I did not intend to visit an emotionally dark place. But now I think I was destined to be there, to maybe find some light.
Recently, I began a literature review of articles on workplace aggression toward mental health clinicians. It was meant to be a routine process. Instead, I became focused on research exploring how workplace violence fundamentally changes people, and how, for some, perceptions of self and others are altered forever. I’ve decided not to write the article because, in the process, I realized I wasn’t reviewing literature. I was clarifying my own trauma.
Decades ago, I was the victim of patient aggression. Given the realities of confidentiality, I will not elaborate on specifics. Suffice it to say, it happened more than once. But there is one instance that stands out with disturbing clarity. In that encounter, the unfortunate reality of physics sent me flying into the air.
Looking back now, the problem wasn’t the impact. It was the freefall. The sensation was floating. I felt suspended, completely powerless, waiting to hit the ground. It went on forever, and I remember it like it was yesterday.
For years, I gave that experience a lot of thought. I remain perplexed by those in authority who told me it was just part of the job. I’ve also felt confused by the mixed menagerie of emotions I wasn’t allowed to admit. Instead, the most immediate and consistent conclusion was simple: I never want to be in that situation again.
Unfortunately, this was not resolved. Instead, a hyper-vigilance took root. For years afterward, during almost all my subsequent appointments in similar clinical situations, a hidden threat analysis ran through my mind. I would privately disengage for a few seconds to run tactical assessments. What is the best route for escape? If there is aggression right now, how will I handle it? Externally, I functioned as a professional. Internally, I rationalized that it was just a natural adaptation.
Several years after the incident, my daughter, who was eight years old at the time, decided she wanted to learn martial arts. My wife and I found a local, traditional school. We would sit on the sidelines, watching her practice, smiling at how cute it all was. One evening, the school’s instructor approached me. He thanked me for my commitment to my daughter’s attendance and casually mentioned that they also trained adults. It was a polite gesture. I agreed.
My reasoning was simple. I wanted to learn self-defense skills. I wanted to understand how these laws of physics worked so that if I were ever put in a situation where I felt as if I were floating in suspended animation again, I would have the tools to prevent it.
What followed was a ten-year commitment. As anyone who has spent time in a traditional dojo knows, duration of commitment inevitably leads to advanced skills. My internal monologue was reassuring: This is healthy. This helps you adjust so you never experience that lack of control again.
The school I attended used traditional but extreme conditioning methods for adults. Our master believed that the best way to develop effective weapons from our hands and feet was to take away their original functions. A routine drill was to go outside to a wooden telephone pole and repeatedly kick the raw timber with our bare feet until they bled. Eventually, you develop a massive, deadened callus over the bone.
Even more extreme was the way we trained to fall. It wasn’t enough to learn how to break an ordinary fall from a standing position. We trained by jumping off six-foot-high ladders into the air, launching ourselves so that our bodies were parallel to the ground in free flight, learning to absorb the impact and roll back onto our feet.
The irony, looking back decades later, is twofold.
First, I was incredibly lucky that I never faced another physical assault during those years. I was no longer trained to exercise clinical discretion or engage in therapeutic de-escalation. Had an incident occurred, no jury in this country would have looked favorably on a clinician with master-level martial arts training using countermeasures on an unwell patient.
The second irony, and the far more painful realization, came while I was reading about how trauma changes people. I realized I had never actually resolved self-hatred. I thought that I had, but I was wrong. Deep down, I still feel that somehow I have failed, and the attack was somehow my fault. In retrospect, I was not dealing with the fear of being attacked again. I was dealing with anger. Not toward the person who hurt me, but the anger and unforgiveness that I felt toward myself. How could I have been so flawed as to become a victim in the first place? How could I have allowed that to happen?
It makes no logical sense, but trauma rarely does. Because the truth is, my devotion to that extreme training was never about protection. It was driven by a belief that I deserved the punishment. I deserved the pain, and the bleeding feet, I deserved the bruises, and the penance of forcing myself to float in midair over and over again. I was paying a debt born of self-hatred. The martial arts school was entirely innocent.
When a patient attacks you, it changes your life. Don’t let anyone tell you otherwise. It follows you. If there is a point to any of this, it is a warning. If you are a clinician in a similar situation, be careful about how you choose to heal. And if you are a friend, a loved one, or a colleague of someone who has been assaulted on the job, do not just pat them on the back, say “That’s tough,” and assume they will be OK. Watch their lives. Because it is not a one-and-done event. It is a deep psychological burn. The outer tissue may eventually close and appear healed, but the inside has been permanently altered.
Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
