Borderline Personality Disorder “No Longer Has a Place in Clinical Practice”

Researchers from the UK and New Zealand argue that Borderline Personality Disorder should be abandoned as a diagnostic category.

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Borderline Personality Disorder (BPD) is a diagnostic category in the DSM-V and ICD-10/11 that has faced constant criticism from various sectors. Critics argue that the term does more harm than good due to the stigma associated with the label and the way it pathologizes responses to trauma.

Researchers have also questioned the scientific validity of BPD since it shares significant overlap with other diagnostic categories. Many suggest that it is time to retire this label.

In a new article, psychiatrists Roger Mulder and Peter Tyrer present a well-informed case against the scientific validity of BPD and highlight the confusion it causes researchers and the clinical harm it causes service users.

“Twenty years ago, George Vaillant, in a paper titled ‘The Beginning of Wisdom is Never Calling a Patient a Borderline,’ noted that the diagnosis of borderline often reflects the clinician’s emotional state rather than careful assessment,” the authors write. “This was not an isolated opinion, but we argue that little has changed, and borderline, in the context of personality, has now become a detrimental term hindering progress in research and treatment.”
Image depicts the thoughts and behaviors typically associated with BPD.
The image depicts the thoughts and behaviors typically associated with BPD.

According to the authors, Borderline Personality Disorder emerged as a category during the heyday of psychoanalysis, where it was used to designate cases that fell “on the border” between neurosis and psychosis.

Despite being classified as a personality disorder (PD), the authors argue that the features of BPD do not align with the consensus understanding of other PDs. For instance, “its diagnostic criteria are not enduring personality traits but rather fluctuating symptoms and behaviors.”

They elaborate:

“The triad of unstable mood, erratic relationships, and disturbed behaviour may be readily identifiable but that does not make it a personality disorder; chronic sleep disturbance creates the same symptoms.
A constant and undisputed diagnostic aspect of true personality disturbance is the presence of traits, characteristics reflecting individual function, which are generally stable over time and, when disturbance becomes disorder, are maladaptive. The widely gyrating features of emotional instability do not belong in this paradigm.”

The authors do acknowledge that BPD holds some clinical utility. Its symptoms are easily recognizable in many individuals seeking treatment, common (especially from adolescence onward), and in some cases, it can be reassuring to assign a name to such a complex phenomenon as BPD. However, whether this reassurance benefits the clinician or the individual seeking treatment is a matter of debate.

Interestingly, the authors state that both the DSM and the ICD research committees initially rejected the inclusion of BPD, but the category was ultimately included due to pressure from powerful interest groups. They note, “It is not only Big Pharma that can influence diagnostic practices.”

While BPD may seem sensible when viewed in isolation, problems arise when compared to other disorders. ADHD, bipolar disorder, and other mood disorders share similar symptom profiles, which ultimately confound the diagnostic landscape.

The authors assert that one of the most commonly used justifications for BPD is that it can guide clinicians and individuals seeking treatment toward effective treatment approaches. However, this claim is misleading. Regarding these specific treatments, they state:

“The evidence of their efficacy has been overstated. When the patina of language such as dialectic, mentalization, schema formation, and transference is stripped away, the treatments offered are exactly the same as those offered for general psychological distress and dysfunction, now given an unnecessarily new title, structured clinical management. The methods used to reduce distress are transdiagnostic and apply to all patients.”

They further note that no medications have consistently proven helpful in treating BPD.

The “two largest and best-designed” studies on pharmacological treatment for BPD, involving olanzapine (commonly known as Zyprexa), an antipsychotic, and lamotrigine (commonly known as Lamictal), a mood stabilizer, yielded decisively negative results.

Despite the lack of scientific evidence, “almost all patients with the disorder appear to receive not just one, but many psychotropic drugs for this condition, and several US guidelines continue to recommend drug combinations for the condition.”

Addressing stigma, the authors point out that clinicians are among the “worst offenders” in perpetuating negative stereotypes. They frequently pathologize individuals with this diagnosis, treating them as just “another borderline.” This can lead to inappropriate or even inadequate care, as “emotional instability” is sometimes used as grounds for excluding individuals from treatment.

Such practices can also exacerbate alienation among individuals seeking treatment and contribute to a culture of exclusion for those experiencing symptoms associated with BPD.

Additionally, the authors emphasize that there are numerous reasons why individuals may resist treatment or “distract and annoy the clinician.” Not all of these reasons can, or should, be reduced to pathology.

As alternatives, the authors propose that less severe BPD-like symptoms may benefit from treatments such as less structured group therapy. For individuals with disinhibition and difficulties in social relationships, they recommend highly structured and transparent individual treatment with clear boundaries.

Regarding individuals experiencing identity disturbance and dissociation, they suggest personalized, trauma-focused therapeutic approaches.

Offering distinct treatment options would enable tailoring clinical assistance to each individual rather than continuing to categorize all individuals diagnosed with BPD under one label.

In conclusion, the authors state:

“The diagnosis of borderline, of emotionally unstable, personality disorder is widely and inappropriately used, informs little, creates confusion and uncertainty, and generates tremendous stigma. It has no basis in the scientific study of personality and is used indiscriminately to describe myriad negative interactions in human relationships that have cause far beyond personality function, extending from simple disagreement to total functional breakdown.
Because of its profligate usage and scientific inaccuracy, the management and specific treatment of this group of conditions is severely compromised and has become a major bar to understanding.
Borderline no longer has a place in clinical practice.”

Social researchers often discuss the contextual factors associated with the rise and use of BPD. Psychologist Bethany Morris, previously interviewed for Mad in America, points to the historically misogynistic nature of the disorder, which is overwhelmingly ascribed to women over men—a 75% or 3:1 difference according to one source.

Other research supports the current article, such as the argument that BPD is “really a response to trauma,” that drug treatment is not effective for BPD, and that other forms of treatment, such as psychodynamic therapy, may actually be more effective than what is sometimes considered BPD’s “golden treatment”: Dialectical Behavior Therapy (DBT).

Furthermore, researchers have pointed out that cross-culturally, BPD and other PDs are often inappropriately diagnosed, given cultural differences and a general lack of contextual consideration for issues like the effects of colonization and genocide.

Finally, addressing clinical abuse and misdiagnosis, psychiatric survivors have often spoken at length about the harmful effects of being diagnosed with BPD.

