In 1992, I went shopping. I interviewed a psychiatrist, a psychologist and a social worker for the privilege of becoming my next therapist. The psychologist, Paul M. Cohen, Ph.D., won and we worked together mostly twice a week for the next fifteen years. Paul was ten years younger than me, had attention deficient disorder, and had gotten kicked out of the state psychiatric center, too. (In the course of his employment, Paul had taken a kid to jail to see his mom, an act of which the system did not approve.) Ours was a match made in heaven or someplace nearby. Paul was smart, well-read, enthusiastic, kind, funny, patient and loved to talk. I voted him “Person Least Likely to Bore Me to Tears If Trapped on a Desert Island With,” and we proceeded well together.
Social Security Disability income relieved me of what had become the impossible burden of employment, and case management picked me up and put me in a supervised apartment, so I managed some kind of moderate stability. I volunteered with the Mental Health Association, a private, nonprofit group that tried to assist us crazies by being really, really nice to us. Not a bad idea in theory but not particularly effective either.
And I took pills. I took dozens of pills, tons of pills, antidepressants by the truckload. I was depressed, and a compliant patient: I did what the doctors told me to do.
Then my fortune underwent another major change. I overcame my nationalistic prejudice enough to become a patient of an Egyptian psychiatrist, Dr. Nasri N. Ghaly. Dr. Ghaly was younger than me by six months but he always referred to me as “a young woman.” He has a wise, old soul and treats people with respect and kindness. His alternate career would have been the priesthood. The two most extraordinary things about Dr. Ghaly are that he listens to his patients, and he selectively trusts them.
Dr. Ghaly treated me with the standard antidepressants and repeatedly admitted me to the private hospital whenever I got too suicidal to maintain myself, which was increasingly frequent. We began to discover that the antidepressants were making me suicidal but we didn’t learn the lesson—we just did what everybody else does: when I reacted to one antidepressant, he’d switch me to another. When there were no new antidepressants left, he persuaded me to have shock treatment (electroconvulsive therapy [ECT]), which actually was less bad than the side effects of some of the antidepressants, but didn’t do much good either.
Meanwhile, I got a job as an administrative assistant at the Mental Patients Liberation Alliance. The Alliance was of, by and for people with psychiatric diagnoses, and it was totally radical. We opposed everything: shock treatment, drugs, doctors, therapists, case managers, hospitals, diagnoses, and the system in toto. We were in favor of “patients” being called “people” and making their own decisions; families minding their own business, and getting paid as much as possible for doing as little as we, in our disordered states of mind, were able to do. I signed the paychecks and took naps on the waiting room couch.
The job ended when a board member and I challenged the legitimacy of the director’s position. He responded by changing the locks on the doors and threatening to call the police if I came back. One of the major differences between the NYS Office of Mental Health and the Mental Patients Liberation Alliance was that at the Alliance the fights were raw, honest and out in the open.
Not long thereafter, I became one of the founders of a peer support center that was supposed to be wholly owned and operated by the “patients.” It was promptly co-opted by a woman with an eating disorder, a degree in social work and a way with men, and a case management agency that was run by men. Three of us fought a passionate fight to save the center from the system, but lost—lost essential parts of our hope, faith and trust in American justice. The center attendance dropped from seventy-eight people, who went there with gusto and determination, to twelve people who went because they had to in order to get free bus passes.
In 1999, Dr. Ghaly had his own medical crisis and was unable to practice for six months. When I became suicidal, I went to the teaching hospital where I had started out more than a quarter of a century earlier. The psychiatric resident said I had taken “every antidepressant known to man,” and the attending told me I didn’t have major depression, severe and recurrent; I had bipolar depression, type 2. The attending then discharged me without treatment and Paul threatened to sue her.
Dr. Ghaly returned to work in time to readmit me to the private hospital. I began appropriate treatment with a mood stabilizer and a mood elevator (see also: antidepressant). When my Medicare ran out, the private hospital kicked me out. Dr. Ghaly transferred me back to the Catholic hospital and noted in my chart that I was being admitted “to secure [my] safety” because I was suicidal—still or again, one could hardly tell.
Three times in six weeks I had been admitted to hospital because I was suicidal. Dr. Ghaly admitted me on Monday and went on vacation on Wednesday. The doctor covering for him was the same one I’d had in the state psychiatric center—the one who discharged me in a suicidal state. She walked into my hospital room and her first words to me in ten years were, “I’m busy. I don’t have much time. What do you want?” I asked for a pass to leave the hospital for a few hours and she gave it to me. (To be continued)