To Hell With Today – and the Philosophy of DBT

Today sucks ram and ass bollocks.

My range of happy experiences since last night are the delightful following:

  • The fabulous agitated depression *
  • Severe depersonalisation
  • Paranoia
  • Anxiety (of course)
  • Insomnia (what a surprise)
  • Racing and disjointed thoughts (related to, or a symptom of, the agitated depression, naturally)
  • Physical restlessness – rocking back and forth, desire to pace blah blah blah
  • No particularly strong suicide ideation for a change, but certainly self-harm ideation

* I wrote about this state before, calling it “Simultaneous Mania and Depression“.  I didn’t know there was actually a psychiatric name for it – a Mixed State – but apparently there is.  In a sense this is reassuring as I was convinced this was an infinitesimally unlikely psychological place to exist and that ergo I must be the only person on Earth thus afflicted.  I am clearly not, however.

I am not anywhere near approaching the state I was in the night of my cousin’s birthday party, but what I described there is basically just a more extreme version of what’s been happening now.

I am trying to “mindfully breathe” (even the name pisses me off) and maybe I should find my stash of rubber bands or a fucking ice cube so I can feel lovely pain and maybe whilst I am at it I should paint on myself with red fucking dye or some such wank.  Heh, is it really bitchy that making snide remarks makes me feel marginally better?

This leads on quite adequately to a long discussion I had with A’s friend, G, on Saturday night.  As stated in the afore-referenced link, G has a degree in psychology and is incredibly clued-up on Eastern (as well as Western) philosophies.

Basically I complained that DBT and mindfulness were both a pile of patronising, meaningless fuck and that in particular even thinking about C’s particular choice of book on these matters made me angry.  I also told him of my recent diagnoses, making him one of only about five “real life” people that is aware of them (though having said that, I’m sure Mummy Dearest has told half the world by now.  On the other hand, maybe not, because perhaps now she knows it is not “just” depression, she is probably ashamed of me because I am certified by a consultant psychiatrist as being clinically insane.  Not a good conversation starter down the golf club, is it?).

My memory is absolutely awful since I lost my marbles, so I tried to take notes on stuff G said, which he found quite amusing (as I would have done had the situation been reversed).  The notes don’t grasp the conversation properly, but they do serve as something of a reminder that I wouldn’t have had otherwise.

The essence of the conversation is that G thinks this stuff has benefit.  He is dubious about Linehan‘s development of the background issues in dialectics, and argued that although statistically DBT has been proven to alleviate some of the typical symptoms in borderline people, there is very little empirical research to back up the actual science behind it.  Nevertheless, he claimed, the actual concept of dialectic argument has a strong and ancient philosophical background.  The main philosophers practicing what Linehan tries to call radical acceptance were the Greek Stoics.  I believe the argument ran that philosophical stoicism allowed the Greeks engaging in it to reach ataraxia (though if I am mistaken in this, please, please point it out.  I was very brave and gave G the URL of this blog so he – or anyone else with knowledge of this – can correct me if I have remembered it incorrectly).

He also told me to look into the works of Max Stirner, his current favourite Western philosopher, and Georg Hegel, who also wrote extensively on the concept of dialectics.  I haven’t done any of this, but it is my project for today and tomorrow assuming I can overcome my mixed episode and all its little idiosyncrasies.

I told G that I would review online material of all the above but that in the meantime I was still dubious about the notion of radical acceptance or ataraxia or whatever the fuck you want to call it these days.  I contended, as I had done here, that to simply accept everything was to cease to have an opinion, and therefore was equal to losing a sense of self, which in my case is something with which I very strongly struggle anyway.  I even went on a similar rant about Hitler, Ahmadinejad etc as I had done here.

G took my point but the man is too clever for his own good and has an answer for everything.  DBT is to be taken in four stages, of which acceptance is one of the early ones.  Once one has made psychological progress and is able to cope and deal with the symptoms of their illness, opinion can be reintroduced to the person  By this stage you are able to see the issues with which you struggle in a more rational, less all-consuming light.

