“A young girl’s traumatic event may have triggered her inherited undiagnosed mental illness. The Turned Leaf follows one woman’s struggle with a mental illness, the effect it has on her and her loved ones. This drama is infused with modern dance , video elements, modern song and digs deep into the heart of the illness. ”

Below is a brief synopsis of how she came to write the play and what she hopes to accomplish with it.

Walking on eggshells is not just a phrase to me. It is a living, breathing entity where one false step can have catastrophic repercussions. I grew up with a mother who could literally turn on a dime and what set her off is, to this day, a mystery. I have spent my life trying to reconcile the fact that it is the illness which I hate and the mother’s heart which I love.

Those lines recently blurred when her blind rage attack sent my father to move in with me and my husband. This is what prompted me to write The Turned Leaf.

Growing up I never knew what was the truth or a made-up truth to cover the hurt but throughout the years a pattern prevailed. The Turned Leaf is based off of some moments of lucidity and by putting together pieces of a very abstract puzzle.

She is undiagnosed. She is untreated. She is miserable. And she is lonely.

The Turned Leaf is ultimately a love letter to my mother’s heart, and may help to shed an understanding light into mental illness, the demon within, and how it may have gotten there.

The Turned Leaf will be performed at the NewBridge Theatre Company in Hastings, Minn. May 16-18 and May 23-25, 2013.

How then later did I come to embrace cognitive behavioral and related therapies that spell out that we are, essentially, just a mess of behaviors (good and bad)?

If you dig into your family dynamic, and maybe establishing relationships with others from equally dysfunctional backgrounds, you are bound to have a change of heart about old Skinner. Maybe there is something to behaviorism after all, and it can jibe with the deeper therapies that ask you to reflect on early places of pain and identity-molding.

Dialectical Behavior Therapy (DBT) is particularly of interest not just to me, but folks trying to come to grasp with certain subsets of mental illness — borderline personality disorder, bipolar and other depressive disorders. But its principles can be significantly farther-reaching than mental illness circles alone.

There are 4 critical components to the DBT methodology. The categorical names alone should conjure hope for those suffering from mental illness symptoms and individuals afflicted with interpersonal issues at home and in workplace: mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation.

Any reader of Daniel Goleman’s Emotional Intelligence, with an introduction by the Dalai Lama, knows that mindfulness is at the core of human attempts to find balance and centeredness in our own body, as well as connection to others. Nothing is more key for individuals with beginner-level trust in family or therapists or slowly-developing insight into dysfunctional ways of relating to colleagues.

Interpersonal effectiveness involves “strategies” — practical, effective means of dealing with thought, mood and behavioral maladjustments. Yes, actual skills are taught, driven by goals for different situations. (Sound like business counsel?) This is invaluable to those with borderline personality disorder, who “possess good interpersonal skills in a general sense” but are unable to have self-insight to get past “problematic situations” when stress hits.

Now, what better need do we have as humans than to develop distress tolerance? It can help us in our workplace, for ill loved ones, and for ourselves when debilitated by depression, addictive thoughts, or the surfacing of manic traits. This is integral to DBT’s beauty. As in Alcoholics Anonymous, where people are encouraged to discern between what can be changed and what can not, distress tolerance skills involve “the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation.”

The heart of helping ill individuals and ourselves lies, I believe, in letting this mindset seep in, allowing for gentle, passive strength. (Not to mention that this simple maxim is a behavioral powerhouse when artfully practiced and applied, and can profoundly affect our professional, family and social life.) “Self-soothing” and “pros and cons” work are two tactics in the distress tolerance strategy, one whose benefits to mentally ill family systems can certainly be equally applied to the needy masses of a larger society.

The last outlined DBT component is emotion regulation, so critical to disorders such as bipolar, where emotional intensity and stress make for frequent anxiety. But we all have encountered situations with bosses and friends that contain these elements. How do we identify obstacles and triggers, and then work on changing emotional patterns? And can we increase positive emotional experiences? Like the mouse after his cheese, is it not possible to stack the deck a certain way in families, in the workplace and within the mental health system so that the satisfaction of getting a little more of that nibble — stability, harmony, collaboration — can happen more effectively and more often?

Want to learn more about dialectical behavior therapy?
Follow our blog, Dialectical Behavior Therapy Understood or read the article, An Overview of Dialectical Behavior Therapy.

These events touched many families personally. For those of us not directly affected, they can still leave us with feelings of horror and wanting to hold our loved ones near.

As a nation and as individuals, we could not possibly have anticipated or planned to have to deal with the emotional consequences of such an event. And yet here we are… many of us saddened, enraged and overwhelmed.

