Posted by fxckfeelings on February 14, 2013
To paraphrase Keyser Soze in “The Usual Suspects,” the greatest trick mental illness pulls is convincing the sick person it doesn’t exist. Either through making you feel perpetually insecure or unbelievably happy and confident, mental illness’ true gift is preventing you from knowing you have an illness and thus blocking you or the people who love you from helping you. Acknowledging you’re unwell may be hard news to face, but it gives you two valuable gifts; the opportunity to manage your illness, and the ability to spare yourself responsibility for the feelings and thoughts your illness can cause. You may never exorcise your illness entirely, but you can learn to identify it before it limps away with your life.
–Dr. Lastname
I wonder if I could have OCD and if I should consider getting evaluated. I spend a lot of time going over social interactions and thinking about what I should have done differently. Often I get very silly fears about having hurt my friends’ feelings and need to apologize or get reassurance that things are OK, or asking my friends/husband for reassurance about things I may have done to upset/hurt someone else. I am constantly questioning my own perceptions and have a very, very difficult time making even minor decisions (like whether to save or throw out leftovers). My husband claims that I shower 3x longer than most people and thinks I avoid showers for that reason. I am very slow and meticulous at almost everything I do (gardening) and wish I was different. I don’t have any unusual fear of germs though I do work in a lab and sterile technique is a big part of my job. There have been times when a 1-2 hour task took me 3 hours because I was behaving so irrationally about sterilizing the instruments (and I knew this). Sometimes though I think maybe I want to have OCD because otherwise there could be something even worse wrong with me.
Your obsessive worries probably have a positive side, in that they make you very, very good at your work using sterile technique in a lab, but make you very, very miserable in the process.
While the fact that you hold down an exacting job and have friends and a husband to pester with worrisome questions means that your constant worries haven’t stopped you from doing what’s important, unfortunately, that support team hasn’t stopped your constant worries or the worrying about worrying. So, while being obsessive isn’t all bad and hasn’t impaired your life too much, it doesn’t make you feel too good, either. WAIT! There is more to read… read on »
Posted by fxckfeelings on February 11, 2013
For people who suffer from mental (or almost any serious) illness, finding the right course of treatment is a lot like dating; the goal is to find a match that’s steady, provides what you need (even if it provides some minor things you don’t), and gets along with/doesn’t burden your family. The risk of side effects—not side effects themselves, but their risk—is like the risk of wasting time with jerks, unavoidable for almost every treatment, and weighing those risks against the need for treatment and its benefits is what makes medical decision-making tough. Since you probably wouldn’t go for an arranged marriage (or even a matchmaker on Bravo), you shouldn’t assume your doctor is responsible for finding a safe, no-side-effect treatment while you sit back and wait. Nerve yourself to do the research, face the risks involved and then give yourself credit for the required courage, no matter how many medicinal Mr. Wrongs you face along the way.
–Dr. Lastname
I’m glad my wife was finally helped by her third antidepressant, because she’s now a lot less grumpy with me and the kids and she no longer seems touchy and unhappy all the time. The trouble now is that she’s less interested in sex that she was before, if that’s possible, and it leaves me feeling frustrated and ignored. It’s sad, because we used to have great sex and it always brought us together, and now we’re under greater stress than ever and she acts like sex is just more work. I don’t want to sound like her wanting to have sex is more important than her not being depressed, but I can’t pretend her total lack of interest isn’t hard to deal with. Surely there’s a better solution to her depression, so my goal is to help her find it.
I wish I could tell you that the treatments for depression are surefire and reliable, but they aren’t. This is due partly to the mysterious nature of the brain, but also because no doctor worth his or her salt will tell you that any treatment is 100% effective, 100% of the time. Even Athlete’s Foot can be tricky (and also decrease libido, at least for one’s spouse).
That said, finding the medication and/or therapy to relieve depression is especially tricky, so it’s important to remember that whenever you hear the words “this treatment has proven effective,” what they mean is “better, on average, than nothing.” So, unfortunately, there may be no treatment better than the one your wife is now taking, even though it’s the worst for her sex drive. WAIT! There is more to read… read on »
Posted by fxckfeelings on February 7, 2013
As anyone who’s loved someone crazy or addicted knows—or really, anyone who’s watched any non-duck or -storage related programming on A&E—some addicted and/or mentally ill people take too much responsibility for the impact of their behavior on family, and others put too much responsibility on their family for saving them from themselves. In actuality, your job is never to act on your feelings of responsibility until you’ve first observed, and then accepted, what you actually control. The result may suck, and leave you feel totally helpless, but you need never be a slave of guilt when you’ve done what you can with what you’ve got (which is hopefully more than basic cable).
