Marsha M. Linehan - Building a Life Worth Living: A Memoir

M ARSHA L INEHAN HAS personally treated hundreds of the most difficult patients, but her very first was by far the toughest. This was a troubled and troubling teenage girl who had been hospitalized for more than two years, much of it spent isolated in seclusion. Her life had reduced itself to a repetitive cycle of self-harm from burning, cutting, violent head-banging, and suicide attempts. High doses of every conceivable medication, alone and in combination, and multiple trials of shock treatment had no effect. Psychotherapy appeared impossible, because the girl was so bitterly angry and mistrustful. Her hospital record revealed how much helplessness, desperation, frustration, and anger she provoked in the staff. She was described as the most incurable patient they had ever seen and was unceremoniously discharged, uncured.

But things worked out quite differently than anyone might have expected. The chaotic young girl matured into a highly successful woman, became a psychotherapist and therapy researcher, and went on to invent a remarkable behavioral therapy that has helped hundreds of thousands of people all over the world. She was, of course, Marsha Linehan. Marsha found a way out of her own personal hell that allowed her to lead others out of theirs. She developed practical ways of taming her own self-destructive and provocative behaviors that could easily be learned and widely taught.

Only a few of us knew Marshas past before she revealed it in a speech that was given prominent coverage in The New York Times a few years ago. It took great courage to go publicto share the most painful and private moments, ones that anyone might naturally want to forget and protect. My esteem for Marsha, already profound, deepened much further. Marsha has never been timid in anything she has done, and this bold act was not just personally liberating but, more important, it was liberating for everyone suffering from similar problemspast, present, and future. There is always hopeseemingly incurable people routinely get cured. Marsha has walked the walk; she has lived it, not just talked it. This is an inspiration for patients and therapists never to give up, even when the future looks unrelievedly bleak and giving up seems the only remaining option.

The therapy Marsha created is called Dialectical Behavior Therapy. DBT is the most effective treatment for highly suicidal and self-destructive people, often people diagnosed with borderline personality disorder (a terrible term, but we seem to be stuck with it). These are people who suffer greatly, and also cause great suffering around themto family and friends, and to therapists. They have the highest incidence of completed suicide and suicide attempts. And they often tie therapists in therapeutic knots because of their complex, unpredictable, and sometimes emotionally and physically violent behaviors.

Before Marsha developed DBT, therapists often gave up on treatments that seemed futile and going nowhere, and patients often ended up in the hospital or dead. It was hard to find the damsel in distress hidden under the threatening dragon. This is no longer true. During the past two decades, 10,000 therapists worldwide have been trained in DBT, bringing emotional relief to hundreds of thousands of the most deeply disturbed psychiatric patients. And in 2011, the editors of Time magazine named DBT one of the 100 most important new science ideas of our time.

In the past half century there have been just two really influential clinical innovators in the field of mental health. One is Aaron Tim Beck, who developed cognitive therapy in the 1960s. The other is Marsha. That she has made this major contribution to psychology, a field previously dominated mostly by men, is testament not only to her intellectual creativity but also to her determination to overcome all obstacles.

And there were more than a few. I first met Marsha in the early eighties, when I was on the committee of the National Institute of Mental Health that decided which psychotherapy studies to fund. Research on BPD is a hard sell. The studies have many potential fatal flaws that can give critics an excuse to blackball. And Marsha was blackballed. But she stuck to her guns and kept on submitting better and better grant proposals, and she finally convinced even the most ardent of naysayers.

Many people come up with good ideas but dont have what it takes to get them into the world. Marsha has the charisma, energy, commitment, and organizational skills to turn dream into reality.

In myths the world over, heroes must first descend into the underworld, where they are faced with a series of epic challenges to be overcome before they can prevail in their heroic life journey. Once they succeed, they return to their country bearing some special new secret of life. Marsha was plunged into an unbelievably challenging journey of self-discovery, far away from family support, and returned bearing precious insights to help turn abject misery into lives worth living.

Thank you, Marsha, for being you, for courageously sharing your story, and for imparting the wisdom gained from your life of suffering, discovery, and love.

D R. A LLEN F RANCES

Professor Emeritus of Psychiatry and Behavioral Sciences

Duke University

I T WAS A beautiful summers day, toward the end of June 2011. I was standing in front of an audience of about two hundred in a large auditorium at the Institute of Living, a renowned psychiatric institution in Hartford, Connecticut.

Uncharacteristically for me, I was anxious about giving my talk. I was there to tell the story of how, more than two decades earlier, I had developed a type of behavioral treatment for highly suicidal people, known as Dialectical Behavior Therapy (DBT for short). It was the first successful treatment for this population of people who experience their lives as being in hell, so miserable that death seems to them a reasonable alternative.