I have just been on two course-days about dissociation, and was happy when I discovered a news-letter from ESTD (I am a member now). There I found the following post about how hard it is to become a patient dealing with abuse. I have so much respect for people who want to live a better life after abuse, since this is no easy task. I hope this can be a reminder of just that
By Esther Veerman
THE CHOICE TO BE A PATIENT
Being a therapist for patients with chronic childhood abuse and neglect needs a conscious choice. Not a lot of colleagues will do the same, and sometimes it is quite a lonely voyage that one starts to make. Becoming a patient with a history of chronic childhood abuse and neglect demands a conscious choice as well. It is not logical to start exploring the traumatic past, once a survivor has learned to avoid the memories of the same. And in the field of psychiatry, it is not easy to find the help a survivor so desperately needs. Often it takes many attempts to find good help over the years. And of course, courage to keep looking after a lot of disappointments. For me, it meant that I had to decide to take on the role of a patient, despite my aversion to this role. Of course, I rather wanted to be a helper instead of the one needing help. Maybe I can explain some of my struggle in this, in order to help the helpers understand some of the dilemmas going on in (future) patients.
Being a patient of severe childhood trauma is a choice I had to make 20 years ago. I was young, still busy studying theology, and wanted a normal, happy life. Weird things happened to me every once and awhile. During a lecture on psychology, when a movie was shown, I started to feel really sick. I had immense chest pain and feared I would die. Nothing was the matter with me, and I did not remember what the movie was about. And sometimes a horrid thought would come into my mind that, when I would have children, I could hurt them. Once I realized this thought and fear, I decided to seek for help. I would never want to have a child if I could harm it.
It took a lot of courage for me to look for psychological help. I did not know what was the matter with me. Sometimes I stumbled upon little words: there is something with my father. But I did not understand the content of these whispers. One of my mentors listened to these words and asked me the reason why I spoke them. I was too scared to remember, and so he sent me for the first time to a psychologist. Within two or three sessions, in which I was not able to tell about the images and fears in my head, the psychologist decided to bring my father into therapy and ask for reconciliation. For me, this was a message to (again) keep my mouth shut. For some time, I succeeded in doing this. My system collapsed when I gave birth to my son. During and after the delivery of the baby I re- experienced rape intensely. I fell into a dissociative psychosis in which I experienced incinerated hands and bodies, who raped me constantly. I tried to stay at home, take care of my son, even breastfeed him, until it seemed I had no choice but to listen to the doctor and get hospitalized into psychiatry. It was a complete nightmare to be hospitalized. I was extremely anxious, did not understand my own behaviour at all, but the psychiatrist said I have a hysterical personality. I went home and got hospitalized for a second time. The next psychiatrist thought I had PTSD, but could not believe that the symptoms I portrayed belonged to trauma. I could collapse for example, in a split second. It happened at the table when all the patients had dinner, or worse, in the shower. One time I collapsed in the hallway of the psychiatric ward, and later I heard, that the psychiatrist stepped over me, and said: she is just overreacting.
Years later, when I was hospitalized in a psychiatric hospital, I was shocked and felt humiliated by the bad conditions we had to live in as patients. I learned to check out the refrigerator before eating, to look at the dates of the meat and cheese that was in there for the patients. A lot of the food was out of date date. And when a lamp, or tiles in the bathroom were broken, they were not fixed. We had to live with ten patients on a very small ward, and the staff would sit in an office with the door closed. If something bad happened, like aggression between patients, most of it was not seen by the nurses. Sometimes patients hated each other, mostly because they were scared or aggressive in themselves. For example: a patient hated me because I had screamed out of fear, and she thought I had reacted to her. So when I went to the bathroom, she would come in and vomit, so that I could not wash my hands in the sink. Another patient who was known to be highly aggressive, would throw chairs at me as I wanted to pass by. Nothing was done about this. Two times, I was locked away by “accident”. On one occasion I had permission to draw and sat in a room all by myself. I got re-experiences and hided in a corner of the room. A nurse came in the room, thought it was empty and locked the room. They did not miss me for hours. Another time, I had an appointment to talk with a nurse, she went away to answer the telephone and I again, hided in a corner, because I was so scared. After a long time, another nurse came by and locked the room. She did not come back for talking to me, she did not remember I wanted to speak with her. Another time, when I was hospitalized with serious suicidal feelings, I got away, and went back to the ward, very suicidal, and laid down under my bed, and for one day and one evening, nobody had missed me, or looked for me. I had not eaten and drunk and nobody had thought about speaking to me.
Every time I came home, after hospitalization, I was worse than before. As I described before, for me it felt humiliating to be hospitalized. It was almost impossible to keep my dignity in those periods of time. Sometimes I did not even feel human anymore. We had to ask for everything, the medicine (we had to stay in a line to receive them), the food, going out and getting back to the ward. It felt really degrading when all the power was taken off from me. One can say, maybe I was not able to take care of myself anymore. But many times, I felt that what I wanted to say was not heard at all. Of course, in those periods of time I could not express myself so well. That is true. But when people are not willing to listen, talking becomes extremely difficult. Maybe it is dangerous to say, but I think psychiatry felt for me like the environment I lived in as a child. Neglect, silence and disrespect.
