The end of the semester

I’m tired and ready for this semester to be past. But still, the end of each semester is always a little hard for me, because of:

• regrets and rumination about things that could have gone better
• preparing myself for the ways that students who are disappointed in their grades take that out on professors
• anticipating missing some of the students who have become important to me and are moving on
• my mind getting stuck in a groove, finding it difficult to disengage from something I’ve been highly invested in pretty much all the time for 4 months

Just like after a breakup, I find myself waking up in the middle of the night thinking about the class, and having to remind myself: But it is over now.

Riding the wave

My silence here lately isn’t for a lack of things to say, but because I’ve been so busy doing something really different.

When last semester ended, I realized how long it had been since I had taken a real break from work. Although tenure-track professors with children may be perpetually busier than those like me without children, they typically feel justified in devoting time to their kids in their daily lives. In contrast, I had felt unable to justify taking time for anything but work, and couldn’t stop feeling bad about it long enough to enjoy doing other things anyway. Even my vacations have been working vacations, full of anxiety/guilt about the time I didn’t spend working. Facing my first between-semester break after receiving tenure, the pressure was lifted. It was suddenly clear to me that I need and deserve time for things besides work, just like everyone else.

I started doing very low-stakes craft projects:  things that serve no alternative purpose and that are inexpensive to make, so that if something is not working out I can stop and discard it without hesitation. These projects have involved a lot of experimenting, and problem solving as I go along; nothing has been from a kit, or with predetermined rules. Working on these projects, I get totally absorbed in what I’m doing, and my mind is clear of everything else. Psychologists call this a state of “flow,” a term that reminds me of lots of surfing metaphors for being open to the present moment. I don’t surf and can’t even swim well enough to try, but I can readily imagine that it would feel similar to the new and completely exhilarating sense of freedom I’ve been getting from bending wires or spreading paint.

When I was a child I was making things all the time, but as I got older my enjoyment of these activities was ruined by feelings of shame and fear.  My visual arts projects were an embarrassment to my father for as long as I could remember. (Ever give your parent a handmade gift and have them say “What the hell is this?” or “Why would anyone want this?”) He’d yell at me and criticize/insult me when he saw me working on crafts, and I remember my mother saying things like “Daddy will be very unhappy if he sees you playing like this.”

In part, I think my father hated my craft projects because he is so competitive and saw my record of accomplishments as a reflection on his. In other words, if my creative endeavors could have gotten me recognized as a child prodigy or something else I could use on my college applications, I’m sure he would have been all for it. In fact, when I was 12 my father encouraged me to submit my short stories/poetry and musical compositions for review for publication. But these weren’t adult-quality, publishable things — just private, personally meaningful endeavors, and therefore a shameful waste of time in my father’s eyes. Don’t get me wrong, though, my father doesn’t see all leisure activities as shameful. For example, he has always spent plenty of time watching sports events on TV (an activity that isn’t going to create anything prize-worthy), and he really wanted me to enjoy watching sports with him. But he saw watching sports as the kind of activity that normal, healthy, popular kids do, whereas he saw my craft projects as something only a “backwards” child would do. He punished me for my non-competitive creative hobbies because he cared enough about me to try to stop me from being so “backwards”.

I didn’t join the literary magazine club as most of my friends did in high school, because I felt so much shame about my writing. When friends said that although I wrote a lot, I wasn’t a “real” writer like they were, I assumed they were right to exclude me, and it didn’t even occur to me to question letting a bunch of self-appointed teenage writers decide whether or not my writing was “real”.  In college I continued to do creative writing, piano, and various crafts – but for no one but myself, and by this point largely in secret.

After I got married and went to graduate school I no longer had the private space/time I’d needed for my creative work, and moments taken away from pursuing my academic/career goals became harder for me to feel good about.  I sometimes found disguised ways to be creative – such as making window shades and other things for the household that I could tell myself had a practical purpose that made them worth doing.  But eventually these practical crafts felt more like pressure than fun, and I largely stopped doing them when I became able to afford store-bought or professionally made items instead.  It has really been decades since I have done craft projects for their own sake, as I have been in the last couple of months.

I’m needing to learn to budget my time better to fit creative projects into my schedule, and I’m also needing to find ways to keep my work space better organized to accommodate things like paint, wire, and glue along with the piles of paper I use as a professor.  But starting this seems to have opened up a floodgate of interests so long suppressed that I didn’t know I still had them, and I’ll ride this wave where it takes me.

