How about this…instead of thinking about changing language and the words we use, how about we re-think what those words mean? What if ‘personality disorder’ meant something that existed in relation to services. And what if it didn’t exist in isolation? Away from services people are distressed or lonely, afraid… but, in relation to services, ‘personality disorder’ is born. It can’t exist outside of services because services themselves work to create it.
Again, as before, I’m not claiming to like or agree with the term ‘personality disorder’ but I believe that noble efforts to overturn medically dominated and blaming terminology can only go so far.
To do something different – to create and maintain wise mental health services – we need to better understand the dynamic between workers/organisations and those they work with. So many initiatives designed with the best intentions somehow fail to make a difference because, I think, we refuse to notice what we need to – that workers feel afraid, incompetent, ashamed in their work and organisational practices emerge to manage those anxieties at the expense of those who use the services. Many of us – often the best of us – in subtle, almost unnoticeable ways maintain a lie that ‘personality disorder’ (or however you want to describe the ‘symptoms’ that could lead to its diagnosis) is somehow stable within individuals. We refuse to notice that it is dynamic. That it exits in relation to other humans – can be ‘treated’ only in relation to other humans.
For example, ‘personality disorder’ isn’t a fixed and stable problem for the man who is confused and lonely after 20 years in prison but it is the moment when I ask him for a bus ticket to reimburse his travel and he thinks I don’t trust him. Personality disorder is the anger that emerges when I – foolishly, clumsily, defend myself because I’m angry at his furious accusations and what feels like his stubborn refusal to understand something perfectly reasonable. ‘Personality disorder’ is the gulf that widens between us; a cavernous gap filled with the ghosts of those who hurt him, lied to him, refused to trust him and my self righteous inability to see that I have become one of them.
The woman from years ago who carried a knife because she was so scared was just that without me (or someone else) – scared. She ricocheted around our town terrified, lost. But with someone – with me – personality disorder emerges as she screams and laughs at me because I try to help using therapy words which have no meaning for her. It is the moment I fall away from her because I don’t know what to do and I don’t know how to help. I get paid to help people and I don’t know how to help her. She is so frightened and she has nothing and I can’t make it better. I’m lost and confused and probably ashamed. I struggle onwards within my frame of professionalism – expecting these words to click as much with her experience as they did with me when I studied them and wrote them in essays and used them to explain myself to other professionals. Her ridicule and desperation push me further away into my shame. It would be easy to blame her for this moment and I could walk away, intact. It almost comes to me – “this is your problem, not mine”, “if you don’t want to be helped”….
‘personality disorder’ is the moment when X allowed me to see that she hated the man she was sleeping with. It’s the moment when I stopped listening – and she noticed – because I was immediately frightened by her hatred and panicked about what she might do. It’s the moment I didn’t understand and asked for clarification and received a torrent of abuse for not listening and then felt angry – and stopped listening. It’s when I turned up for an appointment to find the other person bloodied from self harm, stomach distended with medical dressings, disorientated and sad. The enormous well of her need unreachable, incomprehensible, overwhelming for me. Where to start?
This is what it is….it is one person (with less power) screaming at another (with more power) in outrage. Outrage because that person is supposed to help but their words and their faces and their body language and this room and everything make the pain worse. And it is the helper at a loss because their tools (the things they have been given, taught to use) are useless. It is a helper frantically using those tools more bluntly, more haphazardly, more cruelly, more rigidly, more angrily.
‘Personality disorder’ is our shitty, worst interactions. That’s what it is. It is no more or less than that.
And, if that’s where it lies, that’s where it can be relieved, soothed, made better. All it requires is that we sink our professional selves into a scary place of not knowing. A place where we rely on intuition and humanness and – yes, admittedly, a reasonably sophisticated understanding that people always have very good reasons for everything that they do. Personality disorder is cured moment to moment by brave, authentic workers who allow themselves to get it wrong in the pursuit of getting it properly right.