Maybe this means he can help me.
I need an expert on the human mind to help me figure out why mine cannot cooperate, why consciousness has become so unbearable for me.
I am sitting on the couch in his office. He sits in his desk chair, awaiting my gaze to meet his. When I do, he delivers his first question:
“Have you been considering suicide?”
I am at the brink of desperation, and I figure I must be totally honest for him to help me.
“Yes,” I say.
“Do you know what suicide is?” he asks. He does not wait for my response. Instead, he lifts two middle fingers and pushes them toward my face. “Suicide is this to your family.”
In that moment, I had not yet learned the genetic and chemical causes of my depressive episode. Fires ignited on my cheeks, and I felt the intensity of the shame and self-blame that is reserved for people whose chemical deficits are in their brains, as opposed to their pancreas or any other organ in the body.
While interacting with this “educated” clinical neuropsychologist, I felt sub-human, as if I had committed an egregious sin that warranted punishment rather than medical attention.
Of course, I was well aware of the cultural stigma against people with mental illness, especially psychiatric in-patients, as I was at the time, but condemnation from a supposed expert in the mental health field dealt a special blow to my hopes of recovery.
Had he taken the time to ask me about my thoughts and feelings, I would have told him that I absolutely did not want to hurt my family or myself. I wanted all the hurt to go away. My brain was telling me that I was a burden on my family, that I was hurting them with my inability to be “normal,” “productive,” and “successful,” that perhaps suicide was the most loving thing I could do for everybody involved.
Throughout my depressive episode, during which I was in and out of hospitals for over a year, I witnessed a staggering range of attitudes that mental health professionals held about me as a person with mental illness. Some were compassionate and informed, but I also experienced discrimination from professionals who were paid to supposedly help me. It wasn’t until one progressive psychiatrist informed me of my genetic testing results that I fully understood how little I deserved to be blamed for my illness and the horrible, slicing thoughts that inhabited my mind during that period of my life.
In fall of 2013, my depression got so bad that I withdrew from graduate school, and I returned home to live with my parents. The pain was so unbearable that I tried to distract my mind by cutting and burning myself. Those methods had little effect, so I attempted to electrocute myself with a hair dryer in a bathtub. Desperate for help, my mother took me to see the psychiatrist who had been prescribing my antidepressants for the past few years.
I trusted him. He had helped me through a previous depressive episode, and his degrees in psychiatry and psychotherapy were from the best schools in the country.
After we entered his office, my mother told him about my behavior and that I had admitted to my suicidal thoughts persisting.
As his feet pushed against his ergonomic footstool, he replied, “I don’t deal with people who do that.”
My mother was stunned.
“Can you recommend a hospital where I can take her?” she asked.
He said he didn’t know of one and that he had another patient waiting outside, so could we please make out the check to him and see ourselves out through the back door?
From that exchange, I internalized that having suicidal thoughts meant I was beyond help, that someone with authority and education had deemed me a social pariah unworthy of medical intervention.
My parents asked around for recommendations for other psychiatrists in our city. They heard of one affiliated with a local hospital, board certified in psychiatry and neurology.
As my mother and I approached her office, I still held out hope that I would find someone who could make sense of what I was experiencing, who would not only understand but know a solution.
During the interview with this doctor, I opened up to her about the thoughts going through my head. I told her how ashamed I felt that I had fallen off of a respectable, sustainable career path and how terrified I was that I would never be a productive member of society. As I continued, she suddenly interrupted me, turned to my mother, and said, “Are your other children like this?”
Her tone dripped with condescension, with accusation.
With no solution in sight, I spiraled. My parents checked me into another hospital. The board-certified psychiatrist/neurologist was assigned as my doctor.
I was confined to a room with only a twin bed, a toilet, and a shower without a curtain. The staff gave me a notebook and pencil, so what I did all day was write down all of the thoughts whirring in my brain, still hoping that if I poured out honesty to this doctor, she would use that information to help me.
But instead of appreciating my attempts to help myself, she refused to even read what I had written down.
