How My Panicked Trip to the ER Exposed a Major Flaw in Mental Health Care

As soon as the doctors confirmed there was nothing physically wrong with me, they sent me on my way—and I’m far from the only one who has been ignored.

I’m lying in an emergency room bed, wires and sticky pads clinging to my chest. My pulse zigs and zags across a screen. Fluorescent lighting illuminates my blue-and-white-striped hospital gown; my hands are folded neatly across my belly. My husband Dan is sitting with our sweet four-month-old baby girl in his lap. Claire is still wearing the white fleece pajamas with pink roses that I zipped her up in last night. They’re my favorites.

It was around four a.m. when I rubbed her back to wake her. I had woken up panicked by a tightening in my chest and shook Dan by the shoulder. I knew that the answer to his question – Do we need to go to the hospital? – was “probably not.” But what came out was, “Yes.”

I have dealt with depression and anxiety for most of my adult life, learning to recognize some of the symptoms. But this morning, my irrational mind had me convinced that a pain in my chest was a heart attack and that the numerous waves of dizziness were due to a brain tumor.

The doctor walks in and does a couple of quick checks, pressing on my abdomen and listening to my heartbeat. He makes jokes like pediatricians do to distract a child from a needle aimed at their arm.

I start going through my list of symptoms: the feeling of a weight on top of my chest, heart palpitations, numbness in my arms and dizziness. I tell him I’m not sure if it’s just the after-effects of having a baby. The doctor, a large man with wild, curly gray hair, looks at me above his glasses and says, “Well, you know they are aliens right?” A grin spreads across his face and he tells me about how the fetus, with distinct genes than the mom, is not unlike a foreign invasion.

The author with her daughter at their local pumpkin patch, October 2015 in Pittsburgh, Pennsylvania. She says, “As I walked through the pumpkin patch, I would see other families laughing and think, ‘Why can’t I be normal like them?’ Three days later I was in the emergency room.” (Photos courtesy of Caroline Shannon-Karasik)

I feign interest, but all I can think about is that I have felt like there has been a intruder in my body ever since my daughter’s birth, something clawing at my throat to make its way out.

The doctor says he can’t find anything outstanding about my physical evaluation, and that my blood work and chest X-ray came back normal. A nurse comes in to discharge me and hands me papers about non-specific chest pain. I want to hand them back and tell her I already have the information from the last time I was here, just a month ago.

We leave and I think: Why is no one stopping me? Why can’t anyone see that I need help?

* * *

“Unless you are lucky enough to be in an emergency room at a hospital with a reputable psychiatric unit, you are not likely to encounter care providers that have sufficient training in mental health,” says Sepideh Saremi, a Los Angeles-based psychotherapist. “That, coupled with stigma, means that you probably won’t get good referrals or resources if you are having something like a panic attack.” Saremi says that in traditional medical settings, mental health care tends to be separated from other services.

According to a poll conducted late last year by the American College of Emergency Physicians, 52 percent of ER physicians surveyed said the mental health systems in their communities have “gotten worse.” Additionally, the emergency department has become “the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system,” Dr. Rebecca Parker, president of the American College of Emergency Physicians, asserted in a press release. Only 16.9 percent reported having a psychiatrist on call in the emergency department.

“It isn’t an illness or injury that you can physically see,” says Dawn Daum, who has worked as an ER mental health evaluator and is the co-editor of the website Parenting with PTSD. “For some reason, there is an unspoken attitude that it is acceptable and encouraged to seek help with a physical ailment, such as a broken bone; however, if the complaint is in regards to mental or emotional pain, it is unacceptable for a person to seek help.”

She says that, because of a constant cultural reinforcement to “get over it” or to adopt an “other people have it worse” attitude, this stigma and lack of empathy continues to “create barriers in seeking emergency mental health attention.”

This was painfully apparent when Jacqueline Ledoux-O’Donnell, a 23-year-old Boston resident, attempted suicide five years ago by swallowing an entire bottle of prescription Prozac. One of the first questions an ER staff member asked her was, “Well, why would you want to do that anyway?”

Ledoux-O’Donnell had been on the phone with her friend when she took the pills and told her she “just wanted to go to sleep.” The friend rushed to Ledoux-O’Donnell’s house and took her to the ER. When her parents arrived at the hospital, Ledoux-O’Donnell felt patronized by the staff, who kept discussing her situation with her parents “like I was a kid.”

“They made me feel like they were disregarding my experience,” she says.

After an evaluation by a psychiatrist, a nurse was tasked with suicide watch until Ledoux-O’Donnell was moved to the psychiatric ward. She was deemed stable after five days and provided with no further instructions for care.

* * *

When I left the ER that day after my apparent panic attack, I felt calmer, but only as a result of spending hours with my anxiety tucked underneath a scratchy, sterile hospital blanket. Every monitor and test indicated my health was O.K., giving me a temporary point of view that the facts would be enough proof to send my anxiety packing. As my daughter Claire and I sat in a Whole Foods parking lot while Dan ran in to grab a few things, I called my mom to tell her what had happened.

“Oh, honey, when is enough going to be enough?” she said. “It’s O.K. to get help.”

A week later, I was rocking Claire to sleep when the dimmed lights in her room seemed to grow increasingly darker. My palms started to sweat and my vision tunneled until I felt encased in blackness. I kept yawning, desperately trying to catch my breath. Swaying back and forth, I clung to Claire as if she was the only thing keeping me anchored. I didn’t move for at least an hour.

It was another panic attack.

* * *

One in five adults – more than forty million Americans – have a mental health condition, according to Mental Health America. Under the Affordable Care Act, hospital, maternity and mental health care are considered essential benefits. But the American Health Care Act that passed the House of Representatives earlier this month categorizes each as pre-existing conditions, allowing states to obtain waivers and dictate what type of benefits insurers have to cover.

Should this bill pass the Senate and become law, the results, Daum says, will be disastrous for Americans, leading to recurring mental health crises being presented in emergency care settings “with no direction to go in except the same damaging ‘not my problem’ cycle.”

It took five months before Ledoux-O’Donnell sought help. At the time, she was living with her grandparents because her parents could no longer handle her condition. She was bedridden, refused to shower, change her clothes, work or eat. “I knew that if I didn’t make a change, I would likely attempt suicide again and be successful,” she says.

She searched the internet for answers and found information about electroconvulsive therapy (ECT). With a referral from a psychiatrist, Ledoux-O’Donnell tried ECT and found that it “got me to a place where I could function like a normal person again.” She still struggles with several mental health conditions, including depression, anxiety and obsessive-compulsive disorder, but she graduated from college last year and is now working full-time.

“I wish the ER staff understood that each and every person is different,” Ledoux-O’Donnell said. “We’re not all textbook cases of depression and anxiety and there are different reasons we all ended up where we did. A one-size-fits-all style of treatment is not helpful to someone who’s currently operating in crisis mode.”

* * *

According to a September 2016 study, psychiatric visits to the ER increased by 55 percent – from 4.4 million to 6.8 million – between 2002 and 2011. Many of those patients were met with longer wait times than non-psychiatric patients. The solution is dedicated beds and care for mental health treatment within the emergency department, says Lee Tomatsu, a physician assistant in the ER at Sharp Grossmont Hospital in La Mesa, California. Tomatsu says that because of “a dire shortage of psychiatric inpatient beds” patients can spend “up to several days” in the ER at Sharp Grossmont.

“Psychiatric patients generally have different needs than medical patients,” she continues. “When in acute crisis, the patients can be agitated, requiring efforts at verbal de-escalation and sometimes chemical or even physical restraint, if the patient is felt to be a danger to themselves or others.”

Psychiatric patients at Sharp Grossmont are taken to the “E station,” a section of the ER that opened in January 2017 with thirteen beds dedicated to psychiatric patients. Patients receive a medical evaluation to be cleared for underlying medical conditions, and then meet with a psychiatric specialist who can assess if there is a need for inpatient psychiatric admission.

If a patient is discharged, he or she receives information about outpatient therapy and community resources, as well as follow-up with the hospital’s social workers.

The author with her husband on their six-year anniversary, May 2016, in Pittsburgh, Pennsylvania. She writes, “Even though the ER left me with no answers, I had tremendous support to find the help I needed. But I always wonder, ‘What if I hadn’t?’”

“This is a tremendously helpful service we have recently been able to provide our psychiatric patients, many of whom have not had consistent access to outpatient psychiatric care,” Tomatsu says.

* * *

It took me almost a year after that early morning trip to the ER to find the help I needed. Like Ledoux-O’Donnell, I had to eventually establish my own course of action, one that included regular acupuncture and therapy. A prescription for Lexapro followed, but when I think about the time I spent looking for solutions and the people I had to lean on, I can’t help but worry for those who leave the ER and don’t have the same support on their side.

