A history of borderline: disorder at the heart of psychiatry

Abstract

This article suggests that to appreciate some of the conundrums that surround ‘borderline personality disorder’ (BPD), we need to understand more about its history and the contexts and cultures in which it arose, consolidated and proliferated. Previous work on the development of personality disorder diagnoses (Jones, 2016) points to their emergence and shape being determined by the interaction of a multiplicity of forces including the needs of distressed individuals and communities; the manoeuvring of professional groups seeking to provide solutions to that distress and the cultural, public and media representations and responses to those problems and the proposed solutions. This single article can only begin to outline some of the key issues and will focus on the emergence of the diagnosis within the discourses of psychiatry. As we will see in the case of BPD, like other, so-called, disorders of personality, there are connections to major social changes; in particular to some of the anxieties raised by urbanisation and industrialisation and later processes of deindustrialisation and their impacts on people’s lives and identities. The article argues that significant roots of the diagnosis can be traced back to major fault lines in the discipline of psychiatry and unresolved questions about its own borders. Is psychiatry a branch of the medical profession or is it a cross-disciplinary endeavour that centres the mind as an object of study and treatment, which cannot merely be located in the individual but is instead immanently connected to the social and cultural world?