In the midst of tragedy and crisis, it can feel as if life is spinning out of control.  An event like this can remind us of devastating events from the past, which in turn can trigger thoughts and emotions connected to our own personal misfortunes and heartbreak.

We can’t change what has happened, but we can use a few strategies can help get through intense painful feelings and do what needs to be done in our daily lives.

• Turn off the news. 

  Give yourself permission to take a break from the images, thoughts and emotions related to this tragic event.  As with a car accident, when something terrifying or tragic occurs, we can feel compelled to watch and gather information about the event.  But it’s important to your emotional well-being to get a break from it.

• Distract yourself. 

  If you’re plagued by persistent thoughts or painful emotions, try engaging in physical or mental activities that take your mind off of it.  You might try things such as going to a movie, exercising, doing a puzzle or playing a video game.

• Help others. 

  One of the most effective ways to feel better is to help others.  Whether it’s volunteering for a charity, watching a neighbors pet or saying kind words to someone else, helping others can improve how you are feeling.

• Do something opposite to how you’re feeling. 

  You may be feeling angry, sad or depressed.  Don’t take lightly the impact a pleasant experience can have on your mood and emotions.  Some things you might try include watching a funny TV show, talking to a light-hearted friend or listening to comforting holiday songs or upbeat music.

• Soothe yourself. 

  Often when we’re in the midst of painful emotions we neglect to do the things that can make us feel calm and relaxed. You might try lighting a scented candle, baking cookies, wearing soft clothing, putting on a special scented lotion or looking at pictures of loved ones or special times.

When you have good reason to feel bad, it can be hard to regain your equilibrium and get through normal daily activities.  A few simple coping strategies can make a bigger difference than you might expect.

If feelings triggered by the tragic events in Newtown Connecticut are interfering with your ability to function, it’s essential that you employ strategies that will help you bear the moment and get through this difficult time.  These strategies or seeking help from a professional are important.

It’s been hard in recent years to ignore young entertainers’ breakdowns, drug habits, and bad behavior. Demi Lovato, a 20-year-old singer/songwriter, actress, and newly appointed judge on the talent show “The X Factor,” has endured much internal struggle.

But she has courageously sought mental health assistance and boldly documented her journey to share with others for inspiration. Along with her “stay strong” motto, she’s demonstrated that obstacles can be overcome, which is what ultimately highlights her as a different type of role model.

Katie Couric (who struggled with an eating disorder during her college days) interviewed Lovato earlier this year. In a heartfelt discussion, the young celebrity opened up about the origins of her body image issues, and the time she spent at an Illinois treatment facility for anorexia, bulimia and self-mutilation.

“I always had self-confidence issues in my body and self-image problems,” Lovato said. “It also didn’t help that I had kids at school at such a young age that were really, really naturally thin, so I always felt like I was the bigger one of the group.”

She initially dealt with her insecurities by overeating, which then turned into starvation, along with binging and purging. Lovato said that certain traumatic situations could trigger those destructive habits, and she candidly spoke about being teased and berated by other peers at school.

“People don’t realize how badly cyber-bullying and verbal harassment affects you,” she said.

With regard to her eating disorders, she confirmed that being in control was important, and those unhealthy patterns developed as a coping mechanism. “Some people don’t want to feel the emotions that they have — I think I just didn’t want to feel.”

After Lovato instigated a physical altercation with one of her friends, she realized her emotions were out of control, and she knew she needed to get help. She checked herself into a rehab center shortly after the incident.

“Treatment was so difficult at first,” she said. “I remember walking around saying ‘I’m in prison,’ and they needed to have strict rules in order for me to understand how sick I was.”

The “X Factor” judge admits that while she’s currently in a comfortable place, these issues most likely will stay with her for the rest of her life. She noted that during these past two years, however, a new mindset recently clicked; a mindset of acceptance and embrace for her natural body.

This past July, Lovato told “Good Morning America” that she’s happier allowing others to see her flaws, and that’s what defines her as a new kind of role model.

“That’s what being a role model is about,” she said. “It’s not about being perfect. It’s about speaking about your issues and inspiring others to get help.”

That’s why I’m pleased to introduce our newest blog, The Emotionally Sensitive Person with Dr. Karyn Hall. This blog will be focused on topics that would benefit anyone who’s “emotionally sensitive” — you know, people who react emotionally to things in life that are usually a little out of proportion to the actual event or problem. Some might say “over emotionally,” but it’s all a matter of subjectivity.

The blog will tackle topics of how to put DBT practices into every day use, providing many of the tips and techniques of this powerful form of psychotherapy.

