Posted by fxckfeelings on September 21, 2009
In difficult situations with difficult people, we’re often tempted to turn to the law for help, hoping that the authority of police or the court can set things right and not asking ourselves what is really likely to happen next. In many cases, if you’re dealing with raw feeling, going to the cops or court brings in a whole new wave of complications and misery. So, as we always say, when cornered by a crazy person, act as you would if under attack from any wild animal; lie low, play dead, and just hope it loses interest and goes away.
–Dr. Lastname
I dated this guy years ago—only for a few months, nothing really serious because he seemed kind of weird even then—and he’s been harassing me ever since. Six months after I broke up with him, he wrote me a bunch of emails and left a ton of voicemails saying he wanted to know what he did wrong, that we should be together, and I did talk to him once just to tell him I was sorry but it was over and he should move on. He told me once that he was bipolar and I was sorry for him—he had seemed very normal then and I thought maybe his family didn’t like his eccentricities, which I thought were charming—but his messages seemed intense, illogical, and angry, and I started to worry. Then, six months after that, another bunch of emails and messages, this time more menacing, so I told him resolutely never to talk to me again. Just recently he started again, but this time the messages were actually scary—he threatened to kill me if we couldn’t be together. He said he felt broken inside and that he wanted me to feel the same way so that I’d understand him and then we could be friends again. Basically, I want to know if I need to get a restraining order against this guy—I’m really scared, and if anyone ever deserved police protection, it’s me. On the other hand, if he’s dangerous, maybe he needs to be put into a hospital and that’s something the police should be able to do. My goal is for the police to do something to protect me and, I hope, him.
In a fair and reasonable world, it would be easy for the police to lock up people who become temporarily dangerous because of mental illness, and doctors would be able to cure them. Unfortunately—naturally—that’s not the world we live in.
Unless someone is overtly dangerous in a way that is immediate and unequivocal—they’ve recently written threatening letters, or said something scary to a reliable witness, or can be expected to act aggressively when interviewed by the police or an emergency room clinician—they’re not going to get hospitalized. That’s the way our laws work for involuntary hospitalization.
These laws seem to do more to protect the accused than the alleged victims in that they protect the individual’s right not to get locked up for being different. In reality, they’re often worse for the mentally ill people they’re intended to protect, because they prevent them from getting treated for an illness that is killing their brain cells and ruining their lives.
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Posted by fxckfeelings on September 14, 2009
The not-MD here: Now that an actual health care bill is almost upon us, I thought this would be a good opportunity to ask my writing partner, as an actual health care provider, for his take on how we can improve health insurance.
We don’t like to get political, and everyone’s entitled to their own views (at least I think so—he’d probably tell you you’re just wrong), but this is not an entry about politics; at its core, the health care debate is about health care, and as a doctor, not a Democrat or Republican, this is his medical point of view. We’ll return to normal cases on Thursday.
–Dr. Lastname
One thing you learn as a parent is that there’s never enough time, money, or resources to provide perfect safety and security for your family. Worse, if you hold yourself responsible for providing it, you’ll go nuts the first time something goes badly wrong and you can’t control it. You’ll blow everything on something that can’t be helped, feel like a failure, and have nothing left, financially or emotionally, for those who need you.
As such, compromising on how you spend your resources is as much a part of good parenting as is nurturing, although it often makes you feel terrible. So it is with health care systems.
Democrats sometimes emphasize the nurturing part of this process, our shared humanitarian desire to provide more care, while Republicans sometimes emphasize the tougher part of this process, our desire to make sure that treatments work and are well delivered. But at the heart of good management there is always an unavoidable need to make good compromises, and that’s what I think needs more attention and reform. Not fewer denials from the insurance companies, but denials that are more fair and decided upon more ethically.
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Posted by fxckfeelings on September 10, 2009
No matter what your illness, medication should never be your first option for treatment. Everything you put in your mouth, from aspirin to spinach, has risks attached, so you should always proceed with caution before you add chemicals to the mix. Then, once on medication, most people are eager to get off it as soon as possible, but that has its own set of risks, as well. If you make your health the first priority, then the choice of whether or not to medicate won’t become risk-free, but it will become clear.
