THE BLOG

'Crazy Eyes' and Throwing Pies: Borderline Personality Disorder in Women's Prisons

The first week in October, Mental Health Awareness Week, and October 10, World Mental Health Day, should have improved our understanding not only of illnesses, but also the hidden populations that suffer from them.

2015 was just like Mental Health Awareness efforts of years past; it totally ignored the real mental health problems in women's prisons. Sure, there were media mentions of depression, bipolar disorder and schizophrenia, but none of them improved our understanding of what's really happening in correctional facilities.

Luckily, when the news fails, we have entertainment. "Crazy Eyes," the nickname for character Suzanne Warren on Orange Is the New Black for which actress Uzo Aduba won her second Emmy last month, is probably the greatest lesson on the reality of mental illness in women behind bars.

Crazy Eyes leaks into every dysfunctional situation on the show. She ends up in the middle of Piper's clash with penal life when she arrives at Litchfield, attempting a romantic relationship with her. She unwittingly becomes the pawn in the game between counselor Sam Healy and social worker Berdie Rogers. Because of her pliability, Crazy Eyes becomes targeted by sociopath Vee who wants Crazy Eyes to become the fall girl for an assault she perpetrated on the cook.

Conversely, anything organized -- the Mother's Day picnic, Piper's panty exportation ring, evenly matched games of charades or even Vee's drug smuggling business -- intentionally keeps Crazy Eyes on the periphery. Crazy Eyes finds chaos effortlessly and resists anything orderly, a traditional manifestation of borderline personality disorder (BPD).

The drama that develops inside a women's prison and arrests rehabilitation -- while usually attributed to "feminine manipulation" -- is largely clashes between women with borderline personality disorder, an illness that remains untreated because it was misdiagnosed.

My expertise in all of this comes from being misdiagnosed with BPD. Within the Connecticut judicial branch, it's no secret, in my battle both to defend myself against criminal charges and against my family's dysfunction, that my parents had me involuntarily hospitalized several times.

While none of my stays lasted more than a few days, I spent each psych stint sitting in the hallways of hospitals where I would read the nurses' copy of the Diagnostic and Statistical Manual -- the shrinks' playbook -- and peruse all of the criteria for diseases to find one more reason why I couldn't be ill and shouldn't be there. As I memorized symptoms, I could hear the misdiagnoses around me. I would argue with the staff about how they were wrong about me... and Patient X and Patient Y.

I never knew that my resistance actually provided the evidence of possible BPD. Among other symptoms, BPD causes an intense fear of separation and rejection, even going to extreme measures to avoid real or imagined separation or rejection, inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, unstable interpersonal interaction. Telling the medical establishment off with an angry tone had them checking off symptom after symptom for me.

In the United States, BPD is often misdiagnosed. Researchers at the University of North Texas and Brown University found that 40 percent of people with Borderline Personality Disorder had originally been misdiagnosed.

Because of these mistakes, estimates of women in prison in the United States with BPD -- while scarce -- are not accurate representations of how many really suffer from it. But the numbers are still high. A secondary study of 805 female inmates in Virginia found that 59 percent had been diagnosed with BPD. When one considers that a portion of the number of women in prison diagnosed with bipolar disorder -- a range between 2.1 and 4.3 percent -- is classified incorrectly and can be added to the BPD population, it's obvious that this inorganic mental illness is very prevalent in women's prisons. And there's virtually no treatment offered for it.

The reason for misdiagnosing BPD and under-treating the condition in favor of treating organic mental illnesses is that medication is no longer an option in psychiatry, it's an equation; treatment means medication and little else. As Barbara Zaitzow, professor of government and justice studies at Appalachian State University, wrote in her study of psychotropic control of female prisoners: "[p]roviding psychotropic medications to "troubled" inmates may appear to be the sole strategy to treating mentally ill female inmates, due to convenience and limited therapeutic resources."

Many physicians simply label women with bipolar disorder -- instead of BPD, the condition that besets them -- because that's the most justifiable way to pill them up and sedate them. Medication is cheaper and quicker rather than employing the most effective clinical treatments for BPD: individual psychotherapy and skill building. In layman's terms, that's called taking time and listening.

Prisons offer an overabundance of group therapy, probably because it has shown some effectiveness outside of the correctional setting for sufferers of BPD. Group therapy in a prison often includes in the mix some individuals who have anti-social personality disorder -- sociopaths -- and they damage the group dynamic that might have been able to help sufferers of BPD had the treatment occurred elsewhere. While I was in prison, I eventually refused any more group therapy -- even risked being disciplined for it -- because I saw how many women with BPD were regressing by manipulating members of the group and violating confidences in ways that destroyed others' trust.

Failing to diagnose and treat BPD properly has serious implications and may explain why so many female offenders -- 60 percent are rearrested and 30 percent return to custody -- recidivate: Because they remain ill when they discharge, they re-involve themselves in chaotic situations.

It's telling that women released from prison are more than twice as likely as men (15.8 percent vs. 6 percent) to recidivate over a public order crime. If their BPD is untreated, they resist a tidy and well-behaved life. It's one reason why sufferers of BPD statistically find it difficult to maintain employment, another anchor that keeps ex-offenders from being pulled back into the bedlam behind bars.

All personality disorders are difficult to treat, and BPD is no exception. But such a significant medical problem cannot be ignored or treated as it has been, by hiding it under another diagnosis, one that can be easily medicated and the patient dismissed.

Lest anyone believe that I live in a glass house, hurling diagnoses toward others like Crazy Eyes throws pie, while thinking I am fine: I admit my bad behavior contributed to my own misdiagnoses. Me thinks I did protest too much and in the wrong ways. Instead of accusing and harassing clinicians toward the ultimate admission of their mistake, I should have ignored the confusion, not immortalized it. That's what people with Borderline Personality Disorder do when things are calm: create the chaos that comforts them. Hardly hardened criminals, BPD sufferers are the people who annoy us the most, so we lock them up for their illness and refuse to treat it.

I was wholly focused on my feelings of anger and how bad it was to be labeled with a disease and not have it. It never occurred to me that must be worse to have a disease but not to bear the right label to attract the proper type of attention or treatment. I didn't realize how often those misdiagnoses affect the criminal justice system until I arrived at a prison. Then I became aware.