Danielle Hanisch 11 th August 2012 danielle.hanisch@unisa.edu.au

1. “The abuse led to the disorder that caused the behavior”: Making connections between abuse and disorder. Danielle Hanisch 11th August 2012 danielle.hanisch@unisa.edu.au

2. Background • Feminist arguments argue that the over representation of women in diagnostic categories such as BPD are actual responses to trauma rather than expressions of female madness (Bremner et al., 1995; Rausch et al., 1996; van der Kolk, 1994 cited in Berg, 2002, p.57). • BPD is a highly controversial diagnosis within the fields of social work, psychology and psychiatry, in part due to its diagnostic prevalence in women who have a history of CSA (Warner & Wilkins, 2003 & Wirth-Cauchon, 2000). • At the centre of the controversy are questions about the extent to which CSA is a causal factor in receiving a diagnosis of BPD. • Those who dispute the causal connection argue that BPD in women who have experienced CSA is confusing the effects of their experiences of CSA with a biomedical precondition (Warner & Wilkins, 2003).

3. Background • Seeing women who have experienced CSA as personality disordered shifts understanding from the social level to the individual. • This pathologizes women’s normal responses to distressing events associated with CSA, therefore stigmatizing individual women rather than looking at the cultural and social norms and institutions which enable this abuse to occur. • The different perspectives on the intersections between CSA and BPD have major implications for women as the subjects of the discourses which inform these positions.

4. Methodology and Methods • Women with histories of CSA and a diagnosis of BPD • Explores women’s understandings of the links between CSA and BPD and the potential implications of these understandings for their subjectivities. • Post-structural feminist informed research • Qualitative research • 15 women • In-depth interviews (3 each woman) • 2 hour interviews

5. Genetics I'm already, um, at a disadvantage genetically, um, when it comes to, um, if – if mental disorders are hereditary, I'm assuming that they are in some way. Even if they're not DNA linked but those – those two people still raised me, so you grow up with mental people, the mental people do mental things to you, you grow up mental on top of mental, yeah, that's got to be some – some sort of yeah, reasonable link there (Sienna).

6. Connections in the brain I suppose the way the connections were made in my brain whilst I was growing up, um, and I think also possibly the idea that the sort of repeated trauma …[]… it's probably had an effect because there was not much of my home time where I wasn't on guard waiting for stuff to happen (Chanel).

7. Significance of CSA I want people to know that I’m not a monster. I’m not the sum total of my behaviours. I think if I hadn’t been sexually abused then perhaps I wouldn’t have received any diagnosis. I knew that there was – there was a – a connection, albeit it a, um, flimsy one or what some people would see as an imagined one, you know, between being sexually abused and – and the borderline (Liana).

8. Boundaries Borderline, one of the key things about it is about boundaries, when even your body isn't your own, you've got no boundaries, you've got nothing …[]… You know, so borderline is – is very much linked to sexual abuse (Imogen)

9. The abuse led to the disorder I really believe now and having read a lot and lived a lot that’s why, (the CSA) totally explains it all the way, I don’t think I would have become the person I became had I not been abused, I would be a very different person. The abuse led to the disorder that caused the behaviour (Mia).

10. Multiple forms of abuse Maybe you were born in a house where you were not sexually abused but there’s other forms of abuse, there’s the emotional abuse, there’s, um, physical …[]… a lot of those abuses are so linked together. The – the emotional one is the playing on your emotions to get – to give you, if you want attention, that’s how you’re going to get it (Mia).

11. Multiple forms of abuse I had a lot of issues probably – I just think it's because I was so fucked up, alcoholic mother and then my stepfather raping and molesting me and I got this stupid dickhead that bashed me all the time and whatever and took to me with a shotgun …[]… and I just think all that combined made me just – had a snowball effect (Chloe).

12. Multiple forms of abuse I think that borderline is – can occur from any type of trauma, not just sexual abuse, um, I would – I would say more so sexual abuse but I think, I'm not saying maybe trauma when you're older, I think trauma when you were younger like, um, maybe verbal abuse, physical abuse, anything like that may stem into when you, um, get older (Beth).

