by Andrea Vassilev Chair of DBSA California Education Committee
I adored my peer support group. I loved seeing the same friendly faces every week, connecting with them through shared experience and helping to foster hope and well-being. I was a leader, a trainer and, briefly, the CEO of our charity chapter.
But eventually, I had to stop attending and facilitating. I had referred too many of my clients to the group — and me showing up would have created a massive conflict of interest and dual relationship. No one wants to see their therapist in a peer support setting.
The irony of my situation is that my work as a peer support leader is what led to me beginning my journey in a doctoral program in clinical psychology. I found such joy and success in those early peer meetings that I wanted to make it my life’s work.
I’ve succeeded at this, becoming an active member of groups such as the International Society for Bipolar Disorders and presenting at national and international conferences. I have developed and deployed an original program to address self-stigma in bipolar disorder. But five years later, working as a therapist under my supervisor, I’m still fleshing out the nuances of inhabiting both sides of this space: peer and clinician.
Being a Peer and a Clinician Is a Balancing Act
As a peer, I have 25 years of lived experience with bipolar disorder. As a clinician, I have a thorough comprehension of the causes, correlates and treatments for this mental health condition. As a peer, I write, speak, and share regularly about my own experiences. As a clinician, I often keep that under wraps. I can be both — but sometimes, it’s hard to be both at the same time.
I continue to grapple with the tension between the two: how to be taken seriously in both realms without seeming like a traitor or phony to the other. My Instagram profile is a study in contrasts: I share both clinical knowledge and coping skills alongside stories of my own struggles and survival. It’s a bit of a unicorn, but it’s the truth of my situation.
Lived Experience Has Taught Me How to Be a Better Provider
My experience with mental illness is what makes me an effective clinician to treat it. As someone with both personal and professional intimacy with the disorder, I have a unique understanding of what the condition is, how it feels, how to align with my clients and what they need to hear or experience to live their best lives.
It’s impossible to convey the painful realities of bipolar disorder to someone who hasn’t experienced it. A clinician who understands the use of medication through textbooks won’t necessarily be sympathetic when you want to stop taking it due to side effects. This is along the lines of what therapists call “use of self” and, when done properly, it can be incredibly powerful.
Embracing Strategic Disclosure
I don’t immediately share my diagnosis with new clients. On the contrary, many of my clients don’t even know I have a mental health condition. They don’t have to know my history to reap the benefits of my personal experience with common symptoms such as depression, anxiety, and intrusive thoughts.
As for my clients with bipolar disorder, I don’t necessarily disclose my diagnosis. However, if I choose to share, it typically comes up in the context of talking about stigma. I have found that clients often range from feeling uncomfortable with to ashamed of their diagnosis. They have to swim out of the quagmire of self-stigma before they can start to understand the condition as just one piece of their life’s experience. That’s where a little disclosure can be worth its weight in gold.
Not only is that kind of shared knowledge a boon to the therapeutic relationship (“Wow, you really get what I’m going through!”) but it helps to lessen the power of self-judgment. Seeing others whom you respect (and hopefully my clients respect me a little) survive and thrive with the same condition fosters hope — the same kind of hope one might experience in a peer support group.
That’s not to say that my sessions become peer groups — far from it. I keep my disclosures very basic, usually just my diagnosis. To share more, one of two conditions must be met: either it will be of great benefit to the client to share more specific information or it’s in response to a direct question that, again, I believe it will help to answer.
My ultimate goal and priority is always the well-being of the client. But if a client asks if I’ve ever experienced the same manic symptoms as they have, I’m going to be strategically honest. There’s an inherent disconnect between patient and clinician experiences, and it’s one that I work tirelessly to bridge.
Ultimately, I couldn’t be more grateful for my 25 years of lived experience. They make me the human, and therefore the clinician, I am today.
Andrea Vassilev is a fifth-year doctoral student in clinical psychology and a student therapist specializing in the psychological treatment of bipolar disorder. She is the creator of the original program Overcoming Self-Stigma in Bipolar Disorder (visit www.ossibd.com). She is also a dedicated peer advocate, speaking and writing passionately about her lived experiences and mental health topics. Instagram @andrea.vassilev
It’s been thirteen years since I took two vials full of lithium and Lamictal and chased them down with a bottle of wine. I felt I had gotten the “go-ahead” from Jesus, with whom I was conversing at the time. We had been having regular conversations since I was a child, trying to remove the nails that bound Him to a crucifix in my grandparents’ old bedroom. Then, I had wanted Him to rescue us from the lower-case him in our home.
I was beyond rescue at this point. Two abusive relationships and one rape in, my childhood mantra that “things will get better” had long grown stale. This was not my first attempt, but I was determined to make it my last. After my first attempt three years earlier, an ER doc told me I would have had to take an entire vial of each of my meds to succeed. (I’m pretty sure “succeed” wasn’t his choice of words, but I felt I got the gist.) Vials on hand and what I thought were neatly tied conversations, I was ready to embrace the silence.
I woke up convulsing, panicking, looking for the kitchen phone that no longer existed. It did not come to me that my cell phone must have been nearby. I remember the moment briefly, when the only presence speaking was mine. I didn’t want to die.
I woke up again, but this time in the ICU, hooked up to a dialysis machine. It seemed no vein was left untapped; I was entangled in cords. I did not get myself to the hospital. (As I was later informed, I had passed out in a pool of vomit.) Someone who long ago forfeited being any measure of a “friend” (I said I wasn’t ready. Did he not hear me?!?) “had a feeling,” which set in motion actions that resulted in my being there. I snapped a selfie with my shitty flip phone. “Do not try this again,” I captioned it inside my head.
