Knowledge is Sour

Posted by fxckfeelings on April 2, 2015

When faced with a seemingly insurmountable issue—an illness, personality flaw, really ugly feet—most people think that getting to the bottom of that issue and finding an answer of some kind is their ultimate goal, when in reality, it’s just the beginning. Too often, they’re actually looking for someone to blame or focusing on one small problem and ignoring the big picture. So don’t let helplessness guide your assumptions, your searches, or your choices in footwear. Ask yourself what answers you’re really looking for and whether you actually know more or less than you think you do and, given that knowledge, whether anything other than life is really to blame.
–Dr. Lastname

I can’t stand seeing how depressed my husband is, and no medication seems to help. Several things he tried were very promising at first but then pooped out or quickly caused side effects that made him even more miserable. I can’t get a straight answer from his doctors as to why they’re not working or whether his symptoms are from his illness or being over-medicated. No one seems to know what they’re doing, or what to try, or why the medication isn’t working, or when to stop when they’re not working…I feel really lost. My goal is to find some way to get his treatment on track.

When treatment doesn’t work, it’s natural to feel helpless and look for an explanation. Both fortunately and unfortunately, for most psychiatric problems, the answer is simple– treatment often doesn’t work.

Remember, the scientific meaning for “effective” is “better than nothing,” not “usually works.” And when “better than nothing” translates to “maybe less terrible than normal,” it’s easy to feel effectively screwed.

Finding a good treatment, however, is still a realistic hope, because there are many possibilities. Finding one that works is easiest for the person closest to the disease, which makes you the second most qualified expert to your husband. That’s why expecting psychiatrists to have all the answers and wondering why they don’t also has an easy answer– when it comes to your husband, you know a lot more than they do.

That’s because, in the absence of any good tool for predicting which treatment is most likely to work (good tools would include blood tests or predictive symptoms, which are of no help with this kind of problem), the only way to find a good treatment is to try one after the other while closely observing their impact, both good and ill. Since, for some unknown reason, most psychiatric medications require several weeks to work, a series of trials can take a long time.

That’s where you come in, since you will probably have a better opportunity to observe changes in your husband’s behavior and symptoms than a psychiatrist will. Particularly if your husband is sick and uncommunicative, a psychiatrist will be able to get very little information about his improvement, or lack of it, unless you’re able to share what you know.

In addition, if you keep a record of medication and dose changes, you’ll be the first to rate a medication’s effectiveness and/or drawbacks and compare it to other treatments. A psychiatrist’s observations depend on a brief interview; your observations encompass the whole week.

So don’t assume that treatment failure means that future treatment is bound to go badly, or that your husband’s condition needs better professional expertise, or that your idea of failure and the scientific definition of failure are really the same thing. An ineffective trial is business as usual; the business of depression, not surprisingly, is usually terrible. What’s really required is for you to learn everything you can about his illness and become an active observer and evaluator of what each treatment does for (and to) him.

In the end, your work will probably make a decisive difference in finding treatments that work (in as much as treatments do work). It’s a complicated disease, but at least the process for finding treatment, while painful, is still simple.

STATEMENT:
“I can’t stand watching my husband take medications that seem to make him worse, but I am becoming knowledgeable about his illness and the usual impact of treatments, and I know that my observations are a key measure of how well they work and which one works best.”

My son is right about me– I’ve always been too dependent. I’ve always been a ditz (I am a blonde, after all), but I’ve always been lucky and had people looking after me, starting with my parents, then boyfriends, then my husband, and back to boyfriends again. Of course, it is harder to get dates as I get older, and while my flakiness has always annoyed my son, it’s also starting to bother me, too. I don’t like not being able to keep track of my money or get to appointments on time, and I know that, as my ex-husband would say, it isn’t cute anymore. My goal is to learn to stand on my own two feet after all these years and be less blonde and more responsible.

Most people think that ditzy women like to be dependent because it’s easier, or because men like to be in charge, or because good looks allow pretty girls to get away with it. Sometimes, however, ditziness isn’t just a result of sexual politics, but of neurological strengths and weaknesses. In other words, hair color has nothing to do with it; don’t confuse being an airhead with possibly having ADHD.

Ask yourself whether flakiness made it hard for you to do school homework or keep track of tasks and appointments when you were younger. If you weren’t interested in schoolwork, review your experience with activities that mattered to you, like managing social events, travel, or your children’s schedules. If it was always hard for you to identify priorities and get places on time, your brain may be poor at executive function (even if your looks and personality might have saved your ass).

Having an executive dysfunction doesn’t mean you can’t get organized or manage your own affairs; just trying to change your habits or become more independent through willpower, however, may not be enough. You may need to work harder than other people and learn special techniques for managing schedules and priorities.

Get an evaluation by a neuropsychologist if you think it’s appropriate, and ask for advice about tools for creating and tracking to-do lists and putting alarms into your schedule. You may prefer to use a paper system, like a big wall calendar, or a smart-phone organizer synced to a computer. You many also need to develop several new daily habits, like checking your organizer at the beginning and end of every day.

In any case, congratulations on your efforts to become more independent. If you can improve your systems for managing time and money, you may well find that your emotional need to be dependent is not so great, and that a blonde can take care of her business as well as anyone else.

STATEMENT:
“I always assumed I needed help from others to take care of myself, even if it was sometimes humiliating, but I now have the experience and assistance to manage my own life if I wish.”