Being Vigilant and Proactive Pays Off When You Are Suffering From Depression

It's been almost eleven years since my most recent suicide attempt and psychiatric hospitalization which I attribute to a combination of taking what I learned in therapy and continuing to apply it, vigilance, self-awareness, and being proactive in realizing when I need help, and asking for it.

The Lifelong Work of Vigilance

My diagnoses of borderline personality disorder, major depressive disorder, and anorexia, all of which I’ve recovered from leave me particularly vulnerable to relapse. I was raised in a chaotic household with an alcoholic father who when he got sober, retreated into his own world of depression and never re-emerged.

I have always maintained that even if one has been emotionally stable for a substantial amount of time and has a history of severe depression (in my case with psychotic features), there are no guarantees. One must remain vigilant and proactive regarding one’s emotional health for warning signs. I know when I spiral, I spiral fast so I need to reach out promptly. I know that depression is hard-wired into my DNA — thanks to my father — so vigilance is a strict requirement.

The Search for the Right Support

At the end of 2022, I was suffering from high-functioning depression and burnout. I was in a fee-for-service job, working six days a week and still not earning enough money to pay my bills. I was exhausted and stressed out. I found a therapist online who accepted my insurance, but it was not a good fit. Once she heard my history of recovery from my aforementioned trifecta of diagnoses, and that despite all that I’d managed to become a licensed clinical social worker, it seemed every session she’d tell me how resilient and strong I was. That wasn’t what I needed. At that time I needed someone to listen and encourage me to take better care of myself, perhaps even taking steps to find a new job. I eventually screwed up the courage to tell her I was taking a break from therapy.

I did take a break for a couple of months, and I did get a new job which turned out to be more stressful, with longer hours and more responsibility but not more money. When I interviewed, I miscalculated how many hours I’d actually be getting paid for so I thought I would be earning a larger salary than I did. I felt myself sinking even deeper.

Being proactive, I again reached out for help and thought perhaps a therapist with more experience would be a better fit. Wrong. This therapist had more experience but liked to talk about herself and provide examples from her life. As a therapist, I know I’m careful not to talk about my own experiences in sessions unless they move the therapy forward. This woman seemed to be indiscriminate in discussing her life with me. I terminated with her shortly after we started.

A Moment of Crisis and Clarity

There was an incident at work that eventually proved to be unfounded. Still, while it was being sorted out, I experienced suicidal ideation and urges to self-harm more urgently than I had in a long time. This frightened and strangely comforted me. This is where being vigilant and proactive becomes especially important. I still possessed enough insight and self-preservation to realize I shouldn’t find the thought of killing myself comforting.

Alarmed, I reached out to Dr. Lev, the psychiatrist who I had previously seen for eleven years for transference-focused psychotherapy (TFP) and who still managed my medication. I hadn’t returned to her for psychotherapy because she had raised her rates, she didn’t accept insurance, and I couldn’t afford what she was now charging. She squeezed me into her schedule, and we explored why this incident had so strongly activated the urge to kill myself. She knew me well and together we connected the dots to my perfectionism and shame. I doubt any other therapist could have done that in one session.

A Path Forward

My session with Dr. Lev sustained me for some time but our hour together also sparked the realization that I needed to make changes. I found a new job where upper management is more supportive, the hours are regular and I’m finally getting paid a solid salary instead of fee-for-service. We are currently in the annual review period, which is bringing up issues of perfectionism as I have set a goal of being promoted to a supervisor position by the time I am there one year which will be in three months. I’m no longer suicidal or thinking about self-harm which is a relief.

I'm continuing to apply what I learned in TFP. Dr. Lev had a favorite phrase she used when I was reticent to speak. She asked me “What comes to mind?” Now when I’m trying to connect my own dots I listen, and I hear her voice, and we still figure it out together.