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Borderline Personality Disorder and the Biomedical Mismatch

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities

ISBN: 978-1-78560-403-4, eISBN: 978-1-78560-402-7

Publication date: 4 July 2016

Abstract

Purpose

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

Methodology/approach

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Findings

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

Originality/value

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.

Keywords

Citation

Sulzer, S.H., Jackson, G. and Yang, A. (2016), "Borderline Personality Disorder and the Biomedical Mismatch", 50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities (Advances in Medical Sociology, Vol. 17), Emerald Group Publishing Limited, Leeds, pp. 263-290. https://doi.org/10.1108/S1057-629020160000017011

Publisher

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Emerald Group Publishing Limited

Copyright © 2016 Emerald Group Publishing Limited