Reflections on Mental Health Services

“Now, take your eraser and erase everything you see,” Susan, my therapist, said to me.

He was the first to go, of course. His looming, hulking figure, perched on my bed, knees pressing into the Strawberry Shortcake sheets, the cheap mattress underneath, my bare little thighs. I then proceeded to erase each parallel of my sixth-grade bedroom one at a time, in 30-second increments with gentle buzzers vibrating back and forth in the palm of each hand:

• The blank wall with the small dresser the head of my bed and pushed against it, including my pillow soaked with tears and snot. Erased.

• The wall that hosted one side of my bed plus the two side-by-side windows draped in Strawberry Shortcake curtains, behind which someone had once peered in at me while I was changing into pajamas. Erased.

• The wall with the nook and desk built into it, where the resident cat (his fucking cat) once frightened my hamster to death. Erased.

• The wall with the door that he had knocked on, asked if he could come in but ignored the distress in my 11-year-old voice; the door that he paused in before he left, asking as I sobbed into my pillow, “We can still be friends, right? This will be our secret, ok?” Erased.

• The floor covered in all the random carpet samples, my footsteps, his. Erased.

• The ceiling, which feels suffocating now that I try to recall it. Erased.

As the session came to a close, I stood on nothing and with nothing, in the absence of memory, in endless blackness. A moment in time and space without any interjection, with possibility for the future perhaps.

This was the conclusion of my first round of EMDR (Eye Movement Desensitization and Reprocessing), a method for treating trauma and one of the reasons I remember just how valuable professional mental health care can be.

I spend a lot of time talking and writing about my aggravation with people asking me, “Have you gotten counseling?” That question and others like it feel like people are trying to get me to shut up, go off into a private corner to talk about these uncomfortable, sometimes horrifying things. Sometimes, I want to cry with someone who loves me, feel less alone with this horror in the world. Sometimes, I need the people in my daily life to understand what is burdening me. Sometimes, I just need a break.

Sometimes though, I truly need professional guidance. I have reached out most times I have needed it – at least as an adult, starting (in a way) with my suicide attempt at 19. My experience has been mixed, to put it very, very simply.

This is a big topic, so I am going to treat this blog entry as a kind of scan, like a 100-level college course. I will describe my own experience with mental health systems in the United States, but before I do, I want to be clear that I have a lot of privilege that affords me a greater chance of success when dealing with mental health and other systems in the U.S., mostly due to pure luck:

• I am white, so most therapists will look like me and have direct experience with and understanding of my cultural context; I will not have to explain my culture in order to get help that may be actually helpful for me.

• I am highly educated (in part because I was born to college-educated parents that expected me to be highly, formally educated), and I have studied, volunteered in, and worked with mental health systems, so I have a better than average understanding of what services are available and how to access them.

• I have had access to resources (earned or accessed through clever financing or the grace of friends/family) that gave me a safe place to sleep, healthy food to eat (which helps to think/reason more effectively in addition to generally keeping the body healthy), pay bills to keep the lights on and water flowing, buy cigarettes (which, believe it or not, helped me to breathe for many years), and after all that and sometimes with the help of insurance, pay for mental health care.

• My mental illness is not biological/chemical, so I do not require high-level psychiatric services to help me navigate life. This means that there are likely dozens of mental health professionals nearby that could possibly meet my needs, as opposed to the situation for my friend with Bipolar I Disorder who couldn’t find a qualified provider in a city with over 200,000 residents.

All these factors and possibly more that aren’t coming to mind right now make a big difference in a person’s chances of success when seeking help from professional mental health service providers. I was well-positioned for success, no matter what shit life had in store for me. Still, it only worked out for me some of the time…

Mental health therapy and related services have helped to keep me alive on multiple occasions. If you are or have been feeling suicidal, professional mental services are extremely important, maybe essential. I count my 72-hour hospitalization after I swallowed that bottle of Tylenol at 19 as one of the most important encounters I’ve had because the therapists there helped me to understand the basics of what I was going through, which was enough to keep me alive. Therapy helped to save my life again over a decade later, after Jasmine died. I was in the accident with her and couldn’t get through any day or night without reliving it. Such cruelty in traumatic memory! We truly relive the trauma…the worst agony again and again. Luckily, I was able to go back to the same EMDR therapist, releasing me from the worst Groundhog Day ever, allowing me to move forward at least. My life was again in danger several years later when I quit drinking and was forced to re-face everything without my liquid crutch. I had few resources at that point – friends had drifted away and my household income was insufficient to cover my most basic needs. I leaned into the crisis system, frequently calling the crisis line in my state and once even walking several miles to talk (and sob) with a counselor at the nearest crisis clinic.