 

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Mulder, R., & Tyrer, P. (2023). Borderline personality disorder: A spurious condition unsupported by science that should be abandoned. Journal of the Royal Society of Medicine, 116(4), 148-150. (Link)

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Micah Ingle, PhD
Micah Ingle, PhD
Micah is part-time faculty in psychology at Point Park University. He holds a Ph.D. in Psychology: Consciousness and Society from the University of West Georgia. His interests include humanistic, critical, and liberation psychologies. He has published work on empathy, individualism, group therapy, and critical masculinities. Micah has served on the executive boards of Division 32 of the American Psychological Association (Society for Humanistic Psychology) as well as Division 24 (Society for Theoretical and Philosophical Psychology). His current research focuses on critiques of the western individualizing medical model, as well as cultivating alternatives via humanities-oriented group and community work.

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139 COMMENTS

  1. I agree with all of this, but I’d note that a wider lens could be used to make similar arguments about any “disorder” listed in the DSM:

    – They are all pathologizing

    – The very notion infers that disorders are “things” (nouns) that people “have”, when in fact the evidence is clear (to me anyway) that they are dynamic processes (verbs) that come online as the result of trauma

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  3. Good article. But why stop at “borderline personality disorder”? The beginning of wisdom would be to dump the entire “DSM”.

    The video by Daniel Mackler entitled “Critique of Borderline Personality Disorder by a Former Psychotherapist” scores another bullseye.

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  4. “Additionally, the authors emphasize that there are numerous reasons why individuals may resist treatment or ‘distract and annoy the clinician.'”

    Distract them from what?

    This is why this profession of “helpers” will never change. They can’t resist blaming patients for everything. Here the patient is responsible for distracting the clinician from what they’re supposed to focus on…which is the patient. Same old, same old.

    I won’t hold my breath for the helping people to come and wipe the borderline label and all the other terrible things they said about me from my medical record so that I could finally get some health care minus the abuse.

    Maybe if they want to retire the label they should stop doing studies about how to treat the thing that they made up, the thing that they now write papers on how abusive and unscientific, misogynistic etc. the term is.

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    • It’s not the client’s responsibility to avoid “distracting and annoying” the clinician. “Resistance” is supposed to be part of the treatment, at least it used to be back when therapists knew what they were doing. If a person is “resisting,” it was supposed to indicate that you’re getting to an issue that needs to be addressed. It’s not a reason to punish the client!

      If clients have to act in certain ways to keep the clinician happy, there is no therapy going on. That’s usually what got the client into their problems in the first place!

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      • In my case, I resisted many things, including but not limited to:

        * “Repairing the relationship” and “giving the benefit of the doubt” to an outpatient therapist who had already committed numerous ethical violations and then lied to cover them up.

        * Admitting myself to the inpatient ward for what was being described as an “ECT consultation” — after I’d made very clear that I had already undergone ECT, it led me to going from full time employment to being declared permanently disabled, and the psychiatrist had told me, ” You have borderline personality disorder. That’s why the ECT didn’t work.”

        * A third thing I resisted was remaining on a high dose of Abilify when I didn’t feel that the abilify was helping me or was needed, as I was not psychotic.
        I didn’t know the term akathisia back then, but now I realize that it was also causing me to have akathisia.

        * Another thing I resisted was taking three categories of blood pressure meds at high doses when experiencing a hypertensive crisis that I knew had been caused by a trial of parnate, but which the doctors insisted was due to aging. I was also suffering from severe iron-deficiency anemia at the time, and I made several annoying declarations that I needed an iron infusion because I believed my heart was working too hard and that that was raising my blood pressure.

        I know that my treatment providers found me highly annoying, willful and non compliant, and the eye rolling and disparaging remarks increased whenever I resisted, but I’m not sure I’d still be around if I’d resisted less than I did.

        I agree with commenters who say that the whole DSM should be dumped.

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          • The DSM, (i.e., ‘psychiatry’) is both sham and scam:

            SHAM: the DSM is a gimmick used by psychiatry to fool people into accepting ‘diagnosis and treatment’.

            SCAM: the DSM is a gimmick used by psychiatry to bill insurance companies for their ‘services’.

            Definition for gimmick: a trick or device intended to attract attention or business but has little to no intrinsic value. It is used to make people buy something.

            All psychiatric diagnoses are glorified insults, and you don’t help people by insulting them. And it’s clear as day to any sensible person that people react to how others treat them.

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          • Who’s to say “what needs to be addressed” when resistance is often a form of necessary self-preservation?

            Anyone who thinks they know what’s best for another is arrogant. And this includes therapists.

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          • I’m assuming the intent of a good and respectful therapist is to help the person before them to free up energy used to protect themselves from past traumatic experiences so they can use it to create a better life in the future, by their own definition, not the therapist’s. It is true that not everyone is prepared at a given time to go there, and such resistance should be respected as a behavior that meets a need for the client, something DBT seems not to recognize at all.

            In any case, what I’m pointing out is that “resistance” (which is a word I would never use) has historically been viewed as an indicator of exactly what you said, that the person is feeling it is necessary to protect him/herself from danger. These mechanisms are developed for very real reasons to protect from very real dangers at the time, and one HOPES that therapy becomes a safe place to identify what these mechanisms are (help the person be conscious of them rather than having them be automatic), and for the CLIENT to re-evaluate for him/herself whether and when such approaches remain necessary. This should leave the client with all necessary defense mechanisms intact and usable, but cut down on the times they are used on a knee-jerk reactive basis when not really needed, such as becoming hostile to the butcher because he wears the same had your dad wore all the time and his voice sounds similar so he must be dangerous like your dad, etc. Gaining personal awareness and decision-making power over such responses should leave a person feeling more in control of his/her life in general. That’s the theory anyway, and it appears to have been very successful for the clients whom I worked with.

            So the idea that the CLIENT is supposed to somehow abandon any “resistance” and just go along with what the “therapist” says is very, very damaging to the client. It is reinforcing the idea that they were WRONG for judging the past situation as dangerous, that the “authority figure’s” feelings are more important than the client’s, and that the big problem is not that the authority figure was abusive, but that the client wasn’t “understanding” enough of the needs of the authority figure and should try HARDER to repress and undermine any actions they took to feel safer. This is exactly the OPPOSITE of what I’ve found to be truly helpful, which is validating the client for taking necessary actions for self-protection and admiring their courage in doing so.

            One of the very first things I did as a counselor/therapist was to help the client validate that the “crazy” things they tended to do were not crazy at all, but made perfect sense to them at some time in the past. I would share that I’ve found it helpful to look at what DOES make sense about the behavior (AKA to what extend DOES it act to protect them) and validate them for coming up with effective “coping mechanisms” for a difficult situation. Only after getting very clear on that point would I propose to the client the possibility that such mechanisms are often used by all of us humans in situations where they aren’t as helpful as their original intended purpose, and that becoming more aware and intentional about them, or even developing some new ones with our adult intelligence and recognition that in many cases the danger is not current, might be a good path to follow.

            That gives maybe just a little feeling of how important it is for me to respect whatever behavior the client has come up with to survive in their world. I always assume that ALL their actions have purpose, and the question is only whether these actions continue to serve the purpose they were intended for in the present. I have never intentionally tried to force a person to drop or dismiss any behavior they feel is important to their safety and survival. I have tried to run only based on their own stated desire to change a certain pattern of behavior, and “resistance” is important in recognizing when the actual reason for the behavior is coming to light. Naturally, a person is entitled to hang onto whatever “resistance” they feel they still need. Therapy should only be in service of meeting their own goals, not mine!

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        • When you go for counseling, you’re stepping off a dock and into the big huge unknown. You wanted help, you had to trust someone, and the one you met with is as complicated as any other human being. Healing begins with a human bond, which can take years of “talk therapy”. You can dump the DSM and the bond will form more quickly. Counseling/psychotherapy needs to take a long walk back from its present mechanistic dry hole.

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    • I wish this were true, but I can’t agree. Whether it is society itself or some higher force that demands the we label certain people and reduce their freedom in the name of treatment, the process seems inevitable. Traditionally we drew the line at real criminal behavior. You can’t let someone who just killed or raped somebody just wander around like a “normal” person.

      But we obviously need gross reforms which would include actually effective treatments rendered for as short a time period as possible, with professionals who actually know what they are doing and care about the people they are working with. The fact that this seems like an impossible dream doesn’t mean that we should totally give up on it.

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  7. After careful consideration, I have reached the conclusion that resistance in therapy can be regarded as a means of addressing childhood trauma, or alternatively, acknowledging its existence. Allow me to provide further explanation. If an individual has endured a childhood marked by violence, neglect, and emotional disregard, it is likely that they will resist engaging in relationships that begin with a deficit, reminiscent of their experiences as a child. In situations where two adults come together for a therapeutic service, and the service provider initiates the session by inquiring about the reasons for seeking therapy, the adult client may express a desire to better understand themselves in the presence of others and gain insight into how their trauma continues to impact their life. From the outset, it is important to recognize that in therapy, both the therapist and the client bring their personal histories and traumas, whether they have been processed or not. Consequently, in order to acknowledge the client’s history, they may resist the power that the therapist holds over them, with power being understood as a form of influence. When the client becomes fatigued by this power imbalance and vocalizes their concerns (following a prolonged period of resistance in which the therapist was unable to impose their will upon the client), the client may choose to terminate therapy, gaining a deeper understanding of the immense difficulty they faced as a child in surviving under the greater power wielded by their parents and the community. It is profoundly distressing to subject the client to the therapist’s dominance, rendering them helpless and susceptible to a severe relapse while under the influence of a paid professional. Such an approach extends beyond mere gaslighting. Instead, the client needs to learn how to address power imbalances in order to regain equilibrium. Unfortunately, therapists often fail to facilitate this process of balance, resulting in the emergence of borderline behaviors and name-calling.
    By allowing the resistance and the success of the resistance, is exactly th “as if” for both the therapist and the client. Now as things stand, the therapist is operating “as if” where the client is operating under reality. This may be simplifying but at the end, two adults in a room, and one having power of influence over the other without directly saying so but acting regardless is what causes trauma in the first place in most people.

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    • This is all very well said!

      One approach I sometimes used with traumatized clients is to say, “I am guessing you don’t trust me at this point. I wouldn’t trust me either if I were you. You have no idea who I am or whether I’m a safe person, and distrust is very appropriate in such a situation. I’m hoping I can earn your trust over time.” Or something like that. Acknowledging the “rightness” of them being skeptical seemed to give the clients some sense of getting some power back. It always used to bother me when clients were dinged for “not trusting their therapy team.” I always said, “How do you know they can trust the therapy team?”

      I wasn’t very popular with a certain kind of therapist…

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      • I suffered multiple traumas in childhood and I have NEVER Found any therapist that didn’t JUST want to medicate me and NEVER heal the trauma’s. After 17 year’s of trying to get therapy and T. M. S. I’m of the mindset that no one can Help me. I refuse to take medicine that just keeps me in a dah State and I have to be a functioning adult, I’m not crazy I’m just traumatically hurt and don’t know how to properly react to life stressful situation because I was NEVER taught because of the dysfunctionality and trauma as a child and when I have more traumas as an adult they JUST make me feel worthless and I have no friends and My family don’t know how or what to deal with my lonely depression. I wish I could find a therapist that would help me with learning new behaviors without drugs. I’m Smart enough to get it. Please Tell me where to find the Help I need. 5015297614

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        • I really wish I could refer you to someone! Have you considered support groups for people traumatized in childhood? It hurts my heart to hear that such therapy, which used to be considered at least one of the main approaches, is virtually unavailable to you now.

          I have found people associated with the domestic abuse or sexual abuse worlds to be much more likely to understand about trauma and approach it differently, in an empowering way. Perhaps a local women’s or domestic abuse helpline has a referral for a therapist who understands how to be helpful in these situations? They may also be a source for peer support groups, where you would at least meet others who have been through what you have (including the incredible rigidity and blindness of the so-called “mental health” services) and might have some support and/or ideas for healing? And maybe make a friend or two and feel a bit less lonely?

          I’m much more inclined to recommend peer support these days than therapy, as so many therapists (as you report) have become handmaidens of the psych industry. Anyone starting off with diagnosing and recommending drugs should be immediately eliminated from consideration, and in your case, that sounds like everyone!