When I got in the car on that early October morning, my need for help felt no less urgent than when I was twelve years old and my mother took me to the ER after I fell from a tire swing and shattered my ankle. But whereas my broken bones were met with immediate care and follow-up appointments with an orthopedic doctor and physical therapist, my mental state was completely overlooked. As I signed my discharge papers and walked through the hospital’s sliding glass doors, I left feeling like a trespasser in a place where there were no answers for people like me.

 

 

When My Abusive Father Got Alzheimer’s, Spoon-Feeding Him Helped Me Forgive

I didn’t think I’d ever be able to face him without fear, but in his docile, vulnerable state, we forged a new dynamic.

I watch him pick up his burgundy cloth napkin, drape it over his spaghetti and meatballs, then fumble with his spoon before balancing it on top of the sealed Hoodsie cup. This isn’t unusual behavior for someone with Alzheimer’s. Still, I ask my 74-year-old father, “What are you doing?” He gives me a hollow stare, his blue eyes as dry as his memory. I unveil his plate, cut up a meatball, then scoop up a spoonful and hand him the spoon. He sets it back down on top of the Hoodsie. I pick up the spoon and offer it to him again, but he gives me that same hollow stare, and re-drapes the napkin over the plate. I feel compelled to feed him, but the aides here at the nursing home usually do that. Though I worked as a nurse for 20 years and fed lots of people, I don’t want to feed him. I consider my reluctance. Am I afraid of the final admission that the parent has become the child?

The truth is, I’m terrified of feeding my father. Sitting in the naturally-lit dining room beside him, close enough for his hand to strike my face, an image flies back to me from the past. I’m 13; my father chases me into my bedroom and grabs from the top of my dresser the skating scribe I use to carve patterns in the ice. I dart into a corner. He lunges toward me, and raises the sharp end of the scribe over my head, inches from my skull. Desperate to protect myself from his metallic rage, I curl into a ball, my face against my knees. My heart beats in stutters, in my ears, in my throat.

I don’t remember what I did wrong. Maybe I forgot to take out the trash, empty the dishwasher, neglected to walk the dog. There were other incidents of rage, but I don’t remember what my failures were that provoked my father. The most horrifying memoires are the ones that involved my siblings. I remember crying in my bedroom, listening to my father’s heavy footsteps as he chased my older sister through the house. I remember the time he bloodied my younger brother’s face with his fist. I can’t recall what they did wrong, either.

My thoughts spring back to the present. I’m almost fifty. It’s time I kick my fear of my father out of my mind’s bedroom.

He’s in a wheelchair, and hasn’t been able to walk for months. He certainly can’t chase me now. Alzheimer’s has also had a calming effect on him, or maybe it’s the medications, which are supposed to slow down the progression of the disease. Either way, he’s mostly gentle and quiet, displaying moments of delight like clapping when my husband walks into the dining room, or smiling and patting me on the shoulder when I lean down to kiss him on his mole-flecked forehead. He even shocked me once by speaking to a basket of bananas: “So beautiful.” My pre-Alzheimer’s father was a left-brain thinker, and never noticed the aesthetics of fruit. I don’t recall him ever regarding beauty at all.

In an attempt to overcome my fear and judgment, I tell myself that my grandfather is to blame for my father’s dysfunction. He verbally abused others around him. He once whipped an olive at a waitress for forgetting he had ordered his martini with no garnish. My father, who witnessed these kinds of tantrums as a child, inherited my grandfather’s intolerance and impatience.

So I take a chance. I lift the meatball-filled spoon from the Hoodsie and guide it towards him. “Here, Dad, doesn’t it look good?” He raises his hand from the table, and steadily reaches for the handle gripped between my pointer finger and thumb. My hand trembles as the tip of my finger meets the side of his finger, the spot once swollen with a knobby protrusion from his pen gripping days.

He clutches the spoon, and lifts it towards his mouth, pauses, raises it higher. It tilts to the left then to the right. I wring my hands. My teeth sink into my bottom lip. I want to help him; I don’t want to help him. His jaw juts forward, his neck veins pulsing. He eases the spoon closer to his mouth. I hold my breath. He bites down on the crumbled half meatball. He chews, swallows. I lean back. Breathe.

Again, he sets his spoon down on top of the Hoodsie and drapes his napkin over his plate. An aide with generous hips dances a little sashay over to our table. “Hey, Joe,” she says, rubbing my father’s back. “I thought Italian was your favorite. When you’re done, you can have all the ice cream you want.” He smiles at her. I smile at her too, comforted by her recognition of what he enjoys most: Italian food, back rubs, and ice cream.

“Come on, Joe. Here.” She sits beside him, and ties a clean napkin around his neck, as if he’s about to eat a lobster. “We like to keep his clothes as clean as possible,” she says, looking directly at me. I nod, but feel as if I’m being scolded for my oversight. She takes the spoon, shovels up another half a meatball and tenderly slips it into my father’s wide-open mouth.

“See, Joe. Isn’t that good?” After he swallows, she wipes the corners of his mouth with his napkin. “He’s okay,” she assures me. “Sometimes he just needs help. You can feed him.”

My stomach does a somersault. What would she think of me if I tell her I can’t, or won’t, feed my father? I’m embarrassed to tell her that I’m terrified of doing so. I could lie and say that I don’t feel qualified to feed him. But what kind of qualifications does one need to feed your own parent?

“Go ahead,” she urges. She hands me the spoon. And walks away.

I look at my father, who’s eyeing his hand resting on the table, the one with the knobby finger protrusion. He hasn’t gripped his pen in a year. As a savvy businessman, he filled his yellow pad with the latest land-for-sale deals, the highest bond interest rates, and upcoming foreclosures. I wonder if my father has forgotten about his pen – his blue, ballpoint Bic pen.

He slides his hand towards mine also resting on the table, and touches it. He squeezes, as if he’s trying to tell me something.

“Dad, you want more?”

He nods.

I gulp down my fear, and mix some sauce with crumbled meatball and spaghetti, scoop it up, then slowly raise the spoon to his mouth. He opens it for me, just as he did for the aide. Quickly, I slip the food off the spoon. He chews, swallows, rubs his belly.

“More?” I realize that I’m not asking him if he’s hungry; still wary, I’m asking for permission to feed him.

Again, he nods, and opens his mouth.

Again, he chews and swallows. I ask if he wants more, wait for him to nod, then feed him another spoonful. This exchange continues a few more times before he reaches for the Hoodsie, and slides it towards himself.

“You ready for ice-cream?” I ask.

A smile spreads across his face like a sunrise. In a matter of minutes, we have choreographed a new father-daughter dynamic.

I visit him again on Thanksgiving. As I walk into the dining room, I rehearse the steps in my head, hoping my tying of his napkin bib around his neck is enough of a cue that our dance is about to begin. But he’s having a good brain day, and he’s mostly able to feed himself the ground turkey and sweet potatoes. When he tires and doesn’t have the strength to lift his glass of milk, I lift it for him. “Here, Dad, you want some milk?” I bring it closer to him, and he grabs it. Slams it against the table. I startle, skid backwards in my chair. He’s over-stimulated, I think. Frustrated. He lets go of the glass and looks at me, his eyes wet and crinkled at the edges. Our faces, and bodies, are capable of saying “I’m sorry.”

Another piece of history comes flying back to me. It’s six months earlier, and my father is hospitalized for abdominal bleeding. I’m standing over his bed, holding his hands so he doesn’t yank out his IV. Completely out of context, he says, “It’s not your fault, Melissa.” I accepted this as an apology for all the times he hurt me. The language of genuine contrition is as diverse as each of our regrets.

I give up on the milk and try to feed him. He cooperates on the first bite. I try again – another spoonful of Thanksgiving. He chews, swallows. This time he burps. We giggle. When his eyes droop, I lead the next dance step. I untie the napkin, wipe his mouth clean – and rub his back. His head falls forward and he begins to doze. In a few seconds, he opens his eyes and lays his hand on top of mine. I massage the smooth spot on the side of his pointer finger until he falls into a slumber.

As I watch my father sleep, I know it is his utter helplessness that has made it easier for me to want to be with him, to deeply care about him, despite his past hurts. That’s exactly what I’ve needed for so long – a father I no longer fear, but one who unconditionally lets me into his vulnerable world and gives me the chance to begin to forgive him.

 

 

The Secret History Behind England’s Deadly Sarin Gas Plant

During the Cold War, at a single facility, the British military covertly produced enough chemical weapons to kill every person on earth five times over – and in the process dozens of their own were left dead.

In May 1953, when Ronald Maddison volunteered for scientific tests conducted by the British armed forces, he was told the experiments were part of efforts to research the common cold.

