I had the great delight this summer to reconnect with a writer-friend Judith Schwartz. We had met 15 or so years ago through the American Society of Journalists and Authors. I found her warm and Intelligent and enjoyed our conversations about writing. Then she moved to Chicago and we lost touch. I later heard she was in graduate school, training to become a therapist.
So I was surprised to learn that she had, indeed, been on her way to becoming a therapist but had changed her mind about practicing. She now lives in Vermont with her writer/professor-husband and their teen-aged son and is back to writing full time. In fact, she had recently finished a memoir,The Therapist's New Clothes (Shire Press 2009). I got hold of the book and once I started it couldn't put it down.
Judith is a gifted writer, and the tale she tells about how she became addicted to therapy is as engaging as it is disturbing. Her story covers three chronological years in Judith's life. It opens in Chicago, where she is treating patients under supervision while becoming increasingly embroiled in therapy herself, and ends in Vermont, where she has finally finds happiness with the help of an SSRI. The narrative moves deftly between past and present, weaving in childhood memories, past therapies and Judith's insights as a clinician, patient and writer.
Judith pursued therapy for most of her adult life. "It was more than a crutch ... it was a religion," she writes. "I believed that if I doggedly worked through my story, interpreting and reinterpreting key events, not only would I heal but it would all make sense." She clung to this promise of future deliverance, and, she says, it almost destroyed her life. Because what she learned after years and years of therapy and many therapists is that she had a mood disorder (mixed anxiety and depression).
There were certainly good reasons for Judith for to seek treatment. Her grandmother committed suicide, an unexplained tragedy about which her family shed little light. Along with anxiety and depression, she had panic attacks and intense fears - of suicide, of hurting her child, of being "the bad one."
After her husband lands a teaching job in Vermont, Judith leaves her therapist and Chicago. Still depressed, she turns to biopharmacology, an avenue she had gone down once before but never gave a chance. This time medicine works, and to her amazement, the fog lifts and an entirely new world opens.
She is understandably angry, more with herself than with her Freudian clinicians: all those years wasted in misery, the attention she didn't give the people she loved. Her self-preoccupation and childhood focus had put a great deal of tension on her relationship with her parents and distanced her from her husband and son.
The book's title alludes to Hans Christian Andersen's The Emperor's New Clothes, a tale about con men who promise an emperor a new suit of clothes invisible to those unfit for their positions. When the emperor parades naked before his subjects, a child cries out, "The king has nothing on!"
Judith identifies with the emperor who allows himself to be duped because of his own self-delusions. Therapy, she says, deceived her into thinking she was in more in control of what was happening to her than she was and that "through reason, determination and an outlay of cash" she would be able to overcome a lifelong depression.
But clearly Judith had some not- so-good therapists. What amazes me is that not one of her therapists allowed for an expanded view of depression: that of a multi-dimensional disorder, with biological components based in genetics and neurochemistry. This wasn't the Dark Ages or even the 1970s. Prozac, the first of the new generation of SSRIs, hit the market in 1988. Research about the depression-serotonin link was out there as were theories about heritable traits associated with suicidal behavior.
The clinicians weren't evil and probably not incompetent, at least in their area of expertise. They undoubtedly thought they were helping; however, their psychoanalytic view was narrow-minded and rigid. To them, the culprit was nurture, with little credit given to the powerful influence of biology on history.
Here is Judith's description of her relationship with a therapist she calls Dr. Hammond. "She encouraged me to feel compassion for the two- year- old child I once was, that child that felt bad about herself, alone and unloved. This, she said, would allow for psychic healing. "
This clinical model encouraged regression and dependence, which got Judith further hooked on therapy to manage her illness. The mistake her therapists made was not recognizing that Judith wasn't getting better. When a therapist sees a patient isn't improving over a reasonable amount of time, it should be his or her responsibility to consult with others and consider new approaches.
The Therapist's New Clothes is a memoir that Judith felt compelled to write. She needed to get her story out to patients and clinicians. She wanted to know if this had happened to anyone else. It became so important that when she couldn't take another publishing rejection, she decided to publish the manuscript herself. Luckily, her local bookstore was experimenting with the "Espresso Book Machine," which offers a print-on-demand program through its own imprint, Shires Press, at a reasonable cost.
I am happy that my friend has found contentment. On her blog she writes that having her illness under control has allowed her to pursue all sorts of ideas and questions. "With my mind free of the minutiae of self-analysis I can tune into what's around me in new ways," she writes.
But I'd hate for people to come away from the book feeling that talk therapy is a waste of time. Despite her devastating experience, Judith believes there is still a place for the examined life, pursuing unconscious fears and motivations, and the healing power of a relationship. "My brain may be biochemical, she writes, "but my mind is still psychological."
What caused Judith's problem has less to do with her individual therapists than with our health care system, which continues to separate mind and body - with talk therapy in one camp and medication in another. Mental health advocates have been somewhat successful in bringing mental illness up to par with illnesses deemed physical. Many states now have laws that insurance companies have to reimburse at the same rate for certain "parity" mental health diagnoses, such as depression or panic disorder, which are considered "biological."
But it's not enough. Physicians can prescribe medicine, while social workers and psychologists, for the most part, cannot. Psychiatrists also trained in clinical psychology are rare, and even if you find them, they're too expensive for long chats. Internal medicine and family medicine doctors are only beginning to be trained to recognize depression and other mental health disorders and treat them. Two states, New Mexico and Louisiana, have taken the unusual step to make it legal for psychologists to write prescriptions - an admirable, but controversial, accomplishment that doctors aren't too pleased about.
It would be interesting to know how those who have been in therapy and their clinicians, MDs as well as mental health practitioners, receive The Therapist's New Clothes. Though it may have not been Judith's intent, her book makes a great case for further breaking down the barriers between society's healers.
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