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    • Nope. Not well said by either of you as neither of you address the central question: Why have a power imbalance if it causes resistance? Purposely re-creating the dynamics of childhood in therapy is not a good reason as peer support well demonstrates. The truth is there’s no good reason, except to enhance the feelings of power experienced by the therapist, which in turn emboldens the therapist to stamp inappropriate diagnoses on vulnerable people unfairly under the influence of the so-called “therapist”. And “borderline personality disorder” is only one example of why the whole therapy schtick needs to go the way of the dinosaur. So, it sounds to me as though you both need to question yourselves to see if perhaps in some unintended ways you may be favoring the therapist’s position, and if so, why.

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      • I’m not ‘favoring the therapist’s position,” just describing what has to happen for it to work for the client. I fully acknowledge most “therapy relationships” don’t occur in this way and are mostly destructive or at best do nothing helpful.

        And “borderline personality disorder” is a DSM diagnosis and has literally nothing to do with therapy, except as providing an excuse for certain kinds of “therapeutic interventions” that ignore the needs of the “client.”

        I engaged in therapy that worked very well for me, and I wouldn’t be who I am without having done so. But I was lucky, very lucky. I’d have to be much MORE lucky today to find such a person, as I see most of those claiming to be “therapists” being guided down the wrong path. You yourself have acknowledged in the past that there are exceptions where people do benefit from a therapist, but we both agree it’s rare and in many cases not even possible. I’m not promoting therapy as a profession. I’m just describing what I see as necessary for it to work. Again, I’ve already agreed and acknowledged that most therapists are incapable of this level of awareness, and that one is just as likely to benefit from talking to someone they know who has some good listening skills. Therapy is a setup for most people, because of the inherent power imbalance and most “therapists'” inability to recognize let alone manage their own needs to heal their own power relationships. Alice Miller had it right.

        I hope that clarifies where I’m coming from. Definitely not of the “everybody needs therapy” school of thought!

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        • It is true, those clinicians who speak up are either dismissed as kooks or attacked. That’s what drove me out of the field, I couldn’t deal with being “behind enemy lines” all the time! Advocacy ended up being much more up my alley. Could use my skills without helping sustain a system that did so much harm!

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          • Steve, I’m at a point in my life where I want to get involved with advocacy towards systemic reforms of mental health care; I have a lot of lived experience, I’ve read a fair amount of research papers, I’ve got a rudimentary understanding of medicine (trained to be a paramedic once upon a time), and I’m a software engineer by trade — i.e. I’m big on conceptually modeling problems and processes to find solutions.

            Interacting with NAMI is no bueno. Any thoughts on were I can be useful? I feel like it would help make my symptoms much easier to live with, knowing that I’m working to make life better for somebody like me in the future.

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          • Well, I worked first for the Long Term Care Ombudsman program, which provides advocacy for seniors in nursing homes, assisted living facilities and adult foster homes/care homes. This is a US program that exists in every state, and while I was a paid employee, most of the Ombudsmen are volunteers. There are plenty of issues with psych drugs in nursing homes, I can tell you!

            Then I worked for 20 years for the Court Appointed Special Advocates program (CASA), sometimes known as the Guardian Ad Litem program. This provides volunteers for kids in foster care who advocate to get them to a safe, permanent home as quickly as possible, and for them to be safe in the meanwhile. The number of kids on psych drugs is beyond comprehension, and the longer they are in the worse it gets! So I found plenty of opportunities there to get into the grill of the psych profession, in an effective way.

            Mind Freedom, Inc. is also a more or less worldwide association of advocates for those in the “mental health” system, so the advocacy there is more direct.

            There are no doubt other organizations I have not mentioned who do advocacy for those in psych “hospitals” or other “mental health” facilities. You’d have to look around where you live and see what’s happening there.

            I’m glad to hear you are ready to take that step! It sounds like you certainly KNOW enough to do a great job – the trick is getting through the insane levels of resistance from the people who should know better, especially the psychiatrists themselves! But it’s worth it when you get a victory. I encourage you to go in that direction!

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  8. More on “resistance”: too often there’s a big difference between what should happen in “therapy” and what actually does happen in “therapy”. And imo, this is because any adult, confidential relationship that starts off with a nonsensical “power imbalance” and ends with a stigmatizing “diagnosis” is apt to damage the “client” in ways that the client has every right, reason and responsibility to “resist”, something that in my experience most “therapists” refuse to respectfully acknowledge, except with another erroneous “diagnosis”. And none of this qualifies as “therapy”, imho.

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  9. More on “resistance”: Too often there’s a big difference between what should happen in therapy and what actually happens in therapy. And imo, the reason for this is because any confidential relationship between adults that starts off with an erroneous power imbalance and ends with a stigmatizing diagnosis is apt to damage people in ways everyone has every right, reason, and responsibility to resist, something that in my experience most therapists refuse to acknowledge, except with another so-called “diagnosis” or “disorder”.

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        • That is the huge glitch. And I don’t even think they bother training new therapists/counselors about this any more. It’s all about the DSM. The odds of getting a helpful counselor have dropped dramatically from when I was in counseling back in 1983. Very few are really up to the job, and an incapable therapist can do a HELL of a lot of damage!!!

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          • i think lately we focused so much on theory and quick theraphy we forgot its human with a human and what matters most is the essence over the techique, i think over philosophy when training the cliniancs (if there is any) is immature and corrupted

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          • My view is that a person can’t really be trained to be a good therapist. I agree, it has to do with the essence of the relationship between two people, and techniques or schools of therapy are borderline irrelevant. “Diagnosis” via the DSM is completely irrelevant. It’s not a “cookbook” procedure, it has to do with creating a safe space and respecting the right of the client to decide what is “right” or not and how to define and pursue “improvement” in their own worlds. I’m not sure what they train “therapists” to know these days, but I know they spend a lot of time on the DSM and “brain scans” and neurology, and it seems not very much on what actually helps people grow and develop in their own way.

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      • “All depends on the therapist backing away from their one-up power relationship…”.

        Nope, not gonna happen because the one-up power relationship is what (unconsciously) motivates a lot of people to become therapists in the first place…(in my unapologetically not-so-humble opinion).

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        • It CAN happen and DOES happen in some cases, but the incentive is to use one’s power for one’s own benefit. And you are right, this motivation is almost always unconscious and therefore very difficult to recognize for the therapist, even if it becomes obvious to their “clients.” Which is why I say you can’t really train someone to be a good therapist. They have to develop an acute awareness of power relationships and their own issues with power and be aware of these at all times when interacting with someone they are trying to assist. I’d say very few therapists ever meet this goal, and in fact, unless I’m wrong about what happens today in “training,” most of them aren’t even aware of it as a problem. So going to a random therapist is, indeed, a very dangerous undertaking. As research shows, your odds are just as good choosing a friend or colleague as someone with a degree.

