I’m a clinical psychologist in my seventies. I’ve worked as a therapist with children, adults, and families for close to forty years. I earned a BA from Yale in 1971, its first graduating class with women, and a PhD ten years after that. As a member of the clinical faculty at Yale Medical School, I supervised Yale predoctoral psychology fellows for fifteen years. In 2008, I won a Distinguished Faculty Award for my supervision. You might not guess that as an adolescent I spent most of the time from my seventeenth to my twenty-third birthday in psychiatric hospitals, diagnosed with schizophrenia and treated with shock treatment. Or, that after three years, doctors at the first hospital gave up and transferred me to another hospital, “unimproved.”
You would likely sympathize with my keeping this part of my history secret—we all know about stigma. I was proud of what I accomplished after I connected with a gifted psychiatrist and finally left the hospital. I was grateful to become a psychologist myself, so I could pass on the healing psychotherapy that saved my life. I knew I owed much of my clinical skill to my early experience, but because of stigma I didn’t speak about that. My psychiatric history remained hidden.
After practicing full time for twenty years, feeling satisfied personally and professionally, I sent for my hospital records. Shock treatment had erased almost all memory of my life before twenty, and I wanted to see what I could find out. I was stunned: all of the symptoms from my youth returned full force. I vowed that, if I recovered, I would share what I learned. Here is my story.
* * *
In May 1960, I was admitted to a psychiatric hospital for the first time. My mother had read in my diary that I was going to drown myself during a Memorial Day weekend at the beach with my high school friends. I had just turned seventeen.
I had been active in my high school. I had had leading roles in school plays, was an editor of the literary journal, worked on the yearbook, was active in the Honor Society, etc. Yet for several months prior to the admission I had been shrinking: my handwriting got smaller and smaller; gradually the differentiation between lower case and capital letters disappeared. My voice volume diminished until I was almost inaudible. I stopped speaking in the first person—I couldn’t say the word “I.”
In the hospital I admitted I wanted to die, but I was unable to articulate my reasons for this beyond saying that I was crummy and bad. My thinking and ability to express myself had shrunk along with my voice and my handwriting. All I wanted was to disappear. The hospital’s psychological testing report referred to my slipping into a quicksand-like illness… deeply depressed with suicidal preoccupations and fantasies.
Along with suicidal ideation, my symptoms included insomnia, depersonalization, and de-realization—I understand now that I was very dissociated. I was described as shy, fearful, obsequious, dependent and infantile emotionally, while my inability to express myself was identified as stubborn resistance and withholding. My inaccessibility annoyed and frustrated the psychiatrist treating me. Less than two weeks after being admitted, I was started on a course of twenty-five ECTs. I began to experience hallucinations. My nightmares increased. During the day I remained passive and withdrawn.
In the 1950s and 60s schizophrenia was a very frequently applied diagnosis. It was used for out of control, rebellious, dope smoking teenagers whose parents didn’t know what to do with them, and it was used for withdrawn, socially isolated youngsters who were depressed and suicidal. Some—like myself, although I didn’t know it consciously at the time—were fleeing abusive situations in their homes. Treatment for schizophrenia included medication, often electroshock treatment, and sometimes psychotherapy. Overmedicated teenagers were one consequence. For many of us, it was also shock treatment, which affected our brains and destroyed short-term memory. And, for me, the shock treatment itself was traumatic. I understood that ECT induced a seizure by sending electrical impulses into the brain. I figured that all it took was a slight miscalculation to end up electrocuted. As a consequence, I approached every treatment terrified; I was sure that I was about to be killed.
After several dismal months, I was assigned to a new, young psychiatrist who was lively and liked me. Slowly I began to get better. I had been admitted in May, and I returned to school to complete my junior year the following April, commuting from the hospital. I returned to live at home on an extended visit—a six month pass—in June, just over a year after my admission. That fall, I was elected President of my high school National Honor Society; I had a leading role in the school play; I was an illustrator for the yearbook; I took Honors classes. Then, less than two months into my senior year, I began to have seizures and dissociative episodes in school. I began to slip.
After about seven months at home, in January 1962, I was readmitted to the hospital intensely suicidal. My condition had deteriorated significantly. All my apparent gains from the prior year had been lost. I was given more shock treatments and deteriorated further. I began to act out in increasingly blatant, self-destructive ways.
