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The Recovery Industry

I've written elsewhere about the fact that I am a survivor of childhood sexual abuse and have been treated for depression in the past. As a result, I had an extended experience with the recovery industry in the United States. I have real problems with many aspects of that industry.

I would hate to see anyone read my concerns about the recovery industry use those concerns as another excuse to delay getting help for mental health problems. Please don't. I do hope that anyone reading this essay will be a more informed consumer and simply be more aware and proactive in seeking mental health care.

When I first sought help in 1988, I simply went to a practice recommended by other people in the organization for which I worked. The particular psychologist I happened to see in the practice was determined by the fact that he was the one who had a weekly slot available on his schedule. I didn't think about shopping around or trying different therapists to see which were best for me. I thought of going in for therapy about the same as going in to a medical doctor to get antibiotics for strep throat. Unfortunately, I had no real rapport with the therapist. Going to see him weekly turned in to just another thing I had to do each week. It was a hassle, not a help.

The psychologist referred me to a psychiatrist in the practice who saw me once, didn't take a medical history of any sort, and prescribed an antidepressant, a tranquilizer, and a sleeping pill. I later learned from a pharmacist that the three particular drugs he prescribed are countraindicated if taken together, but obviously I didn't have a very attentive pharmacist at the time (or a competent psychiatrist). That same psychiatrist later switched me to another antidepressant that is also used to treat people with high blood pressure, which led to a hospital visit for dangerously low blood pressure. (My normal blood pressure was 90/54, something he didn't bother to notice.) He didn't even respond to the calls from my family doctor, who admitted me to the hospital, so I never went to see the psychiatrist again.

Through trial and error, I did learn that I relate best to female therapists, and that I needed one who would be blunt with me if she thought I was avoiding some issue. I learned that group therapy is utterly useless for me, because I'm very good at redirecting attention from myself to someone else in the group. I learned that I am most comfortable with a therapist who shares, or is at least very sympathetic to, my spiritual beliefs, so that I can be open without being defensive.

I ran into trouble as soon as I made it clear that I do not do twelve-step groups. I tried a few meetings, found that I have a nearly irresistible urge to make fun of the rhetoric and just about everything else associated with them when I'm there, and decided that they are not for me. I quickly learned that twelve-step groups are taken for granted so much by some people in the recovery industry that anyone who isn't a twelve-stepper is regarded as being unwilling to work on getting better. It doesn't really matter if that person is an addict of some sort, has been abused, or suffers from depression or PTSD or whatever. If you're in therapy, some people expect you to twelve-step. It's like always having fries with your fast-food burger. Twelve-stepping, no matter how useful it is to some people in some situations, is not applicable to everyone in every situation. For those of us who don't follow a traditional (or any) spiritual path, the language of twelve-step programs is troublesome. I personally believe that particularly for abuse survivors, the whole business of doing a personal inventory of those we have harmed is ridiculous and feeds into the negative suspicion that somehow we deserved to be abused.

Finally, some therapists and others in the recovery industry don't ever foresee a time to end treatment. Even if a patient is functioning normally and no longer experiencing the problems that caused her to enter treatment in the first place, some psychologists and others regard any attempt to end treatment as signs of illness. Yes, there are people who end therapy too early. Once you're functioning and don't have new issues to work out, I think it's time to end the therapy relationship. Yes, you might need more treatment later if new issues come up. There is a time to be finished, though, even if the therapist does still have a high car payment or has just signed a new mortgage.