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          • Thank you for clarifying where you’re coming from. I understand and agree with you fully. And I’m very thankful you regard “diagnosing” as “basically rarified name calling”, which brings me to the following points…

            Good things do happen in therapy in some cases, but that hardly makes up for the fact that so many therapists use their power for their benefit, consciously, unconsciously or both. And it’s beyond unfortunate that modern society conditions people to trust strangers just because said stranger has a degree in this, that or the other thing. But we live in a society that conditions people to outsource their problems to “experts”/strangers trained to commercially exploit what most often are someone’s contextually generated problems. So what sense does it make to expose oneself to someone you don’t know beyond their diploma who has the power to permanently stigmatize/”diagnose” you and is legally obligated to do so? The harm this can cause should never be underestimated, especially with something as stigmatizing as the so-called “personality disorders” of whatever flavor, precisely because it’s supposed to be an integral part of the therapy process, which for many turns out to be the most lasting and damaging part of the entire “therapy process”.

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          • I don’t disagree with anything you said. Except that “diagnoses” are not PART of the “therapy process,” they are the justification for assuming authority over the “clients,” and as such are the opposite of therapeutic. The “diagnoses” are an evil that extends FAR beyond the “treatments” it is used to justify. It starts the process of “othering” and allows people to discriminate and downgrade the “mentally ill” (as they call them) with impunity. If there were no “therapy” at all, the DSM would still be incredibly destructive!

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          • I’m still confused by this sentence: “…but the incentive is to use one’s power for one’s own benefit.”

            Who’s the ‘one’ you’re referring to? Therapist or client? And what does it matter when (most?) “therapy” is constructed to ALWAYS benefit the “therapist”— hence THEIR “diagnoses”.

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          • I meant the therapist. I have no problem with the client using his/her own power to his/her own benefit.

            It matters because it applies to everyone, whether a therapist or not. What you’re saying is most therapists TAKE ADVANTAGE of their one-up power situation. But not all do so, even if it’s tempting. Same is true of humans you meet on the street, though they have less of a natural advantage in the power department, so it’s probably safer. But lots of “regular humans” take every advantage of their power over others and seek to maximize their influence at the expense of the person they are engaged with. It’s not fair to paint ALL therapists with that brush, any more than all humans. There are even psychiatrists here and there who have a heart and understand their power advantage and don’t use it to hurt their clients. Admittedly, not a common experience, but it happens. I had a fantastic therapist who REFUSED to “diagnose” me or interpret anything I said or did, but always put the question back to me. I kind of hated her for it, but it was the right approach, and I was much the better for my 15 months of weekly meetings with her. Worth every penny I spent. So it’s important not to overgeneralize about people we don’t know, just because they have a certain assigned “role” in “the system.” There are and have always been mavericks who do it their own way. I like to think I was one such.

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          • Thank you for the clarification.

            First of all, I know very well there’s lots of “regular humans” who take advantage their power over others and seek to maximize their influence at the expense of the person they are engaged with. And I am NOT saying ALL therapists or psychiatrists take advantage of their clients. What I am saying is this: the “mental health system” is set up in such a way (“power imbalance”, “diagnoses”, exorbitant fees) that incentivizes therapists and psychiatrists TO take advantage of clients AT their most vulnerable, which I believe happens more often than is ever reported. So, in that sense I don’t think I’m overgeneralizing and is why I think it best to err on the side of caution when entering a “therapeutic relationship” because the cards are stacked IN FAVOR OF THE THERAPIST AND NOT THE CLIENT. Simple as that. And the fact that so much luck is required in finding a maverick only supports my viewpoint.

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          • Can’t disagree with a word of that. The current system makes it as easy as possible to dismiss a client/patent’s concerns, ideas, plans, motivations, etc. and to blame the client for “having the disorder,” and blame “the disorder” for any failure or damage to the client. I think it is much, MUCH harder to find someone today working for the system who is worth seeing than it was back in the 80s when I went. And I was still lucky!

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          • I would estimate that 9 out of 10 therapists are either sold out to the system or don’t really know how to be helpful. I was, indeed, very lucky. And this was in the 80s before the DSM III had taken hold. The odds are a lot worse today!

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  10. I don’t think mh professionals realize that this having this label doesn’t just open a person up to abuse/discrimination/victim blaming within the system…it opens them up to abuse/discrimination/victim blaming everywhere in society.
    Even if a person rejects the label and drops out of treatment (which, conveniently, the treatment providers see as proof that the diagnosis is correct), it’s still on their medical records. Their family and friends may continue to see them through that lens (to the point that everything a person with this label says comes under immediate questioning. If that’s not crazy making, I don’t know what is). Receiving this formal insult from “helping professionals” is, for some, a wound that never heals.
    It doesn’t help that we’re constantly subjected to this sort of thing:

    “NeverStopRecordingBPD4defense
    May 25, 2023 at 12:08 am
    Regrettably, it is likely that a lot of the descriptions of absurd and uncharacteristic behavior by therapists in these comments have been filtered by a BPD mind. I have two of them in my life. You can only send the villagers to kill the wolf so many times.”

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    • It’s sad that everything a mh client says is viewed through a lens of pathology, almost like they’ve committed a crime when all they’re being is human. So, it might be useful to remember your Miranda rights, i.e., “anything you say can and will be used against you” when you happen to be around anyone in the medical field.

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  12. There are problematic people in all facets of life. There are decent individuals, decent individuals who have turned harsh and problematic due to circumstances, malicious individuals who simply are like that naturally, pathological liars and all sorts of people.

    We can see each individual for what they are and act accordingly. There is no need of “personality disorders” in “clinical practice” if you want to help out an individual going through problems or even if you want safety from someone who has hurt you.

    If you have been wronged by someone, falsely accused of something, use the law, if not possible, use other avenues. Whoever is able to help. Again, the stamping of anyone with a “personality disorder” is not required for any of it.

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  13. “…diagnoses are not PART of the ‘therapy process’, they are the justification for assuming authority over the ‘clients’, and as such are the opposite of therapeutic.”

