Doctor? No.

Posted by fxckfeelings on May 5, 2011

People like to turn to an authority when they’re helpless, and if that helplessness only applied to 911-like situations, there would be no problem. For problems that don’t involve theft or fire but sadness and family, however, authority is useless; sure, doctors like me can give advice, but until medical schools start borrowing from Hogwarts’ curriculum, the best resources you have are your own. The sooner you realize that, the sooner you’ll learn to draw on your own authority to come up with the best possible management plan and execute it with confidence. You are your own best first responder.
–Dr. Lastname

I need to find a doctor who will tell my daughter she needs to take her medication. She’s always had a problem with depression, and she did well in high school when she took antidepressants. Now, however, she’s 24 and very reactive to however she’s feeling, whether it’s not getting out of bed, or not working, or feeling dizzy and deciding it’s the medication and stopping it. My husband and I can’t get her to stick with anything, and she won’t listen to us in any case, so our goal is to get you, or some professional, to tell her what she needs to do.

Whenever parents want a doctor to tell their kid what to do, you can be pretty sure they’ve lost faith in themselves and overestimated the power of communication/a medical degree.

And no, it doesn’t matter how old the kid is or how many Harvard degrees the doctor has; the doctor doesn’t have more power than the parents, no matter how powerless the parents feel.

In your case, I don’t know whether your daughter can be induced to take her medication, but I do know that she’s not going to be persuaded by the authority of a doctor at the age of 24 if her own experience and your words haven’t done it by now.

The probable reason for her unresponsiveness, by the way, isn’t stubbornness or a lack of respect, but a lack of control over her own impulsivity (probably enhanced by depression). In other words, it’s not clear she can make herself take medication regularly, even if she sincerely believes she needs it. At some point, other impulses take over, like the impulse to stay in bed indefinitely.

Fortunately, even though persuasion is probably useless, you have other tools that a mere doctor can’t touch. You can access them if you believe you know what your daughter needs, regardless of what she has to say about it.

For instance, if you believe that she needs to get up early and follow a daily activity regimen, then let her know that’s what you’ll pay for. If she says she’s too blah, tell her you know it’s hard, but she needs to try, and that she might be able to do it if she puts together a schedule and asks friends to help her keep it.

If she argues that she can’t do it until she feels better, tell her that you don’t know when she’ll feel better, so she’d better start trying to keep busy now, and maybe that will help her feel better later. Your tone should say that you believe what you believe, and there’s no point in arguing.

If she tells you that you don’t know what she needs, tell her that you’re the mother and you have a good idea what she needs. Don’t ask a doctor to be the authority– get whatever information you need from the doctor, and then assume you’re the authority. At 4 or 24, your kid needs to hear the same thing; you’re the mommy, that’s why. End of discussion.

If your incentives don’t work, don’t blame her or yourself, because, again, you don’t know whether she’s too sick to have the control she needs. By putting a priority on self-control, however, you provide her with a blueprint for moving forward that is not reactive to negative feelings or thoughts or painful side-effects.

You’re urging her to embrace goals that arise from her values and that she can stick with, regardless of how she feels or how much she accomplishes. Knowing medicine isn’t as important as knowing your daughter and what’s best for her. If she won’t listen to me, you can, and I’m telling you you’re the most qualified professional for the task.

STATEMENT:
“I’d like to think my daughter could respond to persuasion from someone she respects, but I suspect it’s not true. I’ll push her towards doing as much as she can, regardless of how she feels, and hope that incentives for good habits will take over where persuasion has failed.”

I need an answer about what’s wrong with me, medically. I’ve always been healthy and athletic, right into my early 70s, and if there’s something I can do to improve my health, I’ll do it. Along with my husband, I ran a small company before I retired, and I’m good at getting things done. Lately, however, I’ve been having bowel problems and dizzy spells and fatigue that no one can explain, and I’ve gone to some terrific doctors. It’s gotten me down, and I haven’t been exercising or getting out as much as before. I need some answers about my medical problems so I can get going and get my old life back.

The weak side of being a great problem-solver is that it’s hard to change your expectations when you hit a wall, and old age is a wall. You’re accustomed to believing in the value of hard work, perseverance, intelligence and ingenuity. That’s a dangerous belief when their value happens to be zero.

What happens when hard work, and your belief in hard work, don’t work, is that you feel like a failure, try harder, and feel worse. You can’t undo the effects of aging, but you can always make them worse. I’m sure that isn’t a comfort, but it’s the truth.

Give yourself credit for getting yourself the best medical care, and then suck it up and admit that there’s nothing more you can do to get a diagnosis or find a cure. Cry if you must, but then figure out what comes next (besides death, which is everyone’s sad conclusion).

What comes next, once you give up on getting to the bottom of your medical problems, is using your good, well-developed discipline to get yourself going and re-claim as many of your old activities as possible. If being strong means achieving great results every day, then you may never be strong again. If you decide, however, that being strong means achieving all you can with limited equipment, then you’re about to become stronger than you’ve ever been.

Once you accept that there’s no curative treatment for aging or mortality, you can explore a wide range of treatments, including medication, that may improve your symptoms. Nobody lives forever, but there are plenty of ways to live a little better, and do what’s meaningful despite diminished capacity, at any age.

STATEMENT:
“It feels like a defeat to accept the limitations of age, but it’s actually a bigger defeat not to. Once I’ve completed a reasonable search for a definitive answer, I need to stop myself from searching further and re-order my priorities. I’ve got defective equipment and correcting the defect isn’t my department. I will do my best with the equipment I’ve got.”