I know Stephanie Foo’s name from the credits of This American Life, and this book breaks open some harsh behind-the-scenes reality of what appears to be a public-radio-hipster’s career dreams come true.
Foo’s story starts well before her radio days, when her mercurial mother and disinterested father move her to California. She’s given journaling homework at age five and her mother berates her for every “mistake.” It’s a violent and terrifying environment, until her mother leaves when she’s thirteen. Then it’s just lonely. Her father gives her cash for groceries and mostly leaves her on her own while he dates, marries, and starts a new family.
It’s during this time that Foo finds her true talent and passion–journalism. She throws herself into learning the trade, first at her high school paper and later in college and early adulthood. These years aren’t easy. Friends drop her and call her toxic. She’s growing as a professional, but she’s lacking self-awareness needed for growing into a fully realized human. She didn’t have role models in her parents, or practice in being in a healthy, balanced relationship.
Foo does make it big and moves to NYC to produce for This American Life. Around this time, her therapist reveals that she has a diagnosis of Complex Post-Traumatic Stress Disorder, or C-PTSD. Foo is appalled that her therapist did not share this sooner. She cuts off contact with this therapist because she feels betrayed or lied to, which makes sense. But it breaks my heart to see a valued therapeutic relationship end over a diagnostic label. This is the flipside of what Jennette McCurdy experienced. Putting a name to our experiences can be empowering, and it can also be overwhelming. It’s a choice therapists make every day–how much information to share, when, why, and how. If we share too much, the client may be overwhelmed or disbelieving, and could even end their treatment. If we don’t share enough, they may feel lied to and end their treatment. There is an art to sharing our assessments with clients and keeping them engaged at the same time.
Foo wants all of the info. She reads up on C-PTSD and sees herself in the list of symptoms: emotional instability, lack of trust in others, struggling to hold down a job. Despite her know-how and talent, things aren’t going well at TAL.
One thing worth noting about C-PTSD, and diagnosis in general, is that these diagnostic labels are always in flux. The DSM-V is the fifth version of a book that gathers names, code numbers, and symptoms for mental disorders. The DSM is not a monolith, and it is not set in stone. It is written by humans, all of whom have their own biases and limits. The first DSM, published in 1952, listed homosexuality as a disorder, and that remained a disorder, per the DSM, until 1973.*
The main reason the DSM is used in therapy is because health insurance companies want to know why they are paying for treatment, and a diagnosis is one way to show them that therapy is necessary. However, a lot of therapists are turning to cash-only practices that eschew diagnosis because this system can be…icky. It involves labeling people who are often responding in typical ways to high-stress situations. Recently, grief disorders were added. This is controversial because grieving is normal when someone you love dies, right? But if you want to get therapy to help you through grief, and you want to use your insurance, you have to have a diagnosis.
In Foo’s case this is even more complex because–plot twist!–C-PTSD is not even in the DSM-V. It was researched and proposed by a group of professionals for addition to the DSM, and the committee that makes those decisions chose to leave it out. So C-PTSD might make sense. A person could google the criteria and see that it describes them to a T, but they can’t be formally diagnosed with this condition. According to the Diagnostic and Statistical Manual, C-PTSD does not exist. Maybe that’s one good reason for a therapist to not tell their client that they have it.
Eventually, Foo quits her job and goes on a healing journey, trying therapists, meditation, yoga, and any practice she can access that might help her suffer less from the effects of C-PTSD. All the while, she’s collected a passel of supportive friends and a romantic partner who cherishes her and brings her into his family–an experience that is foreign to her, but welcome. After struggling through some therapies she finds less than adequate, she finds herself in the office of Dr. Josh Ham, a well-respected psychologist who typically charges $600 per session. He waives his fee in exchange for recording the sessions, in hopes that they might make something for the public that will help others.
At least part of that something is this book. Excerpts from therapy sessions are included. In the audio book, it is telling to hear Foo’s confident “radio voice” narrating in contrast with the hesitant, quiet voice speaking in her therapy sessions. There is plenty of vulnerability throughout this book, but hearing her live in therapy is something different and rare in memoir. Any memoir about trauma is by nature a recreation, through the lens of a self who was strong enough to write and publish a book about their own worst moments. I hope this glimpse of Foo, vulnerable in the therapist’s office, is inspiring to others in the early days of their healing journey. A condition like C-PTSD will never entirely leave you alone, and Foo’s frustration as she searches for a treatment that will cure her is palpable. Her strength in continuing to try through so many disappointments is admirable. I have had therapy clients who expressed anger that they have to commit to therapy and work so hard just to function, while others around them seem to be thriving with little effort. And they are correct. It isn’t fair. But progress and healing can happen. The work is worth it. We all have the power to connect to our strengths and define the values we want to live by. I am grateful to Stephanie Foo for this book because it is a portrait of tenacious self-advocacy.
* See this link for more history of the DSM and homosexuality: https://daily.jstor.org/how-lgbtq-activists-got-homosexuality-out-of-the-dsm/
A Therapist's Book Club 