News for today's 2018

FIVE EU COUNTRIES CALL FOR NEW MILITARY “STRUCTURE”

6:41 AM Tukiyooo 0

<br /> <br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Jj1TE3Dd4Qx_s565UkrbSrboMKGuMpLMb1OwNYaF13oi-7pZ7AO-EjF_hJrm4mggEC3IO7Usgzlcf5e3iOIsY8Xpqu8wkqR8GtaQP7gqxh7kjLPRmEOMBQt3NEJTT-L0GAFnf2BzpsVl/s1600/250px-Coat_of_arms_of_the_European_Union_Military_Staff.svg.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Jj1TE3Dd4Qx_s565UkrbSrboMKGuMpLMb1OwNYaF13oi-7pZ7AO-EjF_hJrm4mggEC3IO7Usgzlcf5e3iOIsY8Xpqu8wkqR8GtaQP7gqxh7kjLPRmEOMBQt3NEJTT-L0GAFnf2BzpsVl/s1600/250px-Coat_of_arms_of_the_European_Union_Military_Staff.svg.png" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US;">Coat of arms of the EU military staff</span></td></tr></tbody></table><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="color: red;"><span style="font-size: x-large;">EU MILITARY PRIORITIES</span></span><span style="mso-bidi-font-weight: bold;"></span></span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">Five leading EU countries, but not the UK, have said the UNION needs a new military “structure” to manage overseas operations.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">The foreign and defence ministers of FRANCE, GERMANY, ITALY, POLAND and SPAIN issued the call <a href="http://www.blogger.com/blogger.g?blogID=6896989063397229776" name="rdb-footnote-link-1"></a>in a joint communique after a meeting in Paris on Thursday (15 November).</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">The paper says: “We are convinced that the EU must set up, within a framework yet to-be-defined, true civilian-military structures to plan and conduct missions and operations.”</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">It adds: “We should show preparedness to hold available, train, deploy and sustain in theatre the necessary civilian and military means.”</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">It lists a number of EU military priorities for the coming years: helping SOMALIA to fight Islamists and pirates; “a possible training mission to support the Malian armed forces” in reconquering north MALI; “assistance to support the new LIBYAN authorities” against Islamist militias; “normalisation” of the Western Balkans; “conflict resolution” in GEORGIA; and police training in AFGHANISTAN.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh0HTCMW31Qym7uMGcytzIXh128n1sNIrNzjOYjvLXW1G_y8WUglfYM0CmmcISBodMPZ375CwLHY77sjM7aazX0usafWGY-RJKqzwQlDlRG8vlI9wsIJfmho3gdBOJi339J8Kad_zXZRDU/s1600/callmember.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh0HTCMW31Qym7uMGcytzIXh128n1sNIrNzjOYjvLXW1G_y8WUglfYM0CmmcISBodMPZ375CwLHY77sjM7aazX0usafWGY-RJKqzwQlDlRG8vlI9wsIJfmho3gdBOJi339J8Kad_zXZRDU/s320/callmember.jpg" width="320" /></a></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">The communique also calls for more “pooling and sharing” of EU defence hardware in the context of crisis-related budget cuts.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">It identifies “space, ballistic-missile defence, drones, air-to-air refuelling, airlift capacities, medical support to operations [and] software defined radio” as pooling areas.