Hard to imagine

About 30 years ago, after leaving residential treatment against the advice of my doctors, I finished my undergraduate requirements on a part-time schedule, took the GREs, and applied to doctoral programs in clinical psychology. I knew that acceptance to one of these programs straight out of college would be a long-shot under the best of circumstances, but because I had trouble imagining my life without being in school, I thought why not try applying anyway.  And go figure, I got in.

Shortly after my college graduation, I moved across the country to an apartment near where the graduate school was located, and found a highly-recommended psychiatrist (Dr. P.) to continue my mental healthcare in this new city.  Dr. P. evaluated me for several sessions and obtained my records from my previous doctors. Then, knowing that I was supposed to be starting graduate school in a matter of weeks, she urged me to withdraw. She said I wouldn’t be able to succeed in this path, and that it would be a terrible mistake to try.

I didn’t know what to do, but didn’t think it made sense to drop out of graduate school before I’d even seen what it was like. I tried to explain this to Dr. P., but she insisted that I was being unrealistic, and embarking on a dangerously stressful course that could only end in failure and regret.  So I went to a nearby outpatient clinic to get randomly assigned to a new psychiatrist, and started graduate school as planned.

My progress in school was slow and uncertain for many reasons. But the biggest reason was that every time I faced a setback, I feared that maybe Dr. P. had been right. Maybe I was too mentally ill to succeed as a clinical psychologist. After all, my own mental health history was more severe than the most impaired of my patients at the clinic, the ones my professors referred to with stigmatizing labels and hopeless prognoses. Though in retrospect it seems clear that every reasonably self-aware clinical psychology trainee ought to have some self-doubts, the degree of fear and stigma attached to my self-doubts was staggering. Maybe I never should have left the smoke-filled TV lounge of the residential program, where I had been so desperate for air and non-delusional conversation?

I did finish my Ph.D. after a decade which included two leaves of absence for depression. Afterwards I worked for close to a decade more in a series of temporary, often low-paying post-doctoral positions.  Still having trouble managing my illness (and requiring two more leaves of absence), I worried that I would never be able to use my degree for stable employment. It took me several years of applying for faculty jobs before I received an offer. And soon after starting this tenure track job I was back on emergency medical leave again, haunted by Dr. P’s prophecy.

It was nearly five years ago that I returned from leave for one last chance at redeeming my career, and though it hasn’t been easy or smooth, I’ve really given it everything I could. With the help of ketamine infusions, I have accomplished far more during this time – in terms of being a scholar and teacher and functional adult – than ever before.  It really has been one of the most strenuous challenges of my life, and I am grateful to everyone who has helped encourage and support me through it, including several on-line readers.

Today I found out that I have been awarded tenure. For the first time I feel like I can really say that Dr. P. was wrong about my future — and that she was wrong to have made my young self feel crazy and stupid for still wanting to try to pursue it. She might have talked to me about the likelihood that I’d need more time to get my degree, and more support, than my classmates. She might have talked to me about the importance of being patient with myself through this process. But what she said was more or less the opposite of those things. Even if she did it with good intentions, to tell me my plans were doomed to end catastrophically was harmful, as well as factually incorrect. Today as I am finally leaving Dr. P’s prophecy behind, my future is opening up. Sure the road I took to get here was much longer, steeper and more meandering than that of most tenured professors. But what I’ve experienced and learned along the way only makes me better at my work, not worse.

That I’ve actually arrived here hasn’t quite sunk in yet, but I know it will mean many positive, anxiety-reducing changes in my life. It also means that I have definitively defied the odds against me in a way that even now seems practically impossible.

After having seen all that they saw,
It’s hard to imagine. It’s hard to imagine.
Things were different then. All is different now.
I tried to explain somehow.
Things were different then. All is different now…
~Pearl Jam (1993)

I’m sorry

A week from tomorrow my materials are due for my tenure evaluation. What this means is that after next week the college I work for is going to decide: either I get a promotion, or I get fired. There is no in-between.  I’ve been working to obtain the desired position for most of 2-3 decades, and preparing for this evaluation practically non-stop for the last year. If I don’t get it and instead lose my job, my husband and I will have to move to who knows where to do who knows what, and I don’t even want to contemplate what this means for my treatment or my mental health.

I have plenty more unsaid stuff to say but I have been finding it hard to really invest in writing about it, because I keep thinking about the upcoming deadline and evaluation. I hope you understand and I’m sorry.