He was lied to.

Instead, like many others, Maddison, a leading aircraftman in the Royal Air Force, became a guinea pig for chemical weapons tests. He entered Britain’s main chemical warfare lab and received, without his knowledge or informed consent, 200 milligrams of liquid sarin dripped directly onto his sleeve, which seeped through the fabric onto his skin.

Ministry of Defense (MOD) scientists used “volunteers” like Maddison to design protective equipment and improve their own sarin for potential offensive use. The doses weren’t intended to be lethal; everyone already knew sarin killed quickly. Maddison was given just enough to gather more data into how sarin worked and how it could be stopped – or so they thought.

Within minutes this “routine” experiment went horrendously wrong.

Barrels of deadly Sarin.

Years later, ambulance driver Alfred Thornhill described his trip to the hospital with Maddison: “His whole body was convulsing… I saw his leg rise up from the bed and I saw his skin begin turning blue. It started from the ankle and started spreading up his leg.” Thornhill said the effects seemed to mirror those of an electrocution.

Terry Alderson, who like Maddison was another “volunteer” around that same time, later furiously described the lies told to him: “It was Russian roulette. Reading between the lines they have got away with murder. Our health was never monitored afterwards and nobody knows how many died. This shows what liars [the MOD] were – nobody volunteered for these tests, we were sent in there like sheep.”

Forty-five minutes after being dosed, Maddison died. His death was immediately covered up. Home Secretary David Maxwell-Fyfe requested the coroner’s inquest remain secret, citing national security.

The sarin gas that killed Maddison was manufactured and tested at the “Chemical Defense Establishment,” which was set along a remote stretch of southwest England’s Cornish coast, an area of sparse employment, with a small population, far from prying eyes. Today Cornwall is best associated with stunning sunsets. Few know that it hides one of Britain’s darkest secrets.

* * *

The recent use of sarin by Syria’s President Bashar al-Assad has again brought chemical weapons into the spotlight. Western governments, including the U.K., condemn the “poor man’s atom bomb,” citing international law. But the British government itself hasn’t always been quite so ethical.

After the Second World War, Britain was nearly bankrupt; the Empire was collapsing. But with the Cold War in full swing, the British military was still developing weapons, including weapons of mass destruction.

During the war against the Axis powers, Prime Minister Winston Churchill had advocated using both biological and chemical weapons, which the military was experimenting with. (The Scottish island of Gruinard became so saturated with weaponized anthrax during World War II field tests that it remained uninhabitable for decades.) But they were never unleashed in battle, partly because Churchill’s cabinet feared equal retaliation from Hitler.

After defeating Der Führer, British experts toured the former Nazi Germany, confiscating equipment and data used to develop chemical weapons, including sarin.

But if they were going to manufacture chemical weapons of their own, the Brits needed a safe, remote location to do so, someplace where, if the worst should happen, there would be the fewest possible casualties. Royal Air Force base Portreath – or RAF Portreath, for short –had opened in 1941, built on what locals called Nancekuke Common in Cornwall. It was as good a place as any. Mothballed after the war, RAF Portreath was secluded and close to the sea, which was convenient for waste disposal. The few locals weren’t bound to ask many questions either. Any potential whistle-blowers knew they faced prosecution under the Official Secrets Act. Being government property, the authorities also had “Crown Immunity” to use RAF Portreath as they pleased, almost entirely without public oversight.

A scientist at Nancekuke measures out chemicals.

Still, local farmer Ernest Landry didn’t share the government’s enthusiasm for the base’s choice location. The Ministry of Supply used a compulsory purchase order to requisition much of his land to form part of the new complex. Landry was compensated, but he’d lost his farm’s water supply, which came in the form of a pond on that surrendered plot.

In a short memoir, Memories of Nancekuke, Landry described his anger when a Ministry of Supply official forced him into selling:

He said that I had a perfect right to go to arbitration, but if I did he would knock a thousand pounds off the purchase price and he would see to it [that] it cost me another 500 in expenses. This was said to me in front of a witness. I asked the witness afterwards what he thought about it. He said, “It’s no good … he would say he never said anything like that.”

Churchill was one of Nancekuke’s biggest boosters. As a battalion commander in World War I, he knew the devastating power of chemical weapons. He’d once made sure the Soviets did too. In the summer of 1919, while Secretary of State for War, his British troops fought the Bolsheviks in the Russian Civil War. On Churchill’s orders they used large amounts of Lewisite. Numerous Bolshevik-held villages were bombed by British aircraft, and Churchill’s fondness for gas didn’t stop there. In 1919 he openly advocated gassing rebellious tribes in northern India. Furious at what he called “squeamishness” from cabinet colleagues who blocked the plan, Churchill unpleasantly asked, “Why is it not fair for a British artilleryman to fire a shell which makes the said native sneeze? It really is too silly.”

Come 1950, Churchill’s keen desire for an independent British chemical weapons capability was largely inspired by intelligence reports showing the Soviets were developing their own. If, he reasoned, the Russians had it, then so should the British. According to declassified British documents disclosed in a 2001 TV documentary, Nancekuke would, in Churchill’s mind, evolve from a small pilot facility into a mass producer of sarin.

RAF Portreath became the “Chemical Defense Establishment, Nancekuke.” The factory enabled scientists to improve their production process and technology, and between 1954 and 1956, Nancecuke’s pilot plant produced 20 tons of sarin. The plant also produced several other chemical weapons like VX, Soman and Cyclosarin. Prospective employees were vetted; former staff members were reminded of secrecy laws and penalties for breaking them. The government discussed Nancekuke only when forced to, continually restricting public and press knowledge.

A range of chemicals were produced during Nancekuke’s history like VX, Soman and Cyclosarin.

In 1965, as the counterculture became increasingly vocal, and trust and deference to authorities rapidly eroded, the secret of Nancekuke was exposed. Peace News magazine ran a story in December of that year attacking Nancekuke’s safety record. The article summarized what were rather benign incidents, citing “two occasions poison gas [escaped] and gas masks [had] to be worn.”

Tom Griffiths narrowly survived one. On March 31, 1958, he was ordered to fix a pipe that ran throughout the Nancekuke factory. He immediately noticed a single drop of liquid hanging from a flange. Griffiths knew it wasn’t water; it could only be sarin.

Griffiths bellowed a warning, jumped down the ladder he’d scaled, and he and his trailing co-worker staggered away, suffering sarin poisoning through inhalation.

According to one account of the incident: “Outside in the fresh air, as their breathing returned to normal and objects stopped swimming before them, with the happy-go-lucky fatalism born of working at Nancekuke, the two men congratulated each other on an extremely lucky escape.”

They weren’t lucky for long. Griffiths became chronically ill. Secrecy laws prevented him from discussing Nancekuke, even with doctors, and in 1971 he applied for a disability pension. A medical tribunal rejected it.

* * *

It took decades for information about Nancekuke’s WMD production to emerge. Even today some files remain classified. Over the years there have been senior government ministers that were never told about the site. In 1969 it was reported that hundreds of animals died around Nancekuke without any explanation.

As Nancekuke became increasingly exposed, pressure to close it grew, and it was shut down in 1980. The lab was virtually demolished; some equipment was buried onsite, and the rest dumped in mineshafts.

Nancekuke never employed more than 200 workers at any time. Between 1950 and 1969, nine died there, and numerous others like Tom Griffiths developed permanent health problems. Some were threatened with prosecution if they revealed anything.

But Griffiths did file a lawsuit. He claimed his medical records would have undoubtedly proved long-term poisoning. However, in the early stages of the proceedings, his filed records vanished. He settled out of court in 1976 for a mere £110, which at the time equated to roughly $60.

 

 

For Decades, Shame Kept My Dad’s Schizophrenia Secret from our Pakistani Immigrant Community

Now my concern for the mental health of my children is making me finally face my family’s past.

Daddy sat in the rickety metal folding chair, his eyes hidden by the dark sunglasses he had taken to wearing day and night. During the day, I would tell myself it was to shield himself from the uneven sunlight that would shine into the living room. At night, however, the sunglasses protected us. He wasn’t violent. There were no flying fists or abusive shouts coming from our two-bedroom apartment. Not like some of the Pakistani immigrant families we knew in our community, in which the fathers would assuage their sorrows and humiliations by leaving a trail of tears and cowered silences where their children once played. No, the sunglasses shielded us from his stare, unrelenting, shadowed, looking out into space as if he was seeing another life play out. His cigarette made a slow glowing arc from the glass ashtray on the folding table to his mouth, hidden behind the curling gray smoke. 

