Lois’ Story
Past
While most of my friends were learning to camp, I spent my summer learning to write. At fourteen, I read Eudora Welty’s “One Writer’s Beginnings,” which chronicled her pathway to listening, learning to see, and finding a voice. Her bold and intimate description of human life conveyed with both affection and unflinching honesty, became a roadmap for my own navigation of the world ahead of me.
Through the journey of my formal education, I contemplated human civilization and its discontent (i.e. Freud and other legendary social theorists), the destructive problems of individuals and societies, and the way we all endeavor to find a coherent identity that folds us into belonging somewhere in this lonely world. While that was all very intellectually stimulating, I yearned to help people who were suffering, and connect with humanity through service. I decided therefore, to become a physician and psychotherapist.
The turning point of my path was when I encountered John Gunderson, who was at once vibrantly human and imposingly academic. Little did I know he would change the course of my life and career. He derailed my plan to nestle into a neat psychoanalytic practice in a sleek office in Cambridge and opened my world to the sound and fury of personality disorders on a global scale.
My training years at MGH-McLean were like a dream, though at the time, it seemed quite ordinary and stressful. My first rotation was at the Erich Lindemann Center, following patients with legal difficulties in psychotic states, in a concrete building featured in “The Departed.” Illustrious Bostonian legends in psychiatry taught me how to listen and see the minds behind human behavior.
John Gunderson was relentless and unapologetic about his pursuit to make me a partner in his work. He convinced me to apply for funding for a postdoctoral research fellowship. In three years, I absorbed a broad literature on personality disorders, their causes, features, and treatment. I became an expert and opened an intensive residential program, before completing the term of my postdoctoral fellowship. He told me then I would need to take his job, anticipating his death in a few years. I had heard he was a provocative person, so I did not believe him.
Founding the Gunderson Residence
I founded the Gunderson Residence, an intensive specialized service for complex, treatment-resistant, suicidal female patients with borderline and other severe personality disorders. I knew very little at the time but learned a lifetime of psychiatry in one decade from the patients, their families, and the team I lead. That experience was the most important part of my education and personal development. I expanded the adult BPD services at McLean to include both self-pay and insurance using evidence based manualized psychotherapies. I developed a training institute to disseminate Good Psychiatric Management (GPM), a generalist clinical management approach using APA guidelines and his longstanding theory of BPD as a disorder of interpersonal hypersensitivity. John passed away after we filmed the online course for GPM and finalized proofs on our last book, Applications of GPM.
The year after his death was a difficult one, filling his shoes in a way I had no idea I could, and realizing over time the reality that he was gone and I had to carry the torch.
As COVID struck, I left my clinical responsibilities aside, to attempt to develop a grant funded research laboratory. Now as the Director of the Gunderson Personality Disorder Institute, I research the treatment and psychopathology of personality disorders while also teaching professionals and institutions around the world how to provide pragmatic care for those with BPD.
Quality at Scale
I learned that while intensive forms of evidence-based care have potent effects on both the professional world and the lives of patients, they are grossly limited in their supply and scope, essentially islands in the practice of mental healthcare and rest stops in the challenging lives of patients. My vision of the near future is that technology will shoulder the heavy lifting that we as clinicians bear in BPD’s treatment. I found a voice to advocate for scalable interventions accessible not only to those who can afford it, but more widely as a generic facet of mental and primary healthcare. I quickly discovered that the for-profit world brought a level of technical expertise and creativity not available in a medical environment.
During COVID, I also learned from a dear collaborator with lived experience Rebbie Ratner, that online resources hold the potential to convey a fuller, more alive portrayal of what it means to have a personality disorder, how experts and clinicians think about their interventions, and what treatment involves. Her YouTube channel, Borderliner Notes, has catalyzed a community and forum for people to better understand the many dimensions of how personality disorders and treatments work.
Creating Personily
When Lindsay approached me to consider new directions in using digital psychiatry to augment access to care, education, and self-assessment fueled by the best of industry funding, business wisdom, and cutting edge computerized digital healthcare platforms, I knew this was going to be the future of helping more people learn to listen to themselves, see the world with order and optimism, and find a voice for getting what they want from life.
I believe Personily represents the future of empowering people with personality difficulties to embrace themselves and others with affection, unflinching honesty, and a grounding in what steps to take to make their vision of themselves a reality.
