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Goals, not wishes-- I'm a doctor, not a genie.

Wednesday, March 29, 2017

Yes We Plan

Posted by fxckfeelings on January 17, 2013

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It’s often been said that if you want to make god laugh, make a plan, but this is not the case for people dealing with mental illness, mostly because of all the pain you have to accept before you even get to the plan-making stage. If you ignore that pain, you’re a dumb ostrich who will make an avoidant plan, but if you focus too much on it, you develop a ruminative plan and become your problem. So brace yourself for unavoidable pain, prepare to do two things at once, and plan away. Then your choices will take you as close as possible to where you want to be, and your plan, or at least your ability to make one, will make any higher power proud.
Dr. Lastname

I have a big problem getting myself to study. I do things late and then don’t get good grades, or I don’t get anything done, or I stop somewhere in the middle. I guess I have a problem with concentration and also with laziness. I’ve also done this thing since I was a little child where I turn on music, I sit on a couch or my bed and rock myself, hitting my back towards the backrest of the couch, sometimes it takes hours, sometimes it’s quite quick, like half an hour. I also have quite low self-esteem, not sure what is the reason…I am trying to overcome it somehow but it always gets to me again and I have to deal with it and then I have these days like I do not want to get up—I can’t think of a reason to, and I do not want to go anywhere and I am scared of everything. Sometimes I feel like people are watching me and criticizing me and I don’t want to go to the market because I don’t want to deal with anyone. Sometimes I eat a lot because I am in that crazy mood and I feel bad about it, not because I’ll gain weight (maybe a little bit) but especially because of my health… I criticize myself a lot. I write something or say something and in a while I hate it even if the first impression about it was really good. So… I might be a little bit screwed up I guess… I would be thankful for some opinion or advice what to do with all this.

You’ve certainly got a ton of problems, including trouble concentrating, studying, getting up in the morning, keeping your weight under control, dealing with paranoid thoughts, etc. (but hopefully not memory, because I’d have to think there are even more issues you forgot and left out).

The big question to ask yourself, however, is not what’s wrong with you and to count all the ways, but what you’ve done with your life in spite of these problems.

Yes, you may have a problem with inattention and distraction (ADD) and/or depression, and you’re also anxious and phobic about leaving the house. One thing I’m not clear about, however, after reading your letter carefully, is whether these problems have stopped you from getting an education, building friendships, and making a living.

If you’ve managed to put a life together in spite of your distraction, low energy, fears and phobias, then you’re certainly on the right track and should be proud of yourself. All you need do is consult a psychiatrist and/or learning specialist and try out a number of treatments for ADD, depression and/or anxiety that may help your symptoms. Cognitive behavioral therapy (also known as CBT) could also help you appreciate your accomplishments, challenge your negative ideas about yourself, and develop techniques to get work done and face leaving the house.

On the other hand, if your symptoms have caused you to skip studying, rock for hours, binge and avoid people, then treatment won’t help much until you decide what you want to do with a number of bad habits that are hard to break. Even when treatment works well and reduces symptoms, it doesn’t change bad habits; it just eases the pressure. So if your symptoms have actually controlled your life, as opposed to causing you to feel as if they control your life (but don’t), then you’ve got to find the strength to overcome bad habits and revise your priorities.

So don’t compare your symptom-ridden self to what you think of as normal. Instead, list whatever life goals you consider meaningful, like trying to work, make a living, find friendship, and/or raise a family. Then, ask yourself whether you’re making a good effort to achieve these goals, without making yourself responsible for results you don’t control.

If you score well, congratulations, but if you don’t, then at least you’re beginning to think about goals other than making your symptoms go away.

After that, you can find a therapist, ask friends for advice, look for helpful literature, whatever, but taking this first step towards action is your first step towards overcoming your symptoms, possible memory issues included.

STATEMENT:
“I’ve got more hang-ups than I can count, and sometimes I hate myself, but I have values and I know what matters. I will focus on how I want to live, symptoms or no, while doing my best to manage them or, if they’ve been controlling my life, I will take back control.”

I can’t blame my eighteen-year-old daughter for being totally argumentative because she has Asperger’s Syndrome, as well as huge mood swings. The truth is, we sometimes enjoy arguing with one another because she has a geeky sense of humor that most people don’t get, but I do. Nevertheless, unless she takes medication, she gets into major trouble and she just won’t agree to take it. Without it, she gets violent with her younger sister or falls into depression and can’t get out of bed for months at a time. It’s happened regularly over the last eight years, but the more I point out how much trouble she’s had, the more determined she is to dump the medication that has clearly helped her. Right now, she takes medication because I have some authority, but I don’t know how long that will continue and I won’t live forever. My goal is to get her to listen to her doctors before she does something crazy and/or really hurts her sister.

Your daughter, like many adolescents, hates to see herself as having a mental illness because it disqualifies her from being a normal member of the human race, so telling her that she’s sick on the strength of authority—either yours or the doctor’s—will probably make her fight you for control. Truly, the only good thing about adolescence is that it’s usually finite.

On the other hand, if she’s the argumentative geek you make her out to be, she will find it hard to resist an intellectual challenge. So instead of telling her you want her to take her medication, put the decision in her hands by asking her to define her symptoms in her own way and engage in a contest that might prove you wrong. That way, you’re not telling her that the medication will help, but asking for her definition of her problems, like whether they include not getting out of bed, not studying, not seeing friends, or hitting her sister. Don’t sound rhetorical and don’t try to influence her choices; give her control by creating an experiment that measures the things that bother her, not you.

After she tells you the symptoms that bother her most, create a calendar where she can log incidents and a five point scale for measuring the daily severity of each. Announce your intention to record your observations and scores in the calendar, and invite her to do likewise. Invite her to propose a moderate medication change, which you’ll carry out after a few weeks of data-gathering, assuming her doctor agrees that the risk of the medication change is manageable. Then, together, you’ll use the results to see if her symptoms change for better or worse.

As much as you don’t want to see her relapse, it’s more important that she develop her own ability to self-observe and make decisions that aren’t reactive to you or her own irrational wishes. By giving her more control, you hope to awaken her abilities to observe, estimate risk, and quantify results. Then, even if she relapses, she will own whatever lesson there is to learn.

Remember, you’re coaching someone who will soon be making her own decisions. Urging her to see what you see will spark opposition, but urging her to find ways to see for herself and make her own mistakes will challenge her to beat you at your own game while using rules of logic and reason, not moods and anger, and everyone will win.

STATEMENT:
“It makes me cringe to hear my daughter argue away her symptoms when I know they made her totally crippled and miserable for months at a time. However, I will keep my protective feelings to myself, avoid argument, and look for ways to give her control, bit by bit. I will challenge her to develop her own methods for gathering facts, estimating risk, making treatment decisions, and then learning from whatever happens.”

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