Skip Navigation Link

Northern Wyoming Mental Health Center Inc.

Looking for Help?
Click Here for the Office Location Nearest You

Review of "Women and Borderline Personality Disorder"

By Janet Wirth-Cauchon
Rutgers University Press, 2001
Review by Christian Perring, Ph.D. on Jan 16th 2003
Women and Borderline Personality Disorder

The main claims of Women and Borderline Personality Disorder are that BPD is a feminized category and that it illuminates how contemporary treats gender.  Wirth-Cauchon adopts a feminist stance and explains that her approach is akin to Susan Bordo?s analysis of anorexia nervosa as the ?crystallization of culture? in Unbearable Weight: Feminism, Western Culture, and the Body, and she argues that BPD plays a very similar role in psychiatry today to that played by hysteria in the late nineteenth and early twentieth centuries.  Her work is strongly influenced by Elaine Showalter?s classic work The Female Malady: Women, Madness, and English Culture 1830-1890, Judith Herman?s influential Trauma and Recovery, Jane Ussher?s Women?s Madness: Misogyny or Mental Illness, Dana Becker?s Through the Looking Glass: Women and Borderline Personality Disorder, and Janice Cauwels' Imbroglio: Rising to the Challenge of Borderline Personality Disorder.  She also draws heavily on a 1997 article published in Affilia by Mary Ann Jimenez, entitled ?Gender and Psychiatry: Psychiatric Conceptions of Mental Disorders in Women, 1960-1994.?

BPD first entered into the American Psychiatric Association?s Diagnostic and Statistical Manual in 1980, and currently 15-25% of hospital and outpatient cases receive the diagnosis in the US.  About three quarters of those diagnosed with BPD are women.  Wirth-Cauchon?s aim is not to explicitly deny that there is such a thing as BPD or that women who are diagnosed with the disorder experience distress.  Rather, she wants to, quoting Kathy Ferguson, ?deconstruct meaning claims in order to look for the modes of power they carry and to force open a space for the emergence of counter-meanings? (p. 27).  Wirth-Cauchon draws primarily on feminist theory, psychoanalytic theory, and discussion of memoirs by people diagnosed with BPD.  Her writing style is for the most part very clear and she does not get bogged down in obscure terminology, although it is disappointing that she devotes very little space at the end of her book to the practical applications of her ideas.

There are six chapters.  After the first introductory chapter that explains her stance and methods, Wirth-Cauchon devotes the second one to a history, or Foucaultian genealogy, of the borderline diagnosis.  Wirth-Cauchon has not done a great deal of original research into this history, but she provides an excellent summary of the literature on the topic, and her ability to explain clearly the complex relations between different ideas is remarkable.  She makes it clear that there is no single agreed conception of BPD and there are many different factors have led to the current thinking about the disorder.  She emphasizes that BPD has a negative connotation, and is especially used to as a synonym for ?difficult patient? and may be most often applied to women who engage in behavior that goes against typical feminine roles, such as acting out of rage or being sexually assertive.  She also argues that BPD has a higher incidence among people who have suffered sexual abuse, and more women are abused than men. 

In chapter three, Wirth-Cauchon summarizes some of recent theory concerning female gender identity.  She relates this to women who have been diagnosed with BPD, using cases from clinical literature of psychoanalysis and psychotherapy.   Their selves are not unified, but instead are incoherent, split, or empty, dissolving or vacillating.  Men diagnosed with BPD tend to be seen as rigid and defensive, by contrast.  The next chapter goes into case histories in even greater detail concerning the fragmentation of selfhood, using a variety of sources.  She devotes many pages to the narrative in Every Day Gets a Little Closer: A Twice-Told Therapy by Irvin Yalom and Ginny Elkin and also to a case from Yalom?s patient Marge in one of the cases in Love?s Executioner and Other Tales of Psychotherapy.  Wirth-Cauchon argues that ?Marge?s split self can be understood as the embodiment or personification, in exaggerated form, of the dual image of women in Western perception? (p. 142).  The rest of the chapter is devoted to discussion of Susanna Kaysen?s Girl, Interrupted and Jane Wanklin?s Let Me Make It Good.  Wirth-Cauchon?s interpretation of Kaysen?s account of her hospitalization at MacLean Hospital with a diagnosis of BPD is that Kaysen is ?at odds with normative femininity? and that her only option is resistance that takes the form of paralysis (p. 150).  Wirth-Cauchon mentions with approval Kaysen?s critical discussion of the diagnosis of BPD. 

