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I have initially created the Better Than Cured Guide to Healing and Happiness to help patients in my psychiatric private practice who were suffering from anxiety and depression. My goal was not only to help them get well, but beyond that, to also help them find a viable path to a happier life. They were loosing any hope that they can ever be healthy and happy again. They were amazed when they did it. If hundreds of my patients could do it, so can you, my dear reader. I hope their stories of courage and success will empower you to reinvent yourself and rekindle the hope that your life too can be better and that your pain can be healed. Set your life course on a "better than cured" path that leads to your own profound and personal journey to healing and happiness. For more information about my medical career and my private practice, please visit my web site at drforest.com.

Wednesday, December 22, 2010

“My Own Strength and I”



Happy Holidays everyone! Thank you for staying with me through the year. Thank you for your support and generous comments. I hope you will find the next story inspiring, comforting and uplifting.


Happy Holidays and a very happy New Year!







Alice came in as a new patient a few months ago. From the start, she told me she suffers from “schizoaffective” disorder, or so she was told by the psychiatrists she had seen to no avail so far. She came from out of town to participate in an outpatient program at a reputable mental health research clinic in Los Angeles. She put her college education on hold to do this, but the waiting list even to get an initial evaluation interview was a few months long. She was desperate and did not know what more to do to get help. She was taking two mood stabilizers, two antidepressants, one powerful sedative and an antipsychotic --a lot of medication. Still, she was not feeling any better. She was still hearing “voices” telling her to do “terrible things” to herself and could not sleep more than two hours a night. She was feeling “heavy,” depressed, hopeless and constantly exhausted from lack of sleep. She found me through a referral, and she wanted to have a psychiatrist in town to manage her medications until she got into the clinic.
At the first glance, she seemed a pretty straight forward case. The first thing we did was to go over her medication, addressing the reason for her coming to see me. At a closer look though, her medication regimen was a pharmacologic mess. It seems that the few psychiatrists she has consulted were at a complete loss of how to help her, and all they could think of was to pile up more and more medications on her. The two mood stabilizers were redundant so I recommended stopping one of them--the one added most recently and from which she felt no improvement. I recommended replacing the two antidepressants with one that was more effective and had a broader spectrum than either of the two combined. I suggested replacing the antipsychotic with a different one, which I hoped to be more effective and more sedating to help her get more than two hours of sleep at night.
These were a lot of changes for the first session. But Alice was brave and desperate to feel better and decided to go for it. One week later, she felt somewhat better. She reported her mind being more “clear” and she was getting three to four hours of sleep at night. But she still felt depressed and very tired through the day. The “voices” were still there.

