Warning, this episode is full of polarities.

Adderall and Xanax, Kernberg and Linnehan,

Buddhism and Catholicism, doctor-inpatient.

But we'll tie most of them together in this final installment

on borderline personality disorder.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

When we left Marshal Innihan last week, she was driving down the coast of Seattle to Shasta Abbey,

a Buddhist monastery in the mountains of California.

In this episode, you'll learn the core skills of DBT that she found there,

how she challenged and was challenged by the psychoanalytic establishment,

and how Marsha Linehan ended up back where she started at the psychiatric hospital in Connecticut.

The regimented life at Shasta Abbey left Linnehan tired, bored and distracted.

But that was all grist for the mill as she practiced meditation day in, day out.

And from these two seeds, she formed the core skills of DBT, mindfulness,

from Buddhist meditation and radical acceptance from willingness. Both of

these are hard to put into words. They are experiences more than they are ideas, but we'll do our

best borrowing from Linahan's own words. Mindfulness is the act of consciously focusing the mind

in the present moment, without judgment and without

attachment to the moment. It contrasts with automatic, habitual or rote behavior. When we are

mindful, we are alert and awake, like a sentry guarding a gate. It is the awareness of what

...