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    Expert on Mental Illness Reveals Her Own Fight

    Expert on Mental Illness Reveals Her Own Fight
    By BENEDICT CAREY, New York Times
    June 23, 2011

    Are you one of us?

    The patient wanted to know, and her therapist ? Marsha M. Linehan of the University of Washington, creator of a treatment used worldwide for severely suicidal people ? had a ready answer. It was the one she always used to cut the question short, whether a patient asked it hopefully, accusingly or knowingly, having glimpsed the macram? of faded burns, cuts and welts on Dr. Linehan?s arms: ?You mean, have I suffered??

    ?No, Marsha,? the patient replied, in an encounter last spring. ?I mean one of us. Like us. Because if you were, it would give all of us so much hope.?

    ?That did it,? said Dr. Linehan, 68, who told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. ?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.?

    No one knows how many people with severe mental illness live what appear to be normal, successful lives, because such people are not in the habit of announcing themselves. They are too busy juggling responsibilities, paying the bills, studying, raising families ? all while weathering gusts of dark emotions or delusions that would quickly overwhelm almost anyone else.

    Now, an increasing number of them are risking exposure of their secret, saying that the time is right. The nation?s mental health system is a shambles, they say, criminalizing many patients and warehousing some of the most severe in nursing and group homes where they receive care from workers with minimal qualifications.

    Moreover, the enduring stigma of mental illness teaches people with such a diagnosis to think of themselves as victims, snuffing out the one thing that can motivate them to find treatment: hope.

    ?There?s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life,? said Elyn R. Saks, a professor at the University of Southern California School of Law who chronicles her own struggles with schizophrenia in The Center Cannot Hold: My Journey Through Madness. ?We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.?

    These include medication (usually), therapy (often), a measure of good luck (always) ? and, most of all, the inner strength to manage one?s demons, if not banish them. That strength can come from any number of places, these former patients say: love, forgiveness, faith in God, a lifelong friendship.

    But Dr. Linehan?s case shows there is no recipe. She was driven by a mission to rescue people who are chronically suicidal, often as a result of borderline personality disorder, an enigmatic condition characterized in part by self-destructive urges.

    ?I honestly didn?t realize at the time that I was dealing with myself,? she said. ?But I suppose it?s true that I developed a therapy that provides the things I needed for so many years and never got.?

    ?I Was in Hell?
    She learned the central tragedy of severe mental illness the hard way, banging her head against the wall of a locked room.

    Marsha Linehan arrived at the Institute of Living on March 9, 1961, at age 17, and quickly became the sole occupant of the seclusion room on the unit known as Thompson Two, for the most severely ill patients. The staff saw no alternative: The girl attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on.

    The seclusion room, a small cell with a bed, a chair and a tiny, barred window, had no such weapon. Yet her urge to die only deepened. So she did the only thing that made any sense to her at the time: banged her head against the wall and, later, the floor. Hard.

    ?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.?

    Her childhood, in Tulsa, Okla., provided few clues. An excellent student from early on, a natural on the piano, she was the third of six children of an oilman and his wife, an outgoing woman who juggled child care with the Junior League and Tulsa social events.

    People who knew the Linehans at that time remember that their precocious third child was often in trouble at home, and Dr. Linehan recalls feeling deeply inadequate compared with her attractive and accomplished siblings. But whatever currents of distress ran under the surface, no one took much notice until she was bedridden with headaches in her senior year of high school.

    Her younger sister, Aline Haynes, said: ?This was Tulsa in the 1960s, and I don?t think my parents had any idea what to do with Marsha. No one really knew what mental illness was.?

    Soon, a local psychiatrist recommended a stay at the Institute of Living, to get to the bottom of the problem. There, doctors gave her a diagnosis of schizophrenia; dosed her with Thorazine, Librium, and other powerful drugs, as well as hours of Freudian analysis; and strapped her down for electroshock treatments, 14 shocks the first time through and 16 the second, according to her medical records. Nothing changed, and soon enough the patient was back in seclusion on the locked ward.

    ?Everyone was terrified of ending up in there,? said Sebern Fisher, a fellow patient who became a close friend. But whatever her surroundings, Ms. Fisher added, ?Marsha was capable of caring a great deal about another person; her passion was as deep as her loneliness.?

    A discharge summary, dated May 31, 1963, noted that ?during 26 months of hospitalization, Miss Linehan was, for a considerable part of this time, one of the most disturbed patients in the hospital.? A verse the troubled girl wrote at the time reads:

    They put me in a four-walled room
    But left me really out
    My soul was tossed somewhere askew
    My limbs were tossed here about
    Bang her head where she would, the tragedy remained: no one knew what was happening to her, and as a result medical care only made it worse. Any real treatment would have to be based not on some theory, she later concluded, but on facts: which precise emotion led to which thought led to the latest gruesome act. It would have to break that chain ? and teach a new behavior.

