A quick note before jumping into this week’s post: MTV, The Jed Foundation and media company SoulPancake are looking for young adults to participate in a mental health awareness special, “Don’t Give Up: There’s Always Hope.” They’re looking for people between 18 and about 24 who have overcome severe depression, self-harm or suicidal thinking, and their contact is AlwaysHope (at) EpicJunction (dot) com.
This week’s post is an interview with a social worker who wishes to use only her first name, Melissa. She’s one of several people in the mental health field who’ve reached out to this site to talk about their experiences, including the fear among colleagues of acknowledging that this can happen to anyone.
“I would love to see the profession being more open to people with mental illnesses,” she says. “There should be support in place for the professionals who have these illnesses instead of this private, shaming knowledge that many of us suffer and have to hide it from our colleagues.”
Here, Melissa talks about the need for far stronger mental health legal groups, her professional observations of the psych ward and a serious fandom for “Buffy the Vampire Slayer.”
Tell us about yourself.
I grew up in a farming community in the Midwest, like a very tiny, tiny town, less than 50 people. It no longer exists, actually, since the Postal Service took away its zip code. I lived there until I was a junior in high school. And after that, I moved in with a friend because my parents moved away and I didn’t want to switch schools. I moved in with my friend, then moved to a slightly larger town closer to St. Louis. I went to undergrad in St. Louis, got a BA in English, then moved to New York and got my MFA in creative writing, then an MSW from Columbia. I just graduated. I’m also an incest survivor and survivor of multiple rapes and physical abuse as well. My previous professions are an adjunct lecturer, a trade book production manager for Scholastic and a film critic. All those things at the same time. I was very busy.
Then you went to Columbia? Why?
In my application essay, I said it was because of my experiences teaching. I didn’t want to say it was because I had the life I had. I didn’t want to go into social work school announcing I was the wounded bird. There are still a lot of misperceptions of people in the profession, that we’re not suited to do the work. I obviously don’t agree with that. I didn’t want to hear it from colleagues. I heard it anyway because I heard it from supervisors and occasionally from professors. I didn’t want to hear it directed at me.
You heard it in general?
Yes. There was an article in the Times, or The New Yorker, about a woman with schizophrenia who became a doctor or lawyer or whatever, became successful, and that sparked a discussion of people with mental illness in the helping professions. “This person is an outlier.” I was in the room, and this is the bullshit I’m hearing? Excuse me, I curse a lot. And I didn’t say anything. Maybe the reason so many people you’re working with are unable to do things like this is because you make them feel unable to do things like this. I said something to the other social work intern when we were alone, “This shit is offensive!” She said, “I know.” She knew I have multiple mental illnesses. She was aware.
You’ve mentioned that you’ve just graduated, but you’ve also just left the hospital. What happened?
Well, this time. It wasn’t the only time I’ve attempted suicide. I’m also an alcoholic. Most people with my history have some history of substance abuse. I was sober 11 years. Then, when I moved to New York, I was doing really well for about three years. I was in therapy, but not like super fantastic therapy. When I finally started talking about my father, I started drinking again. Since then, I’ve started relapsing, six months on, six months off.
About three months ago, or four, my dog died, And I was alone. I’m a very solitary person, and my best people live far away, and I don’t have a family. So I don’t have a net in New York. So I have dogs. And I love them. I get fucking attached, like crazy attached. I rescue chihuahuas, so many of them are in need of homes. And my dog, who I adopted when she was 10, she was perfect. She got really sick and I had to put her down at the end of April. Then, another friend I had been close to for 27 years cut off contact with me, didn’t want to deal with my history. I graduated, and I am in extreme poverty. If I don’t do something soon, homelessness kind of poverty. And I have DID, and things are out of control in my head most of the time. Also depression, complex PTSD. Just too much.
