Thread by @Shrink_at_Large

There are no doubt some brill clinicians at #BIGSPD19 + more importantly service users bravely speaking out. But what appears to be missing is consideration of how the lack of services +care for the majority of patients that is lamented is produced by ideas of ‘BPD’ it promotes.

Rather than have conferences for specific diagnoses,which exclude as many people as they include but make attendees feel like vanguards, we need whole workforce, trans-diagnostic commitment to depth help for those experiencing the kind of sphlintering anxiety that can wreck life.

That is whole workforce training on things like:
- dissociation and other extreme states
- the profoundly complex and human ways that we can try to show others the often unspeakable pain we are in
- staff sadism and it’s enactments
- scaffolding alongside trauma work
- hope etc

The idea of ‘PD’ as something some people have and others dont is problematic at so many levels but one of those is allowing disavowal of the fundamentally interpersonal nature of all complex mental health problems. To workforce training rather than diagnostic silo mentality pls!

ICD-11 is about to place the majority of patients on a ‘PD’ spectrum. Parking the problematic nature of this for one minute, it’s BONKERS to talk about specialist services with that context. You are not going to be able to ‘rescue’ everyone to these.

The number one task of the #BIGSPD19 at this time should be therefore to think how do these ideas affect the majority, are they ethical. The answer is clearly no. As the Perkins review said, for most all the negative stuff of diagnosis on identity none of the functional utility.

Rather than congratulate one another on specialist services and commit to expanding these (despite decades of this having failed), why not write a new workforce narrative celebrating the good bits (containment, depth work) in a value-free, new optics way that we could get behind?

Lastly, we know there is nothing specific to ‘BPD’ in any of the treatments offered. Nothing. So we can take the good bits and couple those with a fresh approach that isn’t #iatrogenic for many and develop new approaches that bring in things like #misogyny #traumainformedcare etc

Lastly lastly shout out to all the Survivors there. It’s a real gift to professionals for you to be there. Whatever your views on the diagnosis, conferences can take their toll. Thank you.

Shout out also to those triggered by #BIGSPD19 +the violence it reminds you of. Mute # ❤️