Counselor, stifle thyself

How do I write about my quietly subversive and duplicitous relationship with psychiatrists, without jeopardizing my present and future relationship with them? I am not against psychotropic drugs. While I do believe in the potentially higher quality and greater staying power of psychotherapeutic healing, I am no purist. These drugs enable greater functioning, sometimes save people’s lives, and often make them feel different, or feel less, which is usually what they mean by “better.”

Maybe the biggest axe I grind comes out of the conflict between my therapy approach and medication’s and psychiatrists' effect on clients’ attitude about it. Simply put, a number of clients stop coming to see me after they’ve been started on depression or anxiety meds. They don’t ditch counseling when taking antipsychotics and bipolar meds. Why is this?

I will offer to work to mitigate depression and anxiety through depth process. This means digging to the roots and reasons of pain, sometimes staying with and working and crying through childhood agony. Medicine on the brain makes that drastic stuff feel unnecessary, and maybe distasteful. I remember a young man, in 1999, who felt at all times a moribund depression but prepared for therapy – and much of his day – by presoaking in marijuana. By session time he hadn’t the slightest interest in any emotional work: His depression – already a repressive entity – was given a dirty pink coat of paint by the chemical mellow. There was no work to do.

With psychotic and bipolar clients I rarely offer to try to undermine their disturbance, for different reasons. Bipolar is, per Alice Miller, a double-defense package (“grandiosity is the defense against depression, and depression is the defense against the deep pain over the loss of the self that results from denial”*), and so is more deeply entrenched than most mining can reach. Plus, clients are even more likely to believe the biological, not psychodynamic, theory of mania: It looks “chemical.” And while psychosis should, I believe, also be understood to have causes in childhood tragedy,** it is too desperate a problem for community mental health – with its thin walls, concrete Objectives-based treatment plans, easy-listening culture and creamy strength-based mission statements.

I’ve said “I will offer to work to mitigate” depression and anxiety. Often, admittedly, the process will in time moonwalk from sublime to pedestrian if the client proves unable or unwilling to “go deep.” When it does, counseling remains acceptable, does not goose the sleeping giant of medication effects. But it’s in the interim zone, when he or she is in a place of disturbing discovery – first efforts to peel the onion – when the allure of chemical amelioration can turn heads, and leave me an empty chair.

I can’t and don’t confront the psychiatrist about this wrong done to a client. Obviously He, the doctor, is master of the mental health universe. And, She is so lofty not to be ruffled when I occasionally mention published cautions about Paxil withdrawal, or the need to monitor one’s own medicated feeling, or in a reckless moment cite Breggin’s “chemical straitjacket” or “involuntary intoxication,” a concept that has exonerated perpetrators and punished pharmaceutical companies in criminal cases. And yet . . . walking this line, after so many years I have finally come under fire. A perfect storm occurred where my loose lips, the client’s impressionability or ambivalence, and a doctor’s disdain for depth psychotherapy, all collided.

Out of the blue, good therapy clients would consult with the doctor and come away condemning child focus or Empty Chair or my tendency to give information, sometimes at length. Disclosing painful stories of their mistreatment by parents, they would complain to the nurse practitioner or psychiatrist that I had determined their parents were faulty. The weeks or months of complex, heartfelt, empathic and eye-opening process would disappear, replaced by their lamentation about therapy. I could not understand how people I had served with intense effort would, in a sense, betray me – until I discovered the three-fronted storm.

I feel, wanting to be powerful and therefore to have agency, that I brought this on myself. A minority of people want to fight their human nature, which is to be solved and soothed quickly. Psychiatrists may allow but not embrace psychotherapy whose implicit requirement is – be open to feeling, not medicated against it. In the future I will suppress my meds talk but for some basic theory that says “feeling is healing.” And if I ever challenge the doctors again, it will be after I win the lottery.

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* Alice Miller, The Drama of the Gifted Child, 1997 edition, p. 34.

** See Modrow, Breggin and Harry Stack Sullivan, R.D. Laing, Theodore Lidz – the old guard.