As far back as I can remember, I’ve had suicidal thoughts. Like, hello, when you’re held captive by sadists, dying seems like a pretty good idea. While I’m not held captive, I believe I very much still am. This is the first thing that comes to mind as a solution. Most of the time, I manage these thoughts very well. My family doesn’t know where I live. They don’t know my phone number. I know I’m safe. I try to distract myself. But on May 29, I was extremely intoxicated. And I was dissociating on and off, and I just did it. I knew I had this sort of amorphous plan. I don’t even remember doing it. I remember sitting on the couch and drinking, then being in bed. And then, the next thing I knew, I was waking up in the ICU. I couldn’t open my eyes. They were trying to give me a bath. I was fighting them because I didn’t understand what was going on. “I don’t want these people touching me.” They didn’t bother to explain, as far as I know. They pinned my arms and did it. I passed out, woke the next day, couldn’t open my eyes. They had taken out my breathing tube. I had to be on life support because I did die and they had to revive me. Sorry, this just happened recently, so I’m kind of like, whoo.
When I woke up, I was like, “I don’t understand why I’m here.” And it clicked. I’m healthy. I’m a sassy, fat, lesbian feminist. There’s nothing that would get me to the ICU. Then it clicked. I just kept telling them I wanted to go home, I wasn’t suicidal. They didn’t seem to care what I said. Then they sent me to a psych hospital. Which, I understand the decision, but it was definitely the wrong one.
Because I’ve been in the hospital four times now. Every time, I’ve left traumatized by the experience. And I say I’ve survived severe trauma. My father abused me ’til I was 28 years old. So when you tell me I’m going to be locked somewhere and not escape, all I think of is escaping. And also, because I have DID, I have to give time to my alters, and you can’t do that in there. It’s like this experience of constant surveillance. And the minute you go into the hospital for psychiatric reasons, anyone who ever trusted you stops doing so. That includes the treatment team in the hospital. And when you tell people you’ve been raped every day of your life and they still force you to have a male psychiatrist, that’s shit. I went about getting my own treatment.
I just did the same thing I did when trying to find treatment for my patients when I worked on an inpatient unit. I called people, explained the situation: “Do you think I’d be a good fit?” Then I started meeting with people. I finally found someone. I still don’t know how I feel about her. But I have a great deal of trouble trusting people in general. I’ve had some negative experiences with clinicians in the past.
How come you had to stay so long with your father?
I didn’t believe I could leave. He used to strangle me until I passed out, so I was keenly aware he was capable of killing me. I moved out when I was 24 and lived in an apartment, but I would go there to do laundry, and he would still do it. Then I moved to New York, and when I would fly back to visit, he would do it again. So I stopped visiting. And I moved and didn’t tell them my address or phone number. I also had a big discussion with my family about what had happened, and they protected him.
And the police?
My mother knew what was going on when I was a kid, and she would do everything in her power to make sure no one found out. I wasn’t going to tell, if I was going to go home and be killed. I remember I went to a doctor for panic attacks. I was in the seventh grade, maybe. And the doctor said, “There is no medical reason for this. She doesn’t have asthma, no pulmonary issues. Something is happening to her.” And we never went back to the doctor again.
Will you specialize in your social work, and how?
Since I was raised working class, my focus is just to have a job and do it well. But my interest is in working with populations that don’t have access to quality services. I have this sort of long-term dream in mind of opening a clinic for people who are low-income who have a history of childhood sexual abuse, who need treatment in adulthood. Long-term, down the road. But I was a clinical student with a focus on health, mental health and disabilities. Which, I think, is the most popular combination at Columbia. Many people have used social work as a shortcut to therapy. I chose social work because the perspective is so much different than psychology or mental health counseling. It’s so totally different.
One of the things you hear a lot in recruiting for social work programs is, they have a strengths-based perspective as opposed to deficits-based. But the thing that really attracted me is the idea of the person in their context, not just the person. It’s not that others are not willing to engage the context, they are, but they’re looking at the person. Social workers are encouraged to look at the entire context and intervene where necessary. If one is living in extreme poverty and has a mental illness, yes, you need mental health treatment, but you also need help with the poverty. You’re not going to make depression go away unless you deal with the poverty. Social work can deal with that in a way other disciplines aren’t equipped to do.
