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. As a result, I’ve had exten­sive 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 to a med­ical doc­tor to get antibi­otics for strep throat. Unfor­tu­nate­ly, I had no real rap­port with the ther­a­pist. Going to see him turned into 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 con­traindi­cat­ed 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, lead­ing 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 that 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 I am most com­fort­able with a ther­a­pist who shares, or is at least very sym­pa­thet­ic to, my spir­i­tu­al beliefs (or lack of belief) so that I can be open with­out being defen­sive. I have a long list of ques­tions that I ask any poten­tial ther­a­pist to weed out the ones who are, for me, duds.

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.