AbstractBorderline Personality Disorder (BPD) has a long history as a controversial psychiatric diagnosis. It is frequently criticised by feminist scholars for its gendered nature and for reinforcing an endemic tendency to deny or obscure the social causes of distress. The failure of the psychiatric profession to respond to the frequent traumatic antecedents of BPD, combined with the extent to which the diagnostic label implicitly frames the source of the ‘disorder’ as being situated within an individual’s own personality functioning has resulted in a widespread perception that individuals with BPD are ‘untreatable’. It is therefore a highly stigmatised diagnosis that can have significant implications for treatment, understandings of recovery and identity. This research draws upon feminist, critical realist, contextualist and narrative theoretical and methodological approaches to explore the personal meaning of diagnosis to women with a BPD diagnosis in the context of their life histories and wider societal attitudes towards women and mental health. It examines the ways in which these factors influence their understandings of self and identity and the function, purpose and meanings associated with the creative coping strategies that women with a BPD diagnosis use to negotiate distress. It also explores the systems and structures that are helpful and (unhelpful) in fostering concepts of recovery and supporting individuals to (re)build a sense of identity within or outside of the framework of diagnosis.
The research was carried out in two stages. Stage one involved a qualitative secondary analysis of eight interviews conducted with women with a BPD diagnosis as part of a research project examining experiences of being detained under Section 136 of the Mental Health Act. Building upon the themes identified in stage one, the second stage of the research explored experiences and attitudes towards diagnosis and treatment, conceptions of identity and the experience and meaning of creativity to four women with a BPD diagnosis who self-identified as having an involvement in artmaking or other creative activities. This was done using a collaborative approach that offered participants the flexibility to share their stories in the way that best suited them. All participants chose to take part in one or two face-to-face interviews, with the majority sharing examples of their creative outputs during or after the interview to illustrate the feelings and concepts discussed. The data were analysed using an approach to thematic narrative analysis that was sensitive to the feminist idea of ‘voice’ and the inter subjective experience of the research process. Visual data are included in the thesis where appropriate to illustrate themes.
The findings reveal a strong theme of invalidation that pervades participants’ accounts of their early childhood experiences and is often perpetuated in adolescence and adulthood by stigmatising attitudes towards their experiences of distress and the diagnostic label of BPD. Experiences of invalidation and complex histories of trauma occupy a privileged position in participants’ narratives and have a profound effect on how they form and maintain their identities in the context of diagnosis. Receiving a diagnosis of BPD can intensify or exacerbate an already unstable or uncertain sense of self and being given a diagnosis frequently results in a denial of access to treatment or referrals to services which further compounds experiences of trauma or invalidation. The study finds support for an alternative perspective which challenges psychiatric positivism, acknowledges the experiential reality of events and emphasises the meaning attributed to these events, rather than focusing merely on what is considered wrong or ‘disordered’ in an individual’s behaviour. It argues that this is best reflected in the work of Johnstone & Boyle (2018), who developed the Power Threat Meaning Framework as an alternative way of conceptualising mental distress and distressing behaviours as adaptive responses to childhood trauma in order to maintain personal survival.
The research finds that progress towards self-defined concepts of recovery amongst women with a BPD diagnosis appears to be realised through the combination of a supportive and appropriate therapeutic environment and an individual exploration of creative ways of expressing and understanding identity and emotional distress. The findings show that, both in a therapeutic and everyday setting, creative activities can be a powerful way of alleviating distress and renegotiating identity by providing a platform for women with a BPD diagnosis to render different aspects of their identity visible, thus enabling them to build a more coherent and holistic sense of themselves. The thesis provides practical recommendations for services supporting women with a BPD diagnosis that focus on the need to provide a validating and empowering space to explore and identify not only the individual experiences that have contributed to their distress, but, crucially, the response and meaning associated with them and how they have shaped their sense of selves.
|Date of Award
|Helen Johnson (Supervisor), Rebecca Grist (Supervisor) & Hannah Thurston (Supervisor)