Scared Selfless

by Michelle Stevens, PhD

It wasn’t a panacea, though. I was still battling anxiety and depression—although I had no words for what I was feeling at the time. No self-awareness. I only knew that I felt awful and lost. Moreover, I was gaining weight and flunking out of school. Desperate for help, I made an appointment at NYU Mental Health. After a brief assessment, some lady in a tiny room told me I had bulimia. I was vaguely familiar with the term, though I hadn’t realized it applied to me. Again, zero self-awareness. They put me in a group that dealt with eating disorders.

  Groups were not my thing, though. People were not my thing at that time—especially girls my own age. I didn’t know how to relate to them and their seemingly white-bread worlds. When they boohooed over Mommy and Daddy’s divorce or the ballet teacher calling them fat, I couldn’t help but roll my eyes. I had come from so much violence, so much deprivation, that the problems of normal people were foreign to me.

  You’re sad that Daddy doesn’t call you as much since he got a new family? Try not having a father at all, even on your birth certificate. You’re upset that Mommy suffocates you? Try having a mother who throws shoes at your head.

  I realize now that I was being terribly callous. My parents had never shown me empathy, so I was incapable of feeling it for others. Instead, all I felt was jealousy, anger, and contempt for these girls and their perfect little lives. I also felt shame because I knew that deep down I was way more fucked up than anyone else in the group. My family, my life experiences, my mental health problems were so extreme that I felt like an alien. The other girls started to make friends with one another and get better. I just got more depressed.

  The facilitator of the group noticed. Dr. Taylor was a psychiatry resident at Bellevue who also worked at NYU. I don’t know what, specifically, made him flag me. But one day he pulled me aside and said the group wasn’t a good fit. He offered to see me privately for psychotherapy. Sure. Why not? He seemed like a nice enough guy. A few days later, I found myself walking east on Twenty-ninth Street toward the infamous Bellevue Psychiatric Hospital.

  —

  BELLEVUE, CIRCA 1986. What can I say? It made the place in One Flew Over the Cuckoo’s Nest seem like a resort. Outside, it was an old Gothic building. The grimy windows were covered by metal bars, and there was soot an inch thick on the crumbling stone walls. The place looked like it hadn’t been cleaned since it was built two hundred years ago. No one had bothered to tend the grounds either. The sorry shrubs were either overgrown or dead, and there were more weeds than cement on the sidewalk. Off to the side of the building, I found a nondescript door with a small sign that read OUTPATIENT SERVICES. I entered to find a dimly lit waiting room with flickering fluorescent bulbs, broken plastic chairs, and cracked linoleum floors. It felt like the set of a horror movie. Some nurse-type women were behind bulletproof glass. They gave me a couple of forms to fill out and told me to pay seven dollars. I sat down in one of the plastic chairs. In front of me was a wild-haired old woman yelling at no one. To my right was a twentysomething guy who kept twitching and smelled like urine. For a girl from the sticks, Bellevue was shocking.

  Shit, I thought. If I’m here, I must be really nuts.

  Eventually, Dr. Taylor came out to fetch me. I followed him through the foul-smelling hallway to his office. I don’t remember much of what we talked about, just that it felt awkward. At some point, he told me I felt “sad.” This was news to me. I mean, I didn’t want to cry or anything. My problem was that I felt nothing at all. But he said I was depressed and gave me a prescription for the antidepressant imipramine. After filling my prescription at the Bellevue pharmacy, I walked back to the Seville, stopping at a deli along the way. I took a bag full of junk food back to my hotel room, downed it, and threw it up.

  In the following days, I continued to do the same. The only difference was the little white pills, which I started to take faithfully.

  I began seeing Dr. Taylor on a regular basis. Once a week, I’d make the trek over to First Avenue for our fifty-minute session. For the life of me, I can’t remember anything we talked about. School, I guess. The bulimia. We should’ve been talking about the abuse I’d suffered. Unfortunately, I couldn’t talk about something I didn’t remember. I had all the symptoms of abuse—anxiety, depression, self-esteem problems, trust issues, eating disorder—but no clue why. As long as my psyche was committed to self-deception, psychotherapy was pointless. There was nothing to talk about. Nothing real, anyway. And try as he might, Dr. Taylor could never make an in. I couldn’t let him because subconsciously I knew I couldn’t handle what he would find.

