Posted by fxckfeelings on August 30, 2010
Someday, people with psychiatric problems will get safe, effective treatment without having to make difficult choices, and Thanksgiving dinner will come in a pill, and jetpacks will be available cheaply for every man, woman and child. For now, the state of the art is much better than it’s ever been, but it’s still primitive, and it certainly isn’t inexpensive. Until the silver bullet for curing mental illness is found, patients have to make innumerable tough decisions for themselves, weighing everything from side effects to costs. Or they can just bide their time until their jetpacks arrive to make everything better.
–Dr. Lastname
I decided recently to listen to my friends and family and see a psychiatrist about my depression, but I don’t know whether I’ve made the wrong decision, or whether I’ve just chosen the wrong doctor. Basically, I decided to get help because I feel helpless, but my doctor wants me to do a lot of the work myself and doesn’t really help that much. It’s not just he wants me to ask myself a lot of questions (and answer them—if I had the answers, would I really be paying him?—but also deal with my insurance company and read up on the medication he suggests (he tells me about them, sure, but he says I owe it to myself to read up on them on my own, and that doesn’t make sense to me since he’s a doctor, knows everything about the pills, and he could just tell me himself). My goal is to figure out whether therapy is worth it, or whether I’m just getting help from the wrong source.
I hate to sound like your psychiatrist, but ask yourself what you have a right to expect from treatment, given what you know about its limits and your resources for paying for it.
If you want, you can spin things positively by saying that you’ve heard about good new treatments that can really help and that you’ve got great insurance that you pay a ton of money for. Of course, you’d probably be full of shit.
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Posted by fxckfeelings on August 12, 2010
In this “Intervention”-happy society, we tend to believe that bluntly confronting friends about their problems is the ultimate solution. In reality, if you really want to warn a friend about worrisome behavior, it’s better to discuss risk without expressing worried feelings/”your behavior affects me in the following ways.” Worried feelings say you think people don’t know what they’re doing and you do, whereas discussing risk says you’re interested in how they value the cards in their hand and what they’re going to do with the losers. Don’t worry that your calm demeanor will fail to get across the depth of your concern. An in-your-face approach often fails to do much of anything.
–Dr. Lastname
I’ve done some research, and I think my girlfriend is bipolar. She gets into these very good moods for no particular reason, and when she’s in this mood she can’t stop talking and seems high and silly (and that’s when she sometimes drinks too much). When she’s like that, she’s more obnoxious-funny than really funny, but she thinks she’s a riot. I’m not crazy about her up times, but what I really dread is the crash that follows; it’s hell for her and everyone around her. I know she sees a shrink, so I told her what I was worried about, but she acted like I was insulting her and then she said she was sorry, maybe I was right, but she likes feeling happy and doesn’t see anything wrong with it and why should it bother me. My goal isn’t to take away her joy, but I wonder if it’s bad for her to be bipolar and, if so, what she should do about it.
You’re right to worry about your girlfriend’s highs, but getting through to her may not be easy. Manic people aren’t exactly perceptive, unless by perceptive, you mean frighteningly giddy and overwhelming obnoxious.
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Posted by fxckfeelings on August 9, 2010
Whether it’s wishful thinking, fear, or a powerful sales pitch from the church of Scientology, we have lots of emotional reasons for shutting down our logical minds when we have to make medication decisions about psychiatric illness. The good news is that, while those decisions should be made carefully, they’re not rocket science. The bad news is that it requires more courage than brains (or Thetans) to be a good manager of your own health.
–Dr. Lastname
I recently started going to a doctor for my depression. She thinks I should take pills, I’ve seen lots of articles about how antidepressants don’t work and the main reason they’re prescribed is because of the huge investment that big pharmaceutical companies have made in producing and marketing them. It makes sense to me that there are better natural, holistic solutions that get played down by the medical establishment because they can’t make money for anyone and threaten the profits made by those companies. My goal is to find treatments that work best, not the treatments that server the corporate interests.
The problem with most criticism of current drug treatments is its hopefulness; it implies that there are good, effective, cheap and low-side-effect treatments for depression (that are being suppressed). If only principal clause of that statement were true.
Sure, a magic bullet, holistic or otherwise, would be great (there are lots of other unsolved and incurable problems I can work on, so I’m not worried by the hit my business will take).
The truth is, however, that current treatments are time-consuming, weak, often costly, sometimes risky, and not guaranteed to work
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Posted by fxckfeelings on July 29, 2010
Fear isn’t all bad (e.g., fearing snakes goes a long way towards keeping you from poison venom). On the other hand, fear itself is stressful and painful, so our first instinct is to avoid it, no matter what…which is, of course, when things start getting really frightening. No matter how much we want to protect ourselves or those we love, it’s not gonna happen, so we have to accept the unavoidable scariness of life (and anacondas). It won’t necessarily calm you down, but it will give you the strength to do what matters, fear or no.
