Madness (23 page)

By Winsome Thomas

Kate Richards is one of the most courageous and intelligent clients I have ever had the opportunity to work with.

Kate's first session took place on 19 April 2004. She came without referral having just seen my brochure at street level. When asked how I could help her she said that she had suffered episodes of depression since the age of fifteen and had been hospitalised for electroconvulsive therapy (ECT). She had been on medication for about ten years and was taking a mood stabiliser and an antidepressant. Two months prior she had deliberately burned herself with hydrochloric acid. That session marked the commencement of our five-year journey.

All therapy is an excursion into the behaviours, emotions, life and mind of the client. Some relationships are intense and some are gentle. All relationships endure only while the client has issues. Most last several sessions but Kate's relationship with me was much longer. It covered considerable periods when she was hospitalised (usually after a suicide attempt or a psychotic episode) and then later resumed therapy after several weeks. Her illness was much more severe than most. Here was a young woman who suffered from a mental illness that failed to have a definitive diagnosis – not that the label per se would have assisted a great deal. It was sufficient to say that she was very ill and that her symptoms indicated the presence of psychosis and major depression.

I recall two major turning points in her therapy.

The first occurred early on when Kate spent quite some time during the session walking up and down in the room and avoiding real engagement. I challenged her and said something like, ‘Kate, you can entertain me for as long as you like but it will not help you. I'm not playing games here.' She sat down, looked at me very seriously and later said that I was the first therapist that she had been able to trust.

The second took place much later. Conformity with desired doses of medication was a real issue for Kate. She had trained as a doctor and knew a great deal about drugs, their effects and which ones suited her or not. It was she who discovered that a relatively ‘old' medication alleviated her nightmares. At each session I would ask her about her symptoms, her lifestyle (for example her diet, sleep patterns, supports, work and use of alcohol) and her compliance with the medication prescribed. At times Kate would either not take her medication or would adjust it in a way that she thought appropriate without blood samples having been taken. Of course, her stability fluctuated accordingly.

One day in a session I said to Kate something like, ‘You know Kate, you have a mental illness. Once you admit that and acknowledge that you cannot live without your medication then your life will change.' I recall the long pause that ensued with Kate looking at me and then shifting her gaze while squirming in her seat. She finally acknowledged the truth of my statement. That was the turning point. Thereafter she started to take her medication appropriately.

In my view, therapy is both an art and a science. Intuition, relationship and trust are essential components. Throughout therapy I called a spade a spade and did not resile from discussions about suicide plans. As a result the knife in the kitchen drawer was to be brought to the next session or was to be put well away from reach. Kate suggested the roof. If she were to become psychotic she was to phone me and/or friends and/or family. Names and numbers were to be accessible. Much discussion took place about doctors, hospitals, medication and psychiatrists. We talked about who could she trust, what meds were appropriate for her and where she felt safe. Each was a major hurdle in itself.

Later, our slow journey focused on normalising her life. Here's a sample:

‘No, ten espresso coffees do not constitute an appropriate diet.'

‘It's ok for someone to touch and hug you.'

‘No, you can't stay up all night, a regular sleep pattern is required.'

‘Supermarkets are not places to be feared and haunted at 11.00 p.m. at night.'

We also talked about prosaic issues such as buying underwear or clothes that fitted, wearing makeup, taking a bath and relationships with others. We determined what was essential in a basic life and lifestyle and what were optional extras. I felt immense compassion for this young woman who struggled with the very basics of life.

My work with Kate, as it is with each client, was forensic, cognitive and analytical – not to mention, immensely challenging and thoroughly rewarding. I never had any doubts regarding Kate's intelligence. I'm now so pleased that I encouraged her to return to her passion for writing and to enrol in the writing course at RMIT. This book is a testament to her great skill, tenacity and insight.

Kate's journey has been painful indeed in so many ways. Her capacity to endure, to reflect, to trust and to survive is remarkable. How privileged I have been to walk the journey of recovery with her.

20 November 2012

VIKING

Published by the Penguin Group

Penguin Group (Australia)

707 Collins Street, Melbourne, Victoria 3008, Australia

(a division of Pearson Australia Group Pty Ltd)

Penguin Group (USA) Inc.

375 Hudson Street, New York, New York 10014, USA

Penguin Group (Canada)

90 Eglinton Avenue East, Suite 700, Toronto, Canada ON M4P 2Y3

(a division of Pearson Penguin Canada Inc.)

Penguin Books Ltd

80 Strand, London WC2R 0RL England

Penguin Ireland

25 St Stephen's Green, Dublin 2, Ireland

(a division of Penguin Books Ltd)

Penguin Books India Pvt Ltd

11 Community Centre, Panchsheel Park, New Delhi – 110 017, India

Penguin Group (NZ)

67 Apollo Drive, Rosedale, North Shore 0632, New Zealand

(a division of Pearson New Zealand Ltd)

Penguin Books (South Africa) (Pty) Ltd

Rosebank Office Park, Block D, 181 Jan Smuts Avenue, Parktown North, Johannesburg 2196, South Africa

Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England

First published by Penguin Group (Australia), 2013

Text copyright © Kate Richards 2013

The moral right of the author has been asserted

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.

Design by Allison Colpoys © Penguin Group (Australia)

penguin.com.au

ISBN: 978-1-74253-562-3