Denial By Fire

Posted by fxckfeelings on December 11, 2014

A doctor’s diagnosis may make a serious illness official, but talking about it with professionals and people you trust is what makes it real. That’s why admitting you’re seriously sick can be so hard; if you admit you’re ailing from something manageable but incurable, the illness might scare people away, but if you admit it and become obsessed, you might needlessly scare yourself. That’s why you have to consider carefully when it’s better to focus on your problem and make it public, and when it’s not. Talking about your problems might make them real, but not talking about them doesn’t make them disappear.
–Dr. Lastname

I’m perfectly healthy now, but I had a couple nervous breakdowns when I was eighteen and twenty, and I wonder whether I should tell my fiancée. I really don’t want to drive her away. I tried stopping my meds a month ago, to see if I’m really OK now, and I still feel great, so I wonder if I need to tell her about a problem that I may not have any more, now that I’m twenty-six and working full time in a profession. I exercise and eat right now, which I didn’t do then, and I’m really not a nut job. My goal is not to screw up a wonderful relationship by bringing up past events that may not matter any more.

It’s common for people who take medication for severe mental illness to decide they no longer need said meds once they start feeling better, and it’s not hard to understand why; it’s natural for someone who’s taking crazy pills to rationalize that sanity equals success.

After all, you wouldn’t keep wearing braces after your teeth got straight, or taking antibiotics after an infection cleared up. Especially if you felt your fiancée might leave you if she found out you once had a slight under-bite or athlete’s foot.

The difference, of course, is that medication is supposed to manage your symptoms, not make your brain better. That’s why stopping treatment can be so dangerous, because declarations of health can turn to hubris at a frightening speed.

Hopefully, you’re right, and aging and exercise have made your possible instability a thing of the past. What’s worrisome, however, is that your eagerness to establish a clean bill of health might be more motivated by shame than a careful weighing of risk and benefit.

Instead of rushing to put your embarrassing past behind you, do a thoughtful evaluation of what you could stand to gain and lose by going off your medication and not telling your fiancée about your illness. Sure, telling her could make her think less of you, but by not telling her and having a breakdown, you could lose her entirely.

Luckily, you and your parents are the best experts on how sick you were in your late teens and whether or not medication made a big difference. The only thing shrinks can add—and it’s really common sense—is that, whatever the nature of your illness, there’s a good chance it will happen again.

You and your family know how bad your breakdown was and how quickly it responded to medication, so review the facts to estimate the risk you run from stopping it. Thinking over those factors with a possible partner is also important, because it’s the best way to let her know that you’re good at managing tough problems and honest about facing them.

Yes, she might be frightened to know that you’ve suffered from an incurable illness. On the other hand, she’s had time to get to know you well, and illness is a part of life in general. If, knowing how well you’ve done, she can’t tolerate the fact that you’ve had mental illness, then she’s not the partner you want or need.

Unfortunately, by not telling her about your illness, you’re showing her that fear and denial control your behavior: fear of losing her, and denial that you’ve ever had an illness because you haven’t had recent symptoms. Better to accept the fact that you’ll always be at risk of relapse, then to determine what’s been most helpful about past treatment and what the smartest course is going forward.

Maybe now is a good time to stop medication and see what happens. Regardless of what you decide, however, if you accept risk realistically and share information with the people you care about, regardless of fears, you’ll have a better chance of maintaining your progress and a better definition of success overall.

STATEMENT:
“I’ve always hated the idea of having a mental illness and with each passing year of normality I’ve prayed that I’m cured, but I know better. I will use my experience to make good decisions and hope that the strength I’ve acquired will attract good people to my side.”

I got spooked the other day when I introduced myself at a party to someone I’ve actually known pretty well for years. I’m in my 60s and in good health, but the idea of losing my memory scares the shit out of me. I talked it over with my wife, and think it would be good to see a doctor and try to get a diagnosis and treatment. I don’t want to run away from this problem, but I’m scared of what it can do to me. My goal is to get proper treatment.

It would be nice if tough problems like memory loss had a diagnosis that didn’t just consist of the Latin word for memory loss and had a proper treatment that was more effective than no treatment at all. Unfortunately, we aren’t there yet, so there’s not much a doctor can tell you, and not much you can do about what you’re told, anyway.

The harm in looking for diagnosis and treatment when medicine doesn’t really have answers is that it focuses you on measuring and re-measuring a disability you can do little to change. The goal of curing dementia can do little to actually improve your memory, reduce anxiety, or add meaning to your life.

A better goal is to continue what you’re doing as much as possible while finding new ways to prompt yourself when your memory fails. Begin, however, by asking your primary care physician to look for curable causes of memory loss (i.e., other causes besides Alzheimer’s). Then assure yourself that you’re not harming your memory by neglecting or undertreating it, and begin to build substitutes, aids, and workarounds.

Hire a good cognitive psychologist/coach to give you ideas for managing your memory. Give yourself time to make meaningless small-talk until a word or facial expression tells you you’re more familiar with a person or story than you thought. Don’t tattoo yourself with names and places, but do place checklists where you can’t miss them. Create routines and habits, so there’s less to remember. Enlist everyone from your wife to your cellphone to help alert you when a reminder is necessary.

With luck, you won’t lose your memory quickly, and you won’t waste time watching it deteriorate. Instead, you’ll go about your business, do work, and function in relationships until it’s no longer possible, knowing that it will take more than a little dementia (or a little diagnosis) to stop you from living your life.

STATEMENT:
“It’s creepy to think I’m heading for dementia, but I won’t waste time dwelling on the details unless it’s useful. With new reminder systems, I will carry on what’s important in my life until it’s truly impossible.”