Jen Acker and Gary Katz facilitated panel discussion following Maddie Corman’s astounding performance in Accidentally Brave.
“Courageous, daring, and unflinchingly honest, ACCIDENTALLY BRAVE is Maddie Corman’s inspiring true story about discovering a new normal when her world falls apart. This new play challenges perceptions, captivates audiences and sparks an emotionally charged discussion that will leave you wondering. . . what would I do?
ACCIDENTALLY BRAVE is the must see new play of the season that explores what it means to navigate a world with no certainty.”
Women raising children are warriors. How do you fight for your child(ren)? How did your mother fight for you? If you were not protected by your mother, this day can feel heartbreaking. Maybe you can find a different way to acknowledge Mother’s Day, a way that feels safe and comforting for you. Be the mother you wish you had today.
Borderline personality disorder (BPD) is a highly stigmatised and misunderstood condition. Australians with BPD face considerable barriers to accessing high-quality and affordable care, according to new research published today.
For every 100 patients we treat in inpatient psychiatric wards, 43 will have BPD. People with this condition are vulnerable, impulsive, and highly susceptible to criticism – yet they continue to face stigma and discrimination when seeking care.
We have come a long way since the days of viewing mental illness as a sign of weakness, but we are lagging behind in our attitude towards BPD. At least part of this stems from the way we frame the condition, and from the name itself.
Rather than as a personality disorder, BPD is better thought of as a complex response to trauma. It’s time we changed its name.
How common is BPD?
BPD is strikingly common, affecting between 1% and 4% of Australians. It is characterised by emotional dysregulation, an unstable sense of self, difficulty forming relationships, and repeated self-harming behaviours.
Most people who suffer from BPD have a history of major trauma, often sustained in childhood. This includes sexual and physical abuse, extreme neglect, and separation from parents and loved ones.
This link with trauma – particularly physical and sexual abuse – has been studied extensively and has been shown to be near-ubiquitous in patients with BPD.
People with BPD who have a history of serious abuse have poorer outcomes than the few who don’t, and are more likely to self-harm and attempt suicide. Around 75% of BPD patients attempt suicide at some point in their life. One in ten eventually take their own life.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) does not mention trauma as a diagnostic factor in BPD, despite the inextricable link between BPD and trauma. This adds to viewing BPD as what its name suggests it is – a personality disorder.
Instead, BPD is better thought of as a trauma-spectrum disorder – similar to chronic or complex PTSD.
The similarities between complex PTSD and BPD are numerous. Patients with both conditions have difficulty regulating their emotions; they experience persistent feelings of emptiness, shame, and guilt; and they have a significantly elevated risk of suicide.
People with BPD are highly susceptible to criticism. Andrew Le
Why the label is such a problem
Labelling people with BPD as having a personality disorder can exacerbate their poor self-esteem. “Personality disorder” translates in many people’s minds as a personality flaw, and this can lead to or exacerbate an ingrained sense of worthlessness and self-loathing.
This means people with BPD may view themselves more negatively, but can also lead other people – including those closest to them – to do the same.
Clinicians, too, often harbour negative attitudes towards people with BPD, viewing them as manipulative or unwilling to help themselves. Because they can be hard to deal with and may not engage with initial treatment, doctors, nurses and other staff members often react with frustration or contempt.
Explicitly linking BPD to trauma could alleviate some of the stigma and associated harm that goes with the diagnosis, leading to better treatment engagement, and better outcomes.
When people with BPD sense that people are distancing themselves or treating them with disdain, they may respond by self-harming or refusing treatment. Clinicians may in turn react by further distancing themselves or becoming frustrated, which perpetuates these same negative behaviours.
Eventually, this may lead to what US psychiatric researcher Ron Aviram and colleagues call a “self-fulfilling prophecy and a cycle of stigmatisation to which both patient and therapist contribute”.
Thinking about BPD in terms of its underlying cause would help us treat its cause rather than its symptoms and would reinforce the importance of preventing child abuse and neglect in the first place.
If we started thinking about it as a trauma-spectrum condition, patients might start being viewed as victims of past injustice, rather than perpetrators of their own misfortune.
BPD is a difficult condition to treat, and the last thing we need to do is to make it harder for patients and their families.
As Mother’s Day approaches, so many injured voices echo in my brain. Women living with the heartbreak of Mother Hunger struggle to find appropriate, authentic ways to recognize this day. Through hurt, anger, or disgust, the pressure to “honor thy mother” is a heavy task this week. Both wounded daughters and regretful mothers face terrible grief around Mother’s Day. In a world that minimizes women, mothering, and the developmental needs of children, toxic stress interferes with bonding, leaving a legacy of wordless loneliness. The irony of Mother’s Day is difficult to discuss, but if you’re feeling ambivalent, sad, or angry as this day approaches, I hope you know that you’re not alone.
Outlined in my book Ready to Heal are four beliefs about love and sex that women inherit from Disney land culture (McDaniel, 2008, pp. 29-40). In chapter two, I explain how fantasy images of women create an “inescapable” impasse, a sexual double bind. When conflicting rules collide, and choice A or choice B is wrong, women will hide or rage. How have you hidden your beauty? Or used it for pseudo power? What choice did you have? Do you have different choices now?
The concept of a “self” is foreign country for women healing from Mother Hunger. Without a safe early attachment relationship, forming a “self” is congested with survival strategies. As a result, many women are without an “inner compass” to direct life choices. We flounder through life responding to the needs of others, addictively chasing happiness without self-awareness. Unfortunately, there is no shortcut to well-being…the “persistent nagging” will stay by our side until we lean into healing mother hunger, and reclaim our buried “self”.