What about your own context?
I am open about it with trusted people. The fact is that this kind of information, you have to be careful because it can be used against you. It is very important to me that I have a successful career. I’m happy to lean on supports I do have. I have friends here in New York who know my diagnoses and all that. There’s no way to not be judged. And my illness is not my fucking fault, and I’m not going to sit there and be blamed for them.
Have you noticed any changes toward being more open in the field about lived experience?
I would love to see the field being more open, but not to clients, because typically it’s not helpful to clients. If it’s not helpful, you shouldn’t tell them, period. And you shouldn’t spend 45 minutes chatting with someone. But I would have loved to have been able to openly say something like that in class. I would also love to see the profession being more open to people with mental illnesses. There should be support in place for the professionals who have these illnesses instead of this private, shaming knowledge that many of us suffer and have to hide it from our colleagues.
You mentioned drinking. How do you manage it, or plan to manage it?
I’m going to AA with a friend who’s been sober for three years. I’m constantly critical of things because I feel that’s the only way to make sure of what you get from the system. I’m an atheist, but I keep my mouth shut. I just try to take what I can from it. And to be honest, since I didn’t intend to kill myself this time, I’m so terrified that I think that will keep me sober for three months. And I’ll build on it. But in terms of work, drinking has never affected it once in my life. I don’t get hangovers, because I drink so much. It’s not something I knew, but it’s something doctors told me in the hospital. The worst it would be is that I was tired the first couple hours of the morning.
Otherwise, how do you get through your days?
I try really hard to keep breathing. I distract myself as much as I can. I reach out when I need to, which is right now. And I sometimes let myself dissociate so I don’t have to deal with situations. That’s probably something I should be working on, but getting through the day is exactly something I need right now. When I need to reach out, I can call my friends. I talk to them more right now than I typically do. Also, I’m unemployed right now, so I have more time to be broody. My functioning improves so much when I have a job. When I’m working, I’m good to go for quite a while.
Do your friends know about your latest attempt, and how are they doing with it?
Surprisingly well. My two best friends who are in St. Louis are not handling it as well. But they’ve been in my heart for over a decade and are much closer to me. I would say all of my friends in New York know what happened. But there are three in particular I’m close to, and they’re the ones who’ve been supportive of me. They’re also very accepting that this is all I can think of right now. Honestly, this is about all I can handle at the moment.
You must be familiar with the idea of after care, after someone’s released …
I can tell you what’s supposed to happen and then what did happen. What’s supposed to happen is, you’re discharged and within three days have an appointment with a psychiatrist. Anywhere within a week. A psychiatrist and therapist, both of whom are an appropriate fit. What happened to me is, I was discharged to a substance abuse intensive outpatient program that refused to treat me.
They made it sound like because of my trauma history, which seems ridiculous to me. I had a feeling this was not gonna work, because I’ve never left the hospital with a good discharge plan.
Like you said, it takes finding your own treatment.
Yeah. The therapist I had before I went to the hospital abandoned me. Which happens quite a lot with someone who’s suicidal. And that’s actually the most damaging thing. Termination is actually a really important part of treatment. What usually happens is that you never talk to them again. She is literally the only person in my life I ever trusted. I love my friends, but there are times I don’t trust them.
She told the treatment team she would no longer treat me.
And that’s that?
I can’t force her to be my therapist. And I don’t trust her now anyway. After the hospital, we’ve been sporadically communicating, and she’s kind of been treating me like trash, like I have no value. I could never go back to someone like that. And the fucked-up thing is that she specializes in people with trauma and who are chronically suicidal.
It’s not like she didn’t know your past, right?
First of all, I met her a week after being hospitalized after my first suicide attempt, and she was comfortable with treating me then. She’s also the first person I told about my father. And to have a relationship end like that, after I disclosed information like that, is extremely painful and very damaging. That’s like the primary thing that absolutely needs to change.
