New York Times: Expert on Mental Illness Reveals Her Own Fight

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Previously we have written about Marsha Linehan, clinical psychologist who developed dialectical behavioral therapy, and who has worked throughout her career with persons who display severe suicidal behaviors or symptoms of what is called borderline personality disorder. On June 23, 2011, the New York Times presented an intriguing story, Expert on Mental Illness Reveals Her own Fight. Now those who admire Linehan’s work will have even more respect for the personal story behind her professional success.

Many times, patients will want to know from a therapist, “Have you suffered from this, too?” In some treatment areas, such as alcohol or substance abuse or anorexia, part of a therapist’s credentials might include sharing a similar history with the client. But in many other areas it is a taboo, and therapists may deflect a question such as, “Have you been treated for depression?” by a comment such as, “So you’re asking if I’ve suffered like you, if I can truly understand what you’re going through,” which offers some empathy but might also be considered evasive.

At age sixty-eight, Linehan made a decision to share details of her early life, an extremely troubled time that included over a year of inpatient psychiatric hospitalization at The Institute for Living in Hartford, Connecticut. In fact, she was placed there fifty years ago and treated with methods that included medication, electro-convulsive shock therapy, and psychoanalysis, and it is from here that she told her inspiring story.

Although I’ve never met Dr. Linehan, I could not help but feel a personal connection. She graduated from the clinical-psychology program at Loyola University before me. She recounted some affirming spiritual encounters at The Cenacle, a retreat center on Fullerton Avenue in Chicago, near DePaul. It seems that God has had a role in her personal and professional development, a rare thing for an accomplished therapist to acknowledge. And a few years ago she graciously responded to an E-mail from one of my students at Marist.

The details of Dr. Linehan’s story are deeply personal and I refer you to the Times article to read about them. But here’s a good overview of her professional achievements:

“‘I decided to get super-suicidal people, the very worst cases, because I figured these are the most miserable people in the world; they think they’re evil, that they’re bad, bad, bad; and I understood that they weren’t,’ she said. ‘I understood their suffering because I’d been there, in hell, with no idea how to get out.’

“In particular she chose to treat people with a diagnosis that she would have given her young self: borderline personality disorder, a poorly understood condition characterized by neediness, outbursts and self-destructive urges, often leading to cutting or burning. In therapy, borderline patients can be terrors; manipulative, hostile, sometimes ominously mute, and notorious for storming out threatening suicide.

“Dr. Linehan found that the tension of acceptance could at least keep people in the room: patients accept who they are, that they feel the mental squalls of rage, emptiness and anxiety far more intensely than most people do. In turn, the therapist accepts that given all this, cutting, burning and suicide attempts make some sense.

“Finally, the therapist elicits a commitment from the patient to change his or her behavior, a verbal pledge in exchange for a chance to live: ‘Therapy does not work for people who are dead’ is one way she puts it….

“Dr. Linehan’s own emerging approach to treatment, now called dialectical behavior therapy, or D.B.T., would also have to include day-to-day skills. A commitment means very little, after all, if people do not have the tools to carry it out. She borrowed some of these from other behavioral therapies and added elements, like opposite action, in which patients act opposite to the way they feel when an emotion is inappropriate; and mindfulness meditation, a Zen technique in which people focus on their breath and observe their emotions come and go without acting on them. (Mindfulness is now a staple of many kinds of psychotherapy.)”

Dialectical Behavior Therapy is one of the approaches from clinical psychology that “works”; it is acknowledged as an empirically supported treatment.

Thank you, Dr. Marsha Linehan for all you have done to help people in need.

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