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Turn of the Tide

By Kathy Whitney
January 2011

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The office of psychiatrist Beth Baxter, M.D., MD ’90, is homey. Located on the first floor of a nondescript building on 21st Avenue in Nashville, it doesn’t sport a sleek leather couch on which patients might recline. Instead, they can plop down on an overstuffed loveseat, whose cushions are slightly catawampus. Knickknacks occupy real estate on tables, shelves and walls, and one quickly takes note of the numerous turtles among them.

Why so many turtles?
“I use turtles as a metaphor for the gradual decline into mental illness, and the slow, steep climb out of it,” Baxter explained.

Baxter is referring not only to her patients’ struggle to escape the quagmire that is mental illness, but to her own.

While a student at Vanderbilt University School of Medicine, and for the 20 years since graduating, Baxter has suffered from mental illness, which has taken her to the depths of despair and back. She shares her story of perseverance with advocacy groups, mental health associations and even her patients, offering hope and reminding them that the “lowest ebb is the turn of the tide.”

Poised for Success
Baxter grew up in Nashville and attended Hillsboro High School, where she excelled academically and graduated fourth in her class of 300 in 1981.

“No real problems,” she recalled of those years. “I had a lot of friends, did a lot of things, studied a lot and worked at the Green Hills public library.”
After graduation, she went to Rhodes College in Memphis.

“That is where my story starts,” she said.

She was majoring in chemistry and became involved in a lot of extracurricular activities. She was a resident assistant, and a leader in several organizations, eventually becoming president of the student government association. She began to experience clinical depression her freshman year, but didn’t know what was happening to her.

“I knew there was something wrong with my brain,” Baxter said. “I had to study very long periods of time to do what I needed to do because it was so hard to concentrate.”

Even though she was active, she began to withdraw socially, avoiding personal interaction when possible. The school cafeteria opened at 4:45 a.m. and she would hurry in, make a peanut butter sandwich and go across the street to the chemistry building where she would study for hours in the basement. Before the cafeteria closed again, she’d go back and make herself another sandwich, and that would be her dinner.

She started to experience symptoms of psychosis while in college, what she calls “ideas of reference.” She believed she was receiving messages from inanimate objects in her environment. A magazine opened to a certain page, the noise of an airplane overhead and people on television were telling her what to do.

“I was the only one who knew what the messages were supposed to mean,” she said. “I was getting messages from everything. I was always looking for messages and it was hard to do other things in addition to that.”

She sought the help of a guidance counselor once, but embarrassed by her problem, she never went back. She graduated in four years, applied to medical school, and was accepted to Vanderbilt.

Managing Medical School
She entered VUSM in 1985 and was elected president of the first-year class. She had difficulty assimilating new information, but managed to pass her courses, despite her illness becoming more pervasive and debilitating.

During her second year, she experienced more severe psychotic symptoms. She recalled sitting in a classroom, staring at an exam paper for four hours. After she left the lecture hall, she called a Psychiatry professor who asked a resident to examine her in the hospital.

“They recommended me to get care, and of course, I didn’t. I was not very open to it at the time,” she said.

She failed all of her mid-term exams. She took a leave of absence and went to her grandparents’ farm in Texas thinking she could recover in the serene surroundings of the wide open space. One day, in a delusional state, she packed her car and drove away. She was found along a Texas highway after her grandparents issued a missing persons report. She was admitted to the hospital for the first time and was diagnosed with bipolar disorder.

“It was hard to believe that a future doctor was psychotic. It’s unusual,” she said about the original diagnosis. She would eventually be diagnosed with schizoaffective disorder, a condition in which a person experiences a combination of schizophrenia symptoms – such as hallucinations or delusions – and of mood disorder symptoms, such as mania or depression.
She returned to VUSM and repeated her second year with the help of a tutor for each of her classes. Together, they talked through all the notes she had to learn. Despite having some recurring episodes of depression and psychosis during the third and fourth year, she graduated in 1990.

Baxter, right, at her medical school graduation, received the Dean's Award from Dean John Chapman, M.D., in 1990 while Deborah German, M.D., left, looked on.

Baxter, right, at her medical school graduation, received the Dean's Award from Dean John Chapman, M.D., in 1990 while Deborah German, M.D., left, looked on.

“I had a lot of teachers who really stuck by me and were loyal to helping me out,” Baxter said.

Jeanette Norden, Ph.D., professor of Cell and Developmental Biology and Neuroscience, was one of the faculty members who advocated for Baxter.

“When I see a student who is struggling with something – whether that is depression or any other mental illness or personal issues – I always feel that every effort should be made to help the student. The only time which I would not do that would be if it’s a student I felt clearly didn’t care about being a doctor. What I remember about Beth is that she really wanted to be a doctor; she really wanted to care for others,” said Norden, who was asked by the Dean’s Office a few years ago to formally serve as the second-year academic and personal adviser.

“Different students have different challenges. You’ve got to be a strong person to make it through even if there’s nothing else wrong. Part of what I look for in knowing how to help someone is how strong they are as a person. Beth was very strong. She had a couple of setbacks while in medical school, but I think having people believe in you, and believe that you have what it takes, I think it makes a difference.”

