It’s time to stop the practice of diagnosing humans with psychiatric labels and allow them to naturally experience distress, trauma and shock when they are abused and violated by another human being.
I want to share with you the moment I realised that enough was enough.
In 2012, I took over a rape centre. The centre provided free counselling and group therapy for women, men and children who had experienced recent or non-recent abuse, sexual violence or rape. I trained and line managed around 35 psychotherapists and counsellors and some months we were working with caseloads of over 150 people. We only covered one town in the Midlands so that’s a very high caseload for a small organisation.
Previous to this job, I had managed crown and magistrates courts with responsibility for the VIWs (Vulnerable and Intimidated Witnesses) Programme. I had always worked with people who had experienced trauma from crime, which is a specific type of trauma. Trauma from crime is specific because it is a man-made trauma. It is a trauma caused by the actions and decisions of a fellow human being. It’s not like a natural disaster. Its not like a freak accident. The person copes significantly better with those types of traumas because, eventually, the person can allow themselves to believe that there was nothing they could have done to avoid it and it certainly wasn’t their fault – or anyone else’s fault. No one meant for the freak accident or natural disaster to happen. However, crime – now that’s a different story. Crime is perpetrated by humans. It includes decisions, choices, targets, perpetrators and victims. It leaves people with questions like ‘Why me?’ and ‘Why did they do that?’ and ‘Don’t they care about the impact it had on me?’ and ‘Did I do something to deserve that?’
It’s no wonder that victims of sexual abuse and violence – crimes meticulously planned, based in power and control to violate a human being – suffer such varied and severe emotional distress to what happened to them.
Within about six months of being in post at the rape centre, I noticed a worrying trend.
“Jess, my client has just been diagnosed with Borderline Personality Disorder…” became a common conversation starter from my team. First it was one or two, then it was a handful, then it was ten, then it was thirty.
As I had responsibility for all face to face and telephone counselling and supervised every counsellor and psychotherapist in the centre, I was able to carefully analyse hundreds, maybe over a thousand cases of sexual abuse and rape that we held and realised that almost all of the women and girls referred into mental health teams in the NHS were quickly diagnosed with BPD and medicated. I specifically say ‘women and girls’ because in the rape centre I worked in, I saw very few men and teenage boys with a BPD diagnosis despite them experiencing very similar histories and emotional responses.
I was still very early on in my career and hadn’t yet started to specialise in forensic psychology or feminism but even back then, at 22 years old, I was horrified by what I was seeing. People who had been abused and raped, who were 100% entitled to be traumatised and struggling with life were being told that they had something fundamentally wrong with their personality. If you could freeze-frame my life at that exact moment and zoom in on the face I was pulling – you would be able to pinpoint the moment I realised that women and girls were being diagnosed with disorders instead of being allowed to be in emotional distress. It felt scarily familiar to ‘hysteria’ diagnoses.
Clients were attending the centre with higher and higher dosages of medication. One 18 year old woman was sexually abused throughout her childhood and had been medicated with three rounds of electro-convulsive therapy (ECT). I remember reading her file and discussing this with her as she had attended one of my groups and she told me that the ECT made her feel like a zombie. I also remember listening to her and thinking ‘I didn’t even know we were using ECT with children in the UK!’ and spent the rest of the evening at home googling it.
A couple of years later, I was chatting to a woman I met whilst in the third year of my degree. We were talking about life and relationships and she started to talk about her relationships breaking down and how she longed to settle in a healthy relationship but had gone round and round the cycle of abuse for nearly twenty years. As always, I didn’t offer any perspective or theory but listened carefully. However, whilst listening to her story I did recognise her life journey as incredibly similar. Eerily familiar…
And that’s when she said it:
“I will never really settle down with anyone because I have this thing called BPD. Its a personality disorder. My CPN told me that’s why all of my relationships are abusive. I attract wrong ‘uns. I always wondered whether it was because I was abused as a teenager but when they told me I had BPD, I was so relieved. I realised that I had a mental health issue and that’s why people keep abusing me…”
I wasn’t at work. I wasn’t duty bound. I was talking to this woman in a personal capacity. I toyed with my ethical duties. I decided to stick my neck out.
“Kaci*, do you truly believe that? That there is something wrong with your personality? I think you are brilliant. But isn’t it possible that you were right all along? That you were experiencing emotional distress from the abuse you experienced as a teenager? And that’s totally okay. You can struggle. You can struggle for years if you need to. Other people abusing you in your relationships was never your fault – even if you were struggling. Don’t you feel its a little unfair to tell you that you have something fundamentally disordered about your personality?”
I immediately regretted it.
She stared at me, open mouthed, tears in her eyes.
“I’m so sorry, Kaci*. I didn’t mean to…”
“No, I’m not upset at you. But you just said exactly what I’ve been trying to say to the mental health teams for years! You are the first person to ever say this to me…”
And I have been saying it ever since.
Borderline Personality Disorder has a pretty (shall we say… inclusive?) set of criteria, meaning that most of us who have ever experienced a period of distress would fill enough criteria for a diagnosis. In fact, if I am having a particularly shitty time, I can honestly admit that I fulfil most of these.
Criteria for BPD (not all are required for diagnosis):
- Feelings of anger or irritability at minor issues
- Risk taking behaviours or engaging in activities without personal regard
- Acting impulsively
- Self harming during emotional distress
- Feelings of being down or depressed
- Fears of rejection of not being loved
- Intense feelings of anxiety and fear
- Emotions easily changeable and unstable
- Relationships with mistrust and neediness
- Hypersensitivity to emotions and situations
- Change or instability in life goals or direction
- Issues with body image
- Issues with self-identity
In fact, a piece of research by Middleton (2013) showed that people who have experienced a complex trauma such as sexual abuse, neglect, rapes or exploitation, on average, would have enough ‘symptoms’ to be diagnosed with between 10 and 12 disorders at any one time. You read that right.
Add this to the fact that we are still not 100% sure how psychoactive medications work and we are now much more aware that antidepressants are not the magic cure-all we once thought they were; and we now have hundreds of thousands of people who have experienced sexual abuse and violence being told that there is something fundamentally wrong with them whilst being told to take more and more medications and sedatives to numb their feelings. Their completely valid feelings.
I am here to call out the psychiatric diagnosis of sexual abuse and violence victims.
Whether its unqualified, knee-jerk front line professionals telling parents or children that they think they have ‘anxiety disorder’ or ‘PTSD’ or qualified, established CPNs and Psychiatrists telling people who have recently been raped or remembered significant histories of abuse and trauma – I’m here to ask you: What is your obsession with pigeon holing people and telling them that there is something ‘disordered’ about their psychology?
Why can’t we just accept that the ongoing, malicious, violent and abusive grooming and violation of children and adults, often by people they trusted most, is possibly one of the most harmful things they could ever go through? Why can’t we create space for people to react and respond and cope in the way they need to without labelling them? Why can’t we support them through their ‘extreme’ responses to extreme harm?
Instead of saying:
“You are showing symptoms of BPD. That’s why you are feeling like this. Not the abuse. You have a personality disorder. Here are some pills that will mask the feelings.”
Why can’t we simply say:
“You have seen and experienced things that have changed your life. Those people hurt you and they have scared you. They have changed the way you react to certain environments and feelings. They have heightened your senses and your emotions. And you know what? That’s totally normal and totally understandable. You are entitled to respond like this. Is there anything I can do to help you to cope with these feelings and thoughts? What do you need right now? What helps and what hinders you?”
Is this response really that unreasonable and unrealistic?
Jessica Eaton is an independent national specialist writer, speaker and researcher in sexual violence, forensic psychology and mental health.