CW: Suicidal ideation, self-harm
It was just another Wednesday afternoon in February. I played with my pen between my fingers while I waited for my client to respond to my question.
“How likely are you to follow through with your plan to attempt suicide?”
My client, a Japanese American woman in her 60s, hadn’t showered in a week and had brown stains all over her shirt. I was surprised she made it to our session on time, and I was glad she did because I was certainly uncomfortable sending her home that day. My client and I often processed her family of origin and the emotional and verbal abuse she faced from her parents who repeatedly told her that her existence was worthless and burdensome to them. With both her parents and grandparents having been imprisoned in internment camps, my client carried generational trauma. Perhaps her parents’ expectations for their daughter to achieve beyond perfection was informed by the internalized message that their existence, too, was unwelcome in the United States, unless proven to be useful. Becoming impaired by depression was the opposite of being useful, according to my client.
Finally, she looked at me with tired eyes and a sagging face weighed down by decades of depression. She answered, “7 out of 10.”
There. That moment, I forgot I was the therapist. The room instantly changed into my former therapist’s office. He had just asked me the very same question I posed to my client, waiting for my answer to confirm that I needed to be hospitalized. I was struggling to find the line between my memories and reality because I knew exactly what my client was experiencing — all the questions, the sense of betrayal, the simultaneous numbness and overwhelm — this situation was all too familiar. And yet, it was my job to trigger the process of psychiatric hospitalization, a traumatizing experience I had gone through. Eight times to be exact.
As I looked at the woman in front of me asking for my help, a voice whispered as if to taunt me, “That’s going to be you in 40 years ... is it really worth it to keep living?” I knew her voice well. Oftentimes I found comfort in her criticism, not because of the way her messages shamed me, but mostly because she could see all the secret rooms where I locked away my true self: a monster. Others gazed at me with love and admiration, fooled by my strategic masquerade of good works, good grades, and good behavior. Like my client, I was a product of an Asian honor and shame culture that was deathly fearful of failure and obsessed with perfection. Reinforced by legalistic Christian faith, I began to suffer from severe mental illnesses as a young adult searching for a greater purpose other than pleasing people simply to belong. So I kept asking myself if it was worth it for me to live if my efforts to earn love continued to fall short. “Would I be like my client, replaying the past until the future also fades away?” Then I remembered I was the therapist.
After five hours of waiting, a social worker, three police officers, and an ambulance, my client was safely transported to the ER. I walked out of my office and smiled at my colleagues who praised me for my tact and grounded composure. I walked into my house and greeted my mother, to whom I reported that my day went well. I walked into my room, closed it quietly, then collapsed on my bed as flashbacks of my past replayed like an endless nightmare. Feeling lonely in a moment of vulnerability, the memories called out to me like a siren, luring me to indulge in my addiction to existential dread.
I cut myself that night. Or perhaps the girl who had whispered was compelled to do so. Either way, I really needed to feel something to shake off my dissociative state.
We Don’t Graduate from Therapy
A little over a month later, I recovered from my depressive episode. I always do, especially now with healthier coping skills, an incredibly supportive church family, and proper medication. Yet up until this point, I had always been in crisis, unable to process the trauma that was perpetuating my mental health challenges. The build-up of small traumas caught up to me, which became most obvious as I began my practice as a therapist.
One way to think about the impact of trauma is to consider the impact accidents have on a car. If a car crashes, it will most likely require fixing. Repeated crashes will most likely lead to even greater issues, not only externally, but also internally. Even if the car can still run, it’s likely that without intervention, its capacity to remain functional will be limited and quickly depleted.
Similarly, singular and repeated events of trauma are the crashes that hurt us: the unexpected, shocking, and undeserved pain. Because trauma has great power in influencing our worldview, we often arrive at overgeneralized conclusions about life based on our trauma. I believed a lot of things to explain why I went through what I did.
“I am bad.” Age 8.
“I deserve to be punished.” Age 14.
“Everyone is better off without me.” Age 20.
“I must protect others from myself because I am a monster.” Age 23.
