I've expressed my delight in the posts of The Last Psychiatrist several times before. He keeps it coming so here I am delighted again.
From his post on borderlines last week:
"But the sleight of hand is that it sounds like personality disorders are crappy and unreliable diagnoses and have little in common with their original meaning. In fact, most psychiatric diagnosis are equally crappy and unreliable. When you read articles saying "borderline is a pejorative term, and these patients are often really bipolar" what you need to understand is that "bipolar" is not a more valid or reliable diagnosis, it's simply another heuristic. It isn't less pejorative, it isn't more "real." It carries a different set of implications, but it isn't a more rigorous, more "biological" classification. It's not like saying, "it's not a unicorn, it's a rhinoceros." It is like saying, "it's not a unicorn, it's a pegasus."
This, by the way, is the reason why so many defenders of psychiatric diagnoses can't accept that "borderline" and "bipolar" are equally subjective terms. They say, "the diagnosis of borderline has very poor inter-rater reliability; bipolar has high inter-rater reliability." But reliability is not the same as validity. If you take twenty thousand members of the KKK, and ask them to "diagnose" the problem of contemporary society, their answer will be the same, i.e. reliable. But it's wrong, obviously. The diagnosis of bipolar is reliable, but in the same way as the KKK's diagnosis of society's ills was reliable. It may be completely wrong, it may be completely right, it may be partly right, partly wrong, in some cases but not others, etc.
If you want to know why I've used racial analogies throughout this post, it's because these are all, in essence, prejudices. "It's bipolar." "It's borderline." "It's poverty." "It's bad parenting." "It's..." Well? It's not really any of those after all, is it?"
