Posted by fxckfeelings on May 3, 2010
Poor, well-meaning, dedicated therapists and the patients who love/destroy them. After all, it’s enticing to let someone persuade you that you’re their guardian angel and the only therapist that can help. It’s a fun ride for everyone, at least until you realize that you’re responsible for something you don’t control, and they’re even less responsible than before for dealing with reality as it is. While this is a shrink-based site, we are the first to admit that therapists are not perfect people, especially when they get in in their heads that they actually are.
–Dr. Lastname
I have a 30-year-old patient whom I’ve been seeing in weekly psychotherapy for 6 months and he had a terrible history of sexual and physical abuse and years in state care. Amazingly, despite all his trauma and several prior failed treatments, he settled into a trusting relationship with me. He tells me I’m the first person he’s bonded with, and he’s been able to stop using cocaine, and, for the first time, sees some hope for himself. The problem is that he just got a new job, and I’m not covered by his new insurance plan. He wrote me a letter telling me how much he feels his recovery depends on continuing the treatment we’ve started and I feel professionally obliged to put his welfare ahead of my financial needs, but I’d like to get paid. My goal is to do right by my patient, and not trigger the feelings of abandonment that underlie much of his negative behavior, but I’m not sure how long I can afford to see him for nothing.
There are many therapists who believe the best thing you can do for a troubled patient like this is to “be there,” providing the steady acceptance and secure relationship that they need for healing. I’m not one of them.
The sad fact is that the healing power of currently available treatments is vastly over-rated and a good example of false hope and the harm it can cause.
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Posted by fxckfeelings on April 8, 2010
Many jobs, especially those involving leadership or sales, depend on making a good impression with the public. The risk is becoming so focused on public reaction that you end up like Ed Koch, asking “How’m I doin?” with such frequency that you lose track of exactly what you’re supposed to do (aside from getting people to curb their dogs). Most public jobs, however, involve lots of duties that only make an impression when done very poorly, so success can’t be defined by accolades, and you’re the only one who knows best. It’s up to you to be your own best judge before you end up so hungry for approval that you get stuck in deep dog shit.
–Dr. Lastname
As rabbi of a medium-sized temple for 10 years, I’ve enjoyed a good relationship with my congregation and I love the work. My problem is that I rely on the temple Board to decide whether I get a raise, and, during the last recession, there wasn’t one because everyone felt too poor to pay more dues. When, recently, I began looking at what rabbis of comparable congregations are making, however, I found that my salary is well below the mean, so I’ve been wondering how to become more active without appearing to be greedy, selfish or unresponsive to the problems of the congregation. One way that occurred to me was to do a “360 degree review” and ask everyone to give me feedback on how I’m doing, including the congregation, the board, and people who work for me. My goal is to get a high approval rating and use that to get a raise.
Unlike the woman earlier this week who was too afraid to rock the boat by asking for a raise (until anger made her want to torpedo the ship), you’re inhibited by guilt, empathy, and that certain Jewish ne sais quoi.
Still, no matter how tempting it is, don’t ask the congregation to clap if they think the rabbi deserves a raise. You’re a scholar and a leader, not Tinkerbell.
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Posted by fxckfeelings on March 15, 2010
Part of being a kid is testing your limits with your parents-how late can you stay up, how many times can you hit your sister, how frequently can you have keggers in the garage-but what’s discussed less frequently is how parents have to test their own limits with their kids. While you might not want to be too forceful with your kid, part of being a parent is making choices and enforcing them. On the other hand, you don’t have to be so pushy that you go from parent to endless nag. It’s a careful balance, but the family buck stops with you, so you’ve got to make the call. Besides, if you don’t get it right, then those keggers will be the least of your problems.
–Dr. Lastname
My son was diagnosed with severe depression when he was a freshman in high school. I know it’s supposed to be a hereditary disease, but neither I nor my husband have any history of it; we both come from stiff-upper-lip backgrounds, and when our son attempted suicide, we were completely taken by surprise. He was also doing drugs, and we didn’t know it. He’s doing much better now, seeing a therapist weekly, but I still worry about his going off to college next year. He doesn’t share much with us, but I know he wants to do what’s “normal.” I don’t want to intrude on his relationship with his therapist or undermine his confidence or make him feel pressured, but we need to decide whether he’s ready to go. My goal is to make the right decision without hurting him in the process.