  Nonetheless, I kept going to the appointments. I kept taking the pills. And little by little things began to change.

  Unfortunately, they got worse.

  In the fall, I’d been panicky and lost. By spring, I was downright suicidal. I don’t know if it was the pills or therapy or what, but everything careened downhill. I was bingeing and purging constantly. I almost never left my room, causing my GPA to plummet. I had very little social contact and no desire to do or accomplish anything. What was the point? No matter what I tried, it was bound to turn to shit.

  Like so many people who have been held captive, I’d spent my time dreaming of escape. In my fantasies, I assumed that freedom would be easy and wonderful and perfect, but that was magical thinking. When we are stuck in prolonged crisis—war, slavery, domestic abuse, kidnappings—we are forced to focus on survival. In order to muster the strength to stay alive and get away, we have to believe that escape will bring unbridled happiness. What we can’t imagine is how hard it will be to adjust to a world of normal people who don’t understand what we’ve been through. Nor can we comprehend how much the crisis has changed and damaged us. When we realize that life after trauma can be just as hard, or harder, than life during trauma, our fantasy of carefree happiness is shattered. That’s when a deep, immutable hopelessness can set in.

  —

  AT FOURTEEN, I’d been quite dramatic about my suicidality. There were lots of dark drawings and morose poems, lots of moping around the halls. I’d been crying out for help back then, hoping someone would stop and take notice. At eighteen, the experience was different. I was truly and utterly hopeless. I couldn’t delude myself into believing anyone gave a shit whether I lived or died. So I kept my urges to myself. I didn’t even tell Dr. Taylor how bad I really felt. I didn’t tell him how I’d lie in the dark for hours trying to imagine what it would be like to not exist. I didn’t tell him how often I counted out those little white pills he gave me, just to make sure I had enough.

  As spring came to a close, I knew my time was running out. The semester would be over soon, and I’d made no living arrangements for the summer. That meant I would have to go home to New Jersey. To my mother. To Gary. Thinking about it made my stomach turn. The only thing that gave me solace was the fact that during my high school years I had gone to great pains to fix up one of the barns in my parents’ backyard. The two-story structure, once storage for hay and equipment, had fallen into disrepair. Wanting some privacy and peace, I had personally taken on the work and expense of remodeling it. With help from some DIYer friends, I’d put up Sheetrock and laid wall-to-wall carpeting. I’d even bought myself a little sofa bed and an air conditioner so I could sleep there at night.

  On the day I packed up my belongings and boarded the bus back to New Jersey, I knew it would be a rough summer. I’d barely talked to my mother or Gary since I left for New York, a silence that suited all three of us. The only thing that would make the summer bearable was the fact that I would not actually be living with them. I would be in my little barn. Alone. Safe.

  When I got to the barn, however, there was a rude surprise. My mother, a bit of a hoarder, had filled the entire place with junk. Old furniture and dusty boxes were piled floor to ceiling. It was so packed that I could barely open the door, much less live there. My mother knew what the barn meant to me; she knew how much time and money I had poured
into it. She knew I planned to live there. Yet she gave me no warning about its condition. This was my mother being her typical immature self. The crap in the barn was a game—her way of saying she was glad to be rid of me and didn’t want me back.

  But I had nowhere else to go. I felt trapped and frantic—not a good combo when one is depressed. I ran into the house and demanded that my mother move her things. With smug satisfaction, she refused. Desperate for sanctuary, I begged and pleaded. Tears streamed down my face as I implored my mother to show mercy. The scene was reminiscent of ten years earlier when at the age of eight I had begged my mom not to move in with Gary. She ignored me this time as she had before, with a contemptuous countenance that screamed, How dare you presume to inconvenience me!

  Distraught and enraged, I went crazy, impetuously grabbing my purse and pulling out the imipramine inside. In a nanosecond, I popped off the cap and swallowed the entire bottle in front of my mother.

