The Many Faces of Anxiety

Does Anxiety Have a Grip on your Life?

Holy Macro! Books

DORA

Her Story

She found her way into the Victim Assistance Program office where I was an intern. At Victim Assistance we had a counselor for domestic violence and two additional counselors who worked with victims of other crimes. But since this woman was barely verbal, they didn't know to whom to assign her. No one could figure out who she was, what had happened to her, or what she wanted. So, they assigned her to me, who, at 40, was the new kid on the block.

I was totally unprepared for and unqualified for Dora. But, as it happens sometimes, clients are clearly so wounded and so fragile, that once you begin with them, if you even say hello to them, you have no choice but to continue and try to get yourself up to speed with their unconventional and unintentional on-the-job training. To send such a vulnerable client elsewhere is perceived by them as yet another rejection, another abandonment.

For me the hardest part of working with Dora was staying awake. I was a single mom raising three boys, working four part time jobs and completing a graduate degree.

Anytime I encountered silence, I immediately fell asleep. An hour with Dora was 50 minutes of silence interspersed with maybe 10 minutes of information that required a lot of filling in of the blanks.

Dora's story told itself haltingly and cryptically. Dora had an older brother who was married and the father of two children. Dora adored her niece and nephew and babysat whenever possible. God only knows how she did it. She herself still lived with her mother and father. She didn't work; she was unable. I would not have left my children with her.

Dora's mother was a mysterious creature who lived with Dora but played no part in her life, except that apparently she cooked. As far as I could tell no meals were ever eaten at Dora's house, but there was food available to be consumed, always in solitude.

Dora's father, on the other hand, was ever-present in Dora's life, and he played a continual and despicable role in her life drama. He introduced Dora to drugs, specifically heroin. He was her supplier. When she did what he wanted her to do, she was rewarded with a needle and a fix. When she didn't do what he wanted her to do, she was treated to the initial stages of withdrawal. Before long, she complied with his wishes.

His wishes, what he wanted her to do, became disgustingly apparent. He wanted her to have sex with whomever he brought home. If she was reluctant or expressed repulsion, she was given more drugs, perhaps some Xanax or some prescription pain-killers, something to numb her resistance. The sexual activity was entirely at the whim of the buyer. Whatever the buyer wanted, the buyer could have, including sodomy or sadomasochistic sex, and this could be photographed or videotaped, as the buyer wished, all if the price was right.

Dora had been taught by her father how to please these men. Her father was her first and most constant sexual predator. He taught her to be compliant, and he made sure she knew how to endure abuse. He made certain that she was "well-trained." Pain, punishment, and the withdrawal of that to which one is addicted, are powerful motivators.

Dora's father worked in a factory, so he had plenty of potential friendsto bring around. What they paid depended on what they wanted. Dora received none of the money, of course. If she had the audacity to complain, her heroin supply dried up. By the time she was in eighth grade, she was dependably silent and reliably docile.

She acquired a new and additional perpetrator that eighth grade year. She walked out of her junior high school in the usual victim walk, head down, feet shuffling, and from under her lowered eyelids she couldn't help but notice a snazzy white limousine.

She realized that on various days different girls were invited to get into the backseat and when they accepted, the limo sped away.

One day she was chosen. She recalled feeling special. Finally, she was going to be the one selected. When asked if she'd like to "go for a ride," she silently nodded yes and slid in the open door. Off went the limo with a dreamy, happy Dora in the backseat.

She hadn't paid any attention to where they drove, she was just delighted to be riding in a limo. What eighth grade loser like Dora wouldn't be? Finally, the other girls would envy her.

The limo stopped at a park she didn't recognize. She could see out, but the windows were tinted so no one could see in. The limo driver crawled in the back seat with her and raped her. She was used to it. She wasn't even surprised. She was raped a couple nights a week, usually more than once a night. She didn't usually get a limo ride out of it.

Once it was clear to the limo driver that he'd get no resistance from this girl, he upped the ante. What he really liked was the feel of warm blood, and so he started cutting her vagina. Not all the time. Just some of the time.

Dora never knew if this would be the day she had a little ride, the day she got raped, the day she performed oral sex, or the day she got sliced and bled.

What this new uncertainty did was throw her even farther over the edge of sanity. Already she never knew which days her dad would bring a friend home, which days two or three friends, or which days the niece and nephew would appear and all would be familial and seemingly normal. But now the cutting in the back of the limo, with its added tension of when and how and how bad, resulted in debilitating anxiety. Dora's panic attacks and episodes, as her family called them, rendered her helpless, vulnerable, non-responsive in a corner, or hiding behind her clothes in her closet.

