No Therap-easy Answers

Posted by fxckfeelings on January 6, 2011

Names are often misleading; there are no arts or entertainment on the A&E channel, Greenland is mostly ice, and, most importantly, Therapy isn’t necessary therapeutic. Fact is, few therapies work completely or all the time, whatever kind of medical problem you have, and there are no guaranteed cures for psychiatric problems. That means there are no no-brainer decisions; all decisions require your brain, so you’re the one who must make all the tough calls. As such, you’re the one who must decide whether a therapy is therapeutic and whether, given its risks, it’s worth trying. The more responsibility you take, however, the more control you’ll experience over your choices, and the more respect you’ll command from others and yourself. If you want to see the mushy kind of therapy, you can watch it on A&E.
–Dr. Lastname

Things have been much better since my husband began therapy—he’s much less explosive and sensitive lately—which is good, because I didn’t really think we could start a family the way he was acting before. He was traumatized as a kid, and it’s made him very suspicious and touchy. I think therapy is helping him to get to the root of his problems, and that, if things continue to go well, we could actually have kids, but I’m not sure when he’ll be well enough for the time to be right. My goal is to set a goal for us.

Your husband may be happy because his relationship with his therapist has filled a deep need, or because he’s excited about a breakthrough, or because the McRib is back.

Sooner or later, however, therapy or no, life won’t be so easy, particularly if you have kids and you run into the usual kinds of medical, economic and personal kinds of bad luck that happen to most of us.

That said, don’t use your husband’s apparent happiness or serenity to decide whether he and your partnership are ready for child-rearing; what you need to know is how well his serenity stands up to stress.

Thinking wishfully, you’d like to assume that therapy helps all those who genuinely want to be helped and that his being in therapy is a good sign, but that’s not necessarily true. Therapy sometimes helps, sometimes not—it has nothing like a 100% cure rate, no matter how well motivated patients are and no matter how skilled (or Harvard-educated) the therapist. So don’t just look at whether it makes him feel better, but whether he also behaves better, particularly when he’s not feeling so good.

In fact, if his therapist told you he was fully engaged in treatment and working through painful issues, and that’s why he was acting like a jerk, you would be wise to ask yourself whether that boded well, regardless of the therapist’s optimism.

That’s because those who act like jerks under pressure are usually jerks full-time, and there’s no evidence to suggest that therapy is particularly good at turning jerks into nice guys. As the saying goes, you can go through therapy and still be a dick, but at least you’ll know the source of your dickishness. As a matter of fact, you may even learn to embrace your inner dick, be less critical—and cross over from dick to asshole.

If you really want to assess the results of therapy, give your partnership a test; go traveling together, preferably in an old VW Minivan, or, if you must fly, have at least one lay-over in Omaha. Maybe start some do-it-yourself, low-budget renovations, or invite his parents over with no finite end date.

Don’t hold back, because babies sure don’t, and if he acts like a big baby in tough times, then adding a child would be one baby too many. If that reality causes unhappiness, you could always try therapy, or maybe just a nice McRib.

STATEMENT:
“Quite aside from the fact that I love my husband, I have a right to worry about whether having kids would make his negative behaviors worse, hurt the kids’ mental health, and make him impossible to live with and rely on. He’s high risk, but maybe he can pull himself together. I’ll see how he does under stress, accept what I see (without pretending it’s better than it is or likely to change), and plan accordingly.”

I haven’t taken the antidepressants my doctor gave me, even though my kids have been urging me to do so, because I simply don’t like medication; I don’t want to upset them, but I’m 70-years-old, and I’m on too many medications already. The possible interactions and side effects are what make me depressed in the first place, so the last thing I need is more medication. My goal is to cut down on medications, not add more.

The best way to invite condescension from your kids (or physicians) is to share your negative feelings about medication.

Of course you have good reason to hate medication; it costs money and carries risks. Expressing negative feelings, however, suggests that they’re more important to you than your adult assessment of the risks and benefits of taking medication, and that maybe you haven’t done such an assessment or don’t want to because you’re just too angry and afraid. Give them emotional bull, you’ll get the patronizing horns.

What I assume, despite your statement, is that you’re old enough to know a thing or two about depression, and that you think you’re functional enough, and safe enough, to ride out a bout of the blues without having to fear for losing your job, your marriage, or your ability to wake up in the morning and live your life.

If you’ve been around long enough, you don’t need an expert to tell you when depression is dangerous, regardless of how unhappy it makes you feel. I hope that what you’re thinking (as opposed to saying) is that you would always take medication if you felt the risk of not taking it was worse than the risk of taking it; but that, in this case, you don’t think medication is worth the trouble and risk unless your depression gets worse than it is now.

If that’s not what you’re saying—if you just don’t like little pills and don’t want to bother with another bottle that’s a pain in the butt to open or possible dry mouth—then ask yourself whether the possible side effects, i.e. dry mouth, are worse than the effects of your depression, i.e. two weeks wearing pajamas and crying while your husband goes from worried to out the door.

There’s just one additional, technical piece of information you may not be aware of and should take into account. Recurrent bouts of severe depression may damage your brain and make it more vulnerable to Alzheimer’s. As you can see, it’s a very complicated decision that requires a rational weighing of alternatives, not an irrational tsunami of emotion.

Now, if you’ve done a risk benefit analysis, even if it’s intuitive, that’s what you should share with your kids. Expressing an opinion based on your experienced, informed choice gives you the authority of an adult manager. Others may disagree, but you’re not inviting them to treat you like a child and, if they do, you can raise an eyebrow, insist on your right to make a reasonable decision, and stop further discussion.

Don’t let yourself worry too much about what they think. If you’ve thought through the consequences, using your own experience and whatever expert advice you need, you’re entitled to have confidence in your conclusion.

There are good things about being old, and one of them is that you have the experience to make pretty good guesses about what will happen when you’re sick and whether it’s really necessary to get treatment. If you have a heap of knowledge to stand on, your kids can’t talk down to you, even if they disagree.

STATEMENT:
“I never use medication unless I have good reason to think it’s necessary and, so far, I don’t think my depression needs it. I’m functional, I can stand the pain, and I think it will get better. I appreciate the concern that other people have for my happiness; but happiness is not the most important thing to me and, as long as I’m doing well enough, I’ll stick with non-medical treatments and a good stiff upper lip.”