Wirth-Cauchon?s interpretations of cases raise a central question: is she saying that women diagnosed with BPD have no mental illness, but are in fact reacting in rational ways to contradictions in the social roles given to women and the diagnosis of BPD pathologizes a normal reaction, that these women do have a mental illness, which is caused by the tensions within social expectations of women, or that they have a mental illness which may or may not be caused by gender roles, but which can help us understand the self-contradictions and sexism of modern thinking about gender?  She clarifies her position somewhat in the fifth chapter, which deals with women?s rage. She makes clear that she believes that patriarchal culture does contribute to women?s rage, and she argues that women?s rage is meaningful.  She does not go so far as to say that, in a non-patriarchal society, women would never be diagnosed with BPD, although at various points she seems to come close to such a claim.

In the final chapter, Wirth-Cauchon endorses Marta Caminero-Santangelo?s view in The Madwoman Cannot Speak: Or Why Insanity Is Not Subversive that it is a mistake to ally feminist accounts too closely with antipsychiatry, to interpret madness as a political response, and to ignore the suffering of individual women.  Wirth-Cauchon is clear that she rejects a disease model of BPD, and she endorses a socially aware therapeutic approach to helping women diagnosed with BPD.  She approvingly discusses narrative, social constructionist and postmodern psychotherapy that enable patients to find new ways to tell their stories and to abandon fixed accounts of selfhood and enable the emergence of the patient?s subjectivity.

Women and Borderline Personality Disorder is impressive in its synthesis of many different ideas.  The strength of the book lies in its ability to provide an interesting perspective.  Readers who are not already sympathetic to feminist interpretations of society and its problems will probably find that there is little in this book to change their opinion, and it is disappointing that the author does not provide much in the way of evidence for the truth of the interpretation.  It would be helpful for therapists to know whether feminist approaches to treating BPD were more effective than other approaches, and at a minimum, the author could have done more to explain how feminist psychotherapy would differ from other forms of psychotherapy.  Nevertheless, both clinicians and people diagnosed with BPD may find much of value in Wirth-Cauchon?s thoughtful and provoking analysis.

 

© 2003 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island, and editor of Metapsychology Online Review. His main research is on philosophical issues in medicine, psychiatry and psychology.

