How Clinicians Failing to Recognize Dissociation Nearly Killed Me
If you experience suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741.
When I first asked a doctor about mental illness, specifically depression, I was 17. I had grown up in a world where mental emotional problems were treated as spiritual issues, and had interpreted my mental illness symptoms as signs of a spiritual defect or lack of faith until that point. In actuality, my earliest years were traumatizing in ways that would affect me for the rest of my life. It would take me 10 years from the first time I asked a doctor about my mental health to discover this truth.
I was diagnosed with depression and anxiety by a general practitioner after little assessment of my symptoms. He did not use the depression or anxiety quizzes, which I am now very familiar with, nor ask me follow-up questions about the symptoms I reported, nor did he issue a referral to a mental health professional. At the time, I didn’t know about my patient’s rights to ask for a referral, or even the right questions to ask about the medication he prescribed me. I simply accepted his assessment and the prescription and tried to feel better.
This general practitioner, and the majority of clinicians afterward, took me at face value. As I’ve read on several of my clinical assessment reports, I appeared well-dressed, calm, and even friendly. I appeared well-spoken, direct, and clearheaded. I presented as a mildly distressed, “high-functioning,” mostly pleasant person. It never occurred to these general practitioners, or many other clinicians, to contrast what I was actually saying with the way I appeared. They simply dismissed my concerns because in their view, a calm person was a stable person, a clearheaded person would not attempt self-injury or suicide, and a pleasant, friendly person like me wasn’t going to become a problem for them.
Despite reporting high degrees of distress, deep depression, unbearable anxiety, increasing self-injury, and a well thought out suicide plan, I was never treated with the concern I felt I deserved. I was assessed as being stable, provided with the same useless pamphlets, and dismissed from crisis services several times during the period when I was at the highest risk of attempting to end my life.
I would ride the bus home feeling numb and hopeless, and I would contemplate my options. Clearheadedness seemed to be a reason they believed I wouldn’t attempt suicide, but I knew when I was clearheaded was when I was at most risk. I wouldn’t attempt during an emotional moment, as they had implied. My plan included being calm, lucid, and intentional. However, if I tried to kill myself, my loved ones would be in pain, and if I didn’t succeed, we would all be in pain more than I already was in the current moment. But if I didn’t at least attempt, I couldn’t see how I would be taken seriously or offered the kind of supports I knew I needed. At my lowest point, I even considered violence against strangers as a last resort to accessing some kind of clinical help for my increasingly severe and distressing symptoms.
It didn’t seem to matter how accurately, how detailed, or how long my descriptions of my distressing symptoms were. They were witnessed through my calm and clear dissociated state, and therefore they were invalid. The survival mechanism that had served me so well inside the isolated and authoritative world of my childhood was now harming my chances of getting support. The same part of my brain that hid my emotions and vulnerability from abusive authority figures was hiding the rawness of my distress from healthcare authorities. There was no way for me to turn it off, even once I realized what was happening. At this realization, I felt destroyed.
Once I learned I wasn’t doing anything wrong, that these clinicians had simply disregarded one of the most common symptoms among childhood trauma survivors, my anger slowly turned away from myself and toward the medical model of mental health. I felt so much rage toward my doctors, the crisis center workers, and the entire health care structure itself. They had been trained to ignore me, rather than trained to look for me. Even when I sat in front of them, rattling off paragraphs of symptoms they could have found under numerous diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM), they couldn’t be bothered to investigate me, diagnose me, or treat me. I was left on my own during the most intense years of my suffering because I was capable of communicating clearly while I struggled.
These days, I am highly critical and avoidant of clinical mental health services. During the time I was abandoned by them, I discovered models of therapy and recovery that work for me, models which are not used in the health care system where I live. I still carry plenty of anger and bitterness around these experiences, and I still dissociate, whether I want to or not, to protect myself from health care professionals when I’m forced to interact with them. The trauma clinicians caused me by dismissing my cries for help only increased my internal need to protect my emotions and traumatized parts from health care professionals. Even if I meet someone I like and want to trust, the best I can do is let them know it’s not personal, that my mind and body refuse to fully trust anyone working for the system.
Now, I am well aware my mental health issues stem from trauma in early life. Now, I have a good grasp on how trauma has impacted me during various stages of my life. Now, I have helpful strategies, therapies, skills, and communities to rally around me when I am struggling. But I had to find all of this on my own. And while there is a lot of pride and feelings of accomplishment that come with doing this on my own, I am still hurt. I am deeply saddened by how I’ve been treated, and I worry about people like me, people who dissociate, and how they are being treated when they ask for help.
Unsplash image by Janko Ferlic