When I first met Carmelita she was a 49 year old school teacher, with a history of depression of such severity, that at the time of her referral she had been hospitalized twice. She was hanging on to her
career by a thread. After a comprehensive Whole
Psychiatry assessment (which included a full psychiatric and psychosocial history, a psychopharmacologic re-evaluation, and assessment of
nutrition, digestion, inflammatory/ immune function, detoxification disturbances, and endocrine abnormalities) and institution of treatment, Carmelita achieved a degree of mood stability, verified by her family and employer, which she had not had in a decade.
Despite the obvious benefits of following the comprehensive program. Carmelita had great difficulties complying in a consistent manner with the recommended changes in diet, exercise, sleep regulation and nutritional supplementation. And so, compliance with the regimen became the constant focus of her monthly sessions. Carmelita was unable to understand her behavior, realizing that she would feel much better if she could do what needed to be done, however, another part of her was enraged that she could not live life "like everyone else". "I'm just crazy" was her frequent refrain. "Why do you bother with me?."
Carmelita seemed to be at war with her self, and her mental and physical health were the prize. I automatically, and self-assuredly, took the side of "health", consistently pushing, nudging, cajoling, and at one point even threatening her with termination if she didn't comply. I tried cognitive behavioral approaches, we set small goals, we jointly adjusted her medical regimen to make it easier for her, all in the hope of rescuing vitality from the jaws of depression. Carmelita was unwilling to leave my care, having improved so much, and despite the civil war within, a fondness grew within me for her. My crusade continued for about 4 years.
Then, one day, when we were in our familiar stances (she angry with both of us, and I patiently pressing her), I transcended the dance we were engaged in. I (finally) recognized that I was battling a "complex" of thoughts, feelings and emotions. By definition, one never wins a battle against a complex using behavioral, logical methods. I explained to Carmelita what Carl Jung's idea of a complex was, that we all have plenty of them, including myself, and that they are the result of unconscious factors-usually related to some sort of trauma-which control our behavior. When we are operating out of a complex, we are often mystified by our lack of control over our own behavior. This was the first step in de-pathologizing Carmelita's behavior.
In the next session, we began to talk about her attitudes towards medication as well as her illness. As she did, she became aware of the fact that the African American culture sees depression as a "White Man's Disease", a luxury which African American's can not afford. The fact that she had been so severely depressed that she had required hospitalization did not square with the cultural view, and so she was obviously a failure in her culture, or her culture was wrong. The discrepancy created tension. Then on further reflection, Carmelita remembered her abusive father's very derogatory attitude towards her mother's use of medications. And finally, she recalled her first husband's negative attitude as well. The session closed with her realization that her personal experience did not square with the attitudes of the predominantly male culture around her, and that the attitudes of these males, who were damaging to her in so many ways, were actually controlling her behavior each and every time she was to take care of her self via medication. This explained why she would see the medicines in front of her but still forget to take them.
Carmelita left the session deeply disturbed.
After one more session several weeks later, processing this material, Carmelita began tracking, on her own, her compliance. Her compliance improved to 72-80 % on medications and supplements. Her sleep rhythms, which were very erratic, became normal as she no longer fought sleep.
Following this, Carmelita took a workshop on poetry writing for people with chronic illnesses. She was to write a poem around a quote, or a thought. Her thought was " He gave you your life back." After she wrote the poem, she processed it with her group. The group pointed out to her that the premise of the poem was incorrect, because she never had lost her life, and that she was in fact the one in control all the time. This reframing took her from a passive position, and re-established her sense of efficacy and self-potency.
As the complex was made conscious, changes began to occur in other areas of her life as well. Carmelita came in to one session, having written a couple of letters to the editor about racial issues, wondering if she were perhaps becoming manic. However there were no such indications. In fact, Carmelita was simply enjoying the release of creative and potent personal energy released because of work on a previously unconscious complex which was rooted in her family and culture; Now, she had finally wrestled back control of her life from all of the males, the last one being her self righteous, and narrowly focused doctor.
