Dear Past Therapists,
I thought about writing pleasantries, but I’m just going to cut to the chase here. I’ve wanted to write this letter for a while now, because I’d really like to talk to you a little bit about stigma. Yes, you. You mental health professionals. You helpers. You college trained, seasoned veterans of psychotherapy. Your stigmas lead to assumptions and, frankly, you failed me because of them. I don’t mean to be harsh or over-dramatic, just open and honest.
I’ve been afraid to write this letter. I didn’t want to upset you or insult your work. I know, in some ways, each of you helped me, and I’m not trying to be rude or ungrateful here. But, in reality, you didn’t give me the help I needed. You misdiagnosed me and you minimized what I was dealing with and you let me “lead” sessions even though I told both of you that I kind of suck at expressing myself and that I struggled expressing my thoughts and feelings. Even when I asked you guys to take the lead and give me some damn questions to help get me talking, you didn’t. You didn’t view it as necessary. You both took me at face value as a “pretty together person”.
I’ve held this in so long because I didn’t want to hurt your feelings. And I didn’t want to let you down. Because both of you, on multiple occasions, either hinted or flat out stated that I was “doing fine” because I was able to handles school or hold down a job and be a mom and have friends and all that jazz. And, after a few sessions of learning that you believed I was doing fine, and that you expected me to be doing fine, I began to feel obligated to continue to come across as fine. But here’s the kicker, I wasn’t fine. I was never fine. The fact that I have seemingly held my shit together and repeatedly rode out the things life threw at me does not detract from my need for help. The fact that I “take everything as it comes” and have a hard time opening up about (or even understanding) my feelings at times is not evidence that I don’t need therapy. In fact, it turns out, those traits are actually symptoms of some much larger problems. Who knew?
Well, I did, on some level. That’s why I saw you. That’s why I continued coming to see you every week. See, I wasn’t coming to you just because I was stressed with my job or homework or family life. I was coming to you for the help I knew I needed, but couldn’t articulate. I wasn’t qualified to make any definitive statements on the quality of my mental health. But you were. But instead of listening to my symptoms, when I tried to explain them, you downplayed them:
“Of course you’re stressed. But I promise it’s not a symptom of anything more serious. It’ll pass.”
“Sure, your childhood was difficult, but look, you got through it, and it could have been worse.”
“Don’t worry, that period of barely sleeping was just a reaction to a stressor. You have good reason to have insomnia. But it’ll break. Try some deep breathing before bed.”
“I’m not giving you a diagnosis, because I don’t think you need one. We just have to talk you through some coping skills to get over your childhood and you’ll be fine.”
“I’ve diagnosed you with Adjustment Disorder Not Otherwise Specified, just because I have to for insurance purposes, and that’s the diagnostic code I use when people aren’t mentally ill.”
It may not have been your intention, but can you see how ridiculous those statements are? I heard, “You don’t really need help” in every single one. I appreciate you trying to comfort me and “normalize” what I was going through, but here’s the thing: IT’S NOT NORMAL. Being depressed is not normal. Not sleeping for days (sometimes over a week) at a time is not normal. Being so consumed by fears of the past that I can’t live in the present is not normal. And none of those things need to be normal. I didn’t need to be “normal”. I needed to understand what was happening in my brain and learn ways to cope with it. But, for some reason I can’t quite understand, both of you seemed to need me to be “normal”.
Now, mind you, I wish I was “normal”. I don’t want any of the struggles I’m facing. I would like to get back to being someone who can manage a full time job plus family responsibilities. Not being able to do that right now is very challenging – if you remember, I’m a bit of a work-a-holic. Right now, though, my situation is such that I cannot work in the only field in which I have experience. And I cannot be branching out for a new career and a full time job just yet. And that’s just something I have to accept.
But I came to you for help before all my issues came to a head. I was trying to be preemptive. And if either one of you had taken the time to help me dig a little deeper (because I definitely didn’t know how on my own) maybe we could have caught the mess of stuff happening in my fucked up brain before it hit critical mass.
See, it turns out I’m not as “high functioning” as you thought. As a matter of fact, I’ve been quite a mess recently.
To my college therapist, Junior and Senior year: You were the first therapist I had ever seen in my life. I admit, I was ignorant to the questions I should be asking, or even the things I should be talking with you about. Junior year, when I asked you if it was possible that I could have “Bipolar tendencies” (because I recognized some red flags, but didn’t understand hypomania or the concept of mixed features), you assured me I did not, without so much as asking me what I meant by the question or what would lead me to ask such a thing. You just said, “No, you’re not Bipolar” and moved on. You shut it down and I didn’t know that I could (and should) push a bit harder. Senior year was really rough, too. The last time I saw you was right after the SSRI antidepressant my doctor put me on caused me to hallucinate, which, of course, is potentially a warning sign for Bipolar as well. But everyone, yourself included, chalked it up to a freak side effect. As you know, a little while later, I had to leave school because I was overwhelmed and, frankly, barreling toward suicidal depression.