But I never stopped fighting, all those desperate years. I realized that I would not survive much longer (I was highly suicidal over the years) and I tried one more attempt at getting the right help. I looked on the internet and found information about trauma therapy and dissociation. I emailed for second opinion and received this. It turned out I suffered from DID. The trauma therapist I spoke to, asked me to register myself for trauma therapy. For 6 years now I’ve been in trauma-therapy. I feel I am taken seriously now, in my desperate search for healing and the question I have asked for all of those years: help me through the nightmares and re-experiences.
Reading this, one can think that I had no choice but to be a patient. On the one hand, this is true. My life was falling apart and I would not have lived, if I had not been hospitalized and taken care of. On the other hand I had to decide to want to learn how I could get away from what haunted me. I have always wanted this. Already during the first hospitalizations I begged to be heard and for guidance to get out of trauma land. This was not honoured at all. Therapists and psychiatrists thought what was right for me. Many times they said that I had to stabilize, but it meant literally loads of sedative medication, and nobody asked me what had happened to me in my childhood. I was allowed to write my own treatment plan, but it was never honoured what I asked for in those plans. I felt more and more humiliated and thought I was really stupid.
After all these long and devastating years with more traumatizing events, the trauma therapy I am receiving (now for 6 years) now makes sense to me. For the first time a therapist explained to me what was going on in my head, with the distinction between Apparently Normal Parts of the Personality and Emotional Parts of the Personality, and their functions, inner dynamics and systems. I learned to distinguish parts within my head and body, who carried daily life (being a Mom, a Partner, one part who was always busy with music, one 8 year old, that had never grown but handled things in daily life; and scared little children in side of me, some freezing, others running away, some parts who seemed to copy the perpetrators etc. and some occupied with sexuality). Together we started to explore what was living inside of me. I did not dare speak anymore, because so many times I heard that what I told was not valid, or that a therapist would not believe me and from my childhood on, to shut up. So, I hardly could find words to describe all that was inside of me for all those years.
This asked a lot of patience from the therapist. Patience and boredom perhaps. This required from me a high standard of courage. To try once more, once more, to speak the words that frightened me the most. In one of the first sessions the therapist asked me: “Esther, do you want to change?” I said: “Oh yes, I do want to change, I just do not know how.” For me, this question of the therapist was very important. I realized, when I wanted to overcome all those years of trauma, I would have to be able to change, and not stick to my Disorder. Of course, I was intensely scared to do so, but I chose not to stay the same anxious twisted person I was. At that time, I had absolutely no clue of my future. I so much lived in trauma time, that everyday life was a challenge in itself, let alone that I had an understanding of the future. From the first session on with this therapist, I mirrored the perpetrators in his face. I told my therapist over and over again he was authoritative, and I was extremely scared of him. After a period of time, he asked me, if I thought he was my father? When I realized he was right about this,I calmed down a bit. In the years that followed I realized more and more, how much I projected on my therapist. I tried to accept inside of me, that the inner parts of me where doing this. I came to an understanding that the reliving of the trauma was necessary to overcome the same. This way I sat in therapy with my hands over my face for five years. Many exercises with looking around, and trying to look in the eyes of the therapist were necessary to overcome this huge stumble block.
When the sexual abuse was addressed, even more projection came into therapy. One of my biggest fears was that the reliving of the trauma would actually take place between the therapist and me. But instead of being silent about this, I chose to speak out, that I thought sex would take place between us, and I let my inner children react as if in the situation of rape, in the way they must have reacted in the situation they were in as children. I was convinced one day it would go wrong between the therapist and me, and I heard my inner voices come out and even ASK for sex. I knew, that my therapist had all the power to be able to abuse me (again), but he always took care of me and protected me, by staying consistent and calm. I had to get used to the feeling, that, although my therapist had more power, he would never use his power in a negative way, but only to help me forward.
Becoming a patient was a difficult and courageous choice. I had to understand and realize that the problems I tried to avoid could not be solved on my own. I believe that I would have been helped from the very beginning to be grounded in my autonomy if I had met the right mental health professionals. In psychiatry I met so many people who seemed persons without the possibility to think for themselves, but I think this is not really true. A lot of problems that they create stem from their taking over the ability to think and decide what is best for a person called the patient. Like being a patient is a choice (one can chose to die, or to do something about it) and healing is the next choice to be made by a patient. But I believe here a therapist can be of tremendous help. A therapist can start to explore the possibilities and strengths of the patient and work together exploring the landscape of healing. Being a patient in itself can bring the key to healing. For the therapist the challenge is to find and guide the patient on this road.
Esther Veerman is founder of the Foundation Art out of Violence (www.artoutofviolence.com) She lives in the Netherlands, is a theologian and an artist.