Dear Listeners,

Welcome to today’s podcast, the conclusion of our five-part series of Julia’s first-person recovery story. By its nature, what’s being told here is certainly unique, as each person’s journey is completely individual. But in this case, the highly unusual nature of our series goes further, as her team—Janneli Chapin, Jack Gipple, and Chuck Knapp—are also sharing their perspective, making this a truly rare opportunity to experience the multifaceted inner workings of a recovery journey.

We had originally planned to have this series end after four segments. However, once we’d finished with the original plan, Julia recognized that there was a bit more we needed to discuss–having to do with looking at recovery altogether—what it meant to her, and its “moving target” nature. This led us into looking at what it took for her to actually want to recover, and the conditions at hand, including luck. There’s a tremendous amount to learn from this series, but probably the most important takeaway is about the power of healthy, honest, and committed therapeutic relationships. Over the arc of their work together, the team helped her to rouse her natural courage to keep stepping back into the wilderness of change, and to eventually tolerate feeling more healthy—and more loved—than she had in a very long time. Julia’s wonder at how she made it out of such entrapment gave rise to so much gratitude and love on her part—actually, on everyone’s part. That in itself will make listening to this podcast well worth the freight—a heart-opening glimpse into the kind of love that can come out of sharing a recovery path.

In wrapping up, let’s come back to Julia’s original inspiration for sharing her story, which is her question: could I be a voice for those still suffering? We didn’t know how this series would play out when we first began, but now that we’re done, I would most emphatically say YES—you, Julia, have been a voice for those still suffering! And most importantly, you’ve offered something to our audience which could be truly lifesaving, what Joanne Greenberg calls “our most prized possession: hope”.

Thank you for making this journey with us,

Chuck Knapp

Please note that below, we’ve also included a review by Dr. Peter Graves, of Julia’s book, Raging Innocence.

 

Review of Julia’s book “Raging Innocence: A Bipolar Journey”
By John S. Graves, M.D., Distinguished Life Fellow, American Psychiatric Association and retired Volunteer Clinical Faculty, University of Colorado Department of Psychiatry.

This is a very moving, unique and courageous account of immense pain and remarkable personal growth in psychotherapy over the course of many years. The author’s direct and pull-no-punches style immediately drew me into her story and held my interest over the entire period of my reading. Her personal honesty and integrity are clear from beginning to end. At times, I was close to tears by the compelling intensity of her experiences.

In order to provide context for this review, I must state that I am a mental health professional who has practiced in Denver and who familiar with several of the institutions and individuals depicted in her writing. I respect the confidentiality of her ongoing and lifelong treatment with Dr. Green and will in no way divulge the contents of her story to others except, of course, to Dr. Green in passing along my review.

Since my copy contained no pagination except for those provided in the table of contents, I have numbered this draft starting with the prologue as page 1. Subsequent comments will refer to pages numbered in this way.

This story, which apparently began as a revelation and apology to her sons, quickly emerges as a tour de force commentary on both the dark and tragic forces at work within some of our mental health colleagues and institutions, as well as the profound and wide reaching benefits of a therapeutic pairing brave enough to go the distance year after year. The courage and persistence exhibited by the author during the entire course of her treatment appears to have been evenly matched by that of her therapist, Dr. Green.

After reading the entire document, I came to the conclusion that part of her title might not do justice to the depth and breadth of her suffering. “Raging Innocence” seems very appropriate. However, I thought focusing the subtitle on her “Bipolar Journey” somehow doesn’t capture the scope and multilayered pain of her lived experience. This is a story about pervasive family dysfunction, traumatic boundary violations, re-enactments of trauma and betrayal in personal, marital and professional relationships and, ultimately, the transformation of despair and self-destructive behavior into hope and significant growth in the course of psychotherapy.

On page 29, the author states: “But somehow the desire to survive was always stronger than the overwhelming need to end the pain.” This appears to be her mantra. Perhaps the concept of survival could be incorporated into the subtitle so as to appeal to a broader group of readers.

Identifying a target audience is always an important organizer and decision for an author. From my perspective this work would be most effectively addressed to those studying and teaching in the areas of nursing, social work, psychology. psychiatry and those working for mental health advocate groups such as Windhorse. The importance of integrating the approaches of these various specialties and careful communication among them in treating complex individuals such as the author is paramount. Our profession should insist that only the most experienced and ethical practitioners be allowed to treat individuals such as the author.