Eventually, after three more courses of ECT—adding up to an overall total of eighty-nine shock treatments before I was twenty—I continued to lose ground. The hospital decided that they could do nothing more for me. I was identified as “unimproved.” Luckily for me, my mother’s best friend from grade school was now married to the Lt Governor of the State of New York, so I was transferred to the New York State Psychiatric Institute (PI, for short), a state hospital and Columbia’s teaching hospital. The Director of PI made clear in a letter that he was accepting me because he was required to do so, and not to hold him or PI accountable if I failed to improve—which he anticipated, given my dangerously suicidal condition and my extremely poor prognosis. By this time, I had lost almost all memory of my life prior to hospitalization. When I arrived at PI, I was twenty years old, and I could not answer the question of how many weeks were in a year.
At PI I was not given shock treatment, which was a relief. But I was assigned to a psychiatry resident with whom I couldn’t connect. We didn’t respect one another. I continued to act out—alternating between passive withdrawal and episodes of smashing my head against the wall. I swallowed glass, burned myself with cigarettes, scratched my face, bit my hands and pressed them against radiators to burn them. I held my breath until I passed out. I had nightmares and screamed in my sleep. I had lost pretty much all memory of my early years; what remained was only a global sense of fear. I was seriously dissociated, dominated by feeling completely unreal myself and experiencing the world around me as unreal as well. I thought I was evil: I hated myself and assumed everyone else did, too. I’m sure at times the staff experienced me as impossible—I was often beyond reach.
Therapy offered no help: I had nothing to say, and neither did he. The length and frequency of my sessions were soon reduced. At the same time, I was given significant medication. I’d been overwhelmingly anxious when I was admitted, and at times I was profoundly depressed. The first hospital had prescribed an early antidepressant, but discontinued everything during the last several months before my transfer. At PI I was given high doses of Thorazine—400 mg of Thorazine three times a day for years, if I remember correctly. I received extra doses prn when my anxiety was out of control.
After I had been at PI for about six months, I made a significant suicide attempt while I was home on a weekend pass. After that, I didn’t go home—even to visit—for close to a year.
In July 1964, after almost a year at PI, I was assigned to a new psychiatry resident. Stanley Heller was someone I liked and respected. I thought he was handsome and smart, and he talked to me. I felt that he took me seriously; he didn’t talk down to me or lecture me. His sense of humor matched mine. When I made stupid puns, he laughed. When I told him that evil garbage stank and should be eliminated, he told me he knew someone who looked for treasures in garbage. “One person’s stink is another’s perfume,” Dr. Heller noted, astonishing me. Humiliation and shame could be interrupted, if only briefly, by my admiration for his cleverness.
I continued to act out in self-destructive ways, but his response to me was direct and real. “What a pain in the neck!” he said once, after I had battered my head yet again. I had to laugh at myself. In the spark of a good joke, we were peers; we connected.
I had been unlucky in that I was misdiagnosed, and the treatment traumatized me, but I was lucky in that in the 1960s along with medication and shock treatment, in the teaching hospitals there was an enormous investment in psychotherapy as treatment, so eventually I was able to connect with Dr. Stanley Heller and begin to find myself.
A colleague asked me if I could explain how as a patient I differentiated the psychiatric residents I respected from those I did not. I think I can safely speak for most of us at the time when I say that I could sense which residents were afraid of patients and which were comfortable with themselves and with patients as fellow humans. The finest therapists understood their work to be a collaboration with each patient; they weren’t afraid to journey together through an unknown and possibly dangerous land. Subjectively, when I felt understood and respected, that is, taken seriously—which was infrequent—I was grateful. In return I gave that person—doctor or nurse—enormous respect. They also got my loyalty. I gave them room to be imperfect in subsequent interactions, as long as they were honest and real. Feeling understood is the essence of connection, and it is this connection that carries healing.
An example of this ability to connect comes from a set of interviews I had with Harold Searles in late 1964. Harold Searles was an internationally recognized psychiatrist, considered a master clinician, who pioneered countertransference in treating psychotic and borderline patients. At the time he was the clinical supervisor for my psychiatrist, Dr. Heller. In the first interview Searles made references to my shrinking, self-effacing demeanor and behavior on the ward and told me I acted like I wanted to be a saint. I don’t remember that interview beyond my thinking he was an uncomprehending jerk. But there was a second interview, and that one I’ve always remembered and credited—even at the time—with changing my life.
