"Skyler!" said Dave, holding out his hand. "It's nice to finally meet you."
"You too."
"Take a seat."
Skyler perched gingerly on the edge of the sofa.
"I'll start by saying that normally I don't treat friends or family members of my other clients. It can affect my ability to treat someone effectively when I'm not getting all of my information from they themselves. Anything that someone else has told me, which might be true or it might not be, but either way it's got their spin on it, and therapy has no room for spin, so normally I don't treat friends or family members of other clients, but Marie explained to me that you have limited time and very high need. She told me what happened on Thursday. We're gonna talk about that, but first I have to explain to you that since we have limited time, which means I don't have time to get to know you, I am going to use what other people have told me. Just so we can cut to the chase a little, so I don't have to ask you all the reasons for your distress. I don't pretend to know all of them, but I do know some from Marie and some from the media, so due to our limited time I'd like to use my own prior assumptions a bit, and I need you speak up if I'm making any wrong assumptions. Is that ok with you?"
Skyler nodded. "Yeah."
"Just make sure you pull me up if I interpret anything incorrectly. That's really important, ok? Just raise your hand and pull me up."
"Ok."
"Good. Now I gather, and this is mostly reading between the lines from what Marie has told me, that you're the sensible sister?"
Skyler laughed. "I used to be."
"Do you feel you've lost some of your identity through all this?"
"Yeah."
"It's ok to feel like that. It's hard. But it's understandable. The first and most important thing I wanna tell you is that you are absolutely normal. You have been through hell, and you're still going through hell, and you're a normal human being, and most mental health issues have their origin in the brain's normal reaction to extreme circumstances. So I'm going to start making assumptions here, and I want you to raise your hand when I say anything that you are not or have not suffered from, alright?"
Dave paused. Skyler nodded.
"In someone who has been through what I understand you have been through, I would be expecting to see anxiety, depression, trauma-related fear, panic attacks, difficulty sleeping, poor eating habits, self-medicating with drugs, alcohol, cigarettes or comfort food, falling self-esteem, difficulty dealing with everyday stressors - perhaps everyday stressors may cause anxiety, whereas more extreme stressors could send you into a panic attack or perhaps something self-destructive like self-harm or even suicidality. You haven't raised your hand once. Can I take that to mean that you have experienced all of those things?"
"Yeah."
Dave sighed. "That is all perfectly normal. You are not crazy. Your mind is not spiralling away from you. You are suffering normal reactions to extraordinary awful circumstances. Normally mental health professionals don't diagnose people with mental health disorders around the time of tragic or otherwise traumatic circumstances, because it's quite normal to experience symptoms like that when your life is going through hell. It's not recent for you anymore, though; it's been eighteen months now since Hank died and a year since your husband died, but for you the extraordinary circumstances have continued, haven't they? Do you think that you've gotten a break at all?"
"No. And I… for me it was going on for a long time before Hank died as well."
"You've been experiencing these symptoms since before Hank died?"
"No. Not the symptoms, I just mean in general my life being a train wreck and being afraid and being unable to control anything that happens to me. Or to my family."
Dave nodded, and made a note in his notebook. "So can you describe for me, starting all the way back then and then moving forward to today, how you've been feeling?"
"That changed a bit over time. First it was shock and anger, then worry. And heartbreak because my husband did this really stupid thing that came between us and wrecked everything, and… put us all in danger including him, I was worried for him. And the more I found out, the more afraid I got, first of the people he was working with and then of him. He changed right before my eyes. He used to be someone I trusted and loved with everything I had, and he would never hurt me, and then... then he did. So betrayal, fear, hurt. And I was trapped. Then Hank died, and that was like a slow-motion train crash, where every single piece of wreckage flew directly at me and hit me from all directions, and the only way I could get through it was to go into shock and autopilot. I lost my house, I was arrested, I was socially vilified. Still am, people say things and throw things - I just have to avoid going out now." Skyler took a breath, looked down and adjusted a loose thread on her sweater.
Dave nodded and wrote something down. "Go on."