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">The reference to new “civilian-military structures” comes after the UK last year blocked the creation of a new operational headquarters (OHQ) in Brussels for EU military missions.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="color: blue;"><span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif";">BRITISH “NOSTALGIA” FOR PAST GREATNESS AS A REASON WHY IT IS PULLING BACK FROM EU INTEGRATION</span></b></span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">BRITAIN’S Telegraph newspaper earlier this week cited a “senior FRENCH source” as saying that EU foreign affairs chief Catherine Ashton supports the idea of an OHQ, which will become a “ripe fruit” in the “long-term” as EU military operations multiply.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">Ashton officials denied the report.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">Meanwhile, the UK’s role in future EU defence co-operation was a big topic at the Paris meeting.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">French foreign minister Laurent Fabius said the UK can join the group-of-five at any time: “The text which we have developed is open to all of our colleagues, especially GREAT BRITAIN.”</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">FRENCH defence minister Jean-Yves Le Drian said the communique is designed to “create a movement” ahead of an EU summit on defence in 2013.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">For his part, POLISH foreign minister Radek Sikorski said: “If the EU wants to become a superpower, and POLAND supports this, then we must have the capability to exert influence in our neighbourhood … Sometimes we must use force to back our diplomacy.”</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">He called for an “ambitious” EU budget for 2014 to 2020 to help with defence co-ordination.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">Speaking in a separate interview in UK newspaper The Times also on Thursday, Sikorski blamed BRITISH “nostalgia” for past greatness as a reason why it is pulling back from EU integration and why it wants to cut the EU budget.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">He touched on historic sensitivities by describing EU spending as a kind of “Marshall plan.”</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">He said POLAND and other former-SOVIET-controlled EU countries missed out on the plan – a massive injection of US money to rebuild EUROPE after World War II – because UK and US leaders at a summit in Yalta in 1945 gave the SOVIET UNION control of eastern EUROPE.</span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: large;"><span style="font-family: "Times New Roman","serif";">“We fought Hitler alone, giving you [the UK] valuable time to prepare for fighting. But we did not enjoy freedom after World War II … Because of Yalta, we could not benefit [from the Marshall plan]. EUROPEAN cohesion funds are our Marshall plan for catching up with EUROPE,” he noted.</span></span></div><div class="MsoNormal" style="text-align: justify;"><br /></div>

