Content warning: discussion of suicide & domestic violence. If you are in crisis, text or call 988.
"Do you know what it is that I fear the most? When I yearn for something so much in a world so hopeless that it weakens my heart."
--
It's a discomfiting idea to confront, the idea that psychiatrists may need help. We're doctors, after all, islands of resilience for our patients amidst a sea of chaos. While we're wonderful advocates for our patients, we hide our most vulnerable moments, fearing the ramifications. But we're subject to human experiences -- depression, regret, shame, anxiety -- as much as anyone else.
Domestic violence and its associated mental health outcomes constitute one such experience from which physicians are not exempt, despite that it should not happen among educated medical professionals. Leaving abuse is among the hardest things we will ever do. Some of us . Some of us will not survive. Most of us will face humiliation, dismissal, and re-victimization from the individuals and institutions .
And what of the aftermath of abuse -- the pain that lingers even years after leaving?
September and October are challenging months for me, an intersection of Suicide Prevention Awareness and Domestic Violence Awareness. For weeks now, I've tried to write about the mental health impact of intimate partner violence (IPV). I could have reviewed papers on its physiological effects or the impact of relational trauma; I could have on risk factors for perpetration and victimization.
But no statistics will sufficiently convey what is happening inside us. In lieu of data, I offer narrative, one of our most powerful tools for connection and empathy in medicine. Unless you have lived through domestic violence yourself, I cannot make you truly understand the intensity of emotion. Many of us rage, and wonder, how is it that those of us who survived continue to endure this pain while our abusers move on?
But me, I withdraw, morosely existing on the periphery of other people's lives and wondering just how valuable my life is. I've become a voyeur, envying people who return to daily stability and love that I borrow only transiently from my support system because I worry I'm a nuisance. Withdrawal, while emotionally safer, is deeply lonely.
My sleep is chronically poor, my emotional load at baseline is too heavy, and with enough stressors, I fall into a deep, prolonged, guilt-ridden depression. But it becomes dangerous when my mind races uncontrollably and one insidious thought, my life is no longer worthwhile, overwhelms all others.
The first time it happened, I was debating, "Stay or leave?" in an abusive relationship. I didn't appreciate the danger at the time. I felt worthless; in fact, he outright told me so. A quiet exit from the world felt like my only choice. Privately, I called it "my escape plan," my little secret, the one thing I could control. The idea lived in the back of my mind for weeks.
The thoughts started racing one afternoon. I knew unequivocally I was remorselessly unloved in that relationship and I feared inconveniencing others with my problems. I collected materials. I wrote a note. I never completed the act.
'Like I Was Nothing'
I didn't tell anyone. Unwittingly inspired by Virginia Woolf ("How many times have people used a pen or paintbrush because they couldn't pull the trigger?"), I started writing to cope. But many women like me take the route I seriously contemplated.
On the psychiatry consult service, I met that version of myself in the form of a patient who had left a relationship similar to mine and later attempted suicide in a highly lethal way. For therapeutic rapport, I broke my rule of non-disclosure, which I break only for IPV victims in special circumstances. "He looked at me ... like I was nothing," she whispered, tears streaming down her face. She described the physical acts of violence against her in excruciating detail.
I froze. I could see his face twisting in rage, cold slits for eyes. I could feel cruel hands on me. My body tightened, preparing to run.
"You're reliving what he did to you, aren't you?" my patient asked. "Your face right now ... you rub your hands to self-soothe. You've been doing it since you first met me in the ICU."
Suddenly exhausted, I leaned against the wall and nodded, unable to deflect. What I didn't say to her: I easily could have done what you did.
"I hope you get better," she said mournfully, almost a question, as though she needed to know that the pain would subside with time. I wanted to reassure her, to tell her with certainty that she would hurt less and be more sure of herself someday. But I knew in my heart I'd be lying, and the words wouldn't come.
"Don't worry about me," I replied instead. "It's not your job. It's my job to worry about you. One day at a time. For whatever it's worth, I'm here for you."
I remembered something she'd sobbed to me that echoed my private thoughts: "I love so deeply. I just want someone to love me the way I'm willing to love."
I hid in a stairwell after that. Then the tears came, fast, hot, blinding.
It Doesn't End With Us
I knew what would come next after leaving abuse -- the reality that I didn't want to tell my patient while she was so vulnerable. Existing, not living. Overwhelming isolation, the desire for intimacy, paradoxically coexisting with a terrible fear of intimacy, wondering if I will ever feel whole again?
Often, I want to reach out to my loved ones, and I don't always want to talk, I just want them there. But the anxious guilt of being a burden stops me, and I withdraw instead.
Externally, I function well. Most people do not understand the sheer force of will it took for me to come this far. "You're the most resilient person I know," someone told me. I'm not, I just didn't have a choice, I wanted to answer.
I don't want to be resilient anymore.
There are some things you don't return from, no matter how hard you try. The hypervigilance, fear, and elevated mistrust are deeply isolating, seemingly permanent features of my life now.
"It's not a life I'd want for anyone," my patient had whispered. "It feels awful."
I could relate to everything she was saying. There are days when I wake up wishing I hadn't. The world seems suffused in gray, less colorful. There are days when I think, What is the point of trying anymore? I am so tired, I don't want to try.
Shortly after I met that patient and inadvertently relived my own past, those racing thoughts began again. Overwhelmed by a terrible sense of guilt and sadness and the thought that my life is pointless, feeling the need to apologize to everyone for being so weak, unable to stop crying, I somehow made my way to my closest safe person, my residency program coordinator.
She sat me down in her office and hugged me wordlessly, the act of kindness I didn't know I needed, the touch I wanted but didn't know how to request. My whole body, tense and fearful, relaxed in her warm embrace. I'll let go in a minute. Just let me stay here for another minute. I want to feel safe only for a few moments. Maybe just a minute longer, and then I'll let go, I promise. Just hold me for one more minute.
Love should not hurt. Everyone deserves relationships free from abuse. The National Domestic Violence Hotline is available 24/7 at 1-800-799-SAFE (7233). If you or someone you love are in immediate danger, please call 911. If you or someone you know may be experiencing a mental health crisis, contact the by dialing or texting "988."
is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York.