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.
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