Randy Can't Diagnose

I was once lured into attending a psychiatry med school class when I was at U.Va.  Randolph Canterbury delivered a bizarre lecture that included an unrelated anecdote about his having recently been assaulted by a prostitute in Amsterdam and his supposedly having walking pneumonia and being offered a cough drop by my med student friend who had invited me there.  He then started talking about borderline personality disorder and how a sure sign was his female patients telling him that was he the greatest physician ever, which was by far the most implausible element of his nonsensical remarks.  Anyway, I didn't really understand the point of the proceedings or even his explanation of BPD, but it turns out I'm not alone because apparently no one has ever agreed on its definition or what it's supposed to represent.  From the New Yorker:

B.P.D.’s nebulous nature is encoded in its name. The concept is generally attributed to the psychoanalyst Adolph Stern, who used it in 1937 to describe patients who were neither neurotic nor psychotic and thus “borderline.” The committee charged with designing measures for personality disorders for the DSM-III discussed its confusing status when debating its inclusion. Some members noted that key symptoms such as identity disturbance, outbursts of anger, and unstable interpersonal relations also featured in narcissistic and histrionic personality disorders. During the internal deliberations, Donald Klein, then a professor of psychiatry at Columbia University, complained that “every conceivable variety of character disorder has been described as borderline at one time or another.” In “Personality Disorders: A Short History of Narcissistic, Borderline, Antisocial, and Other Types” (2023), Allan Horwitz, the medical sociologist, asks why the DSM still treats B.P.D. as a disorder of personality rather than of mood. “Its trademark indicator—emotional dysregulation—is virtually the opposite of the rigidity that characterizes a PD,” he writes.

Then again, a director of the National Institute of Mental Health (the NIH institute that employed sociopath Maitland Baldwin) has characterized the DSM, psychiatry's major diagnostic reference and tool, as an "absolute scientific nightmare."  And the major organization for BPD has advocated for changing the name of the condition to something comprehensible such as emotional regulation disorder on the grounds that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma."