“You should write that down.”
“What? What did I say?”
I was at a Mexican restaurant in Pilsen, post-Dia de los Muertos celebrations with a friend. The cuisine wasn’t ideal for the sour stomach I’d been nursing for days – nerves, self-diagnosed – but what came up violently from the hellfire depths of my core was a frustrated, righteous, angry, thoroughly exasperated and unnecessarily apologetic rant about the quote-unquote mental health system.
“The mental health industrial complex,” my friend corrected me. Mind you, they ran a trauma support group at a local service provider.
People who have survived or been victims of, or however you want to frame it, people who have experienced this kind of severe abuse, they are entitled to the dignity of their own experiences of reality.
Or something like that. That is what they said I should write down. But we both in truth immediately forgot it the moment the suggestion was made, as if this profound insight had been uttered in a trance state from which we’d abruptly awoken. So I think that is what I said. It’s what I am writing down. It seems so innocuous, that string of words in italics. That cannot possibly be what I was instructed to commit to perpetuity. But I’m rather certain it was. Perhaps it was a sentiment expressed more eloquently in skeleton face-paint. Perhaps, taken out of context, it lacks the crescendo of the revelatory moment following rum- and festivities-induced lucidity. Written alone on a computer screen, indoors on a luminous autumn afternoon, the classical music station pledge drive providing the whitest of white noise soundtracks, it lands on the page with a soft thud. What the fuck do these words even mean?
They mean that in my experience, and in the experiences of many others, the treatment provided in the established mental health system quite unsettlingly mimics the dynamic that defines/allows traumatic abuse. And that dynamic is: people in positions of power and authority defining reality for their subjects. The gaslighting of the abused and the unspoken threat, “It’s my word against yours and you are obviously unstable while I am an upstanding member of the community,” is frankly not much different than the diagnosing someone with complaints of severe traumatic abuse as having a personality disorder.
I have no inkling as to the motivation for the latter phenomenon, but it seems like a built-in feature rather than the work of a few bad apples. Say you are raped, beaten, locked up as a kid. For example. You might grow up to be a successful professional or you might grow up to be a homeless addict. Regardless, you are quite likely to grow up and still have some issues, be it an inability to trust people who say they love you, a searing emotional pain you do secret things to alleviate, bouts of inexplicable depression or neurosis, paralyzing panic attacks or nightmares or both, getting ill frequently, having idiopathic neurological weirdness like chronic migraines, fainting spells, weakness. You probably don’t sleep too well. Maybe you tell yourself these are character flaws. That you just can’t do anything right. Normal people can make their parents love them, and you couldn’t even do that. So you beat yourself up. Or maybe you’ve moved past that phase, if only because it obviously doesn’t solve anything or help you sleep. Maybe you know fully well that these are not moral failings but well documented psychological and physical ailments commonly associated with depression or post-traumatic stress disorder. Well, you have some trauma in your past, and if it originated in your family, it’s probably not even comfortably in the “post” category. If you were systematically harmed by someone who was supposed to protect you, you’re probably very experienced at being inconsolably sad. Alas, you may feel enlightened to have made the connection, but it may not be enough to stop these pesky symptoms that are probably a lot peskier than you want to let on. Because that shit is personal. And you have trust issues.
There are a million ways it may have begun, this “seeking services behavior.” Perhaps you were empowered by an episode of the Oprah Winfrey Show that assured its audience that mental illness is nothing to be ashamed of. Perhaps your roommate came home and found you unconscious after one of your “just trying to ease the pain” sessions that wasn’t intended to go this far (but if it did…) Perhaps your bff suggested you take some time off and maybe just give therapy a try? Perhaps you inadvertently scared the fuck out of everyone you know. Perhaps you are simply being a fine upstanding responsible citizen who sees the doctor because you obviously have some type of chemical imbalance and there are drugs that cure that and you would be negligent not to take them. You owe it to your loved ones, your co-workers and yourself. You are proactive. After all, you didn’t go from being locked in the basement like a sex slave at the age of 5 to a well-educated, world-traveling, fully employed human being without being proactive!
