Louisa had a difficult life but never showed it. Putting on a brave face was how she got by. Nobody knew about her abusive childhood and only those closest to her were trusted with why she really left her husband. Thinking about it made her break down, collapsing and weeping, for hours on end. Frankly, being that way made Louisa feel so deeply ashamed that she just wanted everything in her life to end, but she couldn’t do that. She cared about her kids, despite a constant sense that she was letting everyone down. For many years she buried her problems as deeply as she possibly could to hold down a job, keep a roof over her head, and pass for ‘normal’.
Can I reach out for help?
She really needed to talk with someone, however wanting help and getting help are two completely different things. Up until now she’d been living her life at the limits of her ability to cope, trying to stay alive and sane. The great paradox was that with every success she ever made, it started to feel safer to approach those traumatic memories. Whenever she did that on her own everything fell apart again. Louisa knew she needed help from someone who knew what they were doing.
The big problem was trust. It wasn’t merely the fact that she would have to find a good therapist, but also the fact that the Medicare system forces you to repeatedly go over your story, first to your GP and then all over again with your therapist. On top of that, Louisa just didn’t know if she could trust herself to get it together enough after seeing the GP, so that she could function back at home. She didn’t want to spill her guts at the medical centre and find that she was an emotional wreck for the next week in front of her loved ones. The prospect of going to a medical centre just to get a referral filled her with dread. Louisa’s trust in others had been repeatedly broken, so the idea of exposing herself by sharing personal and emotionally confronting things with a GP was out of the question. She worried and put it off for months.
The GP had one chance, in less than a minute, to show her some empathy otherwise she was out the door. That day the doctor was friendly enough, but far more interested in medical questions. Louisa felt like she had to beg for psychological support, but at the same time, she was worried that they would lock her away in a psychiatric hospital if she expressed the raw emotion she had been keeping in. Louisa couldn’t bring herself to share the unspeakable abuses she’d been through, so she scored the mood test her GP gave her modestly. She asked for a referral to see a local mental health social worker she heard good things about. Instead she walked out of the clinic with a prescription for antidepressants. Louisa came away feeling that she wasn’t believed and that she was undeserving of care – the same experience she had as a child whenever she risked telling someone what went on at home with mum and dad.
“It was degrading and humiliating to ask for help after being silent for so long”
A year passed. In that time Louisa buried her problems deeper, drinking more, working harder, but gradually deteriorating. A few colleagues had complained about her irritable attitude. She was barely sleeping and not looking after herself. After an interrupted suicide attempt, Louisa decided to try getting that referral again. It took her weeks to build up the courage to pick up the phone and make that appointment after what happened last time. She had to mentally prepare herself for the absurd situation of making her case that she deserved therapy to a complete stranger without leaving herself in a mess afterwards.
This time she told the doctor about how she had trouble sleeping, that she was drinking too much, and how she’d been running on a very short fuse lately. Louisa didn’t have time, in that 20 minute consult, to go over years of abuse. When she filled out the form this second time round, she only toned it down a little bit. Finally this GP got the message, and for $100 Louisa now had in her hands the envelope she needed. Walking out of that place Louisa reflected on where she had just been and how it didn’t really feel safe to start blubbering about her past, with anatomical charts on the wall, pens from pharmacy companies, and pamphlets about erectile dysfunction in plain view.
Taking a risk with trust
Being at the counselling center was completely different, with cups of tea and coffee and a much less public atmosphere. Her therapist remarked, “there isn’t much on this referral”, but to be fair she didn’t tell the GP much at all. Louisa began to allow herself to test the waters with the person she had chosen to trust her life with. The first step was to help her therapist realise that this is not just depression or anxiety, or “mixed anxiety depression” as the referral said – it was years of trauma. The second big step was to actually start going over what happened to her.
She was only just beginning all of that when problems started to emerge. Her therapist explained that Medicare only gave her ten visits to recover before they withdrew support. The system meant that Louisa felt an immense sense of pressure every session. Louisa felt like she had to push herself hard despite not feeling ready at all to make the big changes that were implied by the upper limit of ten appointments. Her therapist kept reassuring her to slow down and take things at a more manageable pace, but Louisa knew that failing to recover in that time would mean no more access to therapy for the rest of the year. Without Medicare support she just couldn’t afford therapy, so she would be once again on her own and struggling.
And then there were the reports and visits back to the GP every few weeks. Valuable time in therapy was taken up with filling out tests and getting paperwork ready for the GP to approve the next few sessions. She knew that after six visits there would be an expectation of improvement, and if not, her GP would suggest upping her medication. Louisa noticed that taking the antidepressants made he feel disconnected and emotionally vacant, but honestly, she just wanted to work on herself more without relying on pills to cope with everyday life.
“Going back for additional sessions is like having to stand naked in front of someone and have them stare at me. Then I have to beg for more sessions and go thru it again. If I can’t face the gp i go without help until I crash again.”
Abandoned by the system
After three months Louisa had run out of therapy. There was no plan for her other than to wait until January next year when she would be eligible for another ten visits. It had taken her years to start telling her story, but all she could do now was wait. The following year she decided to space out her appointments, just in case she found herself feeling suicidal again. With only ten visits that meant less than one session per month, ineffective and sometimes more harm than good, but at least there was someone she could trust who was keeping watch.
“My sessions are every 4-5 weeks how is that supposed to help. I’m reliving my trauma everyday & night the fear, shame guilt I could not hate myself so much. To isolate myself from the world. My self- esteem is shattered… life goes on”
Louisa is just a hypothetical case example, but the sad truth is her story is a reality for many Australians. All of the quotes used above come from real people on our discussion forum who volunteered their perspective as trauma survivors. ABC Fact Check found that “one in six women and one in 20 men have experienced at least one incidence of violence from a current or former partner”. The Australian Institute of Family Studies reports that our children are exposed to alarmingly high rates of abuse and neglect. Statistically speaking, these figures mean that in every Australian classroom we are likely to find at least one or more children who are living with trauma. Just like the case of Louisa above, it often takes years for any person in that situation to reach out for help. Most people reach out later, in adult life, only to find that Medicare tries to rush them through therapy. That’s not good for them and it’s not good for our society.
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