Share This

Resources

  • Articles

    • What is a Personality Disorder?
      • Introduction to Personality Disorders
      • What is Personality?
      • Flexibility: The Key to a Healthy Personality
      • Why Don't People Know They Have a Personality Disorder?
      • The Definition of a Personality Disorder
      • Defining Features of Personality Disorders: Distorted Thinking Patterns
      • Examples of Personality Disorders With Distorted Thinking Patterns
      • Defining Features of Personality Disorders: Problematic Emotional Response Patterns
      • Defining Features of Personality Disorders: Impulse Control Problems
      • The Most Significant, Defining Featured of Personality Disorders: Interpersonal Difficulties
      • Interpersonal Difficulties Continued
      • Summary of What is a Personality Disorder
      • Treatment - Antisocial Personality Disorder
      • Treatment - Borderline Personality Disorder
      • Treatment - Dependent Personality Disorder
      • Treatment - Histrionic Personality Disorder
      • Treatment - Narcissistic Personality Disorder
      • Treatment - Obsessive-Compulsive Personality Disorder
      • Treatment - Paranoid Personality Disorder
      • Treatment - Schizoid Personality Disorder
      • Treatment - Schizotypal Personality Disorder
      • Treatment - Avoidant Personality Disorder
    • Diagnosis of Personality Disorders
      • The History of the Psychiatric Diagnostic System
      • The History of the Psychiatric Diagnostic System Continued
      • DSM-5: The Ten Personality Disorders: Cluster A
      • DSM-5: The Ten Personality Disorders: Cluster B
      • DSM-5 The Ten Personality Disorders: Cluster C
      • Problems with the Diagnostic System for Personality Disorders
      • Problems with the Current Diagnostic System Continued
      • Alternative Diagnostic Models for Personality Disorders: The DSM-5 Dimensional Approach
      • Alternative Diagnostic Models for Personality Disorders Continued
      • Kernberg's Dimensional Approach: An Alternative Classification System
      • The Dimension of Personality Organization
      • The Three Levels of Personality Organization
      • Linking Two Personality Dimensions Differentiates Personality Disorders
      • Co-occurrence of Personality Disorders with Other Disorders
      • Co-Occurence of Personality Disorders
      • Co-Occurence of Personality Disorders Continued
      • Why Do Personality Disorders Frequently Occur With Other Disorders?
    • Causes of Personality Disorders
      • What Causes Personality Disorders?
      • Biological Factors Related to the Development of Personality Disorders (Nature)
      • Early life Experiences and the Development of Personality Disorders (Nurture):
      • The Bio-Psycho-Social Model of Human Behavior
      • Object Relations Theory of Personality Disorders
      • Object Relations Theory Continued
      • Attachment Theory of Personality Disorder
      • Attachment Theory Expanded: Mentalization
      • Cognitive-Behavioral Theory of Personality Disorders
      • Cognitive-Behavioral Theory Expanded: The Dialectical Behavioral Approach
      • Cognitive-Behavioral Theory Expanded: Schema Theory
      • Other Explanations of Personality Disorders: Structural Analysis of Social Behavior (SASB)
      • Structural Analysis of Social Behavior (SASB) Continued
      • Biological Explanations of Personality Disorder
      • Biological Explanations Continued
    • Treatment of Personality Disorders
      • The Treatment of Personality Disorders
      • Types of Treatment for Personality Disorders
      • Transference Focused Psychotherapy (TFP) for Personality Disorders
      • Transference Focused Psychotherapy (TFP) Continued
      • Mentalization-Based Treatment (MBT) for Personality Disorders
      • Mentalization-Based Treatment (MBT) Continued
      • Cognitive-Behavioral Therapy for Personality Disorders (CBT)
      • Cognitive-Behavioral Therapy Continued
      • Dialectical Behavior Therapy for Personality Disorders (DBT)
      • Dialectical Behavior Therapy (DBT) Continued
      • Schema Therapy for Personality Disorders
      • Schema Therapy Continued
      • Medications for Treating Personality Disorder
      • Medication Treatments Continued
      • Treatment complications: Co-occurring Disorders
      • A Dual-Diagnosis Approach to Personality Disorder Treatment
    • Personality Disorders Summary and Conclusion
      • Personality Disorders Summary and Conclusion
    • Personality Disorders References and Resources
      • References and Resources - Part I
      • References and Resources - Part II
      • References and Resources - Part III
      • References and Resources - Part IV
  • Questions and Answers

