Friday, June 24, 2011

I'm tempted to report this guy as "inappropriate"

There has been a tremendous outpouring of positive response from New York Times readers to the self-outing of Dr. Marsha Linehan. Dr. Linehan is the creator of DBT therapy, whose story of recovery from a diagnosis of schizophrenia appeared in yesterday's paper.

Perhaps you can spot the problem in Mark's take on mental illness. (Well, there are two actually.)

Providence, RIJune 24th, 20119:41 am

Dr. Linehan has done a great service to all people who suffer from emotional and mental problems, and she deserves tremendous praise for having the courage to reveal her personal story. Her story gives hope to those who read it, but the story is more complicated than the Times reports.

Having practiced psychiatry, child psychiatry and primary care medicine for 20 years, I have been impressed that mental illness is a concept that is not as simple as it is often portrayed, and that by oversimplifying it, in tends to stigmatize many people. To begin with Borderline Personality is not a unitary concept, but an aggregate of behaviors and mental and emotional experiences that varies in its intensity and characteristics from one person to the next. There may be 20 or more variants of borderline personality. Many patients who do not meet the DSM criteria are diagnosed with "borderline traits". Many diagnoses in the DSM are probably best not viewed as mental "illnesses" but rather problems that have complex social, cultural and economic contexts. Among these should probably be adjustment disorders, learning disabilities and substance abuse disorders. While I would agree that Schizophrenia and Bipolar Disorder are true mental illnesses, we must recognize that sometimes these terms have been used to describe borderline patients and other patients out of countertransference more than because the patient truly met the criteria, out of an expression of anger and frustration at the process of treating people with provocative behavior.
Personality disorders have a strange place in the pantheon of mental disorders (By the way, what is a disorder? Is it equivalent to an illness or something different). As Dr. John Oldham has written in his books on Personality Disorders, these conditions reflect a spectrum of personality traits that range from the normal to the pathological. The pathological is largely defined by the extent of the traits.

Recommend Recommended by 0 Readers Report as Inappropriate.


  1. Rossa,

    Psychiatry is a religion.

    They can't have people getting "well" and "moving on with their lives."

    They have to stop that.
    It's part of their religious doctrine.


  2. His comment totally pisses me off. How typical. -kimbriel

  3. If psychiatry didn't cling to schizophrenia, there would be nothing left. I'm thinking about starting a T-shirt campaign. "Spot the person with the "true" mental illness?" Seriously, this stigmatization of schizophrenia by psychiatry has got to stop!

  4. I've said it before and I'll say it again. Psychiatry NEEDS the "schizophrenic". NOT the other way around. -kimbriel

  5. Rossa,

    I can think of no more harmful word in the world today than "schizophrenic".

    It's a frightening term... an ugly word.

    Only psychiatry could have come up with a word that comes from the Greek, 'split'... only to have to explain that it does not mean the person has a 'split-personality.'

    I hope we will FINALLY ban that word, once-and for all!

    Having grown up in Texas (past 50 years)... it reminds me of the early 1960s, where blacks lived on the other side of the tracks... and where whites used the 'n' word.

    It wasn't used in our home. Not once!

    There are few words that make me feel cold inside... 'schizophrenic' is one of them.

    In other words, to hear the term 'schizophrenic' literally makes me feel sick!

    Here in the U.S., we've moved from the 'n' word to electing our first black president.

    I look forward to the time when people have been diagnosed with such inhumane labels take their place in our society.... as 'equals.'

    IT'S TIME!

    Duane Sherry

  6. I have a somewhat different take on this psychiatrist's comment. He sounds like someone who is slowly waking up, but still has a ways to go before his eyes are fully open. At least he recognizes that "mental illness is a concept that is not as simple as it is often portrayed." Everything he says about borderline personality disorder is actually equally true of the conditions he still considers "true mental illnesses," but he isn't willing to see that, yet. I think there is hope for him. The interesting question is, why does he now feel ready to count BPD as something other than a true illness? It's because Linehan has shown through her work and her personal example that so-called BPD can be transcended. No one looking at her in her late teens would have thought she wasn't "ill." But look how well she's done and how many she's helped. This argues strongly against the idea of an enduring brain disease that dooms one to a diminished life. So the psychiatrist now questions his DSM's dogma about BPD. But there are people who looked fully 'schizophrenic' and fully 'bipolar' who are doing equally well and helping others just as much. Eventually, this doctor may well discover that, too, and perhaps become a champion of the cause. Sure, he is only half-there, but that's a lot better than the field as a whole.


I am no longer approving comments. All I ask is that you be respectful of others and refrain from using profanity.