By Nina Gutin, PhD
Nina Gutin, PhD, is a clinical psychologist with a private practice in Pasadena, California. She received her MS and PhD in clinical psychology from Columbia University. Dr. Gutin is co-chair of the Coalition of Clinician-Survivors.
I was a patient at Austen Riggs many years ago. Shortly after I “graduated,” I was asked to help start a patient “Alumni” network at Riggs, which is still ongoing. I decided to become a psychologist myself and now maintain an involvement with Austen Riggs on a professional level. With the perspective of someone who has been “on both sides of the couch,” I have strong feelings about my treatment then, and for what continues to pass as “treatment as usual” in the majority of contemporary treatment settings.
As a teenager, growing up with an unpredictably volatile, intrusive, and abusive mother, I remember being terrified most of the time, and had thoughts, feelings and wishes about “disappearing” for as long as I can remember. As a young adolescent, these feelings grew, along with all of the feelings traditionally understood as suicidal: incessant internal monologues filled with self-loathing, hopelessness, feelings of being a burden, etc. I hated myself and I hated my life. As time went on my thoughts, feelings and impulses became more incessant and “active,” and culminated in a serious suicide attempt when I had just turned 17. I was furious when I awoke in the psychiatric ward of a university hospital.
Most of what passed for “treatment” in the psych unit only made me believe that nothing could help me. I remember the psychiatrist speaking to me as though I was a dull child, as though I didn’t have the capacity to have a grown-up conversation. I was told about “privileges” and how I needed to be obedient if I wanted to maintain them. The nurses all avoided eye contact, or else they rolled them if I tried to ask a question. The other patients seemed to fit the stereotype of overly medicated zombies, shuffling around the unit with barely a word. Fearing that this is what I would become, I “cheeked” the meds I was required to take if I wanted to earn my freedom, but feared what might happen if anyone found out. I figured that I’d have to work harder to insure that my next attempt was successful.
Eventually, I saw a social worker, who started by saying “You must have been in an awful lot of pain to have tried to kill yourself. Can you tell me what was going on?” This was the first time I felt like I might be able to connect with someone. But I feared being put in the “observation” room again so I told her that I was feeling much better. She laughed and said, “I highly doubt it feels better to be locked up. It might feel better to be able to talk about what’s really going on without fear of being punished for it, and I promise you that I wont let you be punished for feeling bad.” So I took the risk and opened up to her.
To make a long story short, she found a referral for me where, without being in a locked hospital, I’d be able to get the kind of treatment she knew I needed. This was Austen Riggs Center. In contrast to my experience in the psych unit, the “examined living” philosophy at Riggs included intensive psychodynamic therapy with a therapist and staff who attempted to (and tried to help me to) understand what I was feeling, even when these feelings and related behaviors were overwhelmingly negative/self-destructive. Their efforts were not aimed towards convincing me that I was a mental patient who required multiple medications and earned “privileges;” rather, through compassion and patience, they helped me to reflect upon my self-destructive thoughts and feelings, and to understand their paradoxically adaptive functions in the context of my developmental experiences. In addition, the strong community component allowed patients and staff to both give and receive feedback about how we affected each other. There were many activities available that allowed us to start to feel like we were efficacious and had something to give. (I taught classes at the nursery school, among other things.) They assumed that we could and would take responsibility for maintaining our lives in this community and our treatment, as difficult as this seemed. They allowed me, through connection with their faith in me, to start to have my own hope and faith that my life could improve. Ultimately, I credit them with not only saving my life, but also in giving me the capacity to create a life that I actually wanted to live! This “gift” gave me the impetus for pursuing a career in clinical psychology, and the hope that I could provide to others some version of what had been given to me.
Being a patient at Riggs wasn’t easy, as it took quite some time (and “testing”) before I could actually trust my therapist and the treatment team. And it didn’t work for everyone. Some, by virtue of severe mental illness or other reasons, weren’t able to tolerate treatment in an open setting. Sometimes medications were not well-managed. Some patients had hidden/denied substance abuse issues, which derailed the treatment. And sometimes staff did tend to “over-interpret’ fallaciously. But looking back on my treatment there, and comparing it to my training and “professional” experiences in many treatment settings, I see how unique the Riggs experience was, and that it continues to be one of the rare treatment facilities which accords patients the dignity and respect which is consistent with an open and “examined” setting.
Having maintained contact with other Riggs alumni and staff through the years, I know that although some conditions have changed, Riggs remains committed to its core principles of examined living and intensive psychotherapeutic treatment in an open setting. They continue to work on the assumption that, accorded freedom, dignity, and meaningful ways to contribute to their own community, patients can better begin to understand and act on their own abilities to make positive changes, changes that can subsequently enable them to find value in living and to constructively deal with both internal and external challenges.
More from Nina Gutin, PhD: Secrets We Dare to Speak