Sunday, 28 February 2010

Personality Disorders

I am pissed off. I was reading a book earlier and it annoyed me, enough that I felt I needed to blog about it. The book is 'Bedside Stories - Confessions of a Junior Doctor', by Michael Foxton, and it is a good book. It is basically a Junior Doctor's account of his first 2 years working as a Doctor. I found him likeable, and the book was funny, parts of it very funny. I would recommend it if you like that kind of book. However, what pissed me off was his attitude towards personality disorders. Fairly on in the book there was a reference to PDs, which I thought seemed quite negative, but it was brief and I just kind of ignored it. Then later on there was another one, but again I was able to gloss over it. This one I wasn't able to gloss over. He was working in Psychiatry, and was risk assessing a girl who was presenting in A&E as suicidal.

'It's a blatant personality disorder, a world full of frustration, untreatable, incessant, lifelong maladaptive, manipulative, anxiety inducing nightmare punters from hell. I just don't get them. I think that's because nobody does.

Right then, don't hold back - let's hear what you really think about personality disorders shall we? What really got me about that quote was how accusing he sounds. A 'blatant personality disorder'. Sounds like it could be rephrased as 'Blatant attention seeking'. So what if someone has a personality disorder? Personality disorders are valid mental illnesses. Patients with a Borderline Personality Disorder make up about 20% of inpatient admissions, and approximately 10% of people with a BPD diagnosis commit suicide. I really genuinely do appreciate that some personality disorder presentations must be frustrating for staff. I know people with personality disorder diagnoses who frequently attend A&E having taken a few painkillers, or having self harmed superficially, and I understand that A&E staff must get frustrated with this. But people doing this ARE still ill, and I think the fact they are needing to do that implies that they probably need more, or different, support to that which they are currently receiving. And finally, not everyone with a personality disorder is the manipulative attention seeker that he is making out.

Turning up at A&E when you are feeling strongly suicidal is really not an easy thing to do. For a start, you feel very divided about going full stop - after all, you are suicidal. But sometimes you can just manage that last grasp for help before you fall totally off the edge. And then you come across staff who clearly have the sort of attitude expressed above, and it just succeeds in making you feel worse about yourself. Michael Foxton's attitude towards people with Depression is very different. He seems sympathetic and understanding. So why the change when someone has a personality disorder diagnosis? It really makes me angry when I hear of professionals with this type of attitude. It is unhelpful and distressing, and I think probably still far too common.

Oh, and at the end of his House Officer training years, Michael Foxton became a Psychiatrist. Comforting, huh?


  1. Could this be why people react so badly to that label? Especially when a "professional" (NOTE the quotation marks!!!!) uses phrases such as that.

    I shall remember to make a note of that name and pray i never come across it - even if he didn't diagnose me with a PD, i wouldn't want anything to do with anyone with views like that at all!


  2. Wow, this sucks big time.

  3. I've read that book, in fact it's on my book shelf but it was years ago and I don't remember those bits particularly. I do remember being frustrated by his incredibly negative attitude to his psychiatric post in general. May have to reconsult it or perhaps not, would probably end up throwing book at the wall!

    I'm not ashamed of my diagnosis but I do wish it didn't have so much stigma and judgement automatically attached to it.

  4. He became a psychiatrist?! I dont know weather I'm shocked or simply horrified by that. His opinion at that time STINKS no doctor should have an opinion like thta as far as I am concern, the way he treats someone with a PD or MI could determine weather they go and commit suicide or not!

  5. Unacceptable entirely. NICE and the NHS are constantly banging on the PDs are no longer diagnoses of exclusion - if that's really true, then maybe they should be educating their own fucking staff about the genuine validity and suffering in these groups of conditions.

    Horrified to read he went on to be a psychiatric specialist. No wonder BPD and other Axis-II illnesses are ones that get the bad press, if the supposed professionals are coming off with this kind of nonsense.

  6. I am glad I am not the only person who was angered by this; I sometimes wonder if I am too sensitive about this sort of thing, but seemingly not in this case.

    I think it is outrageous that there is still so much stigma around surrounding PDs. It has always frustrated me that services respond to me differently to somebody with a BPD diagnosis, to how they did when I had a Depression diagnosis. I am the same person, with the same symptoms, and the same emotions. Nothing has changed for me, so why should their attitude towards me?

    SI, this book was written pre the current NICE guidelines. I can only hope that they will have made a difference to the attitude of professionals, but unfortunately I doubt it. Med students clearly aren't being taught enough about PDs, for a young Doctor of 25, 1 year out of med school, to have this type of opinion. Clearly something is going wrong with the system. I always expect younger Doctors to be more clued up on things like this, but sadly it appears that my faith is misplaced. I truly hope that his attitude has since changed, but who knows?

  7. Ugh, that's terrible! I don't have a PD, but everytime I read about the attitude people have to people who do, it makes me SO angry. So many people are so clueless about BPD in particular, when I was in hospital there was a girl who was diagnosed with it & she asked for some lorazepam so she could calm down. The nurse said to her 'go and cut yourself, attention seeker, and then you'll get some lorazepam'. Just awful. She put in a complaint about him but the next day he went off on holiday to Nigeria, so they couldn't really follow it up & by time he got back she'd been discharged. It's so unacceptable, this should NOT still be happening.

    A couple of years ago I did read something similar - it was in a book written by an A&E doctor as far as I remember, and he was similarly lacking in sympathy towards personality disorders/self harm/suicide attempts.

    A psychiatrist now? I feel genuinely sorry for his patients!

  8. Goodness, I can't believe a nurse would say that to their patient. Some attitudes really are disgusting. And that is so dreadful that it didn't go any further - her having been discharged should have made no difference whatsoever, it should have been followed up and he should have been disciplined - preferably fired.

    I really don't understand the stigma around BPD, I don't understand what it is about it that is so terrible, and that professionals hate so much. Stories like yours make me so angry though.

  9. I know, it really is terrible. I honestly fail to see why half these people go into mental health, maybe they think it'll be easier than being a medical nurse?! Lots of things like that happened on that ward, but apparantley the ward manager would shred any evidence of incidents like that to make the ward look better. I doubt it's true, but you never know...

  10. That's a terrible attitude that he has. When supposed professionals say things like that, it encourages even more misunderstanding towards mental illness and personality disorders. Self harm and suicidal intentions are not just attention seeking behaviour like he says, these people genuinely need help and support. I really don't get why he went on to become a psychiatrist, with that sort of attitude. Feels sorry for the poor patients who see him...