Diagnoses are a matter of classification and categorization (Foucault 1982; Madigan 1992). BPD is currently understood through an arrangement of human behavior that classifies like individuals into typologies of deficit. A personality disorder diagnosis declares the deficit to be a fundamental feature of a person rather than a transient state. When a clinician, armed with this model and definition, makes a diagnosis of BPD, for instance, the power to classify derived from this knowledge can influence how individuals view themselves in relation to societal standards. In Foucaultâs (1982) sense, the client may therefore internalize the problem discourse and come to understand themselves as deficient and that deficiency as a fundamental quality.
The etiology of BPD is a highly studied field by researchers, and even critics of BPD have adopted a causal model that names childhood abuse as a risk factor for BPD (Shaw and Proctor 2005). The public comes to think that BPD is the understandable and inescapable result of a stressor, when in fact it is a diagnosis dependent on the mere judgment of a clinician. This is to say, âthere is no disorder ⊠unless somebody with authority applies a psychiatric conceptualizationâ (Burstow 2005, 1299).
Of importance here is that a BPD diagnosis is situated within the dominant Western discourse on identity, a conception of selfhood that values autonomy and goal-directed behavior. These characteristics are closely tied to cultural norms of self-provision through work. In order for members of society to be self-sufficient and goal-directed, personality and identity must be conceptualized as relatively stable, inherent aspects of oneself that emerge through behaviors, traits, and other external manifestations (White 1999; Bradley and Drew 2006). In traditional treatment, clinicians decode and interpret these manifestations in relation to their deviation from societyâs norms for behavior (Madigan 1992).
For example, self-injury and suicidal behaviorsâtwo diagnostic criteria of BPDâare seen as pathological actions that undermine the valued sense of selfhood. Disrupting the dominant narrative of goal-directed behavior, the self-directed injury is seen as an inability to be an agentic, goal-directed individual. Some types of self-harmâsuch as overworking at oneâs place of employment to the point of causing physical ailments, neglect of interpersonal relationships, and loss of sleepâare not seen as pathological because these acts resonate with cultural values, such as self-sacrifice for a greater goal. But because the self-directed nature of self-injury cannot be reconciled with other cultural norms, self-injury is seen as a manifestation of severe pathology; the person must be viewed as disordered for such an action to make sense (Madigan 1992).
Studies of BPD offer us reasons to rethink these dominant conceptions of pathological behavior and the supposed stability of identity. We know now that BPD symptoms diminish over time such that âafter about 10 years, as many as half of the individuals no longer have a pattern of behavior that meets full criteriaâ for BPD (American Psychiatric Association 2013). Another study showed that among an adult cohort, 73 percent were in remission from symptoms after six years (Zanarini et al. 2003), which undermines the narrative that personality is largely unvarying. Furthermore, many symptoms of BPD are normative during adolescence, such as chaotic relationships, recklessness, and extreme emotional shifts, but deemed unacceptable in adulthood.
Feminist critics of BPD offer an alternative perspective, generally viewing the diagnosis of BPD as pathologizing the ways that women respond to gendered abuse and oppression. Shaw and Proctor (2005) theorize the diagnosis as a form of social control: â[BPD] can be applied to women who fail to live up to their gender role because they express anger and aggression. Conversely, the diagnosis is also given to women who conform âtoo strongly,â by internalizing anger, and expressing this through self-focused behavior such as self-injuryâ (485). They show how the diagnosis of BPD presents a double-bind: women with BPD who engage in behaviors that are not stereotypically feminineâself-injury, multiple sexual partners, external expressions of angerâare cast in the archetype of the overemotional hysterical woman.
Here, it is evident that the feminist framework, like other radical frameworks, ties the individual problem to a broader political context. Rather than a pathology that is endogenous to the individual, a feminist perspective theorizes these behaviors as a response to, or relationship with, gendered power relations.
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