So you get to the doctor’s office. You are given drugs. Maybe they work, maybe they don’t. Maybe they work for a while and stop working. Maybe they ease your symptoms but the side-effects are worse than the cure. Maybe more drugs are added on to counter the side-effects. Maybe the original drug is switched. Once. Twice. Three times. Maybe your doctor suggests that despite apparent inefficacy you do not stop taking drugs, whatever you do. It’s too dangerous. Maybe you are given new experimental off-label use drugs. Maybe you are given a stimulant for depression, a sedative for insomnia, a benzo for panic attacks (made worse by the stimulant) and an atypical anti-psychotic because even though you are not psychotic, the doctor reassures you, they have a great success rate when added to an anti-depressant. Maybe you are still having nightmares and panic attacks and your memory is shit and you feel stoned all the time and wonder if people can tell. Maybe you tell this to the doctor. Maybe the doctor changes your diagnosis from “Depression” to “Bi-Polar” because you are not cured by SSRIs. Maybe you tell the doctor you don’t actually have manic episodes. Maybe that doctor tells you that’s what Bi-Polar II is, bipolar without the mania. “With hypomania.” “What’s that?” “Do you ever have times you are feeling very confident and productive and happy?” “Yes.” “That’s the Bi-Polar hyomania.” “Oh. I never thought that was a problem, to be honest. I’d like to keep that part.” “Do you want to get better or not?” Maybe your doctor thinks your are being difficult. Maybe you go home and blame yourself for not getting better. For not trying harder. For not being able. Maybe you spiral down a hole of self-doubt. Your doctor hates you now. Way to fuck everything up. Everyone hates you. And you’ll never get better. You are beyond help. You have to live with this stupid suffering bullshit for the rest of your life. Because you are drug resistant and doctors hate you.
Maybe you decide no way are you going on like this for the rest of your life. Besides, you’ve really only become a burden to your friends with all your mental health mumbo-jumbo lately. And your family is basically never going to forgive you for opening up this wound, talking openly about ugly family secrets. And you’ve managed to go from someone who knew how to function outwardly and keep her ailments a secret, on the inside, where they belonged, like that other stuff, to someone people look at and just see INCEST and SUICIDE and MENTAL CASE. Maybe you cannot even look yourself in the mirror. Maybe you swerve violently between desires. The devil on one shoulder wanting to ending it once and for all, out of breath and energy, too emotionally drained to fight and you know it will always be a fight, with a society that doesn’t understand how to help, with a system that won’t accommodate a spectrum of abilities but only sees black and white, with yourself who is hell-bent on killing yourself, replaying a dark childhood self-defense fantasy triggered by every single injustice, hurt, fear… And the angel on the other shoulder who makes a very compelling case about loving your family and friends too much to do that, about the fact that you don’t actually want to die, you want to live in less distress, and about whoa there, you did not survive all that to throw in the towel now, girlfriend. You aren’t the one who needs more punishment here. You didn’t get yourself abused as a kid. You didn’t get yourself mental by shooting up in an alley. You didn’t invent your messed-up family situation. You didn’t give your mom cancer. You went to school, did well, got a fancy degree and job in academia, avoided jail, addictions, unplanned pregnancies and eating disorders. You are a fucking inspiration. That’s what they said. You took the meds, you went to the therapy sessions, you did the CBT worksheets, you called people when you felt you were a risk to your own life. You took vitamins and did yoga and served food to the homeless. You don’t get to hate yourself. You are not the one who failed dramatically here.
Maybe with new-found perspective and girded with the courage of your convictions you go to your doctor and suggest a possible link between your, you know, that, and your current struggles. Maybe you have some kind of PTSD. Maybe you would like to not take so many drugs and do a little more hard-hitting stuff in therapy. Maybe your doctor looks at you like you are nuts. Maybe your doctor is visibly angry at you and scribbling more notes than usual. Maybe your doctor starts asking more questions about your personal life, more questions about why you are not married and have no kids. Maybe you think this has nothing to do with why you are in his office… Maybe he tells you you want to be miserable based on your confession that you don’t want kids or a husband. Maybe he tells you not to think about your past. Maybe he suggests that you are making that up.
Ok. Maybe you change doctors. What century is this, amirite? Maybe you have this experience repeated with the next doctor. And the next. Maybe you are accused of doctor shopping. Maybe you are now spending all of your time at the doctor’s talking about your dating habits, your living by yourself, your curiously assumed inability to form stable relationships. “But I can give you my friends’ phone numbers, no really. And M and I were together for like 8 years, it ended because we’d become more like roommates, and he was seeing someone else. And the other guys I’ve dated, well, I haven’t been looking to settle down, and my personal life is overall something I am perfectly fine with. I have fun. Yes, I was devastated after the cabbie, but I mean, getting your heart broken, I don’t think that is mental illness… Why are we talking about this and not my dad?” Maybe you notice the doctors also spend an uncomfortable amount of time commenting on your good looks. Maybe you keep going back because the Klonopin and Wellbutrin do help. Not cure, no, but help, yes. Still maybe you make less and less an effort to pretend this hasn’t become a fucking farce. Maybe your insurance is about to drop your LTD (Your employer offered it up: you have benefits, take them. Your friends agreed: yes, do this for yourself.) because you’ve seen a lot of doctors and gotten a lot of different diagnoses and it just seems fishy…
Maybe I am talking about myself.
Maybe the therapist I had been seeing was actually really good. And I have seen a lot of therapists. And I knew I had something I needed here. Maybe the therapist gave me Judith Herman to read. Maybe the therapist scoffed, lectured and exasperatedly reassured me I do not have Bi-Polar Disorder and I do not have a personality disorder. Maybe he called it “Complex-PTSD” and “melancholia” because I hate the word “depression.” And I want to believe him because I spend 2 hours a week for a year talking to him, whereas I meet with a psychologist for 5 minutes a month and he talks mostly about my looks and boys and it’s just awful. Maybe I spend most of my time in therapy talking about stuff that feels a bit subversive. Society. Feminism. The way women are treated differently than men. Not wanting to change who I am fundamentally. Wanting empathy. Empathy helps. Liking who I am cures my anxiety. Anger. How I’ve always been terrified of anger, associating it with my father, never feeling it, only feeling hurt or fear. How I was becoming pro-anger. Anti-violence, but pro-anger. How I found it amazingly motivational and grounding. Maybe we had a plan where I would call him and stay with a friend or family member if I was “in crisis” rather than going to the hospital, which he thought would be too degrading and isolating. Maybe it was a life-changing experience the way you secretly think no way can therapy be. Maybe it didn’t cure me or make me a more suitable member of society. Maybe it gave me a far deeper appreciation of my messy parts that I don’t want to disappear or to have to hide from people. They are for better or worse my battle scars, my monument to an innocent victim who is not dead yet. Maybe that’s just where I am at. Maybe in ten years I will wake up and think, ok, suffery girl, your time is up. Get out. But suffery girl has a lot to say and isn’t finished and unlike others, I’m not going to make an effort to shut her up. She’s real. She’s a hell of a lot more real than well-adjusted girl. Anyone can learn to fake it and pass for what is expected of them. Well, I can. But learning the ability to walk up to a disgusting mess oozing with INCEST and SUICIDE and MENTAL CASE cooties and being in the same room with it and listening to it takes time and trust and love. And if that’s what I am asking of my friends and family, I better be able to do it myself.
Maybe I was in a good place.
Maybe my insurance ordered an independent medical exam. Maybe I was told I would lose my insurance if I did not appear at the appointment they’d made for me. Maybe I went. Maybe I was summarily dropped shortly thereafter. Maybe it took 6 months and a lawyer to get an explanation and instructions for appeal from my insurance. Maybe I was sitting in a law office 2 weeks ago staring in shock at the psychiatrist’s conclusion: “Borderline Personality Disorder.”
