I am a trauma survivor who has been repeatedly failed by therapy. I am also a trauma therapist questioning if I want to stay in the field given how harmful it can be. Do I want to be part of a system that causes harm, even if I hope that I’m doing my own very small part to make a difference for those I work with?
Recently I was medically hospitalized for 11 days. A psychiatric consult was called for medication, as well as my ongoing depression and suicidal ideation stemming from lack of access to care over multiple years. My request to the psychiatric and social work consults was to help me find providers in the community, which I identified as my biggest need, and was told no. They straight out told me they only cared about what happened while I was in the hospital. What they offered me was SSRIs, which have never provided me any relief (trust me, I wish they did). They asked if I was sure I had taken them long enough, and at a high enough dosage, seeming not to believe me when I said that I had done so, repeatedly. Given that I have taken multiple types of antidepressants, mood stabilizers, and antipsychotics (along with three separate rounds of bilateral ECT and ketamine infusions), I found that insulting and not helpful.
Why did they find the need to question my integrity and knowledge about my health and medical history? None of the medical doctors treating my medical condition that landed me in the hospital questioned or indicated disbelief in my responses, even when asking for narcotic pain medicine. It was provided, without an issue. Only psychiatry treated me with suspicion and distrust.
Now that we’ve cleared up that I am not going to take any SSRIs/SNRIs, or any type of medication that has not worked for me, the psychiatry team moves on to asking if I want to go to inpatient psych after the medical issues are cleared. I had communicated from the start to the medical team that I was absolutely terrified of being treated as a psych patient and potentially committed. I was fortunate that the nurses advocated for me and that the medical providers saw my distress as part of my medical condition having gone untreated for years.
Rather than do what I asked, help me find outpatient providers or listening to me, the psychiatric providers came in with their own agenda and bias. I found it so triggering and dehumanizing that three times after they saw me, I asked the nurse for my rescue medication…to help me sleep because they made me feel so unsafe. The providers charged with caring for my mental health triggered it and made me feel suicidal. I finally asked that they not interact with me again except when absolutely necessary about the change to a medication for PTSD flashbacks.
Contrast that with the care that I received from the interfaith chaplain.
I grew up Roman Catholic, but am now Unitarian Universalist. The chaplain visited with me three or four times, about the same amount of times as the psychiatric providers. But the difference in approach, in care, and in impact, could not have been more different. She had no agenda or preconceived notions. She simply sat with me and listened. She bore witness to my distress and pain. She validated my reality and met me where I was at. She saw me as both a human being, a person in distress and a spiritual being. She tended and ministered to my whole being. Every interaction I had with her I felt genuine support and care. I felt seen, nourished, and validated. She didn’t have any answers, she didn’t have solutions. There was no need for them. Just truly listening and being present provided more relief than any SSRI or psych visit did for me.
I’ve thought about this difference in care since returning home. It’s made me strongly consider leaving the field for good, especially as I’ve been on extended medical leave. Perhaps I should just not return. I began to think about what was the difference; what is pastoral/spiritual care getting right that psychiatry and mental health are getting so wrong?
I realized it came down to a very simple difference. Psychiatry and social work were the only providers who did not treat me with a basic degree of respect and personhood, someone with the dignity of knowing my mind and body. They looked at records and made decisions based on those. They did not take the time to get to know me. It was paternalistic care, where the only input I had was to say no (and I was fortunate to maintain that right). There was no collaboration. This was a huge contrast with the medical team, who actively acknowledged my intellect and knowledge, and made me a partner in my care, in a realm where they did have more knowledge than me, but recognized my autonomy. The psych team by contrast treated me as the problem for not blindly trusting and agreeing with their plan of care, which was developed without me.
I finally realized that psychiatry and mental health have lost their humanity, whereas pastoral care has retained it. Mental health care now has an agenda, whereas pastoral care had none. In mental health care, you have to codify distress, problems, and goals. You have to demonstrate progress, or lack of progress, and what will be changed to create progress. Insurance puts a premium on solutions and evidence based care. This tends to be things like SSRIs or specific types of therapies. You have to demonstrate the medical necessity of treatment in every single session. As a therapist and as a client, I loathe having to do treatment plans and goals, which typically happen on a quarterly basis. A general plan is good, a road map, but rarely in trauma treatment is it a simple straight line. Goals and treatment organically change based on the need of the client in any given session. The relationship and collaboration on the journey are what
matter, not a SMART goal.
For years the mental health field has tried to eradicate stigma by insisting that mental health care be treated like medical health care. I think it was a grave mistake, one that has set the field back years. Often times students in divinity school or seminary shadow a mental health clinician as part of their studies or practicum. My recent experience has me thinking it should be the opposite, that clinicians should be shadowing chaplains. As providers, we are taught to do – do something, usually measurable – to help fix distress. And yes, there are measurable things that can be done, like make phone calls to help find outpatient treatment. Offer an SSRI. But often in times of crisis, of grief, of trauma or medical illness, what is needed more than anything is compassion and bearing witness. To be with, not to do. It is something I struggle with as a provider, I want to be able to fix, to offer some form of relief. What a lesson for me, that the relief I sought didn’t come from doing. It didn’t come from healthcare. It came from an interfaith chaplain, who graced me with solidarity, witness, and presence. She provided strength by doing so. She saw me, as a person – a whole person. She didn’t see me the way psychiatry did, which was a broken person incapable of making my own decisions.
Where do I go from here? I’m not sure. It makes me even more trepidatious about seeking mental health care and support for myself. It makes me yearn for a revolution in my field, to eradicate the paternalism and pervasive sense of distrust clients are so often met with when seeking help. The change needs to happen within the field itself, we need to respect clients as whole people, with rights and dignity, as the authors of their own stories. Our various governing bodies need to radically change how we are paid and how insurance is billed for services. They need to change the justifications and rationale for care. Sometimes the best care is sitting with someone as they are alone in the darkness. Never underestimate that power. Mental health providers need to look at what we’ve lost over the years about the art of healing. It is possible spiritual care and chaplaincy could shine a light on the way back.
Postscript: I ended up back in the hospital for a night of observation. I was offered social work services, but declined. I asked for the chaplain, who was the sole individual to treat me as a whole person, not someone broken. It was a full circle moment in how broken medical care has become.