“I think it’s pretty, the way Daddy’s hands glow and the smoke climbs in to the sky,” I said to my older brother. “It’s not pretty,” Kamran replied curtly, only ten years old but already aged beyond his years, the unfortunate side effect of being the only boy sandwiched between two sisters, the unwitting man of the house when my father sat with his thoughts. “It just means he’s sick. You can always tell when he’s sick. He stops talking, smokes all day and then it gets bad. We don’t talk about it. But he’s so sick that he can’t be our Daddy right now.”  

Schizophrenia is a word I learned even before I could speak properly. I don’t know when I heard it. We never said it out loud. Not in our family. Not within our Pakistani immigrant community in New York. In the world I grew up in, mental illness was a taboo topic. But I knew the word I could barely pronounce was attached to Daddy. Only when he was sick, though. Really, really sick. And only within the walls of our Borough Park apartment. Outside of our little apartment, for the outside world, for the aunties clad in satiny salwar kameez or cheap wool pants and ill-fitting sweaters, who would take the train down to the Fort Hamilton Parkway subway stop to visit my mother, for them the diagnosis was simply depression.

“He lost his job and we have all of these bills, of course, of course he’s depressed,” Mummy said. “He’ll be better soon. Inshallah.” 

Inshallah. God willing. It became the prayer and the demand we based our lives on. God wouldn’t have brought my parents and my brother and sister from Pakistan to New York, only to leave them in darkness. He wouldn’t have brought me into the world just as Daddy’s mental illness began to spiral out of control, when he was still a young man, not even 40 yet. God wouldn’t have done all of that if he didn’t plan on making it better. We just had to wait. And hope. And pray. He would get better and then we would carry on with the hopes and dreams that my parents had originally imagined in their little North Nazimabad house, in the humid coastal city of Karachi. Daddy’s depression simply hit the pause button on those dreams. Inshallah. 

The label of depression made complete sense to our immigrant community. How many of our uncles and aunties, having left behind good jobs and respectable homes in Pakistan, grew depressed and disheartened when the American Dream did not embrace them right away. It was easy to understand depression. In our case, it was also a lie. 

Lying became ingrained in my DNA for almost 40 years. It became a comfortable shawl that I wrapped myself in even though I had no rational reason to do so. I was educated and knew the medical reasons behind schizophrenia, how it was an unfortunate gamble involving genetics and environmental stress factors in which the loser had to pay with his sanity. I knew that the sick man who filled up notebooks with grandiose ideas and inventions in cramped illegible handwriting was not the same man who sang Bollywood songs from the 1950s and 1960s, his angelic voice rising clear and deep, when he was well. I knew that celebrities, such as Brian Wilson of the Beach Boys and Syd Barrett of Pink Floyd, had been geniuses that struggled with the disease. It was out in the open. The world had definitely changed since I was a child growing up in the eighties. 

Just not in my community. Within the Pakistani-Muslim community in the United States, the attitudes towards mental illness have remained as negative as ever. Among the uneducated or superstitious, mental illness is a supernatural affliction, possibly from djinn possession. Wear a blessed taweez from a sheikh and pray salat, sister, and the mind will be all clear! 

For the educated, mental disorders are considered a real illness but nonetheless shameful, indicating a feebleness of mind and self-control. Bad blood. We don’t want to marry into that family, their genes are bad. The word paagal, which means crazy in Urdu, still cuts through me like a knife. As a child, the world sounded like a sneer made audible. We weren’t allowed to use the words paagal, or its English translation, for any reason in our house. It’s a tradition I’ve carried on within my only family.  

After my father passed away in his sleep almost seven years ago, part of me thought we were finally free of the stigma, finally free of fear, finally free of the isolation we often felt. After all, he had died as the proud owner of a beautiful little house with a lemon tree in the backyard. His children had grown and embarked on successful careers and marriages. He had grandchildren to spoil who loved their Nanoo completely with the untarnished innocence of childhood. All in all, it was a peaceful culmination to a tumultuous life. The lies should have ended. But upon his death, we found ourselves continuing to pretend that schizophrenia had never touched our lives. We all but erased any discussion of his so-called depression in an effort to honor his memory – as if the shame of mental illness could follow him into the afterlife. For us, the stigma didn’t end with his death. It simply passed on to the rest of the family. 

And that family now includes my three children and my two nephews. When my children were born, I worried about what I would say to them. How I would explain that within their DNA lived a hidden disease, dormant in some, rearing its ugly head in others. The rational side of me, the one that was Westernized and educated, said there was no grand explanation needed. It was an illness like cancer or heart disease, part of their genetic makeup but one that may never emerge. But there was another side of me, born of culture, bred in secrets that held on to the stigma that mental illness retained in my society. The fear that asks “what will people say?” 

So I watched them covertly, looking for signs, overanalyzing every misplaced laugh or spacey stare out the car window. One day my daughter came home and excitedly told me that there were voices in her head. “I like Joy a lot, Mom, because she makes me happy. She tells me about all the wonderful things in the world,” she said. “I don’t like Anger, though. He makes me see red.” 

My heart suddenly stopped as I looked up from my book. “You hear voices?” I asked her, attempting to keep my own voice neutral even as a dull thudding sensation began to spread from my temples to the back of my neck. My husband, who came in behind her, quickly walked over to me. “Relax, she’s talking about the Pixar movie “Inside Out,” he said, putting his hand on my arm. “The main character’s emotions are portrayed as voices in her head. We just came from seeing the movie. It’s not what you think.” 

I nodded and managed a smile at my daughter as she ran upstairs to listen to her iPod. I felt a sudden, dizzying rush of emotions: gratitude, fear, but most of all, love. I was shaken but I knew that no matter what may come, I would accept her and love her. I would never hide from anything that made her who she was. It was an acceptance that I had never really been able to give my own father. And I was deeply ashamed, not of him but of myself. 

At that moment, I realized that the specter of schizophrenia would always hang over me because it is in everything I am today. It is the corrosive suspicion in my heart that makes me question not only the innocuous actions of my loved ones but also myself for any signs of illness. It is the source of the anxiety attacks that have plagued me since I was a teenager. It is the source of the self-doubt that haunts me whenever I am about to embark on a new challenge – the mocking voice in my own head that wonders whether my ambitions are really just delusions of grandeur. It is the lie I maintain to the world to hide the fragility I feel every morning when I open my eyes.  

And it’s the judgment that I unwittingly still held against my father, the man who would try to smile at me no matter how many voices assailed him. The man who loved me completely even when he couldn’t love himself. By denying his illness for years, I denied the strength and perseverance of the man who suffered from it. I held him accountable for my shame. I blamed him for a crime he had no part in committing. And by hiding from it, I hoped that maybe I could rewrite our history. But that would rewrite the man that my father truly was. Brilliant, soft spoken, ambitious, proud, complicated, troubled, bitter, schizophrenic. 

I still tell myself every day that if I pray hard enough, maybe my children will never suffer from it. Maybe they will never feel the shame that we felt growing up when people, hearing idle gossip about my dad, would avoid us at parties as if his illness was either contagious or dangerous.  Maybe they will never have to look at themselves in the mirror and see themselves as pariahs.  

Maybe. But I won’t hide from the word schizophrenia anymore. My children will know their grandfather in all of his glory and messiness. And they will be proud of him for everything he suffered and sacrificed and endured. I will join them in that sense of pride. I just wish it hadn’t taken me so long to feel it.  

 

 

In 1913, She Walked Down the Aisle Disguised as a Man

Colorado’s first same-sex marriage happened more than a century ago, when a lovable rogue named Helen Hilsher — posing as "Jack Hill" — married her sweetheart.

In the winter of 1911, a handsome young man arrived in Meeker, Colorado. He wore a smart suit and introduced himself to the residents as John Hill – or Jack, as he preferred to be called. No one in that small White River Valley town had ever seen him before. He was in his early twenties, and had come from the east, he said, to be revived by the bracing western winds.  

His first job in the town, however, was not out on the plains, but at the local saloon owned by one John Davitt. Handsome and well-mannered, Jack was instantly popular with the Davitt House’s patrons, working his way up from dishwasher to barroom porter, before finally achieving the status of bartender. Though he did not join the town’s men in their drinking – a quirk which soon earned him the title of “Davitt’s teetotaller” – the men did not begrudge him his temperance. Jack was adept at minding his own business, turning his attention to a dirty glass or unswept floor when their profanities drifted across the bar towards him. If he heard them at all, or disapproved of their risqué talk, he did not show it, and for this he earned their unspoken respect. 

Jack’s stoical charm was not only popular with the men of the town. Enamoured by his thick curls and smooth face, tanned from his work on the ranches, the local girls looked with interest upon their newcomer. Within a week of his arrival, they had rechristened him “Handsome Jack,” and within three they had collectively voted him “the most handsome and captivating” man in town, according to the Herald Democrat. 

