A Legal Anthropology of Personality Disorder
Lead Research Organisation:
Birkbeck, University of London
Department Name: Law
Abstract
My proposed research investigates how people living with personality disorder (PD)
diagnosis become criminal subjects and what PD diagnoses come to mean within processes
of criminalisation. Asking, 'How do people living with PD become criminal subjects?', I will
conduct a multi-site ethnography that follows people diagnosed with PD through legal
process in the UK. Data of their experiences, as well as their relations with lawyers,
clinicians, police and the courts, will be collected and analysed. The study addresses the
current lack of empirical studies on the everyday practices that shape mental health
diagnoses' entanglement with the criminal justice system. Situated within the history of PD
as a diagnostic category, the project synthesises understanding from psychiatric anthropology
and critical legal studies to examine how PD diagnoses emerge within, and are constructed
through, the experience of becoming a 'criminal'.
A cluster of mental disorders formally defined in 1980, PD is heavily overrepresented in UK
prisons. The disorder is diagnosed in 5-13% of the general population yet in 62% of male and
57% of female prisoners. Originating in medical psychiatry, the diagnosis now dominates
forensic mental health work, motivating - from 2001 onwards - nationwide initiatives
dedicated to managing those with 'severe' PD through the criminal justice system. Diagnostic
guidance suggests all forms of PD are initially indicated by: 'an enduring pattern of inner
experience and behaviour that deviates markedly from the expectations of an individual's
culture' (DSM-5, 2013). To date, critical legal scholarship has addressed how unequal power
relations construct 'deviance' and normative 'culture' here, as well as recognising
psychiatry's role in the inception of prisons and the production of criminal subjects (Foucault
1964, Gilmore 2002). Psychiatric anthropologists have critically assessed PD as a
construction particular to Western psychiatry (Littlewood 2002), its prevalence amongst
vulnerable populations marked as 'deviant' through state intervention (Anleu 2005), as well
as the variety in PD's expression across cultures (Mulder 2012).
While both disciplines stress the importance of everyday practice in the making of criminal
subjects, and of illness, empirical work on PD has largely been conducted in prisons and
clinical settings (Galanek 2012). There has been little ethnography devoted to the minutiae of
relations, experiences and practices that shape PD's meaning and sufferers' experiences as
they become, and are made into, criminals'. My research fills this gap, focussing on the
courts and the constellation of relationships formed around criminal trial. The research offers
new knowledge on the social texture of key areas of study for the disciplines on which it
draws, on medicalised deviance, the construction of normative selfhood, human
subjectification in medicolegal interactions, and the construction of PD as a diagnosis.
Practically, recently published British Psychological Society (BPS) guidelines have called on
mental health and criminal justice practitioners to seek alternatives to Western diagnostic
categories, and to be vigilant to these categories' tendency to reproduce social harm (BPS
2018). In its focus on sufferers' experiences and subversions, my study is a timely response
to this shift in approach. It is particularly urgent and significant considering the deepening
mental health crisis in UK prisons.
My extensive knowledge and relevant experience means I am well placed to conduct this
study and undertake interdisciplinary research that will be relevant to critical legal
scholarship, psychiatric anthropology and to the community of practitioners working at the
intersections of psychiatry and criminalisation. My research connects two leading
institutions, UCL Anthropology and Birkbeck Law.
diagnosis become criminal subjects and what PD diagnoses come to mean within processes
of criminalisation. Asking, 'How do people living with PD become criminal subjects?', I will
conduct a multi-site ethnography that follows people diagnosed with PD through legal
process in the UK. Data of their experiences, as well as their relations with lawyers,
clinicians, police and the courts, will be collected and analysed. The study addresses the
current lack of empirical studies on the everyday practices that shape mental health
diagnoses' entanglement with the criminal justice system. Situated within the history of PD
as a diagnostic category, the project synthesises understanding from psychiatric anthropology
and critical legal studies to examine how PD diagnoses emerge within, and are constructed
through, the experience of becoming a 'criminal'.
A cluster of mental disorders formally defined in 1980, PD is heavily overrepresented in UK
prisons. The disorder is diagnosed in 5-13% of the general population yet in 62% of male and
57% of female prisoners. Originating in medical psychiatry, the diagnosis now dominates
forensic mental health work, motivating - from 2001 onwards - nationwide initiatives
dedicated to managing those with 'severe' PD through the criminal justice system. Diagnostic
guidance suggests all forms of PD are initially indicated by: 'an enduring pattern of inner
experience and behaviour that deviates markedly from the expectations of an individual's
culture' (DSM-5, 2013). To date, critical legal scholarship has addressed how unequal power
relations construct 'deviance' and normative 'culture' here, as well as recognising
psychiatry's role in the inception of prisons and the production of criminal subjects (Foucault
1964, Gilmore 2002). Psychiatric anthropologists have critically assessed PD as a
construction particular to Western psychiatry (Littlewood 2002), its prevalence amongst
vulnerable populations marked as 'deviant' through state intervention (Anleu 2005), as well
as the variety in PD's expression across cultures (Mulder 2012).
While both disciplines stress the importance of everyday practice in the making of criminal
subjects, and of illness, empirical work on PD has largely been conducted in prisons and
clinical settings (Galanek 2012). There has been little ethnography devoted to the minutiae of
relations, experiences and practices that shape PD's meaning and sufferers' experiences as
they become, and are made into, criminals'. My research fills this gap, focussing on the
courts and the constellation of relationships formed around criminal trial. The research offers
new knowledge on the social texture of key areas of study for the disciplines on which it
draws, on medicalised deviance, the construction of normative selfhood, human
subjectification in medicolegal interactions, and the construction of PD as a diagnosis.
