When I Finally Fell

Nine years ago, on the first day of December, shocked, dazed, and bewildered, I found myself sitting in the "quiet room" off the waiting room of the ER of Northwestern Memorial Hospital in Chicago. My belongings had been taken away from me and there was a security guard at the door. At one point someone inquired about his whereabouts over the radio and he responded, "I'm sitting on a 64." That was me. A 64. I didn't need a code book to tell me what it meant. A 64 was a psychiatric patient.

It could be said that landing in a psychiatric hospital was my destiny from the moment I was born with a brain that couldn't properly produce and process neurotransmitters the way healthy brains can. It was inevitable that at some point my depression would plunge to depths beyond what I could cope with. Moving to Chicago that August had set in motion the events that would land me in the quiet room.

I graduated from college in May of 2003, spent the summer working at a mortgage company, and then, in August, moved to Chicago to pursue a MFA in Writing at the School of the Art Institute of Chicago. The only time I'd been to Chicago prior to the move was when I visited in late July to look for an apartment and the only person I knew was one of my best friends from high school.

One of the school buildings on
Michigan Ave.

I loved Chicago from the outset. I loved the old buildings, the big-city energy, and riding on the el. I loved that much of the School of the Art Institute of Chicago was housed in skyscrapers; how cool is that? One of those buildings was on Michigan Avenue, across the street from the Art Institute of Chicago (the museum) and there was a cafeteria on the 12th floor with a phenomenal view of the lake and Grant Park. I hadn't expected the waters of Lake Michigan to be so turquoise! It was one of many things about the city that delighted me.

I lived with my friend when I first arrived, having been unable to find a satisfactory apartment during my brief visit the month before. She lived in Roger's Park, at the far north end of the Red Line, when I first moved there, but shortly afterward she relocated to Hyde Park, as she was starting graduate study at the University of Chicago. The trip from Hyde Park to downtown had to be accomplished by bus, a less congenial form of transportation in my view than the el, which spurred my efforts to find my own place. I ended up with a great studio apartment in Logan Square.

My first apartment was on the second floor at the bottom of the "U" of this courtyard building.

It was spacious, as far as $500/month studio apartments go, with a separate kitchen, a walk-in closet, lots of windows, and had recently been refurbished with new kitchen counters and cabinets, a new fridge, a fresh coat of paint, and the floors had been refinished. Shortly after I moved in, the landlords replaced all the windows, too. It was my first place of my very own, and I loved it accordingly, taking great pleasure in cleaning it from top to bottom every week. I liked that the buildings across the alley from my kitchen window had back yards, so I had a view of nature rather than the wall of another building. (I also, at night, had a view of rats swarming the dumpster behind a restaurant, but that, too, had its own charm, since it was part of living in a big city.) I liked that my apartment was just off the far end of the Logan Square Blue Line el stop. I also loved the address of the apartment itself: 2649 ½ N Spaulding. It was the "½" that delighted me: I hadn't known that fractions were permitted in an address!

My little kitchen!
(I took only nine photographs during my time in Chicago--this is one of them.)

I had also, much to my surprise, fallen in love. My high school friend had introduced me to a coworker of hers as a potential roommate and friend. The roommate option ended up not working out, but it had been practically love at first sight for both of us. He lived in Logan Square, too, and I loved walking from my place to his and marveling at the old apartment buildings on Kedzie.

In those first months, Chicago was, for me, the buildings I'd read about during my history of American architecture studies: Burnham and Root's Mondanock Building, walking past Louis Sullivan's Carson Pirie Scott Building every day on my way to school, the iconic Sears Tower, and the view north along Michigan Avenue of the Wrigley Building, the "corn cob" buildings, the Tribune Tower, and the John Hancock Building; it was the taste of Indian food on Devon Ave, vegetarian food at the Chicago Diner in Boystown, nachos at the Heartland Cafe just down the block from my friend's Roger's Park apartment, chocolate chip pancakes at the Bongo Room in Wicker Park, the Puerto Rican dishes cooked up and offered for free one night a week for a time by the motherly bartender of the Whirlaway in Logan Square, and last but not least, Pasta "YiaYia" (a divine concoction of feta, cinnamon, brown butter, and garlic) at Logan Square's Lula Cafe; the Picasso statue downtown, the view of Graceland Cemetery from the Red Line, the bizarre (in my opinion) wood fire escapes on the back of every brick and stone apartment building, the black dust in my apartment (no doubt from the coal-fired power plants still burning in Chicago at that time), the unfortunate sewer aroma that emanated from every storm drain, the constant cacophony of horn-honking Chicago drivers, swarms of pigeons with missing toes (frozen off during the frigid winters?) perched on the underside of the elevated line that rose over Wabash Ave outside the building that housed most of my classes, and the pleasure of stumbling upon the vibrant sounds of the Hypnotic Brass Ensemble, as this was during their early years when they were still playing on the streets of downtown Chicago.