I handed her the notebook, and she simply said, “I don’t have time for this.”
Again, the message I got was: I am so miserably hopeless that I am not even worth a doctor’s time and attention.
Fortunately, as my journey progressed, I came in contact with professionals who treated me like a human being with a legitimate medical problem. Those who helped me most all shared the same basic paradigm: that chemicals, not character, were to blame.
I remember the first time a therapist told me my suicidal thoughts indicated that I simply needed to try a new medication, that the right one was out there, we just hadn’t found it yet. Relief overwhelmed me, infusing me with faith that a rational solution existed.
However, it wasn’t until a few months later, after I was transferred to another mental health organization — this time, a therapy farm — that the most effective solution for me was found.
The therapy farm was an idyllic place to heal, quite the drastic departure from the cinder block walls of hospitals. Open pastures dotted with farm animals were nestled in the mountains. Most of the food fed to us was grown there. Each “resident” (as opposed to “patient”) was assigned a meaningful job to contribute to the community. I got my hands dirty in the garden for a few weeks and then I transferred to the kitchen, where I helped prepare lunch and dinner for the staff and other residents. Chopping colorful vegetables was therapeutic, as it helped me focus on a tangible task rather than the enduring abstract pain in my head.
Most importantly, however, every staff member at the farm treated me and the other residents like respected members of an inclusive community. Their compassionate attitude was not only humanistic but also informed by science. They all knew about the genetic factors that contribute to mental illness of all kinds. They knew that counseling was important but that it needed to be combined with proper medication management. There was no blame, just understanding, and therefore, no shame.
The psychiatrist at the farm was unlike any I had previously encountered. His practice contained the optimal combination of genuine caring and objective scientific data. In my sessions with him, he truly listened to me and explained to me how he would gather information about my genetics and the chemicals in my brain in order to help me. To him, my suicidal thoughts were a treatable symptom, not a scarlet letter.
He gathered data about my illness by performing a blood test that allowed him to measure the levels of “happy chemicals” in my brain. He also sent off a sample of my cells to Genomind, a genetic testing company, which performed an analysis on my DNA to see if I had genetic factors contributing to my depression.
The blood test revealed that my “happy chemicals” were drastically low. At that time, my brain was producing only about 20% of the amount of serotonin required for a healthy brain. Additionally, the genetic testing report showed that I have genetic mechanisms that were contributing to my depression. First, my brain lacks adequate serotonin transporters, which recycle serotonin so that it can be re-released in the brain. And second, there is an inverse relationship between cortisol and serotonin production in the brain. Essentially, when I get stressed, my already drastically low amount of serotonin plummets, causing me to become even more depressed.
Based on my genetic profile, my doctor informed me that it was inevitable that I would have a mental health crisis at some point in my life. Starting graduate school while having just stopped taking the antidepressants I’d been on for years, set up a perfect storm in my brain: climbing cortisol levels and plunging serotonin.
My doctor used the information from the genetic testing results to prescribe me an antidepressant that I hadn’t yet tried, which would fill up those serotonin transporters more effectively than the countless others I had tried. Within a few weeks, I noticed that interacting with others took less effort, and I could focus my brain on things besides the pain I was feeling. I started taking online courses for a new career path, and I could actually concentrate on the material. The next time my doctor performed a blood test to check my serotonin production, he saw that my brain was making four times the amount of serotonin it had been making when tested initially.
My doctor at the farm saved my life, and I am profoundly grateful to him for practicing psychiatry so compassionately and progressively. I got lucky by being put in his care. I also got lucky by having a family who had the emotional and financial resources to keep trying until we found something that worked for me. Far too many people who suffer from mental illness get caught in a system that doesn’t treat them effectively using up-to-date scientific methods such as blood tests and genetic testing. These technologies allow psychiatrists to make more informed treatment decisions and help their patients feel better, faster. Suicidal thoughts are not reprehensible and outrageous but have a rational basis in the brain, which means that people having them can be treated rationally, humanely, and effectively.