Mayday! Mayday! The Dialectical Behavior Therapy Approach to Our Country


What do the United States and borderline personality disorder have in common?

split flag



Over recent weeks, I have brought up various distress signals that I see coming out of our country. They began to remind me of our professional challenge in treating patients with borderline personality disorder (BPD).

BPD was historically very difficult to treat. A great step forward was Marsha Linehan, PhD’s dialectical approach. Dialectical is a method of processing opposing ideas to find the truth in a synthesis. For instance, each generation has the challenge of synthesizing the past with the present challenges. For those with BPD, that could mean working with the tension between acceptance of the status quo and the need to change. Linehan herself had been viewed as a hopeless patient, but feeling that God still loved her, as well as applying Zen principles to the traditional cognitive behavioral theory, made for a breakthrough for her and other patients.1

So it seemed to me with our country. Actually, our 2-party system is set up to be dialectical, and when power alternates in the 2 parties, consistent improvement is difficult. In a country that emphasizes the individual, balancing with our collective is also a dialectical challenge.

Applying individual-based DSM psychiatric principles to a country is a very risky proposition, may seem like inappropriate stereotyping, and if it feels a little desperate, it is. Can the characteristics of BPD be writ large to our country? Let’s see by looking at various aspects of BPD.

Take what might be deemed our nation’s symptoms. They include rapid mood swings, explosive anger, stress-related governmental paranoia, and the predictions that our country is heading towards self-destruction, all of which are consistent with BPD patient symptoms.

How about the presumed social determinant factors? Common with those with BPD are inconsistent parenting styles, lack of attention during development, and violence at home. Seems to me that could correlate with the frequent changes in governmental policy, a lack of attention by the party in power to the opposition party that followed, and our country’s history of unresolved traumatic violence.

It is common in inpatient wards for those with BPD to split the staff. Correspondingly, we see much splitting in our country politically, culturally, and generationally. An individual can regress under perceived risk. Is our country regressing to a Bion basic assumption group of dependency and pairing off?2

Even if this analysis is appropriate, how will it be practically useful? After all, politicians and others in conflict are not liable to ask for psychiatric help. BPD therapy includes mindfulness, distress tolerance skills, and skills for negotiating social relationships. Some of that can be taught. If Linehan herself overcame such severe borderline symptoms to both discover and become a therapeutic model, can our country do so, too?

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.


1. Linehan M. Building a Life Worth Living: A Memoir. Random House Publishing Group; 2021.

2. Alexander RP. Bion on groups. Melanie Klein & Object Relations. 1993;11(2):3-10.

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