Being dropped because of being suicidal?
Yes. When you say you’re a provider who’s not comfortable with it, that’s OK. You’re allowed to create a practice you’re comfortable with. But it’s not OK to cut off contact. What you should do in that case is to find a way to terminate with the client effectively. And not let the treatment team at the hospital be the ones who tell this information to the client.
Are there no regulations, ethics, etc., in the field to address this?
There’s very little oversight in this area in general. And there should be more. There are professional values and ethics to guide whatever discipline you’re in. You’d have to abide by the social work code of ethics if you’re a social worker, but those are meant to be interpreted. How would a patient know this? That’s the question. How would they know how to deal with this if they want to stand up for themselves? It’s not like the therapist says, “By the way, if you feel like I’m treating you unethically, here’s who to call.”
It sounds like you’re on a crusade or revving yourself up for one.
Also, I feel the focus should be on suicide prevention and not on the imprisonment of people who are suicidal. There was a girl in the hospital I was in. She was about 20 and had been abused her whole life. She came in after a suicide attempt. They kept her, like, two weeks and wouldn’t allow her to leave. She submitted a letter, and she got locked in the hospital with paper pants, a paper shirt, and has not seen the sun in seven months. It’s a gross violation of her human rights. In two months, she is going back to court to try and get out again. If they win, they have six more months. Also, the “treatment” you receive is 15 minutes a day with a psychiatrist. Also with groups, most of which are offensive. That’s not treatment. It’s unacceptable that you’re in the hospital and not seeing a therapist.
“Offensive.” What do you mean by that?
Like, I was in a group in the unit, a women’s group. I went because this was to be an opportunity to deal with my trauma in a hospital setting. Instead, the nurse went on a rant about people coming to the med window in the morning without having showered or brushed their hair. Me and another patient went off on her. “Look, this is an acute psychiatric facility. If you expect them to get off the floor in the morning to brush their hair, you can go fuck yourself.”
I was in another group, talking about like experiencing racism or sexism. I was being encouraged not to speak up. She was like, “It’s not effective.” I was like, “It’s about standing up for yourself. It’s about being clear about what you’re experiencing and not being told to be silent when people do oppressive shit to you.”
Were you worried about running into colleagues or former classmates as a “consumer”?
Yes, I am terrified of doing so. Seriously terrified. Actually, the hospital referred me somewhere that ended up not treating me, but while I was in their office for the intake, a friend of mine from school came out and told me she was doing fee-for-service work there. She was very kind, but when they told me that another friend of mine was also working there, I was so terrified. I’ve been referred to a lot of organizations that I would one day hope to work for, and I have to choose not to seek treatment there. I want my treatment to be very private, and it’s really limited my options in terms of treatment.
How to change this entire experience?
You know, since I got out of the hospital, I’ve tried to find a way to advocate for people who’ve had this experience, and I’m not having a lot of luck with it. For instance, not all units are like this, and weirdly, this one is one of the best in the state, which shocked me. The unit I worked on, I feel, was quite different. Every single person who runs a group had been taught how to run a group. And also every patient would meet with a psychiatrist once a day for far more than 15 minutes _ typically 30 minutes to an hour _ and meet with a social worker at least once a week, who was the primary discharge planner and also therapist. We also did weekly family meetings. We’d visit with them, help them how to figure out how to help loved ones. None of this shit happened on the unit I was on. Like, after they told me my therapist had dumped me, I got very angry, and my affect clearly showed it, and I spent the day pretty much crying on the bathroom floor. The next day when I met with them, they talked to me like I was a behaviorally challenged child. “We’re really proud of how you behaved yesterday.” I thinking, “I’m about to punch you, so that thought will fade.” Many male psychiatrists, as soon as they meet an intelligent woman, the first thing they do is to make her feel small. I don’t put up with that shit. I’m sorry, I’m a feminist, I believe I have value. I will not stand for someone who tries to make me feel that way. So I fight back. and they don’t like it.