He provided some really good physical analogy for this, which annoyingly I don’t remember.  My very inferior, shite and frankly airy-fairy-cunty alternative analogy is something like you have to take your clothes off to have a shower to rid yourself of dirt, but once you are clean you can put them back on again.  How fucking arsey can you get?  I fail as ever.

G further stated, when I whined and whined about my failure to develop a career and even hold down a job because I am mental, that if anything the intellectuals amongst us are in many ways the more hoodwinked in the world.  He said, quite rightly I think, that those with lower IQs and others who happily work in what some might see as “lesser” jobs are in actual fact much more savvy than those of us that think we are entitled to glamourous careers due to having brains because – funnily enough – they simply accept their lot in life and as such are happier people.  I agreed with him that oftentimes ignorance is very much bliss.

I’m not eloquent at all in my description of this conversation and for that I would proffer my apologies to G.  The reality is that his knowledge and persuasiveness was as strong as ever, and he articulated himself verbally in a much superior way to the way in which I do so do via any medium.

In any case, the problem, for me, is in learning to deal with acceptance of this nature.  I have already alluded fairly extensively to the fact that I have real issues with that.  You can’t just click your fingers and suddenly find that everything is accepted and unjudged in your mind.  So, today, I will try and read about Hegel and Stirner’s philosophies on dialectics, and indeed on the Greek Stoics.  I might well end up completely mind-melted, but at least I am not likely to feel patronised in the way the tossy book from C makes me feel.

Again, a lot of my issues with DBT lie in the presentation of it.  Some of the ideas have merit – though I certainly don’t think they all do by any means – but condescending wank just makes me angry and homicidal, and I would really have expected C to have been aware of this after nearly four odd months of therapy.  But perhaps Messrs Hegal and Stirner can convince me, and in fact I think I am now feeling sufficiently improved from how I felt when I first started writing this entry to actually go and try and read stuff about them.  In some ways writing this blog is cathartic, but in an additional way writing it serves as a decent distraction from fuckuppery.  (Ha – C will be delighted, as writing the blog is one of the activities on my “distraction plan”.  But on the other hand no doubt he’ll be fucking annoyed because he features so strongly in it.  Can’t win.).

At the very least, I can now go to C’s office on Thursday armed with loads of intellectual ammunition.  He’ll tell me that as ever I’m intellectualising matters, but at least he can’t accuse me of not making an effort to engage with this.


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24 Responses to “To Hell With Today – and the Philosophy of DBT”

  1. That’s really interesting thankyou. I would look into that but I’ve got the intellectual ability of a twisted teaspoon at the moment. My C also said that DBT had merit but he understood why it pissed me right off.

    Our days are sounding similar in some ways at the moment. Again we are the same person. I’m finding this reassuring and odd at equal measures.

    Be well me dear hugs x

    • I agree. It is always comforting to know that you’re not the only one going through shite like this, but then one feels guilty for not being outraged that someone else is experiencing it. Plus the odd doppelganger thing is a little strange 😉

      To be honest I’ve been too busy reading your blog and the link you sent me to actually read about Hegal, stoicism et al as promised here! But I will get to it. It’s hard, when in this weird state, to do anything much never mind engage in the finer points of dialectical philosophy. But I want to be a complete bitch and trump C’s ideas about DBT with the really intense intellectual ones.

      I’m sorry you’ve been having such a completely shite time recently. Contrary to what you think, you really don’t deserve it.