Karyn Hall, Ph.D. earned her doctorate in child and adolescent psychology from the University of Virginia and completed her internship at Case Western Reserve University and Rainbow Babies and Children’s Hospital. She is a licensed Texas psychologist, as well as the co-author of The Power of Validation. You can learn more about her here.

Please give her a warm Psych Central welcome, as I look forward to learning more about dialectical behavior therapy and strategies of benefit to people who may be more emotionally sensitive.

* By 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.

* Of the more than 6 million people served by state mental health authorities across the nation, only 21 percent are employed.

* More than half of adolescents in the United States who fail to complete high school have a diagnosable psychiatric disorder.

* Between 2009 and 2011 states cumulatively cut more than $1.8 billion from their budgets for services for children and adults living with mental illness.

* In 2009, there were an estimated 45.1 million adults aged 18 or older in the United States with any mental illness in the past year. This represents 19.9 percent of all adults in the U.S.

*Serious mental illnesses cost society $193.2 billion in lost earnings per year.

* The annual total estimated societal cost of substance abuse in the U.S. is $510 billion.

* In 2008, an estimated 9.8 million adults aged 18 and older in the U.S. has a serious mental illness.

With our economy still in the toilet, states and federal government threaten to cut even more dollars in mental health funding, which would result in less or no access to mental health treatment and services for countless Americans. Ultimately the cuts steal the one thing that keeps those of us struggling with chronic mood disorders alive: hope.

Yesterday a group of mental health advocacy organizations hosted a joint symposium titled “Mental Health Hope: Lost People, Lost Dollars, Lost Hope” at the Reserve Officers Association in Washington, D.C. to raise awareness about the imminent threat and impact of such budget cuts. Actress Glenn Close and her sister Jessie, former second lady Tipper Gore, and a handful of prominent doctors and directors of behavioral care centers addressed the symposium moderated by the award-winning journalist Cokie Roberts.

I very much wanted to be there to take notes myself — and to meet my best friends Glenn, Tipper, and Cokie for a cup of coffee — but ironically I couldn’t attend because I need to work so many hours at my day job in order to pay for my mental health care, most of which is not covered by my health insurance plan. Thus, this is an issue I feel very passionate about, and urge you to pay closer attention to yourselves.

“Too often policymakers only see the immediate savings of cutting budgets to mental health services,” said John M. Oldham, M.D., President of the American Psychiatric Association. “We want to emphasize that these programs are already providing significant savings within the health care system and in other sectors of society, by increasing employment and workplace productivity, and by decreasing homelessness, substance use, and overcrowding in emergency rooms.

Mark Covall, President and CEO of the National Association of Psychiatric Health Systems, added:

The work we have done to increase access and quality of care for those in need will be severely threatened without the resources to keep the programs going. We’re already struggling to deal with increased demand due to the down economy. If we see any further cutbacks, the result will be incredibly costly for the wider community.

Actress Glenn Close launched her anti-stigma campaign, Bring Change 2 Mind, to educate the public about mood disorders after watching her sister, Jessie, battle an undiagnosed bipolar disorder for years, and helping her nephew, Calen, who lives with schizoaffective disorder, get the care he needs.

“Access is critical,” Glenn wrote in an op-ed piece published yesterday on the website Politico.com, “because more of us are affected and in need of support than most people realize. Close to 60 million Americans live with a diagnosable mental illness, and one in four families has a relative living with mental illness”

For more information about the symposium, please visit: www.mentalhealthhope.com.

All there is to do now is listen to your roommate snore and mutter to herself in her sleep and the sounds of the nurses talking and phones ringing at the nurses station. You remember a Seroquel-induced nightmare you had previously in the night in which you were trapped in a house that was filling with water, drowning and gasping for air. You make a mental note to mention the dream to your doctor later on.

7:00 am: Morning checks. A tech bangs on your door just as you have started to drift off into a sweet sleep again and informs you that you must be up for breakfast in thirty minutes. You incoherently moan something that resembles an “OK,” roll over and close your eyes again.

7:10 am: Brush your teeth, brush your hair, make your bed, and put on a sweatshirt.

7:15 am: You drag your exhausted body out of bed and grab a cup of the weakest, wateriest coffee you have ever ingested from the nurses station. You line up against the wall and prepare to be paraded down to the cafeteria.

7:30 am: Breakfast time. Today is Friday so it’s pancake day, which means spirits are high among the residents. Eggs with cheese, bacon, grits and cereal are also served in the cafeteria, which reminds you of the one that you ate in during your elementary school years. You opt for Cheerios, which you will eat by putting three at a time into your spoon (you are very ritualistic when it comes to your eating habits) and a few sips of black coffee.