You’re going to be working inside the system. Is there a way to change it from there?
I hope so. It’s tough, though. I don’t know, when I was much younger, I would go to protests, things like that, try to make change from the grassroots level. That shit is hard, you know? Making systemic changes, I don’t mean to be pessimistic, but it’s borderline impossible. The only way in the U.S. is through lawsuits.
But I don’t see many strong mental health legal organizations.
I know. That’s exactly what I discovered. I called NAMI, but everybody was like, “We don’t really do that.” No one is standing up for people with mental illness. No one. This is the first time in my life I thought I should take a different track. I have the advocacy fire right now.
They give you a list of rights when you enter a ward, but you can’t exercise any of them. And knowing that two people on the ward had been in for months after turning in a letter … It’s like this dangerous game you’re playing. There’s help you need, but if you tell the truth, you’ll be pulled out of your life and won’t get to live it.
Maybe it’s time for law school instead.
No, lawyers can’t get jobs either! Also, I don’t need any more degrees. I feel if I get one more, I would be officially unemployable. If I ever do go back to school, because I love being a student, it would be in cultural studies, something like that. I don’t want my learning in other areas to stop.
What else would you like to add? This been fast-paced.
I think fast. One thing that needs to be said: It’s OK to, once you get out of the hospital, to still wish you were dead. It’s absolutely OK to just be where you are. A lot of discussion about suicidality is, “I’m so glad I didn’t succeed.” But it’s also OK when people wish they had. To be honest, there have been many days I wish no one had come and taken me out of my apartment. And I imagine that for a very long time I will be having those thoughts. If you’ve been trained from birth that you do not deserve to live, you don’t just suddenly believe you do.
One thing I like about social work is, you’re taught to meet the client where they are. It’s like in DBT, where you have to accept the situation before you can charge it. With something like this, of course, you want your client to not be suicidal, but you have to understand that’s how they feel. You can’t make it go away if you’re not willing to deal with it.
And I guess the other thing, something that’s really bothered me, is that people do not honor the trauma of being hospitalized. The staff treats you like they’re giving you a gift, and all you can think is, “I have to get out of here right now.” When you say you want to get out, you feel imprisoned, they don’t care. I said to my doctor it was very dehumanizing. And he asked me, “Can you tell me how it’s dehumanizing?” I’m sorry, if you work on an inpatient unit and can’t think how it’s dehumanizing, you’re in the wrong fucking job. They made me take off my clothes, they counted my scars, wrote down my tattoos and piercings. I guess for maybe five people in the world that’s a comfortable experience. I said to her, “Look, I’ve been abused my entire life, and I’m not comfortable with people looking at my body.” She said, “OK, I’ll make this as short as I can.” I still felt like I was in there a week. How is that not dehumanizing? When I had to take off all my clothes? Everything you want for yourself is gone. I only eat ethically farmed meat, so in the hospital I ask for a vegetarian diet. It took them until two days before I was released to put me on a vegetarian diet. So I was eating pasta with no sauce, mashed potatoes, not eating real meals. It’s small things like that in which your humanity is just stripped away. And they add up. And I know there are people who have positive experiences in the hospital. I’m not one of them. And I believe there are others like me. And I’ve been in worse hospitals.
Do you think it really helps being more open about this experience?
Yes. Absolutely, talking about things is better than not talking, 100 percent. Not talking creates shame, and it’s paralyzing. However, it would be helpful if you talk about them in a way that’s more effective than not. One of the great things for stories like this is, you’re using your story to help others. That’s the way to do it. However, if you talk about your attempt with your loved one, that’s best to be facilitated by a professional. That’s not to say not to have it on your own. If there’s no access to services, talk anyway, man. Across the board, it’s always worse to be silent. Of course, this is coming from someone who was raped every day of her life. So I feel like I really learned the lesson of “Do not shut the fuck up.” Unless you’re saying something racist or sexist or homophobic, in which case, shut the fuck up.
