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.