“I Have To Go Back To Work!”

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

I met with Robin’s parents in June 2003, after my return from vacation. They seemed grateful to hear more information about what was going on, given that Robin had returned to her usual pattern of minimizing her difficulties with everyone other than me. I was given permission by Robin to talk about anything her parents wanted to know. I was thrilled to be able to, finally, have a conversation with them with no restrictions in terms of confidentiality. Honestly, my motivation in initiating the meeting was partly that I wanted her parents to fully understand that Robin was still at significant risk for suicide.

Robin’s parents, as I had experienced before, could not have been more supportive. They just wanted to understand why Robin was still having so much trouble and was unable to do the job she had performed successfully for many years. They had no idea Robin had been drinking and skipping her medications prior to losing her job. I tried to help them understand that this was due to the remaining biological depression she was experiencing, combined with her inability to manage the stress of working full-time. We talked about our collective hope that the three additional ECT treatments Robin had received were going to help her brain to continue to normalize.

I was able to educate Robin’s parents about her ongoing difficulty being open with people, and that before her meltdown she had not even been completely open with me. I knew they were not aware of her serious suicide attempt by carbon monoxide four years earlier. I told them about it, not to freak them out but to help them understand how Robin’s severe depression, rigid brain and social isolation could lead her down that path. Robin’s parents asked a few questions but mostly they just listened. They seemed surprised about the seriousness of Robin’s suicide attempt, but not surprised when they heard it was her significant OCD symptoms that saved her life. Without coming right out and saying “I want you to be prepared for the possibility you may lose your daughter,” I tried to help them understand that it could happen. I assured them I would do everything possible to help.

The day after my meeting with her parents, Robin met with her bankruptcy attorney and with Dr. Greene. Later in the day, we had a session.

“I feel okay about filing bankruptcy, but I don’t know how I’m going to come up with the money to pay for it. I’m so afraid I’ll never be able to go back to my job.” Robin said, fighting back tears. “I can’t deal with one more bad thing happening,”

Robin admitted she had continued to obsess about suicide and had been thinking about going back to the hospital. “If I was in the hospital I wouldn’t have to make any decisions. I feel pressured to do the right thing, but I don’t know if I can follow through with it.” She was referring to me repeatedly saying that she needed to take her medications and not drink. She had continued to have trouble being consistent about these things, which remained a source of tension between us.

I suggested Robin consider partial hospitalization, which was an intensive outpatient alternative to being in the hospital. It involved going to treatment five hours a day, five days a week, and meeting in various groups to talk intensively about current and past issues. Even though Robin had not gone to many groups in the hospital, the partial hospital program was likely to have people with whom she had more in common.

“Robin, I think the partial hospital program would be a good next step. It would give you structure, distractions from obsessing about your situation, and input from people other than me…if you could be open.” I needed to throw this out as an option, but I knew Robin was not likely to go along with it.

“I have led groups in a partial program before,” she said defensively. She thought for a minute and then shifted. “You’re right. It’s probably the right option for now, but I don’t know if I can do it. I’ll think about it.”

The next day on the phone Robin was more rational than I had heard her since before the meltdown. I was thrilled to hear she had talked to her mom openly about the partial hospital program. She sheepishly eliminated this as an option because her OCD symptoms continued to compel her to lay in the sun for hours at a time. She didn’t think her brain could shift from obsessing about tanning if she was attending the program, since she saw the partial hospital program as “voluntary.”

When it came to tanning Robin had always been able to make an exception for work, which she did not see as voluntary, but otherwise during the summer she still had to lay in the sun for many hours on any nice day. When she explained why she couldn’t attend the partial hospital program, it actually made sense in the context of her OCD symptoms. Robin went on to say she and her mom had a more open conversation than ever before about her illness, including a discussion about a significant family history of OCD she had never known about.

“I’m starting to realize I was doomed genetically (with OCD and Bipolar Disorder) even before I was sexually abused,” she said. “This changes my whole view of myself.”

“Robin, I am so glad you and your mom had such a good conversation,” I said it calmly, but inside I was cheering. Thank God she was talking more openly to someone other than me. And, thank God her mom seemed to be okay after our session and was being more open with Robin. Yay!

“My mom said I seem to be back to myself. I guess I really am good at faking it,” she said, acknowledging that she still didn’t feel remotely like herself. “I’ve been doing it automatically for as long as I can remember. I think what happened when I had my meltdown is that I just couldn’t fake it anymore.”

“I agree,” I said. “How are you feeling about the bipolar diagnosis?” I wanted to get a sense of where she was in terms of processing her new identity.

“I actually think I’d rather have people know I have bipolar disorder at this point,” Robin said, surprisingly. “It would explain to people why I had such a hard time at work and had to quit.” Wow! Her mom was right. Even though she was still feeling depressed, Robin was thinking so much more clearly. She may not feel like herself, but she was starting to sound like herself. The additional ECTs seemed to have helped, thank God.

I was surprised further to hear Robin say she had investigated the amount of money she would receive in the form of Social Security Disability benefits if it came to this. She actually said she was beginning to accept that she would not likely be ready to return to her job as soon as she had hoped.

“I’ve been thinking about what I could do instead,” she said. “Maybe I could help my brother and sister-in-law by watching my nephew a couple days a week. Or maybe I could volunteer as a court-appointed special advocate at some point to use my skills and stay in touch with people I know through work.”

It was fantastic to hear Robin say these things. Although I knew she wasn’t ready to volunteer anywhere due to the stress this would cause, the fact that her brain was going there at all was miraculous. I couldn’t believe she was actually allowing herself to consider ways in which being on disability could be okay. I took the opportunity, in the moment, to suggest what I knew needed to happen. I had previously been afraid to bring it up.

“Robin, I think it’s time to find out more about your long-term disability benefits,” I said, knowing she was going to exhaust her short-term disability benefits in a couple of months. She agreed and said she would call her employer’s human resources department.

Unfortunately, Robin’s ability to think completely rationally was brief. She called to tell me she had lunch with her co-workers, which she said was awkward and made her feel more depressed. She said she believed the reality of losing her job was beginning to sink in. This reality and its effects on her mood exacerbated her obsessive suicidal thoughts, although she continued to say she didn’t want to kill herself and hurt her family. A few days later, Robin called to say she had learned about her long-term disability benefits.