Each of those girls inside of me chanted these beliefs like a hammering chorus. But they were just protecting me. From their eyes, we went through too much pain to bear it again, especially having spent the past six years in therapy learning to manage and prevent crises. Because I worked so hard to expand my capacity to fully participate in life with God, people, and my passions, I was resistant to allowing a therapist to intentionally take me underwater and teach me to befriend those sirens hissing at me.
It was my psychiatrist who recommended EMDR, or eye movement desensitization and reprocessing, a therapeutic modality designed to alleviate traumatic stress and reframe maladaptive beliefs about one’s trauma. EMDR uses the combination of bilateral stimulation, free association of memories, and cognitive reframing. In layman terms, the client simultaneously recalls their traumatic memories and makes rhythmic left to right eye movements that assist the brain in “refiling” the traumatic memories. The goal of EMDR is to help the individual develop resilience and a reappraised meaning of their narrative.
“So what do you think?” my psychiatrist asked. I stared through the Zoom screen with skeptical eyes. “You know it will help ... ”
I sighed. She was right. I had dissociated in front of a patient that I was supposed to protect and immediately fell into a month-long depressive episode after that night. If I couldn’t resolve the distress triggered from all the reminders of my traumas, my work would not only be potentially detrimental to me, but also to my clients. I had to admit that my healing work was not over.
Swimming and Drowning
Left, right, left, right, left, right ... my eyes followed the therapist’s hand in front of my face like he was waving goodbye at me for a whole minute. I’ve stopped paying attention to his hand at this point and notice chills down my back as my heart starts to race. I feel nauseous and I am frozen ...
• • •
“Dude, I can’t wait to get off work, it’s so late.”
“Same, I need a drink. You wanna grab a beer after this?”
Those were the EMTs that rolled me into the psychiatric hospital. I couldn’t see them because I was strapped onto a gurney, unable to move my arms and legs. For the past 36 hours, I had lain catatonic in a dimly lit room at the emergency department on a cold February night. I was requested to change into XL scrubs and artificial undergarments made out of the same material as dental bibs. Once the ER found a placement for me at a psychiatric hospital, an ambulance was waiting for me. The EMTs motioned for me to lie on the gurney, then reached across to tighten the straps over my body. Clearly seeing my discomfort and fear, he said to me, “It’s just protocol.”
The walls of the hallway were off-white and gleaming from the reflection of the fluorescent lights that occasionally flickered. Ten to 15 patients on gurneys and wheelchairs formed two rows against both sides of the hallway. “Next!” a nurse yelled. The wheels below me squeaked forward, then silence once again. Though we arrived to be kept alive, the slow progression through the intake process felt as if we were marching in one by one to sign our own death certificates. What choice did I have but to admit that I was dying? I was already frozen ...
• • •
The therapist’s hand slowly came to a pause. I blinked several times to reorient myself, but it appeared that the room had submerged in water. Muffled sounds. Blurry objects. My lungs desperate for air. The taste of salt. I was drowning, yet unwilling to emerge out of the water because it felt safer to dissociate than to risk the possibility that I might be experiencing my trauma once again.
“You’re safe here. You’re not in that hallway anymore.” The voice was familiar and clear. I wanted to search for it.
“You’re safe, Serena. Take your time to come back.” It was soothing and calm, a voice that I could trust. I blinked again and came to the realization that I was crying.
“Where were you just now?”
I took a deep breath and told him all about the scene at the hospital and my inability to move. I told him about the dehumanizing experience of being treated as a problem to be contained. I told him about the connections to my upbringing in a conservative church where I always felt surveilled in the name of “spiritual accountability”. I told him about my family and the role I played as a silent, obedient daughter, unable to freely speak my mind without reprimand. I told him how this trauma felt as if God had sent me away to be dealt with in Hell because Hell was already inside of me. But I was just sick.
“So what happened after?” My therapist was looking for my reframe of the story.
What happened was the rediscovery of my resilience.
Monsters Need Love, Too
Only six months after that final hospitalization, I started social work school. I felt so honored to work with a wide range of diverse clients and their unique stories. Unfortunately, I was under the impression that finally getting to sit on the other side of the couch was a sign that I claimed victory over my pain. Far from it.
