From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

An Open Letter to My Patients

What I Would Tell My Patients if I Could

The words contained in this letter are the words I would say to my patients about mental illness and recovery and much of what goes along with these from my experience — if I had complete freedom to disclose what I've endured and discovered.

To My Patients:

First, do not be ashamed that you are suffering from a mental illness. You are truly courageous and depression or bipolar disorder or an eating disorder is no more your fault than having diabetes or having a broken arm. The only difference is that you are not wearing a cast that says to the world I am hurting.

You are not a borderline or a schizophrenic or a bulimic. You are way more than your illness and your diagnosis is not your identity. You are a person who suffers from depression or post traumatic stress disorder. You have many other qualities as well.

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The fact that you have chosen to seek treatment speaks to your strength. Undergoing therapy is not a weakness; in fact it is a process for the strong. That you are willing to explore your feelings, your fears, your vigor, and delve into all of this with a person who starts out as a stranger is a sign of your courage.

Remember that therapy is a process and not always a pleasant one. As you dig deep, things may seem to turn upside down and get worse before they get better. If you feel that you have a good therapist, I urge you to stick with it. The muck that you find in the caverns of your psyche will be cleaned out, and will be replaced with a core that is solid, healthy and constantly in stimulating stages of growth. You will come to like yourself and to love yourself.

If your psychiatrist recommends medication, consider it in combination with psychotherapy. Finding the right medication may take multiple trials which may not always be agreeable. Medication does have side effects like dry mouth and constipation but you can learn to live with them. Once the right medications are found, it can make a huge difference. I have accepted that I will probably be on medication for the rest of my life and that’s okay because without them I believe I would not be able to function the way I am currently able to. Without them I would most likely slip back into a severe, intractable, suicidal depression (perhaps with psychosis) and end up killing myself. The right medication can be a godsend.

Psychiatric hospitals are not an ideal place to be, but they do exist for a reason. If you are so depressed that you are feeling suicidal and feel that you are incapable of keeping yourself safe, then that is the place you need to be. The staff at the hospital can observe you and also make adjustments in medication differently than can be done as an outpatient. I have had over twenty inpatient hospital stays over the last twenty-five years, ranging from 9 ½ months to two days. I wouldn’t recommend myself as a role model; twenty-plus is too many, but if you need to, don’t hesitate. This is your life we are talking about.

If you feel that you need to be evaluated, call 911, or ask someone to take you to your local emergency room.

About drugs. Don’t do them. I started smoking pot at age fourteen, progressed to cocaine, and then Dexedrine which led to anorexia. Then years later in 2007 I became addicted to Klonopin. None of the highs or the lows — and there were many more lows than highs — were worth it. The upshot is that it was all about numbing and escape. I was always trying to do one or the other, or both —sometimes simultaneously. And it never worked. I ended up more screwed up then when I took that first toke, snort, or swallow. And God know how many brain cells I have fried.

Eating Disorders. This is a tough one. As those of you who follow me on a regular basis know, I continue with to struggle with anorexia. The only advice I can offer you is don’t start. Eating disorders are different from any other addiction because you cannot practice abstinence. We still have to eat and face food several times a day.

Anorexia almost ruined my life. First I almost died from this illness and its medical complications. Secondly, I lost an initial career that I had worked extremely hard for — climbing the “corporate ladder” up from a secretary in an advertising agency to a development manager position in a major packaged goods corporation. I had taken so much time off for hospitalizations that management couldn’t hold my job for me any longer. A depression followed the job loss and led to a suicide attempt. And it only went downward from there.

There are different levels of “recovering” from an eating disorder. One is eating enough calories and maintaining a healthy weight for your height. Another is being free from food obsessions, mirror checking, distorted body image and eating a wide variety of foods without thinking about calories and weight while doing the first. There are also levels in-between. Right now I am at the first level, but I don’t know, because of the longevity of my illness, if I’ll ever get to that top level. Trying to put the anorexia behind me continues to be one of the most difficult challenges I face.

