About this post: As a psychiatrist, I share part of my process in therapy. Denying mental health symptoms worsened health, while admitting symptoms set a path to wellness.
When I was a resident, my training program offered us a year of free weekly psychotherapy.
If we were going to be treating others, we first had to know what it meant to be a patient. But it was also an opportunity to work on yourself, to use the sessions to work through conflicts (which we all have) and to strengthen our own resilience because, after all, if we were not at our potential, how could we begin to help others?
I have to say that I was really a terrible patient, and the experience leaves me so grateful for all the patients I work with who are so much more insightful, perseverant, and dedicated than I was at that time. I was late to every session, each time with an excuse about a lab meeting running over or a patient who really needed me at that very moment. Still, excuses run thin when they happen week after week. Although I am well aware of how resistance informs psychotherapy, it somehow didn’t occur to me that my lack of engagement was a form of resistance to accepting and engaging fully in the treatment.
I worked with a psychoanalyst who said little and encouraged me to fill the silence. (Not all therapy is psychoanalytic. Each type of therapy has its own style and type of relationship with the patient, some therapists advising or even sharing more than others). She had a file folder on the ground next to her chair where she kept notes on each patient, as whenever I walked in, she seemed to grab my file and begin to take notes. I would stare at that folder, wondering what lay within, what facts about my life she had decided had the most importance, and what conclusions she may have drawn about me. With each visit, the contents of that file bothered me more and more, and yet, I was never open enough to share my concern or even ask her about the notes.
Each week, I smiled, recounted events of the week, and told her how well I was doing. I’d always envisioned myself to be a strong person, one who knew herself well, who confronted and tackled adversity. I didn’t really need to be here, but I was always up for experiences that would make me a better doctor, so of course I would choose to participate in the elective psychotherapy. If “participate” meant showing up, I did (albeit late), but if “participate” meant engaging, being vulnerable, questioning, and truly being present, I failed miserably. I was great at talking about all the healthy ways I managed work and the rest of my life. I spoke about areas in which I excelled, about relationships that I navigated well, and about how despite grueling hours and workload as a resident, I had the tenacity to continue to thrive.
Now, looking back, I think the file next to her chair must have said something about lack of insight and maybe even narcissism. It wasn’t until years later after I had my children and experienced a depressive episode myself that I realized that strength isn’t about pushing through – it isn’t about acting brave despite obstacles, but it relies wholly and entirely on the ability to be vulnerable.
Wellness isn’t about talking about how well we are doing. It’s about talking about the complexity of sometimes feeling less well, being able to catch those times, and then doing something about it to recalibrate. It’s about having the ability to ask for what you need, to question your own thoughts, and to push yourself when it’s harder than anyone else can know. It’s about looking at the ways in which you see the world, and then trying to see them a little differently. It’s about having meaningful conversations and relationships, and feeling integrated into a community. It’s about living a life with meaning and purpose.
When we introspect and acknowledge when we feel anxious, sad or angry, we begin a process of settling those emotions, but when we ignore or push them away or when we don’t deal with them, we put ourselves at risk for mental health conditions, and we move further away from a state of wellness. Stigma pushes us to silence about our suffering and difficulties, and we fail to realize just how many people every day and in every place experience anxiety, depression, PTSD, psychosis, trauma, bipolar, and the list goes on. Suicidal thoughts even are experienced by many people, and it’s important to realize that having those thoughts doesn’t mean that a person acts on them. Suppressing thoughts of any of these conditions is more problematic, and causes symptoms to surface in unpredictable and unnecessary ways.
I always say that the most “well” people I know are those in our practice at graymatters. People who acknowledge that taking care of one’s health is work and commit to living a better life are usually much healthier than those who don’t engage in any treatment. During the pandemic for example, when most people are experiencing high levels of stress, anxiety and depression, many of our patients are managing fairly well and even educating others on what it means to take care of one’s mental health. After all, they’d been practicing before the pandemic, and so now, they have the tools and resilience to manage the crisis.
Personally, when I made the decision to enter treatment years after my initial resistant encounter, I was finally ready to admit that I could not carry everything I had shouldered for so long, everything that I had ignored and pushed away so that I could push forward with the “strength” I believed I had. I realized that strength is actually having the ability to be vulnerable, to admit our difficulties, to accept help, and to know that everything will be okay and that we will move through it to live an even more fulfilling life going forward. When I did this, my life became infinitely more fulfilling than it had ever been. Relationships were deeper, I had more moments of contentment and peace, and my career moved forward even faster and with more creative energy. Rather than get stuck in spirals of negative thoughts, I noticed the thoughts and was able to attribute them to my mood, which took away their power. In moments when I felt frustrated, I was able to self-reflect, check in with myself about other factors that could be frustrating me, and then have a pleasant conversation with my husband rather than a heated argument.
I wished that I had made the decision to work with a therapist sooner because more of my life could have been spent in this more fulfilling state. I wouldn’t say that my life was unfulfilling at all before treatment, but the difficulties, the depression, the unhelpful thoughts, and the stressors all weighed on me. Now when they weigh on me, I’m able to quickly identify what’s going on and how it’s affecting me, and I think of how to best move forward. I no longer tell myself how “strong” I am and how I can just handle anything that comes my way. In the process, I have discovered a depth of strength that keeps me grounded, content, and fulfilled.
Written by Dr. Tejal Kaur, founder and medical director at graymatters