Then, with the resiliency of a trapped animal, she figured out how to calm her anxiety. If she cut her own vagina and made herself bleed, she could relax afterward. It was a brilliant, desperate solution. Whenever she caused her own traumatic event, which was a re-enactment of the trauma she endured from the limo driver, she could get herself to a different place in the anxiety cycle and experience the aftermath of relief.

Here's the cycle in words: Trauma happens. After the trauma comes the relief that the trauma is over for now. And then the anxiety builds in preparation for the next onslaught of trauma. One starts scanning the radar for signs of the trauma approaching.

The scanning becomes hyper-vigilance. This state of hyper-vigilance, of constant red alert, becomes anxiety. The anxiety builds into panic. The panic and anxiety may ebb and flow from severe to moderate to mild, but the radar is always on, the tension always present, the waiting always taking its toll. And then, from out of somewhere, or out of nowhere, appears more trauma. And the cycle repeats. For Dora I would say the cycle repeated at least four times a week, 52 weeks a year, for about 20 years.

And so Dora became a cutter. She didn't cut her arms or legs or stomach, as do so many cutters. She cut her vagina and rectum. Over the time that I worked with her, she brought me six different pocket knives. I have them wrapped in a Native American scarf I was given at a women's retreat. I revere the pain they have caused and look at the wrapped knives to remind me of the pain I hope to help alleviate in large part because of what Dora taught me about anxiety.

After some time, Dora was able to understand what she was doing and she truly wanted to stop. But every time she gave me her weapon of self-destruction, she ended up getting another. The anxiety of waiting for abuse became more difficult and unbearable than the abuse itself. The waiting was worse than the abuse. This is puzzling until we factor in the relief. The relief can only come after the abuse. The abuse must be endured, and sometimes the abuse will be self-inflicted, to get to the only part of the cycle that doesn't contain anxiety. The relief.

After Dora and I had worked together for about a year, she drove past a middle school one day and saw the white limo. (Don't ask me how Dora could drive. I have no idea. Just as I wouldn't have allowed her watch my children, I wouldn't have permitted her to drive my car, either!) But she saw the white limo at a middle school and drove straight to Victim Assistance and flew, without announcement or appointment, into my office.

Even more amazing, she started talking. With some passion.

We called the detective bureau and asked for a detective to meet us at the Victim Assistance office to take Dora's statement. Dora was healthy enough not to want any other eighth grader to be chosen for a ride in that limo.

Dora made a lousy witness. She had just that once actually freely talked to me. Now here was a man, a stranger, a person of authority. Today I would have requested a woman detective for Dora. At that point I didn't have any of the nuances down. But, that day, together, we were able to get the story out and across to this police officer. "If nothing else," he promised Dora, "there will be no white limos loitering outside middle schools. That much I can promise. I'll try to do more, much more, but that, at least, I can guarantee." Unfortunately, he and I knew well (he, of course more clearly than I), that there were plenty of other forms of available transportation that might fill the bill for someone so demented.

Despite what she had done and what the police had promised to do, Dora slid into a deep depression from which I was never able to see her break free. Every Friday between one and two o'clock the phone would ring in the Victim Assistance office and those of us who were there would look at each other in sadness and resignation. We knew it was Dora.

"Is Susan there?"

"May I ask who's calling?" although we all knew her flat voice.

"Dora."

"I'm sorry, Susan's not here."

"Well, tell her I called to say good-bye." Slam. The phone went dead.

If I was there, I could expect an hour of my Friday afternoon spent fighting to stay awake as Dora and I baby-stepped through her suicide threats. Each week I would pray for some thought or phrase that might give her a reason to make it through more traumatic, abusive, anxiety-laden days and nights. What could anyone possibly say to Dora? She had no high school diploma, no work experience, at least none to be listed on a resume, and her great talent was enduring abuse.

If for some reason I couldn't be in the office on a Friday afternoon, one of the other counselors would try talking to Dora. We all gave it everything we had.

When I left Victim Assistance and went into private practice, Dora found me. She came to see me a number of times. Her actual abuse ended when her father retired and stopped bringing friends home from work. Dora found the strength to say, "No," to his advances, and unexpectedly, he put up no fight.

The heroin mercifully had tapered off gradually enough that it hadn't killed her. She was perhaps 40 at the time and looked 60. Her body and her spirit were so horribly wounded that it would be fair to say she was "broken."

