Wednesday, 25 September 2013

Undermedicalisation: taking mental health seriously

When I was tentatively diagnosed with Borderline Personality Disorder, the first thing I did was get on a bus to my old house to ask a friend if I could borrow her copy of Girl, Interrupted. (The second thing I did was seriously consider getting my hair cut off again like Winona Ryder in the film. Perhaps "Looks really fit with a pixie cut" should be one of the diagnostic criteria.)

This was after ransacking Wikipedia and WebMD and NHS Choices and any other source of internet information I could get my hands on. I mean, it makes sense: someone tells you that you are something; you want to know what that something is. Movies are probably not the best source of information on any mental health condition, but they have one thing that dry medical websites don't: they can try to tell you how it feels.
Susanna Kaysen: [reading from a book] "Borderline Personality Disorder. An instability of self-image, relationships and moods... uncertainty about goals, impulsive in activities that are self-damaging, such as casual sex."
Lisa Rowe: I like that.
Susanna Kaysen: "Social contrariness and a generally pessimistic attitude and often observed" Well, that's me.
Lisa Rowe: That's everybody.
This was actually a really common reaction when I told people: "So, I have an exciting new diagnosis! I have a Borderline Personality! It means I have no idea who I am or who I want to be, and some other stuff!" "Isn't that just being in your 20s?"

Well, yeah, but let me ask you this, Unsure About Your Future Twentysomething: does it make you want to die? Are you so horrified at the gaping vacuum at the centre of yourself that you frequently find yourself curled into the foetal position on the bathroom floor digging your fingernails into your arms to stop yourself howling with fear? Are you suicidal because the idea of figuring out what you want to do with the rest of your life seems like a task you're just not capable of? Does the prospect of getting hospitalised for your insanity sound like a blessed relief?


Then you are probably "just in your 20s".

I think people have this impression that psychiatrists are roaming the streets with nets, cackling madly as they spring upon anyone who displays mildly unusual behaviour and diagnose the crap out of them. "In my day, some kids just had more zip than the others, we didn't call them ADHD and pump them full of drugs." Yeah, and those kids were called troublemakers, underperformed in school, and were denied the chance to deal with their neuroatypicality in a way that suited them.

The idea that we're Overmedicalising Normal Behaviour and Looking For Problems Where There Aren't Any sends people too far the other way, denying the reality of Problems That Are Actually There.

Because these fears are based on genuine issues: yes, the pharmaceutical industry exists to make money, and can best do this by creating medical conditions out of perfectly normal symptoms and patenting drugs to "cure" them. But that doesn't mean illness doesn't exist.

And yes, there are genuine problems with definitions of mental health; BPD is especially contentious because of the disproportionate numbers of women who are diagnosed - hmm, do we possibly think this is because "promiscuity" is only deemed a problem in women?

Reading definitions of mental health conditions, even the healthiest and happiest person can diagnose herself with six different disorders before breakfast. I mean, look at the DSM-IV criteria for Generalised Anxiety Disorder:
A. Excessive anxiety and worry (apprehensive expectation), occurring more-days-than-not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more-days-than-not for the past 6 months).
  1. restlessness or feeling keyed up or on edge
  2. being easily fatigued
  3. difficulty concentrating or mind going blank
  4. irritability
  5. muscle tension
  6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
If there is an adult human on the planet who does not meet those criteria, I want their secret. The point is that there is an unwritten addendum to all of these definitions: that these symptoms must be resulting in dysfunction; that they are making it difficult for the person to live a "normal" life. It's unwritten because no one goes to a mental health professional unless they're actually suffering. Unless it hurts, it's terrifying, it's too much effort to get outside your front door in the morning.

The mental health system, for all its myriad faults, is not trying to make problems where there aren't any. (The NHS, in particular, hardly has a vested interest in creating extra patients.) It's trying to give names to problems that are already there, and have a bash at making them less awful.


The third thing I did was collapse in horrified tears because I've always known I was fundamentally defective as a human being, and now this assessment had been confirmed by a qualified medical professional.

The fourth thing I did was tell my self-proclaimed GBF. He instantly dubbed me his BPD-BBFFF (Borderline Personality Disorder Bi Best Fucking Friend Forever) and promised to get that on a t-shirt.


  1. I have acquired a copy of this book, which I have not yet read but which I think is endemic of this recent obsession with 'OMG mental health problems aren't reeeeeeeal, everybody gets sad sometimes!' thinking.

    Pathetically, I picked it up because I hoped it would make me believe that mental health problems aren't reeeeeal, that if I would only buck my ideas up I would realise that I'm just a normal human being like everyone else and should stop being so bloody namby pamby.

    Needless to say, I don't actually believe this will work. Stupid book has been sitting at my desk for about 4 months.

    1. I would actually like to read that, though yeah it would probably add to the "there's nothing wrong with you reeeeeally" mindworm.

      As a completely random person on the internet, I would like to take the opportunity to validate your own experience of your brain. Your feelings are real! Your suffering is not a product of Big Pharma's machinations! I believe in you!

      Aaaand relax. xx

    2. I just wanted to say I don't think that's pathetic at all. I think a lot of us --- if not all of us --- feel that way sometimes, that we *could* will ourselves healthy if we only had the right inspiration.

      And I'd like to read that book, too.

    3. Apart from anything else, it's a nice idea, isn't it? That there is something you could do that would just FIX IT.

      Thanks for reading x