It’s much easier just not to start.

Depression. It can sneak up gradually, like a transmission breaking down or feel like it comes on with the force of a tsunami, knocking you off your feet. I’ve experienced both kinds. However you encounter depression, the pain is one of the worst I have ever known. It is intractable, unrelenting and without forgiveness.

I’ve had patients in the throes of a severe depression who were holding on like I imagine one clings to the railing of a terrace, trying not to fall fifteen stories, tell me that they now know why people kill themselves, a concept which they could not fathom prior. Because the pain is unbearable.

I discovered cutting and the relief it brought me when I made my first suicide attempt. I was trying to cut the veins in my wrist because the emotional pain was intolerable and I had decided I did not want to live one minute longer. I did not succeed, but I found the act of cutting to be a release and I continued cutting for a number of years.

Side note: Do not start cutting. It is like a drug in that it is an escape and a numbing agent. It causes ugly scars that you will regret when you finally stop.  Like drugs your tolerance to cutting will decrease and you will need to do it more often.  I had developed an entire ritual that took an enormous amount of time and required absolute privacy.  The memory of the last time I cut is etched into my brain forever, because I snuck razor blades into the hospital and cut myself in my room.  I think I need not say that all hell broke loose in more ways than one, and I decided that was the last time. Period.

When you meet someone that you love, he or she will ask about the scars and you won't know how to answer. After I stopped cutting, I went to a plastic surgeon who promised to remove the scars on my forearms and upper arms, and he took my $3,000 and did some kind of procedure that didn’t work, and I still have the scars. When I started a new job over four years ago in the month of July, I wore long sleeves even though I was sweltering. It’s not worth it and it’s something that you will eventually wish you hadn't done.

Back to depression. The first thing to remember is that the feelings of hopelessness and helplessness will pass. Just hang on and hang in. The second thing to remember is that you are not alone in your suffering. If you’re not in therapy, get to a therapist even though you have little motivation and energy. If you are in therapy, reach out to your therapist and/or join a group if he or she has one.

Take care of yourself. You may not feel like it but take a shower, brush your teeth, change your clothes, and eat and drink something. Find something to hold onto. Before I adopted my cat, I held onto a stuffed teddy bear I still had from college. I clutched it tightly and sobbed onto its fur. It may sound silly but just the act of being able to squeeze it as hard as I could without worrying that I was hurting it and covering it with snot helped me enormously. Over and over again. Teddy was always there. Go get a stuffed animal.

Even if you are not a big reader, I recommend that you read a couple of memoirs by people that have suffered from depression when you are able to concentrate. Having those stories etched in your mind will reinforce the fact that you aren’t alone and that you will get better. Two memoirs that I highly recommend are:

1) “Darkness Visible” by William Styron

An eloquent classic by the great writer about his own struggle with depression

2) “Undercurrents: A Therapist’s Reckoning with Her Own Depression” by Martha Manning

A readable account, written in diary form, about a woman’s descent into depression and how she found her way back.

               * Both are available on amazon.com

 

I cannot emphasize this point enough. When you find your way through an episode of depression and come out the other side, and you will — with professional help, because it’s impossible to do it alone — you will feel, well, I felt like the storm clouds had cleared and into my line of vision flowed a cerulean sky that held a promise of hope and expectation. A life about to be reborn.

I will end this post by saying the words and sentences I’ve written today only scratches the surface of what I’ve learned since initially entering therapy over twenty-five years ago and receiving my first diagnosis of dysthymic disorder, and subsequent diagnoses of anorexia, severe depression with psychotic features and borderline personality disorder.

There is so much more I want to tell you, so much more that I’ve experienced, seen and heard, good and bad, so much more I’m not sure you should hear, that I’m not sure would be helpful to know — some that might be useful, even though not necessarily compassionate.

I wish each of you courage, wisdom, contentment, and continued serenity.

Gerri

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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