“I have to go back to work,” she said emphatically. She sounded very upset. “If I go on long-term disability I’d make only 60% of what I made before, but now my $400 health insurance premium would come out of it. I’d never be able to afford to stay in my apartment. And I can’t afford my meds without health insurance. She’s sending the paperwork in case I decide to apply, and she said it usually takes about a month to process it. But I can’t do it. I have to go back to work!”

I was not prepared for this. We had just gotten to the point where Robin was able to begin to consider being on long-term disability. While I didn’t know for sure this was what needed to happen given how much better she was as a result of her latest ECTs, I did know she needed to be okay with this possibility if necessary. As she explained the reality of what she had learned, I knew Robin was not remotely okay with the idea of losing her apartment and her financial independence.

We talked about her plan to talk to Jennifer, her former supervisor, about when a position might open up on her former team. She needed to either apply for long-term disability or return to work within the next two months before her short-term disability benefits lapsed. I immediately took the opportunity to confront her about her ongoing self-destructive behavior.

“Robin, if you want to go back to work in the next two months and succeed, you will absolutely have to stop drinking and start taking your medication completely consistently.” I told her I was very concerned about the amount of time she was spending alone, thinking about how stressed and depressed she felt about her situation. “You need to continue being open with your mom and your other family and friends. You need to let them know you are struggling and ask them to spend time together.”

“I know I need to do all of those things,” Robin replied. “But it’s just so hard for me to change patterns that are so ingrained.” I told her I understood how hard it was especially with her rigid brain, to make these changes, but that I hoped her sudden increased motivation to return to work would make it easier.

It was the beginning of July 2003. Robin had been without a job, trying to wrap her brain around this reality, for several weeks. Over the next month she experienced ups and downs as she dealt with the enormous stress associated with being in complete limbo. The stakes were high. She was thinking more clearly and was therefore able to process things mostly realistically.

Robin, understandably, still wanted to return to her life prior to her meltdown where she was working full-time in a career she enjoyed and was able to support herself. She had embraced the concept of bankruptcy, which meant financial relief. The idea of earning her previous full-time income without the pressure of paying off past debts contributed to her desire to return to work. Obviously this was her strong preference, as this would prevent her from having to accept any significant limitations imposed by her new identity as someone with a severe and chronic mental illness.

During that time, when the possibility of returning to full-time employment in her chosen field seemed realistic, Robin went through periods where she avoided alcohol, took her meds consistently and reached out to her people. Then, inevitably she would be faced with a potential barrier in terms of this goal, or she would have a brief realization that her stress tolerance was not consistent with full-time employment. This would cause her mood to plummet, returning her to the self-destructive patterns that always accompanied depression. I vacillated between being supportive and encouraging when she was not self-destructive, to confrontive and concerned when she was.

Robin’s supervisor, Jennifer, was open to the idea of Robin returning to a position similar to the one she had lost. But, she sent Robin a letter outlining all the responsibilities of this position and said she would need a written statement from her treatment team (i.e., me or Dr. Greene) confirming she was ready to perform all of these responsibilities before she would be hired. It was not clear, though, whether there would actually be an opening during the time frame Robin needed it. Robin had significant difficulty with all of the uncertainty. But, she tried to set this aside and work on her issues.

Robin and I had many conversations about her long-time patterns of social isolation and self-destructiveness, the big picture of her treatment (that she was improving in many ways despite all the ups and downs), and what she needed to do to continue making progress. Because her biological depression was better, she was able to read and watch television again, which served as distractions. I had her reading books on specific ways to overcome depression. She began to walk for exercise. We worked on cognitive and behavioral techniques, which had always previously been difficult for her, to help shift her ingrained patterns.

Robin had her last ECT procedure at the end of July 2003. Dr. Sanchez believed it would be helpful for her to have one treatment about a month after her previous series, in order to ensure that the biological changes in her brain continued. Because Robin was still struggling with ongoing, obsessive suicidal thoughts, Dr. Greene decided to increase one of her five medications, Celexa, to a higher dose. We were continuing to attack her significant depression from every possible angle.

Robin was trying to process the reality of her meltdown, her job loss, and the ongoing uncertainty about whether she would be able to return to her previous career. I was disappointed to learn she was blaming herself for “not controlling her emotions enough” when she was first hospitalized in January 2003. She then insightfully said, however, “if I don’t blame myself I have to acknowledge the degree to which I lost my defenses and went crazy.” Robin was seemingly, painfully, beginning to come to terms with her illness.

I was relieved by Robin’s progress. Very relieved. But I knew we were not out of the woods yet. I knew, deep down, that until Robin was settled….either back at work in the mental health field or on long-term disability in a situation that felt okay to her, things could get dangerous again very quickly.

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Update

A surprising (to us) number of people have continued to return to our site while Robin and I have both been transitioning through life changes. I have been grieving the loss of my mother-in-law and Robin has changed jobs. We are both starting to feel more settled and hope to have a new post, resuming the story of Robin’s meltdown year, completed within the next few days. We are so grateful to the many people who have continued to visit our site. Thank you all for your patience!

Posted in Note to Readers | 6 Comments

Another Note To the Readers of Despair to Deliverance

As I wrote in the last post, one of the most important lessons I learned while living through 2003 with Robin, was to give up trying to control the inevitable changes of life. For those of you who have been faithfully checking in and waiting for the next post, thank you. I have not gotten back to my usual goal of posting approximately weekly, because life has gotten in the way.

After several months of ups and downs my mother-in-law, whose nickname was Peaches, died peacefully with my husband and I with her, on August 4th. At some point I will be writing about the whole process of caring for Peaches in our home for eleven years, then transitioning her to a nursing home, and then witnessing her amazing journey through the last few months of her life. It may become another blog, or it may become another book. Time will tell.

I appreciate the loyalty of our readers and trust that you will be patient as I get through the memorial service for Peaches this weekend, and then return to some semblance of a routine while grieving the enormous loss I have experienced. Writing is what I do, so I will be back to blogging and telling our story soon. Robin is working on her next posts too, and there will be much more from her in Part Two of our book. Stay tuned….

Posted in Note to Readers | 6 Comments

Sometimes Self-Care Strategies Are Not Enough

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

Self-care was something I regularly discussed with the clients I saw in therapy. I had been exercising consistently since high school and journaling since I was ten years old. I had a supportive husband and network of friends who I relied on to process things that were upsetting. While I was never successful at turning off my busy brain enough to practice meditation, I made sure as an introvert that I had enough alone time and silence in order to stay “centered.” Also, listening to music was an integral part of connecting with my emotions. Reading spiritual books helped me stay focused on my newly emerging perspective.

