As A Significant "feminised" Category Of Mental Illness, However, HPD [histrionic Personality Disorder]

As a significant "feminised" category of mental illness, however, HPD [histrionic personality disorder] was superseded in the DSM-III by the introduction of the controversial BPD, a label which has been increasingly applied to women, with around 75 per cent of all cases estimated to be female. Seen as a milder form of schizophrenia and lying on the "borderline" between neuroses and psychoses, the concept has been used in psychiatry since 1938. Like other personality disorders, BPD has a notoriously low reliability level even by the generally poor standards of the DSM, and even within the profession is considered by many as yet another "wastebasket" category (though as Bourne ruefully remarks, the ambiguity of such personality disorders makes them particularly useful in policing deviance in the new century). One member of the DSM-III task force stated at the time of constructing BPD that "in my opinion, the borderline syndrome stands for everything that is wrong with psychiatry [and] the category should be eliminated". The chair of the task force, Robert Spitzer, admitted with the publication of DSM-III that BPD was only included in the manual due to pressures from psychoanalytically oriented clinicians who found it useful in their practices. Such practices have been documented by Luhrmann who describes psychiatrists' typical view of the BPD patient as "an angry, difficult woman—almost always a woman—given to intense, unstable relationships and a tendency to make suicide attempts as a call for help.' Bearing significant similarities to the feelings of nineteenth century psychiatrists towards hysterics, Luhrmann's study reveals psychiatrists' revulsion of those they label with a personality disorder: they are "patients you don't like, don't trust, don't want . . . One of the reasons you dislike them is an expungable sense that they are morally at fault because they choose to be different." Becker reinforces this general view of the BPD label when she states that "[t]here is no other diagnosis currently in use that has the intense pejorative connotations that have been attached to the borderline personality disorder diagnosis." A bitter irony for those labelled with BPD is that many are known to have experienced sexual abuse in childhood, something they share in common with many of those Freud labelled as hysterical a century earlier; a psychiatric pattern of depoliticising sexual abuse by ignoring the (usually) male perpetrator, and instead pathologising the survival mechanisms of the victim as abnormal.

By the mid-1980s, the hysteria diagnosis had disappeared from the clinical setting while BPD had become the most commonly diagnosed personality disorder. BPD is now the most important label which psychiatric hegemony invokes to serve capital and patriarchy through monitoring and controlling the modern woman, reinforcing expected gender roles within the more fluid, neoliberal environment. Nevertheless, as Jimenez (emphasis added) reminds us, the historical continuity from hysteria to BPD is clear: "Both diagnoses delimit appropriate behavior for women, and many of the criteria are stereotypically feminine. What distinguishes borderline personality disorder from hysteria is the inclusion of anger and other aggressive characteristics, such as shoplifting, reckless driving, and substance abuse. If the hysteric was a damaged woman, the borderline woman is a dangerous one."

Bruce M.Z. Cohen, Psychiatric Hegemony: A Marxist Theory of Mental Illness