Maybe I had a therapist who had prepared me for the fact that this is a “thing” that happens to women who want to die and who say they were abused. Maybe I intellectually knew that. Maybe I was still in shock that it had happened to me. I don’t boil bunnies. I love bunnies. I am a trusted pet-sitter. I received “superior” performance reviews at work. I send thank you cards. I hold the door for the elderly and march for inner city school kids and volunteer with the homeless and floss (ok, weekly) and offer to help clean up at dinner parties. I am a good person. Who is extremely sensitive, uptight and has a weird autistic thing where I don’t trust people once they are out of my sight, but I’m actually very ok with my personality and don’t give a fuck if someone else isn’t. What the hell does my personality have to do with this? I am in treatment, not a popularity contest. What the hell? I go out of my way to be nice to people I’d much rather kick in the eye. How do I not get points for that? Who makes these rules?
Oh God. I knew it. The person who raped and beat and locked me up and all that during my childhood was my biological father. BIOLOGICAL. He was a monster, and I am his offspring. I inherited the evil. I have feared this my entire life. I have looked in the mirror and cried. I have been literally trapped in this body, in this being, created by a psychopath. Is it any coincidence my mother is named Rosemary? No. Ok, maybe that’s just silly. But being a psychopath is a real thing, and mental illness is inheritable. Jesus, that psychiatrist was good. He could see right into my soul. Past the pleases and thank yous, past the helping the under-privileged and aged. Past my kindness toward animals and fondness for literary and artistic pursuits and peacenikery. Right into the evil in my soul which I myself could not even see.
I spent a week in bed sobbing in grief for the good person I wanted to believe I was. I made every intellectual argument against the psychiatrist’s findings I could. He’d barely even met me. He left everything about my being generally plagued with sadness and anxiety out of the report. This had happened to others. It was well-documented. Female. Suicidal. History of childhood abuse. Does not respond to medication. Borderline. Still, I could see it in my lawyer’s eyes. He said he would not take my case pro-bono. Obviously it was clear to everyone but me that I was a lunatic and a scam artist. And a failed scam artist at that. Obviously that was part of the whole mental illness scene: you are too fucking crazy to know your own self. Or reality. Though the dropping the disability was a bit illogical, IMO; people that delusional being fit for work? Where? Is the funny farm hiring then?
Some of the psychiatrist’s other findings were that I was:
“Angry.” Ok, yes, now I am. Very. However, I’ve spent a year working on being ok with feeling anger, so that seems very bait and switch.
“Entitled.” To what? Yes. Probably that is true. I feel entitled to all kinds of things: dignity, support in the “recovery process,” a job situation that matches both my needs and abilities, security, a roof over my head, basic medical care, not having white male strangers in positions of power fucking me over. Super entitled. We enjoy freedom of religion in the United States, and I do have the right to opt out of a Calvinist worldview. It’s one I have exercised.
“Lacking insight.” I’ve spent my entire life being praised on my pretty eyes and keen insight. At this point I question if files have been mixed up.
“Playing the victim.” It’s not an act, sweetheart. Not a performance. I’m not here to entertain anyone. No one is entertained. If I do however “act” like a victim, it’s probably less to do with pantomime more do with how my father “acted” like a rapist with a leather belt, like a pornographer, like a criminal, and how my mother “acted” like she had cancer and died when I was younger, and how my cousin “acted” like he blew his brains out and my family “acts” like they drink a lot and … should I go on?
“Manipulative.” Because while I say I want to kill myself, I have not done so. Ok, that’s just not fair! I should prove I have depression and not a personality disorder by actually dying? Didn’t they do that shit with witches and drowning? The fact that I have NOT offed myself and have “services seeking behavior,” that’s responsible stuff I did right. You don’t turn that shit on me.
“Thin.” Thank you.
The report also called into question the veracity of my claims regarding my abuse.
The report also highlighted my political activism as well as my lack of husband and children.
The report also stated that based on the patient’s description of her emotional distress, she can only be lying, as it is more extreme than anything the psychiatrist had ever seen.
