The lowest ebb is the turn of the tide. —Henry Wadsworth Longfellow

My name is Beth Baxter. I am a board-eligible psychiatrist who has personally battled a serious mental illness for the past 15 years. Although I have had diagnoses of schizoaffective disorder and bipolar disorder, I have come to enjoy a fulfilling life. My professional areas of interest are public-sector managed behavioral health care and the treatment and rehabilitation of persons with serious and persistent mental illness. I have found a vantage of wisdom from my personal suffering.

In the early 1980s, I was in college at a small, private liberal arts college in Memphis, Tennessee. By my sophomore year, I had begun to have consecutive clinical depressions. At the time, I didn't know what these episodes were. I did know that my classmates didn't seem to have the same problems I had and that few persons talked to me seriously about my irritable and highly energetic behavior.

I tolerated my feelings of despair, suicidal ideation, difficulty concentrating, and early-morning awakenings for years. I knew no other way of life or even that my experience had a name. I hid my unidentified burden amidst a heavy schedule of chemistry and pre-med courses, as well as numerous extracurricular activities that included serving as student government association president during my senior year. By the time I graduated from college in 1985, I had been accepted at two medical schools, with the offer of a full scholarship from one. I also knew at the time that something was wrong with my brain.

After I began medical school that fall, I was elected president of my freshman class and sat in my very first behavioral science course. As the lecturer explained the symptom of terminal insomnia and its correlation to the diagnosis of major depression, my years of suffering flew before my eyes. As he spoke more about the concept of depression, pieces began to fit together for the first time. I suddenly had not only a name, but also an explanation to put with my previously unidentified experiences.

I now had more answers than I had ever had before in my life. However, my experiences began to take a different shape as I started having additional symptoms. I miraculously passed my first year of medical school. As the summer began, I visited a counselor that a friend had recommended. I also headed off to Washington, D.C., to work as a legislative extern to then-Senator Albert Gore and his health affairs aide. Although I was able to deliver adequate reviews of my assigned hearings, I returned to school that fall more confused than ever about the symptoms I was experiencing and about what was happening to me.

After failing all of my mid-term examinations that semester, I took a medical leave of absence and visited relatives in Texas "to clear my mind." That spring I had my first psychiatric hospitalization and returned to my parents' home in Nashville to continue my recovery. Having personally been introduced to the field of psychiatry, I suddenly found that lithium was more than just a soft metal that was useful for creating fireworks in chemistry lab. I attained some stability through a combination of medication and psychotherapy, and I began another attempt to get through that second year of medical school. For each course I hired a tutor with whom I could "talk through" the subject material. This strategy helped me to pass that academic year.

I am taking the time to describe this period of my life because the onset of my symptoms and their treatment were so unlike any experiences I had had before. Medication, psychotherapy, and the support of many friends and family members were all helpful as I regained my social and academic footing. These experiences were very painful, but I had still not reached my "lowest ebb."

I often describe the rest of my medical school years as if I had held down a full-time job while finishing my training. In other words, it took a lot of energy to take care of myself and my illness during this time. I finished medical school with the refined identities of both "doctor" and "patient."

I was fairly open about the experience of my illness during my applications to residency programs. Although the process of securing a postgraduate training position was rocky, my motivation was keen. I was led to a career in psychiatry by my desire to help others the way that I had been helped during my years in medical school.

My psychiatry residency training was rich in professional clinical experiences and dotted with personal experiences of severe clinical depression that grew closer and closer together in time, until they finally coalesced. In November 1994, I made a near-lethal suicide attempt that changed the course of my life.

This attempt was my "lowest ebb." Knowing that things would have to change dramatically, I began to make the difficult steps toward learning to take care of myself. I grew in strength daily with the knowledge that my life had been spared. I asked myself how and why had I survived. The question of "how" led me to a spiritual understanding of a loving and forgiving God. The question of "why" was answered as I learned to love myself and to believe that my work on earth was not done. Through rigorous introspection, I learned to strip off my masks of "doctor" and "patient," leaving my core features. I was finally able to feel whole without these masks.

I finally came to rest in my hometown of Nashville with my parents. I have continued to stabilize, and I have celebrated three years without a hospital stay. Four years ago, the daily activities of awakening, taking a shower, and showing up for meals were literally all I could do for weeks at a time. Although I still experience episodes of symptoms, I have grown stronger and learned more about taking care of myself. Rather than taking down everything in my path in the fashion of a bulldozer, I have learned to take cautious and deliberate steps toward a goal. A model I try to emulate is the turtle. I may not be breaking any standards of speed, but the measured pace allows me to place a priority on self-care. I have learned to value a different set of goals.

Before I took my present position as a clinician with the Mental Health Cooperative, I recently was employed as a consumer advocate for Merit Behavioral Care Corporation within Tennessee's Medicaid-waiver behavioral health carve-out program. This program serves seriously mentally ill and economically disadvantaged Tennesseans. There I spent much of my professional time doing what many of my peers from medical school and residency were doing—listening to persons who are having a particularly difficult time. Like my peers, I often spoke to the family members and loved ones of these persons, directing them to any of a wide range of services that could make a difference in their lives. I had been given similar opportunities when the tide turned for me about three and a half years ago. I gratefully spent much of my time then and now trying to return the favor.

In addition to helping consumers directly as a liaison, I served as a public-sector corporate liaison for consumer affairs, representing consumer concerns, values, and perspectives both statewide and nationally to executive staff at Merit Behavioral Care Corporation. I represented consumer viewpoints as staff members designed policies and procedures to serve consumers and hopefully to improve their quality of life. I helped to establish national mental health care policy and coordinate benefits to consumers according to clinical necessity.

My recent past and present jobs have required the benefit of all of my experiences as both a mental health care consumer and a provider. The work has seldom been easy and it is never finished, but it has allowed me to contribute to other persons' lives in many ways.

I work in my church and community to educate people about mental illness and to dispel myths and negative social stigma. I speak to audiences of mental health care consumers and interested others across the nation about my experiences of training, illness, and disability. It is important for persons affected with serious mental illness and the general public to see those who have made it through the fire of treatment and rehabilitation and who now have meaningful social and occupational roles.

I believe my recovery has been possible because of my persistence; the encouragement of friends, family, and caregivers; and my spiritual growth. I hope to encourage others so that they may follow in my footsteps and continue beyond where I eventually leave off.

Today, I can say that life for me is better than it ever has been before. "It is the darkness of the night that makes for the brightness of the light," a wise woman and author who was receiving mental health services once said. Dark illness and bright recovery have shown me this truth. At its lowest ebb, the tide turned in my life. And though the night has been dark, the rising sun shines with a promise of hope.

Dr. Baxter is a psychiatrist at the Mental Health Cooperative, 275 Cumberland Bend, Nashville, Tennessee 37228. The column editor is Jeffrey L. Geller, M.D., M.P.H.