"All cut up": the jigsaw puzzle of women with borderline personality disorder: a gift of wholeness to women and mental health nurses

Abstract

This thesis illuminates the experiences of Women with the diagnosis of borderline personality disorder (Diagnostic and Statistical Manual of Mental Disorders IV, A.P.A., 1994). Self harming and risk taking behaviour is common for these Women. I have named this thesis "All Cut Up", due to the self harm and risk behaviour, the cutting and burning of skin which is a prominent coping mechanism in Women. I propose that nurses must consider the developmental history and attachment relationships for this group of Women. Attachment theory (Bowlby, 1973, 1980, 1982) is the theoretical underpinning to this thesis, while other psychotherapeutic models such as self-psychology, (Meares, 1993); Briere's Abuse Focused Therapy (1992) and Linehan's Dialectical Behavioural Therapy (1993) will also be examined. These models will allow nurses to consider different caring approaches away from the dominant discourse of the biomedical model, as championed by the DSM IV (A.P.A., 1994). This thesis proposes that different positionings can enable exploration of the 'naming' of borderline personality disorder and provide nurses with multiple lenses from which they can explore their practice with Women. These Women are often involved in psychotherapeutic relationships with mental health nurses in a variety of clinical settings. Mental health nurses and Women often struggle with the attitudes the diagnosis of borderline personality disorder evokes. The narratives these Women tell often cause great personal distress; their memories are often lost because of the psychological responses due to the trauma. Responses such as dissociation, cognitive distortions, detachment/numbing and even amnesia shatter Women's memories of their lives into 'pieces' (Briere, 1992). With this in mind I have used the metaphor of the 'jigsaw', the putting together of the Pieces, the chapters of this thesis, to symbolise the 'gift of wholeness' this thesis will give to Women and nurses. A fictionalised narrative provides an example of Women's experiences that will allow an insight into their world. This is but a small composite of the narratives that have unfolded over long periods of time while working with Women. The story is fictionalised to preserve confidentiality, and to honour the psychotherapeutic relationships nurses have with Women. My story is part of my own experience that enables me to explore Women's experience of being cared for using concepts outside the dominant biomedical discourse. I will tell my story as a woman and mental health nurse caring for Women, and the supporting of colleagues through clinical supervision who care for these Women. My prose is a part of my own personal journey; it is my exploration of my own developmental history and attachment relationships and illustrates significant themes such as transformation and recovery.