You can’t protect your son from of having an illness and all the trauma that goes with it, so for your own sake, and against all your instincts, don’t try.
On the other hand, if you try too hard to avoid all potentially painful issues with your son and stick to being stoic and reserved, you’ll be helping him avoid the hard choices he has to make, instead of doing your job.
Life is hard, precisely because it includes illness and drug abuse on top of the usual high stresses of being adolescent and finding a way to be independent. It’s a clusterfuck, and you’re the motherclusterfucker; you’re all in this together.
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Posted by fxckfeelings on March 1, 2010
A lot has been made recently about how it seems like every child is being diagnosed with autism; celebrities like Jenny McCarthy, whose son is autistic, have led the charge to blame and outlaw vaccines in order to protect kids. In reality, as science progresses and our understanding of the autism spectrum deepens, the disease hasn’t expanded, just the diagnosis, i.e., there aren’t more autistic kids, just more kids being called autistic. While today’s cases aren’t autism-related, they both illustrate the myth of the power of diagnosis. Focusing too much on what your disease is does nothing to improve your health. Incidentally, Jenny McCarthy has revisited her take on vaccines—it turns out her son’s diagnosis was wrong.
–Dr. Lastname
In the last ten years, I’ve heard voices in my head and most doctors describe my symptoms as psychosis, but nobody can tell me exactly what’s wrong, or find a medication that makes them go away, or really do anything but listen to me give them my laundry list of “how I’m crazy” and try to take the problem apart. In the meantime, I’m struggling to hold onto my job, my wife is struggling to put up with me, and my kids (now grown) just worry and get more distant. My disease stays the same, my life gets worse, my diagnosis goes nowhere. My goal is to figure out what is causing the symptoms, get a real diagnosis, and make real progress.
I wish the word diagnosis meant “we know what’s wrong and what to do,” but it often doesn’t, except in certain special cases. (Like, right now I feel safe diagnosing your reaction as disappointment.)
Very often, all a diagnosis means is that we recognize a group of symptoms that often travel together in the same social circle, and often get a little bit better when they’re treated with a particular group of medications. Tada.
That’s almost always true when the doctor making the diagnosis is a psychiatrist, because we know less about mental illnesses than almost every other kind of illness (and less about the brain then we do about any other part of the body).
We really should use some other word than “diagnosis,” but we don’t, because we love to think we know more than we do, which goes to prove that doctors are just as vulnerable to idiot false hopes as everyone else.
Some people put a premium on hope of any kind, but false hope is dangerous, because we pay for it with unrealistic expectations that lead to feelings of failure. You expect that, once you get the right diagnosis, you’ll get the right treatment, but I diagnose that assumption as bullshit.
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Posted by fxckfeelings on January 18, 2010
People get demoralized when they feel they’re not getting what they deserve, be it pain relief or respect. It’s natural to go on strike and either A, start raging against the machine of injustice, or B, go the other way and surrender to a life on the couch in sweatpants and a snuggie. Of course, the resulting fall-out will feel like a side-effect of the original injustice, not a direct result of your tantrum, but you’ll be too high on rage/comforted by your snuggie to understand. Understand this now, before you protest; better to suffer the original injustice in peace than the further demoralization of unemployment, stiff drinks and a blanket with sleeves.
–Dr. Lastname
I have a dedicated husband, three teenagers, a nice house, a well-behaved dog—it’s not a bad life—but I’ve had a nagging sadness my entire life, and I still do, despite all the good things I’ve got. I deal with it, admittedly, by drinking a bit. I wouldn’t say I’m a drunk, and my drinking doesn’t interfere with my parenting or my marriage anymore than my mood does, but I know that what I’m doing is self-medicating. My husband wants me to see a shrink because he thinks I should take real medication for depression, but if my drinking doesn’t mess up my life, and if, despite all I have, I can’t be happy, anyway, then I don’t understand what makes one medication better than the other. My goal isn’t to be happy, just to withstand my misery, my way, right or wrong.