In therapy I would talk to clients about specific things they were doing to take care of themselves. The concept of balance was also a frequent topic of conversation. We would talk about the importance of balancing work vs. relaxation, time alone vs. time with other people, and consistent exercise and healthy diet vs. being flexible and realistic with themselves. When I was a therapist in 2003, I usually felt I was practicing what I preached in terms of self-care and maintaining balance. As a person with obsessive-compulsive personality traits, I had spent most of my adult life working to be more flexible with myself and to manage my significant anxiety.

During the first six months of 2003, however, my ability to maintain any sense of balance or control over my anxiety completely disappeared. I had a caseload of about 100 clients who I needed to be available for in addition to everything I was doing for Robin. I managed to do this, and also to do the various things I usually did to take care of myself. But, sometimes self-care strategies are not enough. During that time I was completely overwhelmed with stress, anxiety and worry. I lost weight, and I lost sleep. I was in what I always referred to with my clients as “survival mode.” My stress level was magnified by the fact that in April 2003 my husband and I moved his mother, who was 82, widowed and becoming frail, across the country and into our house. This was a stressful transition which caused me to go from having quite a bit of alone time, to very little.

In the six months after her meltdown Robin had begun to rely more on her family for support, but she was not being open with them about her ongoing suicidal thoughts or self-destructive behavior. I had continued to feel mostly alone in the ongoing nightmare with her. I knew my ability to be objective about Robin was somewhat compromised by the degree to which I had become emotionally invested in helping her, so I continued to rely on my professional and personal support network of therapist friends to confirm that I was doing the right things in therapy. These people were very helpful, but I could not talk to them about how overwhelmed and stressed I was. I knew it would concern people to know the degree to which I was allowing a situation with a client to consume me. I had never, during the course of my career, been so caught up in helping someone for such a prolonged period of time with no relief.

I’m not sure what the people I was talking to about Robin would have said, had I let them know how much I was being affected. If things were reversed and a colleague or friend of mine confided in me about a similar situation, I would have been concerned about them. All I knew was that to distance from Robin too much, at that time, was not an option. She needed someone with whom she could be open about what she was really thinking and feeling. If I suddenly stopped being available, there was a realistic risk that she would die. It was never a consideration for me to take that risk. I trusted I was doing what Robin needed, and I felt clear there was a reason we were going through such a difficult time together. I just needed to get through it.

When I left for vacation on the day Robin began her second round of ECTs in June 2003, I drove alone. My husband had work he needed to do and planned to drive separately to meet me at my parents’ house two days later. Having five hours of alone time in the car was a much needed luxury for me. For the first time in months I had some extended time to myself with nothing to distract me.

The timing of the trip was ironic. Robin had just hit rock bottom. After her dramatic meltdown, her new openness with me, my epiphany about her diagnosis, her getting worse and needing ECTS, and then needing to stop the ECTs prematurely to give her a chance to get back to work, she had just lost her job. She was overwhelmed about her financial situation and unable to pay her bills. She was grieving about what could end up being the end of her career. And, she was starting another round of ECTs.

Although I knew Robin did not want to kill herself, I also knew the degree to which she felt like her life had completely fallen apart. I knew how bad she felt about the idea of filing bankruptcy, and I knew she had no sense that doing so would make things better for her. I knew she was reeling from the sudden change in her diagnosis, the fact that she had been hospitalized twice, and especially that she had undergone ECTs and was still having ongoing suicidal thoughts. I had done everything I could possibly do, for such a long time, and she was still at significant risk for suicide as Dr. Rios had said so many years before. There was no way for me to trust that more ECTs would get her to a place where she would feel better enough to stop thinking about killing herself. There was certainly no way for Robin to trust this. I felt completely powerless.

During that five hour drive to my parents’ house, it felt like all the emotions I had been unable to process during the previous six months hit me at once. I was a sobbing mess. I felt completely overwhelmed with sadness. There was the therapist part of me, who knew I had done everything I could do for Robin and that if she killed herself it was not my fault. But the rest of me just felt bad…mostly for Robin who was completely at the mercy of her rigid brain and the depression that had completely consumed her. I felt bad for her parents and her brother, who knew at some level that Robin was struggling but had no idea how dangerous her depression had become. I thought about how shocked and completely shattered they would be if she committed suicide. I thought about her nieces and nephews, who she saw frequently, who would be confused and traumatized if she suddenly died. And, I tried to imagine my own feelings if it came to that. I couldn’t imagine it.

My overwhelming emotions that day in the car were about more than just Robin. Although I had been a psychotherapist for a decade and had treated many people with severe mental illness, rarely had I experienced so intimately the devastating effects mental illness can have on someone’s life. Robin just wanted to be able to live her life, do her job, pay her bills and be okay. She was completely at the mercy of her own brain. No matter what I did, Dr. Greene did, or Dr. Sanchez did as her treatment providers, and no matter how hard she fought to get back to just living her life, her mental illness could still kill her. It was unfathomable. I thought with a new perspective about all the patients I had treated over the course of my career and the impact their illnesses had on their ability to function in various ways.

I thought about members of my own family, going back generations, who had struggled with significant anxiety and probably also depression, without treatment (including a great uncle who committed suicide). I thought about how different all of their lives could have been if effective treatments had been readily available and the stigma of mental illness had not kept them from realizing they had symptoms of it.

As I drove, thinking about all of these things, I remembered my thought the previous January shortly after Robin’s initial meltdown, that this experience was going to be as significant for me as it was for her. In the car that day I suddenly began to get a sense of what that meant. It suddenly felt more clear to me that I was in the right profession. This had not been clear to me, for a number of years.

I had been feeling even before the experience with Robin began, as if I was starting to burn out as a therapist. I knew I was putting a lot of emotional energy into my work. Although I kept my boundaries clear and fairly rigid, clients often gave me the feedback that they felt I was very emotionally present for them. This was true. I was. It was exhausting to be so emotionally present for so many people who were feeling so much pain. But I loved being a therapist, found it very rewarding, and didn’t know how to do therapy any other way.