FIVE EU COUNTRIES CALL FOR NEW MILITARY “STRUCTURE”

Coat of arms of the EU military staff EU MILITARY PRIORITIES Five leading EU countries, but not the UK, have said the UNION needs a new mil...

Expert on Mental Illness Reveals Her Own Struggle - NYTimes.com

1:53 AM Tukiyooo 0

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Are you one of us?</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The patient wanted to know, and her therapist — Marsha M. Linehan of the<a href="http://topics.nytimes.com/top/reference/timestopics/organizations/u/university_of_washington/index.html?inline=nyt-org" title="More articles about University of Washington" class="meta-org" style="color: rgb(102, 102, 153); text-decoration: none; ">University of Washington</a>, creator of a treatment used worldwide for severely suicidal people — had a ready answer. It was the one she always used to cut the question short, whether a patient asked it hopefully, accusingly or knowingly, having glimpsed the macramé of faded burns, cuts and <a href="http://health.nytimes.com/health/guides/disease/angioedema/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Angioedema." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">welts</a> on Dr. Linehan's arms:</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"You mean, have I suffered?"</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"No, Marsha," the patient replied, in an encounter last spring. "I mean one of us. Like us. Because if you were, it would give all of us so much hope."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"That did it," said <a title="http://www.depts.washington.edu/brtc" href="http://www.depts.washington.edu/brtc" style="color: rgb(102, 102, 153); text-decoration: none; ">Dr. Linehan</a>, 68, who told her story in public for the first time last week before an audience of friends, family and doctors at the <a title="Web site" href="http://www.harthosp.org/InstituteOfLiving/default.aspx" style="color: rgb(102, 102, 153); text-decoration: none; ">Institute of Living</a>, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. "So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">No one knows how many people with severe mental illness live what appear to be normal, successful lives, because such people are not in the habit of announcing themselves. They are too busy juggling responsibilities, paying the bills, studying, raising families — all while weathering gusts of dark emotions or delusions that would quickly overwhelm almost anyone else.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Now, an increasing number of them are risking exposure of their secret, saying that the time is right. The nation's <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/mentalhealthanddisorders/index.html?inline=nyt-classifier" title="Recent and archival health news about mental health and disorders." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">mental health</a> system is a shambles, they say, criminalizing many patients and warehousing some of the most severe in nursing and group homes where they receive care from workers with minimal qualifications.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Moreover, the enduring stigma of mental illness teaches people with such a diagnosis to think of themselves as victims, snuffing out the one thing that can motivate them to find treatment: hope.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"There's a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life," said Elyn R. Saks, a professor at the University of Southern California School of Law who chronicles her own struggles with <a href="http://health.nytimes.com/health/guides/disease/schizophrenia-disorganized-type/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Schizophrenia - disorganized type." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">schizophrenia</a> in "The Center Cannot Hold: My Journey Through Madness." "We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">These include medication (usually), therapy (often), a measure of good luck (always) — and, most of all, the inner strength to manage one's demons, if not banish them. That strength can come from any number of places, these former patients say: love, forgiveness, faith in God, a lifelong friendship.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But Dr. Linehan's case shows there is no recipe. She was driven by a mission to rescue people who are chronically suicidal, often as a result of <a href="http://health.nytimes.com/health/guides/disease/borderline-personality-disorder/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Borderline personality disorder." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">borderline personality disorder</a>, an enigmatic condition characterized in part by self-destructive urges.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"I honestly didn't realize at the time that I was dealing with myself," she said. "But I suppose it's true that I developed a therapy that provides the things I needed for so many years and never got."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><strong>'I Was in Hell'</strong></p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">She learned the central tragedy of severe mental illness the hard way, banging her head against the wall of a locked room.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Marsha Linehan arrived at the Institute of Living on March 9, 1961, at age 17, and quickly became the sole occupant of the seclusion room on the unit known as Thompson Two, for the most severely ill patients. The staff saw no alternative: The girl attacked herself habitually, burning her wrists with <a href="http://health.nytimes.com/health/guides/specialtopic/smoking-tips-on-how-to-quit/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Smoking - tips on how to quit." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">cigarettes</a>, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The seclusion room, a small cell with a bed, a chair and a tiny, barred window, had no such weapon. Yet her urge to die only deepened. So she did the only thing that made any sense to her at the time: banged her head against the wall and, later, the floor. Hard.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"My whole experience of these episodes was that someone else was doing it; it was like 'I know this is coming, I'm out of control, somebody help me; where are you, God?' " she said. "I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Her childhood, in Tulsa, Okla., provided few clues. An excellent student from early on, a natural on the piano, she was the third of six children of an oilman and his wife, an outgoing woman who juggled child care with the Junior League and Tulsa social events.