      Take care, big hugs xxx

  2. beautifulstones Says:

    My tuppence worth: I agree with some of the DBT stuff (like I think it is useful to learn how to manage strong and overwhelming emotions), but I find it frustrating as I feel like it only deals with the SYMPTOMS of BPD. I hate the label (I have the label emotionally unstable PD which is basically the same thing – just using the ICD rather than DSM) because it is simply a collection of symptoms and says nothing of the actual issue. The best book I’ve EVER read on it is The bio- psycho- social etiology of personality disorders which is not just a check list of symptoms. Anyway that was off the point, back to the point…. I feel like DBT just addresses the symptoms and not the actual cause of the problem. And sure everyone probably needs a bit of both – learning how come you have the issues you have and then how to manage them. But it feels a bit fatalistic sometimes with DBT – you have this problem, you are always going to have this problem so you better learn to deal with it. There are some things I think I always will struggle with, areas where I will be susceptible when things are difficult. BUT I have found that by understanding what the root of the particular issue is, how it formed and then looking at it in a different light – as an adult now, not a terrified child, I can deal with it differently. And eventually things change.

    • I’ll look into that book, thanks for the heads-up, because most of the literature I’ve read thus far is fairly basic so it would be good to look at something decent. I agree that DBT is limited in its capacity to challenge the actual root causes of BPD. Luckily, my therapist is keen to have the DBT material as only a part of the therapy. Our other discussions are fairly freeform but in my view largely psychodynamic in nature, and I do agree that this exploration of the causes of the disorder(s) are necessary.

      The DBT is meant to deal with the overwhelming emotions in the here and now I suppose. I just find it a little confusing to jump from one type of discussion to another.

      Thanks as ever for your thoughts and I am glad there has been some improvement for you. Take care x

  3. Probably a sign of my own somewhat deranged state of mind, but you’re making sense to me. On reflection that’s not very complimentary, is it? Put it this way: I think you’re saner than you think you are. *hugs*

    • LOL, I’m not sure about that one, but thank you anyway 🙂

      It’s odd, I do manage to articulate myself to a fair level here, but then I finish what I am doing and start banging my head off a wall. Or so I did yesterday anyway.

      I suppose (in)sanity is about perception really anyway. Defining it is highly subjective.

      Anyway, thanks as ever for your kind words. Take care and hugs x

  4. I have been following your dbt-hatred from a certain distance so far. I do understand your point, and I see how stuff like mindfullness and radical acceptance can be annoying from an intellctual western background. having an asian background, I grew up with these philosophical concepts in a more natural way. anyway, I do believe that dbt can be useful to deal with your emotions. so I figured, I’ll just add my 2 cents here and you do with it whatever you want :D.

    I have done some dbt-related stuff a couple of years ago. what I mainly remember about it, is that it was very painful. I was forced to remember and to a certain extent re-experience strong emotions in therapy, and learn where they came from and what has caused my reaction to them. one important thing to remember is that you are as crazy as you act, not as crazy as you feel inside. if you can “control” your actions, you will feel more in control of yourself and less of a victim or your “disregulated” emotions. ugh… dunno if this makes any sense.

    as for mindfullness, it’s basically just a way to “observe and monitor” your emotions. you have to be aware of your emotions if you want to regulate and act on them in a more “sane” way. know that many ppl push the mindfullness bit too far towards new age crap. but that’s not really necessary for dbt. you can learn to be aware of your emotions without the esoteric bullshit.

    same goes for radical acceptance. acceptance isn’t approval. it’s just a way to help you relax in a situation that might be unfcomfortable for you. it means that you are aware of your reality and you know which parts of it you can change and which you can’t. it allows you to choose to act in a more intentional way than you might otherwise.

    not really sure if this comment is helpful in any way.

    • It is. Thank you. What you say about controlling your actions makes a lot of sense. I find it hard to do that, but am continually striving for it. Sometimes I succeed; for example, I am usually quite good socially, even if I am absolutely mental internally. People are always surprised when they hear I struggle with mental health problems as I always, apparently, seem so outgoing and ‘personable’. It’s a mask though, and I suppose therapy of any sort is about uncovering the reasons as to why one feels that mask is necessary.