A portrait of the artist as a young graduate student.

Not everything was easy. As part of my financial aid package, I was supposed to get a work-study job at SAIC. Unfortunately, I moved a little too slowly to secure a position, so many filled even as I applied, but I was also hampered by my terrible social anxiety, which made me unable to even enter the offices (or sometimes the buildings) where open positions were available. This inability to get a work-study job weighed heavily on my mind--and was hard on my finances. And while I very much enjoyed my classes, particularly the elective art course I was taking, I had unfortunately been assigned a writing advisor who was a terrible match for me. He was the sort of person who loved critical theory and I was the sort of person who decided not to become a literature major because I loathed that way of thinking about writing. He criticized the first pieces of writing I submitted to him as not being current enough; I protested that I had just moved to the city, I didn't know enough about where I was to even write about it. And then, when I tried, he dismissed my efforts as cliched. At that time, I was so shy and anxious and insecure that I struggled to show anyone my writing at all, sure that it was not worthy of being seen, and his blunt and sardonic remarks confirmed my fears. I swiftly developed a terrible case of writer's block. It's a truly demoralizing thing to have writer's block when you're in a writing program and I was not well enough at the time to advocate for myself. Things were starting to slip out of my control.

On one side, my sun-lit street, on the other side, total darkness

I can vividly remember walking down Spaulding Ave one sunny afternoon in early October and having this sense within me that I was teetering on the edge of darkness. I could picture it so clearly in my mind, the razor thin line on which I walked, the bright Chicago sun on one side, the black depths falling away to the other. I didn't know at the time that I was experiencing my seasonal changeover from my summer hypomania--which had given me the energy and enthusiasm to embrace this move to a large, unknown city--to my wintertime depression. But the metaphor of teetering on the edge of darkness was very apt, and around the end of the second week of October, I fell.

My $75 purple comforter was only
marginally effective at keeping me warm 

The weather changed, becoming cold. I had spent the past four years in Florida, so while I was well-equipped to handle the summer heat of Chicago, I was ill-prepared to withstand the chill. After fretting a great deal about the price, I bought an artificial down comforter. (I'm allergic to real down.) I also purchased an extremely unflattering "sleeping bag" coat. At night I would huddle under my new comforter with my heavy coat over me, too chilled to sleep. My apartment was cold because I was too embarrassed to call my landlord to say that the radiator in my main room wasn't turned on. It was my first experience living with radiators and I thought maybe there was a valve you turned, but this radiator didn't have a handle on the valve and I didn't have a wrench large enough to turn the bolt. I was worried that somehow I had missed something that I was supposed to know and therefore couldn't stand the thought of exposing myself to my landlord's ridicule: this is how you think when you have social anxiety. I also couldn't bring myself to ask them to unplug the drain in my bathtub, so every time I took a shower I ended up in nine inches of slowly draining water that served as a mocking reminder of my failure to be a normal, functional human being.

Money was also worrying me a great deal. My parents, before I graduated from college, had told me not to expect them to support me, and I took this to heart. Thus, I felt I couldn't ask them for help as my savings dwindled and I remained unable to get a job. Having failed at getting a work-study job, I tried and tried to bring myself to ask for a retail job, but couldn't ever work up the nerve. The holidays were approaching and the Magnificent Mile was crowded with shoppers as I walked up and down Michigan Avenue and through every floor of the Water Tower mall, trying to will myself to walk into stores and ask for a job. Even when the stores had "help wanted" signs posted, I still couldn't make myself ask for an application. I spent many afternoons this way, feeling more and more like a failure. I hadn't been able to afford to fully furnish my apartment, so the box my eMac came in served as my desk; I ate my meals sitting on an upside-down plastic wastebasket with my plate on my knees.

In addition to my lack of a job, writer's block, and cold apartment, I was also beset with racing thoughts that kept me awake late into the night as I worried and worried and worried and worried. I told some of this to my parents when I called home and they provided coaching and encouragement, but as the weeks passed and I still failed to call my landlords and get a job, I starting avoiding my parents' calls, letting them go to voicemail and only occasionally calling back. I was too ashamed to admit I hadn't made any progress.

My drawings with text explored the
possible nature of God.

The week before Thanksgiving was Critique Week at the School of the Art Institute of Chicago. There were no classes; each student was assigned a time and a date when he or she would present work from that semester to be critiqued by a committee. This was extremely nerve-wracking for me, as I dreaded being judged, and my critical, sardonic advisor was on my critique committee. My critique wasn't until Friday, so I had all week long to worry about it. The night before my critique, after having dinner with my boyfriend at his place, he dropped me off at my apartment as he headed out of town. The water in my building had been turned off earlier in the day for maintenance and I discovered, when I got home, that the pipes were groaning and howling at high volume. Fortunately, I was able to catch my boyfriend before he left (this was in the days before everyone had cellphones), and he let me stay at his place. I slept better there than I would have with the pipes serenading me at my own, but I was still so nervous that I broke out in hives while taking a shower that morning. The work I was presenting for my critique was a series of drawings with text that I had been working on for my art elective class; I may not have been able to write, but I had been able to get a lot of good artwork done. Still, I was so anxious that I had to sprint for the bathroom, my stomach in revolt, while I waited for the committee to arrive. My critique went well and I did appreciate that my advisor understood it better than the others. Afterword, he told me I could have been bringing my drawings to our meetings, but I hadn't wanted him near them. I was sure that he would ruin them for me with his cold, rational assessments. Later, he sent me a rather condescending email, calling me "kiddo," and told me that maybe I just wasn't mature enough for grad school yet. I may have been the youngest student in the MFA Writing program, the only one who had gone directly from college to grad school, but I knew the problem wasn't one of immaturity. The problem was anxiety. But I didn't know what could be done about it.

The following week was Thanksgiving, which I spent with my boyfriend's family. I had met most of the attendees of the dinner before, but fretted enormously ahead of time over what I should wear and felt, as soon as I was dressed, that I was wearing exactly the wrong thing. I don't imagine anyone else gave it any thought, but I spend the evening feeling awkward and foolish. I was waiting, too, for the imminent onset of my monthly premenstrual migraine.

At that time I was getting a three-day migraine every month. They were quite severe: I'd spend those three days in a shadowy underworld of pain. I was used to having a mood drop with my migraines, especially as they abated, but this time, the drop was unusually severe. I found myself unable to sleep on the night of the 29th of that month, feeling more and more agitated as I was beset by a frightening desire to hurt myself. I'd had some thoughts of harming myself in the past, but I had made it very clear to myself that this was a line that was never to be crossed: it might be contemplated, but never, ever acted upon. For the first time, I found myself very much in doubt of my ability to resist the urge. Every time I tried to block the idea from my mind, it would think of a new way I could injure myself. Walls suddenly seemed like places to bang my head, windows were things to be smashed and jumped through, every corner of every shelf and desk and table presented itself as an instrument for pain, the razors in the bathroom cried out to be used, the knives and utensils and the blue flames on the stove in the kitchen started singing a siren song, and the urge to run out into the traffic on the busy boulevard was powerfully strong. I sat in bed, I dared not move, as my world morphed into a horror movie. I knew it wasn't right, I knew I should wake my boyfriend, I knew I should ask for help, but I couldn't bring myself to express my horror. I clawed at my forearms with my fingernails, hoping it would suffice, that it would ease my desire to inflict pain upon myself with more dangerous objects. Eventually, I slept. I have no particular memories of the next day, which I likely spent in a migraine daze, trying to shut out the need for injury that had woken in the night. But again, late that night, the desire rose to a level of torment. I was shocked, appalled, flabbergasted, bewildered, utterly opposed to the idea of hurting myself, yet I seemed to be drawn toward it as powerless as an iron filling drawn toward a magnet. I didn't know what to do. I knew full well that I wasn't in my right mind, that things had gone terribly wrong and beyond where I'd ever been before, but I had no idea what one did in such a situation.

Finally, on Monday, December 1st, 2003, I realized that, as a student at SAIC, there must be a student health center I could go to. I was able to get an appointment with the doctor that morning and I presented the problem to her as an unusually severe episode of my typical postdrome migraine depression. After voicing dismay over the general severity of my migraines, she sent me to see the counselor to discuss the self-injury urges. When the counselor heard what I had to say, she cancelled the rest of her morning appointments, hailed a cab, and took me to the hospital.