Therapy has been almost as traumatic as the original trauma at times – I have desperately needed additional, personal support at these times (and rarely accessed that kind of support – a topic for more exploration another time). Hospitalization at 19 was also one of the most traumatic encounters I’ve had with the mental health system. I remember the hours I was left strapped to a gurney in a hospital hallway, the imprisoned feeling of the psych ward once I got there, and the horror of being housed with people with severe delusional disorders and all the strange behaviors around me while struggling with my own issues. Then there were the EMDR treatments, both of them, such is the nature of the treatment: you intentionally relive the trauma over and over again until able to integrate it into your system like ordinary memories. It is extraordinarily helpful eventually, and extraordinarily painful along the way. Then, of course, there was my first encounter with mental health services – the creepy therapist my parents took me to that summer after my birth mother’s husband molested me, the one that asked me if I liked it. There was nothing redeeming about that traumatic encounter.

It’s expensive and not adequately covered by insurance. There have been times when I really needed therapy but couldn’t afford it. For instance, I should’ve had follow-up care after I was discharged from my 72-hour hold on the psych ward when I was 19. As it was, I didn’t have insurance and was $13,000 in debt to the hospital, hurting my credit record for years to come. Again, I should’ve had continuous therapy after Jasmine died (perhaps I wouldn’t have become addicted to alcohol?), but shortly after I completed EMDR, I no longer had access to health insurance or steady income. I also should’ve had regular (weekly, maybe twice per week) sessions with a therapist when I was getting sober. Again, no money for basic needs = no money for mental health care. Only the crisis line was available for free on an on-going basis. (Thank God there are more free therapeutic services available now, for teens at least. That might’ve changed the entire course of my life if it had been available when I was a teenager.)

Finding the right therapist/counselor/therapeutic services can be a challenge. I have gotten good at “interviewing” potential therapists. One thing I did do when I was 19 was participate in a self-help program called The Excellence Series. My birth mother paid for me to participate because she had gone through it and found it very helpful. I was curious and, more so, desperate for help, so I agreed. That program helped me to understand myself in a way that enabled me to know what kind of help I have needed at various times since then, and I’ve been able to articulate it in a way that has limited the number of failed therapeutic relationships I have experienced. Even with those skills and all the privilege I have from birth, even my most recent therapist wasn’t the greatest fit. I knew at the time that I needed someone that could help facilitate greater mind-body connection. I knew the first therapist I engaged was a bad fit in the first appointment. The second one was good enough; she got me to a place that enabled me to be ready for the transformational coaching services that actually helped me far more. In short, I have rarely found a great therapeutic fit immediately. This is ok when not in dire condition. When in severe distress, it would be extremely helpful to have a support system available to help make one’s way to the right therapeutic services – to avoid giving up.

How mental health/illness is understood and taught seems off-base. This is a much larger topic, and I know I can’t do it justice here, but I would be remiss to not mention it. There is an epic guide to mental illness: the Diagnostic and Statistical Manual of Mental Disorders, currently on its 5th edition (the DSM-V). Much of that guide, in my opinion, treats what I see as natural human responses to abuse and/or traumatic influences like illness…like there is something wrong with the person who is suffering, not the circumstances that created the suffering in the first place. I think this can be a real barrier to people getting the help we need in the way we need it, help that acknowledges that how we are responding is natural. While there is personal healing to be done, society, systems, and our loved ones can and should be part of the process too, helping to heal our context by providing the things that were stolen from us, like sense of safety, trustworthiness among the people around us, support and reminders that we are worthy, etc.

Again, to be clear, I entered this world with privilege, which begat more privilege as I grew, so while I have struggled, I realize that things could be much different for me right now without all that privilege. And still, we have got to do better as a society in providing mental health care, and still, I hope that those of us who are suffering will reach out for whatever services we can find that will work best for us when we need it most, hopefully with the help of someone who loves us exactly as we are at any given moment.