“It's all in your head”: When the mental health label harms physical health

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“”It’s In Your Head””: When the Mental Health Etiquette Harms Physical Health

Living with borderline personality disorder (BPD) can have unintended consequences when trying to receive physical care. According to experts, the prejudices linked to this pathology persist in the hospital context.

Prejudices towards people with a personality disorder would have a negative effect on the care they receive in health establishments.

“Rage comes to my heart when I talk about it. The world tells me to trust the system… But let's say that it's more complicated to trust since I was given a diagnosis, “says Diane* immediately, on the phone.


She would be far from alone in her case. Many people living with borderline personality disorder – those referred to as BPDs, borderlines– try to walk through the doors of a health facility in the hope of getting help for a physical problem, except that their psychiatric label often masks wounds that, for them, have nothing to do with them. 'imaginary. They are thus referred to mental health services.

Diane says she is no longer surprised: nearly 20 years after the personality disorder was entered in her medical file, getting physical care is a constant challenge. They pay more attention to what is written in my file than to what I am describing to them.

In 2017, after a fall on a ropes course followed by intense wrist and shoulder pain, she consulted her family doctor. In appearance, nothing is broken, assures the doctor. It's in your head, he says, as a conclusion to the consultation, recalls Diane. She no longer counts the times she has been served the ritornello.

At the time of our discussion, she was awaiting the results of an X-ray which will determine if her shoulder is operable. In fact, she persevered in her efforts and specialists confirmed to her, three years after her debacle, that she was suffering from the after-effects of a broken wrist and a tearing of a muscle in her shoulder. If it's not operable, I'll have to live with my pain for the rest of my life, she says, in a resigned, almost disillusioned tone.

It's always in our head, says Annie*. Me, it is also attributed to my “fragility”. The latter received her diagnosis a few years ago, after a separation. In her case, it took several months – and nutritional issues – before it was finally discovered that she had bacteria in her stomach.

“At some point, you get disgusted, because it's always 'mental'. I'm tired of being ignored. I go on dates for nothing. »

— Annie

Annie has agreed to talk about her reality, but admits that she is often discouraged, especially in the context of difficult access to care.

If the current overflow of emergencies shows once again that the health system is in troubled waters, people living with a mental health problem – whatever its nature – have been living in the turmoil since long before the crisis which is raging. .

The stigma that Diane and Annie say they experience is part of a continuum of factors that fuel the effect of mental health stigma, a concept widely documented and observed in establishments.

The current model of organization of care would mean that several organizations have chosen to prioritize other types of clientele, can we read in a reference framework prepared by the National Center of Excellence in Mental Health (CESM) of Quebec published in 2017.

The Mental Health Commission of Canada (MHCC) goes so far as to say that stigma is so entrenched in practice that it arbitrarily restricts the rights and opportunities of people with mental health issues.

If the phenomenon of stigmatization affects all people living with a mental health disorder, the CESM specifies that people with a personality disorder are particularly identified as impossible to heal.

Until recently, diagnostic reference manuals classified these pathologies as axis II, along with intellectual disability, which did not suggest any long-term improvement in the condition.

As far as BPD is concerned, the many stigmas associated with it are tenacious, argues psychologist Béatrice Filion, who specializes in this clientele. They are mistakenly compared to people who have bipolar disorder, who experience mood swings over a long period of time, who go through depressive and then manic states. [Unlike TPLs] they won't be reactive to something that happens, she explains.

The BPD, I would rather present it as a reactivity of mood. They are hypersensitive people who react more emotionally to what happens to them, says the specialist.

For Béatrice Filion, the key is to understand that people with BPD have a very normal daily life; it is in fact in interpersonal relationships that the shoe pinches. It is fundamentally an instability in terms of relationships, of identity. They feel an inner emptiness that often comes with a bad life, lists the psychologist.

Hence the importance, she believes, that health care professionals health become aware of words or behaviors that can be disabling towards this clientele.

“If a person comes to the emergency room in distress, and if you have a reaction that is not supportive, there is a greater chance that the person will 'explode' and lose their confidence. »

— Dr. Béatrice Filion, psychologist

A vicious circle ensues, where the respective mistrust of patients and caregivers constantly intertwine.