The counselor spoke to the triage nurse in the emergency department on my behalf. It was 12:05 in the afternoon. According to my records, security searched me at 12:10 and I was placed in the quiet room. And there I waited. I had nothing to do. There was a TV with the volume turned down and poor reception on the wall, but I had no interest in the daytime talk shows being aired even if I could have followed their progress. At one point I was escorted to the bathroom to provide a urine sample; later, the security guard outside the door arranged for some lunch to be brought to me. It was a turkey sandwich. I am a vegetarian, so I had to make due with eating the roll. At 2:00, I saw the intake psychiatrist. She decided that I needed to be admitted. At 4:15 I was moved to a small bay on the edge of the ER to wait for my medical exam. A new security guard watched me from across the hall. I began to cry and quickly overwhelmed the meager supply of tissues I had on me. There were no others to be had in the little room and I was having to wipe my streaming nose and eyes on my hands. That was the lowest point, crying under the impassive gaze of the security guard with snot all over my hands, not knowing what was in store for me, feeling frightened and alone. After what seemed like an age, the security guard left her post and came back with a box of tissues. When a nurse came in to get my vital signs, she was very kind. "You're doing the right thing," she said. They let me call to leave a message for my boyfriend. "I'm at the hospital," I told him, but I was too confused and overwhelmed to remember to tell him which one. At length, I was medically cleared for admission to the psychiatric unit. That meant I was transferred to what, I discovered in my hospital notes, is called the psychiatric emergency department. It was now 5:50 in the evening. In the psych ED, I was placed in another small room, this one with a bed, a small table, and two chairs. All of the furniture was bolted to the ground. There was a door communicating to an office where psych nurses were doing paperwork, I presume, and a one-way window through which they could watch me. I was told to change into two hospital gowns, one with the opening in the back, the other opening in the front, and was given footies, the hospital socks with rubber treads. They interviewed me again, I believe, going over the information I'd given to the admitting psychiatrist and other details. But mostly I sat there on the bench-like bed, cold, hungry, and forlorn in my hospital gown. I'd been clinging to keep control over my depression and anxiety over the years, clenching tighter and tighter in recent weeks, digging in with everything I had, and now I'd let go, had signed over my authority of my own sanity to the professionals at the hospital, and was plunging, numbly, toward I knew not what. At long last, a bed opened up for me in the psych unit. I was placed in a wheelchair with my belongings in various bags on my lap, and an orderly and a guard took me via skybridge to the building where the Stone Institute of Psychiatry was then housed. At shortly after 8:30 in the evening, I was admitted to the locked 8 West psychiatric unit where I would remain until the evening of December 12th.

The hardest phone call I've ever had to make was the one I made the next morning when I called my father to tell him I was in a psychiatric hospital.

A description of day-to-day life in a psychiatric unit deserves its own post, though I will say that it was much more mundane and certainly more well-lit than the psychiatric wards of pop culture's imagination, but the reality of being in close quarters with some of the low-functioning patients, especially when you were a nice, very anxious girl from the suburbs like me, was not always easy. One of the notes in my chart mentions I was upset about an incident the day before when another patient became "agitated," a term that does not adequately convey the experience of seeing a belligerent schizophrenic patient tackled and sedated by the nice nurses and mental health workers. But in all of the days I spent in psych units over the next two years, I only saw that happen twice, and while it was extremely unsettling and the possibility that such a thing might occur kept me on edge much of the time, the truth is that I met many very nice, very normal people in the hospital and the vast majority of the low-functioning patients were completely harmless.

Patients tended to self-segregate according to diagnosis, so I spent most of my time with the three other patients who were being treated for depression. One of the other patients was a girl, L., one year my junior, and we got along very well together. It helped immensely to have this other "normal" person my age to talk to! Every time I left the hospital, it was with numerous email addresses of other patients and promises to keep in touch, but once outside the hospital, the desire to remain close usually fell away. I am rather sorry I didn't keep in touch with this girl; I would have, but I lost her email address and didn't find it until nearly two years later. I decided it was unlikely at that point in time she would wish to resume the intimacy that was so helpful for both of us in December of 2003. If L. should happen to read this and recognize herself, I'd like to say that I've thought of you often over the years and wished you well!