In 1997, only five years into my career, I began to take classes to become a certified financial planner. I knew, even then, I would never be able to sustain being a therapist for the rest of my career. And I was afraid taking a management position would be too stressful for me. So I thought about financial planning as a way to help people in a less emotionally draining way. I even did this work part-time for a while. During that drive in June 2003, I began to realize that whether I worked as a therapist or not, I was passionate about helping people with mental illness. I suddenly felt my motivation for my chosen career renewed.

Another realization was suddenly clear…I had no ability to control anything. I had been having glimpses of this realization as things had been evolving with Robin, but it suddenly struck me much more deeply and more completely. As an obsessive-compulsive, competent person, I was used to feeling like I could control my own destiny if I just worked hard enough. I had gotten caught up in this feeling when it came to Robin’s sudden increased vulnerability. I had automatically begun to work harder to help her when it became clear she needed to connect with someone. It felt clear that someone needed to be me. But, while driving north in Michigan to spend time with my family, I suddenly knew…I needed to let go of the need to try to control everything. It was impossible. I wasn’t ready to actually do this yet, but it was significant to suddenly understand this at such a deep level. I needed to get better at “going with the flow.”

As I continued to drive, and process, I was struck by another thought. Robin was probably supposed to be learning the same thing. Whether she actually learned it, integrated it, and got to a better place was not up to me. But, Robin and I both needed to get better at accepting that life is a process of change, that change can be not only okay but good, and that change should be welcomed rather than fought. I knew this would be impossible for Robin in the immediate future, but it suddenly felt less difficult for me. It suddenly made sense. It was a relief to feel like I was getting clearer. Unfortunately, what I still didn’t know was whether one of the changes I would need to accept was Robin’s suicide.

I kept processing and realized that during the course of the previous six months, without even knowing it, I had developed a different perspective about what warranted worry. As an anxious person I had always had a tendency to worry irrationally about minor things. If things happened that were outside of my familiar routine, it caused anxiety for me. I suddenly realized that I had not been worrying about any of the usual minor things during the previous six months. Worrying about trying to help someone stay alive, and having to make constant decisions about how to handle the situation, put everything else into a different perspective. I didn’t know if this new perspective would continue after the crisis with Robin passed, but during my drive to northern Michigan that day, I became clear that this change had happened.

When I arrived at my parent’s house, I was immediately surrounded by family. Parents, siblings, nieces and nephews filled the house with lots of activity. After such an emotional drive, it was very good to be distracted by all the children in my life who I love dearly. Over the subsequent week I was able to feel some distance from Robin, which was very helpful. But, in the midst of the time with my family, I made time to talk to Robin on the phone every other day, per her request.

“My life is a financial, occupational, social and emotional fiasco,” Robin said in one of our phone calls. She acknowledged that she still felt depressed, and was still having some suicidal thoughts. “I’m stressed because I know I need to file bankruptcy.”

“I think it’s time to talk to an attorney,” I told her. “I know the name of one who is really supportive and easy to talk to. I think getting more information about the whole process will help.” Robin agreed, and I gave her the name. Two days later when we talked, she felt better.

“I talked to the attorney. I have an appointment scheduled to see her, which helps,” Robin said.

“I’m glad. How did the ECTs go?” Her insurance company had only approved three treatments, and she had the third one that morning.

“The procedures themselves were fine,” Robin said. “But I’m concerned that they don’t seem to have helped enough.”

“How bad are the suicidal thoughts?” I asked, assuming she was still having them.
“They’re always there,” she said. “But I know my parents and my brother would be devastated if I killed myself.” I was surprised and thrilled to hear her say this. It was the first time her family members, not her cat, had been the biggest barrier for her in terms of suicide. It was the first time she was able to say they would be “devastated” and not just “upset.” Thank God, she was finally thinking clearly enough to realize this. The Robin I had known for so long, who was very sensitive to other people’s feelings, was returning.

“You are continuing to think more clearly, Robin,” I said. “You don’t even realize how much better you are. But there are many situational issues that are affecting your mood. We need to process everything that has happened in the last six months. You need to get the bankruptcy taken care of and feel able to support yourself financially.” I wasn’t sure how she was going to be able to do this, given that it was unclear whether she would be able to return to work. The idea of long-term disability had not even been discussed, because I knew Robin wasn’t ready to hear it. But I needed Robin to be clear that there were many factors contributing to her ongoing depressed mood, and that they were ultimately resolvable. I went on. “And, probably most importantly, you need to keep working on being open with people so I am not the only one who knows how you feel. You are still way too isolated.”

Robin and I talked about her continuing ambivalence about living vs. dying. Given her new awareness of her parents’ feelings, I asked if she was willing to either have a session with her parents or allow me to do so. I had not had a chance to meet with them when we had talked about it earlier in the spring, because Robin ended up being hospitalized before we could do so and then had been focused on returning to work. I was feeling a need to involve Robin’s parents more in her treatment, partly for her, partly so they were more aware of the extent of her continuing struggles, and partly so I felt less alone in Robin’s pain. I tentatively threw this idea out for Robin to think about it.

“I’ll ask them and let you know what they say,” she said.

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“I Feel Like I’m Losing Control Again.”

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

The weekend before Robin was supposed to resume working full-time in June 2003, she stopped taking all of her medications. She admitted she was feeling unsure about managing the stress, and was feeling pressure from me to refrain from acting on her strong urges to drink alcohol.

During the time between her ECT treatments and her return to work, Robin wanted to decrease the frequency of our contact. She indicated she was feeling “too dependent” on me, and she desperately wanted her life to return to normal after such a difficult time.

I decided to shift from automatically scheduling regular phone calls, to asking Robin to tell me when she wanted to talk next. This allowed her to have control and flexibility about the frequency of our conversations without having to be the one to initiate calling me after hours (which was still hard for her). She could stay connected or distance, depending on how she felt. I was relieved when she asked to talk after her first day of full-time work.

“I broke down and took Depakote last night, but I didn’t take the rest of my meds.” Robin said. “I didn’t sleep at all.” Oh no! I was instantly worried.

“Robin, I’m really concerned about you sabotaging yourself. You’re setting yourself up to lose your job. Why do you think you’re doing this?” I asked.

“I know it’s not rational,” she replied. “I’m just not ready to give in to having to take all those meds. I think the reality of everything I’ve been through in the last six months is really starting to sink in. I’m trying to assimilate it all.”

