Veteran of the Psychic War: Anatomy of a Therapeutic History

Last month, I linked to a short essay by Rick Whitaker on the unexpected perils of psychotherapy and noted my dissapointment in the essay's lack of scope. So when a reader left several smart comments on the post, describing his various experiences with therapy, I badgered him to write a guest post that would touch on the same subject as Whitaker's essay, but do so with more analytic verve and nuance. So, I'm happy to introduce Another's first guest post, also the first in a series of posts by Jeffrey Babbitt (of Sisyphus and the Cuckoo Clock Speech) on this topic. Of the series, J. writes, "Veteran" is in some sense an indictment of many of my former counselors, psychologists and psychiatrists. But I hope the subjective nature of my judgments and my own complicity in the "failure" of past therapy are clearly understood. Through the progression of the four or five posts that will make up this series, I hope to illustrate the important therapeutic qualities that were either present or lacking in the mental health professionals who were part of my story. This short, debuting post relays his first encounters with mental health professionals, back when he didn't know "a thing about what I wanted in a therapist, except that s/he should enable me to stop feeling like hell." J. currently lives in Chicago, where he works for a libertarian non-profit. Previously, he studied English at the MA level, and hopes to return to school this fall to become a Registered Nurse.

DISCLAIMER: Names have been changed to protect the incompetent, the unpleasant, and the all-around not-terribly-effective.

Lesson One: Bedside Manner, or "bang head against wall, collect pills"

"Primum non nocere" ~ Galen, Ancient Roman physician

A prospective psychiatrist, psychologist, psychotherapist, or counselor (henceforth referred to as "mental-health professional") should begin by having an interesting psyche of her/his own, and by showing an interest in the psyches of others. Entering into the field of mental healthcare is counterindicated for those utterly without personality, those with repressed or repressive personalities, and those of the type commonly referred to as "assholes." So-called "book-learning" offers a wide range of useful tools for the prospective mental-health professional, but academic settings alone cannot infuse humanity into those deficient in it. The prospective mental-health professional should be prepared to engage the interest of clients who may be emotionally disinclined to be interested.

It's difficult to say what motivated me to walk into the office of my first psychiatrist at age 18. I had been in the same existential condition more often than not since I was 15, and would be through the present day and beyond, although my relationship to the depression has changed. The essential symptoms at the time of my entrée into the client end of the mental health profession: Listlessness. Agitation. Problems with my 16-year-old girlfriend. Problems with the shit jobs I couldn't seem to hold on to. Problems with the academic work that should have been easy but quickly became overwhelming. The dull ache of profound apathy and hopeless inertia. The cuts I made on my arms with my parents' serrated kitchen knives, carving out a sharp and visible pain to match the phantom miasma of my psychic innards. A quantum singularity in the pit of my stomach that threatened to swallow me from the inside.

I suppose there was a series of trap doors in my depression through which I fell at the time. One of them took me from Everything is hopeless, but the hopelessness at least is mine, so I'll hold on to it to Everything is hopeless, but the hopelessness is utterly beyond me, so I'm willing to try something new to crawl out of it. Another, through which I would stumble too soon, would take me to Fuck everything. I'm going to kill myself.

At any rate, falling through the first trap door, I landed in the office of my first psychiatrist -- Dr. Something-Or-Other -- in the health center at Western Michigan University. I was a college freshman who still lived at home, and he had the personality of a concrete slab. I told him a little bit about what was going on, and he prescribed me Prozac and told me not to mix the Prozac with alcohol. I would take the pills regularly, if not enthusiastically, and stay away from booze for days at a time.

(I had discovered the wonderful oblivion of alcohol the summer after I turned 17. A little more than a year later, as an English major in college, and a poet and musician to boot, it seemed ill-advised for me to be dry for longer than days at a time. More to the point, as a depressive who'd found a little temporary release and comfort in self-medication, I didn't want to go without alcohol for very long. Dr. S-O-O didn't press the issue, didn't demand that I abstain, didn't seem alarmed. In fact, I don't recall him ever changing his facial expression from his accustomed look of deep gray boredom. He may have been depressed himself. Or he may have been a robot.)

Sometime later, we switched to Norpramin (an older tricyclic antidepressant not much in use anymore, generically known as Desipramine hydrochloride). Dr. S-O-O advised me that, unlike Prozac, Norpramin afforded me the opportunity to overdose and do some serious, possibly fatal, damage to myself. (He didn't quite phrase it like that, but that's how I heard it.) This opened up whole new vistas of suicidal fantasy, and in very little time, my unfulfilled but obsessive longing for a Norpramin overdose had me doing a voluntary stint in the local psych ward.

The hospital was nice. I get nostalgic for it when I feel overwhelmed by the necessities of "real life," or when I smell poorly-made coffee and Marlboro Reds through congested sinuses. I don't remember my in-house counselor, some guy who took me through a couple of personality tests and told me I was dysthymic with episodes of major depression. I remember my psychiatrist -- Dr. Vader -- a short little Asian woman who, I was sure, hated every second she had to spend with me. To counter Dr. Vader's dark side, a feisty nurse named Marilyn became my Obi Wan. She had the radical idea that I as a patient had rights, and should stand up for them.

With encouragement from Marilyn and some of my crazy wardmates, I asked to be paired with a different psychiatrist. This only pissed off Dr. Vader even more. I remember her (I don't know how accurately) yelling at me about how I had hurt her feelings. She then put forth an intriguing theory about the root of my psychological disorder, that I was a spoiled brat who was used to getting his own way. I was much humbled by Dr. Vader's performance, and agreed to suffer her tutelage until such time as I was well enough to leave the hospital. And then she doubled my dosage.

Posted by nchicha at June 4, 2004 08:09 PM