Therapies

...All too often it seems that we can sense that the therapy lacks only the necessary driving force that would set a change in motion. Some particular dependency, some particular drive-component, is too strong in comparison with the forces we can mobilize in opposition to it...

Sigmund Freud, An Outline of Psychoanalysis

At age 15, I first asked to see a psychiatrist. I would have liked to have seen a psychologist, but only psychiatrists were covered by the Ontario Health Insurance Plan (OHIP). I quit after a few sessions, not knowing how to discuss the state of distress I was living with. The doctor's questions did not help me to articulate the situation.

It seems fairly clear to me now that I was having trouble related to food and body image issues. I was always out of control with food and my weight was constantly fluctuating, and when I saw my mother, and realized she was disappointed in me it triggered an extreme diet which resulted in a crisis or realization that I needed help.

The best I had been able to do was to recognize that there was a problem and to ask for help. I had relied on the adults in my life being able to take it from there. After I quit therapy, the matter was dropped. I didn't experience a sudden remission. It was not a matter of me rebelling or being noncompliant with therapy - it was a matter of me not believing the therapy was going anywhere. I then spent a couple of weeks in bed, and then school started. As for getting a new psychiatrist or therapist, I was not able to believe in it, and at this point I think it was up to my parents to try harder or become more involved rather than just accept that I quit. When the matter was dropped, I don't think it should have come as a surprise that I would eventually start acting out.

The depression (staying in bed for two weeks) might nowadays seem obvious, but back then people weren't as aware of depression and even now I wouldn't be surprised if a lot of parents react in angry ways when a kid is exhibiting signs of depression. If during this time my father could physically drag me out of bed in my nightgown and force me to help feed the horses, he could have insisted that I go to therapy, even if that meant finding a new doctor.

It was not long before my first binge drinking episode occurred, which resulted in a shameful loss of control. With the second, my father had to take me to the hospital with suspected alcohol poisoning. At this point I received a prescription for antidepressants and some mandatory counselling sessions. I liked the counsellor, but she was not highly trained, and mostly the sessions were composed of social chatting. I only went for the mandatory amount of sessions. My day-to-day reality remained unaddressed. One of the big problems might have been that no one at that time was aware of eating disorders, and so troubled eating would be dismissed as a minor self-control or dieting issue, especially if I had a 'normal' or even 'healthy' appearance.

Some months later, the day after my 16th birthday, I overdosed on my antidepressants and was hospitalized for a couple of weeks. I then had mandatory counselling sessions with my father and a social worker for a short time. It was not long after that a series of major changes occurred, which included my mother's death, my pregnancy and subsequent abortion, a major move from country to city, etc.

At age 17 I managed to attend Grade 13 after taking a year at home due to all the family disruptions. I was able to stick it out, in part because I sought out a school guidance counsellor. I saw him regularly throughout the year, and do think that seeing him was helpful to me, but he also dismissed my problems with food and body image - probably because at that time there still was not much awareness about eating disorders, or they couldn't be identified unless a person was obviously underweight, or was vomiting - and at that time I had never self-induced vomiting.

I did not have contact with any form of mental health department again until I myself rang a distress centre at age 21, telling them that I had barely left the house in the last 4 years. The person there said that it was likely my patterns would be set for life if I did not get help soon. I had no idea how to get help. I focused my energy as well as I could, and managed to live on my own for a period of 6 months before I came back to my father.

Shortly after I turned 23, my father had the police take me to a psych ward (in Winnipeg). The psychiatrist there barely talked to me before making his diagnosis, and refused to discuss with me what his diagnosis was, or what and why he was prescribing the medication he was prescribing. The only way he would let me leave the hospital was if I went through with applying for welfare. He said I either had to accept treatment (which consisted only of medication) or leave the hospital, but that I would not be allowed to leave the hospital if I did not have a place to stay.

weight preoccupation therapy:
For a while, a condition of release was that I attend weight preoccupation therapy. This therapy was not highly structured, and the therapists were volunteers without a lot of training. I liked the people there, but I needed more intensive therapy. In the hospital, although the bulimia part of my diagnosis was out in the open, the approach had been that nurses had pressured me to eat, and had made comments like 'Do you want to look like her?' referring to a gravely ill girl with anorexia. Also, I received a visit from a dietician who explained proper nutrition to me, but the psychological aspects of an eating disorder were completely unaddressed.

Shortly after I turned 24, I was in another psych ward, this time in Toronto.