  I suppose there are a lot of emotions a mother can have when watching her daughter down a lethal dose of pills. Shock. Panic. Horror. Disbelief. Distress.

  My mother was pissed. She demanded I throw up the pills, adding in some snide comment about my bulimia. I refused to throw up. I didn’t want to. I didn’t want to live. Frustrated, she turned to Gary, who’d been ignoring the scene silently from his La-Z-Boy, and told him to drive me to the emergency room. Gary refused, saying, “If a person wants to kill themselves, we should let ’em.”

  Still raging, my mother picked up her keys and told me get in the car. I was already feeling groggy and lacked the energy to resist. The car ride is a blank; I guess I was already blacking out by the time I got to the emergency room.

  That’s when I slipped into cardiac arrest and died.

  Unlike the mild over-the-counter sleeping pills I’d taken five years earlier, imipramine is an old-school powerful antidepressant quite capable of causing fatality. Had I not been in the emergency room when its effects kicked in, I doubt I’d be around to tell this tale. I’m grateful to the doctors who resuscitated me. But at the time, not so much. When I woke up in the CCU, in fact, the first thing I did was yank the IV out of my arm.

  I wanted to die all over again.

  —

  ON FEBRUARY 21, 1944, a twenty-four-year-old chemist was sent to Auschwitz along with 650 other Italian Jews. Eleven months later, when the camp was liberated, 620 of those people were dead. By a stroke of luck, the chemist survived and, within a few months, resumed his former life. Neither his family nor his property had been lost, allowing the young man to quickly proceed with life. He married, had children, and enjoyed a thirty-year career in chemistry. By all external measures, Primo Levi not only survived but also thrived.

  Despite all this, the chemist, who would eventually become a world-renowned author, did not walk away from Auschwitz unscathed. He brought back a darkness that stayed with him throughout his life—and may have eventually ended it.

  In his memoirs, Survival in Auschwitz and The Reawakening, Levi expressed that darkness while describing the horrors of the Holocaust and its aftermath. For the next forty years, nearly everything Levi wrote was about his relatively brief time in the camp. Clearly, he remained preoccupied and troubled by the trauma he’d endured as a young man, and by middle age, he began to suffer serious depression. He was suffering from depression even forty years after the war and was certainly suffering on the day he took his own life. While there are myriad reasons for one to commit suicide, Levi’s family and friends feel he was never able to shake the darkness of the Holocaust. As fellow survivor Elie Wiesel noted, “Primo Levi died at Auschwitz forty years later.”

  It seems contradictory that someone would struggle to survive a death camp only to take their own life after escaping. Nonetheless, it’s a common phenomenon. Among the elderly, Holocaust survivors have been three times more likely to attempt suicide than their peers, and there’s a long list of notable Holocaust survivors who have taken their own lives. Art Spiegelman, creator of the graphic novel Maus, lost his survivor mother to suicide. Later, in attempting to understand her death, Spiegelman visited psychiatrist survivor Paul Pavel, who told him, “The only thing a survivor can do is to kill himself . . . After the optimism of liberation all the optimisms fail.”

  While I disagree with the notion that the only thing survivors of horror can do is kill themselves, I know firsthand the pull of suicidality. We who go through trauma, especially long-term trauma, come out the other side with a host of symptoms that can make liberation its own living hell. That’s mostly because our bodies don’t get the memo to calm down after the peril has passed. Instead, we remain in a state of hypervigilance, always ready for the next attack.

  We startle easily, especially at things that remind us of the original trauma (e.g., vets who duck and cover when a car backfires), and suffer insomnia in our misguided efforts to stay alert. Always on edge, it’s no wonder we become emotionally exhausted, making us irritable, detached from others, and disinterested in things that used to be fun. In addition, our minds seem unable to let go of the terrible things that have happened, causing us to experience distressing recollections, nightmares about the trauma, and terrifying flashbacks in which the event seems to actually reoccur. Naturally, we try to block out these upsetting memories, leading us to avoid talking or thinking about the experience, but avoidance only makes symptoms worse.

