The weeks that followed the hell of events that took place in part-time therapy were tough. In everything I did, I had reached my limit very quickly. All the things I liked to do when I came out of the clinic, I couldn’t do anymore. I still wanted to do them, but the fear was just too great. Every time I tried to use my strength/aggression to do something, I was immediately overwhelmed by fear. And that had never been so strong. I really couldn’t do anything, or I became frightened. And the fear had become bigger and bigger during the therapy and occurred faster and more violently, because there was so much pressure on me in the therapy. It kept the aggression down, so to speak, and my aggression was not allowed to exist when I left the part-time therapy. And an important part of identity is that your own feelings (including anger) are allowed to exist. I felt like a nobody and there was nothing unique about me. I let everything happen to me. It was now important that I received guidance so I could rehabilitate.
I was referred to the psychiatric clinic of the mental health care facility, in the same city. There I had an interview, after which it was decided to send me to the RIC (reintegration center of the mental health care facility). There it was decided to let me come by in part-time, because I was managing reasonably well at home with my parents. I would come three times a week for one part of the day. Rina became my psychiatric nurse. When visiting for the first time for part of the day, I was surprised that there were no therapies. It was just a house where psychiatric patients lived. And I saw more people who had it bad and were doing nothing. I absorbed all their feelings, and it didn’t make me feel better. I hated being so downtrodden, but I was able to make contact with the people who lived there fairly quickly, which made them a little less scary. But I was also incredibly anxious, and didn’t trust many people. Especially not the counsellors. My trust in the social workers had dropped to zero point zero. Moreover, they still had to get to know me, and therefore they often said things that were not correct. Because of this I was fighting with them at home in my head. I told them what kind of therapy processes I had gone through and how much I had felt that my aggression was rejected in that part-time therapy. For a long time I had the idea that they did not understand how I was, and that they thought I was just a spoiled and evil little boy who finally had to grow up. The first time I was in the RIC I was disgusted by everyone and everything and regularly gagged. Desmond, my therapist at the clinic, sometimes asked, “Which is your emotion laying behind this disgust?” To which he himself already gave the answer: “Murderous rage!!!” and I totally agreed.
I focused pretty quickly on doing relaxing activities, because I really needed that, and I couldn’t do much more than that, because of the great anxiety. I kept repeating that I wanted to do things, something that was emphasized a lot in part-time therapy in the last few months, and I wanted to comply very much. For some activities, I was signed up at the activity center of the mental health care facility. I would go to the gym once a week and play badminton once a week. Actually, I did this on autopilot for a while. I didn’t enjoy it. In fact I didn’t enjoy anything. I was very preoccupied with death and sometimes wished for it on the one hand, just to be put out of my misery, and this thought came back very compulsively. Now I understood Chris, now I understood Michael, now I understood Sanne (the sister of a friend of mine). They had just felt so incredibly bad, and they had had so little hope of getting better, that death seemed the only option. Fortunately, I was able to resist my thoughts reasonably well, so I wouldn’t do impulsive things.
The end of the year was approaching, and a letter from the social security agency fell on the mat. I would soon be re-examined. I decided to go there alone, which turns out to be stupid. Because during the interview I was playing nice, like I always did, and I didn’t want to show my limitations. I let myself be led by the doctor I was talking to, and didn’t dare contradict him. And then I was declared fit for work, at which point fear struck me. Because there went my income and on top of that I now had to find a job. It was impossible and fortunately I had good support from my parents and from Rina. We decided to object. Together with my parents and Rina I went to this meeting. And my father had written down what he thought of it in a story, and became emotional. He said that I was suffering, and that it was impossible, with so much pressure, to demand that I go to work, after all that had gone wrong. My mother agreed. Rina also told her view on the matter. And this time I told how much I suffered from anxiety. And finally my objection was upheld, and I was declared fully disabled, on psychological grounds. I was very relieved. But the people from the social security agency did want a report from my part-time therapy, and Rina went to ask Eelco de Smet for one. I finally read that report, and I hated it! In the report they constantly pointed at me, that I had aggressive fantasies at the beginning, that I splitted, that I react aggressively to criticism, that I keep breaking the contact and so on, that I am passive and don’t seem to grow. Nowhere did it say what the therapists had done to get me to the point of destruction. And nowhere did it show that there was an understanding of how the situation had come about. All that was said was that I was too vulnerable to continue. Nowhere did it say that they were responsible for exposing this “vulnerability. (That word, by the way, sounds as if it is an acceptable state of being, but it is by no means). I mentioned this to Rina, and then she said that Eelco spoke of a vulnerability, to which she had said, “Yes but it’s a very serious vulnerability!” to which he admitted that he had made a wrong assessment, although sometimes I doubt that he really made an assessment. Rina also told me that Eelco offered me some more sessions to talk about it, but I still felt so bad that I did not want it. Besides, I didn’t trust him one bit. I had the distinct impression that he wanted to cover up the mistake; that he kept all his fellow therapists stupid and didn’t tell them anything about it, to save his own skin; that he had no insight whatsoever into what this mistake had meant for me. And it was clear to me, what would happen in those sessions he offered: I would not be able to defend myself – because my distrust and anger were so enormous that, at one sentence of his, I would like to lecture him for 30 minutes, but I would not be able to – and he would constantly defend himself, and in my opinion he did not have the right to do that! What I noticed with Rina was that she didn’t waste many words on the mistake that had been made. I would have liked it if I had gotten a more convincing understanding. It seemed somewhat as if she wanted to protect Eelco. But I could be wrong.
