Marsha Linehan got tired of her patients screaming at her, throwing things and accusing her of blaming them for the mental illness that caused them to want to die. The therapy she used wasn’t working, so she created her own.
After many decades of research, as adversaries questioned her methods, she convinced the National Institutes of Mental Health to fund her attempts to find something new. That’s when she came up with “Dialectical Behavior Therapy.”
For the first time, treatment used mindfulness and radical acceptance of the patient’s current situation in treatment. And since, studies have shown it cuts emergency department visits in half and cuts suicides in half when compared with other mental health treatments.
Linehan has struggled with her own mental health for most of her life, beginning in her teens with a hospitalization at the Institute for Living during the 1960s. Now 73, she recently won the University of Louisville Grawemeyer Award for Psychology because of her impact on the field.
I spoke with Linehan, who was at her office at the University of Washington in Seattle.
You’ve done a lot in your career. When would you say was the pivotal time in your life that set you on your path?
What led me into it was the promise I made when I was at the Institute of Living, that’s when I realized that I was in hell and I had to get out of hell. That’s when I made the vow to God that I would get out of hell and get other people out of hell, and that has controlled my life.
And when you say hell, what do you mean by that?
Hell? Oh, hell is impossible to describe unless you’ve been there. It’s unbearable pain, unbearable emotional pain, is the hell I was in. I learned a lot by reading every book on Nazi concentration camps and looking at how people there survived and what they did. And one thing they did was radically accept the hell they were in, rather than screaming yelling, “You can’t do this to me, it’s against the law.” Because if anybody did that, they were just shot right away.
And how did that relate to mental illness?
Oh, because I told them that they had to radically accept the reality they were in. It’s a little bit like if a person who is supposed to fix your car doesn’t radically accept something’s wrong with the car, they’re not going to get it fixed.
So you developed a new way to treat people with Borderline Personality Disorder. Where did the idea come from?
Actually, the idea started with my attempt to treat highly suicidal individuals, which has always been my main focus. And I started with the standard behavior therapy of the day, which is a long time ago. The only problem with it was that it wasn’t effective. Clients got very upset with me, saying that I was saying that they were in the problem. I had to rethink what I was doing and come up with a new strategy for treating them.
Many of them had Borderline Personality Disorder, but I had never actually heard of Borderline Personality Disorder. [Note: Borderline Personality Disorder wasn’t a diagnosis until 1980.] I was treating in my mind people who wanted to die, which as it turns out is extremely common for people who meet criteria for Borderline Personality Disorder.
I didn’t want anyone to know I was treating Borderline Personality Disorder because it wasn’t viewed as high science, because there wasn’t a lot of research at the time.
Dialectical Behavior Therapy teaches patients mindfulness, regulation of emotions and how to tolerate pain in bad situations. How did you figure out these things would be effective?
At that time, acceptance wasn’t part of psychotherapy, and I realized that I didn’t really understand it very well. So I got the university to give me time off mainly because I informed them that it was part of my job to go and learn acceptance. Mindfulness and stuff like that wasn’t acceptable scientifically. It didn’t have any science — no wonder it wasn’t accepted. So I was kind of in the closet.
I was trying to figure out how do people suffering intensely get out of it. So I tried to figure out who had suffered the most, and I decided it was the people in the Nazi concentration camps. So I decided I would read every one of those books.
What do you think about the mental health system now and how people get care?
My real problem with the mental health system as it is, is that so many people do not necessarily believe that it’s important that the treatment you give has serious research data that it actually works. There are a lot of treatments out there without data. We have no data, for example, that putting a suicidal person in a hospital will keep them alive.
My group, we’re looking at developing online treatment because so many people can’t afford to get treatment or can’t get to treatment, or don’t have enough money to pay for it. We saw that in our studies, where parents had to bring their kid into treatment.
We need a lot more research. I’m hoping there aren’t big cuts in money for mental health treatment research. I don’t know whether they’re going to be cut or not. So I hope they’re not.