–Dr. Lastname
My wife (we’re gay) has Tourette’s syndrome, anger issues, and a tendency to drink more than she should. I have Bipolar disorder, and an obliviousness to other people’s feelings that is sometimes intentional, sometimes not. My wife and I dated for seven years before we got married, so it’s not like we didn’t know each other’s diagnoses and drama, but most for most of that time I was well-medicated, held down a full time job with benefits, and felt like I wasn’t being my real self. Last summer my anti-depressants kicked me into a full manic break. “God” told me to start collecting camping/survival gear and move in with friends in my home state to work on a civil rights campaign and spend time with my family. We won the campaign, and I got some cherished time with two relatives in their dying days, but I completely f*cked us financially, and ruined my wife’s trust in me. She is adamant that marriage is forever, whether we’re happy or not, and we are going to make it work. I love her, but I’m pretty sure I’m an Asshole, there’s no reason to believe this won’t happen again, and if she doesn’t get rid of me I will ruin her life, whether I want to or not. She wants stability and kids. I don’t think I can provide those things for her. My goal is to reconcile my wife’s expectations with the real limitations imposed by my case of crazy.
As we’ve often said, the best way to know for sure that you’re not an Asshole™ is the fact that you even considered the possibility that you’re an Asshole™. Assholes™ may feel injured, but, since they know it was someone else’s fault, they never feel guilty. Sadly, as a non-Asshole™, you’re forced to feel both.
So just because you’re mortified by what your last manic period did to your family finances doesn’t make you an Asshole™ or a dangerous marital partner, even though that’s the way you feel. It just makes you a good person struggling with a bad illness. WAIT! There is more to read… read on »
Posted by fxckfeelings on January 28, 2013
Everyone will tell you that there are valuable lessons to learn from bad experiences, but unfortunately, there are some valueless lessons as well if you misinterpret your misfortune. For example, some people read too much into their painful experiences and become afraid to take new risks, while others learn almost nothing and have to retake the lesson/get screwed again and again. The answer is not to sample your crises like Goldilocks—trying to find a response that is not too much, not too little, but just right—but instead, to ground yourself in values that help you determine what risks are worth taking, what feelings are worth keeping to yourself, and what’s truly worth learning for the future.
–Dr. Lastname
The end of last year I was able to stop taking my anti-depressants after about 4 years. I feel good, my drinking is in control (though I do sometimes feel the old instinct that, when I’m stressed, a drink will help, though after one sip I know it won’t). I’m free of my fear of going outside my apartment or with groups of people. I did see a therapist, which helped me so much, though we never found out what triggered my depression, so I have a deep worry that it might come back. I know there is no point worrying about something that might never happen (I fully believe that its just a waste of time), but I doubt my relationship will survive another ride on the depression roller-coaster as it was nearly destroyed the first time. Also, my partner is concerned as I hope to have kids at some point and my partner has read that postpartum depression is worse if you have suffered depression before. The thought of being ill again terrifies me and I want to avoid that black hole anyway I can. Should I try to work out why I got depressed before? Is postpartum depression something I should be concerned about what the time comes? If I can somehow prepare myself then I’m hoping that if/when depression comes knocking again I might be able to put up a better fight.
After experiencing and surviving the pain and repercussions of a bad bout of depression, it’s normal to fear recurrence, but that fear is often worse than the thing itself; that’s certainly true with depression, as well as heights, spiders, and gays.
In fact, a PTSD-like syndrome of anxiety is common among people who’ve survived such painful and intense symptoms, so it’s important that you pay as much attention to managing the fear of depression as to treating the depression itself.
It’s understandable that you want to figure out a way to prevent recurrence, but reassuring yourself that everything is going to be alright is as misguided as parents’ insisting their kids they can grow up to be whatever they want; whether you’re hoping to rid yourself of depression or reach the major leagues despite being a one-armed girl, the odds aren’t good, so don’t make the mistake of reassuring/promising yourself that it won’t happen again.
