This week, to coincide with the national Mental Health Awareness Week, we’re publishing a series of articles looking at feminism and mental health. Some readers may find this content distressing.
Emotionally unstable personality disorder (previously known as borderline personality disorder) is a pervasive and distressing condition. It is characterised by mood swings, impulsivity, suicidal ideation and self harm. Sufferers have difficulty with relationships, friendships and self image. According to statistics, up to 75 per cent of those diagnosed are women, and it is stated that 70 per cent have suffered some form of abuse, usually in childhood. Many come from difficult family backgrounds, and EUPD can co-exist with other mental illnesses, such as Post Traumatic Stress Disorder, depression, anxiety, and OCD.
People suffering with EUPD are assumed by mental health services to be very challenging to treat, and personality disorder is often referred to as the “diagnosis of exclusion”. Stereotyping and stigma are rife, and in particular women with the diagnosis are labelled as dramatic, needy, and attention seeking. Specialist services are rarely available and women may find themselves passed from one treatment to the next, which ends up feeding into a vicious cycle of inner chaos, and reinforcing the belief that they are some way untreatable and unwanted.
Unfortunately, for many people, care options can often be dependant on a postcode lottery. Medication, counselling, psychotherapy, and cognitive behavioural therapy (CBT) are used, and some NHS trusts may offer art based therapies.
Therapeutic communities provide a supportive environment to explore issues, but they aren’t mainstream and many women are never offered the choice. The referral process is lengthy, and patients are often sent for a short course of CBT or counselling instead. Therapy on the NHS is expensive and hard to come by; in the current economical climate resources are stretched, and mental health in particular has received huge funding losses.
Psychotherapy for EUPD is usually group based. Patients who have never experienced a stable background or a strong family unit can begin to forge lasting bonds with others and reduce social isolation. If a woman is fortunate enough to secure a therapy space it is likely it will be within a mixed sex group. Women will be sitting and sharing their memories, perhaps spoken for the first time, with men.
This approach within EUPD treatment is to encourage integration by assisting patients to discover a mutually respectful male/female exchange in a place of relative safety. The aim is to enable them to transfer that knowledge to their every day experiences, improving confidence and relation to others. No doubt a positive move in the long run; however, shouldn’t a woman be allowed to decide for herself when she is ready to make that step?
Someone who has suffered abuse grows up with many issues. A woman may experience deep conflict and trauma around ownership of her body, her female identity, and her right to say no (or yes). Could a male group member truly understand and empathise? Acknowledge the lasting and devastating effects she is left with?
A possible conflict within mixed groups could be that women wouldn’t feel they are able to honestly express their feelings, because of fear of judgement, being asked personal questions, or just purely that they are frightened of male reaction because of past experience. There is also the issue of personal beliefs – we live in a victim blaming culture, and this may be prevalent in the minds of everyone. Psychotherapy enables people to share and explore their feelings, but if a man held a particularly misogynistic view, is it the right time for a woman to have to hear that opinion? These concerns could be a barrier to female participation and, in turn, her healing. Certainly, during my career in the NHS, I witnessed women leaving services when they were informed that the groups were mixed, or sitting impassively during sessions, not able to express themselves.
I also have personal experience of mixed therapy, having been in a group for 4 years, and it did present a challenge for me. Disclosing information about painful experiences is never easy. People in groups come for all kinds of reasons, but unfortunately many men hold a particularly difficult attitude to women. I and another woman were told we should “act more like proper women”, “not have an opinion on everything”, and “understand what it’s like to be a man – that’s tough”. This particular member and I almost came to a physical altercation on one afternoon, after he decided to trivialise my disclosure of abuse and compare it to his experience. His exact words were: “For God’s sake, it was years ago, and everyone gets crap anyway – my dad always sent me boxing when I didn’t want to go.” When I and several other people told him he was out of order he became aggressive and stood up to shout in my face.
In a separate incident I was threatened by another male member, again for simply voicing an opinion. He screamed at me to: “Shut your mouth or I swear I’ll smash that table straight over your head.” Men would express their views on women using derogatory terms such as ‘slut’ and ‘bitch’. Whether it’s directed at people in the room or not, it still isn’t pleasant to listen to. When the deep rooted prejudices overspill, it’s the women who bear the brunt.
Of course, not all men are abusers, and not all men are violent. Psychotherapy groups have strong boundaries and strict codes of conduct in place for the safety of everyone involved. But a treatment group is meant to be just that – treatment. Facing personal demons is difficult enough, particularly for those who have never had a voice, have never spoken out before. Having men in a group where the majority of female members have experienced prolonged suffering at male hands may do more harm than good. Treatment for EUPD isn’t straightforward, as sufferers have complex issues. However, women should always have the right to choose.
A. Lewis is a campaigner for changing attitudes around mental health.
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