Not to mention that, according to a recent analysis published by the MHCC, people living with a mental health disorder, including BPD, are more likely than others to receive lower quality health services. So to speak, if we ignore a physical symptom named by a patient and attribute it to his mental health problems, it is possible that his condition will evolve and, ultimately, deteriorate.

“[Stigma] reduces their life expectancy; indeed, people with lived experience die 10 to 25 years earlier than those without these problems. »

— Excerpt from the report of the Mental Health Commission of Canada

BPD is a serious condition, insists Dr. Lionel Cailhol, psychiatrist at the Institut universitaire en santé maladie de Montréal ( IUSMM) and physician mandated to work with the INSPQ on borderline personality disorder.

Among other things, he cites the high rates of mortality and suffering, as well as the numerous associated illnesses (physical or psychiatric), mentioning in passing the very high cost for society of this clientele.

In a monitoring report produced by the INSPQ, the conclusions of studies stipulate in particular that work stoppages and care represent annual bills totaling $25,000 to $50,000 per patient with BPD.

If their confidence remains shaken and fragile, Diane and Annie say they are aware that the reflexes of caregivers come partly from received ideas and taboos that still percolate to this day in the collective imagination.

Annie says don't be fooled; she knows the way people look at her once the medical file has been consulted and which she often perceives as imbued with judgment or discouragement.

“Even I used to struggle with my diagnosis. I thought the TPLs were mentally retarded.


According to work by the CESM, the BPD clientele is historically considered to be chronically dysfunctional and not very treatable, due, among other things, to impulsivity, difficulty trusting others or the unstable way of life that we know of them.

However, we must collectively take the full measure of the suffering experienced by people living with a personality disorder, considers Dr. Cailhol.

For nurse Cathy Martineau, candidate for a master's degree in nursing at the University of Quebec in Rimouski (UQAR), the solution largely lies in empathy. By reversing the roles, she believes, we can reconcile loneliness.

“I had to be in the hospital for a personal reason. I wondered about some of the attitudes of the workers at that time: “Is this really the best way to help the person, especially since he is very unwell?” »

— Cathy Martineau, nurse and candidate for a master's degree in nursing at UQAR

Directed by professor and neuropsychologist Frédéric Banville, she decided to focus her research on the attitudes of Quebec nurses towards people with BPD. Based on the conclusions it draws, it wishes to propose innovative initiatives and solutions to better act with this clientele.

I thought we could try to see how we can help each of the parties to understand each other better, to work better.

Based on responses recently collected from 300 nurses, preliminary data indicates that those surveyed have a high level of empathy, but that 31% of them admit to not being comfortable with BPD clients. Moreover, 50% of the participants in the study go so far as to say that it is not pleasant to work with [people BPD], underlines Professor Banville.

“They are thought to be manipulative. We think that they are not going to help themselves, that they are not capable of it. »

— Dr. Frédéric Banville, neuropsychologist and professor at UQAR

However, still according to the INSPQ monitoring report, this clientele is known to be among the quickest to seek help.

People with a cluster B personality disorder (which includes borderline, narcissistic, histrionic, and antisocial personality disorders) rely heavily on first-line medical services. online (family physicians, community settings) and are considered major users of emergency or hospitalization services.

These are often people who really want to work on themselves… when they are given the validating climate to do so, brings psychologist Béatrice Filion. We must deconstruct the idea that they are unpleasant, manipulative, irritating people. She says just being aware of her biases is a step in the right direction.

“A person with an autism spectrum disorder who comes to the emergency room because they have broken an arm, we will approach them gently. Sensorially, it can be difficult. That's what you don't tend to do with someone who has BPD. »

— Dr. Béatrice Filion, psychologist

For the specialist, putting yourself in the shoes of the other also means thinking about caregivers. When I say that you have to be benevolent, it's not to say yes to everything. There are limits to be set with people who have a borderline personality disorder, a framework must be imposed.

She concedes that the current climate in the health network n isn't the most conducive to a paradigm shift. All the more reason, she believes, for the system to quickly give healthcare workers the tools and environment they need. To build, in a way, a crisis cell for the other crisis.

In the meantime, Annie simply wants the health network to take an interest in what she is going through. I wish they would stop and see beyond our diagnosis, she said. Which Diane fully agrees with.

Just because we're different doesn't mean we can't know what we really feel, end it. -elle.

* Diane and Annie have been granted anonymity to protect their privacy.

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