The woman who went to hell — and came back with a new kind of therapy

What is the quintessentially human endeavor? To face the most terrifying parts of yourself, striving towards truth and goodness of spirit, and at the end of a long journey of self-discovery, to be able to lead others through theirs. To find, in the particulars of one’s own suffering, something of the universally human, and to convey that insight to the world.

This has been the life led by psychologist Marsha Linehan, and the product of her labors has been dialectical behavioral therapy, one of the most thoroughly evidenced forms of talk therapy. To understand this treatment, one needs to understand the woman behind it, and as they say, the child is the father of the man.

Although the young Marsha lived in material comfort and was active and social during high school, her childhood contained the seeds of discord and conflict. Her mom, a controlling and overbearing woman, inherited from her conservative culture an image of the perfect woman, which Marsha always struggled to live up to. Seeing that her sisters seemed to fit that expectation better than she did, she never felt like she could please her mother, no matter what she did. Moreover, she didn’t have anyone in her life to support her through these complicated feelings.

At the age of 18, Marsha fell into a deep depression and started to cut herself regularly. Her behavior prompted her parents to commit her to a mental institution, where her bouts of self-harm became even worse, and developed into unshakable thoughts of suicide. Eventually, she became a prisoner to waves of uncontrollable emotions, completely powerless to her own self-destructive tendencies, as if her body was inhabited by a hostile enemy.

At the institute, Marsha was subjected to crude treatments like cold pack therapy, which involves being stripped naked, tied to a bed by harnesses, and wrapped in wet sheets which had been kept in a freezer overnight. She also spent extended periods of time in isolation.

Eventually, Marsha’s condition improved to the point that she didn’t need to be hospitalized, although she still struggled with suicidal ideation for a long time. Inspired by her own experience to develop a treatment plan for other suicidal people, she focused on suicide and worked her way into the most renowned behavioralist graduate programs in the country. This was how dialectical behavioral therapy began.

As its name suggests, dialectical behavioral therapy is based on a continuous dialogue between patient and therapist. Specifically, the two enter into a therapeutic partnership in which they tackle the patient’s problems using specific life skills, and switch between change strategies and acceptance strategies. The therapy also derives a great deal of its philosophy from Zen, which Marsha studied in an official capacity.

Dialectical behavioral therapy has been proven most effective for those patients diagnosed with borderline personality disorder, a somewhat controversial and ill-defined condition which involves extreme emotional swings, bouts of self-harm, self-destructive relationships, intense fear of abandonment, and self-loathing. Thousands of people have been helped out of their suicidal ideation and achieved a greater quality of life thanks to Marsha’s ideas: they have achieved, in her own words, the power to “build a life worth living”.

Throughout her struggle and eventual recovery, Marsha kept a religious outlook. When she was young, she was fascinated by the self-sacrificial element of Christian saints, which instilled in her a predication for ascetism. Her mantra become “Thy will be done”, and she perceived her own endeavor as an instrument of the divine.

The essence of Marsha’s religious drive is to share with others the tools which helped her out of what she describes as her own personal hell. In what resembles the Buddhist notion of a Bodhisattva, that enlightened one who comes back to society to help others become free from suffering, Marsha experiences her whole life as an attempt to distill the elements of her own self-help to others, in what eventually became dialectical behavioral therapy.

Describing a moment of realization she had in the mental institution, she says:

“There and then, I made a vow to God that I would get myself out of hell and that, once I did, I would go back into hell and get others out. That vow has guided and controlled most of my life since then”

There is no more deeply human endeavor than that: to suffer, to be graciously given enough time and room for self-reflection to transcend that suffering, and then to teach others how to come out of their own suffering. That is purity of spirit, and it’s perfectly exemplified in Marsha Linehan — may God be pleased with what she’s done.

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