By Pamela Siller, MD

When she awoke in the morning, her first thought was of her darling baby, born prematurely, awaiting her arrival in his bassinette in the NICU. Although she knew that she needed to stay strong, her panic steadily rose, until she ran to the bathroom and began to dry heave. Several minutes later, she rinsed out her mouth and started to dress.  A couple of hours later, she was in her stride, lecturing to 32 elementary school children while gently guiding her two assistants, amid skinned knees, grubby hands, and shining faces. In the early afternoon, as she ran to grab a cup of coffee, she suddenly gasped in horror.  A teenage babysitter was on her phone while her errant charge toddled into the street after a runaway ball. Without thinking, Perry dropped her bag and grabbed the youngster, amidst honking cars. Without uttering a thank you, the teenager snatched the toddler and disappeared amongst the people on the crowded sidewalk, leaving Perry gasping for breath at the close call. Suddenly, unbidden memories of her beloved older sister filled her mind. She remembered screaming for help, while her elder sister tried to keep afloat in the lake.  Perry could not save her. Alas, at four years old, she could not swim.

Three hours later, Perry was in the NICU, gently stroking her baby’s tiny arm while praying silently with tears streaming down her cheeks. As twilight approached, she dashed home for a quick bite to eat before her therapy session. As soon as her husband saw her, he began to berate her, as his dinner was not prepared.

“You useless woman! How dare you call yourself a wife, the house is a mess and supper is not even cooked. You are 20 minutes late, where have you been, gallivanting about Brooklyn?” Perry hurried to scramble some eggs and toast to appease her irate husband before her last stop of the day.

At 8:30pm, her therapist opened the office door and Perry couldn’t wait to sink into the couch, seeking support and an objective, sympathetic ear. She breathed a sigh of relief and began to process the events of the last 24 hours. She could not figure out how she could be devastated, strong, composed, in control, calm in the face of danger, overwhelmed by sadness, and submissive in abject misery all in the same day. 

All of us play many different roles in our complex lives, depending on our environment and the company we keep. Our past experiences shape who we become and how we react to different situations. Perry appears to be highly functional, as she maintains a job in a supervisory function and is able to react appropriately, perhaps heroically, in stressful situations, despite the considerable grief and guilt which she carries around. However, she also allows herself to be belittled by a verbally abusive spouse, rushing to do his bidding.  To further understand herself, she has turned to therapy to better recognize her apparent paradoxical reactions and deal with her significant anxiety and daily stressors, as well as obtain objective, compassionate support.

The drowning of Perry’s sister has had a profound impact on the rest of her life. The feelings of hopelessness, terror, guilt, loss, and sadness can only be imagined by the majority of individuals. She has been carrying around these feelings for many years, but had never dealt with them. Many people suppress or repress certain memories as a coping skill in order to continue to function. However, unless these memories are discussed and processed, they may resurface in a form of Post-Traumatic Stress Disorder through nightmares, flashbacks, avoidance, or hyper-vigilance.  Further, a person may experience emotional numbness and avoidance of places, people, and activities that are reminders of the trauma. Increased arousal such as difficulty sleeping and concentrating, feeling jumpy and being easily irritated and angered is common.

Some individuals may place themselves in abusive situations in a convoluted form of repentance, while others may act out or isolate themselves. Many appear to “move on” and seem to forget the trauma until triggered.

Perry, who is under a significant amount of stress and fear due to her baby’s hospitalization, is further triggered when witnessing the impending death of a young child, which brings back memories of her inability to save the life of another loved one. Her adult self is able to save the child, but she must repress her memories in order to continue to function. Although Perry acts as a strong woman throughout the day, she returns home to an abusive husband and becomes submissive in that role.

However, Perry has found the inner strength to enter into therapy to process her trauma, cope with her memories, and explore the reasons behind her actions. Once she succeeds, she will be able to more fully integrate the many aspects of herself, gain the strength to form more positive and healthy relationships and become the best version of herself, having fully integrated her past and present to encompass a more fulfilling future.

Therapy is usually helpful, although frequently feared. It can benefit those struggling with day to day tasks, as well as those who have already attained success. Treatment length can vary from one session to many, depending upon what is needed.  Although therapy can be limited to just the individual, spouses, parents, children or other family members can be invited into sessions dependent on what is mutually agreed upon as best. Hopefully, many others, like Perry, can find the strength to begin therapy and allow themselves to rise to their fullest potential.

Pamela P. Siller, MD is a Board-Certified Child, Adolescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice in Great Neck, New York. Dr. Siller is also the Director of Child and Adolescent Psychiatry at the Interborough Developmental and Consultation Center in Brooklyn and an Assistant Professor of Psychiatry at New York Medical College. She also provides psychiatric evaluations for the NYC Department of Education. Dr. Siller can be reached at 917-841-0663.