Allure of a Cure

Posted by fxckfeelings on May 30, 2011

When people are in pain and can’t find a good treatment, they often feel like filing a protest—it’s the adult, less-trivial version of a child pitching a tantrum when their situation becomes too unfair. One way to rebel is to embrace a treatment that feels good but does harm, another is to avoid a treatment that feels bad but might help in the long run. As with a red-faced toddler, you can’t help such a person by supporting their expectations, you can only remind them that life is, in fact, unfair, and that they’d better deal with it as it is, or you’ll have to reassess your relationship/take a time out.
–Dr. Lastname

My wife is a good woman, and she loves our son, but she has a trauma history and when she gets anxious, she gets very negative and loses hope in us, herself, and our future. Antidepressants helped some, but less than we hoped. Two years ago, before our son was born, her psychiatrist showed her that negative thinking was half the problem and urged her to get DBT, a kind of cognitive behavioral therapy that would help her develop positive thinking habits. She didn’t follow through but seemed to be doing well until the other day, when I discovered she’s been drinking secretly since she delivered. She says alcohol is the only drug that helps relieve her anxiety, which has been overwhelming. My goal is to find something else that will help her.

Everyone is entitled to anxiety-relief, a fair life, and a healthy body. Along with that entitlement comes the guarantee that everybody (except for a few lucky jerks) has to pay the price.

At this point, her motto is, to paraphrase the New Hampshire license plate, “live free (from anxiety) or drink.” If it were up to you, she wouldn’t feel this way, but it’s not, and you’ve got to tell her that neither freedom nor booze is an option.

Theoretically, there should be a good medication for anxiety, but in actuality all current medications are a compromise. The reliable, effective drugs—benzodiazepines—are also addictive, and the safe, non-addictive drugs—antidepressants and others—are less reliable and slower to take effect.

So, while most people get some anxiety relief from medication, there will always be a few people who don’t. Unfortunately, they’re the ones who are most vulnerable to alcohol addiction and have the most reason to wonder how they can be expected to tolerate anxiety without its benefit.

The sad fact is that she’s fucked, and as long as she’s unwilling to accept that fact—and her question implies that she is—she’ll make herself worse. Helping her means helping her face facts, then seeing what she can do.

There’s no immediate relief, and sobriety, which is what she needs, will begin by making her feel worse. That said, if she can stay sober, she can learn new ways to get stronger. The psychiatrist was right—DBT will help, and so will AA.

Let her know you’ll stick with her if she tries, and protect yourself and your child if she doesn’t. You’re not warning her because you’re angry or want to control her, just because you’re stating the sad facts of life.

Hopefully, once she realizes what’s at stake, and accepts the lack of feel-good alternatives, she’ll be ready to make sacrifices to preserve what’s truly valuable in her life.

STATEMENT:
“My wife’s pain is real and it’s hard to see it without feeling she deserves better, which she does. If she can’t find the strength and motivation to get sober, however, she’ll become a dangerous parent and weak partner. I love her and believe in her potential strength, but I must do what’s necessary to survive if she can’t get herself under control.”

My wife has been horribly depressed for the past 6 months and none of the medications that used to help her are doing much good now. ECT, the treatment they use when medications don’t work, caused her too much memory loss and she can’t do it again. Her psychiatrist says the only medications that might work are ones that sometimes cause weight gain, so she refuses to try them. (Another psychiatrist, whom she saw for a second opinion, agreed.) Now she’s suicidal and insists that there should be a medication that won’t cause weight gain and that she needs to find a psychiatrist who can help her. My goal is to help her, but she’s making it impossible.

Weight gain is bad for her health, as well as her looks, self-esteem, and pants budget, so it’s understandably the side effect your wife hates the most.

The one positive sign in all of this is that your wife is eager to find treatment, even if she’s got the wrong priorities (which is better than reacting like the wife above and looking in the wrong places). The key is getting her to look harder, expect less, and be willing to put her mind above panic about her body.

After all, she should remember that side effects are usually mentioned in the same phrase as the word “risk,” which usually means less than 100%, and that weight gain never appears overnight, so she will always have time to recognize it and respond before acquiring 10 new pounds and a need for bigger pants.

Of course, depressed people often don’t think rationally–weight gain, panic, misery—but that’s where you have to come in and remind her that, unfortunately, a risk of weight gain is a possible side effect of almost all psychiatric medications that are used after the first round or two of treatments fail.

So, if you can’t persuade your wife to take it one step at a time before she rules out meds that might cause weight gain, tell her that she has no other choice. She’s done a good job trying medication, hasn’t been lucky, so now comes the same tough choice that cancer patients face about chemo: brace for possibly serious side effects, or make the most of living with your illness.

If she clings to false hope, expect trouble. You’ll be living with a hypochondriac who puts the search for treatment ahead of other family priorities and blames you and others for not being helpful. The longer she looks for a non-existent solution, the longer she postpones hard choices and distances herself from what’s good in her life.

Show respect for the courage it takes to make tough risk management decisions when there’s no good option. Remind her that there are often good ways to manage bad side effects. Assure her you’re there for her no matter what size pants she wears.

STATEMENT:
“I don’t understand why my wife isn’t able to recover from depression the way she did before, but I know it’s not her fault or the medications’ and that her options are now limited. I’ll encourage her to make tough decisions and respect her, no matter what decision she makes. I’ll make adjustments to help her manage her condition. If she avoids reality, however, I will not accept responsibility for relieving her pain or re-ordering my priorities to help her find a non-existent cure.”