    • She's Lied About Everything
    • Married to a Psychopath
    • What am I Supposed to do With a Hypochondriac Step Daughter?
    • How to Help my Delusional Son?
    • What is This, and What do I do About it?
    • Is my Sister a Pathological Liar?
    • How Can I Overcome my Debilitating Shyness and Fear of Life?
    • Am I Really That Messed Up?
    • Why Do I like Being Abused?
    • Co-Dependent Mother
    • 88 more
      • Should I Stay With a Lying Husband?
      • Jealous Girlfriend
      • Liar
      • Is Erotic Transference Permanent?
      • How do I Help my Hypochondriac Sister-in-Law?
      • I Think I Have a Mental Illness
      • Why Can't I Get Over It?
      • Hopeless
      • Is There Such a Thing as Happiness?
      • How Can I Not Lie Anymore?
      • Erotic Transference and Borderline Personality Disorder
      • Am I a Sociopath?
      • 20 Year Old Viewed Child Porn, Computer Taken by Police
      • How do I Cope With a Parent Who is Trying to Ruin me?
      • Is it Okay to Give Up?
      • I Think I Have Sexual Issue's
      • I Think I Need Some Help
      • Extreme Jealousy
      • I Never Experience Happiness
      • Diagnosis Second Opinion
      • I Think I'm Depressed
      • Born to Lose, or Nurtured to Lose?
      • Why Does He Lie?
      • Help with a Histrionic Friend
      • Silent Treatment
      • Are Personality Disorders For Life?
      • My Husband is Too Affectionate
      • Delusional and Morbid Jealousy?
      • Anxiety Disorder vs. Personality Disorder: Differences?
      • Anger Driven Down Wrong Road
      • Bipolar Woman with Secret Lives
      • Would Medication Help?
      • Sociopath or Sociopath-like Product of My Environment?
      • Help
      • DBS
      • Diet and anxiety
      • My boyfriend is a Sociopath
      • Im so confused...is is BPD or Bipolar?
      • Save my marriage!
      • Why is my mom following me around to take over my life?
      • What is Neuroticism?
      • Anti social with accepting girlfriend
      • Does my husband have a personality disorder?
      • Is it possible to stop being an attention seeker?
      • Are all personality disorders the results of poor parenting?
      • Boyfriend with APD - frustrated - Nelly - Jul 21st 2008
      • I'm overemotional! What's wrong with me?
      • Identity Confusion: I don't know what personality disorders I have
      • AM I BEING ABUSED BY MY THERAPIST?
      • My partner of 6 years suddenly left with no explanation and has completely shut me and my kids out- Elise
      • Is Borderline Personality Disorder a Choice?
      • Can he be changed?
      • I don't know who my true self is!
      • Self-Injury / Self-Harm: How do I stop cutting myself?
      • What Are Some Coping Skills for Paranoia?
      • Ritual Penance and Feelings of Worthlessness
      • Is she mentally ill and is there anything i can do?
      • Please explain how it is that psychopaths can manipulate people if they have no empathy
      • A Friend in Need
      • Three different personality disorders
      • Mild Personality Disorder
      • My OCPD husband can't tolerate my 'flaws'
      • I think i'm lost?
      • Possible borderline?
      • Very confusing relationship
      • Coping with Narcissistic Behavior
      • What is wrong with me?
      • No Friends
      • I want a personality disorder
      • Borderline Girlfriend
      • Habitual Liar? Or Something Worse?
      • Possible Munchausen Syndrome
      • I choose victims to comfort me
      • A Habitual Liar's Lament
      • Protecting Children From Their Grandmother
      • I Don't Have Any Idea What To Say
      • Craving Attention
      • Obsessive Research Assistant
      • Externalization
      • Dissociative Identity Problem
      • Getting Along With Narcissistic Relatives
      • Dysfunctional Family
      • How To Treat Avoidant Personality
      • Personality Disordered Grandmother
      • Schizoid(?) Friend
      • Lying Friend
      • More Than One Personality Disorder?
      • Pathological Lying
  • Book & Media Reviews

    • A Bright Red Scream
    • Almost a Psychopath
    • Antisocial Behavior in Children and Adolescents
    • Borderline Personality Disorder
    • Borderline Personality Disorder and the Conversational Model
    • Children of the Aging Self-Absorbed
    • Children of the Self-Absorbed
    • Coping with BPD
    • Coping With Difficult People
    • Dangerous and Severe Personality Disorder
    • 38 more
      • Disordered Personalities and Crime
      • Distancing
      • Enough About You
      • Fatal Flaws
      • Get Me Out of Here
      • Girl in Need of a Tourniquet
      • Girl Walking Backwards
      • Girl, Interrupted
      • Handbook of Personality Disorders
      • I Hate You-Don't Leave Me
      • Let Me Make It Good
      • Lost in the Mirror
      • Loving Someone with Borderline Personality Disorder
      • Mysterious Creatures
      • Personality Disorders in Modern Life
      • Practical Management of Personality Disorder
      • Prozac Nation
      • Psychopathy
      • Psychotherapy for Personality Disorders
      • Skin Game
      • Stop Caretaking the Borderline or Narcissist
      • Stop Walking on Eggshells
      • Stop Walking on Eggshells
      • Surviving a Borderline Parent
      • The Angry Heart
      • The Borderline Personality Disorder Survival Guide
      • The Buddha & The Borderline
      • The Clinical and Forensic Assessment of Psychopathy
      • The Essential Family Guide to Borderline Personality Disorder
      • The Psychopath Test
      • The Siren's Dance
      • Through the Looking Glass
      • Understanding and Treating Borderline Personality Disorder
      • Understanding the Borderline Mother
      • Why Is It Always About You?
      • Without Conscience
      • Women and Borderline Personality Disorder
      • Women Who Hurt Themselves
  • Videos

    • Rethinking BPD: A Clinician's View
    • Rethinking BPD: A Patient's View
    • NAMI's Ask the Doctor Call--Borderline Personality Disorder
    • "Back From the Edge" - Borderline Personality Disorder
    • What is Borderline Personality Disorder?
    • Personality Disorders
    • What is Antisocial Personality Disorder?
    • What is Narcissistic Personality Disorder?
    • Dependent Personality Disorder
    • What is Paranoid Personality Disorder?
    • 1 more
  • More Information