I understand that chronic depression, which is what we call “nagging sadness” in the biz, isn’t fun. It can make you grumpy, negative, unmotivated, scattered, and lousy at whatever you’re trying to accomplish.
All that’s excluding the pain, so no wonder it can demoralize you into seeing a negative future for yourself. It’s enough to make you want to turn “what the fuck” into words to live by.
If there was some way to relieve your pain that was risk-free and didn’t affect your other life priorities, that would be wonderful (for you—the aforementioned biz would probably dry up).
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Posted by fxckfeelings on January 4, 2010
In fxckfeelings.com terms, most resolutions are just grand, annual wishes, not goals. Goals, as we define them, are realistic, while wishes are failure-prone yearnings that are usually best ignored. The holidays are over, and so are the excuses n’bullshit, so for our own New Year’s babies/cases, happy New Year, and it’s time to ditch these resolutions, stat.
–Dr. Lastname
My girlfriend got mad at me on New Year’s Eve and now she tells me it’s blown over, but I can’t believe her. I’ve always had these massive how-stupid-could-you-be thoughts that I can’t get out of my mind after I say something that might be stupid, even if it isn’t really stupid, but I keep on thinking about what I said and have to tell a friend about it and then, when they re-assure me, I can’t believe them and have to ask them again until it drives them crazy, and I start to worry about how stupid I sound to them, and so on. So my big New Year’s resolution was to stop myself from being so insecure, but now it’s happening again and, even though my girlfriend is a pretty uncritical person, I can’t stop wanting to ask her for re-assurance. My goal is to be able to tell myself that I didn’t say anything stupid and have more confidence in myself and finally become the person I want to be.
Many people don’t grow out of their “I-hate-myself-for-being-so-stupid” reaction, no matter how much they accomplish, or get reassured, or seek professional help. They never find out why they’re so stupid, but they never stop asking.
The reason for their so-called immaturity is a kind of painful mental tic that hurts like hell when it happens, and can’t really be prevented or eliminated (other than by lobotomy, which is a skill I’m trying to acquire, as soon as I can find a willing test patient/Jon Gosselin returns my calls).
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Posted by fxckfeelings on December 21, 2009
Even if none of us has spent Christmas with our entire families, most of us feel like we should help make it happen and feel terribly guilty if we can’t (I just feel guilty for taking their money, but only a little). We have some illusion that the holidays are the time for our criminal or alcoholic or crazy relatives to put their behavior aside, slap on a Christmas sweater, and join their loved ones around the tree and we feel bad if we can’t make the reunion happen, or even let it happen. But fear not, there’s a way to make excuses tactful and blameless without bringing down everyone’s holiday cheer. Gaw bless us, every drunk and lawless one.
–Dr. Lastname
Please note: There will be no new post on Thursday, 12/24, due to the holiday. Please continue to write in, however, because there will be a new post on 12/28. Thanks, and happy holidays!
My ex-wife was always a wild outlaw in high school, (I got the kids), she’d show up from time to time, but rarely when she said she would, and you never knew when she’d be high, so the court imposed supervised visitation. I want my kids to have a mom though, but when she no-shows, the kids are crushed. Of course, the kids want to see her, particularly for Christmas, but what they don’t know is that she and her current boyfriend were caught on video robbing a liquor store, so if she’s going anywhere, it’s probably straight to jail. . My goal is to figure out a way to break this to my kids so that they don’t hate their mother (even though I sort of think they should).
You can’t protect your kids from the hurt of loving an outlaw mother, any more than you could protect yourself for falling for her years ago. Telling your kids that she’s a bad person inflicts a worse kind of hurt, because it devalues the love you and the kids have given her (which, as you know, you can’t get back).
Even if you can’t protect them from hurt, you still can and should protect the value of their love for her and whatever is meaningful about hers for them.
To begin with, don’t buy the idea that outlaws are regular people who make bad choices. That’s one of those stupid, false-hope ideas that assumes that everyone has the choice to be good or bad and can redeem themselves by making better choices. It’s sort of a hybrid of Milton’s “Paradise Lost” and Santa’s “Naughty/Nice” list…and it’s bullshit.