I was unprepared for the intensity of my trauma responses to the triggers I was faced with in my clients’ narratives. The more time I spent as a therapist, the more my triggers troubled me: anniversaries of hospital visits, the exit to Salinas Road, turkey bags, February, law enforcement, physical exam tables. Though seemingly random, the dates, objects, people, and places haunted me, every reminder connected to a memory that came alive when I encountered it the same way it unfolded in the past.
I resented those girls inside of me; I deemed them evil and attempted to avoid them. Without my knowing, my neglect over the years had warped the girls into ugly creatures patrolling the many corners of my mind that kept me trapped. But as I embarked on the journey of healing from trauma, my curiosity nudged me forward to confront these creatures and ask them questions. What happened to you? Why are you holding February and turkey bags? Why do you look so sad? The longer I stared into the faces of these creatures, the more I noticed how deprived of love they looked. My growing compassion soon opened my eyes to recognize little girls hidden beneath their thick layers of scales. They were not ugly. They were armored.
It was in the process of EMDR that I began to build relationships with each one, offering validation, hugs, prayer, and quality time to heal the wounds that pervaded all facets of my humanness. Simply listening to their stories dissipated my fear and transformed my disgust into acceptance. I was 8 when I was molested by a doctor. 14 started cutting to deal with the shame of sin. 20 attempted suicide to cope with disappointed parents. 23 was collapsing from the weight of accumulated traumas. The sirens or monsters I had always labeled as “the bad guys” were just girls reacting to the physical, emotional, and spiritual abuse that none of them deserved.
For me to heal meant bringing along the girls I had been into the process of reconciliation. “Could I be your friend?”
Markers of Resilience
I have grown quite compassionate toward most of my girls, but 20 is a tough case because sometimes it feels like she is the boss of me and she always wants to die.
“You’re stupid for thinking you’re important! You’re just a problem people deal with. Go kill yourself!”
20 was yelling so loudly that all my attempts to challenge her were futile. She was particularly tense because it was close to the anniversary of our suicide attempt. By 2:30 in the morning, I was weeping uncontrollably as 20 presented a “strong” case for initiating self-annihilation. Usually, I fight her by yelling back, “Stop it! Just shut up!” But I was practicing a gentler approach. “It’s OK. We’re OK.” It was just enough self-soothing to motivate me to call my best friend Jojo, even though I still felt like a burden.
“Hello?” Jojo’s voice was low and scratchy. “It’s going to be okay ... just breathe ... this will pass ... I’m here as long as you need.” Hearing those words from someone else made it easier for me to extend empathy and support to my little girls inside. Now it was my turn to tell myself.
“It’s going to be okay, 20. Just breathe. This will pass. I’m here as long as you need.” Jojo stayed on the phone while I had gradually slowed down my breath and began practicing my butterfly tapping, a grounding technique designed for trauma patients to cope with triggers. I crossed my hands over my chest and began tapping as if to comfort myself with an unending hug. “Left, right, left, right, left, right ... ” I fell asleep in peace moments later and the wave of existential despair passed.
These moments of deep anguish are memories I am learning to redefine as markers of my resilience. As my girls each carry their traumas and painful memories, I offer them the many memories of our perseverance to make the heavy ones feel less burdensome to carry.
For 23 frozen on a gurney, 23 now remembers my second evening at the hospital during visitation hour when eight beloved friends and two family members drove for over an hour through traffic to see me. They made me laugh, prayed with me, and offered me books, stuffed animals, and self-care items. All of them held me tightly before leaving and expressed how much they loved me. They saw my secret rooms and all my creatures within. Yet, they still came and they looked forward to caring for me even afterwards. Their gestures of love and care moved me in such a way that catalyzed a shift toward the belief that, whether monster or girl or both, I am worthy of love.
Highlighting memories and experiences like these teaches me to embrace my little girls inside with full acceptance of their stories that made me who I am, with all their adversity and joy and tears and laughter. I find no need to hide them anymore and reduce them to “trauma triggers” or “ghosts of my past”. Though many days I still struggle with hopelessness, exhaustion, or overwhelm, my healing work has helped me recognize bad days as a sign to more deeply connect to the girl in pain and rally her with gratitude for her resilience through hardship. They need me, and I need them.