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">People who knew the Linehans at that time remember that their precocious third child was often in trouble at home, and Dr. Linehan recalls feeling deeply inadequate compared with her attractive and accomplished siblings. But whatever currents of distress ran under the surface, no one took much notice until she was bedridden with headaches in her senior year of high school.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Her younger sister, Aline Haynes, said: "This was Tulsa in the 1960s, and I don't think my parents had any idea what to do with Marsha. No one really knew what mental illness was."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Soon, a local psychiatrist recommended a stay at the Institute of Living, to get to the bottom of the problem. There, doctors gave her a diagnosis of schizophrenia; dosed her with <a title="National Institutes of Health Web page on Thorazine" href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000553/" style="color: rgb(102, 102, 153); text-decoration: none; ">Thorazine</a>, <a title="National Institutes of Health Web Page on Librium (Chlordiazepoxide)" href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000568/" style="color: rgb(102, 102, 153); text-decoration: none; ">Librium</a> and other powerful drugs, as well as hours of Freudian analysis; and strapped her down for electroshock treatments, 14 shocks the first time through and 16 the second, according to her medical records. Nothing changed, and soon enough the patient was back in seclusion on the locked ward.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"Everyone was terrified of ending up in there," said Sebern Fisher, a fellow patient who became a close friend. But whatever her surroundings, Ms. Fisher added, "Marsha was capable of caring a great deal about another person; her passion was as deep as her loneliness."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">A discharge summary, dated May 31, 1963, noted that "during 26 months of hospitalization, Miss Linehan was, for a considerable part of this time, one of the most disturbed patients in the hospital."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">A verse the troubled girl wrote at the time reads:</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">They put me in a four-walled room</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But left me really out</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">My soul was tossed somewhere askew</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">My limbs were tossed here about</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Bang her head where she would, the tragedy remained: no one knew what was happening to her, and as a result medical care only made it worse. Any real treatment would have to be based not on some theory, she later concluded, but on facts: which precise emotion led to which thought led to the latest gruesome act. It would have to break that chain — and teach a new behavior.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"I was in hell," she said. "And I made a vow: when I get out, I'm going to come back and get others out of here."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><strong>Radical Acceptance</strong></p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">She sensed the power of another principle while praying in a small chapel in Chicago.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">It was 1967, several years after she left the institute as a desperate 20-year-old whom doctors gave little chance of surviving outside the hospital. Survive she did, barely: there was at least one suicide attempt in Tulsa, when she first arrived home; and another episode after she moved to a Y.M.C.A. in Chicago to start over.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">She was hospitalized again and emerged confused, lonely and more committed than ever to her Catholic faith. She moved into another Y, found a job as a clerk in an insurance company, started taking night classes at Loyola University — and prayed, often, at a chapel in the Cenacle Retreat Center.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"One night I was kneeling in there, looking up at the cross, and the whole place became gold — and suddenly I felt something coming toward me," she said. "It was this shimmering experience, and I just ran back to my room and said, 'I love myself.' It was the first time I remember talking to myself in the first person. I felt transformed."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The high lasted about a year, before the feelings of devastation returned in the wake of a romance that ended. But something was different. She could now weather her emotional storms without cutting or harming herself.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">What had changed?</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">It took years of study in <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/psychology_and_psychologists/index.html?inline=nyt-classifier" title="Recent and archival health news about psychology." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">psychology</a> — she earned a Ph.D. at Loyola in 1971 — before she found an answer. On the surface, it seemed obvious: She had accepted herself as she was. She had tried to kill herself so many times because the gulf between the person she wanted to be and the person she was left her desperate, hopeless, deeply homesick for a life she would never know. That gulf was real, and unbridgeable.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">That basic idea — radical acceptance, she now calls it — became increasingly important as she began working with patients, first at a suicide clinic in Buffalo and later as a researcher. Yes, real change was possible. The emerging discipline of behaviorism taught that people could learn new behaviors — and that acting differently can in time alter underlying emotions from the top down.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But deeply suicidal people have tried to change a million times and failed. The only way to get through to them was to acknowledge that their behavior made sense: Thoughts of death were sweet release given what they were suffering.