In this second interview, Harold Searles referred to my interest in being perfect—the saint thing—and then he remarked that I appeared to him like a frightened young fawn. My frozen innocence and fear made him feel like a dirty old man, he told me, and this made him feel so bad that he wanted to kill himself. One remarkable feature of this exchange, as I would later understand, is that unconsciously I had communicated, and he had received, the essence of the truth that was unknown to me at the time: my paralyzing fear was indeed connected with a dirty old man, and was driving my own obsession with suicide.
A transcript of this interaction might appear bizarre or quite inappropriate. However, for me, although I couldn’t explain it with words, Dr. Searles made contact. I felt connected and understood. The life-changing aspect was the idea that I could affect the feelings of someone else, especially a respected authority. I had caused him to feel something. For someone who felt as if she floated alone in the universe, unreal and completely without influence, this was a new concept.
I think my awareness that I had an effect on other people began my healing. I experienced myself differently. I observed myself interacting. I developed an interest in what I was doing and why. It was the beginning of insight. Working with Dr. Heller, who had laid the groundwork and whom I trusted as my guide, I was on my way.
Toward the end of that second year at PI, when the July rotations were approaching, I realized that I might possibly remain Dr. Heller’s patient if I got my behavior under control. I managed to succeed well enough, and I remained his patient through the rest of his residency. A year later, I knew I had to be well enough to be discharged in order to continue to work with him after he left PI and opened his private practice. I moved out of PI the day before my twenty-third birthday, about six weeks before July 1. Dr. Heller and I continued to work together for the next five years.
As a patient in a state mental hospital in New York in the 1960s, I was eligible for state services, and through the Department of Vocational Rehabilitation I was sent for psych testing. Although still diagnosed as schizophrenic, I was considered bright enough for college, so they financed my schooling. The next year I began college at the School of General Studies, Columbia’s adult education program.
At General Studies I met the man who was to become my husband. We fell in love after a courtship developed from our intellectual kinship: we reveled in discussions about our sociology class and the concepts and theories we were learning there. Two years later I married him and moved to New Haven, where he was going to attend graduate school at Yale in Sociology. Yale College was accepting transfer students for the upper classes as part of its first year as a coeducational college. Of course, I was rejected as a transfer student. However, as a Yale spouse, I was allowed to attend classes as a special student. I spent most of my junior year walking around with a giant chip on my shoulder. I should have been grateful, and in many ways I was, but all I saw were beautiful women whose applications had not been rejected, and I was envious.
Yale’s transition to coeducation was difficult, and many women left. A year later, Yale reopened admissions for transfer students. I applied again, and this time I was accepted. In 1971, I graduated with the first class of Yale women, Summa Cum Laude, Phi Beta Kappa, with Highest Honors in Sociology. This, in turn, opened further doors for me, by encouraging people to give me a chance, when other aspects of my history might have made them wary of investing in me.
I was determined to become a psychologist myself, and my journey to achieve that goal also involved serendipity, good fortune in having those who believed in me, and sheer grit and determination on my part—stubbornness, actually. I applied and was initially rejected for a graduate psychology program and then for a clinical psychology internship. Essentially, I proved absolutely determined. I refused to stop trying until directors in various programs said, “Okay, if she wants this so much, why not let her do it?” Then I did it.
For the first two years after I was married and living in New Haven, I commuted to New York City to see Dr. Heller. Then I knew it was time for me to learn more about how to be a woman, and, with his blessing, I transferred to a female psychiatrist in New Haven. She and I worked together for the next ten years, while I attended graduate school, did my internship, had my babies, and carried out my dissertation. In 1981, after twenty-one years of therapy—seventeen years of good therapy—I stopped. Three months prior to my last appointment I had a transformative experience while on the way to my session: I suddenly found myself intensely, vividly, alive and present. The depersonalization had vanished; I felt real. It was as if the world suddenly took on color when before that I’d known only shades of gray. When I terminated three months later, for the first time in my life I felt I was truly on my own. At the same time, I knew my therapist was still there for me if I needed her.
That fall, I finished my dissertation, and was hired by a child psychiatrist expanding his clinic. I joined him and his partner, the psychologist Daniel Miller, who became my supervisor and mentor. I’ve worked full time ever since, first with that practice and since 1990 in my own. I’ve spent those years learning from my patients, always trying to understand what it is that leads to people getting well.
