Borderline Family Dynamics in Marsha Linehan's Memoir

Wikimedia Commons: Self Harming With a Knife by Santari Viinamaki, CC Attribution/Share Alike 4.0 International

Dialectical Behavior Therapy

The predominant, most widely applied school of thought for psychotherapy with borderline personality disorder (BPD) is dialectical behavior therapy (DBT). Marsha Linehan, a psychologist at the University of Washington, is the person who came up with the theory and treatment.

She believes that a combination of a genetic propensity to be over-reactive combines with an “invalidating environment” to produce the disorder. Studies that attempt to identify genetic propensities tend to have major flaws in distinguishing normal neural plasticity in response to the environment from purely genetic effects, making that part hard to prove. The invalidating environment is clearly that within the patient’s family of origin, although this point is seldom spelled out in the DBT literature.

Marsha Linehan Writes About Her Own Childhood

Linehan, in a 2011 article in The New York Times, "admits that when she was younger, she ‘attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on.’” She said, “I felt totally empty.” Self-injurious behavior and feeling empty are two of the hallmark symptoms of BPD. Did she have the disorder? She wrote that BPD is a diagnosis "that she would have given” her young self.

When she recently published her memoir (Building a Life Worth Living: A Memoir), I was intrigued particularly about her family of origin and whether there were any hints of psychodynamic conflicts members may have shared. I had wondered why, if she came from such a family, she rarely wrote about how to address invalidating family members, as opposed to merely teaching patients “radical acceptance” (using mindfulness to calmly accept the reality without trying to change anything) of their parents’ ongoing behavior so as to react much less.

If she herself had BPD, and if an invalidating environment is one of two main causes of the disorder as she theorizes, how come she does not address this very much in her treatment plan? She has written that she sometimes does family therapy but mentions it only briefly and without any details both in her memoir and her primary book about DBT.

I obviously do not know anything for certain about her family based just on what she chose to reveal in her memoir. However, her descriptions seem to possibly indicate family conflicts over gender roles—particularly career aspirations for women—and religion. If she were my psychotherapy patient, I would explore that as a possible explanation of her family dynamics, as evidenced by the following descriptions in her memoir.

Dr. Linehan Describes Her Family's Behavior in her Memoir

She herself draws the parallel between her mother’s experiences growing up and her own conflicts with her mother. The mother’s parents lost their fortune and died young. Her mother then took a job to support her two younger brothers but later moved in with a maternal aunt, who drilled into her head that she was to be a social butterfly and attract a successful businessman for a mate. Which she did. Yet she never seemed particularly enamored of her husband.

In particular, her aunt told her she had to lose weight to be more attractive. She did that. She never again had a paying job but later was extremely active doing charity work and also painting. Her art was admired and was hung up prominently in their house, but Dr. Linehan did not know as a child that her mother was the artist. Traditionally, women could work as long as they didn’t get paid and thereby threaten their husband’s image. Mom did all this work despite having six young children.

The author writes that marriage and children were most important for Mother as they generally were for her generation when she grew up. But was she just following her family’s rules?

When Dr. Linehan was a teen, Mom tried compulsively to get her to do the same thing her aunt made her do—unsuccessfully. In particular, Mom constantly nagged Dr. Linehan about losing weight. Dr. Linehan writes that the thing she wanted to do more than anything was to gain her mom’s approval, but somehow she couldn’t manage to do this one thing—which her mother had been able to do—in order to get it.

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Dr. Linehan writes that she knew that Mom’s relationship with the great aunt was the reason her mom was so critical of her but does not discuss why her family acted out this issue in the first place, nor how it might have been transmitted to her. Again, her solution in DBT seems to be radical acceptance.

I would start to explore with her the possibility that she actually was doing what her mother seemed to need her to do— in effect acting out her mother’s repressed ambition, so clear in her non-family activities—so Mother could experience her success vicariously. And then trying to put up with Mom constantly invalidating her frequent, high profile, and very impressive career accomplishments.

When it comes to religion, the author was a practicing Roman Catholic throughout her life and says that her mother “gave” that to her. However, in the book she frequently criticizes the church for such things as rampant sexism and belief of the pope’s infallibility. She later started to mix Catholic ideas about God with Zen Buddhism.

Further evidence in her history suggestive of conflicts over religious beliefs concerned marriage: She couldn’t marry the guy whom she most loved because he wanted to enter the priesthood—even though he never did and eventually married someone else. She wouldn’t marry her next boyfriend because he was an atheist. Going from one extreme to another and ending up in the same place—single—is a hallmark of an intrapsychic conflict.

Mixed messages from parents conflicted over the role of being parents is, in my theory, the major characteristic of families with BPD members, and this one may qualify. Her mother having six children and no apparent career might be evidence for such a conflict. Dr. Linehan was hospitalized with self-cutting and suicide threats for over two years just weeks before finishing high school.