31 October 2022
Mask-Free this Halloween
Yeah, this piece isn’t about Halloween at all, really. It’s about therapy. I have things a-brewin’ in me that need to come out.
The more I am researching, the more I am learning about trauma, the more I’m beginning to believe that our culture, especially our capitalistic medicine machine (Big Pharma), want us to be medicated – but that medication, while often necessary, is not always the long-term solution to certain mental health issues like anxiety, depression, and even some cases of ADHD.
It may not be a popular belief, but that’s ok. Let me flesh it out anyway.
When I crashed in 2018, let me be perfectly clear that it was medication that saved my life. I am not here to tell people that medicine is the devil or that it should not be a life preserver flung to you while drowning. That is precisely how it worked for me; it buoyed me up enough to catch my breath and recover stability so that I could then drive back down with confidence and explore – then, heal.
But medication cannot, itself, heal. I said it just yesterday to a classmate who likewise suffers mental health struggles, and he agreed: medication is a band-aid. It treats the symptoms, not the underlying cause of the ailment/illness.
Interestingly, the very same can be said for therapy, if we are not wise…
The Right Therapist:
My first therapist was a psychotherapist – quite good at what she does. Her name was Raquel _____, and she was a Harvard-trained therapist in Madrid. And because, why not?, let’s look at her training and credentials for a moment:
Raquel _____
Licensed in Clinical Psychology
Master in Counseling and Consulting Psychology
Certified Family, Couples and Systems Therapist,
Master in Clinic and Psychotherapy with a Psychoanalytic Orientation
Completed Specialization
Training in techniques of stress-management, relaxation and cognitive re-structuring
Ok – so Raquel was fantastic. She was my first real therapist, recommended to me by my best friend. It was in Raquel’s office that I was first able to speak without constraint about the things consuming my mind.
Raquel gave me breathing techniques to manage my stress. She helped me to understand what overwhelms me, and to avoid those situations and circumstances. I recall my favorite thing she said, “If you feel a panic attack looming while you’re shopping in Carrefour, just leave the cart – I don’t care how full the cart is, just leave it – and go out to your car. Nothing is more important than your safety and your mental state.”
What Raquel didn’t realize then was how valuable this information would be for me later on…and she probably has no idea why, since her approach was symptom-based. Note that her background touches upon stress management and relaxation techniques, alongside family, couples, and systems therapy.
Again, Raquel was a great start for me; it was she who finally convinced me that I was in enough of a panic state to necessitate medication: sertraline. It’s only unfortunate that my PCM put me on Pristiq instead (a drug I think is truly dangerous).
Yet, I felt that Raquel was not touching upon something – I knew not what. I could eat right, I could run, I could do all the breathing techniques, yet still the panic lingered just below the surface, like a shark about to bite, sometimes nudging at my leg just to test me. Nevertheless, with Pristiq, I stopped seeing Raquel because everything was fine! All of my issues evaporated immediately.
…and along with that evaporation went all of my drive, all of my emotions.
Pristiq numbed.
It wasn’t until we lived in Minot that I noticed my blood pressure had spiked. I’m tempted to blame the Pristiq outright, but its influence was indirect; the Pristiq didn’t spike my blood pressure, but it did numb my feelings so far that I no longer cared how much I ate, drank, watched TV, etc. I was still running, but barely. My weight skyrocketed. Then, I induced a hip injury probably from overuse. My lower back was testy, often seized, often painful, limiting movement.
It was the challenges of getting my Pristiq prescription refilled that highlighted Pristiq as the problem: the base pharmacy did not keep the medication in stock, so it needed to be ordered; I ran out before I could get the prescription filled downtown – to the tune of multiple hundreds of dollars; the two days I went without Pristiq, my withdrawal symptoms were so acute they terrified me. When I turned my head, there was a disorienting whoosh in my ears. Likewise, when my head turned, my eyes lagged to catch up. I was convinced that I’d crash my car if I drove – and I might’ve been justified in that fear.
It took a consult with both my PCM and a Psychiatrist (who wanted to diagnose me immediately with OCD) to get back to the prescription Raquel originally recommended: sertraline.
The weaning from Pristiq and transfer to sertraline was unremarkable – devoid of complications. Sertraline was clearly a weaker drug; I felt my feelings again. I felt them hard, but they weren’t debilitating, and I was ok with that. I pumped those feelings into work and onto the page as I began to write.
In the meantime, I was dealing with so much internal unrest surrounding this insatiable need I could not manage, a need to be seen, accepted, loved, coveted. I was blaming my marriage. I started to see Theresa ______. I chose her specifically because she had background working with military members, and I thought that would help her better understand my circumstances as a military spouse living a military lifestyle. Closer to ideal, but still not perfect. Let’s look at her resume:
“A licensed psychologist, Dr. ______ provides comprehensive psychological care for people dealing with a wide range of mental health issues, including mood disorders, depression, anxiety, serious mental illness, PTSD, and personality disorders.”
