The Wrong Con

Posted by fxckfeelings on December 12, 2013

While most people with mood disorders don’t technically “hear voices,” they sometimes experience something much scarier; their own internal monologue lying to them. Whether your mental illness is convincing you you’re worthless or the king of the world, don’t follow your corrupted instincts when it comes to managing medications and drawing up safety plans. Instead, study the facts, learn from your own experience, and plan the odds, rather than letting your confidence play you and make you crazier than you really are.
–Dr. Lastname

I am a doctoral candidate preparing to defend and graduate in May. I am so terrified of what comes next (giant black hole; there be dragons) that I am undermining my progress and succumbing to despair. This is tied to my utter lack of ambition. I don’t know how to dream Real Things. All this worry and fear and lethargy leaves me feeling exhausted. And I am so worried and so frustrated with (what I perceive to be) my laziness, my incompetency that I become angry at the smallest things. How can I learn to get work done and to build a life? How can I learn to do it just because it must be done? How can I distinguish between real and false selfishness (it feels selfish to build a life just for me)?

The business of many doctoral candidates is to find a meaning in many random, painstakingly-researched, frustrating phenomena that ties them together and gives you a new idea you can dwell on for several hundred pages. Congratulations, you’re very good at it; too good at it, as you’ve turned your talents on your own troubles.

It’s certainly possible that your fear of any and all future jobs, combined with terminal laziness, incompetence, and an inability to distinguish between real and false selfishness have paralyzed you and filled you with self-loathing. More likely, however, is that your self-doubt has written a thesis outline tying together your many layers of failure.

You wouldn’t have gotten through to the final stage of your doctorate without doing a shitload of well-regarded work, so, until recently, you had sufficient ambition to finish courses, master lots of information, and write yourself silly. Then something changed. Chances are, you got depressed and there wasn’t necessarily a reason. It could be a postpartum/presentation depression, but it could just be an unfortunate, random graduation present.

You know depression causes very self-critical thoughts, and it’s their purpose to needle you with guilt and blame. For the time being, they’ve succeeded, which just makes you more depressed. Obviously, it’s time to re-think your thesis—not your professional one, but your personal theory of what’s wrong with you.

Don’t say another word about what you’ve done wrong and how it’s turned you into a glob. Instead, see a shrink and start the usual anti-depression protocol, including good coaching against negative thinking and, possibly, several trials of medication if other things don’t work. At the very least, learn not to blame yourself for this suddenly arrested productivity and start figuring out ways to defend your PhD (which is presumably finished) and find work.

It must be torture for a highly productive person like you to feel helpless, lethargic, and paralyzed. Once you realize you’re depressed, not a dickish loser, however, you’re free to salvage what you can and put together an independent life while you recover. Research treatment and medication, not your own mediocrity, and you’ll go back to feeling more like an academic, less like an asshole.

STATEMENT:
“I can find nothing meaningful about my current state of fear, self-loathing, and no motivation, but I know I have nothing to prove. I will stop asking why and focus on recovery and living as full a life as possible until I’m able to do more.”

I had this weird thing happen last year, when I thought I was the most creative and productive thinker on the planet and it turned out I was having a manic episode and was really writing gibberish after two weeks of not sleeping and talking non-stop. I’d never gotten that wired before, so I never thought I needed help before; I only ended up in the hospital after getting in a car chase with the police, and even then, it took me a while to accept the bipolar diagnosis was correct. Since then, I’ve been careful to exercise every day and get enough sleep, so I expect I’ll be able to stop my lithium and keep myself on the straight and narrow. My wife is worried, however, so my goal is to persuade her I can prevent myself from going off the deep end ever again without having to stay on medication.

You’ve done an excellent job of creating a good, steady routine for yourself, with a disciplined sleep and exercise schedule. You’ve also educated your wife about the symptoms of mania and she’ll give warning if you start to accelerate. Assuming you’re not drinking or drugging, I think you’ve done just about everything that can be done to head off a future attack. Unfortunately, plenty of people who go to the gym everyday still get heart attacks; without medication, you’re still vulnerable.

It’s good to know you haven’t had an attack while on medication, because medication doesn’t always work, but you won’t know how prone you are to relapse until you experiment with stopping medication, which is what you’re doing. Choose a time when you feel calm and aren’t expecting a tsunami and set up an emergency plan with your wife, instructing her to perhaps contact your doctor or urge you to take a particular medication if you go off the rails. Then stop your meds gradually and see what happens.

Have an action plan in case you get depressed, too, because getting depressed after having a manic event is much more common than getting manic again. Like getting manic, it happens to people who are taking perfect care of themselves, so it’s your job to be ready.

Don’t try to convince your wife that you’re cured or she’ll know you’re nuts. Just persuade her that you’ve learned what you need to know, you’re realistic about the odds of relapse, and you’re eager to have her help. Then, even though she knows you might get sick again, she’ll have reason for confidence and optimism.

Remember, beating an illness doesn’t mean getting rid of it or getting absolute control over it with diet, exercise, or even medication. Beating an illness means having the courage and doing the work to manage it, with all its uncertainty and potential disability, while living your life as fully as possible. Admit you’re vulnerable while keeping up the good fight.

STATEMENT:
“I feel so much better and am living such a different life now that it’s hard to believe I could ever go nuts again, but I know that relapse is always possible. Instead of trying to convince people I’m too sane to ever get sick again, I’ll be even saner by being well prepared for whatever happens next.”