Trauma

Gina was 29 years old and she was angry as anything. She had a right to be. She had been abused sexually by her uncle from age 8 until 14. She felt ashamed, dirty, demeaned, and never shared this with anyone. Gina had boyfriends over the years but these relationships were superficial and inevitably led to abuse. It became her strange comfort zone - Gina felt she didn’t deserve better. As time went on, she started hating herself more and more. This led to all sorts of self harm, which then led to psychiatric hospitalizations. When I introduced myself (and I always had a female staff member with me when I saw her), Gina was understandably guarded and made no eye contact. She said she just wanted medications, lots of medications, anything to numb the pain. She said this would help her to stop harming herself. So I medicated her - not that I believed it was what she needed ultimately. But it was a first step, an attempt, for Gina to feel she was being cared for. What soon became clear to me was that Gina’s previous therapists were a disaster. They failed to help her see the distinction between victimization and victimhood. Victimization comes from the outside, as in Gina’s uncle. But victimhood comes from the inside, Gina’s self perception. Sadly, someone who views themself as a perpetual victim is essentially handing their life over to others. True healing can only happen if one refuses the self-definition of victim.

I cannot claim that I am an expert on trauma. There are great therapists who have more direct experience with this than I do. But I do know that the victimhood mentality is not healthy and often perpetuates itself. In my judgment, therapy with someone who has undergone horrific sexual or physical abuse should not be based on defining oneself by one’s trauma. Sadly, this is what happens all too often. Gina and I talked about how she can begin to build a positive self-image. This starts with connecting with her true self, her soul, which is innately good. And then to know that this goodness can never stolen from her - and never was. With this in mind, she can then let go of her anger and love herself again. As Gina left the hospital after a one week stay, I certainly encouraged her to share these themes in her outpatient therapy work. We knew her journey would not be easy; terrible trauma never is. Years later, I heard that Gina was happily married and a mother to three beautiful children. With that, I assumed that she had done the hard hard work that it takes to say goodbye to the demons of her past. I’d like to think - and I pray - that anyone who has undergone horrific abuse can find a way to connect with their true selves - and then move on, wonderfully and powerfully, with their life.

Equus

A 17 year old boy who has a love for horses suddenly turns and blinds the eyes of six of them. This horrific act is the basis of the powerful play, Equus, written by Peter Shaffer. It is not only a story about a highly disturbed adolescent named Alan. It is just as much about the psychiatrist, Martin Dysart, who helps him. In Equus, we see how Dr. Dysart takes the excruciating psychological journey together with this severely damaged 17 year old boy. He finds in Alan vivid layers of sexual and religious conflict. Dysart uses several techniques, including hypnosis and a ‘truth pill’, to help Alan. By the end, we see what led the boy to blind the horses’ eyes. At intervals throughout the play, Dysart speaks directly to the audience and shares with us his own internal world. Dysart is a lonely, desolate soul who feels trapped and has fallen into the dullness of his everyday life. He finds himself envious of Alan’s energy - and so, when he ultimately helps Alan, he also regrets having taken away Alan‘s passion. Like all doctors, the work of a psychiatrist is to relieve suffering. “To do no harm”, as the Hippocratic oath goes. But in this process we must also never take away someone’s zest for life. This is the quandary that psychiatrist Martin Dysart finds himself in, both with regard to helping Alan and also within himself: “You won’t gallop any more, Alan. You will, however, be without pain.” We are all born with innate passion, inspiration, and curiosity. This is because we have a soul, a spirit that yearns for attachment and connection, connection in a good and healthy way. Unfortunately, all too many people direct their passion in unhealthy ways: addictions that enslave us, infatuations that destroy marriages, outbursts of anger that put others in danger and belittle ourselves. This is why, sadly, mental health troubles are permeating everywhere these days.

A mental health professional should never squelch a patient’s passion. The same goes for parents with their children. But the passion needs to be channeled correctly. Psychiatrist Martin Dysart grieves that he has taken away Alan’s passion and in that sense, he has great courage and sensitivity to look at himself. But Dysart’s own life is stuck and this blinds him. In the end, he fails to see that passion doesn’t have to disappear, that it can be re-directed, powerfully, in beautiful ways.

