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Seal EL, Kokanović R, Flore J, Borovica T, Broadbear JH, McCutcheon L, Lawn S. Talking about borderline personality disorder, shaping care: The multiple doings of narratives. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38838130 DOI: 10.1111/1467-9566.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
This article focuses on the narratives that circulate about borderline personality disorder (BPD) in health-care settings in Australia and the effects such narratives can have on how people practice and seek out care. People with a BPD diagnosis frequently access health-care services, often encountering stigma and discrimination. Drawing on narrative theory, we critically unpack the circulation and capacities of BPD narratives and the ways they can often contribute to poor and troubling experiences. This article is based on qualitative interviews with people living with a BPD diagnosis, as well as health practitioners who work with people with a BPD diagnosis. Our findings identified insidious and powerful BPD narratives that circulate in health-care settings, particularly in short-term, acute, or non-specialist contexts, such as emergency departments and in-patient units. These narratives influenced the ways that participants both practiced and sought out care. To improve health service quality for people with a BPD diagnosis, or those experiencing mental distress, it is important to challenge the sociocultural-political norms and relations that can influence approaches to care and practice. Disrupting and reframing negative BPD narratives and raising awareness about the impact of stories that are told about BPD have the potential to generate social change.
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Affiliation(s)
- Emma-Louise Seal
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Renata Kokanović
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Jacinthe Flore
- School of Historical and Philosophical Studies, University of Melbourne, Melbourne, Victoria, Australia
| | - Tamara Borovica
- School of Global, Urban and Social Studies, RMIT University, Melbourne, Victoria, Australia
| | - Jillian H Broadbear
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
- Personality Disorder and Complex Trauma Research and Innovation Centre, Richmond, Victoria, Australia
| | | | - Sharon Lawn
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Lived Experience Australia Ltd, South Australia, South Australia, Australia
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Borovica T, Kokanović R, Flore J, Blackman L, Seal EL, Boydell K, Bennett J. Experimenting with arts-based methods and affective provocations to understand complex lived experience of a diagnosis of borderline personality disorder. Soc Sci Med 2024; 350:116950. [PMID: 38733731 DOI: 10.1016/j.socscimed.2024.116950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/27/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
This article draws on arts-based psycho-social research to explore embodied and visceral knowing and feeling in the context of people living with a diagnosis of borderline personality disorder (BPD). It presents a discussion of creative artworks solicited through a nation-wide online survey conducted in Australia in 2021 that generated intimate and affective understanding about living with a diagnosis of BPD. To investigate what lived experiences of distress associated with a BPD diagnosis communicate through sensation, emotion, image and affective capacity, the authors put to work Blackman's (2015) concept of "productive possibilities of negative states of being" and the broader theoretical framework of new materialism. This approach allows a more transformative feeling-with that exceeds the normative affective repertoires and scripts associated with a diagnosis of BPD. The authors recognise the often unspoken and invisible affects of complex mental distress and trauma, and purposefully open the space for affective and symbolic aspects of creative artworks to communicate what is less known or has less presence in dominant biomedical frameworks about living with a BPD diagnosis. The article foregrounds the lived and living experience of participants to generate experiential rather than clinical understandings of the diagnosis.
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Affiliation(s)
- Tamara Borovica
- RMIT University, 124 La Trobe Street, Melbourne, VIC, 3000, Australia.
| | - Renata Kokanović
- RMIT University, 124 La Trobe Street, Melbourne, VIC, 3000, Australia.
| | - Jacinthe Flore
- School of Historical and Philosophical Studies, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia.
| | - Lisa Blackman
- Goldsmiths University of London, New Cross, London, SE14 6NW, UK.
| | - Emma-Louise Seal
- RMIT University, 124 La Trobe Street, Melbourne, VIC, 3000, Australia.
| | - Kathrine Boydell
- Black Dog Institute, UNSW, Hospital Road, Randwick, NSW, 2034, Australia.
| | - Jill Bennett
- University of New South Wales, Greens Rd, Paddington, NSW, 2021, Australia.
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Gould WA, MacKinnon KR, Lam JSH, Enxuga G, Abramovich A, Ross LE. Detransition Narratives Trouble the Simple Attribution of Madness in Transantagonistic Contexts: A Qualitative Analysis of 16 Canadians' Experiences. Cult Med Psychiatry 2024; 48:247-270. [PMID: 37737532 DOI: 10.1007/s11013-023-09838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
Emerging evidence suggests that transgender individuals are more likely than cisgender peers to receive a diagnosis with a primary mental disorder. Attributions of madness, though, may serve the social function of dismissing and discrediting transgender individual's self-perceptions. The narratives of individuals who stop or reverse an initial gender transition who also identify as living with mental health conditions can sometimes amplify these socio-political discourses about transgender people. Through a critical mental health lens, this article presents a qualitative analysis of 16 individuals who stopped or reversed a gender transition and who also reported a primary mental health condition. Semi-structured, virtual interviews were conducted with people living in Canada. Applying constructivist grounded theory methodology, and following an iterative, inductive approach to analysis, we used the constant comparative method to analyse these 16 in-depth interviews. Results show rich complexity such that participants narrated madness in nuanced and complex ways while disrupting biased attitudes that madness discredited their thoughts and feelings, including prior gender dysphoria. Instead, participants incorporated madness into expanding self-awareness and narrated their thoughts and feelings as valid and worthy. Future research must consider provider's perspectives, though, in treating mad individuals who detransitioned, since alternate gender-affirming care models may better support the identification and wellness of care-seeking individuals who may be identified (in the past, present, or future) as mad.
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Affiliation(s)
- Wren Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- School of Social Work, York University, Toronto, ON, Canada
| | - Kinnon R MacKinnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- School of Social Work, York University, Toronto, ON, Canada.
| | - June Sing Hong Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Evaluative Clinical Sciences (ICES), Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, General and Health Systems Psychiatry Division, Toronto, ON, Canada
| | - Gabriel Enxuga
- School of Social Work, York University, Toronto, ON, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Health Systems & Health Equity Research Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Redikopp S, Smith S. Interrogating nonsuicidal self-injury disorder through a feminist psychiatric disability theory framework. SOCIOLOGY OF HEALTH & ILLNESS 2022. [PMID: 36189737 DOI: 10.1111/1467-9566.13560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
This article explores the proposed psychiatric diagnostic category of nonsuicidal self-injury disorder (NSSID) through the lens of feminist psychiatric disability theory. Mobilising insights from labelling theory's accounts of stigma and recovery, in conjunction with critical and feminist disability theory's attention to emotional and physical pain, we suggest that a feminist psychiatric disability approach to NSSID can illuminate the limits of a fully demedicalised engagement with self-injury. While remaining critical of psychiatrisation processes, we explore the implications of 'strategic (dis)identifications' with illness labels as mechanisms through which to manage and access care, treatment and recovery. Such a nuanced account engenders more deeply material considerations of pain, stigma, treatment and 'cure' at the site of NSSID, opening new avenues of engagement with self-injury for sociologists and critical disability scholars alike.
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Affiliation(s)
- Sarah Redikopp
- Graduate Program in Gender, Feminist and Women's Studies, York University, Toronto, Ontario, Canada
| | - Sarah Smith
- Department of Gender Studies, Queen's University, Kingston, Ontario, Canada
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