As a psychiatrist, I’ve worked with many patients whose lives had been entirely upended and derailed. Alcohol, drugs, gambling, pornography, affairs, scam artists, or something else took hold of their lives and led to their undoing. For each person, the individual factors and causes that led to their downfall were unique. Every one of them, and every one of us, has our own personal weaknesses and susceptibilities — whether we get a rush from gambling or are soothed by drugs. So while these differed, the common factor was that something external took advantage of their weaknesses when their natural defences were down. They were vulnerable and not taking care of themselves.
This also happened to me. At a time when I was vulnerable, I fell down a rabbit hole of physical and sexual abuse at the hands of a psychopath who had taken control of my life. I lost my career, came very close to losing my family, and nearly lost my life. Before it happened, I never could have imagined that this is something that could happen to me — stories like this were for other people. I thought I had all the tools to protect myself and keep me safe from such an end. But as I’ve reflected on what happened to me, I’ve come to realize that my experience has a lot in common with the experiences of my patients. Like them, I have my own natural weaknesses and challenges. Then, at a time when my normal defences were failing, my weaknesses were exploited to a disastrous end.
Why I Was Vulnerable
~January 2015: I’ve started the new year anything but rested. The previous year, and the one before that if I’m honest, had been very difficult and I am no longer enjoying my job. I knew that I should have put work aside during my short Christmas break and spent the time with my husband and son, but instead I caught up on paperwork and returned emails. So, I’ve come back to work feeling just as exhausted and anxious as I did at the beginning of the holidays.
It’s my first morning back and I hurry to the psychiatry unit to meet the new patients who’ve been assigned to me. I find one man in the dining area surrounded by other patients, including a much younger woman sitting very close at his side. He’s telling some story, but I interrupt to introduce myself and ask him to come with me. In a way that is vaguely unsettling, he looks me up and down, grins, and jokingly tells the others to wish him luck.
As he walks jauntily down the hall beside me, he remarks on how busy the hospital is and how stressed the staff seem. With this insight, he differentiates himself from other patients and speaks more like a colleague who is stuck in the trenches along with me. As I sit down for our initial intake interview, he regards me intently and, to my surprise, makes a joke. People ill enough to be admitted to hospital are not usually capable of jokes. Caught off guard, I laugh for the only time that day.
It felt good.
Looking back on that time in my life, it is now obvious to me how poorly I took care of myself and, as a result, how vulnerable I had become. I was a sitting duck for whatever — or whoever — might wish to hunt me down. While I was certainly under a lot of stress because of a difficult and toxic work environment, there were mistakes I made in how I handled those stressors that led to my vulnerable state.
For years, I had failed to set limits on what I would give of myself at work. I’d been repeating a pattern that is familiar to many and perhaps also to you: I worked later than I intended to, didn’t leave others to handle things that they were supposed to be responsible for, and said yes to extra commitments that I didn’t have the time or energy for. The hospital was willing to take as much from me as I would let it, and I let it take a lot. Instead of setting boundaries that might have kept me well, I didn’t protect myself. I was burned out.
I was experiencing more than just work burn out though. Like many people struggling to keep their heads above water, I was also dealing with a personal loss. Recently I had suffered a miscarriage and, instead of facing it, I tried to bury my sadness and grief. If I let myself think about it rationally, I knew that my mental health was in trouble; I was feeling much the same way as I had after my son was born and I struggled with postpartum depression and anxiety. I knew I should ask for help, but I never did. I always came to the same poor conclusions: that I could handle things on my own, that there were lots of people who needed help more than I did, and that neither I, my patients, nor my colleagues could afford me the time away from work to deal with my own problems.
Burn out and mental health issues are common experiences, but they can affect each person differently. In my case, they were fuel to anxiety and sadness as well as frustration and resentment, all of which I kept hidden as best I could. These clouded my mind and hampered my ability to protect myself.
~March 2015: The morning has flown by. I’ve barely had enough time to see all my inpatients before I rush upstairs to collect my first patient for my afternoon clinic. As we take a seat in my office, I follow up with the things that I think he needs help with; can I refer him to someone in the community to assist with his legal and financial troubles? But he’s not interested in the help that I am offering. Instead, he compliments me on what I’m wearing and surmises that the hospital must be keeping me very busy because I was a few minutes late.
I’ve come to think of this man as having high standards, and I’ve heard him say harsh and judgmental things about others. Yet his comments about me are complimentary and much more positive than my own judgments of myself. He tells me I’m an excellent doctor and that I’m doing my best to help and care for people. He says that none of the hospital’s failures are my fault. He tells me that I am smart, caring, and attractive.
By the time he left my office, I felt better about myself than I did before he arrived.
Not everyone is a people-pleaser, but some of us are especially drawn to the approval of others. For me, pleasing people has always been a powerful reward. I’ve learned to recognize this as a weakness in myself, and the ways in which it has led to problems in the past. At the hospital, I wanted the people that I worked with — colleagues, co-workers, patients and their families — to not just benefit from my efforts, but also to approve of them.
I was used to working hard and well enough to regularly have that approval, but at this hospital, it was nearly impossible to do the kind of job that anyone could be satisfied with. There were far too few resources, waiting lists were too long, and everyone, including me, was stretched beyond their capacity. Staff and even the patients were overwhelmed, frustrated, and desperate. I gave everything I had — more than ever — but I still wasn’t meeting my own perfectionistic standards. In the absence of the success that I was used to — and in an exhausted and burned out state — I was vulnerable to the addictive feedback of approval from any source. In this case, the wrong source.