–Dr. Lastname
Before I got treated for depression, my marriage was rocky, but not doomed. I would be irritable and lethargic, which was tough for my husband to deal with, but mostly he was concerned and caring, and he was glad when I decided to get help. Now I’m taking medication, which has helped a lot in stabilizing my moods and keeping the black clouds away. The downside is that my meds have also, surprise, made my sex drive disappear, and this is doing way more harm to my marriage than my depression ever did. My husband isn’t a creep—he’s put up with a lot, and has always been supportive—but I can tell that there’s a distance growing between us. It’s different now that I’m the same old me but not interested in him physically, as opposed to a crying mess who wasn’t interested in him but also couldn’t get dressed in the morning. Is there anyway to not be depressed and not be libido-less? My goal is for both me and my marriage to be healthy.
Equating a happy marriage with a lusty sex life (as does every magazine in the supermarket checkout line) is dangerous, because it directly links the state of your union to something you don’t actually control.
If you could control it, you wouldn’t be writing to me in the first place. More than that, the fact that there are so many sex therapists should tell you how limited your control is (as is theirs).
That’s what the word therapy means in ancient Urdu: doing something that may or may not help for a problem you don’t control but think you should. And if therapy fails, then you’ve got a bad marriage because you’re libido-deficient.
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Posted by fxckfeelings on September 3, 2009
Families share more than last names and lactose intolerance—they also share feelings and physical space. So whether you’re divvying up your attention among parents, or rooms among siblings, or a wheel of brie among brothers, do so with care and caution.
–Dr. Lastname
Growing up, my mother and I were very close (dad left, I was her only son). Sure, she would sometimes get very intense about relationships—she gets focused on being close with whoever she really cares about—but I thought, no matter who else was in the picture, we had a strong bond. Now that I’ve started living independently in a nearby city, I expected her to be happy when I come home and to understand that I need to see my friends as well as spend time with her. Hell, I look forward to spending time with her. But the last time I visited home, which was practically the first time since I graduated and moved away, she got badly bent out of shape and I can’t figure out what I did wrong. I didn’t lie around and do nothing or get things dirty and not clean up. I spent some time with her, was considerate. So I was shocked when she told me she was very offended and I shouldn’t visit again unless I was really interested in sharing time with her. My goal is to figure out what went wrong and straighten things out. I love her, but I can’t let her control my life whenever I’m home.
It would be nice if you were an idiot who needed nothing more than a good etiquette coach to straighten out your behavior and mend your strong bond with mama, because then you’d be welcome in your (former) old Kentucky home.
And it would be nice if your mother was having a sudden acute attack of depression complicated by outright and totally uncharacteristic bitchiness which could be expected to disappear once she got treatment and/or lucky. The good news, however, is that you’re probably not an idiot and she’s probably not depressed.
And, if that’s true, then the sad news is that she’s probably got a problem with her character that neither one of you is going to change, and her home will never be yours. So it’s true, you can never go home again, especially when it was never your home in the first place.
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Posted by fxckfeelings on August 3, 2009
Like almost every useful treatment, medical or otherwise, psychotherapy can be dangerous, particularly when you rely on your (say it with me now) feelings to decide whether or not to continue. Ironically, feeling good is one of the worst reasons to stay with therapy, and feeling crappy is one of the worst reasons to end it.
–Dr. Lastname
My therapist is about to depart on vacation for one month, and I’m feeling f*cking nervous and tense about it. I’d like to know what I can do to make the best of this break in therapy and come back refreshed and ready to start work again when my therapist returns, and also how to keep the unpleasant feelings of missing her to a minimum.
Congratulations! While your question seems like a short-and-sweet query (or maybe a chance to cheat on the classic back-to-school essay, “What I did on my therapist’s summer vacation”) it’s actually a perfect example of the dangers of focusing too much on feelings when you’re undergoing psychotherapy. A+
Look, there’s nothing wrong with enjoying therapy, experiencing emotional relief or a feeling of personal growth, or liking or missing your therapist. Just remember—you’re paying for this and should never forget what you’re getting it for. Or you’ll be sorry.
If you rely on your feelings to tell you whether to continue therapy, you may never have reason to stop. You may continue to like your therapist, find the subject interesting, learn something new, and feel the treatment supports you in a way nothing and no one else does.
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Posted by fxckfeelings on July 1, 2009
Human nature tells us that the best way to solve a problem is to get to the root of the issue, but some problems, like mental illness, have no simple cause and no solution to speak of. In today’s cases, two people need to rethink their approach to mental illness; when you stop looking for someone to blame or a silver bullet cure, you can get to the real business of learning to cope with the reality of the present.
