I am a psychologist who spent the first ten years of my career doing full-time clinical work at a large community mental health center. The agency was growing quickly and the administrators kept trying to promote me but I declined, even when I was starting to burn out as a clinician. I am a bit obsessive-compulsive and had always been stressed by ambiguity or change. My fear about joining the management ranks was that it would just be too stressful for me.
Robin came to see me early in my career with symptoms related to a past history of trauma including depression, posttraumatic stress disorder, dissociative episodes and self-mutilation. She also had significant social anxiety and severe obsessive-compulsive disorder. She was very smart, funny, likable and knowledgeable about her symptoms as she herself had worked in the mental health field for several years. Robin was very good at presenting to the world that she was feeling better and was healthier than she actually was. She had told very few of her mental health savvy friends about her symptoms. I was honored that she agreed to let me in, and she quickly made significant progress in treatment. Within a couple years she was stabilized on antidepressant medication and was no longer self-mutilating or dissociating. She and I spread out our sessions, meeting more frequently for periods of time when she would have sporadic episodes of increased depression. These episodes always responded well to adjustments in her antidepressant medication, and she continued to develop better coping skills and an increased understanding of her illness.
In early 2002 Robin became intractably depressed. We both assumed situational factors were the cause of her increased symptoms. A year of medication changes and other therapeutic strategies, however, brought little relief. In early 2003 she was still working full-time as a case manager in the mental health field despite having been significantly depressed for the previous year. She finally was unable to contain and manage her symptoms any longer, and ended up being hospitalized for the first time in January 2003.
What happened during the subsequent eleven months is a dramatic story of Robin struggling against almost constant obsessive suicidal thoughts, and me learning that she had been hiding many of her feelings and symptoms from me and everyone else (did not want to lose “my respect”) for many years. Once Robin’s defenses completely abandoned her and she began to talk, I became as spiritually clear as I have ever been…that I needed to be her life-line if she was going to survive. I became painfully aware that this person I cared about and had known for so long, had been completely alone in her significant illness. She was not consciously hiding it. Minimizing and trying to “be normal” was her defense. She did not know how to be open about how “crazy” she was feeling. As I started to become immersed in the reality of everything I had not known about her, it suddenly became clear to me that she had been misdiagnosed…by me and by her psychiatrist. Her psychiatrist agreed, and we worked closely together to try to get Robin’s symptoms stabilized. After four hospitalizations, eleven electroconvulsive therapy treatments, a planned suicide attempt that got interrupted by completely coincidental events, a job loss, and five medications, Robin finally said the words I had been waiting, desperately, for so long to hear… “I feel like myself again.”
That year changed me forever. I had no choice but to abandon whatever techniques I had learned as a therapist and to completely “trust my gut.” I agonized, consulted colleagues and supervisors, extended boundaries in ways that felt appropriate, lost sleep, and worried a lot. Robin’s brain was torturing her. Her severe obsessive-compulsive symptoms took over her thoughts and she could not shift out of obsessing about killing herself. At the same time, I became completely clear that all of the meaningless things I had ever worried about prior to that time were unimportant. Witnessing the life and death struggle of someone I cared about, for eleven months, caused everything in my life to take on a different perspective. The bottom line is that I am no longer afraid of change or ambiguity. I am no longer stressed by the challenges that used to stress me. My life has been through many, many changes since that time including stopping my therapy practice, allowing myself to be promoted many times over a seven year period to various positions with increasing management responsibilities, and then changing career paths again.
Robin has continued to heal since that horrible year of despair. Her story is dramatic. There is much to say about how others can learn from her experience. She has managed to overcome the stigma of mental illness and to accept herself and her remaining symptoms. She is now open with others about her illness and disability.
I will be forever grateful to Robin for letting me in, for allowing me to witness her pain, and for the positive changes that happened to me as a result. Robin and I need to tell her story. There is a book to write, so that others may benefit. This blog is the vehicle through which our book will be written.
Sharon DeVinney, Ph.D. completed her doctoral degree in clinical psychology at Purdue University. She spent ten years doing full-time clinical practice at a community mental health center with primarily adults, many of whom experienced symptoms of severe mental illness. She then spent eight years working as an administrator at that same community mental health center while continuing to maintain a small caseload of therapy clients. During the past four years she has worked as an administrator and disability evaluator, and provides clinical services in long-term care facilities.