      I appreciate your clarification over mindfulness. I hadn’t really read or thought about it that way before, and in principle I think it’s fair enough. Again with radical acceptance – in principle, the idea is OK. I just have difficulty putting these things into actual, tangible action when I flip.

      I think this touches to some degree on what beautifulstones said. DBT can help treat the symptoms, but more than just that is necessary. To be fair, C is trying to achieve this. I am slowly becoming slightly less contemptuous of DBT (perhaps I have radically accepted it ;-)) but I still struggle with the way in which C’s workbook is written, as I find it highly condescending. That, I think, is the worst part of the whole lot. Having said that, I appreciate that only two chapters have thus far been explore and perhaps that future, more advanced techniques maybe do not assume the reader has an IQ of an amoeba. If they do, though, we’ll have to see if we can find other guidance material on the subject.

      But yes, in terms of the actual practices, I am now more willing to give them a go.

      Thank you for your thoughts – very interesting – and you take care. *Hugs* x

      • the process of learning and applying dbt does actually deal with how the emotions arise and where they come from. understanding the emotions and their causes is an important part of “mindfulness”.

        also, learning your triggers, new thought patterns and coping skills is a way to treat the causes, not just the symptoms. to a certain extent, dbt is trying to “reprogram your brain”. you first learn to act “healthy” despite of “unhealthy” emotions. but if it succeeds, your are able to replace your old “unhealthy” emotions with new more “healthy” ones through that process. in that sense, it does heal the “personality disorder”.

        of course, implementation of dbt always depends on the therapist and the client. and success differs widely from person to person.

        sorry for rambling, explaining the concepts of dbt is a bit of challenge.

        from a personal point of view, I do think dbt could have helped me, but I wasn’t ready at the time. which means I stopped therapy and ran away with my unhealthy coping skills :D.

        good luck with whatever you choose 🙂

    • I disagree about being as crazy as you act, not as you feel. To me most of the time in public I can keep my actions under control but I still feel crazy and it’s that that makes me feel shite not the fact that I can keep things under control on the whole.

      • I’m conflicted on this one to be honest. I can see the argument that controlling your actions can lead to a more stable mindset in some ways, and as I said, I strive for this with great frequency and it appears, outwardly, to be successful. A lot of people argue that if you can convince others of your sanity then you can convince yourself, ultimately and with practice. Perhaps this is part of what DBT tries to achieve, I’m not sure.

        The flip side is that by pretending to be normal when you are not feeling it, everything is pent up inside you and you finally flip. Again, this is something with which I am familiar.

        Overall, whilst I see merit in the idea of crafting your sanity through your behaviour, ultimately it isn’t working for me – not at this stage anyway. The point is the mask is always there, even in private in most cases, but the mentalism hasn’t gone. Perhaps there are ways to address this, but they have yet to be discovered by me.

        Thank you both for your thoughts 🙂 x

      • Similar for me: external behaviour, normal. Train arrives: get on it rather than jump under it. In my head: another story. Who am I, what am I? Who or what is this person who looks back at me when I stand in front of a mirror? Why am I inside this body? True, it’s the same body I’ve always lived in — but why am I lumbered with it? Whose body is it? Body swap anyone?

        • What you’re saying totally resonates with me. I’m sorry you’re having to go through this as well. It’s hard to talk about, but if you never need an “ear” over the internet, you know where I am.

          Hugs xxx

          • Thanks. For now, simply reciprocating the hugs… (it has its uses, this body: used it this evening to persuade a couple of yobs who were kicking at the church door to go play elsewhere).

            Now why am I here at this time of night? Sleep. Sleeeeeep…

  5. beautifulstones Says:

    I just find it a little confusing to jump from one type of discussion to another. — yeah I would too. As a general rule I tend to work on the overwhelming emotions and the here and now, when things are overwhelming and crazy. When they are slightly more settled we work on the causes. However sometimes when things are really emotional and I’m feeling vulnerable we are more able to access the rubbish from the past because I’m less defended. In those cases we work on it, but always try and end the session focussing back on how to manage with all of this.