Tenacity

When I was a younger psychiatrist in training, I had the pleasure to meet a remarkable woman named Sarah. Here’s what happened. Sarah grew up in an immigrant family. She was the youngest of six children, all girls. She told me that when she was born, her father cried and cried because he so wished for a boy. As a result, young Sarah became quite active in sports, a tomboy they called her back then. She was tough. Nobody messed with her. But she certainly had a feminine side. Boys were attracted to her - and at the age of 19, when she saw a tall young man giving a speech, she orchestrated events so they would meet. And soon they married. Sarah wanted children, lots of children, and in quick order the pregnancies came: six beautiful kids in eight years. Life moved on and all was well. Yes, there were the inevitable tensions and dysfunctional moments that afflict most families but for the most part the young kids played and consumed each others’ energy. It was a pretty stable home. And then something happened. At the age of 31, two years after giving birth to her sixth child, Sarah began to act differently. It started subtly enough, with Sarah requiring less sleep. She then started buying all sorts of stuff, unnecessary stuff like 30 beach towels, each one a different color. She started yelling at her husband and kids for no reason. Sarah became a sea of unstoppable energy and she wouldn’t listen to reason. Her husband, frustrated and concerned, took her to the hospital. She signed herself in to the psychiatric ward “to show everyone that I’m ok”, she said. And so we met. I was a psychiatric resident in training, and assigned to do the initial interview of Sarah. She told me lots of things about herself, like how she used to dance with the Native Indians during their summer festivals; how she memorized the entire Scrabble dictionary; how the Queen of England was awaiting her visit. Sarah spoke nonstop, fast, rambling, switching from topic to topic. Clearly she was in the thick of a manic episode. But I also noted Sarah’s strength, her inquisitive mind, constantly challenging me. She was not an easy, compliant patient. And I liked that about her. I presented Sarah’s case to the psychiatrist in charge who said we should immediately medicate her. As anticipated, she flatly refused. Sarah told me that a doctor once advised her to have her tubes tied so that she wouldn’t have any more children. “How nutty is that”, she told me, “doctors playing God. I don’t trust them, none of them. I’m not even sure that I trust you.” Sarah then went on a hunger strike. She said that she would refuse to eat as long as we kept offering her medication. Her treatment course became a silent battlefield: every day she would be offered the medication and every day she would not eat a thing. It was Sarah against the psychiatric attending, the administration, the whole psychiatric bureaucracy. She wasn’t aggressive or violent; she was simply determined and quietly defiant. After three days of this, the hospital authorities couldn’t take it anymore. They stopped offering Sarah medication. Sarah’s persistence, a lifelong skill, had won the day. In the next couple days, her manic symptoms naturally and slowly decreased. The psychiatrist in charge agreed to discharge her as long as she would follow up - with me - at least once a year. With that, Sarah went home, turned to her husband and said “See, I told you. I’m fine “. (As an important caveat, please know that most people with significant manic episodes do require medication treatment. Without it, they can lack so much insight and judgment that they can engage in very dangerous activities.) Sure enough, Sarah held to her word and we met once a year. She was as spunky as ever. She did have a couple more manic episodes, but they happened just once a decade - and again resolved naturally. Her husband never took her to the hospital again. Sarah never touched a medication for mania. She continued to raise and adore her children. She went back to school and got a PhD. And she continued to have a mind of her own. Years later, and a few months after our annual appointment, I learned that Sarah had fallen ill and suddenly passed away. Her family called me with the sad news. As I sat, frozen and quietly crying, they told me that one of Sarah’s last requests was that I attend her funeral. At the funeral service, I could not hold back my tears as each of her children spoke with so much love and adoration for their remarkable mother. “Always a twinkle in her eye”, they said. “She loved us for being who we are“. “She taught us to never give up”. “Her life was all about her children and grandchildren - she put a bumper sticker on her car that said, ‘Foxy Grandma’.” Yes, there was nostalgia, sweet memories, tears and laughter. And I especially smiled when her daughter shared that Sarah never lost a game of Scrabble. Sarah was Sarah, resolute and tenacious. She showed the world how to live life with a confidence not dependent on the approval of others. And her spirit, her soul will never fade away.