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

Thursday, May 25, 2017

The Mental Touch

Posted by fxckfeelings on February 16, 2015

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Some medical issues can be resolved quickly, but most of the serious ones aren’t that easy; for every temporary infection and sprain, there’s the eternity of diabetes and, of course, mental illness. Just because your crazy isn’t going away, however, doesn’t mean you can’t try to figure out how to lead a sane life anyway. And if you can get your crazy under control, you have to stay vigilant in order to keep it that way. So don’t try for control that is perfect or permanent; that’s as farfetched as a cure. Prepare to take one drug and one symptom at a time until you know what you have to deal with and what works best for the long run. Even if you can never cure the pain, you don’t have to let it be an overwhelming pain in the ass.
Dr. Lastname

I’m not depressed any more, but going to the hospital and taking medication didn’t change the fact that my wife looks at me in a different way than she used to, and she spends more time at the gym, where there’s a handsome trainer who knows her name. She says I’m crazy and paranoid because this guy’s gay and just being friendly and, after twenty years of raising the kids, she’s too tired to mess around anyway, but I know what I see. And there have been signs in the way she seems happier and sweatier when she gets home from working out and her sweat smells more manly than feminine. My goal is to get someone to see that it’s more than coincidence, and that I have good reason to feel she can’t be trusted, and I’m not just nuts.

The paradox of feeling paranoid is that validating your fearful suspicions is what you both crave and dread the most. If you’re right, then you’re not crazy, but neither are your worst fears; your sanity may be intact, but your world would be destroyed.

Having those fears invalidated isn’t so hot, either, because it means that you can trust the world around you, but your own brain is suspect. So if proving and disproving your suspicions will always end badly, learn how to give less weight to those nagging thoughts in the first place.

Being wary of your wife’s behavior after twenty years of marriage and child rearing isn’t all bad—it certainly shows you’re strongly bonded and nothing is going to cause you to drift apart—but it also stirs up painful and dangerous conflict. Once started, these suspicions want to be confirmed or dispelled, but what you want is more important, namely, to keep your family intact.

The fact is, if you haven’t discovered infidelity after twenty years of marriage, you probably won’t find it now. That’s not an assurance that you have nothing to fear—no one can give you that, either from having a perfect knowledge of events or influence over your fears—but a statement of the reality that there’s nothing you can do to make yourself feel better, and that’s what you have to start managing.

You can certainly sit down with a therapist or have a talk with your wife if you haven’t done so already, but once you’ve had your talks and confrontations, stop and take stock. Living with your wife puts painful fears in your head, but ask yourself whether that’s worse than living without her. Take into account the good things you’re still able to enjoy together (if any) and the impact on the kids, dog, finances, and parental lifestyles. Do what’s best for your family and yourself.

Don’t assume your suspicions will ever go away and ask yourself whether you can live with them, answering their urgent pleas by calmly reminding yourself of where your priorities lie. You will have to pit your brain against itself—respond to sense of panic with it’s own voice of reason—which is difficult, but not impossible, and is something only you can do.

Since there’s no safe way to silence your brain—trained lobotomists are increasingly hard to find—there’s no way to make the paranoid thoughts stop, but there are ways to keep crazy thoughts from making you feel crazy yourself.

STATEMENT:
“I wish I could resolve my horrible doubts about my wife, but I know that’s not possible. I will rely on my total experience of our life together to decide what’s best for us, assuming suspicion is just a part, and not the whole.”

I’m feeling much better now than I did two weeks ago, when, after weeks of long hours and study (and months of depression that I wasn’t aware of), I suddenly got nutty, believed I was the Messiah, and spent up my credit cards to their limit. I spent a day in the hospital and started seeing a psychiatrist who put me on medication, but now the medication makes me feel tired and so out of it, I can’t seem to feel very much of anything, period. My goal is to get my doctor to understand that the medication is now the only thing making me sick and that I need to stop it so I can get back to feeling like myself.

If you expect precision from your mental health professional—for your psychiatrist to have total control over your meds, from deciding whether you take them to knowing what they’re going to do to you—it would serve you well to remember that the source of your mental health issue, your brain, is understood as precisely as any giant gray blob could be. Which is to say, we’re doing the best we can, but we haven’t gotten very far.

Almost always, it’s your decision as to whether or not you take a medication, not the doctor’s. The brain might be a mystery, but there is someone out there with an extensive background in you studies, and you’re looking at him/her. Which means the only person who really knows whether medication helps or hurts isn’t your doctor, it’s you.

With other medical specialties, scientific tests tell doctors whether a medical treatment is effective or harmful. With psychiatric problems, the science doesn’t exist yet, so that means you’re the expert, whether you like it or not.

First, figure out the risk of stopping your current medication by asking yourself whether you got better just after you started taking it. Review your hospital record if you need to, and ask friends and family who witnessed your recovery. In most cases, people who get as manic as you did don’t get better until they start medication and, even then, it doesn’t always work and can take a long time. So if you experienced a change in your symptoms shortly after you started a medication, there’s a great chance that it’s effective, but also a high risk that those symptoms will recur if you stop. It’s as simple as that.

You’re right, medications shouldn’t have side effects, whether they make it impossible to get a boner, slow your metabolism to a crawl, or get you feeling like you’re not yourself. In this unfair world, however, they often do all that and worse, so ask your doctor whether there’s any other treatment you can try that might have fewer or different side effects but will do just as much to prevent your symptoms from starting up again.

What your doctor will probably tell you is that changing to another medication might do the trick, because there are other medications that are similar but a little different, but we’re never sure that a new medication will be as good or better than one that has actually worked, so you’d have to experiment on yourself.

That means that if you stop your current medication, there’s a high risk you’ll get sick again. If you switch to another medication, it might be better or worse. So ask yourself whether getting rid of your side effects is worth the risk of rocking the boat. Remember, you can always do the experiment later, after your brain has settled down and there’s a lower risk of relapse. It’s up to you.

Don’t let the presence of a painful side effect control your medical decisions. You’re the one who knows the impact of your symptoms on your life and the probable power of your current medication to keep them under control. If, for the moment, your brain is no good at seeing the big picture, then ask a friend or your doctor to make the decision for you. If at all possible, however, do it yourself, using all the experience and values stored up in that gray glob as your guide.

STATEMENT:
“I hate feeling like a medication is robbing me of my ability to be myself, but I also know I started that medication for a reason and it’s up to me to decide whether it’s doing me enough good to be necessary, at least for the time being. There’s no decision I can make today that will guarantee me a cure. If I make careful decisions one day at a time, however, I will have the best chance of maintaining recovery in the long run.”

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