    ?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.?

    Radical Acceptance
    She sensed the power of another principle while praying in a small chapel in Chicago.

    It was 1967, several years after she left the institute as a desperate 20-year-old whom doctors gave little chance of surviving outside the hospital. Survive she did, barely: there was at least one suicide attempt in Tulsa, when she first arrived home; and another episode after she moved to a Y.M.C.A. in Chicago to start over.

    She was hospitalized again and emerged confused, lonely and more committed than ever to her Catholic faith. She moved into another Y, found a job as a clerk in an insurance company, started taking night classes at Loyola University ? and prayed, often, at a chapel in the Cenacle Retreat Center.

    ?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.?

    The high lasted about a year, before the feelings of devastation returned in the wake of a romance that ended. But something was different. She could now weather her emotional storms without cutting or harming herself.

    What had changed?

    It took years of study in psychology ? she earned a Ph.D. at Loyola in 1971 ? before she found an answer. On the surface, it seemed obvious: She had accepted herself as she was. She had tried to kill herself so many times because the gulf between the person she wanted to be and the person she was left her desperate, hopeless, deeply homesick for a life she would never know. That gulf was real, and unbridgeable.

    That basic idea ? radical acceptance, she now calls it ? became increasingly important as she began working with patients, first at a suicide clinic in Buffalo and later as a researcher. Yes, real change was possible. The emerging discipline of behaviorism taught that people could learn new behaviors ? and that acting differently can in time alter underlying emotions from the top down.

    But deeply suicidal people have tried to change a million times and failed. The only way to get through to them was to acknowledge that their behavior made sense: Thoughts of death were sweet release given what they were suffering.

    ?She was very creative with people. I saw that right away,? said Gerald C. Davison, who in 1972 admitted Dr. Linehan into a postdoctoral program in behavioral therapy at Stony Brook University. (He is now a psychologist at the University of Southern California.) ?She could get people off center, challenge them with things they didn?t want to hear without making them feel put down.?

    No therapist could promise a quick transformation or even sudden ?insight,? much less a shimmering religious vision. But now 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. The only way to know for sure whether she had something more than a theory was to test it scientifically in the real world ? and there was never any doubt where to start.

    Getting Through the Day
    ?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 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.

    Yet even as she climbed the academic ladder, moving from the Catholic University of America to the University of Washington in 1977, she understood from her own experience that acceptance and change were hardly enough. During those first years in Seattle she sometimes felt suicidal while driving to work; even today, she can feel rushes of panic, most recently while driving through tunnels. She relied on therapists herself, off and on over the years, for support and guidance (she does not remember taking medication after leaving the institute).

    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.)

    In studies in the 1980s and ?90s, researchers at the University of Washington and elsewhere tracked the progress of hundreds of borderline patients at high risk of suicide who attended weekly dialectical therapy sessions. Compared with similar patients who got other experts? treatments, those who learned Dr. Linehan?s approach made far fewer suicide attempts, landed in the hospital less often and were much more likely to stay in treatment. D.B.T. is now widely used for a variety of stubborn clients, including juvenile offenders, people with eating disorders and those with drug addictions.

    ?I think the reason D.B.T. has made such a splash is that it addresses something that couldn?t be treated before; people were just at a loss when it came to borderline,? said Lisa Onken, chief of the behavioral and integrative treatment branch of the National Institutes of Health. ?But I think the reason it has resonated so much with community therapists has a lot to do with Marsha Linehan?s charisma, her ability to connect with clinical people as well as a scientific audience.?

    Most remarkably, perhaps, Dr. Linehan has reached a place where she can stand up and tell her story, come what will. ?I?m a very happy person now,? she said in an interview at her house near campus, where she lives with her adopted daughter, Geraldine, and Geraldine?s husband, Nate. ?I still have ups and downs, of course, but I think no more than anyone else.?

    After her coming-out speech last week, she visited the seclusion room, which has since been converted to a small office. ?Well, look at that, they changed the windows,? she said, holding her palms up. ?There?s so much more light.?

  2. #2
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    Re: Expert on Mental Illness Reveals Her Own Fight

    Remarkable!!!!!

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    Re: Expert on Mental Illness Reveals Her Own Fight

    wow, that made me have tears in my eyes....... what hope it gives! i had no idea she had borderline.

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    Re: Expert on Mental Illness Reveals Her Own Fight

    Most drug counsellors have never been drug addicts. Most therapists have not had mental illness. They, with all their compassion and call to duty, have never 'been there'. Refreshing to see someone who has been there, contribute so much.

