Short Chronicles: Our Experiences of BPD, an interview with Clinical Psychologist Dr Gwion

 

Fauziya: Thanks, Dr. Gwion, for coming here and answering some questions about BPD, it’s really important and essential and integral to this project called ‘Short Chronicles Our Experiences with BPD’. So the first question- if you could please give a short introduction to your practice and divisions of specialism that would be fantastic.

 

Dr Gwion: I am quite a senior clinical psychologist and I have been qualified for about 12 years now. When I first started on my journey into the world of psychology, I worked in forensic service, and within that service, there were a lot of people who self-harmed and self-harmed quite a lot. And then I learnt very quickly that people who self-harm also seemed to be told that they have BPD.

 

I was pretty young at the time, but I never quite understood how those things just seem to go hand-in-hand by then. And that kind of created an interest to try and understand -because of some personal experiences as well- to try and understand self-harm and understand suicidality particularly, which then led me into doing a lot of clinical work with people who receive diagnosis of BPD and EUPD, which I'm sure you're familiar with as an alternative term to BPD.

 

I just kind of think that, people struggle and people suffer. I'm not always convinced about the utility of diagnostic labels when they used to harm people- but that's probably a separate point. I think that I spent a lot of my clinical and my academic life working with people who would receive those kinds of diagnoses, who would experience significant amounts of stigma and feeling very othered not only by the world that they live in, but also by services. I think as well, because of my own intersectionality, that that has taken me into places of working with queer people, working with people of colour and trying to then think about how those things do or don't actually make sense when you start trying to put them together. 

 

Fauziya: Thank you for that - the next question is just to please briefly explain what BPD is from like a physician standpoint, I guess just from a standpoint that would make anyone understand it.

 

Dr Gwion:  I think I think that that's a really good question. I think that there's probably a few different ways of answering that. I think from my perspective, I think that borderline personality disorder is probably an outdated term. But I think that maybe what people were reaching for back in the day was to try and speak to the fact that people's experience was in some ways quite split and that people felt kind of very quickly, lots of different kinds of feelings and lots of those feelings would happen in relationships to other people and that that might cause difficulties in those relationships.

 

So in terms of the OG version, I think that yeah, the notion of borderline tries to speak to the fact that people may feel ‘split’ in some way in terms of their affect and in terms of the way that they might relate. I think the way that I view it personally, is people who have experienced something that in the business we would call developmental trauma, which basically is a fancy way of saying that people may or may well have been physically abused or sexually abused or may have been not well looked after, they may have been neglected, that those kinds of children, understandably, may not have been taught or loved or cared for in a way that would help them to understand their feelings, and would help them to understand relationships, and that then as those children grow up, they then become very aware of the fact that they might find things harder than some of the people around them. And they try and seek some help for that. And then they might end up when it comes to adolescent mental health service, and then they may meet some kind of professional then maybe says that they have something called emerging BPD or emerging EUPD, which some people may think that that's a useful way of trying to conceptualise it. But I think that it actually removes the notion of what happened to them and tries to speak more to the notion of what is wrong with them. And I think that then the label is potentially applied to those young people, and then those young people become adults, so you then become fully fledged diagnoses of BPD because you're only allowed to diagnose people above 18.

 

So yes, so personally, I think that it's a product for it's a way of trying to describe people that have had shit lives, and people that have tried to manage their lives the best that they can, but then causes them problems. And then they receive this diagnosis as a way to try and describe and explain the shit that's happened to them ‘away’. I think… I think in terms of maybe from a psychiatric perspective. BPD as a diagnostic term refers to people who struggle with their emotions, people who struggle with relationships, people who find that they struggle with a sense of identity, a sense of knowing who they are, and very often they may then use self-harm as a way to try and manage some of those emotional difficulties in those relational difficulties that they may feel as though their life isn't worth living. Which then may mean that they make attempts on their life either as a way to try and provide them with some respite from their hideousness of what they're feeling, but also in sometimes, you know, because it seems like a solution to something when other solutions are not forthcoming to people. 

 

I think I feel I can give you a really complicated answer, but I think there is kind of what the establishment would say the was in terms of a psychiatric diagnosis, I think that there is what psychologists may say. I think that there is then also probably like a more kind of radical queer perspective, which would say that the individual inhabits the distress that has been given to them by the world around them.

