Larvatus Prodeo

Image from Askville

Last week local newspapers were filled with the very sad story of the suicide of an Australian actor.

This man had apparently been suffering from depression, and in some of the photographs that appeared in the media of him his eyes revealed a great deal of emotional pain. 

Last week there was an item on an overseas newspaper’s website about another young male who took his own life. 

After surviving years of self-harm, addiction, anxiety and depression, and, in the last stages of his life, being diagnosed with borderline personality disorder (BPD), Daniel Brocchini ended his life at the age of 26. 

Although the author of the item should be commended for discussing Brocchini’s plight, the concerns of the deceased man’s mother, and the inefficiencies of the mental health system, there are issues that arise from Robert Speer’s article (there are criticisms of Brocchini’s GP and a clinic in the piece, even though the latter did indeed have a treatment program in place for him and the former was cautious enough not to just prescribe medications without knowing more about the condition that had so disrupted Brocchini’s life).

In the article, BPD is described in the following manner:

The disease, according to the NAPD (National Association for Personality Disorder), is a “biologically based disorder of the emotional regulation system that may be due to genetics factors, the environment or a combination of the two.”  It tends to run in families with a history of mental illness, depression, ADHD or addiction, and often is characterised by abnormal levels of the neurotransmitters serotonin and dopamine in the brain.  

When discussing BPD it’s important to note that the vast majority of people diagnosed with it are women and that a large proportion of those women were sexually abused as children.  

This reality suggests that describing it as a “biologically based disorder” might be incorrect, even if the relationship between biology and environment should always be acknowledged.

When discussing BPD it’s also important to note that it’s a heavily stigmatised and complicated disorder which doesn’t seem to even be fully understood by health professionals.  

On 23 August 2008, the Sydney Morning Herald’s website featured an article about the inquest into a young woman’s suicide. The inquest and the article raised matters to do with the treatment the dead woman had received by a nurse at the Cumberland Hospital:

(The nurse in question) said that during a “handover” of observation duties to another nurse, she mentioned that Ms Chapman may have been attention-seeking, but it was “in the context of it being part of a borderline personality disorder”, not a comment on her suicide bid.  

Given that up to 10% of people diagnosed with BPD will commit suicide and that many BPD sufferers use self-harm as a way of coping with overwhelming emotions, it seems odd that the nurse appeared to be trying to separate Ms Chapman’s suicidal behaviour from her disorder, and it seems even odder that Ms Chapman’s devastating actions were regarded as “attention seeking”.

While the popular image of someone with post traumatic stress disorder (more women are actually diagnosed with that disorder as well) is a war veteran whose difficult behaviours are recognised as being caused by an external event or events, the person with BPD is stuck with a pejorative label that seems to imply that a defective character is at fault.

Carolyn Quadrio from the University of New South Wales provided a compelling explanation of the disorder, as well as a persuasive critique of the BPD label, on Radio National’s All in the Mind last year:

Around about the time of Freud when the contemporary psychiatry really began, Freud talked about hysteria. And I think the classic kind of character of the earlier days is the Marilyn Monroe character who would now be called borderline personality disorder. So Freud’s idea of hysteria actually has some similarities with our contemporary view in that he saw that it had to do with sexual trauma in childhood. And even when it was known that people like Marilyn Monroe was sexually abused as children, there was often the view that they’d be seductresses even from an early age, sort of thing. So there was a very strange view then.

It developed from there until finally we come to modern-day psychiatry where the idea of hysteria has been dropped. And part of it now is embodied in the idea of borderline personality disorder. It’s a very unhappy description because it doesn’t really tell you very much. And it derives from a period where it was thought that people with this condition were sort of borderline psychotic, borderline schizophrenic. We now know that that’s probably not true and so we’ve been stuck with this label of borderline. I’ve written about this and researched about it and I think it’s really important that we should drop the name because we actually know what causes borderline personality disorder. It’s very strongly correlated with childhood trauma and what we should call it is post-traumatic personality organisation. So we need to stick with what we know, which is that most of these people have been severely traumatised in childhood, their personalities are very badly affected by their childhood trauma experiences, and in adult life they have very maladaptive ways of behaving, which results in the diagnosis of personality disorder.

A link to a video about BPD:

Too Late for Kate