Also, I feel like one of the things that’s always resonated with me is that for many of us, living is very hard, and why do we have to pretend it’s not? To be truthful, yes, life is difficult for everyone at times. But for someone who wants to die, it’s a little bit tougher. … I feel like on some level, people are frequently punished for this behavior. My best friend, he was so angry with me. He’s still a little angry with me. But he also loves me and is willing to work through his anger. And I feel like I’m lucky have this relationship with this wonderful man who knows about my history, to understand why it’s so challenging for me. He angry because I lied and said I’m fine and then tried to kill myself. So he’s right with his anger. But sometimes I think loved ones punish with that anger. And I feel that’s so damaging.
Do you want to hear about my first attempt? I think it made me brave enough to do the second attempt. Now I’m not scared of dying because I know nothing happens. You just don’t exist anymore. And the first attempt, I was just fully dissociated. One of my alters did it. Luckily, she’s changed greatly. She’s the one who asked for help this time. The first attempt was actually one month after the last time my father raped me. And I think she just, her job is to protect us, and she didn’t know how to do it. The only way to make sure no one hurt us was to kill us. That’s what she did. And to be honest, I don’t fucking blame her. It was endless, went on forever. And she wanted people to be safe. I think that’s kind of brave, actually. It’s weird. I feel the three years between the attempts had moments that were truly wonderful, and most of the time I feel nothing wonderful is coming. I felt really alone since coming out of the hospital. I’ve just felt it will never stop hurting. And a lot of the time, I think it’s unfair to ask me to live with that. I’m sorry, I’m being weepy.
Who else are you?
Such an excellent question, because coming out of the hospital you feel this is all you are, and people treat you like it. Primarily, I’m a nerd. Like, I seriously have watched the entire series of “Buffy” 10 times. When I was a film critic, my specialization was horror. I own 700 DVDs, and at least a third are horror movies. I lately have been writing a lot of poetry, though my specialization in grad school was memoir. And I’m a serious homebody. I don’t like to leave the apartment unless I’m going to the movies. I want to stay home, have a pet, hang out with my pet, bond, give it a cool name, and watch movies and TV shows and have good conversations with amazing friends. My friend, he’s very good at getting me to talk about something other than my problems. He’s also obsessed with horror movies. I call him, and our conversation for four hours is about horror movies. I think many people don’t have that, someone to distract them and make them happy. He’s an astonishingly wonderful person.
I guess I’m also a feminist and a loudmouth. I frequently call people out on their shit. I went to a dinner party once and was having conversation about something with a guy, and he says to me, “You’re really smart for a woman!” I said, “You’re really smart for a sexist!” He didn’t handle that very well. And one thing I’m really good at is knowing what my values are and always behaving in accordance with them. I think lot people abandon their values frequently, or don’t have them.
And your values? As if you can sum them up in one sentence?
I don’t think I can. Have you read Vonnegut?
No, embarrassingly. I pick it up and put it down.
You have to. He’s brilliant. I have a tattoo of one of his lines on my body: “Everything was beautiful and nothing hurt.” Which I think particularly effective. It’s about this man who was seriously traumatized during the bombing of Dresden in World War II and still died believing life is beautiful. I would like to try that. Also, “God bless you, Mr. Rosewater.” He goes crazy, starts traveling the country, meets twins after their baptism, gives a speech. At the end he says, “There’s only one rule that I know of, babies — ‘God damn it, you’ve got to be kind.'” I try to always be kind to people. When you step on me, I will speak up, but otherwise I try to be kind. I feel if kindness drove our behavior, the world would be a better place. Greed drives, ideology drives … I just choose kindness. It’s hard, though. It’s not easy, especially when you’re angry, and I’m angry most of the time. It’s a hard balance, anger and kindness. I’m telling you man, Vonnegut, he knew how to live in the world.