 

Then again, they received the diagnosis and medical services and mental health services that they kind of just… Kind of ignores all of that stuff that's happened. Because unfortunately, and I speak as a mental health professional myself, unfortunately, I can't undo what has been done to someone. And in some ways, people maybe think it's easier to think about people as being ill in some way. Rather than acknowledge just how terrible things might have been for someone. So hopefully, hopefully that gives you some semblance of maybe what I think or what I believe BPD might be.

 

Fauziya: Absolutely, yeah, no, that was a fantastic answer from different perspectives as well, and I think it's really important.

 

So the next question is, what is the general practice or process that like either  you use or other people use that you're aware of kind of like diagnosing someone with BPD or EUPD. 

 

Dr Gwion: Again I'll probably try and give you like a psychiatric version of events and there maybe be something that might be more kind of psychological or something that's less concerned with the medicalisation of distress. I think from, from a psychiatric perspective they have a magical little book called the DSM, which is the Diagnostic and Statistical Manual. And because I don't use that, I can't actually remember what version they're on. I feel like they might be on version five.

 

Within the DSM, there is basically all psychiatric disorders- section is kind of concerned with particular kinds of disorders, as they call them, disorders of mood disorders or gender disorders. You know, lots of things. And within the DSM, there is the kind of BPD, EUPD section, which is basically a bit like a menu whereby if someone that you meet or someone that your assessing meets, kind of a certain number of characteristics or experiences out of this, what they often refer to as kind of the menu choices, then they could definitely be diagnosed with BPD or EUPD, and a lot of those things will be around -again, this is not my language, this is the language of the of the book- but I think there's lots of things around on stable relationships and stable sense of self, you know, incessant desire to end their lives, increase self, lots of kind of attention seeking, lots of manipulation, lots of all the other really shitty stuff that you could basically say about people is in this description. And again, similar to what I would say before, it doesn't take into I mean, actually, I think that I might be lying because I think that there might be a section that does refer to childhood sexual abuse as something that could be a predisposing factor, but it's not that's not kind of the focus. So similar to what I was saying before, it's less concerned with what's happened to someone I'm more concerned with, just trying to give a very kind of simple description to what someone looks like or is struggling with currently. I think that would be the kind of general way that that version of BPD could be diagnosed by a psychiatrist or by a mental health nurse, by someone who was more medically trained.

 

I think from my perspective, one of the things that DBT (Dialectic Behavioural Therapy) did in terms of trying to train to actually be a bit more specific about what people were talking about when they were talking about people, was to try and create something that was more behaviourally specific- and behaviourally specific, which sounds like a fancy term, but basically what it tries to do is to say if someone does this particular thing, then that might mean that they struggle with this particular kind of thing.

 

What do we try to do, or what Marsha Linehan tried to do when she was developing dignity was to try and kind of take a psychiatric menu selector, and try and think, ‘OK, so what does unstable relationships mean? What does that actually look like or what does labile affect mean? How can we understand that in a behaviourally specific way?’ So a lot of what I do when I see people are a lot of the supervision that I do for the people, when the assessing people is to try and think about BPD as a as a kind of experience whereby someone will struggle with relationships, that someone will very often struggle with their emotions in terms of understanding their emotions, being able to try and contain or manage their emotions… that someone will often experience real difficulties with kind of their sense of who they are.

 

People might experience themselves as maybe not being real or being kind of outside of a version of reality. That can be very upsetting and really distressing for people. Also that people can really struggle with how to get their needs met. In an environment where they've always had to get their needs met in very particular ways and usually quite extreme ways because the environment hasn't really been that interested in them. So, I think I obviously there is still an element of kind of tick-boxing, but the stuff that we're trying to understand is part of the assessment is some of those more kind of nuanced ways of understanding things.

 

I'm not interested in if someone has to say someone has lots of sexual partners, for me, that doesn't mean that someone has terrible relationships, or it doesn't mean that someone has relationships that are unstable or harmful. I guess what it means is that someone is having particular kinds of relationships and we might need to understand why they're doing that. Or someone presents with someone that uses cutting as a way maybe to make themselves feel grounded or to access the body in a particular way or to manage their emotions- again, trying to understand maybe why people do that and what it is.