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    Re: Expert on Mental Illness Reveals Her Own Fight

    Quote Originally Posted by Yuray View Post
    Most drug counsellors have never been drug addicts. Most therapists have not had mental illness. They, with all their compassion and call to duty, have never 'been there'. Refreshing to see someone who has been there, contribute so much.
    It is nice that a doctor can share her personal experience, definitely makes her more relate-able.

    I think drug counsellors and therapists are human though so I think they have been addicts or struggled with mental illness just as much as any other person. They just might not be forthcoming about it. Personally I think that is what drives a lot of professionals to these types of occupations(not all of them obviously), their own experience or knowing someone close to them that has gone through it. I have had a lot of mental health professionals tell me of their own experiences.

    *I have to admit I didn't read the article so if my assumption as to what it was about is wrong then...that's that I guess.
    Last edited by Andy; June 24th, 2011 at 02:53 AM.

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    Psychologists and their mental illnesses

    Psychologists and their mental illnesses
    by Jenna Baddeley, Psychology Today
    June 24, 2011

    Marsha Linehan shows psychologists to embrace their own struggles

    Prominent psychologist Marsha Linehan - the widely-revered developer of the most effective existing therapy for borderline personality disorder - recently revealed that she has personal a history of the disorder (see yesterday's New York Times article covering her disclosure).

    Linehan is certainly not the only psychologist, famous or otherwise, who has struggled with a serious mental illness. Yet I know of only a handful of psychologists who have talked openly about theirs. My guess is that many suspect - probably correctly - that if they came out of the closet as having a mental illness, it would diminish their professional credibility. This is probably why Linehan herself waited so long to disclose her own history.

    The whole field of psychology has been de-emphasizing psychologists' and therapists' own demons for awhile now. When psychoanalysis was the dominant paradigm in the mental health field, therapists in training were required to undergo analysis themselves. Under the cognitive-behavioral model in which many therapists (including myself) are now trained, the therapist essentially coaches the client in a scientifically-based approach to managing his or her thoughts and behaviors. The therapist's own experiences with psychological pain are not relevant to the protocol. Yet part of the difficulty that clients face is feeling alone, inferior, and misunderstood in their suffering. Psychotherapists' judicious disclosures of their own struggles can help clients feel less alone and more hopeful.

    Perhaps the most important part of Linehan's message is that mental illness experiences can be more than a deficit - they can catalyze important personal transformation. As Linehan tells it, it was her psychiatric hospitalization that galzanized her to dedicate her life to treating others with borderline personality disorder. In other words, she suggests that she succeeded not just despite her illness, but because of it.

    I commend Linehan on her courage, and on the therapeutic value that her disclosure will doubtless have in many lives.

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    Re: Expert on Mental Illness Reveals Her Own Fight

    Linehan's memoir was published this January:

    Building a Life Worth Living: A Memoir

    “Are you one of us?” a patient once asked Marsha Linehan, the world-renowned psychologist who developed Dialectical Behavior Therapy. “Because if you were, it would give all of us so much hope.”

    Over the years, DBT had saved the lives of countless people fighting depression and suicidal thoughts, but Linehan had never revealed that her pioneering work was inspired by her own desperate struggles as a young woman. Only when she received this question did she finally decide to tell her story.

    In this remarkable and inspiring memoir, Linehan describes how, when she was eighteen years old, she began an abrupt downward spiral from popular teenager to suicidal young woman. After several miserable years in a psychiatric institute, Linehan made a vow that if she could get out of emotional hell, she would try to find a way to help others get out of hell too, and to build a life worth living. She went on to put herself through night school and college, living at the YWCA and often scraping together spare change to buy food. She went on to get her PhD in psychology, specializing in behavior therapy.

    In the 1980s, she achieved a breakthrough when she developed Dialectical Behavioral Therapy, a therapeutic approach that combines acceptance of the self and ways to change. Linehan included mindfulness as a key component in therapy treatment, along with original and specific life-skill techniques. She says, "You can't think yourself into new ways of acting; you can only act yourself into new ways of thinking."

    Throughout her extraordinary scientific career, Marsha Linehan remained a woman of deep spirituality. Her powerful and moving story is one of faith and perseverance. Linehan shows, in Building a Life Worth Living, how the principles of DBT really work—and how, using her life skills and techniques, people can build lives worth living.

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    Re: Expert on Mental Illness Reveals Her Own Fight

    This helps to know that mental health professionals have also struggled. For me, this would help me to believe that if they can rise up and become as well as they can, so can I.
    Jesse

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