My childhood if you can even call it that was by no means easy. as the oldest of many children I was in charge from early on…. Our father was/is difficult to describe… not only does he seem incapable of holding a job, but he constantly fluctuates between abusive/controlling, extremely depressed, and crazy credit card happy showering us with gifts that his parents eventually have pay for. Our mother is just very meek. It took her over 10 yrs to divorce him and that same year she randomly went blind due to retina detachments. After many surgeries she has some vision back in each eye.
With four younger siblings to take care of, life before college was no walk in the park. But, I still managed to graduate with honors and participate in nearly every academic club. I moved away for college and was doing ok until about a year ago. I was set to graduate with both a BS in psych & a BA in philosophy. I also tutored underprivileged kids, presented my research at several conferences, and played in the orchestra. Plans for grad school were looking great. It was like nothing could stop me. But then something changed. I started have trouble paying attention in my favorite classes. I would read an assignment 5 times and not know what I read. My thoughts seemed to run together. At night instead of studying I would realize that I had just been sitting, day dreaming I guess for hours. I went from hardly ever sleeping to never sleeping.
By the end of the semester I was sleeping a lot, drinking a lot, and quickly found many new friends of the wrong sort. One night after a party at my place was over I went straight to bed. I later awoke to find that I failed to lock the door and one of my new found “friends” had decided to take full advantage of the opportunity. I later learned that he had planned the whole night to go that way. This “friend” just happened to be a very popular student on our campus and known as a great Christian. I knew no one would believe my story. I hadn’t talked to my real friends in a long time and I was scared of their reactions. I just got up and went to school and pretended it never happened. Most of my friends still have no clue. I knew my family would be sad and angry so they don’t know either.
I threw myself back into my work. Still having attention issues, I saw a doctor and neuropsychologist. I came out of testing with a great IQ score, diagnosis of ADD, a math disability, & a reading disability. A few months ago, I wasn’t feeling well and was just having trouble keeping up with my schedule. I was tired all the time and napped during every lunch break, and went to bed as soon as I got home. A friend turned me into the university counselor for possibly being suicidal. Honestly, I probably was. I was given Celexa and Adderall. I didn’t sleep for a few days after that and returned to the doctor with tonsils swollen too much for me to eat. Diagnosis – tonsillitis. Three antibiotics later I was still sick. Finally, blood tests revealed strep in my bloodstream and Epstein-Barr. After a total of 8 new medications in less than two months I still wasn’t feeling well. By this point I was far behind in all my classes, research, and grad school applications. When my GRE score came back lower than expected I was crushed. Trying to catch up with my 19 hrs of classes and still sleep occasionally just wasn’t working. I decided I would much rather die than have a horrible gpa and not get into a PhD program. But, (obviously) I miscalculated and just woke in the ER. To my surprise they actually released me to my mother that same day. The university let me walk in graduation without actually finishing. Most friends think I was hospitalized for mono. I think my professors are a little more aware.
I went home for awhile, but now I am back to face the music. I’m just trying to finish things so I can get out of here. I started seeing a therapist now, and a nurse practitioner prescribed me Wellbutrin XL about a week ago. I don’t think I have slept well since. I’m awake, but not a productive kind of awake. I feel like I’m just here …just existing. Like I said, I’m a psych major. I know the DSM back and forth. I guess I worry that is somehow clouding my judgment. I don’t want to be seen as someone listing symptoms for a diagnosis or something. I didn’t sleep at all last night. I just want to get my life back as soon as possible. Do you have any advice?
- Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
- Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
- Questions submitted to this column are not guaranteed to receive responses.
- No correspondence takes place.
- No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Dombeck to people submitting questions.
- Dr. Dombeck, Mental Help Net and CenterSite, LLC make no warranties, express or implied, about the information presented in this column. Dr. Dombeck and Mental Help Net disclaim any and all merchantability or warranty of fitness for a particular purpose or liability in connection with the use or misuse of this service.
- Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.
If I filter what you’re written through my head, it looks something like this:
You present yourself as a parentified child, meaning that your parents were ineffective and it was left to you to be the responsible force in holding the family together. This occurred way before the time when this kind of responsibility was developmentally appropriate for you to take on. Probably in part because of this unfortunate premature parental role, you have incorporated a hyper-responsibility ethic into your identity and you just don’t feel like you are a good person if you aren’t achieving.
Your father was unreliable, and showed a distinct pattern of mood shifting between depression and elation. I’ll wonder out loud if he has Bipolar Disorder or some variation on that theme and it was never diagnosed. During your early life, your mother acted out a dependent, timid role; perhaps some of your present day hyper-responsibility comes out of a reaction to that; to not want to be that.