Time was a blur. I had no idea how long I had been there, but my father and sister had made the trip from Florida. My college friends added their names to a dry-erase board, as did my high school best friend. None of this guaranteed permanence in my life. Within the month, I’d lose a huge part of my heart, of which the scars remain. But I didn’t know that then.
In the ICU, I decided I would never try to kill myself again. I didn’t want anyone to have to explain my actions to their children, including my nieces, including another that felt so close to being my own. I didn’t want anyone to feel the type of aching void I had felt. But, more than anything, I made peace with God that my existence mattered.
I continue to share my story to let others know they are not alone in this world and that despite the worst thoughts that come into their heads, their lives are worth living. YOUR LIFE IS WORTH LIVING, AND I’M SO GLAD YOU’RE HERE.
Governor Newsom, as most people have heard by now, has proposed a vast new program called CARE COURT.
In this proposal, individuals with mental health challenges or substance use disorders are forced into a new Court system instead of treatment. And those who are unhoused/homeless are forced into that same Court system instead of providing housing for them.
CARE Court constitutes forced treatment: any behavioral health service, support, or treatment that is not entered into 100% voluntarily with informed consent by the participant. Forced treatment can occur in both inpatient and community-based treatment settings. Coercion or force can also take the form of perceived coercion—fear by the individual that noncompliance will result in compelled, forced, or court-ordered treatment—often referred to as “shadow compulsion” or “the black robe effect.” Coercion can also be present if an individual fears they will lose housing or other services if they do not accept treatment. Providing individuals with a petition, subpoena, ticket, or other legal documentation that compels their attendance before a judge is forced simply because there is nothing about a court that is voluntary. Judges, lawyers, or court orders is what all involuntary programs have in common. The fact that an individual is mandated to accept outpatient community-based care, in programs like CARE Court, does not negate the fact that the care received constitutes forced treatment.
It is clear that coercion is counter-productive, and in fact causes trauma – which makes the situation worse than ever by traumatizing the patient, rather than helping them.
AND GOVERNOR NEWSOM KNOWS THIS. Here’s what he wrote just last year in his veto message for AB 1452:
“I understand the importance of developing programs that can divert individuals away from the criminal justice system, but coerced treatment . . . is not the answer. While this [program] would give a person the choice between incarceration and treatment, I am concerned that this is a false choice that effectively leads to forced treatment. I am especially concerned about the effects of such treatment, given that evidence has shown coerced treatment hinders participants’ long-term recovery from their . . . disorder. For these reasons, I am not able to sign this legislation.“
The governor needs to think back a whole year and remember that he opposes forced treatment. . . remember what he said were his core values and STOP Care Court.
Drugs can change mood. Just ask your pot-smoking friends. Marijuana often results in worried people worrying less! This doesn’t mean that cannabis “cures” anxiety or that those who smoke weed and feel calmer had anxiety disorders to begin with. It just means that drugs can alter mood. Thus, even if antidepressants can elevate sad people’s moods (and there is ample evidence suggesting they might, at least somewhat), this doesn’t necessarily indicate that the original depressed mood was a product of neurological illness. So, feeling better when on antidepressants isn’t automatically indicative that you suffered from a mental disorder before you started taking them. It just means that some drugs can improve mood.
My story begins after the most stressful work meeting of my life. I drove home after the meeting and parked my car at around 10:30 am outside my San Francisco apartment. I paused to collect my thoughts for a few minutes, but when the sun started going down, I realized I’d been sitting there for six hours. During that time, I struggled to remember what had just happened in the meeting, but the more I tried to remember, the more memories of things that couldn’t possibly have happened started to fill my brain. Memories of things like seeing people die, of being sued, of being interviewed on CNN. Unbeknownst to me, I was experiencing the onset of schizoaffective disorder, bipolar type.
Eventually, enough of these fake memories filled my brain that I became convinced that a team of psychologists had assumed control of my life and was experimenting on me against my will. I believed that they controlled every circumstance of my life, and I believed everyone around me was a paid actor being fed lines by the psychologists. I thought even my own parents were wearing teeny-tiny earbuds through which the psychologists were feeding them lines. Except, of course, on the few occasions when I thought my parents were robots.
During the ten months I believed this, I talked to myself on the street like every stereotype of a schizophrenic homeless person you’ll ever come across; I picked other people’s used cigarettes up off the ground, put them in my mouth, relit them, and smoked them; I broke into houses and cars; I got tackled by police officers; and I got sedated by injection against my will four times.
My 10-month bout of psychosis came to an end all at once after several medication adjustments greatly reduced the number of signs and clues from the psychologists I was seeing in my surroundings. One day I bit the bullet and googled “characteristics of schizophrenic delusions,” and I realized it fit what I was experiencing to a T. In that moment, I went from being the future president of the United States as my delusions had me believe I was, to being a member of a marginalized population.
The initial stages of my recovery were the most difficult, as I experienced rejection from some family members and was given a pretty grim prognosis from doctors. But I beat the odds and made a full recovery, and what’s more is that I found healing through advocacy work. I began to speak publicly about my struggles, and it felt great to not apologize for who I am, mental health condition and all. I also became a support group facilitator, and I’ve found it rewarding to help others on their own mental health journeys.
Though it’s certainly been trying at times, I’m grateful for aspects of my journey. Because of my schizoaffective disorder, I’ve found a greater purpose in life advocating on behalf of those with similar challenges. I hope that my story can give them hope in a world in which people like us don’t have nearly enough role models.
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