Both Doctor and Patient
While interviewing for a residency slot, Baxter was forthcoming with her potential employers about her mental illness. As a result, she fell through the residency match program, but eventually secured and completed an Internal Medicine internship at the University of Tennessee in Memphis. Working in the public hospitals of Memphis is what she called “an incredible experience.”

“It was very difficult, but probably one of the best things I ever did because it gave me a lot of confidence about myself as a doctor.”

Because of her own illness and a strong desire to help others, she decided to specialize in Psychiatry. She went to the University of Rochester in Rochester, N.Y., for her residency. While learning to treat others with mental illness, she was under the care of a psychiatrist and a therapist, neither of whom could “make a dent in the problem.”

“I had learned to hide it pretty well, even though my illness became severe,” Baxter said.

She functioned by compartmentalizing her internal psychotic world from her external professional world. In November 1994, after her fourth year of residency, however, “the messages had won.” She attempted suicide by smashing a glass tumbler and using it to try to sever her carotid artery. She referred to this time as the "lowest ebb."

The Tide Turns
After an extended hospital stay, she returned to Nashville to live with her parents, and her doctors told them she would never recover. The best she could hope to do, they said, would be to work on an assembly line, putting objects into boxes.

“My functioning had finally caught up with my symptoms,” she said.
Baxter found a psychiatrist whom she credits with helping her escape the riptide of her disease.

“He believed in me and saw, despite my illness, I was highly functional in college. He thought I could get back to that. He was very, very hopeful.”
Not everyone was as optimistic.

“I remember when my doctor was on vacation, he had a colleague check on me while I was in the hospital. He sat me down and told me I would never be a psychiatrist. That lit a fire under me. I’ve had a big fire under me from all of the people who didn’t think I could make it,” she said. “I did [make it], but it was a long road up.”

Baxter began treatment with clozapine, a heavy duty anti-psychotic reserved for patients in whom all other medications have failed. Day by day she slowly felt better.

Practicing Psychiatry
In 1995 she started to work for TennCare’s Merit Behavioral Care Corporation as a consumer advocate, serving as an adviser on policies and programs for people with mental illness. She traveled around the country telling her story. The message she delivered was one of hope.

“My story has been received very, very well. It gives people hope that they or their family members can recover.”

In 1998, she returned to her first love, the practice of Psychiatry. She became a clinician with the Mental Health Cooperative, and later with Park Center, a non-profit agency for adults in Middle Tennessee diagnosed with a severe and persistent mental illness. She began part-time private practice in 2003, moving to full time in 2006. Aside from her Hillsboro Psychiatry practice, she sees patients at the Babb Center in Hendersonville, Tenn., on Wednesdays and works at an eating disorder clinic two mornings a week.

She said most of her patients know about her mental health history before they come to see her.

“I have years and years of experience of being able to set the boundary between myself and my patients,” Baxter said. “Despite the fact that I go around and talk about my illness in public, I really don’t do that with my patients a whole lot. I do it at specific times when I think it can be helpful, but I try to really focus on my patients.

“My story makes me more interesting to them. If I can do it, they can do it. It’s really exciting to see them make that turn. It’s very rewarding.”

David Walley, director of the Babb Center and a therapist, has worked with Baxter for three years, and said he believes her personal experience with mental illness is a benefit to both her patients and her colleagues in the profession.

“Beth is one of the most caring psychiatrists I have ever met. Her experience with mental illness and the depths it has taken her to have taught her a lot about what people go through and how important it is to be able to come alongside that in a caring way. She is very good at that,” Walley said.

“Our therapists consult with her regularly. She is giving of her time and her knowledge. She is full of knowledge that comes not only from her education, but her experience. At our clinic, she is deeply respected, and I think people value what she offers.”

Baxter, who speaks openly about her mental illness, was a panelist at the 7th annual Fountain House Symposium and Luncheon, which took place in New York in May 2010.

Baxter, who speaks openly about her mental illness, was a panelist at the 7th annual Fountain House Symposium and Luncheon, which took place in New York in May 2010.

Baxter received the Mental Health Association of Nashville's Clifford Beers Award in 1997, National Alliance on Mental Illness (NAMI) Nashville's Consumer Advocate of the Year Award in 1998, national NAMI's Exemplary Psychiatrist Award in 2000, and Eli Lilly's Honorary Public Eye Reintegration Award in 2001. She was named a fellow in the American Psychiatric Association in May 2010.

A clinical instructor of Psychiatry at Vanderbilt, she has led grand rounds and has spoken to second-year medical students about her struggles. She is active in her church and continues to educate people about mental illness and to dispel myths and negative social stigma.

“I am doing very well. I still have episodes of illness from time to time, but I see my therapist and my psychiatrist regularly. I keep my system of checks and balances,” Baxter said. “I want to keep doing what I am doing. It brings a lot of satisfaction when a patient comes in and says, ‘I am feeling better.’ To me, that is just wonderful.”


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Turn of the Tide

Psychiatrist Beth Baxter, M.D., discusses being both a consumer and provider of mental health care.

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