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. I really need to say a little bit about stigma. Yes, to you. I’m sorry to have to be the one to tell you this, but your assumptions about what mental illness “looks like” nearly killed me. This may come as a surprise. You may be taken aback. I know, it’s hard to hear.
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. Even when I asked you for help in “digging deeper” (because you know how bad I am with expressing feelings), 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 let you down. That’s pretty silly, right? I mean, isn’t a therapist the last person in the world you should worry about judging you? But the fact is that both of you, on multiple occasions, judged me.
Not in a negative way. You never told me I was “crazy” or “beyond help”. You actually judged me too gently. Because I was able to handle school or hold down a job and be a mom and [insert whatever it is that people with a “serious” diagnosis aren’t supposed to be able to do], you minimized the severity of the things I was reporting.
The thing is, I suck at speaking up for myself – it’s a product of trauma. So, after a few sessions of learning that you saw me as doing “fine”, and expected me to be doing “fine”, even though I felt like I was barely surviving, I began to feel obligated to continue to come across as fine. I picked up on your views, your expectations, and, terrified of what would happen if those views changed, I continued to play the role you expected me to play. Part of that is on me. I know this. But a part of it is on you, too. You guys are the pros, here. I was following your lead. I’m already prone to minimizing my own feelings. Your approach made me question whether I even needed therapy at all. Your comments made me think I was 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 was “high functioning” does not detract from my need for help. The fact that I have a difficult time expressing (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 and accepting my symptoms, when I tried to explain them, you downplayed them:
“Of course you’re stressed. But I promise it’s nothing 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.”
You said these things to me. I heard, “You don’t really need help” in every single sentence. You both treated me more like a peer than a patient. Small talk, jokes, and about equal time spent talking yourself as spent listening.
I appreciate you trying to relate on a human level, but telling me you “enjoyed my company” was a bit disconcerting. And I do appreciate you trying 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 them 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.
I came to you for help, and you treated me like a friend. With interactions with you two being my only experience with therapy, I thought it was just the way everyone did it. I worked human services, I know the deal. You find some common ground and go from there. But the common ground you found with me was professional identity and I think the lines got crossed somewhere. It turns out, though, that therapists aren’t really supposed to treat patients like friends. If either one of you had taken the time to help me be more comfortable exploring what was going on, if either one of you would have pushed a little in the moments that I lost my voice, maybe we could have caught the mess of stuff happening in my 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. I have pretty severe complex Post Traumatic Stress Disorder, but when I would try to talk to you about my past, you’d both praise me for my strength, briefly state that my experiences were screwed up, and the immediately tell me stories of other patients 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.
I brought up the possibility of Bipolar to both of you. I asked if it was possible to have “Bipolar tendencies” because I recognized red flags in myself, but didn’t understand the concepts of hypomania and mixed states. Both of you dismissed it out of hand. Even when the SSRI I was prescribed in college made me hallucinate. Even when I didn’t sleep for 10 days even with a PRN Benzo – you know, that time I couldn’t sit still, couldn’t quiet my brain, and was simultaneously cripplingly depressed and energized and jittery? I had no idea what was going on with me. I felt completely detached from reality and, frankly, insane. I was in absolutely no condition to be doing anything, yet I was still functioning. Still going to work, still completing homework. I didn’t know what was happening with me, but I’m not sure how you missed it – it was a text book Mixed Features episode. You chalked it up to stress.
You both seemed to decide I was a-ok and there was nothing “substantially wrong with me.” And you 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 popped up. Do you do that to all your “high functioning” patients, I wonder? Did you feel some subconscious need for me to be “alright” because you viewed me, in some ways, as a peer? Were you just afraid to backtrack once you’d spent so much time telling me, in detail and repeatedly, how I was very OK ? Was I just too personable and “normal” for you to grasp the fact that some pretty serious shit was going down in my brain? Looking back, I think it must have been a combination of all of the above.
You guys should know, more than anyone, that assumptions and stigma kill. And you should both be aware that even seemingly “normal” people can be struggling with substantial mental health diagnoses. 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. As professionals, I wish you two had been a little more open minded and seen those signs for what they were. 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, and the two months after in intensive treatment, no one is assuming I’m “fine” anymore. At first, I was actually surprised at how no one on the various treatment teams I’ve had tried to relate to me based on my work experience. They all actually told me I had to put my professional knowledge on the back burner and let myself “be a patient.” I’d never even considered that before.
I’ve finally got a therapist who knows and accepts my diagnoses, a psychiatrist, and, actually, a whole 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 19 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 professional, personable, 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, to realize that someone who is “together” may not actually be OK. And that’s not a problem. The problem is when those people, people like me, are immediately assumed to be OK, and that assumption is preserved above all else.