Well I doubt that. I’ve done the psych ward circuit and have seen worse myself. And I happen to know I was not lying, because I was me and there while answering his questions, and there is no note of demonic possession, and I actually remember it all very clearly (yay for my non-existent PTSD which can make me relive scary things in vivid detail) and I remember quite clearly telling the truth. But, well, should I donate my body to science or something? Seriously. That is fucking frightening.
Despite intellectually knowing this report was full of holes, unfounded claims and was written for an insurance company for whom I had become a liability, I internalized every last ounce of it. It was one thing to play a social radical on the internet. Another thing entirely to be on the receiving end of discrimination. First, what were the odds? I had already been a (legitimate, not making that up) victim of my father. Wasn’t one egregious injustice enough for a lifetime? If there were a pattern, wasn’t I the common variable? Wasn’t this on me? Oh, I could look at systematic racism or poverty and see how repeated injustice seems a feature, not a bug, in our society. But I’m white middle class. Literate, eloquent, drug-free, law-abiding citizen. Where is the privilege I’m always hearing about? Sure, I am female, but this is 2013. I can’t be discredited and dismissed out of hand like … other people. Right? My desire to be heard or treated with respect poses no threat to the status quo. I cannot flatter myself with the convenient explanation that The Man just Fears me. Right? Moreover, a healthcare professional would not blatantly say something so distress-inducing to someone already experiencing more distress than they know how to handle unless it were true, would they? Do no harm. It’s an oath. So there must be a rational, necessary justification for the harmful nature of this report, something scientific and impersonal and for my own good. I just am too nuts to see it.
I internalized the FUCK out of it. There was no fighting it. Who are you going to believe? A scrounger or a doctor? There was no telling my friends in hopes of getting reassurance I was not horrible person. Regardless of their current opinion of my decency, I’d have to plant the seed in their mind: a professional conducted a forensic psychiatric exam and found me to be a lying, evil, awful person. If my friends had come to me in the same situation, I would think, why of course that is nonsense. But later, when they did something to piss me off, or made a poor life choice or were PMSing I may think, wow, maybe she is a psycho. … No, I wouldn’t. But I can only speak for myself. Who knows what they would do. My track record for trusting people is not hot. Part of me actually trusted this psychiatrist to give an honest and empathetic report of my well-being. And that part internalized his findings. Why expect anyone else not to?
I had dinner with friends the day after I received the report. One brought belated birthday flowers and wine and chocolate. The other cooked. I did not tell them what had happened, but I put on no airs. I hadn’t slept or eaten. I was in a bad mood. The CTA was late and I bitched about that. I didn’t pretend to like anything I didn’t. I didn’t say nice things just because. And I waited. And they were lovely. They treated me like they always had. They shared their recent travails, funny stories, we drank wine and talked all night. It was disorienting. How did they not see I was a terrible person? A hysterical, manipulative, deceiving, entitled bitch? Why were they treating me like a nice person, a dear friend? Why was it all warm fuzzy vibes and comaraderie and stress-free? It felt like the twilight zone. Or a Poe short story. As if I had just murdered someone, and they didn’t know and were treating me wonderfully and it was driving me insane. I came home, happy, basking in the glow of the sweet person they believed I was. I was simultaneously crestfallen. I suck at being a manipulative, selfish, angry, entitled bitch, apparently.
It was about a week later when someone retweeted a blog post written by a Norwegian woman, completely coincidentally but like a rope thrown to me by the God I’d been cursing up one side and down the other, about being “borderlined” and not believed by her doctor when reporting abuse, about how in her experience, the mental health system she had entered seeking help had caused her more harm than good. It wasn’t a “Ha!” moment of vindication. I simply felt every muscle in my body relax for the first time in a week. My stomach settled and I just stopped freaking out. I felt the a calm sense of sanity. A sanity that I only experience when I do not discount myself. It wasn’t an “I’m right and he was wrong” pep talk. It didn’t matter who was right and wrong so much as it mattered that I give my own experience of reality some fucking credit. Because who else would?
