South African Psychiatry - February 2019

PERSPECTIVE
all I was simply dealing with financial stress and a
hectic business. I did not have a mental illness, right?
Things went from bad to worse, almost overnight. I
had lost hope in everything including my ability to
solve my own problems. I felt like I was going to have
a stroke or die of a heart attack. It was at this point I
started to use illegal substances.
CLAUDIA
As I listened to Mark’s story I began to hear some
of the distress his ‘whirlwind’ mind had caused
him. However, I knew he was not sitting in the blue
vinyl chair across from me because of a lack of
concentration and a busy work schedule.
I WAS AWARE MARK HAD A HISTORY
OF SUBSTANCE ABUSE AND HAD SPENT
SOME TIME IN PRISON. I ALSO NOTICED
HE ALWAYS ALSO SPOKE WITH HUMILITY
AND CONCERN FOR THE WORLD
AROUND HIM. I WAS STRUGGLING TO
HEAR ONE COHERENT STORY.
At the beginning Mark tended to speak at superspeed,
sometimes cluttered super-speed. I wanted to
ask a question, which would assist me to understand
what was fundamentally meaningful to him. Perhaps
then I could listen in a more helpful way. I chose
the question: “what was it that you wished for most
when you were in prison?” I didn’t ask this question
based on a hunch of what Mark’s reply could be,
but when it came, his answer took me by surprise.
Without hesitation, Mark said: “to hold a petal and a
book”. I found the clarity, honesty and depth of that
simple answer quite astounding. At that point Mark
began to tell his story in a paced and clear manner.
Something in his approach to his story shifted that
day.
MARK
FROM THE OUTSET, I NEVER HAD A
STARTING POINT AS TO WHAT MY
PRIMARY PROBLEMS ACTUALLY WERE
(AND THERE WERE MANY).
However, Claudia was able to contain the content
of our discussions by slowly giving me perspective
on one point or another - by initially listening, and
then reflecting back to me in point form. Similar to
painting by numbers, Claudia guided me from 1
to number 50. I did not feel Claudia was trying to
control my content, but rather helping me steer the
pains of my heart.
CLAUDIA
Whilst listening to Mark, substance abuse stood out
as something quite incompatible with the principles
Mark lives his life by. Principles clearly as important to
him prior to substance abuse as they are today. I felt
the part of Mark’s story about his hiatus into the world
of substance abuse was discordant, in comparison
to an otherwise consistent character. Why did Mark
really start using drugs?
MARK
On reflection today, I see I chose drugs to help me
cope with the very things my friend had recognized
I needed psychiatric help and hospitalization for.
Except one 30 minute consultation had not allowed
for a full diagnosis, formulation of a treatment plan,
as well as a complete explanation of all the whats
and whys. During that first appointment I had not
been made aware of the crucial importance of
showing up for follow-up consultations. Despite my
friend’s constant encouragement, I didn’t show up.
I DID NOT UNDERSTAND ‘THE PRESSURE’
WOULD HAVE BEEN DEALT WITH BETTER
TOGETHER WITH A PSYCHIATRIST THAN
WITH ILLEGAL SUBSTANCES. AFTER ALL I
NEEDED HELP DEALING WITH ‘LIFE’ NOT
WITH MENTAL ILLNESS, RIGHT?
CLAUDIA
What exactly was ‘the pressure’ though? Was Mark
referring to pressures of a hectic business, anxiety
and panic attacks? Hadn’t he seen a psychiatrist
for that?
MARK
I HAD BEEN PERSUADED TO TRY DRUGS
‘JUST ONCE’ MONTHS BEFORE MY LIFE
WOULD BECOME AN UNCONTROLLABLE
ROLLERCOASTER RIDE. ALTHOUGH
THE DRUGS HAD NOT LEFT ME FEELING
AN IMMEDIATE ‘AWAKENING WITHIN
MY SENSES’, IN THE BACK OF MY MIND
THAT EXPERIENCE LEFT ME WITH THE
PROMISE OF ‘ESCAPE’, SHOULD I NEED
IT IN THE FUTURE. MY LIFE FELL APART
- I REMEMBERED THAT ‘PROMISE OF
ESCAPE’. ILLEGAL SUBSTANCES STARTED
OFF AS A MECHANISM TO COPE WITH
PRESSURE AND ENDED UP AS DRUG
ADDICTION.
CLAUDIA
Although I have never taken illegal substances, I
found common ground in this part of Mark’s story.
Psychiatrists treat ‘crazy’ people – or that is what I
thought years ago. I bristled against the notion that
I needed follow-up appointments, because I was not
‘crazy’. It took years of medical, mental and physical
frustration until a psychiatrist took the time to gently
draw me out and listen to my complete story, and
then explain his role. I realized he was there to help
64 * SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019