In reality, as with all problems, real consolation comes not from putting the trauma out of mind completely, but from knowing that, whatever happens, you survived the first time and acquired a lot of weapons you’ll use to fight depression if and when it comes again.
Of course, fear will tell you that you and your relationship barely made it, but the fact is, you did make it, which is a great accomplishment. Now you’ve found treatments that work and, most importantly, you know that depression is just a bunch of symptoms, it’s not who you are; it wasn’t personal and you weren’t lazy, just unlucky and sick. Don’t get so freaked, then, by the harm a postpartum depression might do to your kids and/or marriage that you forget that child-rearing and maintaining relationships is always risky, and that you have developed good tools for managing that risk.
Yes, you have a chance of having a post-partum depression, but instead of terrifying yourself with thoughts of that possibility, investigate what you can do to decrease the risk. For one thing, you’ll find you can take antidepressants, even while pregnant; their risk of harming a fetus is low and outweighed by their ability to protect you (and the fetus) from its crushing symptoms.
And don’t fall prey to the notion that because medication has risks, it’s automatically unsafe to take, or that you’re weak or dependent to do so. It means you have an obligation, as with any danger, to weigh benefit against risk by sizing up the chance that your symptoms will come back and deciding whether treatment is worth it. So ask your doctors (and do your own research) to inform yourself about the odds of relapse. If they’re high, find out what the risks and benefits are of taking antidepressants as a preventive vitamin.
Instead of letting depression persuade you that you’ll ruin your family by making your partner and children miserable, treat it like any other disabling illness that tests most families, sooner or later, and teaches them how to survive hard times. Get your arsenal ready for fighting the negative thinking that depression both causes and is caused by.
Don’t let your experience make you a depression-phobic; remember how well you handled that depression, take a cue from the gays, and counter that fear with pride. We’d gladly see that parade.
STATEMENT:
“I can’t think about depression without feeling overwhelmed by fear. I know, however, that fear distorts my thoughts and that my experience with depression has made me much more knowledgeable and better equipped to manage it. I will prepare myself and take any reasonable risk that will allow me to stay as healthy and functional as possible, regardless of whether it recurs.”
I don’t see how I can go back to working in my family’s car business because my brother is such a dickhead. I’m broke and I need the work, and my father doesn’t mind if I work there, but my brother and I have never gotten along, and the last time we worked together he was so insulting, day after day, that I finally picked up a tire iron and we would have killed one another if they didn’t pull us apart. I promised to bury the hatchet and keep my mouth shut—as I said, I need the money—but I was back at the shop for barely four hours when he started up again and I had no choice but to punch him in the face. My goal is to teach my brother to leave me alone, so I can work at the family business when there’s no other work around.
Most of us have an instinct to push back when we’re pushed, particularly if the pusher is aggressive and insulting (and a blood relation). No words are necessary and we don’t have to be in a bad mood—all it takes to get triggered is getting cut off in traffic or a dirty look from a spouse. Maybe this instinct helps us protect ourselves from predators by showing them we’re too much trouble to dominate, but more often than not it just makes assholes, inmates, and/or corpses out of everyone.
Unlike the woman above, whose depression has taught her fear and pessimism, you don’t seem to have learned anything from your many fights. Like her, however, your response is based on feeling, not reason, so it’s both about learning from experience, as well as restraining your emotions.
Your brain is obviously wired to fight back, so if someone pushes, you feel obliged to return the favor, even if you aren’t necessarily looking for a fight in the first place. Trouble is, once that instinct gets hold of you, it gives you no choice but to fight, and the results in the real world usually suck for everyone who isn’t a Hollywood hero. Tough guys get arrested, sued, betrayed, beat up by other tough guys, and, like the rest of us, old and too weak to throw much of a punch.
So instead of just following your instinct towards fury, ask yourself whether you want to satisfy that instinct or control it. Sure, satisfying it feels better in the short run but, you guessed it, always ends badly. Controlling it is hard, takes lots of practice, and it’s what the authorities want you to do, which may make it harder for you to decide whether it’s what you want to do for yourself. Until you control that fighting instinct, however, there’s nothing anyone can say that will protect you from endless fights with your brother and others.
