Revolution on the Horizon


DBT Challenges the Borderline Diagnosis

May/June 2001


On the morning of September 21, 1993, a 37-year-old former graduate student named Susan Kandel took an elevator to an upper floor of Duke Medical Center in Durham, North Carolina, where she was attending a day treatment program. She was panicked and miserable: her therapist had recently moved to another state, and she was about to leave agency-supervised housing to look for her own apartment.

She went to a breezeway connecting two wings of the building and jumped, expecting to fall 90 feet to her death. She landed instead on a maintenance workers' platform 40 feet down and was taken to the emergency room with three broken vertebrae. A month later, still in a body brace but not paralyzed, she was involuntarily committed to John Umstead State Hospital, an aging two-story brick mental hospital in Butner, on the outskirts of Durham. She, the hospital staff and her family all expected her to be there for a long, long time, and she was in deep despair.

It was her fourth commitment to John Umstead State Hospital, and her seventh serious suicide attempt. Two years earlier, facing an oral presentation for her Ph.D. in molecular biology at Duke, she had driven to a motel room on the North Carolina shore and swallowed 250 milliliters of chloroform--more than 25 times the lethal dose. Two days later, she was discovered in a coma, with a hole in her esophagus and her liver badly damaged; when she recovered sufficiently, she was committed to John Umstead for her…

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