“We have a lot to process about what’s happened and I know this feels overwhelming. But if you don’t take your medication tonight and you go a third night in a row without any sleep, you’ll be seriously jeopardizing your job.” I was firm in the tone of my voice. I was concerned. But I was also, for the first time, feeling anger toward Robin. After everything we had been through in the previous six months and after all the extra effort it had taken to arrange the opportunity to return to her job, I was very frustrated about her clearly self-destructive behavior. Part of me understood she was reacting to the enormous stress she felt, along with grief about having to accept her new diagnosis. But she was not giving herself a fair chance to get back to work successfully. She was thinking more clearly. It didn’t make sense that she was setting herself up for disaster. I think she could sense the anger in my tone.

“I’ll take my meds tonight,” she said. “I don’t want you to be mad at me.” Good, I thought.

Robin took her medications, slept well, and said she felt “refreshed” at work the next day. But, that feeling didn’t last.

“I came home from work to lots of bills, and there’s a problem with my checks I need to deal with at the bank. And, my car is not working right.” Robin said she felt overwhelmed by all these new issues and drank three drinks to numb herself.

“I just wish the last six months hadn’t happened,” she explained. “I don’t want to be on antipsychotic medication. I’m really stressed about money and know I need to file bankruptcy, but that bothers me. I don’t feel good about it at all.”

“Robin, you’re experiencing completely appropriate feelings about your situation,” I said, trying to reassure her. “The fact that you are thinking clearly enough to be processing these emotions is a sign of the progress you’ve made.”

We talked about her suicidal thoughts. “My family has been really supportive since I had ECTs and they know I’m stressed about work. I know they’d be really upset if anything happened to me. And besides, I just can’t get past the cat thing. I can’t kill myself.” Wow. I was relieved to hear Robin finally acknowledging that her family members would be very affected by her death. It was another example of the degree to which she was thinking more clearly. And she was making huge progress in terms of being open with her family. But, she wasn’t better enough.

In our session that week Robin admitted she had again skipped all of her meds the previous night because she was drinking, and had then called in sick to work. She was not purposely sabotaging herself. The stress of trying to work full-time and process everything she had been through, as well as the financial pressure she was feeling as a result of not receiving her full pay for a number of months, was overwhelming her.

Despite the drinking, the stress and the lack of sleep, Robin’s affect continued to remain brighter than it was prior to the ECTs. She said she felt okay at work, even with little sleep. She was more focused on the future despite ongoing obsessive suicidal thoughts. She reassured me she was not planning to kill herself, and she began to take all of her medications again.

Robin briefly began to sound better than she had since before her meltdown. She acknowledged feeling better as she was starting to feel a bit more settled into her job. She was still anxious about it, but said the anxiety was manageable. For a few days, she began to sound and act like her old self.

Robin had always enjoyed reading and watching sports on television. During the entire six months following her meltdown, she had not done either. Anhedonia, or the inability to enjoy anything, is a part of severe depression and Robin definitely had this symptom. She said she often had the television on without the sound, trying to distract herself, but couldn’t focus well enough to pay much attention to the programs. As she briefly felt better and believed maybe her life could return to the way she wanted it to be, she was able to watch sports again.

The improvement, though, was short lived. During the weekend after her first week of full-time work, Robin admitted that on Friday night she took “much more” Ativan than she was supposed to. She did not know how many pills she had taken, but said she woke up “groggy and thick headed.”

“Robin, we had just talked on Friday and you said you were going to take your meds as prescribed.” I couldn’t hide my surprise. She had overdosed? Really? “What happened?” I asked.

“I know it makes no sense,” she said. “It was impulsive. I just wanted to make sure I slept, and I wanted to see what would happen.”

“Robin, you seem to be trying to precipitate a crisis,” I confronted her. “You are pushing me to have to do something, and you are clearly jeopardizing your job. What’s going on?”

“It’s not conscious,” Robin insisted. “I don’t know what’s going on. I just can’t stop obsessing about suicide. I guess I haven’t decided about living or dying yet. Part of me wants to live and watch my nieces and nephew grow up, but I’m having a harder time controlling the other part.”

Thank God she was talking to me about her ambivalence. I was grateful for that. But, it was hard for me not to get anxious about the conversation. Robin was basically telling me she had impulsively overdosed. She could have easily misjudged the amount and killed herself by accident that night. We talked about the hospital, and she was adamant about not wanting to go. She insisted she was going to go to work the next day.

I started wondering, again, whether I needed to have Robin detained. I didn’t want to put her in the hospital, knowing it wouldn’t solve anything. It would just cause her to lose her job which would make everything worse. And, after three hospitalizations in six months during which she mostly refused to participate in the programming, I knew she would likely continue this pattern. The decision, as always, came down to a judgment call on my part about whether I thought Robin would be safe, or whether her situation was dangerous enough to warrant having the police haul her to the hospital against her will.

At that point, after we had been through this so many times before, I felt clear I needed to trust that if Robin wanted to kill herself, she would be dead. She continued to stay connected, even after she had said she wanted distance. I didn’t want to jeopardize her trust in me. My gut told me that to detain her would be a bad idea.

Overall I was feeling completely helpless, exhausted, and frustrated by Robin’s ongoing self-destructive behavior. In my own mind I started questioning whether I was doing her any good. I think she could sense my frustration as I again talked about the dilemma her behavior caused for me.

“Robin, you are putting me in a bad position again. Now you are overdosing. What am I supposed to do about that?”

“I’m really sorry,” she said. “I’m not trying to upset you. I can understand why you might be angry at me.” Great, I thought. Robin is depressed and suicidal and now has the belief that I’m angry at her, which will just give her one more reason to kill herself. This was not going well.

“I’ll try harder,” Robin insisted. “I’ll take my meds, as prescribed, and I promise I won’t drink tonight.”

We hung up the phone, and I was upset. It was clear that things were coming to a head. I had no idea what the outcome would be, but I was running out of optimism. Robin was clearly in control of her own destiny, and the probability of her keeping her job was looking bleak. I didn’t think she’d kill herself that night, but I went to bed and contemplated the very real possibility that after all we had been through, Robin was going to eventually end up dead.

The next day, at around noon, she called me at a time when we had not planned to talk. I immediately knew something was wrong.

“I called in sick to work today,” she said. “I feel like I’m losing control again.” She confessed that she had drank and skipped most of her medications the previous night, even after we had talked and she promised not to do this. “I wondered last night if I need to be in the hospital,” said Robin. “This morning I went to the river and had the urge to jump in. I was able to stop myself, but I realize I’m overwhelmed and not in control.”

