Living Bodhisattva

I want to share something significant.  It's another post about a therapist-teacher in my "lineage": Marsha Linehan.  I don't use the term Bodhisattva lightly.  Marsha Linehan is responsible for decreasing suffering on a grand scale, people.  The occasion for this post is that she has now "come out" about her own history of severe mental illness.

Courageous

I have been in the field of mental health long enough to have seen how things were before her therapy, DBT (Dialectical Behavior Therapy) was widely used.  And it was ugly.    

Marsha Linehan developed DBT in the early 1990's for people with Borderline Personality Disorder (BPD).   Prior to DBT, people with this diagnosis were pretty much the lepers of mental health.  Mostly women, usually trauma survivors, some broad-brush features of BPD are:  Extreme emotional sensitivity -- like having no skin -- and the concomitant extreme ups and downs in mood, a tendency to see things in a very polarized way, engaging in self-injurious behavior and / or frequent suicide attempts.  Therapists in the past did not have effective tools to think about or deal with this high-risk, high-suffering population for whom traditional therapies often did not work.  So therapists -- in the face of this tremendous, excruciating pain, ostensibly with the responsibility to relieve that pain, and an inability to do so -- would become frustrated.  Sometimes even experiencing rage at the patient.  Unable to tolerate or even admit their own helplessness and rage, they would often blame the patient for "manipulation,"  not wanting or not trying to get well.  And reduce their behaviors to "trying to get attention."

This is probably why she couldn't have "come out" a minute sooner.

This article reveals Linehan's account of her own 2-year(!) psychiatric hospitalization in the 1960's, which included electroconvulsive therapy, hard core antipsychotic and sedative medications, Freudian therapy and isolation.  Truly the dark ages*.  Things maybe got a little better in that by the 80's and 90's they stopped keeping people with BPD in the hospital for long durations.  Though that didn't stop therapists from dealing with their own helplessness by turning people with BPD into caricatures, or worse.

I have heard colleagues on the crisis phone line I used to work for verbally demean clients, and after hanging up, feel justified and bemoan how the caller was "such a Borderline."  Also have heard of clinical supervisors end all discussion of cases because they were "just a Borderline."  Therapists in general were so hostile to people with Borderline that it became a pejorative term in the field.  Early in my career I witnessed a woman with this diagnosis in a hospital being strapped to a gurney.  There are some situations in which this might be appropriate to protect someone from self-injuring. It was the extra words that the hospital employees used, getting close to her face and saying, "There, now you made us tie you down.  Now you got what you wanted.  Are you happy now?  Huh?"  Remember, many (not all) of these people are survivors of violence, including childhood sexual abuse.  It makes my guts churn just thinking about it.

So here comes DBT treatment:  It's a Cognitive Behavioral Therapy / Zen fusion.  Marsha Linehan, a clinical psychologist and researcher had also been practicing contemplative prayer in the Catholic tradition for decades.  She had also become a serious Zen student.  She took on this patient population that others wouldn't touch with a ten foot pole, and figured out how to operationalize and teach the skills of mindfulness, step by step.

The dialectic in dialectical behavior therapy is an ongoing search for synthesis of polarities.  The primary dialectic in this treatment is Acceptance and Change.  The revolutionary part of this treatment, in my mind, was the acceptance part.  Half of the treatment is about expressing compassion, and validating the patient's experience, sometimes called "seeing the function in the dysfunction."  But this is only half.  Acknowledging and validating someone's feelings is indeed powerful but in some cases, there's an urgency and a sense in the client coming in with REAL life-or-death problems that need SOMETHING.  NOW!!!  DBT includes many many practical skills to place in clients' hands.  Oh that didn't work?  Here's ten, twenty, fifty more things you can try.

This is another primary dialectic

Mostly, though, DBT is for therapists.  It gives therapists a structure within which to work.  It requires that this work be done by team.  That there be a classroom component for teaching skills in addition to the individual therapy component.  And it requires that team to practice the skills themselves, and on each other in a regular meeting.  Marsha Linehan wrote a textbook (dense as hell), and a skills training manual.  The training manual details out step-by-step, session-by-session how to run a DBT class.  The textbook guides the creation and maintenance of a DBT program.  A handful of colleagues and I followed these to the letter in the rural county mental health agency I worked in, and no shit, it worked!  Sometimes I felt like I was emergency-landing a plane with Marsha in my headphones talking me through the steps.   

While I was practicing DBT in this agency, it didn't take me long to realize I needed to deepen my own mindfulness practice somehow.  Then this Zen monastery opened up in the county I worked in, and well, one thing led to another.

Marsha has some serious fans, of course, and I'm unashamedly one of them.  I often joke that I'll make a bundle off my "WWMD" bracelet line.  When she gave a training here, I was able to personally give her one of the singed-robe Jizo Bodhisattva statues made by the monastery.

I have always seen her as a manifestation of  Jizo Bodhisattva going into the hell realms to get others out.

Marsha Linehan, again, with optimism and fearlessness, has done the therapeutic community and the clients we see a tremendous service.  Thank you.


*These meds continue to have their useful place for certain diagnoses and situations, and ECT, now apparently much more refined, is reportedly making a comeback as more of a scalpel rather than the chainsaw it once was.