Marsha Linehan Borderline Personality Disorder and DBT

Dr. Marsha M. Linehan a true mental health hero

By Liz Lockhart

We will never know just how many lives have, quite literally, been saved by Marsha Linehan. For those of you who know little or nothing about this remarkable woman please read on as her story is true inspiration to everyone.

For those who suffer from Borderline Personality Disorder (BPD) she will have particular interest, to mental health providers she has provided a worldwide treatment to help with the most determined suicide patients.

A sufferer herself

Earlier this year (2011) Dr. Linehan admitted for the first time that she has suffered with BPD for most of her life. The fact is that she has survived some of the blackest hours anyone could imagine and has risen to qualify in her field of psychiatry and to dedicate her life to work with ‘hopeless cases’.

Dr. Linehan stood before an audience at the Institute of Living at the Hartford clinic, where she had been treated for extreme social withdrawal at the age of 17. She recalled a therapy session which took place last spring in which one of her patients asked her:

‘Are you one of us?’

‘You mean have I suffered?’ replied Marsha.

‘No, Marsha’ the patient replied ‘I mean one of us. Like us. Because if you were, it would give all of us so much hope.’

As Dr. Linehan relates this to her audience she said ‘That did it. So many people have begged me to come forward, and I just thought – well, I have to do this. I owe it to them. I cannot die a coward.’

More and more people are, at last, feeling able to ‘come out’ about their mental health disorders despite the enduring stigma which teaches people to think of themselves as victims and have their hope snuffed out.

Her time as an inpatient

Marsha Linehan learned the central tragedy of severe mental illness the hard way. She arrived at the Institute of Living on March 9^th 1961 aged just 17. Quickly she became the sole occupant of a seclusion room in the unit known as Thompson Two. This unit was for the most severely ill patients. She had attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her middle, using any sharp object she could find.

This room was a small cell with a bed, a chair and a tiny, barred window. This room held no weapons with which she could harm herself and so she banged her head against the wall and, later the floor – as hard as she could.

‘My whole experience of these episodes was that someone else was doing it: it was like ‘I know this is coming, I’m out of control, somebody help me: where are you, God?’ she said. ‘I felt totally empty, like the Tin Man. I had no way to communicate what was going on, no way to understand it.’

She had been sent to the Institute of Living by her local psychiatrist to ‘get to the bottom of the problem’. Once there, doctors gave her a diagnosis of schizophrenia. She was dosed with Thorazine, Librium and other powerful drugs. She had hours of Freudian analysis and was strapped down for electroshock treatments. The first time she had shock treatment she received 14 shocks, the second she received 16 according to her medical records. Nothing changed and she was soon back in her seclusion room.

On May 31^st 1963 her discharge notes read that ‘during 26 months of hospitalisation, Miss Linehan was, for a considerable part of this time, one of the most disturbed patients in the hospital’.

‘I was in hell she said. ‘And I made a vow: when I get out, I’m going to come back and get others out of here’.

The turning point

A huge turning point came into Marsha’s life while praying in a small chapel in Chicago. It was in 1967 and she had barely survived since her discharge from the Institute of Living.

‘One night I was kneeling in there, looking up at the cross, and the whole place became gold – and suddenly I felt something coming toward me,’ she said. ‘It was this shimmering experience, and I just ran back to my room and said, ‘I love myself.’ It was the first time I remember talking to myself in the first person. I felt transformed.’

Marsha had tried to kill herself so many times because of the gulf between the person she was and the person that she wanted to be, but something had changed inside her and after years of study in psychology, Marsha earned a Ph.D in 1971. She had not understood what caused this change, but realised that she had grown to accept herself as she was.

The start of DBT development

Dr. Linehan began working with patients at a suicide clinic and later as a researcher. The discipline of behaviourism taught that people could learn new behaviours and that acting differently can in time alter underlying emotions from the top down.

Deeply suicidal people have tried to change and failed so many times. The only way to reach them was to acknowledge that their behaviour made sense. The thoughts of death were ‘sweet release given what they were suffering.

Dr. Linehan was closing in on two seemingly opposed principles that could form the basis of a treatment – acceptance of life as it is, not as it is supposed to be, and the need to change, despite that reality, and because of it.

There was only one way to know for sure whether these principles would work in the real world.

‘I decided to get supersuicidal 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 Id been there, in hell, with no idea how to get out.’

She particularly chose to treat people with a diagnosis of borderline personality disorder . A diagnosis that she would have given her young self. A condition which is characterised by needless outbursts and self-destructive urges, often leading to cutting or burning.

Dr. Linehan’s approach to treatment is now called D.B.T. (dialectical behaviour therapy). It includes principals borrowed from other behavioural therapies but has added elements. These include ‘opposite action’ in which patients act opposite to the way they feel when an emotion is inappropriate. ‘Mindfulness’ meditation is also used – this is a technique in which people focus on their breath and observe their emotions come and go without acting n them.

Studies and research have compared the DBT technique with other treatments and found that the DBT approach has a far higher success rate than any of the others particularly for stubborn patients, including offenders, people with eating disorders, drug addicts and severe depression sufferers.

Today Dr. Linehan has reached a time in her life when she can tell her story. ‘I’m a very happy person now,’ she said in an interview. ‘I still have ups and downs, of course, but I think no more than anyone else.’

After she had made her admission last week, Dr. Linehan visited the seclusion room where she had been detained so many years before. It is now a small office.

‘Well, look at that, they changed the windows’ she said as she help her palms upwards. ‘There’s so much more light.’

Photo: Taken from the New York Times interview here