Abstract
New York: Random House,2020, pp. 340, `. 449.
The book is aptly titled Building a Life Worth Living. The book cover cites that her primary research interest is in the development and evaluation of evidence-based treatments for populations with high suicide risk and multiple severe mental disorders. The book also mentions that in 2018, she was featured in a special issue of Time Magazine on Great scientists: Geniuses and visionaries who transformed our world.
In the 340-page memoir, Linehan traces her journey from a popular and energetic teenager to a severely emotionally disturbed and suicidal young woman who lands in a psychiatric hospital where she ends up spending more than two years. She recalls, whatever she can, the 25 months of in-patient treatment including psychotropic drugs, electroconvulsive therapy, cold blanket treatments (if you may call it a treatment), and seclusion. Afterward, she makes a vow that if she could get out of emotional hell, she would help others to get out of hell as well and to build a life worth living.
The story takes us through her subsequent years of night school and college, PhD in psychology, and development of DBT, which has been considered as a major milestone of behavior therapy for people with emotional instability. Side by side, the author takes us through her own personal journey of spirituality through the Christian Church and Zen Buddhism. There is also a persistent effort from her to reconstruct, historically, the factors at play that had resulted in her illness. She focusses on the interaction of a strong family history of depression and the presence of a chronically invalidating family environment.
Marsha Linehan’s struggle with her own mental illness was covered initially in the New York Times in 2011 in an article titled “Expert on mental illness reveals her own fight.” 1 Interestingly, the story was made public before an audience of friends, family, and doctors at the Institute of Living, the clinic where she was treated for extreme social withdrawal at age 17. The article mentions her psychiatric diagnosis as schizophrenia and that she was treated with thorazine (chlorpromazine) and librium (chlordiazepoxide) in addition to electroconvulsive therapy. It was only much later that she could identify, retrospectively, that a diagnosis of borderline personality disorder would have been more probable.
Linehan dispels an important myth—one that has come to stay despite our scientific temper and rational thinking—our tendency to perceive doctors and other health professionals as perfect or near-perfect individuals. She gives the readers a heavy reality check when she asserts that the two-year psychiatric in-patient and the pioneering psychotherapist featured by the Time magazine are one and the same person. It will not be an exaggeration to suggest that doctors and patients were always perceived as hailing from different planets and may continue to be regarded as very much so. Linehan successfully takes a dig at this fundamental misconception.
A big positive of the book is its title theme—building a life worth living. Through her personal and therapeutic experiences, Linehan reiterates, time and again, the importance of building a worthy life while being in the middle of emotional stress, difficulties, and myriad weaknesses. It is about accepting both the thorns and the roses and trying to build a healthy life from whatever circumstances available.
Of particular interest to psychiatrists would be the area where she discusses her reasons for not becoming a psychiatrist when she could have: She initially applied to medical schools with an aim of becoming a psychiatrist in a state hospital. But she was not satisfied with the data supporting the efficacy of mental health treatments and the quality of research in medical schools. So she thought she would fail in her attempt to help patients if she became a psychiatrist. So she decided to become a researcher in psychology to develop treatments which could be proven to work. There is also an entire chapter on DBT in clinical trials, which describes her submissions to the Archives of General Psychiatry and the initial rejections. There are also pages where she describes, in some detail, about her interactions regarding DBT with reputed psychiatrists Otto Kernberg, Allen Frances, and Charlie Swenson.
One area where the memoir becomes a bit enigmatic is Linehan’s foray into Zen Buddhism and subsequent evolution to become a Zen Master. She balances the spiritual seeker and the researcher effortlessly, though it is doubtful whether she can carry her readers along without instilling a bit of skepticism in them.
In conclusion, Marsha Linehan has written a bold and honest memoir, which may be a formidable task for many of her stature. In it, we see the building blocks of a real life—complete with all its dents, flaws, imperfections, and noteworthy accomplishments. It provides, in ample measure, that rare thing which every sad soul seeks desperately—hope.