 

From my perspective, my psychological formulation of BPD comes from that place of generally they've experienced significant developmental trauma in their childhood and in their teens. They've tried their best to survive and manage the hideousness that was going on around them. Unfortunately, those ways of managing can then often cause additional problems and people can get freaked out by particular things that people do that then attract the attention of services. I think from my perspective, I'm much more interested in understanding, what it was that happened and then why it is that people are doing what they're doing as a way to that.

 

Fauziya: Really interesting perspective of expressing how BPD is diagnostic and exploring the reasons of why things have happened rather than just seeing the diagnostic side of it. You touched on it before also about emerging BPD, so generally, as you mentioned you can’t be diagnosed with BPD until you are 18+, and does it usually lead to a full diagnosis for the patient, when they are 18?

 

Dr Gwion: In terms of there are lots of different ways that that young people, teenagers who attract the label of emerging BPD lots of ways that they might be treated within the NHS, private, actually, but mostly within the NHS. In terms of the least helpful kinds of treatment, in my experience and things that I've observed over the years is that people will people will be told that they have this thing called ‘emerging BPD’, which means that they have some kind of chemical imbalances in their brain, that they that it's kind of almost certain that they will have something called a mental illness that they need to take these medication(s) to kind of alleviate some of the symptoms or some of the suffering that they're experiencing.

 

That they kind of experience of distress or the self-harm or the suicidality won't necessarily be directly treated. It will be hoped that the medication will kind of put them in a bit of a bit of a pharmacological straitjacket so that they'll feel less inclined to self harm or make attempts on their life. I think that for young people like it's pretty infuriating to watch that, because I think that what happens very quickly for the young person is that the system around them becomes very, very strict, and they’re usually headed by the psychiatrist who will inform parents or caregiver, is that that that they need to be kind of controlled, that they need to be not necessarily supported, but that they need to be. Yeah- given a very kind of short leash in a sense. And that services will then kind of see the young people as being manipulative and untrustworthy and that they they're almost they're making a choice about how it is that they are, you know, feeling, but also the way that they then behave and in the world.

 

And a lot of that a lot of the focus is on what the young person is doing as opposed to what the young person is feeling or what the young person has experienced. I think that that then I think young people often will internalise those messages and we'll start to see themselves as being ‘mad’ or ill or kind of they feel that they don't have any responsibility or any agency in the in their life or their experience, because people are telling them that, ‘we've got this terrible thing’ and it's in your head and nothing can be done.

 

I think that that that is fundamentally one way that it can be treated, which obviously is barbaric. I think that the other ways that it can be treated is with within services whereby there is DBT available and obviously I'm biased because of my background and because of my my training, but also because I've seen DBT work for people over the years. It's not it's not perfect by any means. But in terms of better than what I've just described, it's definitely better than that.

 

I think that fact, you know, I've worked a lot in CAMHS (Child and Adolescent Mental Health Services) with lots of children attached to services, foster fostering services whereby DBT has been available in those services. I think that for those young people, whilst they are still struggling with the same kinds of experiences, the same feelings, the same urges, the same potential risk in a sense to hurt themselves, I think that what they get is a way to try and understand -that they may not necessarily want this, actually, I'm suggesting that they want it but not everyone does-  but they at least get a framework to try and understand their experience, a framework that hopefully will speak to the fact that, you know what- the way that you were raised or the way that people treated you when you were young has had a huge impact on the way that you experience the world now. And within DBT with this kind of a thing called the biosocial theory, which again, is a way to support people to understand their experience, that actually in terms of your biology… Yes, all babies are born with very different temperaments. Some babies with a pretty placid some babies maybe are a bit more cry-y, a bit more difficult to settle, to sleep, that kind of stuff. And we don't actually know why there are those differences, you know, no one knows truly why there are those differences, but we all have a different kind of biological makeup. So for some people, they may feel emotions more strongly.

 

They may react to emotions in a more kind of ‘full’ way that maybe other people and for some people that, you know, get labelled with emerging BPD, they may have those kinds of nervous systems. The important bit then is to try and think about something that we call the invalidating environment, which is a way to try and conceptualise the potential abuse that people have experienced during their childhood and the developmental trauma that I mentioned. So, these two things put together actually make people feel really uncertain of themselves, make them feel like they distrust themselves, that they have really strong feelings that that kind of take a long time to reduce and for people's arousal to reduce.