    Some books:

    Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treament – Joel Paris- this is the one I was talking about. Very theoretical – academic book but I found it really good. It’s pretty expensive to buy I think (its on Amazon), but if you have access to a university library they should have it.

    Lost in the Mirror: An Inside Look at Borderline Personality Disorder – Richard Moskovitz – a book designed for the person with PD. I can’t remember this one that well – but it is on my bookshelf – but generally I find books designed for people with PD a little patronising or oversimplified. I personally found it more helpful to read a combination of books for professionals and books for people with the label.

    Personality Disorder and Community Mental Health Teams: A Practitioners Guide – (Ed) Sampson, McCubbin and Tyrer – something that can be downloaded from the internet

    Understanding Personality Disorder: A Report by the British Psychological Society (2006) – you can download this online.

    Voices Beyond the Border: Living with Borderline Personality Disorder – (Ed) Lucy Robinson and Vicky Cox —collection of writings and poems by people with BPD

    Will try and find the links for the downloaded articles.

    I hate labels because we are so much more than a label. Especially a PD label – because it’s like someone is saying your personality – your very essense – the basis of who you are – is somehow disordered, dysfunctional, messed up. We are the product of our environments and relationships. The problem is there – not IN us. I rebel against it, and don’t use it, and am lucky to have a therapist who doesn’t really care about labels, but it did help me to understand more about the diagnosis.

    Anyway hope this helps.

  6. beautifulstones Says:

    Here are the links:
    Understanding Personality Disorder: A Report by the British Psychological Society (2006) http://www.bps.org.uk/downloadfile.cfm?file_uuid=28ECFB5B-1143-DFD0-7E28-C7CDA21A3E7F&ext=pdf&restricted=true

    Personality Disorder and Community Mental Health Teams: A Practitioners Guide –hmm can only find this as a book online now. I have some of the chapters from this. Can email them to you if you want?

    • Wow, this is great – I really appreciate you taking the time to dig this stuff out for me. Thank you so much!

      Re: the online book, a few emailed chapters would be great – thanks again. I’ll email you about it as I have your address from to confirm comments on the blog. I’ll get on to looking for the others. Funnily enough I was just discussing with A last night the possibility of rejoining one of the university libraries so I could investigate academic texts on these matters as, like yourself, I tend to find most books written for the client pretty basic and patronising. I know that bourach, who has posted on this thread, found benefit in reading that kind of stuff rather than the crap supplied by the CMHTs as well.

      Apparently the most popular book ever written on borderline is “I Hate You Don’t Leave Me” – I was toying with the idea of buying this as it’s only a fiver now, but reviews are mixed. Apparently it’s well-written, accessible but non-patronising, but is pretty out of date (seemingly no revisions since its original publications in the ’80s) and provides a bleak outlook (not that mine isn’t, mind you). Has anyone read or heard anything of this?

      Again, thank you so much – I really appreciate all this information. I’ll give you an email shout now.

      Take care and hugs x

  7. beautifulstones Says:

    Hey. Didn’t get an email from you, but wondering if it went to my junkmail? If you have sent it, can you resend it and I’ll look out for it.

  8. Interesting post. I also hate DBT and all forms of CBT. I don’t need anyone to teach me how to ‘notice’ that I feel like shit. I notice. And I don’t need my behaviour to be changed. My behaviour is such that I am usually the only person who knows how I really feel. CBT and DBT and their bullshit nearly had me a psychotic break. If you ditch the floofy philosophies and just get real, this kind of crap simply teaches people how to pretend, conform, and lie to themselves about their own innermost experience. The last time a therapist mentioned such stupidity to me, I went off on his ass. I didn’t feel bad for it either. I simply radically accepted that he was at a temporary loss and had fallen down the stupid-chute. 🙂 And then he had to radically accept that he’d been called on his bullshit.