One of the last things she ever asked me was if I still had the knives. I told her I did. She told me I should keep them. I reassured her that I would.

Her Signs

Dora was a victim through and through. Had you noticed her on the street, you would have turned away and tried to ignore her. Or you would have stared. She wore men's pants and shoes and old flannel shirts. Dora's hair color and length were so non-descript one would be hard pressed to be more specific than "dark." I have no idea what color eyes she had, nor could I really describe anything about her. She simply didn't stand out in any way.

Dora did not engageothers. She made no eye contactwith anyone. Had you bumped into her on the street and said, "Oh, I'm sorry," she would have ignored you and hurried away. She walked with her head down, eyes fixed on her shoes. She shuffled, as though her feet were too heavy to lift. She carried no purse or bag of any sort and wore nothing of any color other than drab, if drab is a color.

Dora always came to see me at whatever time I suggested on whatever day I could see her. She had nowhere else to be. If I was late, she simply sat staring at her feet and waited. When I made the appointment for the next week and handed her the appointment card, she simply got up and left. She was completely docile. She never said "hello," and she never said "good-bye," except as a suicide threat. Dora and I never once exchanged a smile, nor did we ever share a laugh. To the best of my understanding, she had no acquaintance with humor. In fact, she was humorless and lifeless.

She possessed no social graces. I never heard her say "thank you," or "I'm sorry," or "please." If I offered her a cup of coffee or a cookie, she ignored me. She taught me to simply sit and wait. It was as hard for her to make herself talk as it would be for me to make myself throw up.

The picture of Dora that emerges, then, is one of someone who was invisible, wanted to be invisible, and preferred being invisible. Her anxiety was such that even being on the same sidewalk or sitting in the same waiting room with another human made her a nervous wreck. The only way she could tolerate proximity was to appear indifferent and disengaged.

Did Dora have other mental health diagnoses? Absolutely. She was, of course, a posttraumatic stress survivor, she suffered from depression, she was paranoid and she had schizoaffective disorder. And that's just what showed on the surface. Of the hundreds of people I have worked with in almost 25 years as a therapist, Dora was the most wounded and possessed the slimmest chance of any sort of recovery. She was the sickest person I ever have seen out in the world.

Unlike Carrie, the rape survivor in The Many Faces of PTSD, Dora had experienced nothing positive or normal before her trauma experiences began. She had no template of normalcy or sanity with which to contrast the insanity and abuse she endured. She may also have been quite limited in intelligence. For example, it never occurred to her to say "No," to the limo driver, or to exit the school from some other door. She possessed no beauty or grace or talents or skills, at least none that ever became obvious. More than anyone I've ever met, Dora needed loving, doting parents to build her self-esteem, help her experience love and joy, and equip her for her journey in this world.

Of all the burdens she carried, her anxiety was the most debilitating. Anxiety kept her body and mind in a constant state of hyper-alertness. Her ever-present disguise was her lifeless apathy. She, turtle-like, kept her head inside her shell. Like a chameleon, she tried to blend into the background and woodwork. Like a possum, she played dead. She was resigned to a painful, loveless, chaotic, meaningless existence.

Her Steps

Dora tried individual therapy. I believe I was the only therapist she ever talked to. I am not being falsely modest when I say that this is too bad for Dora. She needed someone with a great deal of experience and not someone brand new. But, she had no money and no way of knowing how to enter "the system." She wasn't a Medicaid recipient, had no insurance, and possessed no knowledge of what might be available to her. Unfortunately, she met me before I knew anything about helping someone navigate through the governmental mental health morass.

So, we worked together. I'm sure I was the first person who ever listened to her.

Dora came to trust another human, me, and I'm sure that was a first, too. However, it was a double-edged sword. The only reason she trusted me was because I never went behind her back, getting her admitted to the psychiatric ward for an assessment, for example, or pressing her to see a psychiatrist and start on medication. A more experienced therapist would have known how to get her into the system so she could get some medical assistance. I neither knew enough to try, nor did I believe she would do anything other than disappear if I pushed in any way. She was not about to give up her anonymity and invisibility.

Dora allowed herself to be treated with respect, which I'm sure was yet another first. Sometimes when I was particularly sleepy and she was particularly silent, I'd tell her stories. The stories were about anything that came to mind, my childhood, my kids, my worries. I have always imagined that she clung to some of these stories like lifelines, since she had none of her own normalcy on which to rely. I would talk about feeling depressed or anxious and describe what I did in this case or that. Sometimes I just made stuff up and tried to help her learn coping skills, albeit in story form.