This is highlighted in so many ways by the author, who details the sadistic responses of staff who obviously struggle with their own feelings of helplessness, despair and frustration involving her recurrent cutting and other self destructive behaviors. These feelings in staff then get translated into shaming, sadistic attacks which leave her re- traumatized and once again bereft of trust. This essay thus provides a rich, detailed and multifaceted summary of many of the forms of traumatic re-enactment from the most direct forms of sexual and physical abuse by professionals to the more indirect but nevertheless harmful impact of a patient’s reading a clinical consultation summary such as the one by Dr. Duvos. I hope that Dr. Green will read this review with the author in the safety of his office so that the risk of being traumatized by reading it can be minimized.

The sections on cutting represent the most painful, poignant, and realistic description of this phenomenon I have every read or heard from any patient in my 40 years of practice. I would imagine the author’s capacity to verbalize and to write these dramatically charged, terrifying and sometimes orgasmic experiences in and of itself has been of some therapeutic value.

For those professionals who are repulsed and overwhelmed by such descriptions, these passages provide a good opportunity for taking ones own emotional pulse, counting to ten, taking some deep breaths and evaluating one’s capacity to engage in this level of professional work. Cutting can represent a multiplicity of issues and therapists need to understand that it often represents both traumatic re-experiencing as well as the only coping behavior available to individuals experiencing overwhelming emotional pain. At times it is suicidal but to see it only through this lens often misses the point. Cutting can also represent a telltale symptom of switch points in bipolar cycling. Whatever the underlying mechanism, the empathetic therapist, while helping to decrease and eventually eliminate episodes, must fully understand its meaning to the individual. Several therapists in this author’s description were reacting as if they were the targets of the bloodletting. This kind of personalizing, as the author points out, can be highly toxic. Dr. Green apparently comes to realize that the cutting is also a kind of testing communication to him, the message being: “Will you still care for me even as I harm myself, or will you abandon me like everyone else?”

Since I believe that this memoir of treatment experiences contains several cogent learning opportunities for mental health trainees, I would like to highlight some of them. I realize that by doing so, I run the risk of upsetting the author. On the other hand, she frames her narratives in such a way that shouts out for reform in training, monitoring and supervision of mental health practitioners.

On page 21, the author quotes the discharge summary from one of her admissions for ECT. The diagnosis listed include Bipolar, OCD, and Borderline Personality Disorder. She comments on the fact that antipsychotic medications have not been helpful. Nowhere is the diagnosis of PTSD mentioned. I suppose in a technical sense this omission is justified. However many of her symptoms do indeed appear to be post-traumatic. Trauma researchers, including Judith Herman, often emphasize the importance of accurate diagnoses and how traumatized patients are frequently mislabeled as borderline, bipolar or even schizophrenic, even with rigorous psychological testing. Obviously it is possible to have multiple diagnoses operating simultaneously or episodically.

What the author describes in my opinion represents transient psychotic episodes that sever trauma victims frequently experience. The over use (and misuse) of borderline personality diagnoses often predispose staff to negative reactions even before they meet the patient. This then leads to a self-fulfilling prophecy wherein self-destructive behaviors are seen as reprehensible, consciously manipulative acts which tragically evoke sadistic and defensive behaviors in staff. In my view, BPD diagnoses cannot accurately be made until the affective disorder symptoms are well under control.

On page 25, the author describes an experience of listening in on discussions between her then husband Harvey, and Dr. Green. She states:

“However, I listened with intensity to their discussion about me. I was actually a real person, worthy of discussion and concern. I was living in an ECT fog, but I learned a lot about myself from their discussions. I, who basically felt like a non- person, was having an impact on people.”

“Whenever there was a holiday, I always brought Michael something… some little craft or carving… I remember sending him mother’s day cards…my sister was paying his bill, but I needed to give him something too…food is love, in a way.” p. 49.

In these passages, the author teaches us that she is learning to love in a new kind of relationship, one in which Dr. Green can be an adored friend, mother, perhaps even sibling. Dr. Green does not retreat from this love because he knows it is an essential part of the author’s growth and development. She is discovering parts of herself never allowed to emerge and flourish in her tragically dysfunctional family of origin.

The experience of non-personhood runs like a tarnished thread throughout her narrative. These experiences represent epiphanies, the beginnings of a dim sense of the possibility of self-hood. Dr. Green understands that he needs to be transparent to her. This transparency in the therapist is, of course, most evident later on when he becomes furious at the discovery that the author has, with great ingenuity, managed to have an appointment with his wife Rachel.