"Umm. I had to find a crappy small rental place and work as many hours as I could in a very low paid job just to be able to feed my kids. Walt died about four months into that and that was just… That was when I really lost control mentally. That was when it all fell down, but I just had to keep going; I just had to go to work, come home, try and do my best for the kids and often fail because I couldn't spend time with them because I was working, and the DEA would call me in at the drop of a hat and tell me horrifying things Walt had done and I had allowed. And I tried to do whatever I could for Marie, which is pretty hard considering I'm the reason she's a widow. And after Walt died they found Hank's body and found out who killed him, and then I realised that person was there because of me. So it was even more my fault then it would've been if Walt had done it. And we had the funeral and I had to go because Marie wanted me to and I had to support her as much as I could, and I wanted to do that and it's right that I did that, but I still see it every time I close my eyes. Images of her and everyone else who was there, his mother and Steve's family and… they never leave me. And then I went back to my trudging life for another year, just biding my time until I went on trial. Which has been an even worse kind of hell, firstly because I have to spend all day every day hearing all about all of the things I did and caused, all of the reasons I'm a horrible person. Secondly because a lot of those things really frightened me. The memories frighten me so much I lose control of my body, I'm flinching and shaking and fidgeting and adrenaline pumping – my heart feels like it's gonna break right through my chest sometimes. And thirdly because the future terrifies me, because I'm gonna have to go to prison and be away from my little girl and she's not gonna be… and I'm gonna be… I don't know what I'll have to see or go through, I know it's frightening, but more frightening than that is…. what's happening in my mind. At the moment I can push it away when I have to do things. Especially when I have to do things for my family. That helps me retain control of myself. But I'm gonna lose all of that and I'm gonna be in there by myself. And I don't wanna be alone. I know my thoughts will torture me if I'm alone." Skyler's composure finally broke, and her soliloquy ended with a whimper.
"You have done so well. Most people couldn't even imagine it - I can't imagine it. You are such a strong person."
"I don't feel it."
"Oh, you're doing so well. It wouldn't be possible to get to where you are without incredible strength. Do you consider yourself to be someone with strong self-esteem or self-confidence?"
"I used to be."
"That is your biggest asset. I don't think it's gone away, I think it's just bowed down under an enormous weight at the moment. But you can get it back. I know you haven't had a break yet, but you're still standing after - how long?"
"Nearly three years."
"Wow. You are doing so well, you are strong and you are confident, but of course under so much weight that is gonna waver a lot. Give it time. Things will get better. And you will recover yourself."
"I doubt it."
"You can. It'll take a bit of work, but you can. I wish we had more time here but we don't, so what I wanna do is to give you the tools to be able to pull yourself back from situations like anxiety, depression, panic, and self-harm. And I'm really glad to see that you've brought a notebook with you there, because self-analysis and self-recording is really helpful. You need to identify what sorts of things lead to you feeling like that, what sorts of feelings or thoughts come first, and what sorts of things make you feel better. If you can identify when you start to go down that path and immediately start doing the things that make you feel better, then you might be able to hold it off, or at least lessen its impact on you. You've probably already worked out a few things like that. I can teach you some more. And the other thing I wanna talk to you about is triggers. How to identify them, how to figure out when you are behaving a certain way because of them, how to avoid them, how to recover from them. Triggers are another perfectly normal thing that happens to victims of trauma, and the stage you are at at the moment you may not be able to avoid them, but if you can identify them for what they are, you can learn to recognise that your reaction is not in proportion to what is happening, but that it's just a trigger for your past trauma. That won't stop it, but it might help you to calm down and start to recognise which of your thought processes are functioning correctly, and which are damaged.
"I also wanna talk about your self-guilt. That is also incredibly normal. If you had been the driver in an automobile accident where someone died, or if you had a friend who had committed suicide, if you'd been caught in a wildfire where people died - feelings of self-guilt are very common when tragedies happen. Our brain thinks up all of the ways that we think we could have maybe stopped the tragedy from happening, our brain convinces us that if we had done those things it wouldn't have happened, our brain adds 2 and 2, makes 5 and convinces us that it's all our fault even though we never meant for anyone to die, and we didn't even do anything dangerous towards them. We may have made other poor decisions, but do you think if Hank had not been killed that you would've felt as bad as you do about the decisions you made?"
"No. No, that, that… makes everything worse."
"It makes you feel worse about what you did."
"Yes."
"You didn't kill him, though."
"No, but I did things that contributed to his death. Some of them directly."
"Did you notice how I lumped murdered DEA agents in with car accident victims and wildfire victims and suicide victims just now?"
"Yeah."
"I did that for two reasons. One is because any tragic circumstance - and of course tragedies are among those extraordinary circumstances that cause humans to suffer mental health issues like we've been discussing; for any tragic circumstance, self-guilt is normal. It is also normally misplaced. If someone is driving a car and a moose runs out in front of them and they swerve, and the way that they swerve protects them but not the person in the passenger seat and the person in the passenger seat is killed, is that person's death their fault?"
"No."
"Why not?"
"They did pull the wheel a certain way, but they couldn't have known what it would do exactly, like where the car would go and where the moose would go… and anyway they would've just been reacting, they wouldn't have had time to think."
"Correct. Exactly. But do you think the driver who survived might blame themselves for their friend's death?"
"Yes."
"Would they be right in doing so?"
"No. I know you're saying this to try and convince me that it wasn't my fault, but my circumstance could not be more different. And I wouldn't be on trial for it if I hadn't done things deliberately which are my fault."
