Knowing Pro

Posted by fxckfeelings on January 5, 2015

We’ve written many times about the way mental health professionals especially tend to be either demonized or canonized; nobody expects their dentist to fix their lives or thinks their accountant is a monster and a fraud when s/he’s not perfect, but these are the expectations for those who deal in problems that are frightening and poorly understood, like mental illness. People would like to think therapists can provide control, but they’d also like to think the problem will go away by itself if you return to your usual routine. If you can accept the fact that some problems can’t be solved, however, and that the influence of professionals is always limited, you’ll be ready to learn everything you need to know and become your own expert on tough problems, imperfect professionals, and, if you’ve got the time, your own taxes.
–Dr. Lastname

My fifteen-year-old son does poorly in school whenever he gets depressed, which is fairly often, but his current school’s counseling staff is totally worthless—they haven’t just failed to help him, but so many students that their ineptitude is an open secret amongst parents and teachers—so I’m worried that they won’t do much for him once the depression starts and his grades slip. My goal is to figure out what to do to get his school to provide the counseling services he (and other kids) deserve.

If counseling were a reliably good treatment for depression and was available exclusively through schools, then you’d have a worthwhile fight on your hands. The movie version would win awards and you’d get your face on a dollar coin.

Unfortunately for your Oscar dreams, but fortunately for your son, the stakes for your battle aren’t nearly that high.

In reality, the help that almost all counseling provides is limited, and may have less to offer now that you and your son are knowledgeable about depression and can talk to one another about it. Your school’s counseling staff may be especially weak, but their legendary ineptitude need not get in your son’s way.

It’s true that your son may need to talk about issues that are on his mind and can’t be comfortably discussed with his parents. Frequently, however, recurrent depression is not precipitated by specific issues, and the issues that exist are not hard for parents and kids to talk about. So rely on your own instincts to tell you whether a private talk is necessary with a professional listener, or not.

What counseling should always offer, no matter who’s offering it, is a positive perspective on the negative thinking that usually accompanies depression. Depression will tell your son he’s a loser who is falling behind in his work, burdening his friends, and driving away attractive girls, etc. A good therapist is a coach who identifies the illogic of negative thinking, refutes it, and teaches your son how to think positively.

Of course, you can find good therapists outside the school system, although it always requires some searching and screening. You can also observe, learn, and practice many of the techniques that you think work best. In the end, with all due respect to my profession, good parents are often the best therapists for their kids; they have the best opportunity to see what’s happening and say the right thing at the right time.

Continue to assemble a good support system, but don’t make yourself responsible for finding a good school counselor, or improving your school’s counseling system overall. Have confidence in your ability to find other sources of support and, indeed, to provide it yourself.

The more you take the mystery and urgency out of your response to depressive relapses, the more you show your son that they’re always a challenge, but never a defeat, and that, no matter what the battle, you can both live to fight another day.

STATEMENT:
“Having met many therapists, I have trouble tolerating incompetence, but I know what my son needs when he gets depressed and I’m sure we’ll be able to put together the right pieces, even if it doesn’t include the school counselor.”

I’ve been put in the hospital a couple times because I have a weakness for pot, and a bad batch can make me crazy, probably because it was laced with PCP or something and I didn’t know it. The doctors disagree, arguing that my piss test was negative and my symptoms are more consistent with psychosis and mania. I’m feeling fine now, however, so I don’t see the reason for seeing a shrink, assuming I stay away from pot or at least make sure I’m getting good stuff, which should be easy now that it’s getting legalized. My goal is to figure out holistic, non-medical ways to stay healthy without wasting time on professional help I don’t need.

There’s no reason you should agree with your doctors, but you shouldn’t disagree with them unless you’re ready to discuss facts, not intuition; you might feel one way, but your pee tells a different story, and that’s a story worth taking into consideration.

After all, psychotic episodes can cause permanent brain damage, so don’t reject the possibility of actual illness and the protective effect of medication unless your own experience gives you good reason to do so. In other words, don’t let wishful thinking control your decisions.

Review the symptoms you demonstrated prior to being hospitalized, then compare the symptoms of PCP reactions to the symptoms of mania and depression, getting a second or third opinion if you can. Then hold yourself accountable for using facts and evidence-based knowledge to decide what’s best for you.

Unfortunately, you won’t discover any guaranteed treatments. You’ll find that some have a better chance of helping than others, and that there are some non-medical treatments that are helpful. No single treatment or combination of treatments gives you total protection, but they all have a better chance of helping you than just finding purer drugs.

On the other hand, your own experience does give you valuable information about what will work for you. So, if you were fortunate enough to observe improvement after you began a particular treatment, or relapse after you stopped it, or improvement after you started it again, you know what treatment has a better chance of being successful. If you don’t believe it can prevent relapse, at least have that treatment ready to use if you notice early symptoms.

Being your own doctor doesn’t mean doing what you wish; it means binding yourself to what you observe, and ignoring everything that doesn’t arise from facts and experience. Learn everything you can about your illness and, by all means, be your own doctor. Just be a good one, and that starts out by finding good information, not good weed.

STATEMENT:
“I’d like to feel healthy instead of vulnerable to attacks of craziness, but I know that clean living, exercise, and a good diet are no guarantee against the bad luck of recurrent illness. I will do what I can to build my health, but I will also build my knowledge about what treatments are most effective for preventing relapse and reducing its impact when it’s unavoidable.”