Many therapists are taught to do therapy in isolation of significant others, to behave like a blank screen for projections and to stifle any form of self disclosure or self expression. Dr. Green’s behavior in both of these episodes reflects an accurate understanding of the importance of the real relationship in psychotherapy. The best psychotherapists are those who are most comfortable being themselves and in the existential reality of the consulting room, or hospital, acting as any compassionate, sensitive human being would. As Maimonides taught us: we, as physicians should ‘strive to be none other than fellow creatures in human suffering.’

The chapters involving Windhorse were a revelation to me. At first I was surprised that a Buddhist organization would have such sensitive, committed workers in the community. The Buddhist precepts of detachment combined with profound compassion for others became very evident in the actions of Jasmine and Jack. The author’s capacity to utilize these new, extraordinarily helpful relationships was further evidence of how much she was able to grow in her treatment with Dr. Green.

The salient concept here for trainees is that profound changes can occur outside of the treatment setting and should be promoted at every opportunity. The development of autonomous, independent functioning has begun to replace the emphasis on safety and security. Many therapists, while working with similar individuals have a tendency to cling to a cautious over-protectiveness, thus stifling further growth.

In the final pages of her memoir, the author describes, on page 72, the emergence of a new sense of altruism:

“…here I am, a licensed nurse again… I have a mission… to undo the pain, to treat patients kindly and with compassion. As I should have been treated.” On the following make, she asks tentatively:

“Slowly my life developed some clarity. Could I be a voice for those still suffering?”

To which, I would respond, unequivocally: YES!

As a footnote to this review, a lingering question reverberated. I am not Jewish, but it occurs to me that triumph over suffering is a major theme in this work. The author discloses, on page 7, that her parents are both Polish Jews who emigrated to America before the was. It would be interesting to know if she has Holocaust victims or survivors among her relatives, and if so, how this might have affected not only her family dysfunction but also her means of coping with multiple traumatic experiences. There is a significant literature emerging regarding this topic which, if she is not already familiar with, could be useful to her.

Reading this manuscript, as mentioned at the outset, has been a profoundly moving experience for me. I hope that the author will persist in her writing efforts and see this through to publication. I believe it is eminently publishable and a genuinely unique contribution to the literature. The fact that the author is a registered nurse with a current occupation in teaching gives her additional credentials, both as a patient advocate and as an expert regarding the benefits of long term dynamically oriented psychotherapy, combined with judicious use of medications.

The author would undoubtedly be interested in reading some of Kay Redfield Jameson’s work regarding her own struggles with bipolar disorder, as a model for both publication and public advocacy. Dr. Jameson is very accessible on both personal and professional levels.

Please extend to the author my sincere thanks for allowing me to do this review and my best wishes in her ongoing treatment.

Click here to Read Julia’s book Raging Innocence on Kindle

 

Janneli Chapin, MA, LPC and music therapist is a core faculty member of the Contemplative Psychotherapy and Buddhist Psychology (CPBP) program. She has taught for Naropa University as an adjunct faculty over a span of 30 years and is particularly interested in mentoring students in contemplative meditation practices and how these inform the psychotherapist-counselor who seeks to decolonize multicultural counseling. She has worked in a variety of settings from community mental health, psychiatric and rehabilitation hospitals, family center, Maitri Psychological Services, Windhorse Associates, Windhorse Community Services, and private practice.  Janneli and her family built an off-grid sustainable earthship in the mountains where people in extreme states of mind were invited in community to work in greenhouses, tend goats, and make cheese.

Jack Gipple, MA, LPC, CAC III is the Clinical Services Manager of Windhorse Community Services (WCS), in Boulder Colorado. He earned his MA in Transpersonal Psychology in 1991. He has worked extensively with families, couples, and individuals dealing with issues related to behavioral and substance addictions, as well as a wide range of mental health challenges. He taught in the Naropa Contemplative Psychology Department for a decade and has been affiliated with the Boulder Shelter for the Homeless since 1992. Jack co-authored an article with Chuck Knapp “Windhorse Treatment: Group Dynamics Within Therapeutic Environments,” in Group: The Journal of the Eastern Group Psychotherapy Society. He has studied and taught T’ai Chi Ch’uan since 1985. He is a top-bar bee keeper, pinhole photographer, yogi, gardener, home orchardist, father, and husband.