Wanting to control it is no guarantee that you can, and neither is therapy. If you decide to control it, you will probably need to work at building your control day by day, one day at a time, like AA, getting religion, or a gym membership. You can call it anger management, but you’d be better off calling it humiliation tolerance and/or finding goals that are more important than insult and injury (like making a living or being a good guy) and reminding yourself about them, hour by hour. The only thing you have to fight is the urge to fight, and the tire iron won’t do you any good.
STATEMENT:
“I can’t stand to feel pushed around and I take pride in being the guy who never starts fights but who knows how to finish them. I know, however, that fighting always ends badly in an unfair world and I have goals that are more important than what anyone says or does to me, particularly if they’re assholes. I am proud of myself for pursuing those goals regardless of how assholes make me feel.”
Posted by fxckfeelings on January 17, 2013
It’s often been said that if you want to make god laugh, make a plan, but this is not the case for people dealing with mental illness, mostly because of all the pain you have to accept before you even get to the plan-making stage. If you ignore that pain, you’re a dumb ostrich who will make an avoidant plan, but if you focus too much on it, you develop a ruminative plan and become your problem. So brace yourself for unavoidable pain, prepare to do two things at once, and plan away. Then your choices will take you as close as possible to where you want to be, and your plan, or at least your ability to make one, will make any higher power proud.
–Dr. Lastname
I have a big problem getting myself to study. I do things late and then don’t get good grades, or I don’t get anything done, or I stop somewhere in the middle. I guess I have a problem with concentration and also with laziness. I’ve also done this thing since I was a little child where I turn on music, I sit on a couch or my bed and rock myself, hitting my back towards the backrest of the couch, sometimes it takes hours, sometimes it’s quite quick, like half an hour. I also have quite low self-esteem, not sure what is the reason…I am trying to overcome it somehow but it always gets to me again and I have to deal with it and then I have these days like I do not want to get up—I can’t think of a reason to, and I do not want to go anywhere and I am scared of everything. Sometimes I feel like people are watching me and criticizing me and I don’t want to go to the market because I don’t want to deal with anyone. Sometimes I eat a lot because I am in that crazy mood and I feel bad about it, not because I’ll gain weight (maybe a little bit) but especially because of my health… I criticize myself a lot. I write something or say something and in a while I hate it even if the first impression about it was really good. So… I might be a little bit screwed up I guess… I would be thankful for some opinion or advice what to do with all this.
You’ve certainly got a ton of problems, including trouble concentrating, studying, getting up in the morning, keeping your weight under control, dealing with paranoid thoughts, etc. (but hopefully not memory, because I’d have to think there are even more issues you forgot and left out).
The big question to ask yourself, however, is not what’s wrong with you and to count all the ways, but what you’ve done with your life in spite of these problems. WAIT! There is more to read… read on »
Posted by fxckfeelings on January 10, 2013
Deciding whom to blame for a problem you can’t get a handle on is easy if you follow your instincts, but instincts should also tell you that a decision made based on intuition instead of thought is probably wrong. In reality, you need to look carefully at whether a person is doing his or her best with what’s actually controllable before deciding whether what’s missing is better discipline or better luck. Ignore your instincts, assess the uncontrollable and you’ll come up with helpful and constructive ideas by looking for facts, not blame.
–Dr. Lastname
I’m in college, and my problem is that I have ADD and even when I’m on Ritalin, I get distracted very easily if something about a course is hard to understand. Then I wind up fucking around, doing other things, spending too much time with my boyfriend, and falling behind. After two or three weeks, it’s too hard to catch up and I don’t want anyone to know, so I stop going to class. A few weeks after that, there’s nothing to do but drop the course, which makes me feel like a loser. I had the same problem in high school, but I’ve never found a drug or dose that’s made the problem better. My goal is to find a better medication or a way to try harder so that I don’t get behind in the first place.
There’s no doubt ADD is your problem, but another problem lots of people with ADD develop over the years of experiencing learning as a painful, humiliating process is avoidance. It came from your ADD, but it’s its own problem, and not the kind they make pills for.
A lot of people with ADD get good at lying to themselves and others about what they’re failing to do and what the consequences are going to be. It started as a coping mechanism, but it’s developed into a pain in the ass. WAIT! There is more to read… read on »
Posted by fxckfeelings on November 8, 2012
Although stopping long-term intensive psychotherapy can leave you in a state of mourning and fear, particularly if it occurs during tough times or against your wishes, it’s unrealistic to expect that returning to therapy will make everything right again. Instead, give yourself time to adjust to change and reassess your ability to stay functional and positive. Then, if you think it’s necessary, find a therapist who’s a good, supportive coach and use him or her for a different kind of therapy that keeps your head straight without stirring up your deeper feelings. If you’re certain that you have to be “in therapy” to get helpful support and are helpless without it, then the therapy you’re in is helping you a lot less than you think.
–Dr. Lastname
In my early 20s I spent 4 years in therapy (which I think in and of itself says a whole lot about the not good place I was in my head). Therapy ended, not because I was ready, but because I moved. I am now 46, and in the years since I continued to work through a lot of things on my own, with my therapist’s voice in my head, if no longer in actual therapy sessions. In January my grandmother took a turn for the worse, with both health and cognition, and we had to place her in full nursing care. She has always been one of the most influential and positive forces in my life, so I had a hard time dealing with this. It sent me spiraling down into my 4th lifetime episode of depression. I’ve started back on Prozac, which I now realize I need to stay on for the rest of my life to try to prevent future recurrences, and I’ve spent the last 10 months in therapy with my former therapist via phone sessions as we now live 1,000 miles apart. I have finished working through a lot of stuff in that time, meaning I’ve changed my attitudes and perceptions and behaviors, which has changed my life, inner and outer. I wish I’d figured it out 25 years ago, during that first round of therapy, but better late than never. It’s been a hard year. My grandmother died 7 weeks ago. The grief hit me more than I ever imagined. I thought I’d prepared in those months when she was slowly dying, but I was wrong. What is the saying—Where there is no struggle, there is no strength? Good growth has come of the pain—I have returned to college, and I am training for my first full marathon in January. I am at a truly good place in my head and was ready to end therapy, so two weeks ago, with my therapist’s blessing, I had my last session. I knew, though, that ending therapy because I am truly ready is a celebration, but that it would also be a loss. It is currently hitting me harder than I imagined. How do I get through this and find a place of healthy acceptance of this transition?
While it’s unfortunate that stopping intensive psychotherapy after many years is hitting you hard, it’s not surprising. As you well know, loss is painful, be it the death of a loved one or the end of a source of support.
That said, your pain doesn’t mean your psychotherapy has been less complete than you thought or that you stopped it too soon, just that you can be a solid, resilient person and also be very sensitive to loss, both because of temperament and circumstances. WAIT! There is more to read… read on »
Posted by fxckfeelings on October 18, 2012
Assessing one’s self-esteem is like checking for Puxatony Phil’s shadow on Groundhog Day; while we have a long tradition of caring about its status, the results are fairly meaningless. After all, some people with strong characters don’t like themselves because they don’t measure up to high standards, and other people are madder at life’s unfairness than they are at themselves and underperform, not because they don’t like themselves, but because they care more about feeling good than getting strong. And of course, sometimes, it’s just cloudy. In general, it’s better to have a strong character, even if makes you kick yourself, than to see yourself as a deserving, entitled victim in order to break out of the rut of bad decisions and get out of Puxatony once and for all.
–Dr. Lastname
My 14-year-old son seems to care about his schoolwork but he’s unusually stubborn (the psychiatrist says he has Asperger’s syndrome) and he never does his schoolwork the way his teachers want him to. When they ask him to show his work in Math, he refuses, but he often gets the answers right anyway, just without any proof. When they ask him to do a draft of an essay, he just won’t do it, but then the final version he writes at the last minute is fairly reasonable. My son always feels guilty and angry, both for not being understood and not being able to do it correctly, and I’m worried that they’re not teaching him right, in a way that caters to his specific needs. My goal is to get them to give him better help.
You’ve been trying for many years to get your son to show his Math work and finish his preliminary drafts on time, and it just doesn’t happen. He’s had many teachers work with him and no one has found the answer. You’ve made an effort, and after showing your work, it’s fair to conclude “the answer” doesn’t exist.
In addition, telling teachers they need to improve is bound to make things worse since they already have the government telling them they’re responsible for their class’ performance, regardless of what those kids and their families are like. Holding them accountable for not getting results—the “show your work” of the teaching world—isn’t quite fair since you know it’s an impossible job.
