After working two years as a legal assistant, I quit, took time off, and applied for graduate school in psychology. While in graduate school, I worked as an administrator at a battered women’s shelter and completed my field placement doing play therapy with severely emotionally disturbed children in day treatment.
June 1990, I got a Master of Arts in Psychology from New College of California. Over the next two years I worked hard to rack up 3,000 internship hours. Then I studied for and passed the written and oral licensing exams. As there was a strong demand for psychotherapists in the non-profit sector to work with high-risk adolescents, that was where I found my jobs, working with teens: pregnant and parenting teens and severely emotionally disturbed adolescents in residential and day treatment. That briefly summarizes my five-year career, from ages twenty-five to thirty, as a psychotherapist. Though my career was short-lived, it influenced how I think about mental health and mental illness. Above all else, it taught me compassion.
At thirty I had a complete major depressive breakdown, found myself unable to get up out of bed, and had to stop working. For the first time, I turned to a medical doctor for medication. Up until then, I had managed my depression with psychotherapy alone. My internist treated me first with fluoxetine (Prozac), the first Federal Drug Administration (FDA) approved selective serotonin re-uptake inhibitor (SSRI). Fluoxetine overstimulated me and put me on edge. I felt as if an electric current ran through me and wanted to jump out of my skin. To take the edge off this side effect of fluoxetine, my doctor added trazodone, another antidepressant which acts to balance serotonin in the brain.
My parents urged me to get a second opinion from a psychiatrist. Unfortunately, the psychiatrist I saw was old school and did not believe in using SSRIs, for there was no data as to the long-term consequences of using them. First, he took me off fluoxetine, prescribing only trazodone. Then he switched me to a tricyclic antidepressant which led to ramping and cycling. Not only did the medication he prescribed cause me to spiral out of control, he told me that I was stuck at an adolescent stage of development. As I was an independent woman, who put herself through graduate school and supported herself living in the San Francisco Bay Area, I was insulted.
The tricyclic antidepressant triggering mania. I ended up spending a week awake, thinking simultaneously at rapid speed in binary (with ones and zeroes streaming through my mind), about chaos theory (which I had never studied), and about Christian mystics (with whom I strongly identify). At the time, I wished that there had been a way to record my thoughts so that later I could decipher them and see if any made sense. The content involved topics with which I had some basic knowledge and interest, but the experience was that of channeling information beyond my comprehension, way above my pay grade.
Having suffered a week of full-blown psychotic mania, I decided that I was not fit to be a psychotherapist. Though I clearly had a manic episode, I was not diagnosed bipolar at the time. Those who knew me at the time still find this fact shocking. Since the episode was likely precipitated by antidepressants, I was not prescribed a mood stabilizer. My psychiatrist prescribed a three-day regime of antipsychotics which stopped the racing thoughts in their track and allowed me to sleep.
After I had my breakdown at age thirty, I was unable to function on my own. I would fall asleep driving to my temporary job. When at the job, I couldn’t even read. The words were all jumbled. However, I appeared competent. No one could see that I, a highly educated and articulate former professional woman, COULD NOT EVEN READ A SENTENCE.
To my parents’ home and care I returned. They were tremendously supportive and encouraged my recovery. They gave me work to do around the house and as my mental health improved, charged me room and board. The rent was more than I could earn doing odd jobs. We drew up a promissory note with well-defined terms, including interest charged for the money I owed them.
While living with my parents, I received psychiatric treatment and psychotherapy. My new psychiatrist carefully calibrated my dosage of sertraline (Zoloft), another SSRI. I remained stable on a low dose of sertraline for almost a decade, with a couple of trials of bupropion (Wellbutrin).
Once I was up for it, I got outside employment, starting as a temporary file clerk for a commercial real estate firm. What followed was a decade long career in commercial real estate. It was a welcome change, not emotionally draining as helping severely emotionally disturbed youth, and it used my analytic and problem-solving skills. Still, I continued my pattern of overdoing it, working long hours and neglecting myself, leading to repeated burn out and cyclical depression. As a result, my résumé lists numerous short stints at various jobs and in multiple career areas. Three areas, really: legal assistant, psychotherapist, and commercial real estate professional. I worked short stints — shooting high, crashing hard — time and again.
Soon after moving back home and starting work as a temporary file clerk, I met my future husband, a civil engineer who didn’t own a car, just three motorcycles and a small plane. Not your average engineer. Interesting. Complex. He even spoke Mandarin. Three years after we met, we married and later had a son. I found being home with an infant difficult. At the same time, I found being at work, away from him, heart-breaking.
– Excerpt from Kitt O’Malley’s memoir Balancing Act: Writing Through a Bipolar Life