 

So within the DBT programme for these young people, we give them a way to try and understand their experience so that it's not it's not an illness, but it's a product of what you've experienced. I think that then obviously DBT is kind of focussed on individuals like therapy and group therapy and access to your therapist out of hours as well, which again, I think allows people, young people, to develop the skills and the group that they need to be able to have choices about how they manage their feelings.

 

And also being able to develop a real relationship in an individual therapy with someone allows not only them to get a better understanding of themselves, but also to understand that maybe not everyone is shit, and that actually maybe this person called, you know, Dr Gwion, like maybe he gives a shit and maybe, like, I can trust him enough to try and let him in and let him help me a little bit. I think that from my experience, there are other ways that you can try and treat BPD, but I think in terms of the two main ones, they would be the ones that. That I would yeah, that I would recognise and obviously I'm much more of a fan of the second one I described to you.

 

Fauziya: Does it (emerging BPD) usually lead into a full diagnosis of BPD, although sometimes perhaps it doesn't get diagnosed, for example?

 

Dr Gwion: I think, again, in my experience, unfortunately, those young people that I described were maybe services, where DBT isn't available in a particular service or it's not available in a particular kind of geography. I think that for those young people who are just seeing psychiatrists and who maybe are being kind of case managed by a very medical team, I would argue that -I don't have a percentage for you, unfortunately- but I would argue that a lot of those young people would then go on to receive a formal diagnosis upon a time if they were still in services.

 

That's a really important thing just to hopefully for people to kind of think about, because I suppose part of why I decided to do this (the interview) was to try and share perspective and hope to help people kind of think about stuff, because I think that if you never if you never attend a service, you never get a diagnosis. So it's not something you decide yourself. You know, in my career, I've come into contact with lots of young people who have been part of a mental health service for a particular chunk of their life.

 

And people have been like, oh, you know, like they definitely will have BPD when they're older. And then, you know, they've left the service, they've got what they needed. And then maybe I saw them at some random, you know, conference or something once they’re an adult. So actually, that was just the time of their life because they were adolescents, and adolescents is a pretty fucking, you know, difficult ride for some people, regardless of whether you've had a nice childhood or not.

 

I think that often really shocks me when you then see people, ‘living the live that you want to. And you had a really rough time for a couple of years, but now, you know, you're doing what you want to do. And yet things may not be perfect because that's not real for anyone.’ But, yeah, I think it's something really important for people. And if there's people that are kind of engaging with the art who have received this diagnosis or think that they might receive this diagnosis like I think it's really something to think about that, actually. Someone else gives this to you, and if you never access the service, you will never be given it, in the same way as like for a physical difficulty. If I break my toe, I break my toe whether a doctor sees it or not, you know, that's just that's just something that I may not be able to fix the broken toe, but that happens regardless of whether a professional kind of tells me.

 

Whereas I think in mental health, and I think especially in BPD and EUPD in young people moving into young adulthood, I think it's a really complex set of factors that people maybe don't think about -but I feel like I'm digressing. So coming back, I think that if those people have had kind of a psychiatric treatment, then I think that a lot of them, if they remain within that  service up until their 18th birthday, get passed over to adult services, I think that there is a really high likelihood that they will get a formal diagnosis, I think, for young people who have who people have said other emerging BPD that have been able to access a treatment that is that is tailored to work with those kinds of young people and obviously I've spoken about it here with you, but it doesn't need to be DBT some young people, family therapy might work for some young people. They might have some kind of very specific versions of CBT that can just be really useful in helping them move into the next stage of their life.

 

For some young people, it might be something more psychodynamic or Cognitive Analytic Therapy (CAT). I think if young people are able to access treatments that are tailored to what they need and they're much more psychological than medical, I think that there is a much better chance that those young people will not necessarily remain in the service, become but that they become they believe the hype that people tell them about that they're real or that they're mad or bad all the time.

 

And then, yeah, I think that people have a much better chance of not receiving those kinds of lifelong diagnoses- and actually, it reminds me of something else that I don't know whether you're aware, but there is a there is a very long held belief that BPD does not exist in older people because it's supposedly people with BPD is supposed to exhaust themselves by the time they're in their 40s, so it just disappears all of the difficulties that they had in terms of, emotions and relationships of self-harm and wanting to end the life, they all just suddenly disappear because they've exhausted themselves, which is absolute bullshit.