While staying at this hospital, I encountered various therapies.

family therapy:
Family therapy was the most significant. My family members came for a while once a week while I was in the hospital (for the first few sessions, I think), and then once a month after I was released from the hospital. I guess we were supposed to learn how to communicate more effectively, understand each other's differing roles and perspectives, how the family traumas had affected each of us, and we were supposed to avoid triangulated situations - talking about other members behind their backs. I am not sure any of that stuck, but it helped me to be accepted for disability, and then once I had that, things went back to the way they were before.

However, it does occur to me that my family's willingness to become involved may have had something to do with me eventually having my first long-term relationship. The genuine caring which existed in my family beneath the dysfunctional relational patterns might have been eventually represented by my ability to find a caring relationship.

art therapy:
We drew pictures to represent feelings or events in our lives, and then discussed what we had drawn with the group.

group therapy:
A generalized sharing where all members were expected to both share and give others feedback. The problem with this kind of therapy was that patients tended to think that only easy-to-identify issues like rape, incest, abuse, were suitable topics to share or the only ones that 'explained' distress adequately.

relaxation therapy:
We laid down on mats and practised breathing exercises, the tensing and release of muscles, becoming aware of when our bodies were showing signs of anxiety, imagining a personal place of calm, etc.

video therapy:
We were filmed having a therapy session, and then it was played back afterward so that we could get a sense of how we appeared amongst a group, how we sounded, what roles we tended to take on, partly with the aim that we could adjust the picture if we didn't like how we saw ourselves.

I found video therapy excruciating, and it would leave me feeling suicidal. The point was that I was aware of how I was coming across and couldn't do anything to change it. I eventually dealt with it by sitting as quietly as possible, not moving or using facial expressions that would emphasize how unappealing I was, and trying to talk as little as possible so that I would not have to hear my voice, or my inflections.

I also got an appointment to be part of an eating disorder study with a Toronto eating disorder centre, but I had trouble going back to that, in part because I felt like an insensitive jerk for talking about my concerns about my appearance in front of a person (sitting in on the session for learning purposes) who was significantly overweight.

When I left family therapy, it had been recommended that I take individual therapy, but there were problems related to that. There may have been monetary issues, but it was also that I was not personally stable enough to attend therapy. I think I tried to explain that. When it came to family therapy, my father drove me most of the time, and he contributed the bulk of the fee, although the rest of us did sometimes contribute. At that time, I felt extreme guilt regarding that, and thought it was up to me to provide the money. I think it was $50 for a one hour session (once per month). At that time, I was not getting very much money on welfare - it was less than $400, and most of that went to pay my father room and board, but I did still think that I should budget better so that I could have afforded to pay for the therapy.

I remember that in family therapy, I did explain that I was living in a constant state of panic, and one of the therapists asked 'what do you want from your family?' and I didn't know what to say. I only knew how to try to express my state of mind. I had no idea what anyone could do to help, because I had no idea what other families did or how they behaved. I was constantly feeling guilty, as if I had already caused too much inconvenience. I did also say that I constantly wished for death, and that I had a right to kill myself. My family did not say much of anything, but seemed to think that kind of talk was not acceptable. That it was not real, or should not be acknowledged, that it was nothing more than a person out of touch with reality blathering about nothing.

I have had no therapy since I left family therapy in 1991. A couple of times since then I saw the same psychiatrist, when I was reassessed for disabililty. And then in 2000 I saw him again for an assessment when I was trying to get back on disabililty. In living commonlaw for 3 years with my ex, I had lost the right to disability payments, and by law he was considered responsible for me. When our relationship broke up, I tried to get disability again, but because I had not been attending therapy, and because the system had changed and not very many people were being granted disability at that time, I was not likely to be approved. I was going to have to attend therapy a couple of times a week, which I did not see as realistic at that time, and even if I did do that, there was no guarantee I would get disability.

I did spend a lot of time in the apartment not going out over the years. But, I also did some things which the 'mentally ill' might not usually be capable of: I had for a time danced publicly (for a couple of months I went out to nightclubs), had been social for half a year, and then a few years later I had travelled to the other side of the world. I myself felt guilt about these discrepancies. Others I knew might have taken this view: if she can do that, then she can take responsibility for herself, and she is just feigning helplessness.

Since 1991, I have not been hospitalized, and have received no psychiatric (or psychological) treatment. An assessment carried out in 2000 when I attempted to reapply for disability described my prognosis as 'poor'. I did not have the necessary support to go through with the application at the time, and it was dropped. I have said this before: I was 'too disabled' to go through with the process of applying for disabililty.