    I understand and agree that “diagnoses” are not part of the therapy process, that “diagnoses” are used to justify assuming authority over “clients” in ways that harm “clients”. What I was trying to say is that doesn’t seem to stop most therapists from letting “diagnoses” dictate the “therapy process”, rather than respecting what a “client” is saying, trying to say, or chooses not to say, i.e., so-called “resistance”. But I deeply appreciate your thoroughly and thoughtfully describing a respectful way of approaching someone who “resists” a therapist’s insensitive probing.

    And it’s good knowing you unequivocally acknowledge that “diagnoses” are a lasting evil that sow the seeds of othering, downgrading and discrimination. And imo, no amount of “therapy” can completely undo the damage the “DSM” does singlehandedly, which I think is a deeply disturbing reality.

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  14. I was diagnosed with Borderline Personality Disorder, not by my psychiatrist, but by my therapist. Someone who was paid (by my insurance) to talk to me and give me counsel.

    I acted on the so-called BPD symptoms (the “splitting” or ‘black and white’ thinking, the emotional outbursts) because I was convinced that I lacked perspective and self-control. That there was a sickness in my brain.

    Living in New York like I do is enough to drive anyone crazy, especially when you come from a rough environment and have ambitions to be much more than what your GENES (ethnicity, phenotype, heredity and blood relations) and your MEMES (religion, language, cultural background) tell you you are or should be.

    The psychiatrist that I did have prescribed me Topamax, which is an anti-epileptic that is being marketed as an antipsychotic. For people who are photosensitive and prone to seizures Topamax works to mitigate the brain’s reaction to visual stimuli like strobe lights and flashing colors. Imagine what this pill could do to a person who is relatively healthy but is forced to take it everyday.

    In my psychiatrist’s words this medication was supposed to “mentally slow” me, which it did. I became more agitated, had trouble articulating, processing information, and forming complex thoughts and problem solving. It cost me a union job because I couldn’t think clearly. All of this so that I could be “cured” of BPD.

    My greatest therapy has been time and my desire to improve physically (I have weaned off most animal products), emotionally (I have had to disown every relative except my mother), and financially (I stopped letting petty workplace nonsense get in the way of me earning a living).

    Imagine getting blamed for having a personality disorder when the so-called normal people you come across, including your flesh and blood, have nothing on their minds but making their coin (whichever way they can, like street dealers, small business tyrants, and psych charlatans do), preaching about their skydaddies, and talking about what insipid program they saw on television last night. Completely absorbed in delusions and their own self-interests.

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  16. Dogworld says, “…but at the end, two adults in a room, and one having power of influence over the other without directly saying so but acting regardless is what causes trauma in the first place in most people.”

    Undoubtedly. And I think this also explains how therapy for the most part is actually something most therapists use to unconsciously act out their repetition compulsions on vulnerable people, aka “clients”, which is great for therapists, but not for clients, because at the end, clients are the only ones labeled/diagnosed/stigmatized/traumatized, and on top of that expected to pay a fee which is borderline crazy if you ask me.

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    • Agree. Your comment describes why I was against therapy for my struggle. Why pay someone to add to the issues and emotions you’re already struggling with? For me resistance wasn’t about someone getting to an issue I needed to deal with but didn’t want to. It was about a therapist or someone imposing their views and giving advise when they really don’t understand the problem I was struggling with. Often the advise and what the “client” is pressured to do, is bad advise. When you try to assist but don’t understand, you’re are just guessing at what would be helpful. You’re going to guess wrong. You’re going to bring your own unresolved issues to therapy. The lack of understanding of how life experiences impacts an individual means that psychiatry looks at every problem in mood, thought, and behavior as dysfunction or disease. I don’t see any progress in the MH field until that changes.

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  17. Steve, Obviously there are a lot of different opinions about how therapy should be done. My point is that the treatment is largely ineffective because the treatment is preceding an understanding of the problem. The results is a lot of harmful treatments. I believe psychological problem could be understood but the field isn’t putting their focus in the right area. They don’t make use of or take seriously information that can be provided by people experiencing or have experienced a serious psychological problem. I recently saw a film on some women who recovered from schizophrenia. They provided insight on the condition and how they healed. I’ve seen a film on a women with DID who provided important information on how her condition developed. Psychiatry needs to see the commonality across people with these conditions. It needs to look at what causes the conditions, what aggravates or heals them, because there is considerable commonality. There can be unique characteristics to each psychological problem and still be a universal reason why they develop. But psychiatry thinks it can figure it out by studying neurons.

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    • I agree 100%! I always counted on my clients alone to provide whatever useful information was in play. THEY are the only ones who really know what’s going on or what might help! But that’s the opposite of the mainstream view. The DSM itself admits it doesn’t even bother to attempt to evaluate cause. What’s the point of a “diagnosis” that doesn’t try to identify what the actual problem is!

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      • I don’t mean on individual therapy although of course one should listen in individual therapy. I mean for the field of psychology to increase its knowledge overall on what circumstances cause psychological trauma, it’s impact and what support is needed for someone to heal. Not only isn’t there enough effort to understand how serious psychological problems can develop under normal function. By “normal function” I mean there isn’t an abnormality in genetics, biology or reaction. But it seems like there’s a push back against studying it from that angle. Psychiatry is very invested in theories of biology, genetics or dysfunction. In every thing I read, there is a statement, that psychological problems are in part genetic, biological and predisposed in certain individuals, sometimes initiated by trauma. Trauma alone will not cause one. Psychiatry will say what trauma is and if what you experienced doesn’t fit our category, you have a mental illness unrelated to trauma. Psychiatry hasn’t proven that serious psychological problems always have a genetic, biological basis leading to some people being predispose. So why is this view always stated as fact.

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        • That view is always stated as fact because psychiatry believes its own lies. And lies are all it has going for it because psychiatry has yet to prove its own “facts”.

          The fact is trauma means different things to different people and is experienced differently in different people for any number of reasons/facts. It’s sort of like humor: some people have a funny bone, and some people don’t. But I wouldn’t call those who don’t have a funny bone “mentally ill”.

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    • @Christine Burnett,

      Could you kindly provide the title of the film in which a woman experiences recovery from schizophrenia? I am genuinely interested in further exploring this condition.

