The Mystery of Borderline Personality Disorder

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Another skill Linehan taught Lily (and many others, via a popular DVD called Opposite Action) was an anti-anger technique for social situations: "Don't make the situation worse," Linehan counsels on the DVD. "And if possible, be a little tiny bit on the kind side. O.K.?"

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If some of this sounds like advice you heard in kindergarten, it should. Remember that borderlines have never learned to regulate their emotions. It's important to note that Linehan doesn't just practice tough love with her patients; she also tells them she knows they are hurting and doing the best they can. She emphasizes that she believes in them even though many therapists have tossed them aside. "Clients cannot fail," she says. "But both treatment and a therapist can fail." Both compassion and irreverence, both validation and tough love — these are the dialectics at the heart of Linehan's approach.

One criticism of Linehan's Zen-derived method is that for some patients, it seems too foreign, too removed from Western experience. Linehan knows her therapy works for most people, but that doesn't mean she's unwilling to list its faults. "It takes too long. There are too many components. It takes too much training for therapists," she says.

Such shortcomings have not dissuaded other therapists from learning Linehan's techniques. Some 10,000 of them have been trained in dialectical behavior therapy, and Linehan, to her dismay, has become something of a cult figure. "Cults in psychology hurt patients," she says. "People should try whatever works, not my therapy because it has my name on it."

Lily, for one, is glad that it's the therapy she did try. One of her favorite films used to be James Mangold's 1999 adaptation of Girl, Interrupted, in which Winona Ryder plays a real-life borderline author. When Ryder's character learns she has received a diagnosis of borderline personality disorder, she indignantly asks, "Borderline between what and what?" It's a question that weighed on Lily for years and one that many of us may start asking if borderline diagnoses continue to increase. But today Lily is able to laugh about the film because she knows, finally, that the answer doesn't really matter. The key is not defining that uncertain borderline but learning to be happy there.

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