 

But again, just shows there are lots of myths and lots of really significant assumptions around what this is and how people experience and yeah, and I don't think the people I don't think people talk about enough.

 

Fauziya: I completely agree, which is why I guess this conversation so important and it reminds me actually of when I was first diagnosed with BPD and I was Googling it and it just it just seemed like the symptoms kind of like ‘relax’, I guess, as the older you get, but I haven't really looked into it a bit more than that. However it's really interesting about how you talk about, giving autonomy to younger people and kind of like going to the therapy route, perhaps a little bit more than the medicated route and how like the effect of being diagnosed for emerging BPD can make people think a certain way about their own psychology. And also addressing the invalidating environment that they may have come from as well and looking at past things, yeah, rather than focussing on present onwards sometimes it’s good to work backwards as well.

 

Dr Gwion: What you've made me think of them was that the notion of like circular arguments within psychiatric diagnoses. I mean, I think that often when, you know, if someone says to you, ‘oh, why do you self-harm?’ And then people say, ‘Oh, I've got BPD.’ And then it's like, ‘Yeah but, why have you got BPD?’ and they’re like ‘ Well, I just have BPD’ – you know? People haven’t been given the language to understand themselves or to understand why this even is a thing. People are kind of trapped by the fact that people don't educate them about themselves even about, you know, like you said, their own psychology- they just tell people that they are unwell.

 

Fauziya: Exactly- if people who are diagnosed BPD can't really explain it, more complicated, or  more context... How about other people from an outsider's perspective looking in and perhaps like the education or the lack of knowledge is lacking there as well. So the next question is about stigma. And the question is- Why do you think BPD has stigma attached to it and what could be done to ease that stigma as well?

 

The might be a slightly deep read. Why do I think that there is stigma? First of all, I think that there is huge amounts of stigma that relate to misogyny. And I think that the reason the reason I say that is because BPD is often a diagnosis that is reserved for people who, were assigned female at birth or identify as women I think that there is a there is a potential misogyny going on whereby women who don't, fit with whatever it is that women are supposed to be doing at that particular point in history and that they experience things differently or that they are not willing to just kind of, you know, bow down or be oppressed by the patriarchy. I think that there is there is an inherent stigma in that in a sense. And I know that that's quite deep read, but I think I often feel I feel really frustrated with trying to help people think about the history of these things, because I guess BPD didn't just exist like it was created usually by a group of white men in Europe somewhere, usually in Britain or Germany, and, you know, trying to medicalise and pathologise particular kinds of people, whether that be women diagnosing them with BPD or with homosexuality, with transgender, you know, all of when they said that black people had lower IQs- all of these things happen within a historical context. I think that for me, there is definitely an aspect of misogyny within the diagnostic category of BPD for sure. That's not to say that men don't get diagnosed PPD, but it's far less popular. And I guess man would usually get diagnosed with kind of Antisocial Personality Disorder (ASPD) or you know some other more aggressive - because men are allowed to be aggressive, but only up until a certain point.

 

And women are supposedly allowed to be emotional, but again, only up until a certain point and only certain kinds of emotions. I think that I think it's really relevant. In terms of stigma, that obviously relates to what we've just been thinking about, but it's kind of more current now. I think that there is a there is a stigma of the people that I've met over the years who you have received this diagnosis are very often, the people who've had the shittest time of it, and I think that and by the shittest time of it again- I feel I probably repeat myself, but that, you know, maybe I really want people to look at developmental trauma because I think it's a very useful idea- but the idea of developmental trauma and the impact of sexual abuse, physical abuse, psychological abuse, neglect on children's development in terms of their relational development, emotional development is huge.

 

I think that the stigma comes from the fact that these people who then become diagnosed with BPD are often the people that come from very working class backgrounds as much as I did myself, that come from backgrounds where there is more substance use, that come from backgrounds whereby, where is there is maybe not quite so much protection built into those communities or particular kinds of protection. And I think it's much easier for people to say, ‘Oh, well, they're ill’, rather than to say, actually, society's a bit fucked. And maybe the way that we treat people or the way that we don't look after people is a bit fucked. I think that and that's why stigma is associated with it, because it’s like ‘they're kind of ill, they're mad, they're bad, they're manipulative.’ They you know, if they want to kill themselves, then you should just let them, you know, all of these kinds of stories about how we should treat people that are usually the worst treated people in society, similar with men in prison.