To my most recent therapist: I saw you on and off for three years. We talked a lot, and about a lot of different things. It’s been a while since I last saw you, though. I saw you once after I got released from the hospital, and, in the course of trying to set up an appointment after the PHP, I told you I had lost my job due to my mental health crisis. So, you’re up to date on that. You don’t know that I’ve spent the past few months trying desperately to hold on to any semblance of my “old life” I can. You don’t know that I’ve been through every hoop possible to get my current treatment team. And you don’t know the scope of the incredibly hard work I’ve done just to get here. Jobless, but stable. Med managed on State Insurance. Remember back in November when I came to see you on day 9 of no sleep? You casually encouraged me to consider the hospital, but you didn’t even come close to pushing the matter. You mentioned it once and then immediately said, “It’s probably not necessary.” And I took your opinion seriously. After all, you’re the therapist, right? That was also the day you told me I “wasn’t crazy” because “only Bipolar and Schizophrenic people are truly ‘crazy'”. As it turns out, I have Bipolar disorder, and that period of no sleep was a Manic Episode with Mixed Features. How could I possibly return to you with my new diagnosis after hearing you say something like that? And, really man, how did you miss that? I’m not a PhD familiar with the ins and outs of the DSM-V, but you are. I had absolutely no idea what was happening to me. But my symptoms were freaking text book! You just couldn’t (or wouldn’t) accept it.
And this one’s for both of you: I also have pretty severe PTSD. 28 years of trauma floored me in November. But when I would try to talk to you about my past, you’d both immediately tell me how great I was handling everything and then bring up stories of people who had survived “much worse.” I shouldn’t even need to tell you how invalidating and, frankly, inappropriate that was. I didn’t need a Pep Talk, I needed a therapist.
But, for whatever reason, both of you decided I was “high functioning” and there was nothing “substantially wrong with me.” And you both seemed to cling to that belief, even when I was really struggling. It was like you were trying to assure yourselves as much as me. Why is that?
Even as mental health professionals, you labeled me early and then did all the cognitive dissonance dances you could as more symptoms revealed themselves. Do you do that to all your “high functioning” patients, I wonder? Did you feel some subconscious need for me to be “alright” because I was studying social work and, later, working in the mental health field? Were you just afraid to backtrack once you’d spent so much time telling me, in detail and repeatedly, how I was very OK ? Or was I just too personable and “normal” for you to grasp the fact that some pretty serious shit was going down in my brain? I’m inclined to think it was mostly those last two.
You guys should know, more than anyone, that assumptions and stigma kill. Your apparent preconceived notions very nearly killed me. Now, I don’t blame you for not being able to read my mind. No one can do that. But the signs were all there. The intensive treatment teams identified them almost immediately. As professionals, I wish you two had been a little more open minded and seen those signs for what they were. Truly, I hope that I’m not coming across as unreasonable. But a proper diagnosis 7 years ago, or even 2 years ago, could have saved me a lot of suffering, pain, confusion, and guilt.
The good news is, now that I’ve spent a week in the hospital, a month in a Partial Hospitalization Program, and another three weeks doing an Intensive Outpatient Program, no one is assuming I’m “fine” anymore. I’ve finally got a therapist who knows and accepts my diagnoses, a psychiatrist, and a “treatment team” of professionals working to help keep me stabilized. But I can’t help but wonder how much of that could have been avoided if I’d gotten the correct diagnoses when I was 21 years old, or 25 or 27. I’ll be 29 in June, and, while I’m relieved to be receiving treatment now, I sure do wish it hadn’t taken a spectacular crash-and-burn crisis to get me here.
I hope that you both learned a little bit about the importance of not assuming someone is “fine” just because they are talkative and polite. And that you remember that trauma can prevent people from opening up and laying it all on the table without some serious trust building and a little guidance and nudging. I hope that you both recognize that mental illness doesn’t discriminate, and it doesn’t look the same in everyone. Just because I plowed through hypomanic, manic, and depressive swings for a while there without proper medication and therapy doesn’t mean I wasn’t having them, or that I wouldn’t have benefited immensely from a higher level of care than once-a-week Pep Rally sessions. Most of all, I hope that your interactions with me have taught you to withhold judgement just a little longer, and to be willing to admit if you’ve made a mistake. After all, your patients are supposed to be transparent with you, don’t you think you owe them the same?