      I would like to share a captivating article pertaining to this subject. The article discusses the condition and highlights the intriguing aspect of a patient who, despite lacking any prior knowledge or training in quantum physics, has made notable claims in the field. The patient provides visual representations and formulas, although they are not a trained physicist. The article presents information about the patient that exhibits a condescending tone towards their personhood and complete utter dismissal of how could a person like this could think like that to support “grandiosity” diagnosis. My curiosity led me to search for the formula online to assess its accuracy, which yielded an interesting finding. Remarkably, the patient’s assertions were nearly similar. Although I am not an expert in this field, I cannot verify the complete accuracy of the claims; however, I find it intriguing that an untrained individual would make similar claims to what is already known even to draw exactly what they are saying. It is worth noting that one could argue the patient simply looked up and memorized the information, but that would contradict the characteristics of schizophrenia. Additionally, the article mentions that the patient has an IQ of 86 and is extremely “non-functioning”. Overall, this article presents a fascinating read for anyone interested in the subject.

      Here is the link:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3013287/

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  18. My head is spinning.
    Somehow the journal article is amazingly based and also totally oblivious. It goes hard critiquing the usage of BPD as a diagnosis, and the associated experiences of patients and behaviors of providers. It calls out the fact that the providers are the greatest source of stigma — something I’ve been saying for years to anyone who would listen.

    But somehow the article gives the impression that the issue is localized to just this one diagnosis, and that none of the dynamics they’ve described can be generalized to other people receiving mental health services.

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    • The subject of this article is the borderline personality diagnosis. There are other articles and personal histories that address the stigma of other diagnoses or of any mental illness diagnosis or interaction with the mental health care system.

      The borderline diagnosis carries way more stigma than almost any other diagnosis and leads to more extreme abuse in certain settings. Perhaps this is why the authors singled it out in this article.

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  19. Now doctors — including psychiatrists — are claiming something called moral injury, and the New York Times is taking it seriously. Because they hurt too many patients? Ruined too many lives? Now they want sympathy.

    I barely survived what I went through in the mental health system and no doctor of any specialty helped me to survive the incredible physical challenges I was left with because of psychiatric drugging. Instead, they just piled on and chalked it up to my so-called mental illness. They get none of my sympathy. As it is my life expectancy is much lower than it would have been had I never encountered any of these people.

    The Moral Crisis of America’s Doctors

    The Moral Crisis of America’s Doctors https://www.nytimes.com/2023/06/15/magazine/doctors-moral-crises.html?unlocked_article_code=9gPVznz9B0A1yFS9FMsEkZtN8qwcRiAlufPRhmpW4Wv1WSWsphzXtP9BXjoYQ0nbhrjMI1Flh5IvthGhmh8A0uLGuNoTsUO4bs0kvrBfvnCpBHv-tgLI1l7vqr5X5UOQmWBN0OAqLkisxQDqYTIIjaN86P4qgYHQ4tJrPDrdkVL_A338KqzmxgKYcEaSZ_7aPSX3iD07qfTEc7HgsCGvBFtVihFCvl-MM8rM_5AVsSdQ9kqaSwe44_LmIVnOUkG131OHW6oQFdT6ksUtXun5V52RBBHo1HFflF4i_BgXq2eNeR3pXkdBUtH2yuHJpS9Tbu3WdzMrc7oYtsMl8t6b&smid=nytcore-android-share

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    • Wait, now the PSYCHIATRISTS are claiming “moral injury?” I suppose it DOES inflict “moral injury” of some sort if you’re constantly claiming to help people and yet so often make no improvements or make their lives agonizingly worse? Perhaps it’s time for a “Truth and reconciliation” circle as they ran in South Africa to help heal the “moral injuries” of the Apartheid regime? Do they expect us to feel sorry for them that their failures don’t feel very good to them???

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  20. Steve,
    Yes, I think they want sympathy (the article was about all doctors), but they want it from the general public, the media, and the people who are as rich and important as they are, or more rich and important than they are.
    As far as the people on the bottom rungs — the people who have been most injured by the health care system (the poor, the disabled or otherwise marginalized, the iatrogenically harmed, the ones they dubbed “mentally ill”) — I think they want those people to die or just remain silent and invisible. We are to accept all of the blame and to understand what a huge burden and disappointment we’ve always been. This comment summed it up:

    “Doctor here. Corporate medicine is bad yes. But unfortunately a huge source of moral injury are our own patients.

    Patients often treat their bodies poorly and blame the doctors that they won’t listen to.

    Want every test ordered and blame the doctor

    for the bill. Then they come to NYT and write the comments you see here. Just think, would you want your loved one to face the people writing comments here?”

    So far, that comment has 26 up votes.

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    • That does kind of sum it up. That kind of thinking is even more destructive in psychiatry, because blaming the victim is the most overtly damaging thing you can do to a traumatized person.

      If this guy hates and resents his own patients so badly, he needs to find another profession!

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  21. I listened to the NYT article. It complained about the privatization of medical care and says doctor are not able to provide the care they want to because of profit requirements. The “moral injury” is about not being able to do what the physician feel they should morally do. The suit is about stopping profit over care. Actually, I do feel all the push towards for profit agencies providing care does lead to worse care. Money is made through less staff and treating patients in ways that provide the most profit.
    Psychiatry has another problem. They haven’t figure out what they are treating.

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    • The article makes doctors sound like the ultimate victims. They should try being a patient with life-threatening injuries caused by psychiatric drugs, being laughed at by all the doctors around. I have no sympathy. Yeah, they might be stressed — they sure know how to take it out on people beneath them who have even less power, who have zero power.

      And then their friends, the psychiatrists, diagnose them with moral injury while everyone beneath them having an identical reaction to modern society gets diagnosed as mentally ill.

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  22. Good observation, KateL.

    Definition for Moral Injury: psychological and spiritual harm that occurs when one’s core values are violated or betrayed

    Psychiatric diagnoses cause moral injury, all 265 (and counting) of them.

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  23. “..its diagnostic criteria are not enduring personality traits but rather fluctuating symptoms and behaviors.”

    I have always believed this was true. A close friend of mine began the process of seeking help for her ongoing mental health issues. She was hospitalized twice & needed continuous therapy after being released.

    A local clinic submitted her the series of “personality” questions. I can’t remember the name of the questionnaire but it contains around 500 questions.

    The clinic brought her back in to review results from the questionnaire. Their diagnosis was Borderline Personality Disorder. Then, they sent her on her way. She was told if she had depression, anxiety disorder, or bipolar disorder she would of been able to receive treatment.

