critical theory, social ontology, ethics and aesthetics), and politics.
[5] Especially interdisciplinary fields such as psychological anthropology or literature and science.
[6] I use the term purposely as both reference to the categorical-dimensional system applied to personality disorder diagnosis within psychiatry and to this same method being akin to “touching inanimate objects associated with” patients - their temperament and character - in order to “discover facts about” them. // psychometry | sʌɪˈkɒmɪtri | noun [mass noun] 1 the supposed ability to discover facts about an event or person by touching inanimate objects associated with them. 2 another term for psychometrics. // psychometrics | sʌɪkə(ʊ)ˈmɛtrɪks | plural noun [treated as singular] the science of measuring mental capacities and processes.
[7] Clement, C.  and Cixous, H., (1986) The Newly Born Woman. University of Minnesota Press.
[8] Moi, T. (1989) ‘Feminist, Female, Feminine’. Chapter 8 in The Feminist Reader: Essays in Gender and the Politics of Literary Criticism Eds. Belsey, C., and Moore, J. Basil Blackwell, New York.
[9] Oldham, J. M. (2015) ’The Alternative DSM-5 model for personality disorders’ Perspective, World Psychiatry 14:2
[10] ‘Inside the Mind of a Specialist in Borderline Personality Disorder - Interview with A/Prof Sathya Rao’, PsycheSceneHub March 12, 2017 https://psychscenehub.com/psychinsights/borderline-personality-disorder-prof-sathya-rao/
[11] Dantes, E. (2015) Why BPD Should Be Abolished and What Should Replace It, BPDTransformation
[12] Watts, J. (2016) Challenging the Invalidating Diagnosis of “Borderline personality Disorder”. Transformations - the Journal for Psychotherapists and Cousnellors for Social Responsisbility (PCSR)
[13] Jimenez, M. A. (1997)  Gender and Psychiatry: Psychiatric onceptions of Mental Disorders in Women, 1960-1994 AFFILIA, Vol. 12 No. 2, pp. 154-175 http://journals.sagepub.com/doi/abs/10.1177/088610999701200202
[14] Watts, J. (2017) ‘Testimonial Injustice and Borderline Personality Disorder’, Huffington Post
[15] Hahn, (1995). Ch 4 The role of society and culture in sickness and healing, Sickness and Healing.
[16] Kross, E. et al. (2011) Social rejection shares somatosensory representations with physical pain. www.pnas.org/cgi/doi/10.1073/pnas.1102693108

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