Author wishes to remain anonymous

I am a clinical psychologist and worked in the MH system for many years – long enough ago to remember when no one was diagnosed with ‘borderline personality disorder’. Instead they probably received labels of ‘schizophrenia’ or ‘bipolar disorder’ – and these labels can still be seen in the notes of older service users, which just shows you how arbitrary they are.

I have never believed in psychiatric diagnostic labels, and least of all in this one, which effectively tells someone they are both ‘mad and bad’ – and that there is something fundamentally wrong with them as a person.

In the criminal justice system, ‘anti social PD’ is likely to be used to describe a man from a violent and deprived background who has later perpetuated violence. In mental health services services, ‘borderline PD’ is most likely to describe a young woman with a history of severe trauma who is angry and distrustful as a result.

In both cases, the label is shorthand for ‘I don’t understand you, don’t like you and don’t know what to do with you’ – but dressed up in pseudomedical jargon.

An alternative way forward is to co-construct a personal story, or formulation, which makes the person’s reactions understandable. This can also work with staff, who are rarely given the support and supervision they need, and as a result, frequently get drawn into re-traumatising relationships with these clients, as has been confirmed by research. We really must do better.

The diagnostic manuals have been on the point of abandoning this unscientific and pejorative label on several occasions, but are apparently lacking the courage to carry it through. The CJS (Criminal Justic System) now talks about ‘personality difficulties’ rather than ‘disorders’ in its official guidelines – better, but not nearly good enough.

The problems lie not in people’s ‘personalities’ – whatever we mean by that – but in their lives. There are plenty of dissenting psychiatrists, but endless debate is not enough. We drop unscientific labels in general medicine – we no longer diagnose people with ‘dropsy’ or ‘consumption’ – so it is actually consistent with the claimed status of psychiatry as a science to do so with this one.

But so far, the moral courage from leadership is lacking. And in the meantime, we carry on victim-blaming; telling vulnerable people, in effect, that their distress is their fault, because they are flawed for life. It is absolutely unacceptable.

Speak your truth: your own experiences can help create change

If you want to share your experiences around this diagnosis you can take part in Platfform’s Truth Project.

Platfform are campaigning for a review of the use of the diagnosis of PD. Add your voice to our call for change by sharing your story. We will share these with Welsh Government and use them to strengthen our campaign.

For more information, and to access the survey, click here.

If you are in a mental health crisis, please read this paragraph

If you have been affected by anything in this story and would like to talk to someone you can call Samaritans on 116 123. You can also call the national mental health support line for advice on 111 (press 2.)