A Double Whammy!
May had major depression, which she had been struggling with for over twenty years as a result of her abusive upbringing. She had been on anti-depressives off-and-on from her psychiatrist, with moderate success. Due to aversive reactions to her prescribed medication, she was often going without them. She was an intelligent and hardworking accounts manager and had been working for the last 3 years with a large local estate agency. Although she enjoyed servicing her customer base, her job was the bane of her life, as she moved frequently from agency to agency when differences arose over her commissions’ discrepancies. Her sense of fair play and meticulous attention to detail inevitably brought her into conflict with her employers.
One morning, after our third session, I received an urgent call from her. She was sufficiently distraught to contemplate ending her life. Although suicidal ideation is not uncommon for major depression patients, we had explored this in our sessions, and May had not indicated that these thoughts were normal for her. We scheduled an immediate session. Her unstable state of mind stirred my curiosity. Further probing surfaced her fist fight a couple of nights ago, with her husband, James. All this while, May had attempted to protect James’ condition from me, and from everyone she knew. He had a psychotic break in his late teens, while undergoing basic military training in national service, and had been on medication since. He was unable to hold on to a stable job, and had depended on her financially. Constant fights occurred whenever James refused his medication, inevitably loosing his job thereafter. These fights would worsen May’s depressive state.
With James’ unremitting relapses due to his delinquency in keeping to his medication regime, we scheduled appointments to see him alone, apart from individual sessions with May, and a couple’ session once every two weeks. James’ singular mindset in denying his serious mental health condition meant that this remained an on-going battle to disabuse him from his reticence to continue with his regular medication. His countless relapses, some more serious than others, had put substantial strains on their marital relationship, sufficiently for May to consider legal separation.
Now that the family secret was out in the open, May’s suicidal ideations were, in fact, the norm, and continued to remain an important symptom of an elevated stress response. Several important issues to do with their respective jobs, extended family relationships and housing had surfaced in the past, but due to their precarious interpersonal and intrapersonal situations, everything was swept under the carpet, and remained unresolved. We picked them up one by one, and attempted to work through them in order to unpack the unnecessary pressures they had accumulated. This, of course, took several years, but eventually we got through them, and both their conditions stabilised.