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Journal of Contemporary Psychotherapy

, Volume 34, Issue 3, pp 265–278 | Cite as

Between Subjugation and Survival: Women, Borderline Personality Disorder and High Security Mental Hospitals

  • Sam Warner
  • Tracey Wilkins
Article

Abstract

Women in high security mental health care are frequently diagnosed with borderline personality disorder. Such women commonly report histories of child abuse, in particular child sexual abuse, and the vast majority also self-harm. In this paper, we draw on social constructionist theory to develop a framework for understanding these women, the effects of abuse and the reasons they self-harm. We demonstrate how a social model of intervention provides a comprehensive framework for identifying and exploring relevant factors within therapy. We argue that diagnostic categorisation has limited utility in directing therapeutic work with this particular group of women, because it directs attention away from the social world to internal pathology. We demonstrate that it is with reference to women's past and current relationships that “borderline” behaviour can be understood to be meaningful and partially adaptive. We conclude that treatment is more usefully organised around and directed towards those factors, such as abuse and self-harm, that are implicated in women's ongoing relationship difficulties.

borderline personality disorder social constructionism child abuse and self-harm 

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REFERENCES

  1. Adshead, G. (2001). Murmurs of discontent: Treatment and treatability of personality disorder. Advances in Psychiatric Treatment, 7 ,407–416.CrossRefGoogle Scholar
  2. Akhtar, S. (1995). Quest for answers: A primer of understanding and treating severe personality disorders. London: Jason Aronson.Google Scholar
  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV, 4th ed. rev.). Washington, DC: American Psychiatric Association.Google Scholar
  4. Barker, P. (1992). Psychiatric nursing. In T. Butterworth & J. Faugier (Eds.), Clinical supervision and mentorship in nursing (pp. 49–64) London: Chapman & Hall.Google Scholar
  5. Becker, D. (1997). Through the looking glass: Women and borderline personality disorder. Oxford: Westview Press.Google Scholar
  6. Brannon, L. (1999). Gender: Psychological perspectives (2nd ed.). Needham Heights, London: Allyn and Bacon.Google Scholar
  7. Brown, G. R., & Anderson, B. (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148(1), 55–61.PubMedGoogle Scholar
  8. Byrne, N. O. & McCarthy, I. C. (1999). Feminism, politics and power in therapeutic discourse: Fragments from the Fifth Province. In I. Parker (Ed.), Deconstructing psychotherapy (pp. 86–102). London: Sage.Google Scholar
  9. Coleman, R. (1999). Recovery: An alien concept. Gloucester: Handsell Publishing.Google Scholar
  10. Costello, C. G. (1996). Personality characteristic of the personality disordered. New York: Wiley.Google Scholar
  11. Cruikshank, B. (1993). Revolutions within self government and self esteem. Economy and Society, 22, 327–343.CrossRefGoogle Scholar
  12. Department of Health. (1983). The Mental Health Act (1983). London: Department of Health Publications.Google Scholar
  13. Department of Health. (1999). The National Service Framework for Mental Health. London: The Stationery Office.Google Scholar
  14. Department of Health. (2002). Women's mental health: Into the mainstream-Strategic development of mental health care for women. London: Department of Health Publications.Google Scholar
  15. Drewery, W. & McKenzie, W. (1999). Therapy and faith. In I. Parker (Ed.), Deconstructing psychotherapy (pp. 132–149). London: Sage.Google Scholar
  16. Favazza, A. R. (1987). Bodies under siege. Baltimore: Johns Hopkins University Press.Google Scholar
  17. Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse and Neglect, 18(5), 408–417.Google Scholar
  18. Foucault, M. (1990). The history of sexuality: Vol. 1. An introduction. Middlesex: Penguin.Google Scholar
  19. Gergen, K. L. (1991). The saturated self. New York: Basic Books.Google Scholar
  20. Kaye, J. (1999). Toward a non-regulative praxis. In I. Parker (Ed.), Deconstructing psychotherapy (pp. 19–38). London: Sage.Google Scholar
  21. Kendall, K. (1993). Literature review of therapeutic services for women in prison. Ottawa: Correctional Service in Canada.Google Scholar
  22. Koerner, K., & Linehan, M. M. (1996). Cognitive and interpersonal factors in borderline personality disorder. Current Opinion in Psychiatry, 9 ,133–136.CrossRefGoogle Scholar
  23. Kroll, J. K. (1993). PTSD/borderlines in therapy: Finding the balance. New York: Norton.Google Scholar
  24. Landecker, H. (1992). The role of childhood sexual trauma in the etiology of borderline personality disorder: Considerations for diagnosis and treatment. American Journal of Psychotherapy, 29 ,234–242.Google Scholar
  25. Law, I. (1999). A discursive approach to therapy with men. In I. Parker (Ed.), Deconstructing psychotherapy (pp. 115–131). London: Sage.Google Scholar
  26. LeFevre, S. (1996). Killing me softly: Self harm survival not suicide. Gloucester: Handsell publishing.Google Scholar
  27. Lerman, H. (1996). Pigeonholing women's misery: A history and critical analysis of the psychodiagnosis of women in the twentieth century. New York: Basic Books.Google Scholar
  28. Linehan, M. M. (1993). Cognitive-behavioural treatment of borderline personality disorder. NewYork: Guilford Press.Google Scholar