 

 

Escape from ‘codependency’ treatment

At the time of my first hospitalization for depression and suicidal urges, during my junior year in college, I was badly broken by the loss of a relationship, again.  The term ‘codependent’ was a hot new thing back then, so both in the hospital and subsequent residential treatment I was required to participate in addiction groups. I had no problems with substance use — I was just supposed to mentally substitute the idea of a boyfriend in the place of alcohol or drugs whenever they were mentioned by the group or in the reading materials. People kept telling me: “You can’t love anyone else until you love yourself.”

As someone who was raised to hate myself, I found that statement a vicious circle, a trap, one of the most depressing things ever. I was a psychology major and I knew enough about unconditional positive regard and secure attachment and so on to know that people don’t develop healthy self-concepts in a vacuum, they do so through loving relationships. What is a person supposed to do, then, if they didn’t receive what they’d need to love themselves, and therefore aren’t equipped to love others but only get addicted to them and hurt by them?

The impossible instructions I got were that I shouldn’t be allowed to become really attached to anyone until I had spent enough time alone to somehow figure out a way to love myself. OK, not entirely alone, because I could still have my therapist, and my addiction group. As if their alienating piles of pamphlets about alcohol and higher powers were going to comfort me, let alone help me feel something for myself that I didn’t know how to feel.

I felt that I was being criticized and blamed for still wanting relationships. I was being seen as leaving too large of a relationship footprint — after all, in my hand, a loving hand became nothing more than a dangerous substance! In this view, my basic need to connect with others was destroying more than it was helping, making me a burden. Seeing myself this way only strengthened my wish to die, and I started fantasizing about ways I could get myself killed and turned into food for homeless cats.

What I did instead was leave residential treatment with another patient, to start a life together – after we signed forms acknowledging that we were going against medical advice by doing so. Our relationship, which didn’t last, was difficult even from the very beginning. But it was a way out and a way forward for both of us.

I fully understand that people with low self-worth are in danger of being mistreated in relationships, and are unlikely to be able to enjoy or give as much healthy love as others without this vulnerability. Treatment should help us to get better at recognizing when we’re at risk and thriving when we’re not. But a treatment that teaches us we’re unfit to be in relationships is not going to improve our self-worth or our relationship skills. I was lucky to escape.

 

Dangerous ketamine clinics

The clinics we need to worry about aren’t necessarily dirty back-room operations. They have nice-looking websites, use all the right buzzwords, and offer convenient services in comfortable offices at reasonable prices.

Consider the following quotes from a website advertising a new clinic:

The (clinic name) offers exciting and cutting-edge IV infusions for the treatment of Depression, Bipolar Disorder…. administered by .…a highly experienced ….anesthesia provider that holds a national board certification in anesthesia by the NBCRNA.

Currently we do not require a referral for most cases of unipolar or non-rapid cycling bipolar depression…..We are Now Accepting Appointments. We welcome same day appointments, call us today to schedule…. Introducing our NEW Membership pricing option. Buy a membership for $(price) per month and receive discounted infusions…. If you are currently suffering from suicidal thoughts, please contact your local crisis center or call 911.

When the provider from this clinic advertised their services on a ketamine-related message board, I replied with the following question:

Please explain how a clinic can claim to ‘treat’ psychiatric disorders without requiring that their patients be properly diagnosed and monitored by a qualified mental health professional. I mean, if your patients are self-medicating a condition they self-diagnosed, how is that different from recreational drug use? And if your patients really have serious psychiatric disorders, wouldn’t they actually need mental health services, and not just whatever you’re offering?

I’m not saying this just to be obnoxious — I would really like to understand the logic behind a clinic like this. And I’d also like you to understand my serious reservations about it as a patient who is doing well receiving ketamine for severe, treatment-resistant depression.

I want the treatment that saved my life, and the lives of so many others, to be given safely and taken seriously. I don’t want psychiatrists to continue to refuse to work with patients who are benefiting from this treatment. I want the treatment to someday be covered by insurance, and I want people to stop acting as if patients like us are just taking stupid risks to get high. For these reasons I am concerned that clinics like yours are hurting people like us.

The provider quickly answered:

We understand your concern….Here, we do not diagnose mental illnesses and we make that very clear to all of our patients. We require that every mental health patient is diagnosed by and remains under the care of a mental health professional. In fact, we mandate that they provide us with the name, address and phone number of their mental health provider.