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Posted by fxckfeelings on October 15, 2009
Accepting that we are all fucked by life is a basic tenet of the f*ckfeelings.com philosophy; there’s a certain zen to it, as we encourage not just being one with the universe and its glory but also with its amber waves of pain. For people who suffer from depression, pain makes an obvious attempt to define your life goal as “I’ve got to stop this.” But killing pain, as desirable as it is, will always compound your troubles if you make it your goal. Your goal is your goal and pain is pain and never the twain should meet.
–Dr. Lastname
I have been struggling with depression for most of my adult life, and I do mean struggling. No matter how many times I find myself going through months at a time of feeling hopeless, angry, and miserable, I know it’s a treatable illness—a chemical imbalance— nd that there must be a way to control it. Over the past twenty years, I’ve been through a handful of shrinks and at least a dozen medications, because no matter how bad it gets, I’ve refused to give up looking for the treatment that will allow me to fulfill the promise of my otherwise lucky life. The problem is that, twenty years into this battle, and I’m still not winning. Treatment works for a while, and just when it seems like things are finally working out for me and I’m in the clear, everything falls apart again. My goal is to figure out how—with what treatment, medication, game plan—to get control of this disease and live a normal life, because I’m stronger than this, and I refuse to let depression get the last laugh.
Hold up—did I miss the morning’s headlines that declared depression a curable illness? Up until yesterday, it wasn’t, and when you think about it, the list of truly curable diseases is an adorably short one. Really, unless you’ve got athlete’s foot, you’re probably shit out of luck.
That said, it doesn’t mean you should shoot yourself unless you’re similarly upset by the incurability of hypertension, diabetes, osteoporosis, high cholesterol, and all the other illnesses that most of us get, sooner or later. Even athlete’s foot isn’t worth it.
The issue here is that if you think that beating an illness means getting rid of it, you’ve lost before you’ve begun to fight. And if that illness is depression, then losing means getting more depressed, which means becoming a bigger loser, ad infinitum.
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Posted by fxckfeelings on October 8, 2009
It’s easy, when someone can’t control their behavior, to assume that they are evil, stubborn, or somehow defective and that you’ve got to get through to them, one way or another (not so nice) way. Just because someone can’t behave, however, doesn’t mean s/he’s evil and/or totally resistant to your values; and just because you’re getting nowhere with them doesn’t mean they won’t get it together eventually. It’s easy to write someone off, and it’s easy to be written off, but if you’re hoping to work through a problem instead of just blame someone for it, the only thing incurably defective in these scenarios is the moralizing.
–Dr. Lastname
My older daughter just turned 10, and I’m fairly certain that she is pure evil. My wife and I are not bad people—no family history of mental illness, either—but our older daughter, who looks like a normal little girl, says such nasty things to her little sister that it would make your head spin. Our younger daughter, who’s 7, thinks her sister is a miserable terror, and I have to say, I agree with her; the stuff that comes out of our 10-year-old’s mouth is so cruel, I’m almost in awe of it. My wife and I have sat her down and asked her if she acknowledges how awful her words are, how much it hurts her little sister, and how serious we are about how much she needs to change her attitude. Since then, our older has been less mouthy with us, but just as terrible to her little sister, and we have no idea how to make it stop. My goal is to stop my older daughter from being so mean—that is, if she’s not just satanic and hopeless. I’d really like to get her to understand what she’s doing and why she needs to stop (if I can get that through her evil mind).
As those Spanish Inquisition cardinals learned while swishing around in their gorgeous red gowns, any effort to stamp out the devil gives him a giant energy boost and brings him (or her) to dramatic life.
This is because most of us—even the best of us, like David Letterman—have some devilish impulses that bust out when we’re tired, or rubbed the wrong way, and generally when our control is far from perfect.
So when someone tries to eradicate our wickedness, we may initially agree with their goals. Sooner or later, however, when our impulses don’t cooperate by disappearing, self-hate and shame get stronger and, yes, you guessed it, feed the nasty impulses, whatever they are. The cardinals get to meet the very devil they were trying to exorcise, and the devil’s poor host snarls back and throws up pea soup. A classic vicious circle.
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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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