  29. Malan, D. H. (1979). Individual psychotherapy and the science of psychodynamics. Cambridge: Cambridge University press.Google Scholar
  30. Maracek, J. (1997). Feminist psychology at thirtysomething: Feminism, gender, and psychology'sways of knowing. In D. Looser & E. A. Kaplan (Eds.), Generations: Academic feminists in dialogue (pp. 129–147). Minneapolis: University of Minnesota Press.Google Scholar
  31. Monahan, J. (1992). Mental disorder and violent behaviour perceptions and evidence. American Psychologist, 47(4), 511–521.CrossRefPubMedGoogle Scholar
  32. Narcotics Anonymous. (1988). Narcotics anonymous (5th ed.). Chatsworth, CA: Narcotics Anonymous World Services.Google Scholar
  33. Parson, S. (1997). The epidemiology and effects of borderline personality disorder in primary health care. Journal of Psychiatric and Mental Health Nursing, 4(2), 145–146.PubMedGoogle Scholar
  34. Peay, J. (1989). Tribunals on trial: A study of decision-making under the Mental Health Act 1983. Oxford: Oxford University Press.Google Scholar
  35. Reavey, P., & Warner, S. (2001). Curing women: Child sexual abuse, therapy and the construction of femininity. International Journal of Critical Psychology, 3 ,49–69.Google Scholar
  36. Riikonen, E., & Vataja, S. (1999). Can (and should) we know how, where, and when psychotherapy takes place. In I. Parker (Ed.), Deconstructing psychotherapy (pp. 175–188). London: Sage.Google Scholar
  37. Rosenhan, D. L. (2000). On being sane in insane places. In B. Slife (Ed.), Taking sides: Clashing views on controversial psychological issues (pp. 258–275). Guilford: McGraw-Hill.Google Scholar
  38. Silk, K. R., Lee, S., Hill, E. M., & Lohr, N. E. (1995). Borderline personality disorder and severity of sexual abuse. American Journal of Psychiatry, 152 ,1059–1064.PubMedGoogle Scholar
  39. Sperry, L. (1995). Handbook of diagnosis and treatment of the DSM-IV Personality Disorders. New York: Brunner/Mazel.Google Scholar
  40. Spitzer, R. L. (2000). On pseudoscience in science: Logic in remission and psychiatric diagnosis. In B. Slife (Ed.), Taking sides: Clashing views on controversial psychological issues (pp. 276–289). Guilford: McGraw-Hill.Google Scholar
  41. Tavris, C. (1993). The mismeasure of women. Feminism and Psychology, 3(2), 149–168.Google Scholar
  42. Van der Kolk, B. A. (1987). The psychological consequences of overwhelming life experiences in psychological trauma. Washington, DC: American Psychiatric Press.Google Scholar
  43. Van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood origins of self-destructive behaviour. American Journal of psychiatry, 148, 1665–1671.PubMedGoogle Scholar
  44. Waites, E. (1993). Trauma and survival:Post-traumatic and dissociative disorders inwomen. NewYork: Norton.Google Scholar
  45. Warner, S. (1996). Visibly special?Women, child sexual abuse and special hospitals. In C. Hemingway (Ed.), Special women? The experience of women in the special hospital system (pp. 59–76).Google Scholar
  46. Warner, S. (1999). Special stories: Women patients, high security mental hospitals and child sexual abuse. Unpublished PhD thesis, Manchester Metropolitan University, Manchester, UK.Google Scholar
  47. Warner, S. (2000). Understanding child sexual abuse: Making the tactics visible. Gloucester: Handsell Publishing.Google Scholar
  48. Warner, S. (2001). Disrupting identity through Visible Therapy: A feminist post-structuralist approach to working with women who have experienced child sexual abuse. Feminist Review, 68 ,115–139.CrossRefGoogle Scholar
  49. Warner, S. (2003a). Critical reflections on communicating with children: Making the tactics of training and intervention in child protection explicit. Educational and Child Psychology, 20(1), 109–123.Google Scholar
  50. Warner, S. (2003b). Disrupting identity throughVisible Therapy:Afeminist post-structuralist approach toworking withwomen who have experienced child sexual abuse. In P. Reavey & S. Warner (Eds.), New Feminist stories of child sexual abuse: Sexual scripts and dangerous dialogues (pp. 167–186). London: Routledge.Google Scholar
  51. Warner, S., & Wilkins, T. (2003). Diagnosing distress and reproducing disorder: Women, child sexual abuse and borderline personality disorder. In P. Reavey & S. Warner (Eds.), New Feminist stories of child sexual abuse: Sexual scripts and dangerous dialogues (pp. 167–186). London: Routledge.Google Scholar
  52. Western, D., Ludolph, P., Misle, B., Ruffins, S., & Block, J. (1990). Physical and sexual abuse in adolescent girls with borderline personality disorder. American Journal of Orthopsychiatry, 60(1), 55–66.PubMedGoogle Scholar
  53. Wile, D. B. (1984). After the fight: A night in the life of a couple. New York: Guilford Press.Google Scholar
  54. Wilkins, T., & Warner, S. (2001). Women in special hospitals: Understanding the presenting behaviour of women diagnosed with borderline personality disorder. Journal of Psychiatric and Mental health Nursing, 8(4), 289–297.CrossRefPubMedGoogle Scholar
  55. Wolfersdorf, M. (2000). Suicide among psychiatric inpatients. In K. Hawton & K. van Heeringen (Eds.), The international handbook of suicide and attempted suicide ttt2 (pp. 457–266). London: Wiley.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2004

Authors and Affiliations

  • Sam Warner
  • Tracey Wilkins

There are no affiliations available

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