Lady lazarus tweets at @ladylazarusblog and blogs at Lady Lazarus Blogs
[Content note: briefly mentions self-harm]
I was diagnosed with Borderline Personality Disorder (BPD) in 2004. The first time I ever heard of it was when my male psychiatrist gifted me the label. He suggested I go home and look it up, and we’d discuss it in my next session.
The diagnostic criteria for BPD is changing, with the publication of the DSM-V today, but in the previous version (DSM-IV) there were nine diagnostic criteria, for which you need to meet five in order to be diagnosed. I went home and read the criteria. In hindsight, I probably met criteria 2 through 7, and 9, but at the time one criteria stood out and made me believe the diagnosis was incorrect; number eight describes “inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).” This did not fit with my self-perception. Although I was having some quite heated arguments with my parents at the time, my anger was never displayed physically, and it definitely wasn’t inappropriate. I had been socialised my entire life to believe that women didn’t get angry, men did. And yet here I was, being told that I was an angry woman.
Earlier this year, I requested my patient file from all those years ago. It shows that we discussed the diagnosis over three sessions. I recall strongly resisting the diagnosis on the basis that I didn’t meet the criteria around anger, but after three sessions the psychiatrist’s notes still recorded that I met 6 of 9 criteria for diagnosis and a letter was sent to my GP informing her of the diagnosis (without me being explicitly informed that that was happening). The barely legible scribblings over the many following sessions contain notes like “gets angry – self harm”, “holds anger in onto self”, “showing anger by rebellion, appearance; passive aggressively; repressed.”
While these interpretations of my anger were recorded in the notes, my memory is that because I didn’t accept the diagnosis, I avoided addressing my anger in therapy.
I didn’t want to believe that I was angry, because I thought of myself as a good person – a good woman. And good women don’t get angry.
I dropped out of psychiatric treatment after 18 months and got on with my life. But I never dealt with my anger.
The thing is, the BPD diagnosis pathologised my anger. It made my anger about me. In truth, I had a lot to be angry about. My anger wasn’t an illness, it was a reasonable reaction to years of institutionalised, gender-based discrimination and abuse. Yet in diagnosing me, the male-dominated psychiatric institution took away my permission to externalise my anger and instead asked me to locate the problem within me. With hindsight, the pathologising of my anger feels specifically gendered.
Hegemonic/social/mainstream expectations of femininity mean that a woman’s anger will be deemed “inappropriate” or “intense” much more readily than a man’s anger. I haven’t seen a copy of the published version of DSM-V, but earlier revisions suggested that the criteria around anger would be removed. This can only be a good thing.
Nearly ten years later, I’m back in therapy again. I have another diagnosis: moderate depression, which is an improvement on the BPD, major depression, alcohol dependence and anorexia nervosa I was labelled with last time. Hopefully older and wiser, I’ve found a female counselling psychologist through Mind who I know doesn’t believe in diagnoses as a route to treatment.
And what have we been working through over the past six sessions? Finally, after all these years, my anger.