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Can you really spot a “personality disorder” in the workplace? (a person-centred perspective)

Dr Mary Lamia, who wrote Personality disorders in the workplace: how to spot them and what you can do this week for The Guardian, clearly thinks you can.

As a survivor-led service, we have staff and volunteers working within our team who have received this diagnosis, as well as the support we offer to callers and visitors with this label. Dr Lamia’s article not only did not match with our experiences with our colleagues and our visitors, but we found its insinuations quite dehumanising and even offensive.

“Divisive” colleagues who display intimidating behaviour?

Dr Lamia’s asserts that colleagues with a diagnosis of borderline personality disorder (PD) “are divisive, use power tactics, show intense or inappropriate anger, and regard others as either all good or all bad”. These are traits that anyone with or without any kind of psychiatric diagnosis can sometimes exhibit, especially in times of stress, or when dealing with upsetting or difficult situations. Are we now saying that anyone who shows anger, for example, in a response to a stressful experience, or being treated in an unacceptable manner, should be labelled a “borderline” and thus toxic team member? The article likened individuals with personality disorders to workplace bullies; team members who “abuse the emotions of others for their own goals”. Is it any wonder that so many adults who receive mental health diagnoses are excluded from the workplace, as the Thriving at Work report found this week, ironically also reported on by The Guardian in the same week as they published Dr Lamia’s discriminatory and damaging screed against…people with mental health diagnoses. Make up your minds, editors.

We provide both a person-centred service and workplace, where we aim to offer the same core conditions to each other and our visitors and callers. Listening, empathy, compassion, and unconditional positive regard are at the heart of what we do. Most importantly, we offer a non-judgemental service where people can come to us, no matter what labels they have been given in other services, and be welcomed and valued for who they are, not what their medical notes say about them.

Trauma, not personality disorder

The Guardian’s article and the response by professionals missed an important point about the diagnosis of BPD. Fundamentally, we understand this (mis)diagnosis to be an expression of serious trauma and/or abuse, particularly in childhood. The fact that this diagnosis is overwhelmingly given to women cannot be ignored either. There is a long history of women and children’s accounts of their own experiences being dismissed as untrue or invalid; put down to “hysteria”, false memories, hypochondria, or just plain bare-faced lying. Articles like Dr Lamia’s perpetuate this disbelief of survivors’ reality – which is exactly what, in our service, we try to avoid doing at all costs. Sadly, the attitude outlined in this article is all too common across all walks of life, including in many mental health services, and it can feel like an uphill battle to try and do things differently.

Despite the fact that people given the BPD diagnosis have often suffered trauma, we find that the survivors who visit and who work in and give their time to our service have so many positive qualities. Many are highly empathic and in tune with the emotions of others. They are willing to learn, are extremely sensitive and careful in how they give feedback to others, and very focused and dedicated, all of which are excellent qualities for working in crisis support. The stereotypes outlined by Dr Lamia are not ones that we recognise from our experience, which may just show that if you give people a supportive environment to grow, they will, as Carl Rogers said, truly become the best they can be.

End the stigma – speaking out against the ‘BPD rhetoric’

We are at least pleased to see that following the huge criticism the article received, the Guardian have removed it pending review. This was followed by a letter of objection from several mental health professionals and activists. While we were happy that the Guardian published the letter and that this group took the time and care to write it, we felt there was a notable absence of service user and survivor involvement and it was all still very much from the “expert” point of view and did not query the diagnosis itself. Labelling people as “disordered personalities” simply adds insult to injury for people who have experienced trauma and/or abuse, through no fault of their own. Our responsibility as professionals is to listen, validate, and alleviate distress, not stigmatise survivors further.

We hope that by adding our voices to the criticism of this outdated way of viewing and relating to mental health service users, we will move the debate on and improve provision. By continuing to demonstrate good practice, positive relationships with our visitors and callers, and challenging the stigma of “disorders”, we hope to be part of a new movement for radical change in the way services work with trauma and distress.

Liz Smith and Fiona Daniels