I've previously said that, conversely enough, needing to be hospitalized for psychiatric reasons is one of the best things that ever happened to me. I cannot possibly underscore deeply enough what a relief it was for me to discover that my inability to respond to the world like I thought I ought to was not because I was a profoundly flawed human being, but because I suffered from a brain chemistry imbalance. It was also heartening for me to learn that I not only suffered from a brain chemistry imbalance, but a very severe one. I'd suspected as much, in a way, that what I felt was beyond the norm for depression, but it was an affirmation of sorts to be so sick as to impress an inpatient psychiatrist, who dealt with the sickest of the mentally ill on a daily basis. Quite frankly, the doctors and mental health workers who treated me were amazed that I'd coped as well as I had for as long as I had for how very, very sick I was. Suddenly, I went, in my understanding, from a person who was terrible at coping with life's challenges to someone who had been doing an amazing job of coping! It was SUCH a relief. I can't emphasize it enough. And thus I was able to forgive myself for years of not being able to feel happier or less anxious.

What happened next is apparently fairly common for people who have been holding themselves so tight for a long time to keep themselves together: I sloooooooowed down. My thoughts slowed, my speech slowed, my gait slowed. The slightest distraction could interrupt my train of thought. I felt loose and limp and sometimes loopy. I laughed for no reason. A little bit of this could be attributed to the medications my psychiatrist had put me on, but part of it was the reaction of a mind that had finally, at last, been allowed to let go.

By the 12th of December, my mood and my new medication had stabilized to the degree that my psychiatrist was willing to discharge me, but she did so with reservations. I was still very sick. But my insurance coverage had run out: it had a limit of ten days per year for inpatient psychiatric hospitalization. So back out into the world I went, heartened by my new diagnosis and not realizing exactly how unwell I still was or how long it would take to achieve balance. But I had never been well. I thought it was rather funny, when I read over my chart notes recently, to see that I reported having experienced episodes of "mild" depression over the years; now I know that I had been suffering near-continuous depression, with some very severe episodes, since I was ten years old. At the time, though, depression was my norm. I had no idea what true happiness felt like. It wasn't until years later, after I'd been diagnosed as bipolar II, put on lithium, undergone extensive Dialectical Behavior Therapy, and gotten most of the drug Geodon out of my system, that I would experience happiness untainted by depression or anxiety.

It would have been lovely if I'd been able to find out I was bipolar II and had been put on the right medication without having to go through the trauma of getting so off-balance and such a danger to myself that I required inpatient psychiatric care, but I consider myself lucky that I was only 22 when it all began. Had I stayed slightly less off-balance, I might have continued on, deeply unhappy, anxious, hating myself, and just barely coping for years. Instead, it worked out that my last inpatient stay was in February of 2005 and by the time I was 26, life was on a steady, upward trajectory and I was experiencing joy on a daily basis. So yes, I was lucky to be hospitalized.

Inpatient treatment also gave me a chance to see others with mental illnesses up close. I now have far more compassion and understanding for low-functioning individuals whose traitorous brains leave them only tenuously connected to reality and are unlikely to ever be well. As uncomfortable as they may make us, they deserve the best possible care. I fervently hope that psychiatric medicine will continue to improve and more and more individuals will be able to break free from the tyranny of a dysfunctional brain and know the relief that I've felt.

It was a cold night when I left the hospital in the company of my boyfriend; I remember that they offered me a warm coat from supplies for needy patients they kept on hand, but since I had several warmer coats waiting for me in my cold apartment, I declined. I was done with the hospital. My problem was diagnosed, they'd found a medication I could tolerate, and I was sure everything was just going to get better from there on out. I didn't know that within a month I would be back in 8 West. But I DID get better, even though it took longer than I thought it would, and I got much better than I ever dreamed I could possibly be. So I will declare the 12th of December to be a day of awakening, a day of finally moving forward, a day of hope.

And if you happen to suffer from a psychiatric condition, or suspect maybe you do, and things start getting really scary and you feel like you're not sure you can control yourself anymore, go to the hospital. They know what to do. Ideally, it's better to get treatment before you get to the point where you need to head to the ER, but psychiatric disorders have a way of making you act against your own best interests, so if it comes down to needing to be protected from yourself, call 911 or have something take you to the hospital or take yourself. An inpatient psychiatric stay might be the best thing that ever happened to you; it was for me. Finding the right treatment can take time and it can be so hard, but getting your psychiatric condition under control is SO worth it! Feeling good, feeling balanced, feeling normal, being able to respond to the world in a normal way: it's an amazing feeling. Don't let any of the stigma attached to mental illnesses dissuade you from seeking the treatment that you need because there's no reason to be ashamed of having some issues with the way your neurotransmitters are functioning. Get help. It's worth it.

My life has never been the same since the December 1, 2003. But that's a good thing. Being in a psychiatric hospital may sound terrible, but it was far more terrible to feel the way I did for years prior to the hospitalization. I may have been in a locked unit, but it was there that I was first able to begin the process of finally breaking free.