7:45 am: You are put on one-on-one after each and every meal, which means a nurse must accompany you at all times because you are bulimic and they don’t trust you not to vomit up your food. This upsets you greatly and you cry.

8:30 am: Community group. You discuss at length the rules and regulations of the hospital (only use the phone for 10 minutes at a time, bath buckets are under no circumstances to be kept in your room, no towels or food in your rooms, no physical contact with other patients.) Someone complains that their book is missing, someone else cries about something you can’t even comprehend. Someone always cries during your meetings. You set a daily goal (to finish your book, do laundry) and share why you are here.

Most people are there for depression, some for anxiety, many for suicide attempts. One or two are there for insomnia, a few for manic episodes and one boy about your age is there for homicidal ideation. It isn’t as scary as it sounds, he is actually very sweet, close to your age and you are already starting to become close with him. His name is Todd and he beat up one of his friends for stealing his now ex-girlfriend. You yourself are there for a suicide attempt (flashback to overdosing on 3000 milligrams of Seroquel, sleeping for 36 hours and then slitting your wrists, slicing each artery, spewing blood all over the walls of your college dormitory.)

9:10 am: You meet with Dr. Williams, your amazing psychiatrist. He is a young man who always looks perpetually concerned; he is unbelievably kind and compassionate. He runs through the usual routine of questions: do you feel like hurting yourself, how are you sleeping, how is your mood (no, bad, depressed) and he takes you off of your lithium and ups your Abilify. He also prescribes you Ambien, which is stronger than the sleep medicine.

9:47 am: Code one! A 90-pound schizophrenic girl screams and punches the walls (she hears voices and sees monsters that aren’t there) and a code team is called to sedate and restrain her. Incidents like this are uncommon on your unit but not unheard of. They take her away, kicking and screaming.

10:00 am: You and Todd sit side by side reading a book and holding hands. His hand is rough and you can’t help but smile. He makes you a little less scared in an unfamiliar setting like this. A tech glares and scolds you for breaking the coveted “no-touching” policy.

11:30 am: Process group with your social workers. Today’s topic is “combating negative thoughts.” You do an exercise where you write a negative thought and three positive ones to counteract it. Several people cry when they read theirs and one man launches into an off-topic diatribe on the importance of exercise until the social worker, Tonya, politely cuts him off.

A short, older lady who claims to have once been a backup singer for Aerosmith preaches on bipolar disorder.

12:30 pm: Lunchtime. Pizza is being served today so everyone is in good spirits, except for you who is a diagnosed anorexic. You get a salad which you drown in mustard and pepper (anorexics have strange eating habits) and a Diet Coke. You don’t finish your salad and a tech tells you you’re going to lose points for not eating, which means you might have to stay longer. You cry.

1:00 pm: Vital signs are taken. They weigh you and make you stand backward on the scale.

1:15 pm: You drink a ton of coffee and experience a sugar/caffeine-induced mania and decide you’re going to start writing a book. A tech tells you to calm down and makes you drink a glass of water.

2:00 pm: Recreational therapy. You watch the movie “The Karate Kid” and popcorn is served. You don’t eat it, which gets noted in your chart by a tech.

2:30 pm: Education group. A short, older lady who claims to have once been a backup singer for Aerosmith preaches on bipolar disorder and the evils of not being compliant with medication.

4:00 pm: Visitation hour.

5:00 pm: Line up for dinner. Tonight is beef stroganoff (everyone groans) and steamed carrots. You don’t eat and spend dinner hour making an elaborate design out of your peas and carrots.

6:00 pm: You sketch a picture of Todd and he draws one of you. It’s true love.

8:00 pm: Closure group. You review the daily goals you set. Some people meet them, others don’t. You met both of yours (to finish your book and do laundry.) A lady who is in there for bipolar disorder breaks down and sobs for 20 minutes about not achieving her goal.

8:30 pm: Finally out of sight from the techs, you and Todd watch TV, his head in your lap, you stroking his hair.

9:00 pm: Night meds, a very popular time of evening for obvious reasons. Everyone races to be at the front of the line. You would think they were giving out hundred dollar bills and not psychiatric medication. You dutifully take your Seroquel and Gabitril for sleep and your Abilify for depression.

9:30 pm: Everyone hangs out in the common room, laughing and talking about anything and everything. You are a big happy family and for a moment, just a moment, you feel like a normal teenager who is not spending her summer in a mental hospital for being a depressive-borderline personality-bipolar-bulimic-anorexic mess. Life is good.

11:00 pm: “Lights out!” a nurse shouts. The manic patients and insomniacs groan in disdain. Todd kisses you when a tech isn’t looking and your heart melts.

11:15 pm: You happily drift off into a deep, medicated slumber, thinking that today was not all that bad and tomorrow probably won’t be either.

Mental hospitals are very misunderstood places. There is a certain stigma not only attached to being a patient in a mental hospital, but to the whole field of mental health to begin with. The people I met during my stay at Holly Hill were not crazy. They were not nuts. They just needed a little extra help and a safe, relaxing place to recuperate from their problems. Most of the people I met were perfectly normal, functioning members of society with jobs, families, friends and a positive future. Some were students, like myself.

Going to a mental hospital is nothing to be ashamed of or embarrassed by and I encourage everyone to take that step if they find it necessary. Life can be overwhelming and sometimes we just need to heal. Holly Hill changed my life. I went in suicidal, depressed, and a terrified mess, and two months later, I came out, in the process of being healed, with new friends, and a new perspective on life. My hospitalization not only saved my life, it changed it.

For the first time in her life, the mental health expert disclosed her own story (that we also discussed on the blog yesterday), which involved hospitalization at the age of 17 that lasted longer than two years.

Benedict Carey, author of the interview with Linehan, writes:

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.

Now, an increasing number of them are risking exposure of their secret, saying that the time is right. The nation’s mental health 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.

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.

“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 schizophrenia 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.”

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.

Linehan developed DBT as a result of her own transformation that occurred in 1967, while she prayed in a small Catholic chapel in Chicago. She describes the moment in a stirring video that accompanies Carey’s interview. In fact, I watched it five times because I was so moved by it. But here’s the abridged version included in the interview:

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… It was this shimmering experience, and I just ran back to my room and said, “I love myself.” It was the first time I remembered talking to myself in the first person. I felt transformed.

Linehan, then, takes this “radical acceptance,” as she calls it, and incorporating it into the techniques of cognitive behavioral therapy meant to change the harmful behavior of a self-cutter or a person who battles chronic suicidal ideations. In essence, DBT strives for a balance between acceptance and change, or integrating contradictory philosophies (“you are loved the way you are,” however, “you must strive to change”). I like to think of it as practicing and learning to live the Serenity Prayer: accepting the things we cannot change, finding the courage to change what we can, and using our therapists and guides to help us distinguish between the two.

On the website of Behavioral Tech (Dr. Linehan’s website), I found this helpful description of DBT:

“Dialetics” is a complex concept that has its roots in philosophy and science….[It] involves several assumptions about the nature of reality: 1) everything is connected to everything else; 2) change is constant and inevitable; and 3) opposites can be integrated to form a closer approximating to the truth (which is always evolving).

I was impressed with Linehan’s courage to disclose her story because, just as with Kay Redfield Jamison, I think it is especially difficult for experts in the mental health field to come forward. Ironically, the stigma in academic circles can be especially thick, almost as thick as Hollywood.

So, thank you, Dr. Linehan.

At 17 in 1961, Linehan detailed how when she came to the clinic, she attacked herself habitually, cut her arms legs and stomach, and burner her wrists with cigarettes. She was kept in a seclusion room in the clinic because of never-ending urge to cut herself and to die.

Since borderline personality disorder was not discovered yet, she was diagnosed with schizophrenia and medicated heavily with Thorazine and Librium, as well as strapped down for forced electroconvulsive therapy (ECT). Nothing worked.

So how did she overcome this tragic beginning?

She was not much better 2 years later when she was discharged:

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.”

A verse the troubled girl wrote at the time reads:

They put me in a four-walled room

But left me really out

My soul was tossed somewhere askew

My limbs were tossed here about

She had an epiphany in 1967 one night while praying, that led her to go to graduate school to earn her Ph.D. at Loyola in 1971. During that time, she found the answer to her own demons and suicidal thoughts:

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.

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.

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. [...]

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.

Dialectical behavior therapy (DBT) was the eventual result of this thinking. DBT combines techniques from a number of different areas of psychology, including mindfulness, cognitive-behavioral therapy, and relaxation and breathing exercises. Research has demonstrated its general effectiveness for people with borderline personality disorder. She should be very proud of her work with developing and helping people learn about DBT:

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 eating disorders and those with drug addictions.

Dr. Linehan’s struggle and journey is both eye-opening and inspirational. Although long, the New York Times’ article is well worth the read.

Read the full article: Expert on Mental Illness Reveals Her Own Struggle