I can’t believe we’re still saying these things about people with psychosis

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Psychosis is considered a common part of the experiences of people with ‘Borderline Personality Disorder’* and can appear in the form of hearing voices that others don’t and experiencing paranoia. These experiences can be quite intense for many and very distressing.

There are also many harmful beliefs that have long circulated about what we consider to be ‘psychosis’, beliefs which have had strong social and political motivations, and which can cause harm to multiple groups of people. A white mental health practitioner with a large Instagram account who does work around BPD advocacy, recently made a post that perpetuates some of these common beliefs. Because specificity is necessary here, here is a direct quote from their post:

If BPD psychosis is stress-related and resolves on its own, is it a big deal? (TW suicide).

Any amount of psychosis can be potentially dangerous, because it can make people act in unpredictable or unsafe ways. Additionally, we know that people with BPD who experience more psychotic symptoms, tend to struggle with quality of life more, have more co-occurring disorders, and be at higher risk for suicide.

To begin with, I don’t expect perfection in our BPD advocacy and I don’t want to invoke perfectionist tendencies in anyone. It’s unrealistic to expect that we’re always going to say the right thing and make the right points, or that we won’t unintentionally say things that can cause harm.

But this post forms part of a larger pattern of their continually depoliticising these struggles and differences, and I want us to investigate the values and beliefs that underlie these types of narratives and consider — where do they come from? Who benefits from them? Who do they harm? I also want us to understand that there are many other frameworks through which to see these experiences and that these frameworks are not only very important, but some are also much older.

Here is a short list of my major points of contention with this post.

Firstly, statements like this leave no room for people to determine their own relationship to their experiences.

One of the main things that I take issue with around this post is the fact that it decides for people what their relationship to ‘psychosis’ should be. While I use the word ‘psychosis’, I recognise that it is only one way of understanding these experiences of unshared reality and that it is not used by everyone to define their experiences.

I know that these experiences can be absolutely distressing and they can cause a lot of damage in interpersonal relationships. It can be so challenging not to know what’s real and what’s not in your relationships. To have paranoid beliefs that challenge your ability to trust the people in your life.

But for some people, experiencing reality differently is a neutral experience, and, for others, it’s welcomed. Hearing voices and experiencing hallucinations are not inherently distressing experiences, and there are multiple ways of sense-making of these experiences that go beyond the framework of ‘psychosis’ and we don’t get to impose our beliefs onto anyone else about what meaning they should make of their experiences, and whether they should seek to get rid of or ‘cure’ themselves of their differences.

It isn’t harmless for us to promote ideas around only one way of being, one way of having a mind and one way of experiencing reality. It isn’t harmless for us to promote hierarchies of human beings. In fact, our society is already constructed around them.

This is also very in-keeping with the ways that people with BPD tend to already have their treatment goals unilaterally decided for them by practitioners, with little to no input as to what they would like changed and what recovery means to them.

Psychosis and danger are already overly-conflated.

Psychosis is already heavily conflated with danger, and this puts people, often Black and Indigenous people, who experience it, or who are perceived to be experiencing it, at risk in multiple ways. One such way is the risk of police violence in places like the United States, where many of the victims of police violence have been Black people with schizophrenia or bipolar.

The perception of people suffering mental illness as violent and dangerous is another reason police are called. Officers are the only people often perceived by the public to be able to deescalate mental health crises.

-How Mental Illness Affects Police Shooting Fatalities

Not only is this association between psychosis and danger harmful, but what is considered to be psychosis is not a fixed, static state. I have known of people who bear a BPD label, for instance, who have had their beliefs around their mistreatment invalidated as a form of ‘paranoia’.

One notable example of the subjective interpretation of ‘psychosis’ in history is the way that ‘psychosis’ was used as a tool to undermine the civil rights movement in the United States. There are also trans people who have had their gender invalidated as a manifestation of a delusion. So, when we conflate danger and psychosis, I’m curious as to what exactly we mean by ‘psychosis’, because what is interpreted as psychosis has historically been subjective — and this subjectivity has been used to oppress people.

BPD is already overly-conflated with danger and harm.

The BPD label itself is also already overly-conflated with causing harm to others. What are we doing to people with this diagnosis when we add yet another layer to that by insisting that psychosis can also make them dangerous?

It’s a form of cultural oppression.

I say this as someone who will probably never outlive my grief for what colonialism did to me and my ancestors. When you talk about people with ‘psychosis’ being innately harmful and that experiencing ‘psychosis’ is a way that no one should want to live, I hear that you don’t care that many cultures have had different forms of meaning-making of experiences labelled ‘psychosis’ for a very long time, or that many have actually had their cultural beliefs oppressed through the label of ‘psychosis’. When you talk about psychosis in ‘any amount’ being a problem, you forget that many of us have had our cultural and spiritual beliefs oppressed as forms of ‘psychosis’ — and ideas that ‘any amount’ of ‘psychosis’ is an issue can be used to promote harm and eugenics under the guise of ‘care’.

There are many contributing factors to low quality of life for people with BPD and for people with psychosis.

Finally, to their last point that “people with BPD who experience more psychotic symptoms, tend to struggle with quality of life more”, there are many factors that can contribute to this outside of the individual. For example, while I’ve spoken about why people with BPD may struggle to work through an anti-capitalist lens, these statements naturalise capitalism and attribute folks’ low quality of life entirely to their mental and emotional struggles and differences.

They also ignore the fact that many people with a BPD diagnosis are people of colour, trans people, and people who otherwise face heavy discrimination and oppression in ways that can contribute to a lower quality of life. 

As eating disorder therapist, Stacie Fanelli, recently wrote in a post on Instagram, “referring to the way someone naturally exists as harmful puts blame on the individual, not the systems that fail to accommodate them and this allows those systems to continue sidestepping calls for change.”

There is no one ‘right’ way to have a body or mind or to experience reality, and it is particularly damaging when white practitioners working in a field that was borne out of and sustained through the colonial oppression of other cultural and spiritual ways of being and understanding the world promote these ideas. 

Psychosis is not a static, fixed, objectively-defined state, but has been subjectively-interpreted to oppress groups of people — and when we add that psychiatric incarceration remains acceptable as a form of care, we can see how this conflation between danger and psychosis can be used as a tool of social control.

If you are a person with BPD and you find that getting rid of your ‘psychosis’ isn’t entirely a goal of yours — that’s valid and you should have a say in determining what recovery and healing mean to you. Not all differences are in need of ‘curing’. Not all differences equate to distress. And all differences definitely do not equate to harm and danger.

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*(I use the term BPD as the name of a psychiatric diagnosis, not because I believe that anyone’s personality is ‘disordered’, and with a recognition that this diagnosis has caused immense harm to many people bearing it (particularly multiply-oppressed peoples), and that it is a limiting, one-dimensional and often extremely harmful way of making meaning of these experiences. At the same time, I recognise that there are people who have found meaning and validation through this label, and I believe that people should have the right to self-identify in ways that make sense to them.)

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Do you care for someone with BPD and want to gain a better understanding of the experiences, traits and struggles of people with this diagnosis? Or are you a researcher or psych student and are interested in learning more about my anti-oppression critiques of this diagnosis? You can book a 1:1 consultation with me here.