For example, if a woman behaves in an ‘unfeminine’ way, say by expressing extreme anger (another of the diagnostic criteria is “Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)”), the label of BPD is slapped on her by the psychiatrist. “Frequent displays of temper, constant anger recurrent physical fights” are not seen as disordered behaviour in men, they are seen as fairly normal. But it seems that when a woman displays those tendencies she is not normal, she is personality disordered.
Another of the criteria is “Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).” Again, some of these things seen as “potentially self-damaging” (I’m looking at ‘promiscuous sex’ and ‘reckless driving’ in particular) are seen as normal behaviours for men, but in women are considered undesirable enough to be included in the criteria for diagnosing a serious mental illness.
However, in a capitalist country, the less money to be made directly by the professional treating someone, the more likely the professional is to be behind on current knowledge, to be diagnosing or providing treatment for a disorder they know little about past a few hours back in school, etc. and the more likely those outdated ideas are to be applied in practice.
In the case of BPD, those ideas suggested intensely punitive and carceral practices in the past: a woman sleeps with the man providing her treatment; she refuses to do so again; her angry therapist identifies this as a deceptive gambit to garner attention, as disturbed identity because of the supposed instability in life goals & values, and as reckless behavior (promiscuity), and advances a diagnosis of borderline personality disorder; the diagnosis sticks mainly because the patient is a woman, and most professionals at the time are men who have all heard lurid tales of seductive BPD succubi; BPD is (or was) considered highly resistant to treatment, with high likelihood of self-harm and compulsive deception, which suggests involuntary in-patient treatment and ignoring the woman’s version of events; the woman’s freedom is now in the hands of a man who near-certainly took advantage of his power over her when they had sex before and now wants her to submit to his advances again.
This is an extreme example, but the diagnosis was also applied simply as a method of social control over women brought to therapy by parents after running away from an abuser, or by husbands in retaliation for infidelity, and so on, as well as just a quick-draw way for therapists to blame unresponsive patients for the therapist’s mistakes or shortcomings: BPD diagnosis was taken to mean, in many circles, that the patient’s condition had no chance to improve regardless of treatment and that any dissent from the patient should be assumed to be the disorder at work.
Again, all of these scenarios are much more unlikely today for a woman entering therapy of her own accord than they would have been decades ago, in part because the way BPD diagnoses were applied became an intensely shameful scandal within psychotherapy, leading to attempts to revise conventional wisdom about diagnosis and treatment. Potentially less helpfully, in my opinion, it’s also led to a stigma against diagnosing it at all even where up-to-date knowledge of it might lead to effective treatment, though part of that is also because most insurance companies, eager for excuses to deny coverage, still consider BPD to be effectively untreatable. This has led to a lot of people in places such as the United States who are treated for BPD but whose therapists provide a different diagnosis on paper to allow them to continue treatment.
And again, women who are treated without any influence over the decision and who are not paying the provider directly, such as women in prison, are both more vulnerable to the worst results of those older practices and more likely to be placed in the care of someone who still engages in them.
mayakovfefe posted:where i’ve seen nurses mock bpd patients
i see this happen a lot with BPD too, in various fields that all supposedly should know better. nurses, doctors, social workers, therapists, counselors. it's almost too obvious when you think about it, how a diagnosis that is disproportionately applied to racialized, impoverished, criminalized, and abused people, is treated with contempt by the rich white professionals who "care" for them.
tears posted:borderline of what?
the term is an anachronism from a time when BPD was considered to be closely related to delusional disorder (psychosis). there have been some attempts to change the name to something more accurate but they haven't stuck in most places.