DISCLAIMER: The following column is a composite of several different experiences I have had with clients. It does not depict a specific encounter. This story is not about you!
Not too long ago, taking medication for any sort of mental health issue was considered “shameful” among many otherwise intelligent people. Certainly, talking about it, admitting to taking meds, was not a conversation not too many people wanted to have. Thankfully, these days many people are becoming much more transparent about seeking help and benefitting from their decision to take medication and focus on their self-care. On the downside, this has created a large pool of people who are on medication for anything from depression to anxiety to ADHD, a pool that continues to grow to the point that these conditions are almost common nowadays.
Sadly, there are still people who perceive medication and therapy as taboo subjects, something to feel embarrassed about, thus depriving themselves and their loved ones of the help these therapies can offer. It’s an unfortunate situation, leaving individuals alone to struggle far more than they have to, given that help is available. But even more unfortunate is when their resistance to getting help affects not only their quality of life, but also the lives of their loved ones, who never chose to be collateral damage as a result of living with a person who is afflicted with a condition that impairs their behavior as well as everyone’s well-being.
Shiri and Dovid are such a couple. When the work began, Dovid was at his wits’ end, not knowing what to do to help his wife, who was clearly in great pain, and though unintentional, spreading her pain to everyone in her orbit.
Dovid took the initiative to call to schedule an appointment. He wasn’t sure he was going to be able to convince his wife to come in with him, but decided he would show up with or without her. It turns out Shiri wasn’t interested at all in joining Dovid in therapy. From our time together, it was obvious Dovid had a lot to say, the words seemed to burst forth from him. Below is a compilation of our many conversations.
Dovid began: “I’m not a complicated guy. And I come from a family that I guess isn’t very complicated either. I would say that we’re all good people, doing our best, grateful for all our berachos and dealing with life in an upbeat, positive fashion. Shiri and I did not date very long, as is typical among our circles. Our engagement period was also short. Though, from the moment I met Shiri, I was definitely drawn to her for all sorts of reasons. She’s a very special lady with wonderful middos. We seemed to be on the same page for many reasons. She’s clearly sweet and beautiful, and it was easy to fall in love with her quickly.
“I look back on our dating history and wonder whether I was emotionally mature enough to make such a huge decision like getting engaged. Though I keep rewinding the tape, I’m convinced that no one could have seen what was coming. On every date (not that we dated a long time), Shiri was all smiles, positive, up-beat, and showed no warning signs of what was going on beneath the surface. We laughed together, had serious talks, and eventually shared dreams of the kind of future we would have together. It was an amazing time!
“After we got married, Shiri became pregnant, thankfully, right away. I began to see a side of Shiri I had never seen before. She had mood swings that at times became so bad she actually got depressed. I tried to figure out how I could be contributing to the problem, if I was doing anything to make her feel so sad. And for a long time, I would beat myself up trying to find the errors of my ways that could be causing her behavior. Though I tried to tweak my behavior here and there, and bring her little gifts, nothing seemed to help. There were days she couldn’t even get out of bed. I was kind of shocked since I had never seen clinical behavior like this before, but I decided to chalk it up to her pregnancy.
“Looking back, I realize that once she gave birth, things only got worse. She had full on postpartum depression. It was a nightmare not only for her, but also for me. Thank G-d her mother picked up the slack and showed up daily to take care of our precious baby as well as Shiri. Looking back, I don’t know how we all survived that period and the two ensuing pregnancies she had and the resulting bouts of postpartum depression.
“Though now I’ve done a lot of research into postpartum depression, at the time I had no idea what was happening. I had never heard of such things or experienced them. I never knew anyone who was clinically depressed and had no vocabulary for these kinds of conditions.
“At one point, Hashem sent me a lifeline in the form of a co-worker, a person I’m close with. He noticed that I wasn’t myself and I finally shared with him what was happening at home with Shiri. He seemed to know about these things, having grown up with a mother who was depressed, and that is when my eyes were finally opened to the fact that Shiri wasn’t just moody. Her suffering was some form of mental illness.
