From Dis-Ease to Disease: The Construction of Borderline Personality Disorder

Borderline Personality Disorder (BPD) entered the diagnostic canon through the 1980 DSM III. Because BPD is a pejorative diagnosis given primarily to women (75%), feminists have rightly critiqued it. This paper digs beneath the critique to ask how BPD assumed its gendered form in the 1960s and 1970s. “Borderline personality” emerged from intersecting developments: conflict between analytic and descriptive psychiatrists and the contemporaneous emergence of feminism. In the late 1960s, “borderline” described men and women who failed to fulfill gender and class expectations.  But by the late 1970s it began to designate what one writer called “The Intractable Female Patient.” As feminism increasingly argued for the validity of women’s anger and sexuality, BPD encompassed a pathologized version of the same “traits.” This paper utilizes psychiatric literatures on “borderline women” and on their relationships with frustrated, even angry therapists. It also analyzes records of the American Psychiatric Association’s DSM taskforce to trace the formulation of the diagnosis during a time when psychiatry endured harsh attacks from feminist activists. Rather than viewing the politics of psychiatric “resistance” as an external phenomenon, I argue that BPD evolved out of a relational process of resistance.  While certain women “patients” took a resistant stance in therapy, the diagnosis was equally an expression of psychiatrists’ own sense of incompetence and fury when facing noncompliant women. I argue, moreover, that this history has had implications for women’s relationship to the state, influencing access to state benefits, concepts of female citizenship, and the construction of a “sane state.”