BIGSPD conference – reflections

I attended a conference last week in Leeds, the BIGSPD 16th annual conference. I was able to present a paper there describing themes emerging from a systematic review I’ve carried out as part of my PhD – I’ll put the presentation on my other, PhD related, blog site.

For this blog I wanted to think about a theme that ran throughout the conference for me – personal narratives, and who owns them?

The conference opened with a keynote speaker discussing the public health implications of personality disorder. This presentation grounded itself firmly in the discourse of reports such as that available at 1001 critical days.The talk presented, for example, the famous ‘deprived’ child’s brain and used this as an example as to why we must engage in preventing childhood neglect. Now I have a number of issues with the use of this image, some of them are neatly outlined here, but I obviously wouldn’t for a moment argue that investing in social measures to reduce childhood poverty and overall inequality in society is a bad thing. My problem is that the tone of this introductory talk set itself squarely within the neuroscientific understanding of mental distress. I’ve argued previously in this blog previously that as we are biological beings, of course, all our experience is grounded in biology – however the commonly used neuroscience discourse often overlooks or minimises the importance of psychological and social mechanisms in the expression of mental distress. This can be important as anti-stigma campaigns which adopt a neuroscientific discourse may actually be precipitating a worsening public attitude towards some mental health diagnoses [RCPsych paywall].

One of the difficulties that I have with a biological understanding of mental distress is that it immediately conveys authority and power to those with access to technological interventions – i.e. professionals. This was quite neatly summed up in a keynote presentation looking treatment options for individuals who receive a diagnosis of ‘borderline’ personality disorder. In this talk the speaker argued that it was his (gender was important in this context as he was giving an example of working with a female client around ideas of identity) role as the clinician to correct her dysfunctional manner of thinking. I find this position, as a clinician, quite uncomfortable. When we are working with survivors of trauma, as was the case in the example he cited, what authority do we have to define the correct manner in which they should address their trauma? To my mind we can not hold this privilege as while we can attempt to develop empathetic understanding this can only ever be an approximation of their mental state and experience.

This theme was nicely offset by another presentation I attended discussing ‘Theatres of trauma’ – where two survivors of psychosis presented their experience in the form of a performance – suggesting that having a ‘stage’ on which to develop your understanding of experience was important and the role that the ‘professional audience’ must play in this. Despite this brilliant presentation however I would argue that the conference was dominated by a clinical understanding of personal distress, often accepting the construct of personality disorder at an entirely uncritical level, which to me is problematic.

Overall this was a good opportunity to meet some new people – which I enjoyed. However the dominance of biomedical narratives is to me quite problematic… I think it raises issues around who has the right to ‘own’ a narrative – obviously it belongs to the individual, but how much can it be controlled by people in positions of authority?

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2 thoughts on “BIGSPD conference – reflections

  1. I find it heartbreaking that there are entire conferences dedicated to a set of labels that are a sophisticated types of hate speech. The BPD label has done untold damage to me and the internalised self stigma seems irreversible. Living with a concealed stigmatised identity is not a life, it’s a life sentence.
    It has caused me to view myself as fundamentally bad, flawed and damaged. I keep myself apart from others and am aware that how I view myself would seem shocking to most people if I told them the extent of the shame I feel.
    While I’ve read all of the critical material on the label and can intellectually construct a powerful argument against it’s validity, I have no felt sense of this. At core, the harm it has does re-emerges any time I get upset, angry or distressed. £Even loneliness and isolation seem to be proof of my defectiveness, It’s a vicious trap that there seems little escape from.
    It didn’t matter that I had a trauma history that would win prizes, the focus was on my personality being ‘disordered’, a thing gone wrong. Pathetically I pleaded with them to please, not do this to me, that I found it traumatic and terrifying and painful. But they did it anyway. I was from then on a borderline.
    When in hospital 7 years ago, I was told I presented different aspects to different staff and that many people grow up in environments like I did and they didn’t react the way I did, that on some level I had chosen this. I left the mental health system and never went back and they didn’t care. ‘Borderlines’ only ever really hurt themselves and it’d be just another dead woman in a country full of them.
    I’m 41 now. I lost my childhood to parental addiction, severe ‘mental illness’, isolation and terror.
    I lost my 30s to borderline. It really has to change. They cannot continue to tell people the very core of who they are is disordered and malignant. The touchy feely ’emotional dysregulation’ narrative is almost more offensive. DBT to help regulate all the volatile females. It’d grotesque really and because it comes from a woman, this is somehow supposed to make it more palatable.
    I may well kill myself in the end but it would never have happened if I hadn’t encountered psychiatry.
    Because the BPD tag is lethal, it’s the most lethal double bind there is.

    • Thank you for your comment, although I am sorry to hear of the experiences you have had, which unfortunately I do not think are unique to you.

      There is much difficulty with the diagnosis of Borderline personality disorder – although for some people that I have worked with I have found that it provides a positive normalising experience – indicating that they are not alone in their distress.

      However there is also obviously a difficulty with the experiences of many during times of extreme crisis.

      A great deal of critical reflection and assessment of service provision is clearly required if we are to adequately meet people’s needs.

      Andrew

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