“I can’t say that Shiri was 100% depressed every single day. There were definitely good days and bad. There were times she could function fully and even enjoy life. But I constantly lived on edge, wondering when the next shoe would drop and she would go back to her dark place. Once I finally understood what was going on, I did some research and pretty much understood the complicated situation I was facing.
“Ever since, I’ve been desperately trying to get Shiri to see a therapist and hopefully try medication. She’s been very resistant. I know Shiri is the one who is suffering the most, but it hasn’t been easy on me either. And as our children are growing older and becoming aware of their mother’s inconsistent behavior, I see that it’s affecting them as well. I always knew I could handle whatever G-d sent my way, but seeing our three daughters suffer is unbearable.”
Dovid’s story is not as unusual as one might think. Together, we spent time trying to figure out how to get Shiri to at least join us for a session. My hope was that once Shiri and I met, I could help her get over whatever resistance she had to helping herself. But first we had to get her through the front door. Dovid tried various strategies, but ultimately it took a threat to finally achieve our goal.
Shiri made no secret about being forced to show up in my office. She didn’t try to camouflage her reluctance about speaking to a therapist. I tried to help her feel comfortable and secure. I thanked her for showing up and inquired why she was so opposed to speaking to me.
Shiri replied, “I know Dovid probably described me as a very sick individual. I’m not. Yes, I can get depressed at times. Sometimes it can last longer than I would like. But I’m not any different from my older sister, my aunt, and I’m told, even my grandmother. It just runs in our family and we deal with it. Dovid once used the term mentally ill to me and I still haven’t forgiven him. Regardless, who said life is supposed to be easy? I’ve learned how to fake it in public and I do the best that I can. But I’m sure many people have their ups and downs like I do, and life goes on.”
When I asked why she thought Dovid felt so strongly that speaking to a therapist and exploring medication was not just a good idea, but a medical necessity, she responded, “Dovid and his family have been blessed with easy-going natures. He doesn’t understand that many people in the real world are struggling with something. I have friends who suffer greatly from anxiety and even worse ailments. That’s life. We manage.”
I asked Shiri if she thought whether any of her friends might be in therapy or on medication to soften the edges of their chronic condition, to which she replied, “I would never discuss such personal matters. People don’t talk about these things.” “And why not?” I asked. And that’s when the dam burst, and after many tears and tissues, Shiri began to share her feelings of shame and embarrassment that she has felt ever since she realized something was off with her.
Though it was painful for me to watch Shiri’s discomfort, I was thrilled that, for the first time in her life, she was able to share the grief and agony that came from suffering from depression, and the guilt she suffered as a result. She was dealing with a jumble of emotions, from anger to grief to fear. There was a lot to unpack here, and I knew it would take a while for the two of us to sort it out. But I also knew that I had won Shiri over, and that she would continue to see me for many months to come.
At this point, Dovid took a back seat, returning to my office only occasionally. Shiri became my primary client and we met often. We explored the difficulties of her life, her sadness over having missed out on so much joy, and her feelings of humiliation at having an illness that required talk therapy and medication. Ultimately, our greatest challenge was helping Shiri accept the fact that having depression was not her fault, that it was a result of genetics, and it would help her and her marriage if she took medication to regulate it. Her resistance was not unusual, and took a great deal of time and gentle persuasion until she finally agreed to speak to a psychiatrist to “try it out.”
Once Shiri’s doctor found the best protocol for her, she felt like a new person. And like many other people with similar journeys, she wondered why it took her so long to get help. Interestingly, Shiri overcame her initial embarrassment to eventually become an ambassador for mental health awareness, promoting therapy and medication to anyone she thought might be able to benefit from such treatment. As the shame fell away and her gratitude increased, Shiri and Dovid were able to enjoy each other and life in a way that would have been impossible before as the dark, oppressive cloud lifted from her shoulders.
Esther Mann, L.C.S.W., is a psychotherapist in Hewlett. She works with individuals, couples, and families. Esther can be reached at 516-314-2295 or by email, firstname.lastname@example.org.