Ep 3.9 - Epistemic Justice in Diagnosis: Exploring Borderline Personality Disorder with Dr. Awais Aftab

A Therapist Can't Say That

Suppose you polled therapists and asked them what the most controversial diagnosis is in the current version of the DSM. Many of us would likely say Borderline Personality Disorder, and it would certainly be in almost everybody's top three.

I’ve been wanting to do an episode on BPD for a bit because there is something about this controversial diagnosis that allows us to explore the challenging and consequential nature of psychiatric diagnosis itself.

To guide us in this exploration, I've had the privilege of inviting Dr. Awais Aftab, a leading authority in the field. His extensive work on philosophical, ethical, and scientific issues related to diagnosis makes him the perfect person to delve into this complex topic with.

Awais Aftab, MD, is a psychiatrist in Cleveland, Ohio, and Clinical Assistant Professor of Psychiatry at Case Western Reserve University. He led the interview series "Conversations in Critical Psychiatry" for Psychiatric Times, which explores critical and philosophical perspectives in psychiatry, with a book adaptation forthcoming from Oxford University Press. He is a senior editor for Philosophy, Psychiatry, & Psychology and has been actively involved in initiatives to educate psychiatrists and trainees on conceptual and critical issues. He blogs at Psychiatry at the Margins.

In the conversation, we dig into whether Borderline Personality Disorder is “real” and what that means, how it relates to the philosophical concept of epistemic injustice, how context influences the utility of a diagnosis, and more.

Listen to the full episode to hear:

• How treatment of people diagnosed with Borderline Personality Disorder frequently illustrates aspects of epistemic injustice/justice
• The ways that clinical setting and context influence the use, or misuse, of BPD as a diagnostic label and how that impacts patients
• How quantitative psychology is influencing how we conceptualize personality disorders
• Why a BPD diagnosis can be intensely valuable for some clients, and how it helps guide clinicians
• Why we can’t chalk up all psychopathology to trauma
• How calls for testimonial justice from psychiatric patients should serve as a corrective force to excessive skepticism of patient narratives

Learn more about Dr. Awais Aftab:

• Psychiatry at the Margins
• X: @awaisaftab

Learn more about Riva Stoudt:

• Into the Woods Counseling
• The Kiln School
• Instagram: @atherapistcantsaythat

Resources:

• Borderline Personality and Self-Understanding of Psychopathology
• Epistemic injustice
• The epistemic injustice of borderline personality disorder, Jay Watts, BJPsych International
• A Metaphysics of Psychopathology, Peter Zachar
• Peter Fonagy