You can read about my second hospitalization here and my third hospitalization here.

The Best Therapist

Research indicates that the most successful scenario for treating and coping with mental illness is a combination of medication and therapy. Either one, when used alone, is not nearly as beneficial as when used together. And yet, as complicated as the medication can be (and it can be plenty complicated), it can be simple in comparison to the task of finding the right therapeutic match.

For starters, not all therapies are created equal, but there is not necessarily good information out there for patients and families to use to understand the strengths of various therapies and the differences between approaches. Furthermore, a sound therapeutic model does not guarantee that all of its practitioners are good therapists. Again, there is very little information out there to assist individuals in choosing the therapist that will be their best match, especially since someone who makes a great therapist for one person does not necessarily make a great therapist for a different individual.

And there are some bad therapists out there.

Therapists run the gamut from outstanding to good to adequate to mediocre to downright bad. A bad therapist is worse than simply ineffective; they can be detrimental to the patient's health and harm the reputation of the practice of large. Many people, once they've had a bad therapy experience, will write off therapy altogether and never go near it again: that's how damaging a bad therapist can be. It's a shame, since there are good therapists out there who could be helping those who now view therapy as worthless.

In my day, I've had two bad therapists (like the guy who told me to be kind to myself and eat some ice cream when I called to tell him--totally freaked out--that I'd woken up suicidal the day before), a few good therapists, and Andrea.

Andrea belongs in the class of exceptional therapists and for seven years she's been my invaluable guide. This week, I saw her one last time, as she is leaving the practice where she's worked all these years to explore different horizons. Although I'm sorry to see her go, she leaves me in good hands: my own. While I will take on another therapist in the practice as backup, over the years, Andrea has helped me become so skillful at managing my emotions and troubleshooting problems that I've only needed to check in with her every six months or so.

When we first met in March of 2005, it was a different story. I was in bad shape. The month before, I'd had my fourth psychiatric hospitalization in slightly more than a year's time. I was seeing a psychiatrist, but after the overdose that put me in the hospital, everyone agreed that I needed more extensive therapeutic treatment. That's how I found myself at the DBT Center of Seattle.

DBT, or Dialectical Behavior Therapy, deserves a blog post all its own to fully explain why it is, in my opinion, the best possible therapy out there. The extremely short summary is that it teaches individuals how to cope and respond to difficult emotional situations through the use of a variety of skills. It is a therapy of doing, of moving forward, of changing how you think and therefore how you feel, and it is extremely effective. I was first introduced to DBT at the psych hospital in Chicago and had seen a good therapist at the DBT Center of Seattle when I had been home for a few months between hospitalizations two and three. I was, therefore, not wholly unfamiliar with the general concept or that office in particular, but it was with Andrea that my true Dialectical Behavior Therapy education began.

As I said, I was not doing well when we first met. I remember her asking each week if I could make a contract for safety with her, meaning that I would promise not to hurt myself until I saw her next, and each week I would refuse to make that promise because I didn't want to make a promise that I wasn't sure I could keep. There are four units in DBT–Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness, and Wise Mind–and it should be no surprise that we jumped right into Distress Tolerance, the unit that focuses on surviving and coping with the most painful and extreme emotions.

The first few months were hard. I wasn't really well enough to even absorb a lot of what I was being taught, but between Andrea's gentle, kind, but firm guidance and my weekly DBT skills group, the principles started to take root. Six months into DBT, I was started on lithium, and suddenly, everything clicked. From then on, my progress accelerated tremendously.