Once you add your own personal “no child left behind” intervention, don’t be surprised if the teachers start to find fault with both you and your son in order to defray blame. Whatever happens next, it won’t involve praise or more positive results for anyone. WAIT! There is more to read… read on »
Posted by fxckfeelings on August 30, 2012
If you listen to (other) experts, psychiatric treatment should always begin with objective evidence, which then determines a diagnosis, which directs us to proven, effective treatments. This expert, on the other hand, thinks that “evidence-based psychiatry” would be very nice if we happened to know lots more than we do, but it is one of life’s great ironies that the organ we know the least about is the home of knowledge itself, the brain. Until we can fully wrap our heads around our minds and how they work, scientific thinking in psychiatry is often wishful thinking. It can actually get in the way of making good, practical decisions and accepting the necessity of living with the unknown, be it a mystery illness or the grey mush in our skulls.
–Dr. Lastname
I’ve been very confused lately because of what’s going on inside me. My father did some bad things to me while I was growing up—things that I just began remembering a year or so ago (sorry, I can’t label it). Since then, other memories surfaced as well, but not many at all. Most of my memories of my childhood are snapshots that are just little moments in time, separated by years in between that I just don’t remember. Anyway, the thing that distresses me is that sometimes, but not all the time, I’ll feel like I have another part of me who is talking in my head. This came to my awareness mostly after the memories started coming up, although I feel like maybe it happened occasionally before. For instance, recently someone asked me a question, and a child’s voice answered in my head. I have other instances of similar things like that happening. One time it seemed like there were two parts conversing with each other and I was just observing the conversation, per se. That being said, I am educated enough about what happened to me and the consequences of it to know that I think I’m describing DID, but from what I’ve read, I don’t think I have it. I don’t switch to other personalities, and I don’t really lose time or anything like that…but I do know I’m not qualified to make that kind of assessment (and I know you can’t just by reading this letter). But my question does relate to that: is it possible to have the kinds of experiences I’ve described and not have DID? Since I’m pretty sure I don’t have it, I feel like I’m just some crazy, messed up person for no reason. It terrifies me to share this with anyone, but I don’t know what to do anymore, and it’s getting harder and harder to keep going.
Diagnosis in psychiatry is never precise and, when given too much attention, can do more harm than good. Until the day a mental illness diagnosis can be determined by peeing on a stick, all we can currently do is lump symptoms together and try to observe what happens to people who fall within an arbitrary category.
In the short run, knowing you’re not alone might be comforting, but it would tell you very little about what to expect from future symptoms or treatments. Worse, it would get you thinking of yourself as a diagnosis instead of as a person who’s trying to live life in spite of some disturbing, hard-to-understand symptoms.
As such a person, ask yourself what you most want to accomplish in this life, despite whatever’s going on in your head. For most people with traumatic childhoods, it’s always meaningful to be decent to others, whether they’re your kids, relatives, or friends. You know how easily people slip into abusiveness when they’re angry and how much it hurts, so you never take a good, supportive relationship for granted.
Most symptoms that impair the way you function won’t prevent you from being the person you want to be or doing what you really want to do, they’ll just slow you down and force you to work harder to think up alternative methods. A good coach helps you to accept your impairment without getting discouraged or demoralized.
So instead of looking for the ultimate shrink diagnostician, find a therapist who can act as a good coach, who isn’t too upset by symptoms, and is eager to see what you’re capable of, even when you’re distracted by traumatic memories, internal conversations or the sensations of observing yourself.
Consult a psychiatrist at least once or twice to get an overview of possible treatments, including medication. Of course, non-medical treatments almost always pose a lower risk, but many medications are relatively safe and require no more than a few weeks to try out. If your symptoms are sufficiently painful and/or disabling, and non-medical treatment is insufficient, then you owe it to yourself to check out every possibility.
Whatever symptoms you have, you want to do your best to manage them without letting them define your life. Keep up your diagnostic questions until you’re confident you’ve heard what the experts have to say, regardless of how unsatisfying that might be, and then forget about what caused your problems or how they might be categorized.
Your next step is to manage your burden and respect yourself for carrying it, even if the nature of that burden remains a mystery.
STATEMENT:
“My psychological symptoms spook me and leave me feeling distracted and distanced from myself, but they can’t take the meaning out of a good day’s work or a solid friendship. I may never figure out why I feel the way I do, or stop myself from feeling that way, but I can certainly lead my life according to my values regardless of the tricks my head likes to play on me.”