Despite the obvious difficulties of being in your family role, you managed to hyper-achieve and hold it all together and this is a major point of pride. Then disaster struck for some unknown reason; you became cognitively compromised in a mild way. You could not pay attention or concentrate and this made studying hard. Your sleep got screwy too. You started drinking and shortly thereafter you were raped. Not very surprisingly given that you were a parentified child, you didn’t feel safe talking about the rape with anyone and have held inside whatever feelings you’ve felt. Despite your best efforts at getting your condition evaluated and properly treated, it resisted easy intervention and this process of uncovering one problem after another resulted in a new problem, which was that your grades were now suffering and this severely threatened your life plan to go to psychology graduate school. This you decided was not something you could recover from and you attempted suicide, luckily in an unsuccessful manner. At present you’re back at school and trying to repair your grades but really just feeling ashamed and humiliated (if I read between the lines), and still the symptoms that drove you to have problems in the first place are not really resolved.
So, there are a few things to comment on here, the first being your various diagnoses. On the face of it, given that you have attempted suicide, have been raped, have been having concentration difficulties and severe sleep problems and were doing a lot of drinking for a while there, it would seem that you might be depressed or possibly suffering from an acute stress reaction (to the rape). It’s certainly more complicated then that, however. You have or recently have had a variety of physical illnesses which might mimic the symptoms of depression. The rape occurred after the onset of concentration and sleep symptoms. And the doctor and neuropsychologist who evaluated you did not pick up on any signs of depression, choosing to diagnose you with what seems to me to be a somewhat odd combination of disorders. One of the things that makes me frown a bit is that stuff like ADHD and Learning Disorders have a developmental course. They do not come on in adulthood but rather are generally present from childhood on. By your report, however, you’ve been a very high achiever throughout most of your life and under trying circumstances; there is no hint in what you’ve written of past attention or concentration problems or reading problems for that matter. So that doesn’t add up very well to me. You have to take what I say here with many grains of salt as I’m responding only to what is written and don’t have the full picture. But it might be worth a second opinion or two before you just go with the ADHD and Learning Disorder diagnoses. To my mind, the real difficulty here is differentiating what symptoms are likely to be caused by physical ailments like strep or Epstein-Barr and what might be due to something more subtle. It is vital to get this part right, because deciding what the actual root of the symptoms are is fundamental to selecting a treatment which will best relieve your symptoms.
The second thing to comment on is the perfectionism and extreme drive you bring to your activities. These characteristics have served you very well up to this point in your life. They protected you from parental ineffectiveness and protected your siblings too. They have helped you find a career path you like and have helped you find a way to like yourself. All of this is good. Now, with the ongoing crisis of this past year you are having what is perhaps the second major life identity crisis you’ve gone through (the first being successfully resolved by your becoming the parentified child). Your life circumstance is no longer supporting your idea that you can power through all the things in your path with sheer willpower. You are confronting your limits and thus in an early way, your mortality. Your life has changed, and now your identity needs to become more flexible to accommodate this change or you will surely continue to suffer. Like the proverbial snake it is time to shed your skin and expand the ways in which you define your life as successful.
It is not wise to make a fetish out of some social goal you greatly desire like an advance degree. A degree is a great thing and worth striving for, but if for some reason you find that it is not attainable, you need to know in your heart that there are other goals in life that can also be fulfilling which are attainable. You need to be able to abandon goals in order to fulfill them sometimes, is another way to say it. Keep this in mind.
Do what you can do to grow a "reverse" gear in your brain, and also a "neutral" gear. Someone who is driven like yourself only knows how to go forward but sometimes the road gets blocked in life. So it helps to be able to back yourself up. It also helps to be able to put yourself into neutral and let things happen around you for a time before you start driving forward again. The shortest path towards goals in life is not generally a straight line, and this is especially true when goals are difficult to achieve.
In sum, I think you would be well advised to take the pressure off yourself for a while, put yourself in to "neutral" gear and just see what happens for a bit. Use the time to do your various treatments and to continue to refine your diagnoses if you aren’t satisfied with what has been done for you to date. Stay involved with research because that is important to what you want to do, but otherwise declare a pit-stop period for yourself. Work on repairing and restoring yourself. If you want to, talk about the rape and the difficult life you’ve had with your therapist. Or not if you aren’t comfortable with that. I think also, it would be a good idea to talk to people who are older and have met life crises and gotten through them and ask them about how they handled things and what they learned. A great thing to read in this vein is Steve Job’s 2005 Stanford University commencement speech which is linked here. There’s a lot of wisdom in that speech. Take the pressure off yourself for now and do what is necessary to get yourself well. I think that after a while in neutral, the path forward will become clear again. Since you seem to excel at going forward when the path is clear, I imagine that things will turn out okay.