Popular, hardworking, attractive – Jack Hill was, to all appearances, a very successful Meeker man.  

The people of Meeker weren’t to know – at least not yet – that this quiet youth who mixed their drinks with sober care and politely returned their blushing glances in the town’s streets had, only six years previously, been living under a very different name in nearby Coal Creek, Colorado. Indeed, as recently as 1907, “Jack Hill” had been known not as a barman but as a teacher – a young woman by the name of Helen A. Hilsher.  

* * *

Where Helen Hilsher was born or what her life was like before she arrived in Meeker it is, for the most part, difficult to say. Births were not required to be recorded by the state of Colorado until after the turn of the century, but if the age she gave when living as Jack Hill is to be believed, Hilsher was born in 1891. She lived for a while working as a teacher in Coal Creek, a town about 200 miles from Meeker and where, according to her landlady Mrs. J.J. Ross, she had been “unusually popular.” Despite this popularity, however, Coal Creek was too small an arena to play adequate host to Helen Hilsher’s ambitions. Sixteen years old, evidently intelligent and charismatic, but with little or no family or money behind her, Helen was already itching for a way out, searching the stores of her considerable ingenuity for an answer to the problem of her situation.  

In 1909, Helen found the answer she was looking for. She donned a suit and cut her hair, and made the journey 90 miles east – to the nearby town of Wiggins, Colorado.  

It was in Wiggins that “Jack Hill,” according to the newspaper records, first came to life. He arrived without great incident, and immediately took up residence on a 160-acre homestead 12 miles southwest of the town. He was as popular in Wiggins as he would later be in Meeker. Known affectionately among his fellow ranchers as “little Jack” due to his slight physique, he also prolifically courted the town’s women. He even developed a close relationship with one young woman, though her name unfortunately escapes the written record. They were frequently seen out riding together in the Sunday dusk, two slight forms trotting side by side in the dying light. For two years, Jack Hill lived happily in Wiggins. 

In September 1911 Hill went to Denver with a group of young male friends, brought to serve as witnesses in a legal matter. Hill was there to prove that he was the rightful owner of land bought under the name of Helen Hilsher, and he took it as an opportunity to reveal his past identity to his new friends.  

Changing into feminine clothing on arrival at the Denver town hall, Hill presented himself to the group as “Helen” for the first time. Perhaps predictably, the men were disbelieving. According to one report, Helen was forced to remove the wig she had donned for the occasion, and to resume her masculine gait and tone of voice before her friends would finally believe that she was indeed their friend “little” Jack. 

“It was the only thing to do,” said Hilsher afterwards, speaking to a reporter from the Yuma Pioneer who visited her at her home in Denver. “A woman would not have felt safe out there alone, and I just had to do it. Now that it is all over I feel awful about it – but, I am glad I won.” 

This declaration of victorious and satisfied retreat from the masculine world may have been palatable to local newspapers and their readers, but the story wasn’t picked up in Denver or nationally. It had the air of a completed sideshow, a party trick. As far as the papers were concerned, Hilsher had packed away the circus and costume and settled back into the life proper to her as a young woman in that early phase of the twentieth century. Her jaunt in Wiggins was merely a flight of feminine fancy: a local gossip piece.  

This was a false impression. 

Within months of Helen’s departure from Wiggins, Jack Hill arrived in Meeker. 

* * *

During his time working for John Davitt, Jack socialised with the women of the town. As a newcomer, and a handsome young bachelor at that, he was no doubt assailed by introductions from his very first morning. He nodded politely as he greeted each of the eligible young ladies who stopped him as he went about his business, watching with a wry glint in his eye as they walked away, or whispered in the shades of doorways as he passed them in the street. He held his secret close to him like a gleaming talisman, but these girls must have caught flashes of it sometimes – in the way he smirked mischievously at them in full view of their mothers, or the pleasing firmness of his hand as it pressed into each of theirs.  

It did not take him long to find a co-conspirator. Within a few months of arriving in Meeker, Jack Hill was observed to have taken an intense interest in one Miss Anna Slifka, a young woman considered by many to be “the prettiest girl in the White River country.” An electric current of unspoken recognition had passed between them at their first meeting: the understanding that in each other they had found an equal to their own ambition, a mirror-image – a partner in crime. Born in Czechoslovakia, the daughter of a well-to-do rancher and sister of the local cobbler, Slifka enjoyed much the same popularity amongst the town’s men as Jack had found among the women, and by the autumn of 1912 they had become firm friends. Speaking about their friendship and apparent courtship in 1913, the two maintained that they had bonded over their mutual experience of pursuit. 

“The girls just wouldn’t let me alone,” said Hilsher to the Montrose Daily Press, smiling wanly, “and they worried me to death with hints to take them to parties and other social events. I got tired of it all and I found I just had to tell someone, and confided my secret to Miss Slifka.”  

Anna reported the same experience with matching exasperation: “The boys were always chasing me. I didn’t care for any of them. I wanted peace.”  

Together, they concocted a solution to their mutual quandary. “We decided together that we would get married to save me from being annoyed by young women,” Hilsher stated to the Lincoln County News. “Also so that both of us could later on appear as men and earn more wages than we ever could hope to earn as girls.”  

So it happened that on November 14, 1912, Reverend Robert L. Nuckolls married Anna E. Slifka to John C. Hill at the town church in Meeker.  

Did the pair know then that what they had accomplished was a radical act? A historic one? Did they wink at each other from either side of the altar, thrilled with their achievement? We cannot say. Even with all that came afterwards, it is impossible to tell whether their marriage was an act of rebellion, or of rebellious love. We have only their marriage license, and what was reported later on in newspapers.  

The couple, newly married, took up residence on their own homestead out at Flag Creek. They were married for ten months before anyone found out their secret.  

* * *

On September 19, 1913, a man named W.B. Thompson arrived in Meeker from Denver. What his business was there we cannot be sure, but we do know that he was passing through Victor Slifka’s shoe shop when the slight young man conversing with its owner caught his eye. According to the Lincoln County News, as Jack Hill turned to leave his brother-in-law’s shop, Thompson stopped him at the door.  

“You are Helen Hilsher of Denver, are you not?” he inquired, looking into the tanned face, flushing darkly now beneath its crown of shining curls.  

Jack denied the name, avoiding the man’s gaze and pushing past him out into the street. His heart was beating like a fist against the inside of his ribs, sweat gathering under the collar of his suit despite the mildness of the September day. Every eye seemed to flash with suspicion as he passed, and his steps seemed unusually loud as he sped towards the end of the street. 

Looking back as he reached the corner, Jack Hill broke into a run.  

Things began to unravel quickly after that.  

Back in the shop, Thompson had already alerted Victor to his brother-in-law’s “true” identity. Enraged, Slifka hurried to his sister and brother-in-law’s homestead, a doctor in tow, finding the couple making frantic arrangements to escape to California. After attempting to bribe the doctor to protect her identity, Hilsher was led to the town jail, where she gave another false name – that of Helen Halstead – to the police. As for Slifka, she was marched back to her family home by her brother, forbidden from seeing anyone but her close relations.  

Later, in court, the two spouses explained repeatedly that the scheme had been in aid of saving for college tuition at an eastern school. “A working girl hasn’t any chance in the east and I thought I could dress like a man and get work on a ranch in the west where I could earn enough by drawing a man’s wages to start me in a good school,” Hilsher explained, as reported in the Des Moines News. She added to the Oakland Tribune that “Everything was going lovely when I was arrested. We had moved to our homestead and were getting along happily. We were not doing anything wrong or bothering anybody and both of us were saving nicely. I cannot see yet what I have done to deserve arrest.”  

The judge opted to postpone the full trial of Helen Hilsher until September 1914. Helen returned to the home of her foster mother in Denver, and one newspaper reported that she had moved from there to Chicago. Anna Slifka remained at home with her family. Their story was seized upon by the press, eventually being connected to Jack Hill’s previous appearance in Wiggins. In her testimony in 1913, reported in a Denver newspaper, Hilsher declared before the court, “I still love Anna.” 

* * *

Helen’s story is a challenging one for many reasons – first of all, for its willing complication of the norms of its own time and ours. It would not be unreasonable to look at this story as a piece of transgender history, to take Jack Hill as a trans man. It may also be a queer love story – the tale of a marriage for love and not merely, as the couple claimed at the time, money. It may equally be read as a story of women working together in service of their ambition, turning an insolent and androgynous face to the gendered systems that confined them. Or, perhaps, the truth of Helen-or-Jack’s gender and sexuality lies in the shades between all of these things, in their extraordinary Tiresian quality, the daring magnetism that, by all accounts, drew others towards it like a brilliant light. 

