Editorial note: As described on our About page, part of our mission is to encourage discussion and debate on all subject matter related to men’s rights and issues. To this end, we present the following article.
By: Jacob Shaftoe
I’d like to bring up an issue for men. It’s both personal for me, and I also think it’s important for both men and the wider community.
So, first thing first, lets name and describe the issue in and of itself: Borderline Personality Disorder, or BPD. It’s both a mouthful and meaningless in and of itself. The name was coined through Freudian Psychoanalysis, one of the most widely discredited pseudosciences in human history, so trying to understand it through that name is pointless. The Europeans call it Emotionally Unstable Personality Disorder, others are trying to get it renamed Hard Life Syndrome. My favorite alternate label is Complex Post-Traumatic Stress Disorder, because it’s both accurate and somewhat informative.
Now, how to describe the beast to a layperson? Considering it’s stumped humanity for most of recorded history, I can only hope I’m up to the task. Here goes: Are we all familiar with PTSD, or at least the oversimplified Hollywood description thereof? Okay, from that point I feel I can get somewhere. So, you and your friends have a great game you play with each other: You sneak up behind a mate and fire off a starters pistol. Friend jumps, maybe swears, but then big laughs all round, right? That is, up till one mate gets back from serving overseas. He doesn’t have a diagnosis yet, but after what is best described as “The Incident”, you don’t play the starter pistol game with him anymore. Partly because it’s clearly not fun for him, and partly because of the impressive stitch-count earned by the guy who first tried it, am I right?
As a society, 50-odd years ago, we’d blame the soldier for his illness. then, 30-odd years ago, we made a movie that linked PTSD with manliness and standing up to bullies. That movie was Rambo, and everything changed from there. We learned to see his perspective. We learned it was as much our fault as his when “The Incident” occurred. But 50+ years ago, it was all his fault, and off he went to sleep under bus shelters and drink metho, as far from our games as possible.
I’m not spouting hyperbole when I say I know how they felt 50 years ago. Men are expected to be traumatized by war nowadays. What we’re not allowed to be traumatized by is life, and human interaction. Bullying isn’t meant to kill us, but make us stronger. This we can sort of see is bullshit, but bullshit that stands as the dominant paradigm. Men don’t cry, men don’t carry emotional scars. Shit, it takes constant shelling and watching a mate lose his face in the blink of an eye for a man to be traumatized. Anything less we spit out with the tobacco juice and go back to skinning our lunch. So, to find oneself traumatized repeatedly, and in subtle, difficult to define ways, and then react “madly”, well…
One of the best analogies for BPD I’ve ever come across described us as “Emotional burns victims”. We either lost, or never formed the emotional skin that most take for granted. For us, a simple hug can be agony. We wish we could articulate this as the kind gesture it was intended to be, but we just got hugged on our burn scars. An emotional outburst is understandable, if not inevitable. But the scars are not visible. So when we yell, what response can we expect? “Stop being crazy” is the most common, and it’s entirely understandable. All of a sudden, or over time, little starter pistols take the place of normal interactions. A firm handshake becomes bullying, a flirty gaze becomes sexual harassment, a kiss that leads no-where becomes an abuse of sexual power. The everyday world is firing starter pistols left and right, and only we can hear them. Trust me, we all know this makes us crazy. It makes us hard to deal with. Wanna know why? The best treatment we have includes group therapy. I’ve shaken my head in bemusement at the symptoms of others, and had the entire group stare at me as though I was alien, simply because some shared symptoms were expressed differently. Honestly, I still can’t visualize the process of cutting myself without vomiting a little into my mouth. But it was really embarrassing to see the same reaction to my wonderfully effective stress-relief method of getting drunk and taking the piss out of angry looking guys till they punched me.
