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The Social Construction of Borderline Personality Disorder Linh Dan Ta Art by Ailsa Schreurs
Medicalisation is the redefinition of deviance as illness (J. Busfield 2017: 759). It is a diffusion of power and a means of social control. The de-medicalisation of certain mental health disorders, such as homosexuality, reveals the temporal relationship between our conception of deviance and the dominant regime of truth. What is pathological and what is normal shift across time and space, contingent on the mandates of hegemony (P. Bjorklund 2009: 17). An exploration of Borderline Personality Disorder (BPD) is epitomic of this. The disproportionate representation of women diagnosed with BPD, and its feminised aetiology, is both a preservation and symptom of patriarchy. However, its medicalisation can also act to legitimate BPD within the parameters of science and healthcare - unveiling the structures that perpetuate female suffering. Therefore, a pluralistic approach of the medicalisation of BPD can engender inquiry into the conditions and consequences of an oppressive, misogynistic society. In Foucault’s analysis, 18th century Enlightenment marked the collapse of the Sovereign where previously power, discipline, and control rested on a single monarch decreed by God (M. Foucault 1975). Modern governmentality saw the diffusion of power where discursive institutions naturalised norms and ideals that upheld
existing social arrangements. Those that were unable to fulfil the roles and expectations of civilisation were marginalised. Medicine, especially psychiatry, replaced religion becoming one of the most powerful extralegal institutions of social control (S.H. Sulzer 2015: 6). This is mirrored in the medical incarceration of the “insane” during the Age of Reason that was preceded by a professional diagnosis. Problems of illness, both somatic and psychic, fell under the jurisdiction of the physician and the broader medical body, irrespective of its capacity to deal with it effectively (P. Conrad 2013: 205). The language of psychiatry therefore became a “monologue of reason about madness” (M. Foucault 1965: xi). An archipelago of the secure institutions of expert knowledge cast a psychiatric gaze over conceived deviances, medicalising social abnormalities as an apparatus of control (N. Rose 2006: 466). The Diagnostic Statistical Manual (DSM) emerged in 1952 as a standardising nosological tool and a central infrastructure of medicalisation, despite ambivalence on universal diagnoses. An American psychiatrist Karl Meninger boldly asserted that classifications should be abandoned all together claiming them arbitrary and credulous (A. Scull 2019: 278). A carefully controlled study revealed that agreement between two American psychiatrists intrastate barely reached 50 per cent (A.
Scull 2019: 278). Regardless the DSM’s use proliferated, contextualised by the consolidation of Western capitalism in the 1970s. The accompanying pharmaceutical revolution increasingly individualised risk and illnesses, seen as having genetic and individual causes, were mediated by self-regulatory and consumptive behaviours. Consequently, allopathic treatments were increasingly prescribed, reliant on clear diagnostic delineations and perpetuated by medicine’s attachment to both science and prestige (J. Busfield 2017: 762). It is reductionist to claim that scientific advancements within healthcare are a sole engine of neoliberalism, however its implications carry the vestige of cultural and economic histories. Personality disorders present an additional contention and tenuous relationship with diagnostic validity as they do not include obvious organic malfunctioning, but are detected by interpersonal and behavioural effects (N. Manning 2000: 622). Hence, they are more susceptible to social interpretation and represent an embodiment of the ethnopsychological assumptions about the ideal self, the Other, and the modes of experience and behaviour that constitute abnormality (P. Bjorklund 2006: 16). The latest reiteration of the DSM-V (2013) describes Borderline Personality Disorder (BPD) as a severe form of behavioural disorganisation (S.K., Cahn 2014: 263). It