I referred her to another outpatient clinic for evaluation so that she would have a backup if she did not make it for some reason into the first.
Sooner than she expected, she had both initial evaluation interviews. She came to see me after the interviews; she was more desperate than ever. On one of the interviews the psychiatrist took issue with her sleeping pills and recommended she go into a dual diagnosis program, one that addresses addiction and mental illness at the same time. Alice felt, for a good reason, that the psychiatrist completely missed the point, as she was not taking sleeping pills because she was addicted to them but because she was unable to get restful sleep without them.
On the other interview, at the prestigious research clinic, she was told, after half-a-day evaluation, that she did not fit the selection criteria for any of the research studies that were soon to be initiated at the clinic, and they suggested to continue treatment with her private psychiatrist. That was me. Suddenly, I became her only hope, disappointed as she was by her experiences at the two clinics.
Fully aware of my increased role in her treatment, I sat down with her and started discussing in greater depth her symptoms, trying to get a more comprehensive view of what was going on with her. As I became her only hope, she allowed herself to be more open with me. Her previously monosyllabic answers became now more elaborate. She did not know me all that well, but she decided to trust me by default as the other treatment options had not worked out.
We spent a lot of time talking. I asked her all sorts of questions about herself. She answered patiently to the best of her knowledge. She was not hearing “voices” but only one “voice,” that of her brother who abused her sexually when she was very young, and who repeatedly told her to harm herself by jumping in front of traffic or putting her hand into the garbage disposal.
Her brother left home years ago, and she and her family are not in touch with him. But her parents never knew about the abuse. She was in psychotherapy for years trying to address this trauma.
Previous psychiatrists automatically thought she was psychotic because she was hearing “voices.” They did not consider the possibility in her case of the “voices” as a symptom of posttraumatic stress disorder (PTSD). That was likely the explanation of her diagnosis as schizoaffective disorder, which missed entirely her PTSD. That was also likely the reason for the heavy antipsychotic medications she was given, which made her mind cloudy and undermined her ability to work through the trauma. Talking about the abuse was a great vote of confidence in me as she was extremely embarrassed and fearful of my reactions. But her courage and determination to get well held, and we did talk about the past in detail.
“When you hear this voice in your head,” I asked, trying to get as much information as possible, “is it in the morning or at night, or is it related to something you do through the day?”
“I always hear it when I am alone, especially at night, when no one else is in my room.”
“This voice has been telling you to harm yourself for years yet you have never done it, right?”
“I was very close a few times.”
“What did you do then?”
“I called 911. They came and took me to the hospital.”
“So you have never actually attempted to harm yourself. You asked for help every time you got close to do what this voice in your head was telling you to do, right?”
“Right,” she answered, unsure of where I was going with these questions.
“Why?” I asked.
“Why what?” she asked.
“For people who have been abused and traumatized it is not unusual to hear the voice of their aggressor ringing in their head years after it happened. If this voice has been telling you to harm yourself, why do you think you have never actually done it?”
“I don’t know,” she answered, trying to make sense in her own mind about it. “I know, with some part of my mind, that this voice is not to be trusted. He was harming me for years. How could I give in to what he told me to do? I don’t want to obey this voice. I often fight with it. I tell it to go away. Sometimes it does. But it always comes back when I am tired or alone. I try to keep busy, be around other people and try not to go to sleep because that is when I hear it the loudest in my head. Both times when I was very close to taking a knife and chopping my hand off, I was all alone in the house.”
“And instead of picking up a knife, you went to the phone and asked for help, right?” I asked to make sure I understood clearly.
“Yes,” she said a little irritated at my over emphasizing a point that, to her, seemed irrelevant.
“I think the healthy part of your mind is what has always protected you from harming yourself. No matter how loud and obsessive your former aggressor’s voice got, the healthier part of your mind has been stronger and prevailed in protecting you from harm. It seems to me that it is your own strength that is fighting, even now, years after the trauma, to keep you safe. It’s just that, busy as you are dealing with this “voice” inside your head, you have ignored your own strength. You have not paid enough attention to the healthy part of your mind that was working all this time to keep you safe.”
“What are you saying?” she asked in dismay.
“This “voice” becomes stronger when you think you are alone, unprotected and vulnerable. But you see, if your own strength has protected you all these years, you are, in fact, never alone. You are never without your own protection. The voice of your perpetrator still rings in your mind. But also in your mind there is this powerful thought that you should not give in, that you should deny your abuser full access to your mind and your actions, that you should keep yourself unharmed and safe. You have always carried this strength within you. Which means that you are, in fact, never alone and unprotected. That is why you never actually harmed yourself physically.”
“You mean that my own strength and I are always together and that is why I am not alone?” repeated Alice with increasing amazement.
“Exactly. Your own mind is much stronger than you thought. You have just been unaware of it all this time. You had hoped that others, even through their mere presence, would protect you from this toxic voice, remnant of the old abuse, when, in fact, the true strength and defense you need is built into your own mind.”
“What should I do then? How can I use this strength?”
“Practice staying in touch with your own strength. Practice silencing the harmful voice by strengthening the healthy aspects of who you are. It doesn’t matter that you did not get in any of the programs you were hoping to get into. You can create your own program, based on your own strengths and qualities. You mentioned that you like writing. Join a writing group, for example. Stop idling. Be as productive as you can be. Cultivate your own strength and talent. And, when you are ready, make sure you go back and finish college. Do that sooner, rather than later. You came to Los Angeles to start on outpatient program—why not set up your own outpatient program?! You can pick and choose activities that are best suited for your needs rather than trying to adjust to a group treatment program that is not right for you.”
“And I can do all this with the help of my own strength?” she wondered, thinking hard. “But I still can’t sleep,” she said as an afterthought.
“Yes, I can help you. Let’s go over your medications again. Maybe we can find some alternatives to the current sleeping pills. And after that, let’s look at some of the things you would really like to do. We’ll start from there.”
During the next few weeks we made a few more fine tuning adjustments to her medications until she was able to sleep closer to six hours almost every night, which gave her a lot more energy through the day. I suggested to her a writing group I came across at a writers’ conference I attended not long ago, and she took the initiative to research it. She liked it and signed up. She now finds journal writing helpful to manage her storm of emotions. A few weeks after that she interviewed for a part time job as an assistant librarian, an ideal job for her as she loves books. She started planning to go back to college a few months after that.
As she was getting better, we were able to reduce her medication regimen to only two standing medications and one to use just as needed for anxiety. She did not have any difficulties stopping the potentially addictive medications she used to take because she was not an addict. She never was. There are clinical reasons to believe that she will even be able to stop all the medications.
“What happened to the “voice” in your head, Alice?” I asked after a few weeks of her not mentioning it.
“Oh, I am way too busy now to pay any attention to it. It comes back sometimes, but I am able to push it away,” she answered, without any trace of fear or pain.
The day she came to tell me she was returning, in a few weeks to her home town to finish her last semester of college, she was almost unrecognizable. She had a new, chic, hairstyle; she had new, fashionable clothes; but more importantly, she had a radiant face. She was feeling hopeful and strong. She was well. More than well. She told me she was happy.
Each and every one of us has the strength Alice discovered in herself. We need to know how to discover it within ourselves, pay attention to it, recognize and follow it. That is how we make our happiness come true.
Happy Holidays!

4 comments:

  1. Oh Christine! Three cheers for Alice and how lucky she was to find you. It sounds like she is well on her way to a happy and productive life. Her strength is a true inspiration! Thank you for sharing her story.
    Wishing you and yours a very Merry Christmas. xo jj

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  2. Hope you had a great Christmas and New Years. Lets hope that 2011 will be the best year ever and the "Pegasus" or the "white unicorn" from your pictures brings sun in all your actions helping you to follow your dreams.

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  3. Oh that wonderfully flowered path sure beats the yellow brick road all to thunder.

    How fortunate your patients are to have you. What a inspiration you are.

    You were on my heart today and I just wanted to drop in and wish ya a beautifully blessed week sweetie!!! :o)

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