–Dr. Lastname
I think one of my sister’s kids might be mentally ill—he’s 9 and very intense and unhappy—but my sister doesn’t see it, and I don’t know how/if to get her to pick up on it. It should be fairly obvious to her since we saw the same symptoms in our mother, who wasn’t diagnosed as bipolar until we were kids and she had a chance to put on quite a show. I guess my sister doesn’t really understand that our mother wasn’t just a mean drama-queen but actually sick, maybe because she was younger when Mom went to the hospital and doesn’t really remember, or maybe because she’s in denial, or maybe both of those things combined with the fact she and her husband are space cadets that are such hands-off parents they don’t even notice that one of their own children is clearly suicidal. My goal is to get my sister out of the clouds and get my nephew some help, because if something happens to that kid, I don’t blame genetics, I blame her.
As any teacher well tell you, the danger of bestowing your idea of help on another parent’s child is that you have very little control over how parents react, because no parent wants to hear that something is wrong with their child. And their default response lies somewhere between defensive anger and general freaking out.
The freaking out also comes from the fact that it’s hard to keep the urgency and alarm out of your voice, no matter how diplomatic you think you are, and feelings trigger feelings. Suddenly you’re in a perfect storm of hysteria, but hey, no good deed goes unpunished.
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Posted by fxckfeelings on June 8, 2009
These two cases are based on feedback we got from our sibling-related post a week ago. Thanks to the anonymous readers who took the time to write in, and we hope these respond to your concerns.
–Dr. Lastname
Last week, someone wrote in asking how to react to his younger brother’s claim that their father had molested him, and you told the older brother, essentially, to tell his younger brother to move on. I find myself in a similar position to that younger brother—my step-father molested me for years—but A, there is no doubt as to my claims, I assure you, and B, I have yet to tell my family (my step-father just died). If and when I do tell my family, if they react the way you instructed that guy to react, I’d be pretty furious, and frankly, I can’t believe you’d give anyone that advice. It’s taken me years to come to terms with what happened, and I couldn’t tell anyone what happened, let alone my family, until several years after the abuse stopped/I got away. I don’t think I’m wrong in expecting my family to support me, and besides, isn’t advising the older brother to tell his abused sibling just to “move on” just a way of excusing the father’s behavior for the sake of the family reputation while letting his younger brother suffer yet more humiliation? I’m not writing in for advice—my goal is to get you to admit your advice was deeply flawed.
One very tough part of disclosing long-ago sexual abuse is that you have so little control over how members of your family, or anyone, will react. In some families, you will be embraced by people who believe in you, validate your experience, and are grateful that you spoke out. Your courage in doing so will be well rewarded.
But in many families, there are people who can’t believe the abuse happened or who aren’t strong enough to face what they know (even though they’ve otherwise proven themselves to be very loving and supportive while you were growing up.). Your courage will not be rewarded, or even appreciated in the slightest.
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Posted by fxckfeelings on May 27, 2009
Protecting one’s children is a powerful instinct, but it’s important not to become so blinded by that instinct that you can’t see if your protection is doing more harm than good. The two kids in these cases are particularly vulnerable, but their parents might be so committed to fighting for their kids that they can’t see how they’re actually declaring a larger, futile war.
–Dr. Lastname
My son is in 5th grade, and my wife and I were recently called into a meeting with the vice principal to discuss my son’s behavior. We were told that he routinely disrupts class, talks back to teachers, throws balls over the wall at recess, and, overall, “refuses to behave.” His school work is terrible, I admit that, and she says that this is because it’s nearly impossible to teach him since he won’t focus or really do anything but act up. Her recommendation was meeting with a school-appointed psychiatrist, and that that doctor would likely prescribe medication for ADHD. My wife is OK with that plan, but I think the situation is crazy, not my kid. He’s 10 years old, of course he’s acting like a brat, and I’m sick of people throwing drugs at every child that doesn’t sit still. I don’t want my son turned into some Ritalin zombie. My goal is to get him to get him in line with his school without putting him on pills.
You’re the parent, the tough decisions are always your responsibility, and the decision whether or not to medicate your kid is a hard one. What you and any right-thinking teacher or doctor would prefer, first and foremost, is a non-medical way of helping your son control his behavior.
While the common perception (yours included) is that shrinks like myself are eager to put people on the pharmaceutical bandwagon, that simply isn’t an infallible truth. Medication is never entirely safe, and is certainly less safe than most non-medical interventions, like behavioral treatments. Just because doctors can prescribe medication doesn’t mean it’s always our go-to answer.
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