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"She was very creative with people. I saw that right away," said Gerald C. Davison, who in 1972 admitted Dr. Linehan into a postdoctoral program in behavioral therapy at Stony Brook University. (He is now a psychologist at the University of Southern California.) "She could get people off center, challenge them with things they didn't want to hear without making them feel put down."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">No therapist could promise a quick transformation or even sudden "insight," much less a shimmering religious vision. But now Dr. Linehan was closing in on two seemingly opposed principles that could form the basis of a treatment: acceptance of life as it is, not as it is supposed to be; and the need to change, despite that reality and because of it. The only way to know for sure whether she had something more than a theory was to test it scientifically in the real world — and there was never any doubt where to start.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><strong>Getting Through the Day</strong></p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"I decided to get supersuicidal people, the very worst cases, because I figured these are the most miserable people in the world — they think they're evil, that they're bad, bad, bad — and I understood that they weren't," she said. "I understood their suffering because I'd been there, in hell, with no idea how to get out."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">In particular she chose to treat people with a diagnosis that she would have given her young self: borderline personality disorder, a poorly understood condition characterized by neediness, outbursts and self-destructive urges, often leading to cutting or burning. In therapy, borderline patients can be terrors — manipulative, hostile, sometimes ominously mute, and notorious for storming out threatening suicide.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Dr. Linehan found that the tension of acceptance could at least keep people in the room: patients accept who they are, that they feel the mental squalls of rage, emptiness and anxiety far more intensely than most people do. In turn, the therapist accepts that given all this, cutting, burning and <a href="http://health.nytimes.com/health/guides/disease/suicide-and-suicidal-behavior/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Suicide and suicidal behavior." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">suicide attempts</a> make some sense.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Finally, the therapist elicits a commitment from the patient to change his or her behavior, a verbal pledge in exchange for a chance to live: "Therapy does not work for people who are dead" is one way she puts it.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Yet even as she climbed the academic ladder, moving from the Catholic University of America to the University of Washington in 1977, she understood from her own experience that acceptance and change were hardly enough. During those first years in Seattle she sometimes felt suicidal while driving to work; even today, she can feel rushes of panic, most recently while driving through tunnels. She relied on therapists herself, off and on over the years, for support and guidance (she does not remember taking medication after leaving the institute).</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Dr. Linehan's own emerging approach to treatment — now called dialectical behavior therapy, or D.B.T. — would also have to include day-to-day skills. A commitment means very little, after all, if people do not have the tools to carry it out. She borrowed some of these from other behavioral therapies and added elements, like opposite action, in which patients act opposite to the way they feel when an emotion is inappropriate; and mindfulness meditation, a Zen technique in which people focus on their breath and observe their emotions come and go without acting on them. (Mindfulness is now a staple of many kinds of psychotherapy.)</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">In studies in the 1980s and '90s, researchers at the University of Washington and elsewhere tracked the progress of hundreds of borderline patients at high risk of suicide who attended weekly dialectical therapy sessions. Compared with similar patients who got other experts' treatments, those who learned Dr. Linehan's approach made far fewer suicide attempts, landed in the hospital less often and were much more likely to stay in treatment. D.B.T. is now widely used for a variety of stubborn clients, including juvenile offenders, people with <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/eatingdisorders/index.html?inline=nyt-classifier" title="Recent and archival health news about eating disorders." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">eating disorders</a> and those with drug addictions.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"I think the reason D.B.T. has made such a splash is that it addresses something that couldn't be treated before; people were just at a loss when it came to borderline," said Lisa Onken, chief of the behavioral and integrative treatment branch of the National Institutes of Health. "But I think the reason it has resonated so much with community therapists has a lot to do with Marsha Linehan's charisma, her ability to connect with clinical people as well as a scientific audience."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Most remarkably, perhaps, Dr. Linehan has reached a place where she can stand up and tell her story, come what will. "I'm a very happy person now," she said in an interview at her house near campus, where she lives with her adopted daughter, Geraldine, and Geraldine's husband, Nate. "I still have ups and downs, of course, but I think no more than anyone else."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 24px; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">After her coming-out speech last week, she visited the seclusion room, which has since been converted to a small office. "Well, look at that, they changed the windows," she said, holding her palms up. "There's so much more light."</p></div><a href="http://www.nytimes.com/2011/06/23/health/23lives.html?">http://www.nytimes.com/2011/06/23/health/23lives.html?</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Expert on Mental Illness Reveals Her Own Struggle - NYTimes.com