“Robin I really think you need more ECTs,” I said. “You didn’t have enough of them before. I think it’s time we really get your depression under control.” I knew I was suggesting that she needed to quit her job. I knew what a big deal this was. But, it was clear to me she wasn’t going to be able to keep it. As we talked, this became clear to her too. I told her I would call her supervisor to find out what her options were in terms of her job and disability benefits, and I would call Dr. Sanchez about scheduling more ECT treatments.

In June 2003, six months after her meltdown, Robin lost her beloved job with the team of co-workers and supervisors who were so supportive to her. Thankfully, her supervisor told her they would “hire her back in a minute” if they had a position open and she was well enough to perform the job. The Human Resources manager at Robin’s place of employment said she still had three months of short-term disability benefits left, and that she would retain her health insurance coverage during the time when she was collecting those benefits. She also had long-term disability benefits which she could apply for if needed.

“I guess it’s better to take time off and get well rather than going to work, acting crazy, and getting fired,” Robin said when she learned about how her benefits worked. This was another example of the degree to which she was thinking more clearly despite her self-destructiveness in the face of the work pressure. We had a rational discussion about whether she needed to be in the hospital.

“I want to avoid going there if I can,” she said. “But I’ll go if I need to.” She admitted she was feeling more depressed about the reality of losing her job. She admitted her impulse control was weak, and she agreed to pour out all of her alcohol. And most importantly, Robin acknowledged she did not want to kill herself.

Dr. Sanchez was able to get insurance approval for three more ECT treatments, which were scheduled to start on the Friday after she lost her job. The day before her first treatment I arrived at work to a voice mail from Robin saying she didn’t sleep much the night before and was ready to go to the hospital. I knew if she was suggesting it, this was significant. I immediately got Dr. Greene to call in the orders and I called the admissions department at the hospital to get prior authorization from her insurance company. I was scheduled to see many clients that day, and asked Robin if she would be able to have her mom or a friend come with her to be admitted.

“I’ve already made the decision,” Robin said. “I’m coming in. You don’t need to worry about me backing out.” I knew she would be anxious when she arrived and asked the admissions staff to take care of her as quickly as possible. Later that afternoon I received voicemails from both the admissions staff, and from Robin.

“I couldn’t do it,” Robin said in her message. “Please call me.” What? She didn’t go? My heart sank for what seemed like the millionth time in six months. I was getting tired.

Robin said she had gotten to the hospital to find many people in the waiting room, complaining about how long they had been there.

“I almost had a panic attack. I had to leave,” Robin said. “I’ve changed my mind. I don’t need to be in the hospital. I haven’t been trying hard enough.” She said she would work much harder to avoid drinking, and would take all of her medications as prescribed. “I’ll spend more time at my parents’ house.”

I was not able to get Robin to agree to stay with her parents or her brother. But she did agree to allow me to talk to her mother and her brother about calling every evening to check in with her, which would provide accountability in terms of making sure she wasn’t drinking.

I was especially concerned because I was again scheduled to leave for a vacation, this time to spend time with my family. Although I planned to check in with Robin periodically by phone, I would be many hours away and it would be difficult for me to help facilitate a hospitalization if she needed it.

Dr. Greene and I consulted about the fact that he had called in orders for Robin to be hospitalized, her insurance had approved it, and she had then backed out. We had to be on the same page about whether she needed to be detained. We had to explain to the insurance company why we thought it would be safe for her to remain an outpatient while she received more ECTs.

“I think it is actually better for her to have her mother and brother call her every day, and to be aware of how out of control she feels,” I said to Dr. Greene. “If she was in the hospital she would just be isolated in her room and it would be harder for her family and friends to support her. And, it was Robin’s idea to go to the hospital. I think we need to support her and let her family be there for her, since she is saying she wants to stay alive.” Thankfully, Dr. Greene agreed.

Robin’s mother and her brother were both very willing to check in with her by phone, and her father agreed to transport her to the early morning outpatient ECT treatments.
I left town for a week of vacation on the day Robin began her second round of ECTs.

During the five hour drive to my parents’ house, I began to process the extent to which I had been affected by the previous six months, working to help keep Robin alive. I remembered that at the beginning, while she was still in the hospital for the first time, I had felt strongly that the whole experience was going to be as significant for me as it was going to be for Robin. As I drove, and thought, and cried, and felt many emotions, I tried to fall back to my spiritual perspective and imagine what the purpose for both of us could possibly be as we were living through a complete nightmare.

Robin was definitely better, but still very depressed. She admitted she didn’t want to kill herself, but still could not stop obsessing about it. If she didn’t stop sabotaging herself, I was quite certain she would end up dead whether she wanted to or not. I was realizing more and more clearly that I did not have control over Robin’s fate. It wasn’t completely clear whether she did either.

All I knew for sure at that moment was that I needed a break. I was exhausted…mentally, physically and emotionally. I knew I desperately needed some distance to get perspective about the life and death struggle I continued to witness.

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A Note to the Readers of “Despair to Deliverance”

Those who have been following our story know we were consistently posting for many months, and have not been consistently posting for the past few weeks.

Robin and I have both had life events interrupt our writing progress.  My mother-in-law, who just turned 93, lived with my husband and I for eleven years.  She began to show signs of dementia several years ago and has had several falls.  Although she was physically healthy, her balance and her cognitive abilities were becoming increasingly impaired.  My husband and I made the difficult decision to move her to a nursing facility in April 2014.   She was settling in, but then was suddenly hospitalized with pneumonia.  After a second hospitalization she was declared by doctors to be dying and was placed on Hospice.  Miraculously, several weeks later she has now fully recovered and is happily settled into the nursing home.  It has been a stressful, exhausting and uplifting experience to accompany her through this transition.

Robin has been going through a job transition which will be important for us to discuss later in our book.

We apologize to those who have been faithfully tuning in, looking for our next blog post.  We will be back soon to finish the story of Robin’s meltdown year.  Hopefully by next week we will be back on track.  Thanks to all for your patience and support.

Regarding Blog Awards:

Robin and I also want to thank everyone who has nominated us for various blog awards.  We are honored and grateful to be acknowledged and recognized.  Because our blog is a serial blog, focused on telling a serious story, we have decided not to interrupt the story by posting the various requirements of these awards.  We apologize if we have offended anyone who has nominated us.   Going forward, our blog should be considered “an award free blog.”  We always welcome comments and dialogue, as knowing the reactions of our readers, good or bad, is invaluable.  Thanks for your understanding.