There are a lot of times I do not feel sane. But that insanity seems to stem from a phenomenological disconnect between my experience of the world and the official narrative. So much of the work focused on in treatment is about changing one’s own way of seeing the world so that it fits more seamlessly into the official narrative, thereby reducing one’s suffering, and isn’t that what you want? Not to suffer inconsolable sadness or paralyzing fear? It is. But I soon came to realize the only thing that worked for me to feel sane was successfully making sense of my experiences, precisely the opposite of what I was encouraged to do in traditional treatment. I failed in traditional treatment because, despite the psychologist’s report, I have a visceral aversion to performing a charade for personal benefit. The question I repeated in therapy was, “But what if we just create the expectation that people should be empathetic and accommodating toward those who suffer, try to understand them, rather than demand they pretend not to be suffering for the convenience of others?” I adopted a multi-pronged approach: Give me the bravery to do what I can, the expectation of support for the things I cannot, and the wisdom not to give a shit about the rest.
I could appeal this report. I need to for money and healthcare. And on principle. I cannot just sit back and allow such slanderous things to be said about me. I have my pride. But I am also not returning to the mental health system anytime soon. Sure maybe this time it would be better. Now that I know what to say and not to say. And I do need the financial security.
That’s why my mother stayed with my father.
One thing abusers and mental health professionals both do, with possibly very different intentions, is they both tell you that you have no insight into your own situation. They make you question your own interpretation of events, your own response to mistreatment, your own culpability in your suffering. But they provide a safety net. And there are good times. So long as you do what you are told, don’t go off thinking for yourself, it can feel downright lucky. And lastly, chances are you came running to them in an already vulnerable position. Groomed, even…
People who have survived or been victims of, or however you want to frame it, people who have experienced this kind of severe abuse, they are entitled to the dignity of their own experiences of reality.
It’s what makes a person human. It is what was carefully and cruelly stripped from people who have lived in situations of traumatic abuse and injustice. It’s why we have African American History month and gay pride parades and a First Nations tv station. Because the official narrative, like the one you will find online if you google “Borderline” and probably many other DSM diagnoses, has a phenomenally poor record of accurately portraying the experiences of reality of those who do not fit comfortably within the status quo. If you want to turn crazy cutter girls into functioning members of society, or simply want to support them, this should be the very first thing you do. Respect their fucking history and the reality of their experiences. You don’t have to like it, endorse it, enjoy it or even care about it. But you don’t get to deny them it. We don’t negotiate with countries who deny the Holocaust. Because why the fuck would you do that unless you didn’t think it was that bigga deal? And people who don’t think it was that bigga deal scare the shit out of us. People who deny the stories of women (and men) who have experienced severe childhood abuse – not daddy didn’t love me enough, but daddy whipped me with a leather belt until I could not move and then had sex with me and this happened a lot during my whole childhood abuse – I don’t negotiate with such people. They scare the shit out of me. Because what kind of sick fuck doesn’t think such an experience is that bigga deal? What kind of system not only doesn’t think it’s that bigga deal but actively tries to discredit the victims of such experiences? These are institutions we are putting in charge of people’s psychological well-being. There has to be a better way.
My therapist told me not to kill myself because he thought I could change the world. I cannot even change my own insurance provider’s decision. But on the off chance anyone who needs to read this is: People who have survived or been victims of, or however you want to frame it, people who have experienced this kind of severe abuse, they are entitled to the dignity of their own experiences of reality. Period.
If you are having a positive, accepting experience with the mental health system, that is great news, and I do not encourage people who use the system to stop just because I had a shitty experience. I only encourage people seeking support to do what they have to do, often in the face of less than ideal options. I don’t judge. But be aware that this could happen, and don’t internalize it if it does. If it has already happened to you, do you want to start a revolution or something? I’m quite serious. What’s the saying?
Well behaved women rarely make history.
Oh, the report also said I was
Thank you for reading – It means a lot. Comments are off, but readers are welcome to contact me through my contact page, etc.