 

If you look at men in prison, they are often men who've had the shittest time of it. You know, it's sad. It's really sad and I think that in terms of the stigma that people experience in society, but then also experience within the mental health services, there is a lot of a lot of work that I did kind of earlier on in my career was to try and do reflective practise groups with staff working within, inpatient wards or services, specifically for people with a diagnosis of BPD, and part of part of my role, I suppose, is to try and remind people of the humanity of the people that they was working with, and trying to remind people that they're people and that they've had experiences and that people have treated them badly and that they're not manipulative. Well, what they do may be experienced is manipulative, but it certainly doesn't mean that that's what they were intended to do or that, you know, when someone self-harm- ‘are they really trying to just seek your attention or is there something maybe more complicated going on?’

 

It’s very easy when people get diagnoses, especially BPD repeating what they become- it’s almost like they give up being a person and they kind of lose something of themselves within the services and I think within society, people find it difficult to understand why someone might want to cut themselves or burn themselves or swallow a needle, you know, people find that hard to understand, so then I think that they judge and they're critical of it. When it's easier to think again or that they're ill rather than thinking ‘God, what must have happened to someone, for them to want to do that as a way to try to make something feel more bearable?’

 

So the other part of the question is, and certainly if you want to elaborate on it as well, it's just like what could be done to ease that stigma if anything, if you could think of anything`?

 

I’m always a fan of trying to trying to use stories as a way to try and educate people. I think that, obviously, you know, -I feel like a politician, and that's not that's not my bag- but people will say, oh, education is the key. It sounds a bit trite to say it, but it is, because I think that If people were able to hear a particular story or hear a particular version of events that made them understand why someone may look the way that they look or behave, the way that I think that people are much kinder to them that they give themselves credit for.

 

It's just that if they don't have the knowledge or they don't have someone trying to help them understand something, it's much easier to kind of be critical and cross and judgemental than it is to be thoughtful and kind and compassion to other people. 

 

I think as well, and this might sound I don't want this to sound kind of mean, but I think human beings, you know, you only have to look at all of the kind of animal shelters and RSPCA, you know, we kind of we really love animals. Most people we know people genuinely love animals. When a dog when a puppy is being kind of a beast, we understand that that puppy has been abused and we understand that that puppy might be frightened sometimes and it might not be able to do things as quickly as other puppies that didn't get abused. We can kind of treat them within their trauma, but we can't do that with each other – like, we're really rubbish at doing that with each other.

 

If someone knew that I had experienced this as a child, then would that help them to treat me a little bit more gently or something in a particular kind of situation? It may be, but I think I think it's that kind of stuff, trying to use stories and trying to use art and film and poetry and visual, all of that stuff to try and help people connect with what it is that that we're trying to do, that that would have to reduce the stigma, because then you would say, oh like actually that they're much more similar to me than what I've ever given them credit for. I think if we could, we could help people understand it in the same way that we understand the terrible ways that people might treat animals, I think that people could grasp that.

 

Fauziya: Yes, and I completely agree, even like I guess like personification of animals, we do treat animals much differently and much more openly and there's more empathy there and sympathy for creatures. But it was really interesting that all of the things that you mentioned as well, especially for someone who's perhaps like neurotypical or perhaps someone who hasn't got the symptoms in order to be diagnosed with a mental illness, if not make sense, and it may kind of perceive people and not have that kind of have the apathy towards people who I know have experienced things, and that's led to a diagnosis. So that's fascinating to hear from your perspective. Also on the last point as well about how you're talking about misogyny within the diagnosis of BPD, that's also incredibly interesting. I feel like I want to do a deep dive into that now.

 

Dr Gwion: Please do. Please do.

 

Fauziya: Absolutely. Let's see. This is kind of a quite a straightforward question, I guess, and depends how you'd like to answer it. But it's just if someone thinks they may have EUPD or BPD, what would you recommend that they do, or what should they do?

