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Being borderline: Marsha Linehan and Brandon Marshall

March 21, 2012

We psychiatrists have an ethical prohibition called “The Goldwater Rule”. This states that we should not try to diagnose someone without examining them as a patient. For patients in treatment, confidentiality prohibits us from sharing their diagnosis publicly. When Barry Goldwater ran for President of the United States years ago, some psychiatrists publicly claimed that he had some sort of psychiatric disorder that would disqualify him from being President. Our profession was roundly criticized for allowing this kind of statement.

Marsha Linehan should be well-known to most of us in behavioral healthcare. She developed Dialectical Behavioral Therapy (DBT), the first really successful treatment for Borderline Personality Disorder (BPD). But it was indeed a surprise to most of us when she stated in a front page New York Times article (June 23, 2011, Expert in Mental Illness Reveals Her Own Fight) that she herself had the disorder.

On the other hand, unless you are a pro football fan, I doubt you had heard of Brandon Marshall. He was unexpectedly traded from the Miami football team to my beloved Chicago Bears on Tuesday, March 13. And the local, and even some national, sportswriters had a field day, so to speak.

On Thursday, March 15, the Chicago Sun-Times sports pages headline exclaimed “Baggage Claim”, and in much smaller print: “Brandon Marshall, the newest troubled Bear”. But, I wondered, what kind of “troubled” was he? Was he the common football player in a most violent game, where violence occasionally spills out into their personal lives, sometimes aided and abetted by substance abuse, or, was this something else, like the rare occasion when a football player says they have a “Social Anxiety Disorder” or even “Multiple Personality Disorder”, to name two, but who say little else?

Inside that same Sun-Times was the accompanying article, “Identifying trouble spots” by Rick Morrissey. He described several incidents of Marshall’s aggressive behavior toward others, and one where his wife was accused of stabbing him in return. Marshall was nicknamed “The Beast”. This reporter contrasted him with the attention that had been paid the past year to football player Tim Tebow, whose public prayer after football success was often viewed as virtuous. “The Beauty”, if you will.

However, the other Chicago daily paper, the Chicago Tribune, usually less sensationalistic, took a somewhat different slant on the same date. Yes, the Tribune went into his violent past in even more detail, but in their featured articles, titled “Marshall flawed”, they not only mentioned that Marshall publicly held a news conference last July to announce that he had been diagnosed with Borderline Personality Disorder and was starting treatment, but in a hard-to-notice section on the bottom of one page, even went on to describe what this disorder was, stating simply that it was a mental illness that leads those who suffer it to struggle with relationships, mood control, and emotions. That’s correct.

By Friday, March 16, the Chicago newspapers were describing why the Chicago Bear coaches and executives were optimistic. “Coach Smith is the same person day in and day out. Brandon needs that consistency. Coach Smith . . . is a demanding person. He’s also a compassionate person that players can relate to” (Bears Have Marshall Plan, Mark Potash, Chicago Sun-Times). It was also pointed out that Marshall was being reunited with a quarterback, Jay Cutler, who he trusted and respected. Now, I don’t know if these people already studied the treatment for BPD, but they were describing some of the essential ingredients: consistency, compassion, and clear demands.

On the other hand, the Chicago Tribune on that Friday conveyed caution and concern (Mike Mulligan, “Marshall must own up to his mistakes): “Does Marshall feel genuine remorse over his checkered past, and will he express it Friday?”

Apparently he did. Some of the comments from the Chicago papers on Saturday, March 17, included:

  • “The Bears’ newly acquired receiver surely won the hearts of Bear fans . . . when he spoke with sincerity and candor . . . about the personal conduct issues . . . and his battle with borderline personality disorder”.
  • “He spoke about . . . the steps he has taken . . . to be a role model who can break down stigma attached to mental illness”.
  • “His foundation and website, www.projectborderline.com, are dedicated to making an impact”.
  • “It’s a taboo topic in our communities”.

And, his friend Jay Cutler, not known for his cooperation with the press, added: “He said anyone needs therapy. I talk to a lady. I go to therapy”.

Finally, on Sunday, March 18, the New York Times commented on its sports pages, but only briefly on the context of an article on another topic: “The Chicago Bears traded two draft picks to the Miami Dolphins for the troubled, inconsistent wide receiver Brandon Marshall just hours before reports surfaced that Marshall had been accused of assaulting a woman at a night club brawl”. Nary a mention of his diagnosis, nor that the allege incident was the first in the year since his treatment started.

But the coup de grace to all this coverage was a first for me to see in a sports section of a Chicago paper. And, wouldn’t you know, it featured Marsha Linehan, who Marshall thanked (David Haugh, Therapist a help to Marshall: Linehan, a victim herself, pioneered plan for treatment, Chicago Tribune). It mentioned his treatment last summer at the renowned McLean Hospital outside of Boston. Linehan, who apparently is not his therapist, was quoted: “Brandon is such a good role model . . . The most important thing is he’s standing up and telling people, ‘I can change, so can you’”.

I’m sure there will be follow-ups, especially once the football season begins in the fall. He actually reminded me of some of the young Black men I treat in prison, who once they trust you and share the trauma in their past, can be diagnosed with something similar and begin a path to change. However, they didn’t have the athletic gifts that Marshall has, or the wherewithal to obtain expert legal and therapeutic help. Will the treatments have similar or different effects on Marshall’s personal and professional life, the same kind of question that often emerges in the psychiatric treatment of artists? As Marshall himself stated at his press conference: “I call it my gift and my curse. Because without that passion, without that intense approach to the game – which comes from a lot of my pain, a lot of my anger, I wouldn’t be here today”.

So there you have it, the story to date. One is a woman; one is a man. One is white; one is Black. One is a therapist; one is a patient. One is famous for her professional treatment; the other is famous for his professional playing. Together, they have crossed the border of privacy to publicize the suffering from the stigma that hurts us all. If one can say that there can be well-deserved pride in being borderline, these two exemplify that.

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