 

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“I Still Feel The Same On The Inside.”

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

Robin returned to her job half-time on the Tuesday after Memorial Day in 2003.  After seven ECT treatments and a week to recover, she was less depressed than she had been in many months.  She was, however, very anxious about her return to work.  The stakes were high and she said she felt enormous pressure, knowing she would lose her job if she could not do it successfully.  On her first day back to work, the pressure magnified.

“I talked to Jennifer today,” said Robin in a phone call that afternoon.  “She told me I made some of my co-workers uncomfortable when I was at work before, because I was talking about suicide.  I don’t remember that, but I want to make sure everyone knows I’m better and won’t do it again.”

Robin and I briefly problem solved ways for her to do damage control with her co-workers.  Later that day I got a second phone call from her.  I was surprised, since she never called twice in one day.

“I left a voice mail for Jennifer asking if there were a lot of people who were concerned about the comments I made, and whether I could just talk to people individually about what happened,” Robin explained.  “She said she thinks I should talk about it to everyone in our treatment team meeting on Friday.”  I was horrified.  Jennifer did not know how anxious this would make Robin.  What a terrible thing for her to have to worry about on her first day back to work!  Robin said she was so anxious about the prospect of addressing her co-workers in a group, she was feeling strong urges to get drunk.

“I’m really afraid I won’t sleep tonight,” she said.  “I know you’ll be mad at me if I drink, and I don’t want to take too much Ativan.  That’s why I called.”

I was still sympathetic in terms of Jennifer’s situation.  She was looking out for her team of employees.  Robin was returning to work with the blessing of Dr. Greene and me, who had both declared her ready.  I assumed Jennifer figured that if Robin was able to do her job, she should have been able to handle talking to her co-workers about things she said that were upsetting to them.  But for God’s sake, did she have to bring it up on Robin’s first day back to work?  The last thing she needed was the anxiety of being so publicly vulnerable!

I actually had no idea whether Robin was ready to do her job successfully.  She had improved significantly with the ECTs.  But she was also still experiencing depression symptoms and intrusive suicidal thoughts.  I was concerned that she needed a few more ECTs in order to really alleviate her depression.

Dr. Greene and I had released Robin to return to work partly because she would not have dealt well with losing her job.  If she had been unable to even attempt to return, this would have ensured worsening depression.  Dr. Greene and I agreed we needed to give her a chance to get her life back.  I hoped getting back into her usual routine, surrounded by supportive colleagues and supervisors, would help Robin keep the momentum going in terms of the progress that had begun with the ECTs.

But, Jennifer telling Robin on the day she returned to work that she needed to make herself vulnerable to all of her co-workers, in a group, was a disastrous start.  Robin had severe anxiety about being open with her family and closest friends.  How was she possibly going to talk to a group of her co-workers about the experiences she had been through?  She expressed feeling humiliated by the fact that she had upset her co-workers with things she didn’t remember saying.  She said she didn’t sleep at all the night before the meeting.

Miraculously, Robin managed to get through the meeting with coaching and reassurance from me, and some anti-anxiety medication.  She called to tell me about it that afternoon.  We discussed the fact that she had made it through the first four half-days of her return to work, including the stressful team meeting.  I expected her to feel relieved and pleased with herself.  Instead, she sounded more depressed.

“It was a big step for you to make it through this week,” I said trying to be encouraging.

“Last night I was looking at some of the paperwork I got when I was discharged from the hospital the last couple of times, and when I had ECTs,” Robin said.  “I can’t believe that all happened.”  She was thinking much more clearly than she had been in months, and was continuing to try to process the reality of everything she had been through.  The ECTs had left some gaps in her memory, which we had been discussing so she could piece together the events of the previous few months.

“I know I look like I’m doing better on the outside.  Everyone keeps telling me how much better I am,” she said.  Robin had said her family and friends had been noticing and commenting on the improvement.  Her affect was definitely brighter and the psychomotor retardation was gone.  This was very noticeable to everyone.  Her sarcastic sense of humor, which is typically a big part of who she is, had returned.

“I may be better, but I still feel the same on the inside,” she said.  “I hate myself and I hate my life.”

“Robin, remember there’s a difference between biological and psychological depression,” I said.  “Your biological depression is definitely better.  The medication is managing the mania.  The ECTs have helped the depression.  You’re joking around for the first time in months, and all the outward signs of depression have decreased.  That’s what everyone sees.  But the psychological depression is related to all the stress and uncertainty about your job, your financial stress, and your need to keep working on being more open with people so you are less isolated.  I think you still feel depressed because of these issues.  We’ll keep working on all of this.”

“I have to tell you something,” Robin confessed.  She was still feeling compelled to tell me when she behaved self-destructively.  “I drank a wine cooler last night to help me sleep.”

“Robin, I understand you were really anxious last night about the meeting today.  I’m not excusing the drinking, but I know it was a hard night.  Remember, I can’t reinforce self-destructive behavior.  Please don’t continue to put me in that bind.”

Robin talked about her concern about the upcoming weekend, and her fear about having no plans and “too much time to think.”  Although I offered to plan a time to talk, she did not want to have contact with me over the weekend.  We had cut our sessions back to once a week and were talking less often.  Robin was trying to decrease our contact so she did not feel “too dependent” on our connection.  I would have preferred we had waited until she was settled into her job to decrease our contact.  But I knew Robin needed to feel like her life was returning to normal.  As she had gotten better, she felt more uncomfortable depending on me so much.  I needed to honor her need to distance from me.

Although I was concerned about how depressed she sounded, she promised to refrain from drinking and assured me she wouldn’t kill herself over the weekend.  We made plans to touch base by phone after her first full day of work the following Monday.  Later that afternoon, Robin completely freaked me out.

The department where I worked had a small reception area and waiting room, and a large open area with ten offices where my co-workers and I saw clients.  The reception area, which was separate from the office area, had mailboxes for each therapist.   I would often see clients back-to-back with only a short break in between sessions.  During these breaks I would listen to voice mail messages, check my mailbox and chat with people in the reception area for a minute or two, and maybe make brief phone calls.

I was scheduled to see several clients that Friday afternoon, as I often was.  Because it was a short week following the Memorial Day holiday, I was especially busy.  Late in the afternoon, in between back-to-back clients, I came out of my office and went to check my mailbox as usual.  I was stunned and confused by what I found.