13. Trauma I think that the – the posing of, um, borderline being possible without trauma I think is a – biggest load I've ever heard to be honest um, because how do you– how do you have the problem with establishing boundaries and how do you have the problem with a stable core sense of yourself …[]… these are things that naturally form over your life and that the disorder is a lack of that therefore there must have been something that caused the lack of it which was – of course it was traumatic you know, because it's caused a difference in – in what would otherwise have been a normal person (Imogen)

14. Abuse versus disorder? I do think the effects of abuse, um, do have links of at least some forms of anxiety, um, whether that be just be hyper-vigilance or reliving the trauma, um, through PTSD or something like that or the way that they, um, try and make their world safe, which is all, um, sort of the effects, um, of having experiencing CSA, but they were also, um, diagnosable mental health problems (Olivia).

15. Normal reactions They (doctors) reckon I was just dangerous to myself and all this other shit and I was like "fuck off", you know, look at what I've just been through, he done a lot of really nasty horrible stuff to me …[]… and I’m expected to be fucking okay. No, things weren't okay and I wasn't okay (Chloe).

16. Normal reactions I didn’t so much want someone to tell me what was wrong with me. I wanted someone to tell me that I was normal even given these really abnormal situations that happened to me. But my understanding of it now is it’s like how could you ever expect to come out of that in any way, shape or form normal when it was so abnormal, you know (Liana).

17. Concluding ideas • While this research acknowledges there may well be biological and other individual dimensions to the distress experienced by many women who have been abused, it also shows that traumatic life experiences, in particular CSA cannot be ignored in understanding the diagnosis of BPD. • Recognizing this opens the way for other discourses that move beyond medical discourse and the damage discourses to normalizing women’s reactions to traumatic events. These stories show that maybe BPD is better understood as an understandable response to trauma. • Abuse and specifically its gendered nature are fundamental to these women’s explanations of their experiences and medical discourses of BPD and its treatment completely fail to account for this and individualize their difficulties.

18. References • Becker, D 2005, ‘When She Was Bad: Borderline Personality Disorder in a Posttraumatic Age’, in Social Work Diagnosis in Contemporary Practice, ed F Turner, Oxford University Press, USA. • Berg, SH 2002, ‘The PTSD Diagnosis: Is it good for women?’, Affilia, vol.17, no.1, pp:55-69. • Fergus, L & Keel, M 2005, Adult victim/survivors of childhood sexual assault, Australian Centre for the Study of Sexual Assault, Melbourne. • Nurcombe, B, Wooding, S, Marrington, P, Bickman, L & Roberts, G 2000, ‘Child sexual abuse II: treatment’, Australian and New Zealand Journal of Psychiatry, vol. 34, pp:92-97. • Reavey, P (2003), ‘When past meets present to produce a sexual other: examining professional and everyday narratives of child sexual abuse and sexuality’, in New Feminist Stories of Child Sexual Abuse Sexual Scripts and Dangerous Dialogues, eds P Reavey and S Warner, Routledge, London. • Shaw, C & Proctor, G 2005, Women at the margins: A critique of the diagnosis of borderline personality disorder’, Feminism and Psychology, vol.15, no.4, pp:483-490. • Trippany, RL, Helm, HM & Simpson, L 2006, ‘Trauma Reenactment:Rethinking Borderline personality disorder when diagnosing sexual abuse survivors’, Journal of Mental Health Counselling, vol.28, no.2, pp:95-110. • Warner, S, Wilkins, T 2003, ‘Diagnosing Distress and Reproducing Disorder: Women, child sexual abuse and borderline personality disorder’, in New feminist Stories of Child Sexual Abuse Sexual Scripts and Dangerous Dialogues, eds P Reavey and S Warner, Routledge, London. • Warner, S 2009, Understanding the effects of child sexual abuse: Feminist revolutions in theory, research and practice, Routledge, London. • Wirth-Cauchon, J 2000, ‘A Dangerous Symbolic Mobility: Narratives of Borderline Personality Disorder’, in Pathology and the Postmodern: Mental Illness as Discourse and Experience, ed D Fee, Sage Publications, London. • Weedon, C 1987, Feminist Practice and Poststructuralist Theory, Blackwell, Oxford.