The months that followed remained tough, but faithful that I had always been in following my therapies, I also came faithfully to the RIC. And I slowly got used to everyone. With new people I always tried to talk immediately, so that I got to know them and they got to know me. I didn’t feel at ease yet, I was still too anxious for that. I had a conversation with a psychiatrist called Henk de Koning. That was bizarre. He was very quick to judge. And I didn’t argue with that and played nice again. He said, “So you’ve been in therapy for two years, and it hasn’t helped anything,” not knowing that I was torn between extremes, and it had definitely had a big impact on me. He also wrote in his report (I heard this later from his successor, Dr. Blankenberg) that he saw no signs of anxiety or depression. Then it became clear once again that I was very capable of misleading, unintentionally. I couldn’t help myself. I couldn’t show myself in those moments. Because I gained a lot of weight on Zyprexa, the antipsychotic I was taking, and my cholesterol was too high, it was decided to try another drug. Dr. Blankenberg thought of Orap, an older drug. I tried it and it didn’t work. I couldn’t tolerate it. It made me feel more mental pain, so to speak, and my aggression was jumping around in my legs, trying to ascend, a way to muffle the painful feelings, but it was also pushed back to my toes by how I was now. Because of this I could hardly sit still and constantly wanted to flee (akathisia). It also made me very stiff, and I walked the streets like a Parkinson’s patient. And the strangest thing was that one evening my hand went completely inwards, I looked like I was spastic. The pharmacy manager was called late at night to see if she had any medicine for the side effects, and she went to the pharmacy especially for me. Fortunately, this medicine gave immediate relief. Later at the psychiatrist’s we decided to switch to Risperdal, a drug that I was given when the increase in my antidepressant Effexor did not help enough against the anxiety, at the end of the part-time therapy, but which made the symptoms worse, so I was then given Zyprexa. Anyway, I was going to try it again now. I had a whole list of fears that were going on at that time (a lot of death and destruction), but Blankenberg assured me that this was temporary and that things would get better and better. And that was true, but I wasn’t quite at the same dose as with Zyprexa. I was doing well for a while, but sometimes bad things happened, which of course had an exaggerated and traumatic effect on me, causing my condition to deteriorate and at a certain point the anxiety to become so great that it was barely manageable. I discussed this with Rina, and she wondered whether it wouldn’t be better if I came to live at the RIC, so that I would have more structure. But I didn’t want to do that, and I asked if Risperdal could be increased to the same dose as Zyprexa. And that was allowed. And that helped me a lot. But I don’t want to imagine what it would be like if I didn’t have these medications.