Equal to the challenge of telling this story is knowing how to end it. I have so far been unable to find any news of the trial that was scheduled for September of 1914. What we do know is that after Helen – or, indeed, Jack – left Meeker for Denver and possibly Chicago, Anna Slifka remained, marrying a man named Fredrick E. Peaslee, 15 years her senior, on June 14, 1918. The records that remain of Anna after that are almost exclusively bound up with the records of the men in her life: her brother Victor’s World War II registration card, the censuses that note the births of her four sons. She lived out the rest of her life in the small town, and died on November 1, 1979, having been a widow for thirty years. She is buried under the same stone as her husband at Highland Cemetery in Meeker. 

As to her ex-spouse, it has proven impossible to find any records of a Helen Hilsher, Helen Halstead, or a Jack or John Hill that can be definitively linked to the charming wo/man who had so shaken up small-town Colorado in the early part of the century. Efforts to locate the various people connected with the trial – Dr. Helen or Nina Jones, E. P. Osborne, even John Davitt – have either yielded nothing at all, or only information that is useless to the establishment of Helen’s movements after 1913. It is possible that she is simply camouflaged within the sporadic catalogues of marriages, births and deaths in the era; that she returned to society in traditional feminine garb and lived out her days quite conventionally, marrying (a man this time), perhaps producing unknowing heirs to her curious history. Maybe she, too, lies beneath a shared headstone somewhere in a cemetery on the prairie.  

This end for Helen Hilsher, however, seems unlikely.  

When questioned by the Oakland Tribune after her arrest, Helen declared of her time as Jack Hill that “I would not go through with it again for a million dollars. It is all a horrible nightmare to me now that it’s over and I am glad to be wearing dresses again like other girls.” We know what happened the last time she gave such an answer.  

It is not so impossible that, as the dust settled back over Meeker, a slight, handsome stranger walked into a distant town. He wore a halo of dark curls and a broad grin, and beneath the breast of his smart suit a roguish heart beat irrepressibly, irresistibly – ready for a new adventure.

 

 

The Day My Therapist Dared Me to Have Sex With Her

My analyst and I grew more intimately connected each week of treatment...but I never saw this indecent proposal coming.

It’s the waning moments of my fourth session with a new therapist. I’m holding back — and she knows it. My entire body feels tense, not ideal for the setting. I try to relax, but the plush leather couch crumples under me when I shift, making the movements extraordinary. I’ve barely looked into my therapist’s blue eyes at all, and yet I think the hour has gone very well. Of course it has. On the surface, when the patient has been highly selective of the discussion topics, therapy always resembles a friendly get-together.

“Well,” my therapist, Lori, says, the millisecond after I become certain our time is up and I might be in the clear. “I don’t think I should let you go until we’ve at least touched on what was put out there at the end of last week’s session.”

I so supremely wanted this not to come up. My eyelids tighten, my mouth puckers to the left, and my head tilts, as though I’m asking her to clarify.

“When you said you’re attracted to me,” she continues.

“Oh, yeah,” I say. “That.”

Back in session three Lori was trying to build my self-esteem, the lack of which is one of the reasons I’m in treatment. Within the confines of my family, I’ve always been the biggest target of ridicule. We all throw verbal darts around as though we’re engaged in a massive, drunken tournament at a bar, but the most poisonous ones seem to hit me the most often, admittedly somewhat a consequence of my own sensitivity. I’ve been told it was historically all part of an effort to toughen me up, but instead I was filled with towering doubts about my own worth. And since 2012, when I gave up a stable, tenured teaching career for the wildly inconsistent life of a freelance writer, I’ve had great difficulty trusting my own instincts and capabilities. I told Lori that I wish I was better at dealing with life’s daily struggles instead of constantly wondering if I’ll be able to wade through the thick.

She quickly and convincingly pointed out that I work rather hard and am, ultimately, paying my bills on time, that I have friends, an appreciation for arts and culture, and so on. In short, I am, in fact, strong, responsible and “pretty good at life.”

Then Lori heightened the discussion a bit. “I also feel that it is your sensitivity that makes you a great catch out there in the dating world,” she said, to which I involuntarily smiled, blushed and quickly buried my chin in my chest. I was too insecure and too single to handle such a compliment from a beautiful woman.

“Why are you reacting that way?” Lori asked.

I shrugged my shoulders, only half looking up.

“Is it because you’re attracted to me?”

I laughed a little, uncomfortably. “How did you know?”

She gently explained she could tell the day I walked into her office for the first time, after I flashed a bright smile and casually asked where she was from.

Now, a week after dropping that bomb, Lori asks, “So, why haven’t we talked about it?”

“I was hoping to avoid it, I suppose.” I tell her the whole notion of having the hots for a therapist is such a sizable cliché that I was embarrassed to admit it. “For Christ’s sake,” I say, throwing my hands up, “Tony Soprano even fell in love with his therapist.”

Lori snorts, rolls her eyes. “I knew you were going to say that.”

I smile, shake my head and look around the room, denying acceptance of my own ridiculous reality.

“It’s OK,” Lori says, grinning. “We can talk about this in here.”

I look again at her stark blue eyes, prevalent under dark brown bangs, the rest of her hair reaching the top of her chest, which is hugged nicely by a fitted white tee under an open button-down. She jogs often, I’d come to find out, which explains her petite figure and ability to probably pull off just about any outfit of her choosing.

I still can’t speak, so she takes over.

“Do you think you’re the first client that’s been attracted to their therapist?” she asks rhetorically. “I’ve had other clients openly discuss their feelings, even their sexual fantasies involving me.”

“What?” I cackle, beginning to feel as though I’ve moseyed onto the set of a porno.

“It’s true,” she says, acknowledging her desk. “What’s yours? Do you bend me over and take me from behind?”

Nailed it.

“If that’s what you’re thinking, it’s OK,” she goes on, earnestly, explaining that she’s discussed sexual scenarios with her clients before so as to “normalize” the behavior and not have them feel their own thoughts are unnatural. By showing the patient a level of acceptance, she hopes to facilitate a more comfortable atmosphere for “the work” — her painfully accurate pseudonym for psychotherapy.

I take a second to let the red flow out of my face, and ponder what she said. I’m a little unsure about this whole technique, but the more I think about it, the more it makes sense. So I go home, incredibly turned on and completely unashamed.

* * *

One of the great breakthroughs I’ve had in the thirteen months since I began seeing Lori (who agreed to participate in this article, but requested that her full name not be published) is a new ability to accept the existence of dualities in life. For instance, I’ve always had a tremendous sense of pride that, if it doesn’t straddle the line of arrogance, certainly dives into that hemisphere from time to time. I’m great at seeing flaws in others and propping myself up above them by smugly observing my character strengths. I’ve never liked that about myself, but the harder concept to grasp is the fact that I can be so egotistical while also stricken with such vast quantities of insecurity.

In treatment I came to realize that all people have contradictions to their personalities. There’s the insanely smart guy who can’t remotely begin to navigate a common social situation, the charitable girl who devotes all her time to helping strangers, but won’t confront issues in her own personal relationships. In my case, my extreme sensitivity can make me feel fabulous about the aspects of myself that I somehow know are good (my artistic tastes) and cause deep hatred of those traits I happen to loathe (the thirty pounds I could stand to lose).

My next session with Lori is productive. We speak about relationships I’ve formed with friends and lovers, and how my family may have informed those interactions. One constant is that I put crudely high expectations on others, mirroring those thrown upon me as a kid. I’m angered when people don’t meet those expectations, and absolutely devastated when I don’t reach them. Lori points out that it must be “exhausting trying to be so perfect all the time.” I am much more comfortable than I was the week prior, and can feel myself being more candid. I’m relieved that the whole being-attracted-to-my-therapist thing doesn’t come up.

Then, a week later, Lori mentions it, and I become tense again.

“I thought I’d be able to move past it,” I say, adding, “We aired it out, and it’s fine.”

As definitive as I’m trying to sound, Lori is just as defiant.

“I’m glad you feel that way,” she begins, “but I think you owe yourself some kudos. This kind of therapy,” she shares, “isn’t something just anyone can take on.” Such honest discussion doesn’t simply happen, it takes tremendous guts, and Lori can see that I am dealing with it relatively well, so I should praise my own efforts.

“Shit, we both should be proud of ourselves,” she says. “It’s not easy on the therapist either, you know.”

“Why not?”

“Because talking openly about sex is risky at any time, much less with a client.” She explains that therapists are warned any semblance of intimacy can be easily misconstrued. “We learn in our training to not personally disclose, for example,” she says, but adds that, occasionally, transparency can be helpful.

