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)

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.

 

Being unfuckwithable

Last year I was bullied by several students who thought they could pressure me into giving them higher/easier grades. They tried everything they could, including manipulation, lying, disrespectful behavior, turning their classmates against me, and complaining about me to other faculty. In the end, all my students received the grades they had earned based on my syllabus and grading rubrics, so the bullies did not succeed. But the bullies did manage to make me feel so awful that I stopped bringing my class the level of enthusiasm and finesse that my non-bullying students deserved. Now that I am preparing for the Fall 2016 semester, I find that planning the course material is the easy part. What I am most worried about is preparing for how I’d handle it if a student tries to bully me, so that it doesn’t take so much of a toll on me and my work.

I’ve come to realize that while student bullies can be a challenge for any professor, I have a particularly hard time with them because after being mistreated early in life by my father, my more popular classmates, and others, I spent too many years believing I didn’t deserve any better. For instance, among the people I considered my closest friends as a teenager, several openly excluded me from many things because I wasn’t ‘cool’ enough, another threatened to hit me, and a third offered my boyfriend a secret sexual relationship on the side. How did I respond to my so-called friends when they behaved like this? I made efforts to please them by trying to accommodate the new terms they were setting for our friendship, and even gave them elaborate, hand-made gifts! Similarly, even after relationship partners repeatedly cheated on me or engaged in other manipulative behaviors, I stayed with them until they decided to break my heart by moving on.

I think this history helps explain why when someone treats me with disrespect (or worse), my first reactions are to freeze and to doubt myself, thinking that I must have done something to deserve it. But such reactions are particularly problematic in the classroom, because when my students begin to perceive cracks in my authority, their bullying attempts quickly escalate. As a result, even students who aren’t bullies have complained that I seem to lack the personality of someone able to stay in control of the class.

Armed with the realization that my students’ behavior is triggering painful memories, my plan is to try to focus on the ways the current bullying situations differ from the earlier ones being brought to mind. I do not care if my students like me; I do not need them to like me. I completely reject the idea that only naturally dominant, extraverted people can be effective college professors worthy of respect. Regardless of whether any student perceives me as authoritative-looking, I actually HAVE authority over my class, in that no amount of bullying will stop me from grading each student according to my own standards. I am hoping that reminding myself of these facts will help me feel less flustered and self-blaming the next time students try to pressure me, and in turn, help me come across as more authoritative over time.

Fantastic voyage

A week ago I cried (with only brief pauses) for over 8 hours, while on a plane and various airports, on my way home after presenting at a professional conference. When it first started I hid in a bathroom stall and tried to stifle the sounds while other patrons were using the facilities. But over the rest of the day tears found their way down my face even while I was just sitting silently. The barrier had been breached and that was that.

A snarkier, clickbait article about this might be written for various mental illness advocacy websites. The article might be called “X things not to say to a crying stranger,” and would shame the various people who ineffectively tried to help me that day for their ignorance or at least lack of subtlety. But I didn’t know what to do in these situations and can’t find fault in the strangers who didn’t know what to do either.

  • One startled bathroom attendant started shrieking when she saw my swollen, bloody eyes and wet face; I think she was truly upset that some crisis might be under way.
  • The woman next to me on the plane kept trying to reassure me, or to reassure herself, that I was “just having a bad day, that’s all, right?” I shook my head, thinking: ‘I have a serious illness that was in remission and now it is back and I’m frightened about what is going to happen’. But not wanting to have to explain that I don’t have cancer, I forced a teary smile and said nothing. She probably repeated that phrase 3 or 4 times.
  • The flight attendant asked if I was OK and gave me a pile of napkins, which I really appreciated. She also offered to escort me off the plane or get assistance. I said no, all I really need is to get home, and she assured me that she would get me home. This was actually comforting, but the silent tears nevertheless persisted for the entire flight. Before landing, she crouched in the aisle beside me and said “I don’t know what faith you are but if you want me to pray with you, let’s do that.” I thanked her with another weird, wet smile, not having the heart to tell her that I’m an atheist.

Remember it’s true, dignity is valuable
But our lives are valuable too
from “Fantastic Voyage” (Bowie/Eno)

Holding tight to this dream of distant light

I’ve been reluctant to admit this to myself, but the ketamine treatments have stopped working. Trying to deal with this, I’ve been going for booster treatments every 2-4 weeks and getting a relatively strong dose each time. But over the last few months, the benefit of each treatment has become smaller and smaller. Sure, other medications that had been somewhat helpful to me in the past (e.g., MAOIs) eventually stopped working, and I feel a little foolish that I never considered this might happen with ketamine too. I certainly never considered that it might happen quite so quickly. I don’t know where to go from here; obviously some serious conversations with my doctors are the next step.

I’m grateful to have been able to experience those several months of remission I had with ketamine; after so many decades of depression I didn’t even know it was possible to really feel OK like that. I’m trying to hold on to the memory of that feeling, while completely overcome with grief that it is gone.