Still, now I have a diagnosis. Now, at least I understand my problems. Now, there is a working therapy for my issues. So, why am I sharing this, in here of all spaces? Simple: BPD diagnoses are mostly female. BPD diagnoses by gender are 75% women, 25% male, yet practitioners who deal with BPD believe that it affects men equally. So, why the under-representation? Gender biases. Gender biases that lead to most men being diagnosed in prison. Hang in there, it’s gonna get really complicated from here…
Our culture tells us who to be, who we are, and what is valid. Some of the more prevalent views on gender can look a lot like this: Men don’t have feelings, and when we do have to have feelings, they are usually expressed in manly terms: Drinking, fighting, sex, and crashing cars. Women can have feelings, but not too many, or they’re whiny, narcissistic attention whores. So, when one of the main diagnostic criteria is parasuicidal behavior (read: intentional, willful self harm), how do we, as a society process that term? Cutting yourself, swallowing pills then calling your partner, screaming at your partner “I hate you, don’t leave me or I’ll kill myself!”. How many males can empathize with, or even identify with that? Moreso, even if you can, and some surely do, how comfortable would you be with reporting this publicly, especially if you’re aware that these are “girly symptoms” of a “girly disease”? So, men clearly don’t engage in parasuicidal behavior due to distress. We don’t get drunk after a breakup, and keep hitting on some giant’s girlfriend rudely, in the hope he’ll take a swing. We don’t drive too fast, we don’t have unprotected sex with multiple partners. We don’t punch walls and break our hands, and we always put the gun down when the cops tell us to. Nothing to see here, we’re all perfectly sane. No crazy girly behavior here. Also, no-one ever gets hurt as a result of our behaviors, unlike those crazy broads.
Me, I had no problem with my diagnosis, and none with my treatment. Then again, I’ve always been a statistical outlier. I don’t even like football. So, not being judged “manly” was already par for the course in my little world. So, I read between the lines of the diagnostic criteria, and saw everything I hated about myself. I saw any means to change these things as the only viable means of feeling at ease with myself. The easiest way from “I hate myself and want to die” to “life might be worth living” was obvious to me: Don’t be that which I hate. The recommended therapy claimed to offer a means to that end. That claim is powerfully valid, and scientifically verified. First time for everything, I suppose…
So, on to the waiting list I went, to go to Dialectical Behavior Therapy (DBT). DBT describes BPD in ways that allow for it to be treated, which is the same as saying it described BPD correctly. The treatment is complex and difficult, requiring a whole team of psychologists, including some I never met overseeing the therapists I did see, in order to keep a close eye on their judgments. Why? Because it’s really easy to loathe people with BPD. We hurt ourselves and everyone around us, and spend weeks at a time in fight-or-flight mode. We threaten self harm when we’re scared or feel threatened, and we’re scared regularly and easy to threaten. Like all humans in fight or flight response, we often threaten those behaving in ways we fear. So, keeping the therapists themselves from getting over us requires another, specially trained therapist. That’s how hard it is to help people with our problem.
The other reason DBT is so effective in treating difficult issues, particularly ones formerly believed to be intractable: The Dialectical model of acceptance and change. It utilizes Cognitive Behavior Therapy techniques, as well as mindfulness, a kind of meditational self-awareness. Cognitive Behavior Therapy (CBT) was, in it’s heyday, a great advancement for psychology. It has great tools for helping people reorder their lives. It worked so often, some saw it’s ineffectiveness in dealing with BPD as all the proof they needed to believe what was always assumed: BPD is incurable, untreatable. You’d have better luck nailing jelly to a ceiling. CBT’s strength is it helps you to focus laserlike attention on the very things you need to change, but does nothing to make this process comfortable. Applying this approach to people who often try to kill themselves as a direct result of focusing too much on that which they hate about themselves is fine when you’re unaware of the second half of that concept. DBT acknowledged that second part, and developed means to deal with this issue at the same time. Rather than separating symptoms from “annoying” behaviors, it treats everything at once. It’s as grueling as a ladder out of hell, but at least the rungs aren’t coated in jagged glass anymore. Interestingly, a large component of DBT was designed purely to minimize harm to the treating therapists. I don’t think anyone who has been around BPD patients would ever suggest that we’re easy or fun to work with, and I’ve been one.
So, imagine you’re a therapist who has never practiced this model, and comes from a time before it was even thought of. Imagine you’ve tried to help people with BPD, and by people, statistically we mean women. So, all you see from any patient is someone who: A) Doesn’t get any better; B) Has trouble even accepting, and responds very poorly to your treatment; C) Constantly “overreacts” to everything you say, and takes your words out of context to generate some “fantasy” of you actively persecuting them and D) Are almost all women. What conclusions would you think you might come to from this set of circumstances?
You don’t need to think to long on that, I can show you
That’s right, a mental health professional categorizing an entire diagnostic group as “Crazy Assholes”. Also, as all women. I submit to you that both these assertions, while understandable, are also provably false.
