Thorn In The Flesh: Absolutely A Diagnosis of Exclusion

Mad Covid College will be presenting an exciting new course on personality disorders this summer. Relying heavily on bigotry and contempt, the course will take an uncompromising approach to guide psychiatrists on managing these difficult, manipulative and demanding patients. The thorn in your flesh* no longer has to be the bane of your professional life!

*we are obligated to say that using the phrase ‘the thorn in your flesh’ to describe personality disorder patients was not coined by Mad Covid College, but The Royal College of Psychiatrists. Please send all hate mail directly to them.

Course structure

Avoiding the management of personality disorder patients

The best defence in any management of a personality disorder patient is to avoid being put in the position to treat them in the first place. The course will equip you with techniques such as letter-writing (to effectively discharge a patient to their GP) and leaflet-giving (to pawn the patient off on voluntary services). By the end of the training you will be confident in writing character assassinations, disguised as clinic letters, to make sure your patient will never want to see you again. You will learn about the key principles of managing these individuals by way of the ‘three nots’: not mad, not treatable, not my problem.

A defensible approach

If you are unlucky enough to find yourself managing a pesky personality disorder patient, the most important aspect of your care is that the approach is defensible. What we mean by this is that it must stand up in a coroner’s court. This has to be the central tenet of any personality disorder care: if the patient dies, how can you make sure you don’t hold any professional liability? Well don’t worry, we’ve got you covered! Clinicians will take part in some fun role play as part of the training where you will learn the art of performative hand wringing and useful soundbites to relay at inquests.

Un-gripping the tenacious hold on the clinician

We all know that personality disorder patients are a pain in the arse, but perhaps their worst trait is the tenacious hold they have over mental health professionals. Despite having the power to detain and make life and death decisions about their care, we know psychiatrists are completely powerless. The course will cover techniques such as ignoring, gaslighting and discrediting patients to help you regain control. The work sheets provided will take you through common scenarios and advise you on the most effective way to blame and stigmatise the patient in each one. You will learn how to harness your natural arrogance in a way that allows complete authority over the patient and you will be competent in belittling anyone who ends up in your consulting room.


Another helpful tool in managing the personality disorder patient is formulation. This is where a team of mental health professionals, most of whom have never met the patient, make crucial decisions about their treatment based on various psycho-babble concepts. These concepts are incredibly useful because they provide a psychological rationale on why you might need to punish a patient you dislike, blame them for your inadequacies or ignore and neglect them. For example, if you find that there are disagreements within your team, ‘splitting’ is an excellent concept to deploy to blame the patient for your lack of cohesion. These concepts are also a good way to deride colleagues who are in any way nice to the patient, and avoid any one clinician taking responsibility for poor care. The most important thing about a formulation is that it must be done without a patient’s knowledge or consent. We can’t stress this enough: do not make it collaborative. We’ll provide tips on how best to weaponise psychological concepts against your patients and the stealth ways in which you can carry out a covert formulation. Bring your own spy glasses!

Out Of Area Placements

If ignoring the patient isn’t working, you always have the option of coercion. In the training we will provide brochures for you to peruse of the various private hospitals that cater to the especially demanding patients who need to be detained under the mental health act for lengthy hospital stays. These out of area placement are an excellent way to offload risk and accountability, and can get these patients off your caseload for years at a time! Patients and carers are often positive about the prospect of going to these hospitals because they promise therapeutic programs (you don’t need to tell them that such promises of therapy won’t materialise). They have the added benefit of denigrating and dehumanising the patient, with the ultimate aim of wearing them down to the point of compliance. You may be concerned about the use of physical restraint in these hospitals but increasingly, such intervention is being referred to as therapeutic holding. The difference is that this change of name will make a patient feel warm and fuzzy while they are subject to physical violence in the name of care.


The 11th revision of the International Classification of Disease (ICD-11), came into effect on 1 January 22. This updated diagnostic manual abolishes specific categories of personality disorder in favour of a general description of the diagnosis that is divided into the categories of mild, moderate and severe. This is incredibly convenient for psychiatrists because it means more people can be diagnosed with this label, especially the ones you dislike. The training will help you identify people who don’t currently have a personality disorder diagnosis by looking at patient behaviours such as asking too many questions, thinking for themselves and feelings of entitlement to receive adequate care. Find yourself in front of a patient who is irritating, demanding or challenges your sense of superiority? No problem, a ‘Personality Disorder: Mild’ diagnosis will signify that the patient is both disordered AND doesn’t meet the threshold for ongoing treatment. Win win! Helpfully, the ICD-11 has kept the category of ‘borderline subtype’ (that label is just too useful to let go!). This special subtype has no scientific basis but allows you to carry on giving the diagnosis disproportionately to women, particularly the ones that are a bit gobby or extremely traumatised.

The Future Of Personality Disorder

Our course will help you look ahead to the possible changes in the way this diagnosis is used in mental health services. Much like the practice of formulation, services are being redesigned to use helpful euphemisms that hide neglect. This includes ‘complex emotional needs’ pathways: services that provide exactly the same kind of prejudiced care with a fancy new name! It is important to remember that you do not mention personality disorder in relation to these services, or if you must, to put it in ‘scare quotes’. One cutting-edge service is even giving the stigma of personality disorder to those without a diagnosis. The STEPPS EI programme is for “undiagnosed BPD” or “subthreshold BPD”, an ingenious new condition that doesn’t actually exist! As STEPPS is designed specifically to treat people with a diagnosis of personality disorder, making the exclusion criteria for this service “a diagnosis of personality disorder” is truly innovative.

The ICD-11 also recognises the potential to give children the diagnosis. The Royal College of Psychiatrists position statement on personality disorder services sets out the pioneering possibility of giving the diagnosis to anyone over the age of fourteen. An even more novel approach was presented at the ISSPD 2021 conference, where the speakers outlined the way in which the diagnosis could be given to children as young as six, using inventories completed by their parents. As we all know, six year olds should absolutely be responsible for their own mental wellbeing and their fully developed personalities make it clear which children are the disordered ones. We fully support potentially abusive parents being so involved in the decision of whether their child meets the criteria for a disordered personality. Life long stigma IS possible!

There is also exciting new research to widen the reach of the personality disorder diagnosis to other vulnerable groups, such as refugees, highlighting the importance of taking an equal opportunities approach to fucking people over by giving them this diagnosis.

Top Secret® Training

Get CPD for up to 80% less than booking a named course on our website when you book a Top Secret® Training Course with us. You’ll know everything about the training course before you book, except the course content and the name of the speaker. We work with bargain basement psychiatrists around the UK to get you the very best deals but the viewpoints can be ill-conceived and controversial so we keep speaker names Top Secret® until after you book.


“I loved this training session. Professor [redacted] was an excellent tutor in helping me learn not to say the quiet part out loud. I feel well equipped to abuse patients and call it care. Thank you!”

“What a highly enlightening course! I especially loved the group exercise where we came up with rude names for our patients and replaced them with euphemisms that we could say to their face. I went away with an inflated sense of self importance and a resolve to be as offensive as possible when working with this client group. All the resentments I harbour about these patients can finally be put to good use”

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: