"I'm not crazy." That phrase ran through my mind twenty-five years ago as my mother and I made the hour-long drive to the psychiatric hospital that housed an eating disorder unit where I would spend the next six months undergoing therapy and regaining all the weight I had lost. It would be just the first of many hospitalizations. I had no idea it I would be there that long, otherwise I never would have agreed to sign myself in. However, the atmosphere on the unit turned out to be one of the few places where I felt the most accepted and at home during my extended illness.
     "I'm not crazy." Those words echo the voice of most of my patients at one time or another, particularly as they enter a course of therapy for the first time. They may have come on their own after suffering for as much as several years. Or a family member, a friend, or an employer may have suggested that counseling would be a good idea. They may be mandated by the courts. Regardless of how they came to walk through the doors of our clinic, seeking mental health counseling may have come to be seen as a weakness, a character deficit. Somehow the message has been passed down to them that they have to be mentally strong all by themselves. A cast on their arm is okay, taking insulin for their diabetes is fine, but coming to therapy once a week, or taking Prozac is viewed as lacking in resolution.
     I've come to loathe the word crazy and its counterparts; insane, deranged, mad, unhinged. Whenever my patients use one of these words, I interrupt them and point it out. "You are not crazy," I tell them. "Be kind to yourself." I do my best to be a therapist, a teacher, and a guide all in one. I talk about being judgmental — of themselves and how this is not helpful. Education is also important, talking to the fact that depression or bipolar disorder is a biological disorder that often responds to a combination of psychotherapy and medication. Providing the comparison that although a physical illness may sometimes be more visible, such as when a person walks with a cane, the pain and suffering that accompanies a mental illness is real even if no one else can see it.
     The word crazy has become a colloquialism; we — myself included — use it easily, beyond its dictionary definition. I walk into the front office of our agency where we keep our charts and stand there, wondering to myself why I entered in the first place. I start muttering under my breath, saying, "I'm (expletive) talking to myself again. I'm (expletive) going crazy."
     I catch myself. And correct myself. I rephrase and say that my memory has temporarily failed me and the exercise that I've gotten by walking out to the main office (my office happens to be the farthest from the front) is good for me. Soon I remember what I needed and trek back.
     I grew up in the same area as a notorious state psychiatric hospital. Whenever one of us kids wanted to be especially cruel, we'd tease each other by saying, "You're going to end up in the State Hospital with all the crazy people." Ironically years later, when I was on the long-term unit which treated borderline personality disorder my insurance ran out after 9 ½ months. The solution that the treatment team outlined was that of transferring me to that very hospital because they feared I was still a danger to myself. My mother, swearing that her daughter would never end up there fought for me, and a compromise of a 24/7 supervised residence with a partial hospitalization program was reached literally at the last minute. I still have the transfer papers which are signed by the unit chief as a reminder that this critical moment was averted.
     If I can change the thinking of one patient at a time regarding the stigma of mental illness — then that patient goes home and influences the belief system of his or her family and friends. In turn they pass it on to an acquaintance and a neighbor — the message that mental illness is not "catching," and is not something to fear.  Hopefully, the de-stigmatization can begin at the grassroots level.
     During the first year after my last hospitalization I wanted a dog very badly. I had two independent cats, but I had grown up with dogs and ached for the unconditional love that I fondly remembered. I told my brother of this desire and he remarked, "No, what if you have to go into the hospital again? Cats are okay for a short time with just someone coming in to feed them, but dogs are social animals — they need company." And I had the thought — is the time when I can safely have a dog a measure of my sanity? How much waiting-for-dog-time equals two years out? How much waiting-for-dog-time equals four years out? Will I ever get there?
     In February 2012 I will be out of the hospital five years. I now know that I can have a dog if I want but due to my work schedule and long commute, with the number of hours I am away from the house each day, it wouldn't be fair to a dog. It's not a question of having to be hospitalized again that prevents me from snuggling up with Sascha (a unisex name I have already picked out) — it's a practical reason.
     I'm of (Sascha) sound mind, body and soul. Peacefully, patiently, I'll wait until the time is right.