Brain In Balance

In 1961, eighteen-year-old Marsha Linehan was locked inside a seclusion room at one of America’s most prestigious psychiatric hospitals.

Decades later, she would create a therapy designed for people suffering the way she had.

At the Institute of Living in Hartford, Connecticut, Marsha was not a researcher.

She was the patient doctors could not figure out how to help.

She lived with overwhelming emotional pain and repeatedly tried to harm herself.

When staff could no longer keep her safe, they placed her in isolation.

The room was almost empty.

A mattress.

Bare walls.

A locked door.

Sometimes Marsha would strike her head against those walls until staff restrained her.

Treatment became increasingly intensive.

Powerful medications.

Electroconvulsive therapy.

Months inside the hospital.

Nothing seemed to reach the pain underneath.

She remained there for twenty-six months.

And somewhere during that period, alone in that room, Marsha made herself a promise.

She would find a way out.

And if she ever did, she would come back for the others.

She left the hospital in 1963.

Her evaluation did not describe some miraculous recovery.

She simply began rebuilding.

Marsha moved to Chicago.

She worked as a clerk for an insurance company.

Lived at a YMCA.

And spent evenings volunteering at a suicide-prevention hotline.

Night after night, she answered calls from people whose desperation sounded painfully familiar.

She understood them because she had been them.

Then she went back to school.

Night classes became university study.

University became graduate school.

Eventually, Marsha earned a doctorate in psychology.

But she carried a secret.

She feared that if colleagues learned about her psychiatric history, they would stop seeing a psychologist and start seeing a former patient.

So she hid it.

She wore long sleeves to conceal the scars on her arms.

She presented research.

Worked with clinicians.

Entered the same psychiatric establishment that had once locked her behind a door.

And she deliberately chose the patients many professionals considered nearly impossible to treat.

Chronically suicidal women.

People who repeatedly harmed themselves.

People living with extreme emotional instability.

Marsha tried conventional behavioral therapy.

It failed.

She told patients their behavior had to change.

They heard something different.

You are the problem.

Sessions became confrontational.

Patients felt judged.

Marsha realized something was missing.

Demanding change from someone drowning in emotional pain could sound like denying that the pain existed.

But simply validating suffering without teaching new behaviors could leave that person trapped inside it.

She needed both.

Acceptance.

And change.

At the same time.

Marsha began combining behavioral science with ideas influenced by Zen practice and mindfulness.

She taught patients practical skills for surviving moments of crisis.

How to tolerate distress without making it worse.

How to regulate overwhelming emotions.

How to communicate effectively.

How to remain present.

But beneath those skills was a radical message.

Your suffering is real.

And you still have to build a different life.

Two truths that appeared contradictory could exist together.

A dialectic.

She called the approach Dialectical Behavior Therapy.

DBT.

Then she tested it.

At the University of Washington, Marsha conducted clinical research with the kinds of patients who had long been labeled untreatable.

The results changed everything.

Self-harm decreased.

Hospital visits fell.

People who had spent years cycling through psychiatric emergencies began building more stable lives.

The patient once considered hopeless had created a treatment for hopelessness.

DBT spread.

Hospitals adopted it.

Clinicians trained in it.

Manuals were published.

Marsha became a respected professor and one of clinical psychology’s influential researchers.

But she still kept one thing hidden.

Her own story.

For decades, the sleeves remained down.

Then, in 2011, Marsha returned to the Institute of Living.

The same hospital where she had once been confined.

This time, she entered through the front doors as a distinguished psychologist.

She stood before doctors, staff, and patients.

And finally told them who she had been.

She described the locked room.

The treatment.

The despair.

Then she revealed the scars she had hidden for decades.

She told the patients:

She had been one of them.

The promise made by a frightened eighteen-year-old had finally come full circle.

The institution that once struggled to treat Marsha Linehan would eventually use the therapy she created to help people experiencing the same kind of suffering.

Once, she sat behind a locked door while professionals wondered what to do with her.

Years later, she gave them an answer.

The system called her untreatable.

So she survived long enough to invent the treatment.