Eight months after things went so wrong, I wrote a letter to Anke, my therapist from the clinic. In this letter I tell what happened, how I feel, and I tell about my own ideas whether I can still be helped. In my opinion, there was only one therapy that could still help me, and that was a therapy in which the aggression would be brought to the surface again, the same therapy that I had already gone through once, there in the clinic. A therapy that someone only undergoes if there is nowhere else to help him. But I also tell her that I don’t feel like that’s possible anymore, because I have a defense mechanism (just like Dick, whom Anke has known as well), which makes sure that the aggression can’t ascend anymore, the same thing she described when she stopped Dick’s therapy. I ask her for advice, and tell her that she has been a kind of mother to me in the clinic, and that I have appreciated that very much. I received no reply to this letter. It remained very quiet. A few months later I heard from a former therapy partner that Anke had not worked for a few months, and that she was now back. I still have the conviction that she received my letter and was very shocked by it and took responsibility for it, because I know she is a very responsible person, and that what happened to me is close to her heart. She has treated me intensively in that year and has seen me grow and she has been concerned about me, and partly because of her error of judgement, I was sent to part-time treatment. I forgive her 100% for this, because although she could be very hard (she really had hair on her teeth, we say in Dutch, it means you’re a very strong woman), I also got to know her as someone with a big heart for her profession, a lot of specialized knowledge, and very capable in her role, but also very committed to her patients. And she accepted me unconditionally when I had discovered my own identity, with all the negative points, that came with that. Because outside the therapies I was busy, easily angered, demanded a lot of attention (although I could share attention), and was demanding, but now I know that I needed this to remain upright. And what I liked about her was that she was clear and said what could be done and what couldn’t be done, and that she clearly drew a line when she felt it. In short: a top class woman who helped me very well!
Now back to how things went with me, in the years after things went wrong. For at least two years I was still thinking about the therapists from the part-time therapy. What they had all said to me, how I should view this, I was fighting with them all the time in my head, just like I was fighting in my head with the counsellors of the RIC. I thought about what they would say if I were angry. And then thought of a defense to their reaction. This all took place in my head, because to do this during real contact was impossible for me. The fear was too great, and so was the chance of further damage. In order to defend myself properly, I had to think on the level of the therapists, about how I thought I was, how the treatment should have been, what they should not have done and so on. For this I tried to think as logically as possible. After my letter to Anke, on which I heard nothing, I also started to remember things that had been said in the contact with her. I suddenly remembered the important conversation somewhere at the end of my therapy – which I discussed earlier in my story – where we talked about the anxious feelings that followed the aggressive fantasizing, and where Anke asked if it was fear of disapproval, or fear of not being seen. I realized then that I was afraid of both, but that I didn’t tell her about this disapproval fear because I was pretending to be stronger than I was and was unconsciously ashamed of this. I felt very responsible for this and thought that she had sent me to part-time treatment purely because of this answer, but then I realized that she also had certain ideas about how things had gone in my family before, partly because of the systemic talk we had had, and that the responsibility lay with her and Desmond, even though I myself had a share in this. Perhaps it would have been better if we had planned another systemic discussion at the time to talk things through properly, with my parents present.
Meanwhile, it was incredibly important to me that I was seen properly at the RIC but I still didn’t really have the impression that I was always well understood. I had clearly told them that after the clinic I was in my aggression, but that I had learned to handle it through strict behavioral therapy. But when I repeated this later, Rina said: “Yes, but you were too powerful then! But such remarks struck a chord with me, because what was clear to me was that, even though I was in psychiatry, there was less specialized knowledge here regarding my problems and what kind of therapies I had been through, and that in severely traumatized patients it is justified to have aggressive fantasies. Fortunately, the calmer I became, the more understanding I got, for my feelings. Because Rina later understood that my aggressive fantasies had kept me going. And that did me good. And so there were more things that happened at the RIC, of which I was fighting at home, but I did not dare to discuss them, because I already had clear in my head what would be said, and those were certainly not understanding words. I imagined buckets of shit coming at me, for which I had no defense.
But time went on, and I got more and more organized. As a result, I was fortunately able to defend myself better and better in my internal battles. And that was important, because it meant that the psychotic feelings and the extreme fear also diminished (although now I may be reversing cause and effect). I could slowly see the good in people again. And then I thought it was time to write a letter to Eelco de Smet as well, in which I wanted to make clear to him how damaged I was. It was not an angry letter, because I did not dare to do that. I was afraid that if I would show my anger, he would not read my letter in its entirety. So it was a tame and sensible letter. But I did make it clear to him how I felt before the therapy, and how I felt after the therapy. And what a world of difference this was. But also on this letter I heard nothing back, whereupon my image of Eelco, that I described earlier, unfortunately did not really change.