“Still, with you,” she continues, “until I raised the question, I didn’t know for sure that you would go with it; for all I knew you’d run out of here and never come back to risk being so uncomfortable again.”

She’s building my confidence more, and I’m learning that I play a much bigger role in how my life is conducted than I often realize. My treatment wouldn’t be happening if I weren’t enabling it.

Then she says, “And don’t think it’s not nice for me to hear that a guy like you thinks I’m beautiful.”

Crippled by the eroticism of the moment, and combined with the prevailing notion that no woman this stunning could ever be romantically interested in me, I flounder through words that resemble, “Wait…what?”

“If we were somehow at a bar together, and you came over and talked to me,” she says, then flips her palms up innocently, “who knows?”

I laugh again and tell her there’d be almost no chance of me approaching her because I’d never feel like I had a shot in hell.

“Well, that’s not the circumstances we’re in,” she says. “But you might. Who knows?”

I’m confused — Is she really attracted to me or is this some psychotherapeutic ruse? I’m frustrated — I told her I didn’t really want to talk about it. Shouldn’t she be more sensitive to my wants here? I’m angry — Is she getting an ego boost out of this? Most of all, I don’t know what the next step is — Am I about to experience the hottest thing that’s ever happened to a straight male since the vagina was invented?

There were two ways to find out:

1) Discontinue the therapy, wait for her outside her office every day, follow her to a hypothetical happy hour and ask her out, or

2) Keep going to therapy.

* * *

A week later, I’m physically in the meeting room with Lori, but mentally I haven’t left the recesses of my mind.

“Where are you today?” she asks, probably noticing my eyes roving around the room.

“I don’t know.”

“Are you still grappling with the sexual tension between us?”

Here we go again.

“Yes,” I say, with a bit of an edge in my voice, “and I don’t know what to do about it.”

Lori, ever intently, peers into my eyes, wrinkles her mouth and slightly shakes her head.

“Do you want to have sex with me?” she asks.

We both know the answer to that question. All I can do is stare back.

“Let’s have sex,” she announces. “Right here, right now.”

“What?” I respond, flustered.

“Let’s go!” she says a little louder, opening up her arms and looking around as if to say the office is now our playground, and, oh, the rollicking fun we’d have mixing bodily fluids.

“No,” I tell her, “You don’t mean that.”

“What if I do?” she shoots back. “Would you have sex with me, now, in this office?”

“Of course not.”

“Why ‘of course not’? How do I know for sure that you won’t take me if I offer myself to you?”

“I wouldn’t do that.”

“That’s what I thought,” she says, and tension in the room decomposes. “Mike, I don’t feel that you would do something that you think is truly not in our best interest, which is exactly why I just gave you the choice.”

Her offer was a lesson in empowerment, helping me prove that I have an innate ability to make the right choices, even if I’d so desperately prefer to make the wrong one.

I see what she means. I’m awfully proud of myself, and it’s OK to be in this instance. I’m gaining trust in myself, and confidence to boot. But, as the dualities of life dictate, I’m successfully doing “the work” with a daring therapist, while at the same time not entirely convinced she isn’t in need of an ethical scrubbing.

* * *

I don’t have another session with Lori for nearly three months, because she took a personal leave from her place of employment. When our sessions finally resumed, I could not wait to tell her about my budding relationship with Shauna.

Ten minutes into my first date with Shauna — right about the time she got up from her bar stool and said she was “going to the can” — I knew she would, at the very least, be someone I was going to invest significant time in. She was as easy to talk to as any girl I’d ever been with, and I found myself at ease. Plans happened magically without anxiety-inducing, twenty-four-hour waits between texts. Her quick wit kept me entertained, and I could tell by the way she so seriously spoke about dancing, her chosen profession, that she is passionate about the art form and mighty talented too. Shauna is beautiful, with flawless hazel eyes and straight dark hair, spunky bangs and a bob that matches her always-upbeat character. She is a snazzy dresser and enjoys a glass of whiskey with a side of fried pickles and good conversation as much as I do.

Things escalated quickly, but very comfortably, and since we’d both been in our fair share of relationships, we knew the true power of honesty and openness. So upon the precipice of my return to therapy I told Shauna about Lori, and admitted to having mixed feelings about what I was getting back into. I told her I was at least moderately uncertain if my mental health was Lori’s number-one concern since she always seemed to find the time to mention my attraction to her.

The first two sessions of my therapeutic reboot had gone great. Lori appeared genuinely thrilled that I was dating Shauna and could see how happy I was. I wasn’t overwhelmed with sexual tension in the new meeting room, though it wasn’t actually spoken about, and in the back of my mind I knew it was just a matter of time before it would start to affect my ability to disclose my thoughts to Lori again.

Then, while attempting to ingratiate myself with my new girlfriend’s cat by spooning food onto his tiny dish on the kitchen floor, I hear my phone ding from inside the living room.

“You got a text, babe,” Shauna says. “It’s from Lori.”

“‘I’m so impressed with you and the work you’re doing…’” Shauna reads off my phone from inside the living room, inquisitively, and not happily. I stuff the cat food back into the Tupperware and toss it into the refrigerator. I make my way into the living room, angry at myself for not changing the settings on my new iPhone to disallow text previews on the locked screen. Shauna’s walking too, and we meet near the kitchen door. “What’s this?” she says, holding up the phone. “Your therapist texts you?”

I take the phone from Shauna and say the most obvious, cliché-sounding thing: “It’s not what it seems.”

As I text back a curt “thanks,” Shauna tells me she’s going to ask her sister, a therapist herself, if it’s OK to text patients.

“Don’t do that.” I say, a little more emphatically. “I promise, this is nothing to be worried about. We’re not doing anything wrong.” I explain that Lori’s just trying to build my self-esteem.

“The only reason I’m even bringing this up is because you said you weren’t sure about her in the first place,” Shauna reminds me. I can tell she regrets looking at my phone without my permission, but I completely understand her feelings.

At my next session I tell Lori that Shauna saw her text and wasn’t thrilled about it.

“She probably feels cheated on to some degree,” Lori says. “A relationship between a therapist and a patient can oftentimes seem much more intimate than the one between a romantic couple.”

Lori goes on to point out that the reason she feels we can exchange texts, blurring the lines between patient/doctor boundaries — a hot topic in the psychotherapy world these days — is because she trusts that I’ll respect her space and privacy. “You’ve proven that much to me,” she says.

On my walk home, instead of being angry at Lori, I understand her thinking behind the text. But I’m also nervous about how Lori and Shauna can ever coexist in my life.

Isn’t therapy supposed to ameliorate my anxiety?

* * *

A week later, Lori begins our session by handing me a printout explaining the psychotherapeutic term “erotic transference” written by Raymond Lloyd Richmond, PhD. It says that erotic transference is the patient’s sense that love is being exchanged between him or herself and the therapist — the exact sensation I was experiencing with Lori, of which she was astutely aware.

According to Richmond, one of the primary reasons people seek therapy is because “something was lacking in their childhood family life,” perhaps “unconditional nurturing guidance and protection.” Upon feeling “noticed” and “understood” by a qualified therapist, sometimes a patient can be “intoxicated” by their therapist’s approval of them. A patient may in turn contemplate that a love is blossoming between them, and, in fact, it sort of is.

From an ethical standpoint, Richmond argues all therapists are “bound” to love their patients, for therapists are committed to willing “the good of all clients by ensuring that all actions within psychotherapy serve the client’s need to overcome the symptoms” which brought them into treatment. This takes genuine care and acceptance on their part. However, a patient can easily confuse the love they feel with simple “desire.” They’re not quite in love with their therapist, so much as they yearn for acceptance from someone, and in those sessions they just happen to be receiving it from their doctor.

Lori tells me that, all along, she has been “working with what I gave her” and that because I flirted with her a bit, she used that to her advantage in the treatment. In employing countertransference — indicating that she had feelings for me — she was keeping me from feeling rejected and despising my own thoughts and urges.

“There’s two people alone in a room together, and if they’re two attractive people, why wouldn’t they be attracted to each other?” says Dr. Galit Atlas. A psychoanalyst who’s had her own private practice for fifteen years, Dr. Atlas has an upcoming book titled The Enigma of Desire: Sex, Longing and Belonging in Psychoanalysis, and I sought her as an independent source for this essay to help me understand Lori’s therapeutic strategies.

Dr. Atlas explains that there are certain boundaries that cannot be crossed between therapist and patient under any circumstances — like having sex with them, obviously. But many other relationship borders can be mapped out depending on the comfort level of the therapist, as long as they stay within the scope of the profession’s ethics, which complicates the discussion surrounding erotic transference.

