What do Buddhism, Behaviourism and Hegelian Philosophy have in common? They are all part of the radical treatment for Borderline Personality Disorder, Dialectical Behavioural Therapy. Created in the 1970's by Dr Marsha Linehan, it has been at the forefront of psychology, and has saved lives.
It wasn’t always this way. In 1971 at the age of 17, Marsha Linehan was diagnosed with, what doctors labelled ‘chronic schizophrenia.’ Detained in a psychiatric inpatient facility in Connecticut, the sole occupant of the seclusion room, she was quick to learn there are no easy answers when it comes to mental-illness. In fact Lineman was cited as one ‘the most disturbed patient in the hospital’ she attacked staff, cut her wrists, and banged her head against the wall. It took a religious experience and heroic self-belief to recover. She now says of that experience: ‘I was in hell […] ‘when I get out, I’m going to come back and get others out of here too.’
It was no wonder Linehan was an enigma to her doctors; she was not suffering Schizophrenia, but undiagnosed Borderline Personality Disorder. A disease characterised by emotional instability, impulsivity, and suicidal ideation. By naming the demon she learnt to exorcise it. What’s more she created a radical new type of therapy to help others who were struggling with this terrible psychiatric illness. Including me!
When Linehan embarked on her doctorate in psychology, she learnt that extreme trauma creates patients are resistant to the old methods of psychotherapy. While she wanted to treat the most destructive and suicidal patients, she was thwarted by two extremes: Either the patient felt the therapists soothing words of encouragement negated their pain - or the patient felt the therapists words of resignation gave them no hope at all.
As a keen student of Behaviourism pioneered by the likes of Ivan Pavlov, and BF Skinner in to 1940’s, and Cognitive Therapy created by Aaron Beck and Albert Ellis in the 60’s, Linehan used this as a starting point for a new type of therapy. But this was just the beginning.
CBT as its now known just didn’t cut it. The clients Linehan saw, had often suffered abuse, such as rape of domestic violence. Worn maxims like‘think positive you feel better,’ ‘what you think you’ll become’ had no effect on them. Linehan was constantly rebuked with patients stubborn integrity in pursuing their self destruction.
This is why BPD has been considered untreatable — its not. Linehan saw that her forebears lacked empathy. The simple fact was patients didn’t want to be invalidated. Not with fairy stories of success, nor further nightmares of failure. Whats more, self-destructive behaviours were legitimate responses to unbearable pain. She turned to German philosophy for answers.
Hegelian dialectics argues that truth always has two sides, progress can only be made by acknowledging both. As such treatment must take place on the battle-line between opposing forces. This means DBT clients must have faith in the abyss: Accepting the tragedy of personality disorder, but also committing to doing the best one can in the circumstances. With that, treatment was made possible.
The fog of mental illness derails rational thought. For people with borderline personality disorder, this is especially true. If distress is akin to being on fire, then the burning pain of BPD, makes normal thinking impossible. Cognitive reappraisal alone just won’t work
Linehan needed something else in which to anchor her new ideas. The first idea was ‘validation.’ That the therapist and the patient themselves must always validate their own mental states. Just this simple acknowledgement that suffering is real is a partial way to put out the fire. The second way, is through the Buddhist concept of mindfulness. Emotions are only terrible when they are resisted. It is not surprising that Linehan, an innovator herself, knew that this new-fad word of the noughties — mindfulness - was a potential tool in recovery from the early days.
Mindfulness is the ability to recognise, thoughts or emotions when they arise, but not get caught up in them. Cognitive therapy seeks to refute them, behaviourism seeks condition them, but DBT insists BPD sufferers need to accept them. Bed down for the time being, and the storm will pass. Recent technological advances in neuroscience prove mindfulness changes the way are brains function and leads to healing.
These three principles combined with the traditional elements of CBT aim to eradicate the demon trapped inside the head. With dialectical thinking, validation, and mindfulness — self-harm, suicide attempts and behavioural impulsivity should begin to diminish.
Indeed the Results are in: DBT works: Clinical trials from the US, (Linehan-1991–1993, 2006, Turner-2000, Koons et al-2001, Verhuel 2003) showed DBT to create a significant reduction in self-destructive symptoms in patients. Likewise UK based studies concluded the same (Cunningham et al-2004, Hodgetts et al-2007). Whats more service users reported they felt their overall quality of life had improved. I can say as a client myself, DBT is helping me get better. Theres no elixir cure, not least BPD, but Linehan’s method gives us sufferers a fighting chance of recovery.
Yet you don’t have to take my word for it, just look at the therapist herself: From locked up teenager, to eminent emeritus doctor of psychology, emergence from personality disorder is possible. If BPD is the dark night of the soul, it is enough to know their is a sun on the horizon, and with perseverance we can learn to breathe fresh air.