No one was more surprised than I when I suddenly got depressed about a year ago, because it’s not something that ever happened to me before. I lost energy, felt like crying, and got anxiety attacks. There was lots of pressure at work, but my job was safe, and I’ve never been prone to buckling under pressure. Now I could barely get to work and I didn’t give a damn about the projects that I was responsible for. My wife finally forced me to see a psychiatrist, I started to feel better on an antidepressant, and then my internist really surprised me by telling me my testosterone was low and I should try a trial of replacement therapy, which I did. Within 2 weeks I was back to normal and a few weeks later I stopped the antidepressant. So now I wonder whether I was really depressed or not or whether I should have tried antidepressant in the first place. My goal is to figure out my diagnosis so I’ll know what to expect.
Even on that rare occasion when a specific psychiatric diagnosis really matters, it doesn’t matter as much as you think. Yes, it was critical to your recovery that you and your doctors checked out testosterone deficiency as a possible cause of depression; the sudden, unexpected onset of your symptoms raised the odds of your having an unusual and potentially curable cause, which deserved an extensive workup of your hormone levels, vitamin levels, evidence of inflammation, etc., so congrats for making a good decision.
You also discovered that depressive symptoms may have many causes, making depression less of a diagnosis than a cluster of symptoms. So, much like aspirin, antidepressants can improve symptoms, no matter what the cause, if they work at all. (Unfortunately, no matter what the cause, antidepressant trials often fail [35% for each trial] and require lots of time [three to four weeks] before there are noticeable results.)
In addition to lucking out with both the diagnosis and the response to antidepressants, you learned a valuable lesson, which is that anyone can get depression. It wasn’t caused by bad psychological or medical hygiene, just bad luck. Getting depression often doesn’t have a deeper meaning other than that we live in a tough, unfair world where people often get sick for no reason, and sometimes that sickness makes your brain miserable.
Your own observations are the best guide to your prognosis. If you responded rapidly to getting testosterone replacement therapy, then you may be relatively unlikely to get depressive symptoms again (as long as you continue taking the testosterone, which you may need indefinitely). At some point, if you want to experiment with reducing the testosterone treatment, ask your physician about the odds and choose a good time for experimenting, when not too much else is going on in your life.
From what you know, there’s no reason to think that your prognosis—your expected luck—is worse than anyone else’s. You made good choices, which is an essential survival skill when you happen to live in a bad luck world.
STATEMENT:
“I’d love to take my mental health for granted the way I used to, and maybe I will, after enough time of not feeling depressed has passed, but there’s no escaping knowing how easy it is to get sick. I’m proud of having made good decisions and happy to have gotten lucky enough to almost balance the bad luck I had to get sick in the first place.”
Posted by fxckfeelings on July 12, 2012
When a bad habit gets between you and something you really want, it’s hard not to expect that good motivation, loads of therapy and deep insight into why you’re fucking up will give you the control you need. Unfortunately, bad habits don’t have easy solutions; they often have a life of their own and, short of administering a good ol’ lobotomy, the power of therapists often falls short. That’s when you need to accept that, for many of us, the best solution for bad habits isn’t a great therapist, but good management.
–Dr. Lastname
I don’t know why I’m always getting in my own way, but I’ve been a fuck-up since I was a kid in foster care (my parents were drug addicts who couldn’t take care of me). I’ve managed to hold the job that I really love, but I almost lost it after 5 happy, productive years because, for a 6 month period, I couldn’t get myself to show up on time. I’d get up on time, but then find some reason to arrive late, and I couldn’t stop myself until I was within an inch of being fired. I got it together to find a therapist, but I can’t get myself to take medication he prescribes, even though I think it could really help me. I also can’t get rid of my drug-addict girlfriend though I and all my friends think she’s a deadbeat user who does nothing for me. My therapist says I have a problem with self-esteem. My goal is to get control of my life.
It would be nice if the only thing standing between you and keeping your job safe, your home ex-girlfriend-free, and your sanity was depression, fatigue, or low self-esteem, but your problem is probably worse than that. It’s not a matter of what you have; it’s more who you are.
So if you think that a supportive therapist or a pick-me-up drug will do the job, you’re wasting your time and heading for more self-disappointment. You did a great job of diagnosing yourself from the get-go—you’re a fuck-up—and, while you’re not hopeless, you’re not going to get the help you need that easily. WAIT! There is more to read… read on »