Practically, recently published British Psychological Society (BPS) guidelines have called on
mental health and criminal justice practitioners to seek alternatives to Western diagnostic
categories, and to be vigilant to these categories' tendency to reproduce social harm (BPS
2018). In its focus on sufferers' experiences and subversions, my study is a timely response
to this shift in approach. It is particularly urgent and significant considering the deepening
mental health crisis in UK prisons.
My extensive knowledge and relevant experience means I am well placed to conduct this
study and undertake interdisciplinary research that will be relevant to critical legal
scholarship, psychiatric anthropology and to the community of practitioners working at the
intersections of psychiatry and criminalisation. My research connects two leading
institutions, UCL Anthropology and Birkbeck Law.
Studentship Projects
| Project Reference | Relationship | Related To | Start | End | Student Name |
|---|---|---|---|---|---|
| ES/P000592/1 | 01/10/2017 | 30/09/2027 | |||
| 2096055 | Studentship | ES/P000592/1 | 01/10/2018 | 09/07/2023 | Rebecca Seglow Hudson |
| Description | This award has enabled research into the construction of personality disorder, the most overrepresented mental disorder diagnosis in British prisons. The research has uncovered how the diagnosis is constructed and managed through everyday practice, particularly focusing on risk assessments and the Parole Board process. Case study research as part of the award has allowed reflections from former prisoners and Parole Board members to supplement data from assessments and Parole Board decision letters, producing insight into how prisoners experience the diagnosis and how justice professionals understand its impact on 'risk'. Key findings include: - The relatively recent importance of early traumatic experiences in shaping personality disorders, reflected in assessments, justice professionals' understanding and prisoners' reflections on the diagnosis. A prison based nosology of the diagnosis sees trauma as its origin story, wherein disruptive early experience sediments into personality traits and difficulties that comprise a disorder, and generate 'risky' behaviour. - The ways in which personality disorder is felt by some prisoners to serve as an explanatory framework that dismisses their accounts of their own experiences and behaviour, but is taken as continued evidence of 'risk' that they have to demonstrate is reduced. - A comparable set of limits wherein risk assessments gather and reproduce the importance of specific incidents in prison, foregrounding some things as worth attention and/or 'risky', and connecting disparate incidents through personality disorder as an explanatory framework. - A system of core changes that professionals look for in personality disordered prisoners, specifically the presence of insight and a commitment demonstrated through authentic engagement with behaviour change programmes and therapeutic interventions. - Through linking empirical data to historical work, this research traces ascendance of the diagnosis amongst the prison population as being tethered to new penal strategy first developed under New Labour, and intensified over time to the present day. Comparisons between this and previous instances of psy knowledge being involved in prison development in history are made to draw out features of this process. |
| Exploitation Route | Outcomes from this award offer insight into the development of psychiatric diagnosis, and the relationship between psychiatric knowledge and penal strategy. Empirical and theoretical insights from the award offer findings that may be of use to psychosocial studies, sociology, criminology and psychiatric anthropology more broadly - particularly work that links forms of disciplinary control - both in and outside of prison - to mental health diagnosis and rehabilitative intervention. In particular, my findings offer insight into the growing importance of understandings of trauma, and their implication for penal mental health intervention. Further work into how both justice professionals and people in prison experience these narratives - where one's mental disorder is understood to have grown from traumatic experience - has relevance for wider understandings of mental health intervention and service users' experience of diagnostic categories. Insights from this relatively new inclusion of trauma in personality disorder management, found through my research, may be put to use in critical accounts of how changing diagnostic categories influence institutional practice, impact service users, shape prisoners' experiences, and influence forms of risk assessment and wider criminal justice development. Direct routes for further research work flowing from these findings are: - Ethnographic work on the manner in which personality disorder treatment operates, such as through offender behaviour programmes, would be a fruitful area in which these insights could be further tested and applied. - Observations of Parole Board hearings and practice at greater scale, to trace how constructions of disorder diagnosis in assessments shape Parole Board discussion and decision making in situ. - People's experience 'through the gate' (after release from prison) looking at former prisoners' experience of probation interventions could further follow this line of thinking to see how personality disorder diagnoses affect management and treatment in the community. |
| Sectors | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
| Description | - Attendance at a workshop held by the British Psychological Society on the 'Power Threat Meaning Framework use in Forensic Settings', attended by over 150 justice professionals. Findings allowed me to participate in discussion about how diagnostic categories can contribute to social harm in prison settings. - Report to be developed in 2023 for the Parole Board as a condition of my research partnership with them, directly linking my findings to issues of Parole Board practice in conducting hearings for people with personality disorder diagnosis. - Speeches given as part of The World Transformed festival 2021 in Brighton, on imprisonment and mental health. - Engagement with prison lawyers, campaigners and families of imprisoned people in a workshop and research into prison assessments, funded through the Wellcome Institutional Strategic Support Fund, as part of the Psychotechne exhibition at Birkbeck's Peltz gallery. - Workshop at HAU Hebbel am Ufer, Berlin, feminist arts festival on imprisonment and psychiatric diagnosis. |
| First Year Of Impact | 2021 |
| Sector | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
| Impact Types | Cultural,Societal,Policy & public services |