…we aim to offer an ancillary ketamine infusion service that most mental health providers support but are not willing to provide themselves. We are able to confidently administer a GENERAL ANESTHETIC in any setting and we are trained to manage any and all possible serious life threatening complications including acute tachycardia, severe hypertension, cardiac dysrhythmias and loss of patient airway… 

I answered:

I completely understand that mental health professionals rarely administer ketamine themselves (for good reasons) and think it is great that specialists are stepping up to provide ketamine to psychiatric patients on a consultant basis.

But given that this treatment is for patients at high risk for suicide, psychosis, mania, and other dangerous/severe symptoms, I do have an issue with advertising same-day service with no referrals required, even if you do ask for an address/phone number. There is a difference:

– A referral indicates that a mental health professional who has thoroughly evaluated the patient agrees that ketamine is appropriate for their diagnosis and treatment history, knows the patient will be receiving ketamine, and is on board to monitor the patient’s mental health and coordinate their care throughout this process.

– An address and phone number indicates that the patient has a mental health professional’s address and phone number.

The provider replied:

Thank you for your response. I would like to respond to your comments above which are based on assumptions and not on our current policies or procedures. Let me clarify, at (clinic name) we only treat uncomplicated unipolar and depressive phase of bipolar disorders without referral. We do NOT treat patients that are actively suicidal nor do we treat any patients without referral if we feel we may be putting them at risk of further mental health complications. We perform mania, psychosis and suicidal ideation screenings on all patients prior to Ketamine therapy. These type of screenings do not require mental health certifications or degrees to conduct. Patient safety is our priority and we are extremely confident that our current policies and procedures that are in place ensure the safety and continuity of care for all of our patients.

I was speechless. But here’s what goes unsaid:

No, I’ve thoroughly read your website and what you’ve said right here about your policies and procedures.  My concerns aren’t just “based on assumptions.”

 You said: “Currently we do not require a referral for most cases of unipolar or non-rapid cycling bipolar depression,” which implies that you consider “most cases” of unipolar or bipolar depression to be “uncomplicated.” But patients with these disorders ARE at high risk for mental health complications by definition. Just because someone denies manic, psychotic and suicidal symptoms before their infusion doesn’t mean they won’t encounter these or other serious mental health symptoms before or after they leave your office. And why would someone with truly “uncomplicated” depression require an experimental treatment like ketamine infusions anyway?

That you are “extremely confident” making complex clinical decisions based on a few screening questions shows a profound lack of judgment. Mental health screening questions are just tools, and how much training is required to use them depends on what you’re using them for.  People don’t need specialized training to use a knife as a tool for spreading butter, but they sure better have that training if they want to use that tool to perform brain surgery! While you say you will not treat patients if you “feel” you may be putting them at risk, you are making this decision with neither the necessary patient assessment data nor the necessary expertise to able to use your feelings as a gauge of mental health risk.

A clinic like this is a tragedy waiting to happen.

Battle

Chris Cornell’s death hit many of us quite hard, and one of the things I keep hearing is that it was especially hard because he was someone who had beaten his demons. I saw very similar comments when the toxicology report recently came out about Carrie Fisher’s death.

There is no denying that it is hard. Mental illness is really hard. But that so many people consider relapses and suicide risk shockingly unexpected outcomes of mental illness suggests a profound misunderstanding of what it means to battle it.

Despite what movies might have led you to believe, mental illnesses like depression and substance use disorders don’t have a single cause — and treatment rarely is a matter of exorcising particular demons (or memories). Even psychologists who believe that there is something to be gained from reaching into and airing out a traumatic past believe that this process requires repeated, painful efforts over a long period of time, and that success in this process is rarely complete or permanent.

Rather than derive information about surviving mental illness from movies attempting to depict therapeutic treatment, consider the horror genre.  When it seems as if the evil creature has been killed, but it comes back alive after you’ve breathed a sigh of relief, that is what battling mental illness is like. When you’ve discovered that the threats are coming from inside the house, from a place or person you trust, that is what battling a mental illness is like.  And we’re often talking about recurring battles over a lifetime, in which the enemy might lay low, call a truce, and fraternize with our side for a time. We need to celebrate each battle that is won without prematurely assuming that the war has come to a happy end. Labeling someone as a “success story” might make it more difficult for them to ask you to be there at their side, ready to continue the fight, when the enemy silently regains enough strength to attack again, as it often does.

And just because we’ve won the battle doesn’t mean we’ve won the war.