In it was a CD from Robin.  We had exchanged a couple of CDs by that time.  We had just talked on the phone a few hours earlier.  The title of the CD was “Thank You.”  Inside the cover Robin had written, “Sharon, this is an obnoxious repetition of the same song, but I could fill the whole CD with it and it would still not be enough.  I stopped at fifteen times.”

What?  I had no idea what to think.  Why was she thanking me?  Okay, I understood that she would want to thank me, but why then?  I had no idea what song she had copied fifteen times, intending to express her gratitude to me.  I had no ability to listen to it at that moment.  It would have to wait.

I knew Robin was having a rough time.  I felt and understood her need to distance from me.  She had been open about it.  My sudden fear was that this was the “thank you” that was really the “good-bye.”  It had been such an intense few months.  It had all culminated in ECTs followed by Robin’s return to work after disclosing to her employer she had needed ECTs to get stabilized, which embarrassed her.  She had been forced to publicly discuss her mental health issues with her co-workers, which was incredibly difficult.  The thought of returning to work full-time the next Monday was causing high anxiety for her.  She felt enormous pressure about succeeding at her job.  Mostly, she had endured the treatment of last resort and was still feeling “the same on the inside.”

It was completely out of character for Robin to just stop by and leave something in my mailbox.  And, I was aware research shows that people with severe depression are actually at a significantly higher risk for suicide when they are starting to recover (because they have more energy and ability to formulate and carry out a successful suicide plan).  I was worried that this is what was happening for Robin.

There were many reasons why, if Robin was actually going to kill herself, this was a logical time for her to do it.  And then she had just dropped off this CD….thanking me.  What the hell?  I really believed, more than I ever had before, that Robin might be saying good-bye to me as she then went to carry out her suicide plan.

Many thoughts went through my mind.  Mostly, I was just worried.  But I also found myself thinking about the reality that if Robin decided she really wanted to kill herself, I would not be able to stop her.  At that point in my career, I had never had an active client commit suicide.  My co-workers and I had talked about the commonly discussed concept that if one works as a therapist long enough, they would eventually lose a client to suicide.  I had supported several colleagues through this painful experience.  This was just part of the high stakes career I had chosen.

Despite all this, I could not just do nothing.  I quickly dialed Robin’s cell phone number.  I needed to check in with her and find out how she was.  She didn’t answer the phone.  Oh my God!  I left a message asking her to call me back.

I’m not sure how I managed to concentrate through my next client’s therapy session.  This was another automatic pattern therapists learn.  It is important to be able to give enough of one’s attention to whoever is in the office, no matter what else is going on outside the office.  I managed to do this well enough, but in the back of my mind I was worried and distracted.

After I finished the session, my last one for the day, I tried calling Robin again.  I felt somewhat bad about doing this because I knew I was meeting my own anxiety needs.  I had already called once and left a message.  As a therapist I knew I should stay objectively detached, and the fact that Robin had said she wanted distance from me meant I really should leave her alone.  But, in this instance, I couldn’t.

This time, Robin answered the phone.  “Robin, I got your CD,” I said.  “I wanted to thank you for it.  Where are you?”

“I’m just driving around,” she said.  She continued to sound more depressed.  I did not tell her how much she had scared me by dropping off her CD.

“Robin, I’m concerned about you.  I know you’re feeling depressed, and you’re anxious about working full-time next week.  You told me you were worried about the weekend and having too much time to think.  You’re feeling a need to distance from me, but I think it’s okay if we stay in close contact until you are settled with your job situation.  If you want to talk this weekend it’s okay.”  Boundaries should only be extended if it is in the client’s best interest.  I knew she felt she needed to distance, but with all the uncertainty about her job I thought it was premature.  It became clear as we talked that my fear about the CD she had dropped off…that she was going to go kill herself, was unfounded.  Thank God.  But my anxiety about it made me feel that it would be better if we talked later that weekend.  She agreed to do so.

Robin and I talked that Sunday.  She said she had continued to be more depressed all weekend.  “I’ve been thinking about everything that’s happened in the last six months,” she said.  “I don’t know if I’m going to be able to handle the stress of working full-time.”

Robin went on to say she had not slept much the night before and had “forgotten” to take her medications that morning.  She admitted she had been thinking all day about overdosing on Depakote, but did not do so because she was still concerned about what would happen to her cat if she killed herself.  She said she was also worried she would be unsuccessful in her suicide attempt and make things worse.

“Did you take your meds last night?” I asked, suspecting this may have contributed to her lack of sleep and increasing instability.

“No,” Robin confessed.

“Robin, you are sabotaging your treatment.  What’s going on?”  I was calm on the phone, but inside my heart sunk.  Just when I thought things were getting better.  The ECTs had so clearly been helping.  I had hoped she was better enough to return to work, but it was starting to become clear that the stress may just be too much.

“I don’t know.  Maybe I’m subconsciously trying to lose my job to give myself a reason to kill myself,” she said.  “I just don’t want to be on all these meds.  I know it doesn’t make any sense.  I just feel too much pressure.”

Robin went on.  I was impressed with how direct she was able to be with me.  “I know you’ll be disappointed if I screw up.  Maybe part of me is trying to get you to back off.”

Wow!  That was a reality check.  Robin had been trying to tell me she needed distance.  I certainly did not want to be contributing to the pressure she felt.

“Robin, if you want me to back off, I will.  You don’t need to sabotage your treatment to make that happen.  Thank you so much for being honest with me.”  I felt very, very bad about any possibility that I may be contributing to the pressure Robin was feeling.  The idea of distancing from her scared me, since I knew she would be at much higher risk if I did so.  But she was better in so many ways.  She was thinking so much more clearly than she had been in many months.  I realized, in that moment, that whether Robin wanted to stay alive and work through all the ramifications of being diagnosed with a severe mental illness was her decision to make.  I needed to let her make it.  I needed to back off.

This sudden realization made me very sad.  I couldn’t hide my sadness as I apologized for not hearing her when she told me she needed some distance from me.   I asked her if she needed to be in the hospital to stay safe, knowing she would lie to me if she planned to kill herself.

“I’m not planning to kill myself tonight, Sharon,” she said.  “I’m going to work tomorrow.  I’ll probably end up going back on all my meds,” she said.  “It will be unpleasant if I don’t.”

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