We all have our own personal predispositions and predilections that determine what we are uniquely weak to. For some it’s alcohol, for others it’s gambling, drugs, or the rush of an illicit affair. My weakness is the approval of others. You might think of this as silly, or benign, and that such a weakness could not be nearly as destructive as something like hard drugs, but it turns out that any weakness, when exploited, can lead down the same very dark paths.
Manipulating My Weakness
~April 2015: I pause partway through my afternoon clinic to wonder if my next patient will show up. After previously declaring how “wonderful” I was, he didn’t come to his last biweekly appointment and, since then, I’ve been wondering why. Maybe I’m not worth his time after all.
Despite my worry, he does arrive for his appointment. He takes a seat across from me and gazes at me intensely, clearly making an assessment. As I ask how he’s been since his last appointment, he deflects most of my questions. Instead, he comments on the words I use, my tone of voice, and how I’m sitting. Then he presents me with a gift: a picture he has drawn of a woman being released from an iron mask. He is a talented artist and I am touched by his thoughtfulness. I accept his drawing without the usual hesitancy and careful consideration that I give when accepting a gift from a patient.
His drawing made me feel special.
Having sensed my weakness, my attacker gradually manoeuvred himself into a place where I came to appreciate his validation. He showed up on some occasions and not others. Sometimes he was highly complementary and at others, reserved. Increasingly and pathologically, in my vulnerable state I sank more and more of my worth into his judgment of me. I wasn’t getting validation anywhere else, and my need for it was being fed by a totally inappropriate source. This never would have happened had I not been mentally exhausted and unwell, but it did happen. I wanted to pass his test each time he arrived to examine me. He knew I didn’t want to fail.
Clinically, this powerful technique is known as intermittent (variable) reinforcement and it is a common tool used by abusers to groom and control their victims. As a psychiatrist and a third-party observer, I have seen this pattern play out in the lives of many of my patients. Yet I was unable to see it when it was happening to me.
When external factors make us vulnerable, we’re in much more danger if the thing(s) we are weakest to are right in front of us and easily accessible. Perhaps a drug dealer has your number, or there is a casino on your regular drive home. In my case, I literally spent hours in a room, alone, with a man incredibly talented and practiced in manipulation.
The Rabbit Hole
~May 2015: It is Friday afternoon; the end of a particularly stressful week — and month. The man arrives as my last patient of the day. After cursorily answering a few of my standard clinical follow-up questions, he goes on to make a suggestion: that I should come out for a fun social evening with him, his girlfriend, and maybe some of her friends because, according to him, I deserve a break.
He’s suggested this previously and, as before, I say that this is not possible. I repeat myself multiple times when I insist that it would be highly inappropriate. But he is persistent, and in my weakened state he eventually wears me down. Against my better judgment, I finally agree that I will meet him and his friends the following evening to go to a dance club. He smiles and tells me that I’ve made a good choice.
I feel a rush of guilt as soon as he leaves my office. I’ve always conscientiously followed every professional rule in the book, and I know very well that I shouldn’t be associating with a patient and his girlfriend outside of the clinic. But the thought of going back on my agreement and disappointing him makes me feel anxious. Besides, it is true that I need a break and I do like dancing. I’m sick of feeling worried, overwhelmed, and unsupported. The hospital clearly doesn’t care about my health or well-being, so fuck them. I wonder how I’ll explain this to my husband, and I decide to tell him that I’m going out with co-workers to blow off some steam — that’s something he’ll support. I allow myself to get excited about going to a club; something I haven’t done in a long time.
But the next evening when I arrived at the restaurant where our group was supposed to meet, the man was waiting for me alone. His trap snapped shut.
Perhaps you can identify with some aspect of what happened to me, or perhaps you still struggle to understand how I could have been so stupid as to end up in the situation that I did. To be honest, it’s still hard for me to believe that I got played by a psychopath. But from my own experience, and from the experiences of many patients I’ve worked with, I know that lots of vulnerable people have found themselves in situations where their weaknesses were taken advantage of in ways that were extremely destructive. Most never saw it coming.
Some people escape relatively lightly from the hole that they fall into; some money spent, a job lost, a failed marriage. Others lose absolutely everything. Even their lives. There is an element of chance to how each person’s experience unfolds, just as there was with mine. How would my story have been different if I hadn’t met a serial predator when I was at my most vulnerable? Would I have turned it around and found a way to take care of myself without the catastrophic consequences I’ve experienced, or would I inevitably have come to some other end? I’ll never know.
Regardless, the fact is that I made my own mistakes that led to what happened, and those mistakes are on me. If I could do it over again, I’d take much better care of myself, set boundaries to protect myself, reach out for help when I need it, and focus my attention on the people in my life who really matter. I can’t change the past, but since I’m fortunate enough to be present, alive, and surrounded by family and friends, I am deliberate about making sure I do the things every day that I should have done years ago. I don’t ever want to find myself in that rabbit hole again. I sincerely hope that you never end up in a similar situation, so learn from me and my patients: do everything you can to take care of yourself, recognize your weaknesses, and keep your defences strong.