“As a therapist, I have a role,” Dr. Atlas says. “My role is to protect you.” She says it is incumbent on the therapist to not exploit the patient for the therapist’s own good, but admits that the presence of erotic transference in therapy brings about many challenges. “[Attraction] is part of the human condition,” she observes. In therapy, “the question then is: What do you do with that? Do you deny it? Do you talk about it? How do you talk about it without seducing the patient and with keeping your professional ability to think and to reflect?”

I ask her about the benefits of exploring intimacy in therapy, and Dr. Atlas quickly points out that emotional intimacy — though not necessarily that of the sexual brand — is almost inevitable and required. “An intimate relationship with a therapist can [be] a reparative experience — repairing childhood wounds — but mostly it’s about helping the patient to experience and tolerate emotional intimacy, analyzing the client’s anxieties about being vulnerable and every mechanism one uses in order to avoid being exposed.”

Dr. Atlas says this topic speaks to every facet of the therapeutic relationship, regardless of gender or even sexual orientation, because intimacy reveals emotional baggage that both the patient and therapist carry with them into the session. But this isn’t a symmetrical relationship, and the therapist is the one who holds the responsibility.

“Freud said that a healthy person should be able to work and to love,” she says. “In some ways therapy practices both, and in order to change the patient will have to be known by the therapist. That is intimacy. In order to be able to be vulnerable, both parties have to feel safe.”

After I briefly explain all that has gone on between me and Lori, Dr. Atlas steadfastly says she does not want to judge too harshly why and how everything came to pass in my therapy. “I don’t know your therapist, and I don’t know your history,” she says. But she offers that I should “explore the possibility” that I might have created and admitted my sexual adoration of Lori because one of my fears is to be ignored, not noticed.

Then I offer: “Maybe this essay is being written for the same reason.”

“Exactly.”

Maybe I wanted to interview Lori about erotic transference in my therapy sessions for that same reason as well…to stand out as the most amazingly understanding patient ever.

* * *

“I want to be very clear that this was never about feeding my own ego,” Lori says about her approach to my treatment. “We were always doing this in your best interest.”

I’m in Lori’s office, a tape recorder rolling and a pad and pen in my hands.

“I felt I was doing a disservice to you if I didn’t ‘out’ what I felt was weighing on us, which, honestly, felt like a heavy secret,” she says, pointing out that she discussed my therapeutic process for many hours in her required supervision meetings.

In order for Lori to advance in her field as a social worker, she has to attend 3,000 conference hours with another professional to go over casework — kind of like therapy quality control.

We talk about all of this during one of my scheduled sessions, for the entire hour — and go over by a few minutes, too.

Lori says that when she began her career as a social worker, she decided she wasn’t going to shy away from any subjects. “It’s typical for a client to [have] a habitual desire to sweep things under the rug,” she observes, especially about taboo topics. It can become a cycle of behavior that Lori seeks to break.

I refer back to the time when, unprovoked, she brought up my attraction to her.

She says she mentioned it to avoid what therapists call “door-knobbing,” which is when a patient will purposely mention some huge reveal right at the end of a session so as to sidestep a lengthy conversation about it.

“My only question for you is, was I wrong for bringing it up?” she asks. “Only you can answer that.”

Lori’s great at forcing me to reflect.

“I guess when I said I was over it and could move on, that was an example of my strict black-and-white thinking,” I say, throwing back some language she’s used often to describe my challenge in accepting dualities. In my mind, I was either attracted to her and shouldn’t see her anymore, or I wasn’t attracted to her and could still have her be my therapist. There was no in between.

I realize now that she wasn’t wrong for mentioning my feelings for her, even when I didn’t want her to. Lori noticed that I was frustrated with myself and wanted me to know that an attraction to a therapist is so normal and happens so frequently that there are technical terms for it.

I turn my attention towards the presence of countertransference in our session. I’m trying to come up with an actual question here, but, really, I just want her to confirm her feelings for me are real. So I say, referring to her feelings, with a great degree of difficulty, “It’s funny that they seem genuine to this day.”

“They are genuine,” Lori says, adding a moment later: “I think it might be a good idea if we explore why our discussing it suggests a lack of authenticity.”

“It doesn’t, necessarily,” I begin, then stammer through a few sentences, worried I might offend her by implying she’s been dishonest. I finally settle on, “I guess it comes back to my self-esteem issues. Why would a beautiful woman think I’m attractive?”

Lying in bed with Shauna a few months into our relationship, I ask her what she thought about me the moment she first saw me. I’m fishing for a compliment. But we met on Tinder and I just hope that seeing me in person wasn’t some kind of letdown for her after swiping right on my hand-picked glamour shots. Obviously she isn’t going to say something so awful after having committed to me for so long. It’s a slam-dunk ego boost.

She says she liked the fact that I was wearing a blazer and a tie on a first date. She adds that I was a little shorter than she anticipated, but was content with the two of us at least being the same exact height.

“What did you think when you first saw me?” she asks, turning it around, naturally.

Staying committed to my honesty-at-all-costs policy, I say, “I thought you were really beautiful, but not to the point where I was intimidated by you, which was very important because if I was, you would have gotten a very unconfident version of me, and we probably wouldn’t have hit it off as well as we did.”

Shauna thinks about that for a second, and eventually nods “OK.”

I explain that my insecurity could often get the better of me in dating situations. It was easy to convince myself that I’d be rejected by the girl I was with, especially if I thought she was out of my league. I would then slip into a nervous and reserved state that isn’t at all reflective of my true self.

I’m essentially saying that I was so thrilled to not find Shauna so extraordinarily pretty that I couldn’t accept her being on a date with me. That thought made so much sense at the time I said it, but I’ve since come to realize it is as ridiculous as it is insulting. After ten months of being with Shauna, I’m still completely floored by her, on every level, including a physical one. It gives me great pride to walk into a room with her, and I don’t imagine that changing. Therefore, she actually did meet a confident “version of me.” The way people look doesn’t drastically change in ten months but a person’s perception of self can. It seems my emotional workouts in erotic transference were just beginning to produce results.

* * *

“People fuck up,” Lori informs me during one winter session. “Therapists have slept with clients before, just like politicians have had sex with their interns. But, so you have a full understanding of how this works, we can date.” She explains the parameters as outlined in the social worker’s code of ethics. One of the many stipulations is that we wouldn’t be able to see each other, under any circumstances, for at least two years before dating. She tells me she loves her job, and there’s no way she would ever sacrifice my safety or her career for anything, so she would strictly follow all the dictated rules. “If you truly want to date me, there is the option. But it’s ultimately up to you.”

I know what she’s doing here — putting the onus on me, just like last year when she said we could have sex. The difference this time is the answer I want to give is on par with all of my involuntary urges.

“I don’t want to stop the work we’re doing,” I say. “At this point, it’s far too valuable to me, and, really, I know very little about you.” She’s beautiful, exercises, is smart, funny, professional, enjoys good TV…and that’s about it. Aside from whether or not we’d even both be single in two years, and if we’d be in the correct mind frame to explore a relationship, there are several other things I’m considering here: Would Lori and I really be compatible in every way? Would she ever see me as a lover, a partner, an equal, and not a patient? Could I ever reveal a detail about myself, or even just a shitty day of work, without wondering if she was picking it apart and analyzing it?

Frankly, all those questions could be answered in the positive. But, even if I wasn’t in a happy relationship — Shauna makes this choice much easier, for sure — I wouldn’t go that route. I’d be out a therapist.

* * *

It’s a beautiful spring night in New York and only sidewalk seating will do. Shauna and I are out to dinner at a restaurant near her Queens apartment, and we’re both in good spirits. The weather and the alcohol consumption are partly to blame for that, but, on cue with the season’s change, I feel I’ve turned an emotional corner. Work payments that were past due are finally finding their way into my bank account. As it turns out, my short-term money troubles were not an indication that I had no business being a writer, or that my life changeup was as irresponsible as unprotected sex at fourteen years old.

I’d told Lori as much that afternoon. I took a mental step back from my current situation and realized that in spite of my recent hardships, I was succeeding. I summarize my session for Shauna, who nods in agreement, lovingly pointing out that she’s had the same challenging freelancer experiences as a dancer.

“You’re doing great, babe,” she says matter-of-factly.

“Thank you. That means a lot,” I respond. “I guess if I’m going to be a writer I just have to accept all this and have faith in myself. The way Lori put it was, ‘You just have to go all-in.’”

“Good,” Shauna says. “You should listen to the women in your life.”

* * *

Liked this story? Our editors did too, voting it one of our 20 best untold tales!

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Michael Stahl is a freelance writer, journalist and editor living in Astoria, New York. He serves as a Narratively features editor as well. Follow him on Twitter @MichaelRStahl.

Casey Roonan is a cartoonist and cat person from Connecticut. Follow Casey on Instagram: @caseyroonan