Are you one of us? The patient wanted to know, and her therapist — Marsha M. Linehan of the University of Washington , creator of a treatmen...

When Treating Cancer Is Not an Option - NYTimes.com

1:49 AM Tukiyooo 0

<base href="data:"><div style="text-align: left; "><div class="postContent" style="color: black; font-family: Helvetica; font-size: 14px; margin-left: 126px; "><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">When my husband learned he had advanced lung <a title="In-depth reference and news articles about Cancer." href="http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">cancer</a>, he didn't even want to speak to an oncologist about<a title="Recent and archival health news about chemotherapy." href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/chemotherapy/index.html?inline=nyt-classifier" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">chemotherapy</a>. He saw no point in treatment that could not cure him and might make him feel worse.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">Not so, though, for a majority of patients diagnosed with cancers of the lung or colon that have spread well beyond their original site and are currently not curable by any drugs in the medical armamentarium. Most patients with these so-called stage 4 cancers who choose to undergo chemotherapy seem to believe, incorrectly, that the drugs could render them cancer-free.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">That is the finding of a recent national study of nearly 1,200 patients with advanced cancers of the lung or colon. Overall, 69 percent of those with stage 4 lung cancer and 81 percent of those with stage 4 <a title="In-depth reference and news articles about Colon Cancer." href="http://health.nytimes.com/health/guides/disease/colon-cancer/overview.html?inline=nyt-classifier" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">colon cancer</a> failed to understand "that chemotherapy was not at all likely to cure their cancer," Dr. Jane C. Weeks, an oncology researcher at the Dana-Farber Cancer Institute in Boston, and colleagues <a title="Link to the study" href="http://www.nejm.org/doi/pdf/10.1056/NEJMoa1204410" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">reported in The New England Journal of Medicine</a>.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">When patients do not understand the limitations of such treatment, their consent to undergo it is not truly informed, the authors concluded.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">This is not to say that chemotherapy is pointless when cancer is far advanced. Various drugs, some with limited toxicity, can be used as palliatives, perhaps shrinking <a title="In-depth reference and news articles about Tumor." href="http://health.nytimes.com/health/guides/disease/tumor/overview.html?inline=nyt-classifier" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">tumors</a> temporarily to relieve symptoms, slowing the cancer's growth and prolonging the lives of some patients.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">But aggressive chemotherapy when death is but weeks or months in the offing can seriously compromise the quality of patients' remaining time and may delay their preparations for the end of life, to the detriment of both patients and their families.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">"If you think chemotherapy will cure you, you're less open to end-of-life discussions," Dr. Weeks said in an interview.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">When patients pursue chemotherapy under the false belief that they still have a chance for a cure, it often delays their transition to the comfort care of <a title="Recent and archival health news about hospice care." href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospice_care/index.html?inline=nyt-classifier" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">hospice</a>. When patients spend only a few days or a week in hospice, caretakers don't have enough time to get to know them and their families and offer the physical, emotional and practical benefits hospice can provide.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">Dr. Weeks said continued chemotherapy involves more trips to the hospital, blood draws and X-rays, whereas hospice attends to patients' symptoms and concerns, and encourages them to leave meaningful legacies. When my husband entered hospice after two miserable weeks in the hospital undergoing palliative radiation, he experienced such relief that he said cheerfully, though in jest, "What if I decide I want to live?" and then enjoyed a treasured last visit with two of his grandchildren.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; "><strong>'Optimistic Bias'</strong></p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">Communication is a two-way street; doctors and patients alike contribute to patients' failure to appreciate medicine's limited ability to treat advanced cancer.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">In <a title="Link to the editorial " href="http://www.nejm.org/doi/pdf/10.1056/NEJMe1211160" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">an editorial accompanying the journal report</a>, Dr. Thomas J. Smith and Dr. Dan L. Longo pointed out that "people have an optimistic bias." Despite a grim prognosis, this bias prompts patients to believe treatment can cure them.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">"Even with repeated discussions, about one-third of patients are not able to say they have a disease from which they will die in a year or so," Dr. Smith, an oncologist and director of palliative care at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, said in an interview.