  Of course, not everyone responds to trauma the same way. Some people can endure a traumatic event and come out the other side only mildly affected; others become psychologically crippled for life.

  Why does trauma cause long-term problems for some people and little or no symptoms for others? The age, background, and coping skills of the victim have something to do with it. Not surprising, the type of trauma a person suffers also seems to make a difference. While there’s no magic formula to measure this stuff, in general, the more severe a trauma, the more severe its effects. Natural disasters are usually easier to cope with than violence, and a single violent event (e.g., a rape) tends to be less damaging than something long-term (e.g., sexual slavery).

  Long-term repeated trauma—the kind that happens in wars, imprisonments, kidnappings, cults, domestic abuse, child abuse, and ongoing sexual abuse—is generally the most psychologically damaging. For, unlike single episodes of violence, captive victims are assaulted again and again and again. The person who gets mugged may be terrified, but he has the ability to get away, connect with loved ones, and eventually reestablish a feeling of safety. For the person enduring long-term trauma, there is no safety. There is only the constant threat of more injury and possibly death. As a result, these victims and soldiers are always on alert. Fear becomes the new normal, and that fear rarely dissipates once the danger has passed. It subconsciously stays with the survivor, making her feel that she is constantly in danger. In an effort to feel safe, the survivor restricts her environment, relationships, and activities. She grows more introverted, more neurotic, less open to new experiences, and less agreeable. Basically, long-term trauma can actually change a victim’s personality.

  —

  SINCE MY ABUSE STARTED at such a young age, it’s hard to know how it may or may not have changed my inherent personality. What I do know is that by the time I reached puberty, I was already exhibiting classic symptoms of long-term sexual abuse. The severe depression that began to plague me at the age of thirteen, for instance, is quite common among adolescents and adults with a history of sexual abuse. Likewise, suicidal ideation and suicide attempts happen far more frequently in those who have been molested versus those who have not. Bulimia, while not specifically listed as an effect of trauma, has been highly correlated with sexual abuse. And I certainly doubt I’d have developed dissociative identity disorder and dissociative amnesia if I hadn’t had awful memories to block out.

  Anxiety, on the other hand, is not so easily blamed on trauma. About 18 percent of the U.S. populati
on has a diagnosable anxiety disorder, making it the biggest mental health issue by far. The reason for this is simple; we are genetically predisposed to fear things. It was our neurotic caveman ancestors, after all, who probably noticed the saber-toothed tiger in time to run! Our brains have remained hardwired to constantly look out for danger. It is so automated, in fact, that our bodies will instantly jump back from a snake on the ground before our cerebral cortex realizes it’s just a rope. Whew! And we are not only preprogrammed to look for every potential danger but also to remember those dangers forever. That’s why we can’t drink peach schnapps ever again after that time it made us sick in college! (Perhaps I’m divulging too much.)

  Fearful mammals that we are, it’s no wonder we’re prone to anxiety. For many, many people, neuroticism is a birthright. For others, though, anxiety disorders are a direct result of trauma via classical conditioning. Most people know of classical conditioning through the work of Ivan Pavlov, the guy who discovered he could get dogs to salivate on cue. Salivation is the body’s automatic response to the sight and smell of food—just as fear is the body’s automatic response to danger. Pavlov found that when he made a specific sound at dinnertime the dogs learned to associate the sound with food. Eventually, the dogs’ bodies would react to the sound by salivating even if the food wasn’t there.

  The same thing happens during trauma. While terrified, our minds tend to take in not only the danger but also everything else associated with the moment. Our brains remember the “everything else” as dangerous and tell our bodies to react in similar situations. If a person is shot while walking alone down a dark alley, for instance, he will almost certainly be afraid of being shot again. He will fear the sight and sound of a gun as well as anything that looks or sounds like a gun. What’s more, he may generalize his fear to include everything else that reminds him of the assault—alleys, being alone, the dark. He may even become fearful of seemingly innocuous things such as brick walls (like the one in the alley) and neon signs (like the one he saw in the distance just as he was losing consciousness).