When I think back to those early months (not that they are very clear), what I remember most is how helpful Andrea was in helping me confront my severely debilitating social anxiety. Together we made up a list of all the things I was scared to do and ranked them according to Subjective Units of Distress, or SUDs, which is basically, on a scale of 0 to 100, how terrified I was to do them. This list included things like asking for directions, talking on the phone, going into a store even if I didn't intend to buy something, asking a bus driver a question about stops or the route, looking at a map in public, taking the time to find the exact change when purchasing an item, making any kind of request of anyone, and dozens of other seemingly innocuous things that filled me with paralyzing anxiety. Then she had me choose one or two items off the list that I had ranked in the 20 to 30 SUDs range to do each week. It wasn't easy at first. But if I didn't do an item one week, it remained my assignment to do it the next. As items were crossed off the list, they were replaced by ones with higher rankings. Slowly this exposure therapy started to take hold, where years of cajoling and reasoning had failed. As my anxiety lessened, it became easier for me to move about the world without feeling like I was constantly being negatively judged by every single person around me. After I'd gotten the hang of challenging myself, we put the list away, but I remember when we looked at it again perhaps a year or so later. It was astonishing. Things that I had ranked as high as 70 or 80 SUDs now seemed so easy, meriting big fat zeros in terms of subjective distress in my revised view on life. The only thing that remained on the list that I agreed with was singing karaoke: sorry people, not gonna happen! It was amazing to see how far I'd come, and to this day, I still marvel at how wonderful it is to be able to do the kind of everyday things that used to fill me with terror and to be free of that sense of being constantly watched and judged. Without Andrea's advice, encouragement, and underlying firmness, I might still be obsessing over what terrible things other drivers were thinking about me because I had set my windshield wipers to "intermittent" when other drivers (and I was checking the wiper activity of every other car on the road) didn't seem to have theirs on at all. (Seriously, the thought that I might have my windshield wipers on the "wrong" setting used to preoccupy me terribly and any drive in the drizzle/rain/mist--and I live in Seattle, so there was no shortage of drizzly, rainy, misty days--was an exhausting, nerve-wracking, humiliating experience. It was a terrible way to have to live and am so thankful to be free of it.)

It could be argued that I might have done well with any DBT therapist, but I'm sure that without Andrea's attributes, I would not have come nearly as far nearly as fast. She was exactly what I needed in a therapist: friendly and positive without being superficial or exuberant; so clearly patient and kind and nonjudgmental that even I, who was so terrified of being "wrong" somehow, was able to learn to relax and trust her; clear in both her explanations and expectations; and, at the core, where it was needed, absolutely firm. I remember in one early session, during a time when I was still sorting through and dealing with suicidal thoughts, saying something somewhat glib or certainly self-centered about the benefits of suicide and her reply, that suicide really fucks up people's loved ones, shocked me tremendously. That Andrea would say "fuck" in a session was as shocking as, well, my mother saying it, or the queen. And when she said it, I believed her. That was the last time I ever indulged in fantasizing about suicide. From then on, I was wholeheartedly on board in trying to turn my thinking away from self-destruction.

And so I learned how to arrest a spiraling state of emotional intensity in its tracks; to notice when I was engaging in catastrophic thinking and how to make myself stop; how to quiet my mind when my thoughts started racing; how look for the positives in every situation instead of focusing on the negative; how to ask for what I needed and then, once I had accomplished that, how to ask for things I wanted (this was huge because my sense of self-worth was so low at the outset that I didn't believe I deserved to have needs, much less wants, and the worst possible thing would be to inconvenience anyone with something so selfish as asking for what I needed); how to separate the facts of a situation (or emotion) from the judgments and assumptions; and how to effectively respond once the facts of a situation or emotion had been established. With Andrea's helpful tutelage, I was able to leave that cringing, shrinking, petrified, miserable, out-of-control, profoundly unhappy torture chamber that was my life and enter into a positive way of being, where I believe in my worth, in my opinion, my voice, and my happiness.

It's a good thing I had DBT and Andrea at my disposal, since six months after I started taking lithium, I found myself desperately needing the skills I'd been learning. I'd started lithium because I was going off of a drug called Geodon that was causing tardive dyskinesia, or involuntary movements of the mouth and face, a condition that can become permanent if the medication causing it is not stopped. My experience with Geodon will get its own blog post one of these days, but what happened is that after six months of problem-free reductions, with me getting better and better by remarkable leaps and bounds, I slammed head-on into excruciating withdrawal. It was awful. There was agonizing pain, horrible nausea, immense fatigue, bizarre sensory hallucinations, cognitive problems, vision problems, you name it. It went on for years. And not only did the withdrawal symptoms get worse the closer I was to finishing the taper, but they continued for a full year AFTER I was off the medication. I started tapering off Geodon in 2005 and was not wholly free of its effects until 2009. And that's not counting its permanent legacy: hypoglycemia, worsened migraines, and periodic fibromyalgia. I might not have been able to cope with finishing the taper if I hadn't had DBT and Andrea to help me through one health crisis and setback after another. It really might have been unbearable. It's a good thing I was able to endure the withdrawal, though, because emotionally I am so much better completely off of Geodon!