It was the psychiatrist who recommended Theresa for her history working with PTSD-suffering war veterans. She was probably a better fit than Raquel. We did one session of EMDR therapy to talk about my family…but we never truly dug anything up worthwhile. Then COVID hit and we stopped meeting for a while, then met once or twice more, then stopped altogether.
When I moved here to Albuquerque, I was no longer fucking around. This time, I knew I needed to talk about family and my upbringing. I needed to see what all of it meant – and I needed to unburden my mind of all my false beliefs so that I could move out of the private realm into the public realm with my writing.
I sought a provider who specialized in generational trauma and found Rebecca ________: Clinical Social Work/Therapist, LCSW. Here is the official list of therapies she provides:
Attachment-based
Clinical Supervision and Licensed Supervisors
Cognitive Behavioral (CBT)
Culturally Sensitive
Dialectical Behavior (DBT)
EMDR
Emotionally Focused
Family / Marital
Family Systems
Internal Family Systems (IFS)
Mindfulness-Based (MBCT)
Motivational Interviewing
Narrative
Parent-Child Interaction (PCIT)
Person-Centered
Play Therapy
Psychoanalytic
Psychodynamic
Sandplay
Solution Focused Brief (SFBT)
Strength-Based
Trauma Focused
Ok, now, I gotta be real…perhaps Rebecca worked with a better marketing company, but look at this list! I was seeking EMDR, emotionally focused, family systems, internal family systems, mindfulness, and trauma-focused help. This woman checked all of the boxes, so I reached out to perform my own “interview” of her. I wanted to know if she was familiar with personality disorders and knew anything about family dynamics. She was and she did.
Then, I began the process of getting her covered by Tricare, which was a bear because she was listed as a clinical social worker, not a therapist, and Tricare had approved my referral for a therapist, not a clinical social worker. I had to get Tricare to change my referral multiple times before they could find her in the system. In the meantime, I saw Rebecca out-of-pocket for about two months because, duh.
Finally, this was the right provider/therapist. Not only was she familiar with all of these therapies, but she’d dealt with family systems trauma herself (her father, I think). She was receptive to every experience I shared, validated it all, and unpacked it to show how each moment of my upbringing shaped the mind that I have today.
So the therapist’s specialization and personality are critical elements to the success of therapy – but the onus is not solely on them!
The Right Patient:
As much as we must find the right therapist, we must also be the right patient.
So many people I've met swear that therapy is useless. But I posit that it isn't the therapists who are always useless. Therapists are human. It takes a very skilled and experienced therapist to sniff out what the patient needs, especially when the patient is masking (as they might do with personality disorders, ADHD, high-functioning anxiety, and depression).
But even a less skilled, less experienced therapist could be life-saving if the patient commits to the process.
Brené Brown says that shame evaporates when it sees the light of day: “Shame cannot survive being spoken – it cannot survive empathy” because shame depends on the person buying into the belief that they are alone.
On the therapist’s couch, your shame cannot survive if you give it air. On Rebecca’s couch, my shame evaporated because she had experienced it all just as I had. Rebecca took my thoughts/beliefs and considered them, re-stated them in her own words, without judgment. She inspected them to reveal their source, then helped me to deconstruct them and replace them with new thoughts/beliefs.
But Rebecca could only do so much. It was on me even more than her to invest in the process – to place myself in uncomfortable spaces of vulnerability – admitting culpability, fear, shame, insecurity, raw emotion.
In doing so, though, I realized that I can carry those things. I can shoulder them! I am strong enough – because I am not alone. Moreover, I am more than strong enough to carry them without the assistance of medication. Because what was medication doing for me, really, other than masking my very real, very important emotions?
I would not be where I am today, cutting my sertraline pills in half each night, without first committing to my own vulnerability with Rebecca. And what’s crazy is this: once I’d admitted those vulnerabilities to her, suddenly it seemed far less daunting to share them with others. I began in bits and pieces, sharing them with Brian, my blog, Gretchen, other friends, then my father, my sister…to the point that I’m now in a place where I cannot even imagine pretending invulnerability anymore. What you see is what you get, with me.
…and I’m realizing that I do not have Generalized Anxiety Disorder at all. I’m simply a Highly Sensitive Person who has been inundating herself with stimuli for far too long. Do I even need this medication, if I move through my emotions, give myself enough rest, and protect myself from overstimulation and hyperarousal? My suspicion is no. My suspicion is that this diagnosis is fueled by Big Pharma trying to tell me that I’m broken or wrong when I am not – I am simply sensitive and living in a world that demands insensitivity. Well, I reject Big Pharma and I reject this productivity-oriented world.
Listen to me, society. Take your social media scrolling and your mass media urgency tactics and your processed foods and your overscheduling and your productivity-focus and shove them up your ass. I’m not buying what you’re selling anymore. I choose calm. I choose thoughtfulness and quiet. I choose a slower pace and less – everything. I choose nature. I choose sleep. I choose my few, few people. And in doing so, I choose me.