"You're not on trial for Hank's death." Dave paused, watching her. She looked down. He continued. "I know, I understand why you feel that, it's a normal reaction to what happened. I'm comparing it with all these other different kinds of tragedies because feelings of self-guilt by survivors in those situations are well documented and perfectly normal, and not arising from direct fault. The second reason I have made that comparison is so that you can see how easy it is for people who have suffered such tragedies to blame themselves unjustly. When you're in the situation it can be hard to see it, but looking from the outside it's perfectly clear where the blame lies and where it doesn't lie. We wanna argue back because we're like, 'I'm in the situation, not you, I understand it better!' And we don't realise that a lot of the time actually people looking in from the outside can see what really happened a lot better. When we're in the middle of a situation we're too close up to it and we can't see it clearly.
"Write that down in your notebook there. The federal government has put you on trial and they have chosen not to prosecute you for what happened to Hank. And you know if they thought you were involved, they would go after you for it. And your sister. She is not a woman who forgives easily. Not only is she not hating on you and blaming you for her husband's death, she's looking out for you. She got you this appointment. She thinks you're worth caring for and she thinks it wasn't your fault. She was even quoted in the newspaper as having said so in court. And if Marie was a person who was easily lead, or if she commonly did things based on duty or obligation, that would mean less, but she's not, is she?"
Dave met Skyler's eyes and paused for a moment. "Would Marie do something that she didn't wanna do? Would she say things she didn't believe in?"
Skyler shook her head.
"She does value her family, but would she let them influence her feelings or tell her what to do?"
"No."
"No. She wouldn't be doing any of that if she didn't want to do it and if she didn't believe in it."
"Yeah but, what if she just believes it's the right thing, like she feels sorry for me or scared, or through some family obligation that -"
"Is Marie the sort of person who does things out of obligation?" Dave looked at his notes, and then up again. "Does she feel sorry for people often, is she an empathetic person?"
"No, but… she keeps saying that she's trying to understand me."
"Is that something that Marie would normally do? Is she an understanding person?"
"No."
"Then why do think she's doing it?"
Tears came to Skyler's eyes.
"Given how close she was to Hank, would she try to understand or show any empathy to anyone involved in his death?"
"No," Skyler sobbed, "but she's…. she's telling herself the wrong thing, she-she doesn't want it to be me that did that, so…"
"You didn't do that, Skyler."
"Did she tell you what I told her? On Thursday?"
"Yes." Dave nodded. "You didn't kill him. It is not your fault. It is very common when tragedies happen for people to blame themselves. You may not have connected your self-guilt with the other mental health symptoms you're experiencing, but let me tell you, everything is connected. What happened to you did a lot of damage, including to your own thought processes, and it can convince you that something is true when it isn't. And that's hard to fight against, but if you can look at how other people are reacting to the same thing and how their thought processes differ to yours - they're not stupid, are they? Your family? Or the DEA, who would have charged you with it if you were involved. Are they stupid?"
"No," Skyler gasped. "That's just me."
"You're not stupid, Skyler."
"Am I crazy?"
"No."
"Is that your professional opinion?"
"Yes. I can give you my professional opinion on that - no, you are not crazy, but your brain has been damaged by the traumatic experiences it has gone through. It's not permanent, but at the moment, your brain is pretty banged up. And so is your heart, I'd wager."
Skyler grunted. "Yeah." She grabbed a tissue and wiped her eyes and nose.
"So your heart is in a lot of pain, and your brain's function is impaired, which means it can absolutely convince you that something is true when it isn't. It's my fault Hank died, my sister is lying to herself, I'm a bad influence on my kids, I deserve everything I get, my family's better off without me." Dave looked at Skyler piercingly. "Have you had those thoughts?"
Skyler nodded.
"All of them?"
"Yeah."
"They're all bullshit. But how do you think that I, when I've only just met you, can guess that you've had all of those thoughts? Because I've been studying psychology and psychiatry for 20 years - still now I'm studying it, and I know that when people's brains are damaged by trauma, it affects the way they think, and that can cause a number of things to happen but one of them is making you absolutely convinced that things were your fault when they weren't. It can be really hard to tell when your brain is doing that, but one thing that can help is if you look at the thought processes of people close to you and see how they differ from yours, and ask yourself why they differ. It's not because they're stupid."
"It's because I'm broken."
"No. No, you're a little banged up, but you're not broken. This is not permanent. You just have to hang in there and things will get better." Dave paused. "Easier said than done, right?"
"Yeah."
"Are you suicidal?"
"Not right now."
"But you have been?"
"Yeah."
"What stopped you?"
"My kids."
"That's good." Dave nodded. "That's a wonderful reason to stick around. You grab hold of your kids and you hang on. Alright, we're gonna make a plan of what you can do the next time you have those thoughts. The first dot point on the plan is that you have to ask for help. You hang on to your own reasons for staying alive, your kids, as strong as you can and you use that to push yourself over the line to asking for help. I'm not saying it's easy. In fact, it's definitely not easy. But you are a strong woman and you can get through this."