We know a lot about how BPD occurs. We know more about the common conditions that spawn it than we do about serial killers. They’re frighteningly simple for such a long-misunderstood illness: Take a somewhat-to-highly sensitive person, add emotional invalidation from peers/authority figures/loved ones, and if you really want to guarantee that someone ends up with BPD, then add significant trauma, usually but not always prior to adulthood. That’s it. It’s really that disgustingly simple. The sensitive bit is probably what threw people for so long. Sometimes you get one kid in a family with BPD, even though five kids were raised the same way. So clearly, something was seen to be “wrong” with these kids. Never mind that you can have the same thing occur with peanut allergies without any blame. Biology can be weird like that.
So, sensitive people, invalidation and trauma. Now, I’m a father with a young child. Every time I read a story about a father losing their children to what’s described as an unbalanced legal system and an angry, judgmental spouse, I wonder something to myself… Is this guy maybe sensitive? I know I’d be traumatized by even the possibility of losing my kid, let alone losing them while the state invalidates my parental abilities, my very identity as a father. To only be seen as worthy of regular payments to justify my existence. To have an angry ex -wife cut down every good thing I ever did, publicly, only to have the final arbiters of justice within our society scowl in agreement and pronounce me a bad father. That would mix trauma and invalidation, no?
Now, hold that thought, because here comes a big kick in the balls. This shouldn’t be a fun read for anyone. Here’s the whole criteria according to the DSM IV, seen by many who treat BPD with DBT as possibly the least-worst description the DSM ever managed:
1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
Here have link if you want to see for your self
It gets better: 5 out of nine. If you have 5 of these nine criteria being regular features of your life, you have BPD, according to (arguably) the best consensus ever published on the issue.
Ring any bells? To me, in this context, the criteria don’t just match crazy broads, they match everything I’ve heard from or about the experiences that lead to the rebirth of MHRAs. Invalidated in their maleness, traumatized by relationship breakdown, driven to anger, self loathing and suicide. This, if I’m correct, the epidemic that leads most to the doorstep of this movement… Ring any bells?
So, never mind those of us who grew up with this illness, who’re denied diagnosis and treatment by gender biased interpretations of behavior. Ignore us by all means, we’re only somewhere between 1.5-5% of humanity. That’s half the estimates for this illness in the general population. Yet, within the heart of a community dedicated to men’s health, and rectifying the pain men feel in certain biased and traumatic circumstances, someone publicly states this illness is unquestionably incurable and evil… and feminine. Someone who clearly hasn’t kept up with literature and therapeutic models, someone who ignores the wealth of research on the illness, and the efficacy of relevant treatment models. Someone who sees it through a gendered, blaming lens.
I could give a fuck for myself here. I had wonderful luck with getting diagnosed at a very good time in my life, and got the very best treatment available. I’m now approaching the point where I’m not sure if I even meet 5 criteria anymore, and I used to hit all nine with a sledgehammer, and really put my back into it. What worries me is all the men undiagnosed. DBT was developed my Marsha Linehan, in order to try to treat suicide (mostly in women). Here we are, decades later, wondering why so many men kill themselves, and the most prominent psychologist in this community has nothing to say on BPD that wasn’t known, and wrong in 1938.
I’m writing this article for two reasons. One is to call into question many apparent misconceptions about BPD in the wider community. The second is to pose a question for those still practicing psychology who would argue that BPD is incurable: If your interpretation of what BPD is all about is valid, and the DBT model of BPD isn’t valid, then please provide some, or any evidence, that disproves or calls into question decades of peer-reviewed studies that confirm its efficacy. Third, is viewing an illness that could be effecting anything between 3 and 10% of the male population, and is the leading cause of non-psychosis related suicides, as feminine and incurable, not to mention evil, really a great step forwards for men’s mental health advocacy?
Seriously, I really fucking hope not, because for the men whose entire development of BPD hinged on traumatic experiences involving women will have only one hope for anything approaching recovery: Group therapy in a room full of “crazy assholes”, all of whom are women. Still, I made it. So, if nothing else, on this one front I can prove every biased therapist wrong: My name is Jacob, and I’m a man, and I’m also not a crazy arsehole… And I’m healing.
Further reading, courtesy of Marsha Linehan, who developed Dialectical Behavior Therapy
About the author:
Jacob Shaftoe is an odd little duck. Sometimes he writes poetry, sometimes he packs trucks, and he definitely prefers the company of free thinkers to that of ideologues. However, he will engage with either, because we’re still all humans just trying to make sense of a ridiculous world. He is a sensitive man, and lives in Sydney, which is proof he’s not yet entirely sane.