In fact, I was able to do so well, thanks to lithium and Andrea and my year in the DBT skills group, that I was still in the Geodon withdrawal process that I started coming to my weekly therapy appointments without any problems to discuss. I'd become so skillful that I was able to tackle things by myself as they arose. It seemed silly to meet every week simply for me to report on how well I was doing, so we started meeting every other week. But even then I was managing just fine. So Andrea and I started meeting once a month. Before long, even that was excessive! In the last few years, I've been down to two or three check-in appointments a year. A lot of times, they'll just be half hour appointments to touch base. Sometimes, if I have a particular problem that I want assistance with, I'll specifically schedule an appointment to see her, but I no longer need weekly or even monthly guidance. It's hard for me to get downtown to the DBT Center's office now that I've had the chronic migraines to contend with, so we've had most of our appointments over the last two and a half years over the phone, and that's worked just fine.

Lithium, in combination with several other medications, is essential to managing my bipolar II disorder. But if I hadn't had Andrea's gentle but insistent instruction to help me cope during the seven months between the fourth hospitalization and when I started taking lithium, it's probable I would have continued ping-ponging in and out of the psych hospital, almost certain that I would have embarked too far down a road of self-destruction to easily turn back, and possible that I might have ended my life altogether. At the time we met, after years of just barely clinging to a facade of normalcy, I had become unmoored. I knew the frightening thoughts and urges that were flooding my mind were the result of brain chemistry out of balance, but I also didn't know how to stop them, and their warped seductiveness was becoming harder to resist. I was so terrified and also so appalled that I could think such things that it was hard for me to talk about them, but I trusted Andrea, and even before I was able to effectively implement the DBT skills I was learning from her and my group therapy, it gave me hope that I might someday regain control of my mind. It's not a coincidence that I have never needed another psychiatric hospitalization since I started DBT!

And so with Andrea's invaluable help, I was able to grow from a fragile, damaged, terrified husk of a human being into a confident, balanced, happy woman. I went from being so emotionally raw that the slightest thing could send me into a tailspin and so fearful that the mere thought of ordering a pizza over the phone could send me into a panic to the point where I was able, on my days off, to get all dressed up, experiment with a little dramatic makeup, go downtown, take myself out to lunch at a nice restaurant, go to a matinee of a play all by myself, stroll around downtown while enjoying the admiring looks of passersby, check out the latest fashions even if I wasn't planning on buying anything, make a purchase at a drugstore and chat with the cashier while taking the time to find the exact change despite someone waiting behind me in line, and generally have a wonderful time. Even more remarkably, when the onset of the chronic migraines brought an end to those fabulous afternoons and left me unable to work, socialize, or even leave the house because of pain and tremendous light- and noise-sensitivity, I've still been okay. When I am happy, and I frequently am, it is a happiness as legitimate and whole as what I felt on those delightful, confident days spent enjoying the dining, shopping, and entertainment offerings of the city. I owe it all to DBT. Had I not learned how to stop myself from fixating on the negatives and instead see and capitalize on the positives during my climb out of the depths of depression, I would not have handled this disability with nearly so much aplomb!

While I have no doubts about my ability to continue to not only manage my emotions but to thrive, it has been a bit of an emotional process to say goodbye to Andrea. Walking past the Louis Vuitton store on the way to my final appointment yesterday, I recalled how it was one of my earliest assignments in my quest to conquer my social phobia to go in the store and look around for several minutes despite my belief that I was not "good enough" to be in there. It took several weeks for me to work up the courage to open the door and endure the judgmental (I was sure) stares of the security guard and sales associates as I nervously made myself look at every bag and every shoe. It's simply phenomenal how far I've come and while I remain grateful and proud of myself every time I make a phone call or go into a new situation without panicking or ask for help or any other scenario that would have been nearly impossible for me in my anxious days, it's been very moving to really remember down to the visceral level how I used to feel in those wretched days and compare it to how I feel now. I have not seen the last of Andrea; while our professional relationship has ended, DBT guidelines allow for ongoing contact between former therapists and clients if such a thing is agreeable to both parties, and we agree that it would be really nice to get to touch base now and then! I was very glad, though, when we parted, that I was able to tell her that she has made a tremendous difference in this world: she changed--and perhaps even saved--at least one life for the better. She always credits my hard work for my success, but without her approach and personality and patient coaching, I would never have been able to form the bond with her that has, over time, enabled me to succeed.

So thank you, Andrea, from the very bottom of my heart. I love the person who I am now, am no longer afraid of the world and its opinions, and I no longer need to be afraid of myself, three things that, when we met, seven years ago, I never could have even dreamed would be possible. I have been so fortunate to have known you and worked with you and thrived because you. The vastness of my gratitude matches the scope of my former unhappiness, which is, to say, immense. Thank you! Thank you! Thank you!