    It has been my own deeply felt inner experience that DBT and CBT are very invalidating. I find such rubbish offensive and insulting. You know what else pisses me off? Are therapists really so stupid as to believe that a person is unbalanced if they scream and cry in therapy? I figured that is what brought on having it suggested to me. Well where the hell am I supposed to do it then – maybe in the middle of the supermarket? I told him that I will scream and cry whenever I damn well please and don’t need his permission. That whole incident made me hate him for quite a while and it nearly crashed the whole therapy. People carry their pain and their traumas all of their lives. They don’t need people belittling them when it leaks out sometimes. That stuff is like a poison and I don’t need someone hanging around who will try to stuff it back into me when it escapes. If my pain is inconvenient for others, then that’s just to f*cking bad.

    • I think you’ve hit the nail on the head really. Regardless of the philosophy and my willingness to try *anything*, essentially I share the view that it’s patronising and invalidating.

      Change your thinking. Um…do you think I hadn’t thought of that?

      I know error505 who commented above has made fair points and has argued that these types of therapies do actually tackle some of the core issues of mental health problems – and maybe in some applications of them, they do – but it is largely my perception that even when they work they merely deal with symptoms and not causes. I think that’s why in my case C wants to stick with the other types of therapy too. In fact he hasn’t even mentioned DBT for several weeks. Maybe he recognises my cynicism.

      Your second point is interesting as well. It was because I expressed a desire to, and finally manifested, self-harm, that any of this stuff was ever introduced to my therapy. Hmm.

      I’m glad you managed to get your therapy back on track and hope it is continuing to work out for you. It’s a murky bloody quagmire, that’s for sure.

      Good luck, take care and thanks for your very insightful thoughts 🙂

  9. All it took were the 3 little letters of DBT to zing me back to my more distasteful efforts of balancing the ebb and flow of BP. If I never hear the term “minfulness” again, I will be fine. Truth be told, on paper, some of the treatises I’d read on DBT had the semblance of a meaningful effort at approaching the totality of the person. However, once incidiously seduced into traversing the theoretical and delving into the application, I was sorely disappointed. Having battled with BP for many years, Type I, with notable mixed-state phases, I endured CBT as a method of attempting to bridge myself back into some sense of reality–far too many years wasted, not to mention of my time, lapsing as though it can be at times. DBT attempted to hang more labels upon me, along with even more methods to approach control. Control? I’ve given up on that concept. I never know what each day, hell, each hour, may bring. Looking back, I’ve had periods that were quite tolerated. Nevertheless, the blunt truth of it all is that, more often than not, most periods have been punctuated with that searing, wrenching abject dispair and desolation. There has been far more destruction and turmoil than creation and balance. Due to medical insurance limitations (the US concept of access to good medical treatment is such a joke), I am no longer able to afford to take my medications, much less continue seeing my physicians. I’ve been off my meds before and saw the toll that nearly ended my life then. Is that what I have to look forward to again? Time will only tell. But, based upon how I’ve already succumbed into BP’s seductive wrath, who’s to know just how much time is left. The true measuring stick for me right now? I simply no longer care.

    • Thank you for this insightful and informative post. I will reply in more detail – I’m on holiday at the minute and am thus restricted to Internet communications via my phone – but suffice to say, for now, I agree with every word you say.

      Thanks for stopping by; I’ll reply properly and check out your own blog ASAP.

  10. I look forward to more continued discussions. It’s rare to find someone as equally cognizant of the trials and trubulations of BP, and at the same time discuss it at length with some sense of intelligence. I don’t say that to come off sounding like a snob; it’s just that most who blog are often youthful in their experience and there isn’t a shared sense of knowledge and history re BP and the affects upon our lives. I do invite you to check out my blog. Now that I am off my medicines, my entries are all over the place. There is no telling what I may be up for as I look around to choose to see upon which soapbox I shall stand. 😀 Enjoy your holiday!

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