    I remember like it was yesterday how devastating it was that they basically said “sorry” & “Next!”

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  24. In OPINIONS OF PERSONALITY DISORDER EXPERTS REGARDING THE DSM-IV PERSONALITY DISORDERS CLASSIFICATION SYSTEM Journal of Personality Disorders, 21(5), 536–551, 2007; of 537 experts, only 31.3% wanted the term, “Borderline Personality Disorder,” retained in the DSM-V. However just few weeks prior to the final vote of the APA approval of DSM-5, the Board ot Trustees decided to retain all the traditional and poorly validated PD’s unaltered and relegate the new section on the highly research Personality Traits to the back of the book (bus) as an “Alternative Model”.
    Additionally, Mood Temperaments such as the historical and clinically validated Cyclothymia would assume higher position in a diagnostic hierarchy before personality disorders or ADHD are considered. See: Cyclothymia, the Quintessential Mood Temperament: Ignored or Forgotten? Part III: Differentiating Cyclothymia and BPD and Treatment Considerations. in Psychiatrtic Times. H. Yost

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      • Well Birdsong, there is one, and it’s called Déformation Professionnelle. Essentially, any occupational training imparts both a sense and mastery and a certain obliviousness to what that mastery cost-namely other ways of perceiving the world. Dewey referred to this professional deformation as “occupational psychosis”, and Thorstein Veblen as “trained incapacity” (my personal favorites of many like monikers). When I read comments like Hunter Yost or Michael J Scott, et al (as opposed to the comments from the 10 mental health professionals in Daniela Sieff’s remarkable book, “Understanding and Healing Emotional Trauma”) or read the inexhaustible personal accounts of the incomprehensible care and treatment depicted here on MIA (my thoughts now revolving around Donna Carolyn Roy) and elsewhere, I recognize the particular and salient trained incapacity and occupational psychosis of the “mental health professional”, as fulfilling its institutional obligations…

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        • Thank you so much Kevin. It’s good knowing there’s actually a way to describe the insanity within the “mental health” profession. And thank you for mentioning “Understanding and Healing Emotional Trauma” by Daniela Sieff. It sounds like a fascinating book!

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          • Your most welcome Birdsong! You can find this book in an online PDF! This book is, IMO, one of the most generous and comprehensive books on human development and trauma as I’ve ever read-and I’ve read a few!

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  25. When I experienced depression during the pandemic I was unable to see my regular psychiatric NP because she closed her office. My PCP did not feel comfortable stepping in and prescribing in her place. So I went to a local University hospital ER to ask for a prescription for an antidepressant or access to a doctor who could do that for me. I told them I was not suicidal, not a danger to myself or others. But the longer I waited in the ER with the danger of COVID lurking everywhere, the angrier I got. I knew they could at least take me to one of the ER “booths” like they were doing for other patients. After 11 hours they took my cell phone and shoe laces and belt and stuck me in a small room with a huge male nurse to “guard” me. They said they were going to put me in the psychiatric ward. I complained to anyone who would listen that my family needed to be notified. I needed my phone to call them, or access to a hospital phone, and finally said I would call the police and say it was tantamount to kidnapping to hold me against my will. Because I had already said I was no danger to myself or others. They said if I called the police they would have the police section me and hold me there against my will. Yet there I sat for another 2 hours. Still no phone. They transferred me to the psychiatric unit and I asked for release AMA (against medical advice) and was told to sit still until the next day. They kept a camera trained on me, which was further harassment. No one would listen. The next day a young doctor and assistant asked me basic questions about my depression and talked to me about my history for no more than 15 minutes, whereupon they discharged me to go home. They refused to prescribe an antidepressant unless I agreed to stay in the unit for a week for observation. I left without it. The next day, I looked at my online health portal and they had diagnosed me with Borderline Personality Disorder. WHAT? Talking with me a few minutes, hearing my controlled anger (no cursing, nothing untoward) about being kept there they had decided that was enough to qualify me for the BPD diagnosis. Now that is on my permanent record. The cost for this less than 24-hr hospital visit was $10,000.

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    • Many doctors and therapists automatically use the “borderline” label for people who refuse to follow their orders in order to protect themselves from lawsuits since that label has so many negative connotations that discredit the “patient”.

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    • I’m so sorry you were treated this way. How awful. What happened to you is a textbook case of how the “health care system” (I can’t believe we still call it that) penalizes and punishes patients for having health needs. Sometimes (often?) the borderline diagnosis is nothing more than a way to anyone who points at the huge flaws in the system. They are masters at blame shifting.

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  26. Interestingly, the authors state that both the DSM and the ICD research committees initially rejected the inclusion of BPD, but the category was ultimately included due to pressure from powerful interest groups. They note, “It is not only Big Pharma that can influence diagnostic practices.”

    Well, I, for one, would love to know more about these powerful interest groups. So powerful that they can’t be named?

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  28. “Twitter Files” journalist Michael Shellenberger is convinced that the elites who are controlling the “censorship industrial complex” all have “Cluster B” psychiatric disorders.

    I hope someone informs him about the connections between psychiatry and totalitarianism.

    From his Twitter:

    Michael Shellenberger
    @shellenberger
    “The elite bureaucracies are run by people who exhibit the behaviors of people diagnosed with “Cluster B” personality disorders, including entitlement, grandiosity, black/white thinking, obsessive attention-seeking, impaired sense of reality, and lack of empathy.”
    Cluster B Characteristics
    Entitlement & Grandiosity
    Splitting (Dichotomous Thinking)
    Obsessive Attention-Seeking (Narcissistic Supply)
    Emotional Dysregulation/Mood Lability
    Impaired Reality Testing (Fantasy)
    Gaslighting
    Lack of Empathy (for “oppressors”)
    Excessive Empathy (for “victims”)

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      • Yes. I think Shellenberger is unclear on the concept of what psychiatry is and how it has always been used to silence and oppress people.
        I believe even Julian Assange was smeared with some kind of psychiatric diagnosis.
        Someone should show Shellenberger the graphic attached to this article and ask him if he thinks the powerful people running the “elite bureaucracies” behind the “censorship industrial complex” would stand for this sort of treatment. Obviously not. Only a group of people with little to no power (i.e. those who actually receive borderline personality diagnoses) would be subject to this level of humiliation.

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