 

The first thing might be a bit controversial to say- but I think I would try and not Google straight away. If you've seen something on TV or on Twitter, like, and you're thinking, oh, then just try and refrain from just going and just kind of typing in Google: ‘Have I got BPD?’, I think maybe try and first understand what it is that resonated with you from whatever it was that you saw or heard or, and try and have a bit of a conversation with yourself in terms of that ‘Huh, like actually maybe I do struggle with relationships in a particular way, or maybe I have been self-harming and since I was 15 or whatever’, so first of all, before you try and seek outside of yourself, just have a little kind of chat with yourself in terms of, ‘OK, am I then willing to try and do a bit of research on this?’ and to see it as research rather than that whole thing of like, you know, ‘You've had your finger and then you've got full body cancer’ by the time you finish Googling, you know, try, try and not get caught up in that in that panic. 

 

Something that I would say to people is if you if you could be diagnosed or you couldn't be diagnosed, it kind of doesn't matter. Because similar to what I was saying before, there are probably hundreds of thousands of people living on this planet that could be diagnosed with BPD. But I've never been to a service or have  been diagnosed the same way that there is a huge amount of literature that says that hundreds of thousands of people hear voices, but they never get diagnosed with psychosis because they don't find them problematic, so they never go to the doctor. And obviously, there's a lot of cultural differences as well in terms of those kinds of experiences. First of all, like I would kind of say to people like, yes, your experiences may make you wonder, and that's all right, and please do the wondering without the Googling straight away. Also try and remind yourself that getting a diagnosis or not getting a diagnosis actually won't necessarily change how you feel in this moment. But then if you allow yourself to try and be a bit of a scientist and do a bit of research by Google and not just kind of WebMD, Wikipedia, like try and find NHS for something that might be a little bit more, not necessarily trustworthy, but it might be a little bit more balanced and a bit more up to date.

 

And then if you to think that maybe you could have this diagnosis then yeah, I think that I would probably start reaching out to maybe some, self-help groups initially and maybe or maybe talk to people. Hopefully there are people in your life that you can think about this with and talk about it with. Only if you're sure that you want to get on the kind of treadmill of potentially seeing psychiatrists and psychologists – anf obviously I hope that people are able to access that the treatment that they need, but I guess you've got to you've got to prepare yourself for the treadmill that you're about to get on, which for some people is a very traumatising experience. 

 

Once you've done that kind of, you know, being a scientist research back, Google DBT there are tons and tons of self-help YouTube videos and worksheets and, and try and see whether they work for you, why you don't need to be a rocket scientist to understand how to implement or how to try some of these things, how to get you know. If there are particular things that you're struggling with in relationships, there are things that you can listen to and read about and be like, ‘oh, like maybe I'll try and talk in this way, or maybe I'll try and communicate my feelings in this way’, That might hopefully normalise some of it. 

 

Because you know what, there is a diagnosis called BPD, what that is like the most extreme version of things that are all very human. That having difficult feelings is something that we all have, It's just that for some people, they experience it more frequently, that they're kind of re-traumatised by things that are similar to what happened in their childhood.

 

There are lots of psychological reasons why. But what I mean is there is nothing abnormal or pathological with struggling with your feelings, because every person struggles with their feelings. It's just more of the severity maybe that is the thing that might need to be thought about in a slightly more compassionate way. 

 

Fauziya: Yeah. Like you said, you know, it's always best if you are going to go down the route of looking for DBT and BPD. I mean go to accredited sources as well NHS or Mind, too. Really interesting, just especially because like so going back to the imagined thing, men with showing symptoms of ASPD before they’re 18 would get Conduct disorder, but like you said, I think there's definitely a misogyny within there because they can't be a reason why people who identify as female, and like why is there more (diagnoses)? I don't know. But why is that? Why is there more diagnoses? Just before we go, is there anything that you'd like to add on? 

 

Dr Gwion: Not that not that I can think of, I suppose. Just yeah, I hope that I hope it will allow you to, create something that's useful for you, but also for other people to just comment, because I think there is something about being part obviously of the establishment and the way that the world works, you know, there are there are particular stories around BPD and there are particular stories around what some people would call mental illness- I don't buy into that as a as a term myself. But, you know, I think distress is much more useful to think about. But I think I just hope that it offers like an alternative to some of that, that the machine I hope that some of what I’ve said and what you do with it allows people to go with ‘oh, actually that’s a really useful way to think about it’ or ‘ was I given this diagnosis purely because I am a woman and because I feel shit sometimes?’

 

Fauziya: It absolutely will, and I guess from a more holistic perspective it’s an interesting way to think about it all. Thanks Dr Gwion for joining me in this discussion.