References

“…And yet I’m still holding tight to this dream of distant light, and that somehow I’ll survive. But this night has been a long one, waiting on a sun that just don’t come…”
– Speed of Sound by Pearl Jam (2009)

Epilogue: In the fall of 2015 I had severe work stress (I was being bullied by several students) and I started taking clonazepam much more regularly. It turns out that clonazepam has been observed to sometimes interfere with the effectiveness of ketamine infusions (although this depends on the dose and timing of the clonazepam, as well as other individual factors). Once I got myself off of that stuff, the infusions started working again. And of course when that semester was over, the reduction in stress was really helpful for my depression too.

Finally the shades are raised

Over the last several weeks I’ve been trying to finish an essay that is expected to be published in the near future, about my decision to stop talking to my father. Working on this essay made my recurring nightmares about him much more frequent and intense, so I hope it will be worth it.

At the risk of stating the obvious: Pearl Jam songs have been one of my main sources of comfort for over 20 years. I was first drawn in by how much I could relate to the heartbreak expressed in “Black,” a staple of the radio station I listened to in the early 90’s. But when I first saw the band perform on Saturday Night Live in 1994, they did a pair of songs about childhood abuse that took my breath away  – and I still can’t watch that performance of “Rearviewmirror” without getting chills.

Verbal/emotional abuse and neglect were a routine part of my upbringing – but there was never any physical or sexual violence, and with my parents’ encouragement my sister and I were very well-behaved, high-achieving kids. I never felt like I had the right to my real story and these songs helped clarify it for me in a way that nothing ever had before: my father’s cruelty to me had hurt me irreparably, and the futility of continuing to trying to please him was still hurting me. Though it took me another 20 years to say it, eventually I did tell my father: Don’t call me.

“Daughter” tells of a young girl striving to be worthy of her parent’s admiration. But behind the clean pretty façade of this family life, there’s something wrong. The lyrics can’t seem to decide whether it is the parent or the daughter who is unworthy (“unfit”) to claim their relationship with the other, and the daughter is apparently trapped by this same confusion, as she holds the hand that holds her down. As the song ends, the shades go down, both hiding her suffering and leaving her in darkness.

“Rearviewmirror” describes someone who left an abuser behind, and saw things clearer as a result. “I gather speed from you fucking with me… Once and for all I’m far away… hardly believe, finally the shades are RAISED.”

References:

Re-thinking self-injury

Deliberate self-injury is puzzling to many people. Heck, it is still somewhat puzzling to me — even having experienced it – for reasons I’ll explain below. Of course the experience is unique to each individual, so I’m not saying that my own is necessarily typical, but I think it may be helpful to talk about anyway. Also note that I am deliberately going to omit the details about what I did to hurt myself, because I don’t think those details are helpful to talk about.

There have been two distinct periods in my life when I was frequently self-injurious. One was during my third year of college, and the other was over twenty years later. Not coincidentally, these are also the two periods in my life in which my depression eventually became so severe that I required hospitalization. I didn’t have more than passing thoughts about hurting myself during the decades in between, or in the years since.

I only started having problems with self-injury after I survived a suicide attempt and promised never to try to kill myself again. When self-hatred and self-disgust were so strong that I really wanted to die, injuring myself just seemed like the healthier of the only two options I could think of. In this (extremely limited) sense it worked, and in its aftermath I often felt more welcome to remain part of the physical and social world.

To those who would dismiss self-injury as a form of attention seeking, I’d counter that I almost never told anyone about what happened, and that the only times I did were in a proactive effort to stop. I also want to emphasize that there are biological factors involved. In my own experience, I think among the reasons I had such powerful urges for self-injury at these two distinct points in my life were things like extreme sleep deprivation and going through withdrawal from antidepressant medication (Nardil).

What is most inexplicable to me about my self-injury experiences is that they really felt as if I were being taken over by forces much more powerful than myself.  I also felt as if my self-hatred and self-disgust were strong enough to destroy the whole world if not given a more limited outlet.

Looking back now, it is clear that the thoughts/feelings I had about self-injury, and about suicide being its only alternative, weren’t quite realistic — and I’d like to think that next time I’d be less inclined to consider self-injury as a readily available outlet for my internal pain. Instead I’d want to consider other possible ways of making it through each hour at a time, ways that would ultimately make me feel better able to cope. For me this involves promising myself that next time I won’t work so hard to hide my struggle with self-injury, but instead ask carefully selected people to help distract me, wait with me, and guide me through those times. Though my depression has currently receded and self-injury is now quite far from my mind, I want to learn from this especially difficult aspect of my past to be better prepared for the future. Because sometimes life don’t leave you alone.

References

“…It’s an art to live with pain,… mix the light into grey,..
Lost 9 friends we’ll never know,.. 2 years ago today
And if our lives became too long, would it add to our regret?
And the young, they can lose hope cause they can’t see beyond today,…
The wisdom that the old can’t give away, Hey,…
Constant recoil…Sometimes life don’t leave you alone…”

Love Boat Captain by Pearl Jam (2002)