In 2001—forty years after I had first been admitted to the hospital—I seemed to be successful personally and professionally. I had proven to myself that I had made it. But I continued to live with what felt like the shameful secret of my hospital experience and the reality that I still had no memories of my childhood—most of my first twenty years. I avoided talking about my youth, generalizing and confabulating when necessary from facts I had been told or read about myself. Only a few people knew about my history in psychiatric hospitals or my extensive psychotherapy after that. My children were grown and on their own. I decided it was time to find out about my “lost life”—I was ready to confront my past. So, I sent for my hospital records, and I read them.
As an experienced clinician, I recognized immediately what the doctors hadn’t been able to see in 1960: my problem wasn’t ‘schizophrenia’ but PTSD, connected with incest. Once I encountered the clinical reality of my early situation, I started to remember what I had assumed had been lost forever. My memory had not been destroyed by the shock treatment after all, but had been repressed or dissociated even before I was hospitalized.
Confronting the truth of my circumstances via the records profoundly re-traumatized me. I had trouble sleeping and eating, I developed flashbacks and nightmares, was beset with intrusive images, and became very anxious, subject to emotional flash floods of grief and despair. I lost interest in the world around me: I was focused only on finding out who I was and what had happened to me.
When my therapist recommended medication I reacted with rage and deep shame—of course! It reminded me of being in hospitals. After a nightmare in which I saw myself as a toddler with a noose around my neck, I was frightened enough to agree to consult with my earlier psychiatrist, who prescribed generic Celexa and Xanax prn. My gratitude for the relief I experienced was humbling. Five months later, I was able to discontinue the antidepressant. I used Xanax to help manage my anxiety for several more years, but I revealed this to no one.
My various perspectives all came together when I read my hospital records and discovered the trauma in myself in the present. I had known myself as a mature, seasoned therapist who listened to her patients with an informed, compassionate understanding of the whole organic process, accepting the painful ups and downs in the short term by holding onto the big picture. Now I also knew the immediate, pristine, existential perspective of the same woman who couldn’t believe what was happening to her in her own present life.
Today we know about body memory and could have predicted my dramatic reaction, but at the time I had no idea I could be so unsettled. I had thought that I was well analyzed and prepared to deal with anything life might bring me. In fact, I was pretty naive.
Throughout this time I continued to work full time in my psychology practice. I had my own individual therapy, and the psychologist part of me was observing and aware of what was happening to me. But the need to pull myself together in order to be present and true to my professional commitment in my office was an important part of how I survived as well as I did. Each day, no matter how dismayed I felt, I had to summon my adult strength so that I could be present for the people who needed me. I listened to patients plead with me using the same words I’d used with my therapist. At times their courage enabled me to keep going: if they were brave enough to confront their terrors, how could I not face mine?
I continued working with my skilled and experienced therapist, and gradually, over time, I emerged from the other side. My symptoms receded, and I regained an interest in the world outside myself. Some of the emotional intensity of my experience, even though it was relatively recent, disappeared, and, as with childbirth or a terrible nightmare, only the intellectual awareness that I had experienced some feelings beyond ordinary comprehension remained.
I had promised myself that if I survived, I would write about what I learned. To do this on my own terms, I had to became a credible writer. I attended my first writers conference in 2003, a gift to myself for my 60th birthday. National writers conferences, an excellent local writers group, and generous artists in impressive residencies followed, serving as my literary education.
Almost twenty years have passed since the records arrived. I continue to grow, and my world continues to expand in ways I never imagined. My writing has appeared in both professional and literary journals and in three anthologies. Essays have won prizes and been included among Notables in the Best American Essays. Seeking to diminish the stigma of mental illness, I speak to clinical audiences around the country, using myself as a case study. My talks, essays, and stories illuminate lifetime consequences of childhood trauma, harmful effects of fads in psychiatric diagnosis and treatment, the enduring impact of stigma and shame, and the power of human connection to heal. My first book, Smoking Cigarettes, Eating Glass: A Psychologist’s Memoir, won the 2013 Santa Fe Writers Project Literary Awards Nonfiction Grand Prize, selected by Lee Gutkind. It was published by SFWP in 2015.
I have found my voice.