referred to me for a second opinion by her primary care doctor, as she was not feeling or functioning well on the medication regimen prescribed by her current psychiatrist. She was also in weekly psychotherapy with a psychoanalytically-oriented psychotherapist but felt too impaired to use the therapy effectively. In other words, she was stuck—and dangerously so.
At our first session, Adele described through her tears a long and complicated history. However, an overarching theme began to emerge: She felt she was living a “scripted life,” one that was written for her but not by her. Nothing in her life felt right. “Dr. Kehr,” she said tearfully, “I am just not sure I want to go on living. I have no hope for ever recovering. I just feel so vulnerable all the time. I feel terribly sick, yet medications only seem to make me worse. I am at the end of the line.”
I didn’t know it yet, but Adele would turn out to be what I think of as a highly complex “Orchid.” You might remember from my prior blog post on the topic that a variant on your SLC6A4 gene may have a bearing on your levels of resilience: some gene variants allow individuals to persevere through challenges with relative ease—while other gene variants can make these same challenges more difficult to overcome. The knowledge and insight of one’s genetic makeup, paired with the personalized precision care that genetic testing facilitates, can have a major impact on “Orchid” types like Adele.
Several years before I began treating her, Adele was diagnosed with postpartum depression following the birth of her daughter, Susan. But her history with depression had begun well before that. Adele grew up in a household that had lacked emotional warmth. Her mother was demanding, histrionic, and never satisfied with life or anyone around her; her father was emotionally distant. Her mother created in Adele a feeling of helplessness, as she could never predict when her mother would erupt in tears or anger, or level scathing criticisms toward her. This type of toxic behavior didn’t end in childhood—in fact, it persisted in her mother as Adele and I began our work together. Adele never felt emotionally safe or comfortable around her. To complicate matters further, Adele had been repeatedly sexually abused between the ages of six and nine by her father. There couldn’t have been a worse childhood environment for this “Orchid.”
Adele had been on medication for a significant period of time—but a major factor of her feeling at her wit’s end was that her prescription didn’t seem to be helping. In fact, it seemed to make things worse. Following initial treatment with an SSRI antidepressant by an earlier doctor she had seen, she began to feel she was increasingly out of control of her emotions. She developed racing thoughts, increased anxiety, and sleeplessness which at the time were attributed to her being a new mother. However the symptoms began to worsen and included irritability, anger outbursts, frequent migraine headaches, impaired concentration and executive functioning, excessive spending, despair and feelings of hopelessness, and a variety of unusual sensory experiences. Suffice it to say, her daily life could be characterized as an extremely painful “roller coaster ride.”
While Adele had been in psychotherapy for the past several years to work through her having been sexually abused as a child, and the therapy was proceeding well according to her and her therapist, Adele began to experience what she described as episodes where she felt disconnected from others around her—including her baby daughter. She described these episodes as her “spells.” Her condition had further deteriorated to the point where she was unable to work, and she arranged for a prolonged medical leave of absence from her law firm to attempt to regain her health. To complicate things further, Adele had gained a substantial amount of weight as a result of the pregnancy—60 pounds—and had only been able to lose 20 of those pounds in the two years since she gave birth to Susan. Despite her youthful age, Adele presented with many of the symptoms of an unhealthy 80 year old, for in addition to her unstable mood disorder and gazing spells, she suffered from weight gain, gastrointestinal complaints, nausea, muscle and joint aches and pains, deficits in attention and recent memory function, fatigue, and a pervasive inability to concentrate.
At the end of our first session I said to her, “Adele, your story is a sad one, yet it is also filled with hope. Despite growing up with two disturbed parents, and being subjected by them to horrible emotional and sexual abuse, you survived your childhood, and your courage, intellect and drive helped you to become a highly respected attorney; and your capacity to love others, which is remarkable given the circumstances of your childhood, has enabled you to create a beautiful family with a loving husband and a lovely baby girl. Your medical situation is a complicated one, and it would appear that the antidepressant you are taking is worsening your underlying condition. We will begin to modify the underlying biological processes going on in your brain to help you feel better and function more effectively. I am confident I can help you—and I’m proud of you for not giving up.”