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">"Our job is not to force them into acceptance but to encourage them to plan for the worst while hoping for the best," Dr. Smith said. "Such patients have better outcomes — less depression and less distress, and they're more likely to die comfortably at home."</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">Cultural and racial factors, and most likely religious beliefs, influence acceptance of the futility of continued treatment, Dr. Weeks said. In her study, nonwhite and Hispanic patients were more likely than whites to believe that chemotherapy could cure them. But surprisingly, patients' educational level, degree of disability and participation in decision-making were not associated with inaccurate beliefs about chemotherapy.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">What can make a huge difference, Dr. Smith said, is how and how often doctors discuss options with patients and describe the potential of continued treatment. He and Dr. Longo suggested that practitioners master "the conversation known as 'ask, tell, ask,' which consists of asking patients what they want to know about their prognosis, telling them what they want to know, and then asking, 'What do you now understand about your situation?' "</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">Among the questions Dr. Smith said doctors should be asking are, "How much do you want to know about your cancer? What do you know about your cancer? Who would you like to include in discussions about your care? Would you like me to write down the important points? What is important to you? What are you hoping for? Who are your other doctors so that I can communicate with them?"</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; "><strong>Continuing Discussion</strong></p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">Finally, he said, rather than asking the patient "do you have any questions?" the doctor should ask, "Now that we have discussed this, what is your understanding of your situation?" And rather than having this conversation only once, Dr. Smith said, "It should be repeated at every transition point."</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">He and Dr. Longo also recommend that oncologists state the patient's prognosis at the first visit, appoint someone in the office to discuss advance directives, schedule a hospice-information visit, and offer to discuss prognosis and coping at each transition.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">Using this approach, practitioners in the <a title="US Oncology Network" href="http://www.usoncology.com/" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">US Oncology Network</a>, a group of community-based oncology physicians, have doubled the time patients spend in hospice, decreased costs, alleviated patients' symptoms, reduced stress on caregivers and often lengthened survival, Dr. Smith said. <a title="link to article" href="http://www.jpsmjournal.com/article/S0885-3924%2806%2900724-X/abstract" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">Various studies</a> <a title="link to article" href="http://www.sciencedirect.com/science/article/pii/S009082581000404X" target="_blank" style="color: rgb(102, 102, 153); text-decoration: underline; ">have shown</a> that cancer patients in hospice live weeks to months longer than comparable patients not in hospice care.</p><p style="margin: 0px 0px 1em; font-size: 1.4em; line-height: 1.5em; ">When doctors fail to give direct, clear information, Dr. Smith suggests that patients ask, "What is my prognosis, really? What are my options? Can I meet with the palliative care and hospice teams?"</p><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font-size: 1.4em; line-height: 1.5em; ">He noted, "This is the hardest conversation for doctors to have. A lot of doctors wait for someone to bring it up." If the patient does not, then a family member can initiate the needed discussion.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font-size: 1.4em; line-height: 1.5em; "><div style="text-align: left; line-height: normal; font-size: medium; "><footer class="postMeta" style="display: block; clear: both; padding-top: 15px; padding-right: 0px; padding-bottom: 21px; padding-left: 0px; margin-bottom: 0px; "><div class="postRelated module wrap" style="color: black; font-family: Helvetica; font-size: 14px; margin-bottom: 12px; clear: both; display: block; border-top-width: 1px; border-top-style: solid; border-top-color: rgb(204, 204, 204); padding-top: 10px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: static; z-index: auto; "><span class="Apple-style-span" style="font-size: medium; "><a href="http://well.blogs.nytimes.com/2012/11/19/when-treating-cancer-is-not-an-option/?src=recg">http://well.blogs.nytimes.com/2012/11/19/when-treating-cancer-is-not-an-option/?src=recg</a></span><div class="relatedArticlesModule column lastColumn" style="float: left; display: inline; overflow-x: visible; overflow-y: visible; margin-right: 0px !important; width: 427px; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-size: 10px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "></div></div></footer></div></div></div><footer class="postMeta" style="display: block; clear: both; padding-top: 15px; padding-right: 0px; padding-bottom: 21px; padding-left: 0px; margin-bottom: 0px; "></footer></div><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

When Treating Cancer Is Not an Option - NYTimes.com

When my husband learned he had advanced lung cancer , he didn't even want to speak to an oncologist about chemotherapy . He saw no poin...

FIVE EU COUNTRIES CALL FOR NEW MILITARY “STRUCTURE”

Expert on Mental Illness Reveals Her Own Struggle - NYTimes.com

When Treating Cancer Is Not an Option - NYTimes.com

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