
Last week on Wednesday a fascinating article appeared in the Guardian. https://www.theguardian.com/lifeandstyle/2019/mar/27/are-sexual-abuse-victims-being-diagnosed-with-a-mental-disorder-they-dont-have?CMP=twt_gu I am not a regular reader of the Guardian but the topic, referenced by someone on Twitter, attracted my attention. It was talking about what is now known as Complex PSTD and setting out the way that this disorder is found among survivors of any severe trauma. A few weeks ago, I made reference to a book by Gordon Turnbull entitled Trauma. This set out his pioneering work in challenging the psychiatric profession to take seriously the study of trauma and the therapies that are able to relieve it. From his experience of being the psychiatrist who headed up the care of those who were first on the scene after Lockerbie, Turnbull has gained an international reputation in describing and treating this disorder. As I mentioned in my short review, the main message from the book is that traumatic stress of every kind is not the cause of mental illness. When the body has to deal with trauma, whether the result of single event or over a period of time, there will be expected and predictable symptoms. These need to be approached quite differently from established mental disorders.
The Guardian article picks up this same narrative, the one which Turnbull wanted to communicate for the whole of his professional life. When stress and trauma create a recognisable psychological reaction for which there are recognised therapeutic responses, a patient is being given a hopeful prognosis. Any diagnosis which carries the implication that the sufferer of trauma is in some way mentally ill is far more alarming. The Guardian article explores the way in which abuse survivors are sometimes labelled with the diagnosis of Borderline Personality Disorder (BPD). The implications of such a diagnosis can be dire. Treatment options are very limited but worse still there is the suggestion that the mental health of the abused may have been fragile before the abuse took place. The BPD diagnosis simultaneously labels them as chronically mentally ill but also untreatable.
It might seem impertinent to write about a dispute that is taking place among professionals where I have no expertise. But it is clear to me that the issue is not just a matter of professional judgement. If an expert gives what is effectively a diagnosis which carries with it a ‘life-sentence’, then he/she should at least allow some kind of second opinion. If the authority of the expert prevents anyone, least of all the patient, challenging this drastic diagnosis, there seems to be a denial of the laws of natural justice. To give prominence to one particular diagnosis over another, one that is equally credible and respectable within the profession is a political decision. The author of the Guardian article, Alexandra Shimo, quotes Gillian Proctor from the University of Leeds who says ‘the borderline diagnosis for sexual abuse survivors is nonsense and misleading because it suggests that the problem is within the personality of the survivor rather than a result of what has happened to them’.
A series of case-studies are given in the article which my readers are invited to consult. They illustrate the point well as to how devastating the BPD diagnosis can be. The abused find that they are carrying the extra burden and stigma of being considered mentally ill. Such a diagnosis robs them of power and agency. They are the object to whom things are done. Their illness deprives them of any decision about what should happen next. Of course, there may be aspects of the personality which have been damaged by the encounter with abuse. Symptoms like depression and dissociation may well be found but these symptoms are not indicative, according to Gordon Turnbull of actual mental illness.
One facet of being labelled with the BPD diagnosis is its implications in the legal sphere. One abuse survivor in Canada found herself undermined and humiliated by a defence lawyer because of this BPD diagnosis. Stigma is a good word that is used to describe what happens to many abuse survivors when they receive the BPD label. They feel themselves somehow marked out by the label and unable to access proper help or understanding from other professionals. These therapists know the textbook definitions of this illness and that sufferers of this condition are a tough proposition and may be impossible to heal.
In 2018 Complex PTSD finally achieved some recognition in the NHS but many therapists and practitioners still find it controversial and hesitate to diagnose it. Meanwhile we end up with a situation where some people are deemed to be mentally ill because they have been damaged through an act of abuse. Of course, professional people must be allowed to diagnose patients as they see fit, but the rest of us must also be able to point out the immense importance of getting things right for a sufferer. Although my personal inclination is to side with Gordon Turnbull is claiming that PTSD is a description of the body responding to stress rather than a mental illness, the opposite point of view has to be heard. The issue becomes more complicated when other things are added to the equation. How do claims for legal injury work out when the professionals disagree? Is it not a temptation for a lawyer seeking to limit legal damages to suggest that the victim was already a sufferer of mental distress before the incident of abuse?
The claim that church abuse victims come up against a variety of obstructing institutional blockages is often heard. The church is sometimes seen to be deploying delaying tactics – ‘forgetfulness’ on the part of those in authority and various legal ploys. The legal system is sometimes felt to be on the side of the abuser as well. Now in addition, the Guardian article points to this further problem of the political divisions within the mental health profession that can also militate against abuse survivors. What we would hope for is that the individual whose abuse is established beyond reasonable doubt would be automatically protected from further harm. The opposite seems to happen. Instead finding instant support and comfort, the survivor is made to jump through a series of difficult hoops, each of which requires considerable stamina. Those who do follow through the difficult path and arrive at an apology or legal compensation may not feel as though they have won. All that they have achieved is what feels like a grudging acceptance of the wrongs that have been to them. Many others who have potential claims must feel deterred by the sheer difficulty of breaking through the many hindrances that are put before them to delay their pursuit of justice. The absence of any sign of generosity on the part of those in positions of church responsibility continues to rankle among the survivors who speak to me.