–Dr. Lastname
My wife and I liked to party when we first met (nothing too crazy, we just went out a lot), but we just had our first kid, so we now spend a lot more time at home. My wife used to be a fun, bubbly person, and she still sort of is, but ever since the baby was born she’s been really stressed out, worrying that something bad will happen and the baby will die. Not stuff she could possibly prevent, just a random act that would kill our child, and the stress is so bad she is haunted by visions of our son in a casket. I think she’s dealing with this stress by drinking a bunch of wine with dinner and getting a little more than tipsy. I’ve told her to relax about stuff she can’t prevent, but she says she can’t help it, and I don’t like that she’s drinking too much, and where that’s going to go. I want to see my wife get some treatment that will relieve her stress so she can stop drinking too much.
You might wonder how wanting to help someone could be bad, and it’s because, as goals go, it’s often one you can’t reach. If you don’t accept that fact before making your plans, you’ll make things worse.
Here, for instance, there’s a good chance she’s too busy drinking and/or avoiding her problem to heed your good advice and, at least at first, she may not be able to stop herself (and if she could stop herself, you probably wouldn’t be writing me in the first place).
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Posted by fxckfeelings on July 19, 2010
Today’s post tackles a common, yet heretofore-not-submitted question about therapy, namely, how to find good help without breaking the bank in the process. While it’s a simple question, the answer isn’t, so we’ve dedicated the entire post to helping those who want help with their mental illness, but don’t have a dime to spare.
–Dr. Lastname
I’ve been depressed for some time and could use some treatment, but my insurance has a big deductible, so I’ll be paying everything out of my pocket, which isn’t deep. My goal is to get treated for the least amount of money.
I’ll assume from your tone that depression isn’t making you suicidal or putting you at immediate danger of losing your job and/or family because, if it is, you need to forget about the cost of treatment and value the cost of your survival.
If depression is putting your life/work/family in danger, get a psychiatric evaluation, in an emergency room if necessary. Do not pass go, do not collect $200 (no matter how much you need it).
If that isn’t the case, there’s lots you can do to reduce the amount of money you spend on treatment…if you’re willing to spend some time, do some research, and use your common sense.
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Posted by fxckfeelings on July 15, 2010
We Americans love our stuff, but the lust for said stuff can cause individuals to behave badly (see: the demonic/orgasmic audience reaction to Oprah’s car giveaway). Usually, when someone goes overboard with longing for/accumulation of stuff, it’s a family member who steps up to put the breaks on, but when anyone, family or no, gets between someone and their stuff, things can get uglier than anything Oprah could imagine. If family members put limits on their responsibilities, however, there are still ways for stuff-addicted loved ones to break the stuff cycle.
–Dr. Lastname
My parents have decided to retire, sell the big house I grew up in and move into a smaller condo closer to my sister and me. The move makes sense—my sister and I are adults with our own families—but it’s brought up a sort of taboo issue for my parents, which is my mother’s attachment to stuff. She’s not a hoarder, but if my dad wasn’t around to put his foot down, I sometimes worry it could be, because my mother has trouble throwing anything away. She says that moving all the time as a child has given her a different appreciation of objects, and that it’s better to regret having too much stuff than to miss something you threw away and can’t get back. Problem is, there’s no room for this stuff in the new condo, they won’t have the budget for storage, and my sister and I aren’t able to put all of her old work files, souvenir spoons, and elementary school textbooks (seriously) in our basements. What I’m afraid will happen is that my father, who has always taken responsibility for managing their money, will try to get my mother to agree that they can’t afford to move and store her stuff when they move, she’ll keep complaining, and he’ll get nasty. How can we get my mother to learn to let go?
I know you and your father want to make your mother happy and have harmony, but it looks like she’s not eager to adapt a sparse, Zen lifestyle.
The problem is, trying to make someone happy when it’s just not possible usually causes more unhappiness. False hope is dangerous, no good deed goes unpunished, and stuff happens (sometimes in great quantities).
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Posted by fxckfeelings on June 24, 2010
For those over-endowed with emotion, reacting without thought is dangerous, whether the extra burst of feeeeeeling comes from present love or past trauma. Flying off the handle isn’t good for anybody, so take time before booking your flight to remember that you’ve got better goals than to open your mouth and make yourself more miserable.
–Dr. Lastname
My ex and I had a drama-filled relationship and a rough break-up. Drama because I was drinking, which meant I was sometimes out of my mind, and rough because I got my shit together and tried to make it right with her but she dumped me anyway. The problem is that we work for the same boss, and now that we’re not together anymore, but I’m sober and sane, I’m wondering how to act towards her. Be friendly and normal? Are hugs in bounds? I can’t just ignore her, and I don’t want to, but things are strange. I want to show her that I’m cool, not nuts, and want things between us to be normal (whatever that means).
Be you an alcoholic or a Mormon, you have zero chance of instantly re-establishing friendship with someone you’ve just broken up with. Like cold fusion or a 2010 World Cup game without vuvuzelas, it’s never going to happen.
Since you are an ex-drinker, however, you should know that self-control is something you can never count on, particularly when your feelings for an ex-love are intense and her actions unpredictable.
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Posted by fxckfeelings on June 14, 2010
While most people have multifaceted personalities (or should), there are an unlucky group whose personalities aren’t so much nuanced as they are binary; fewer shades of grey, more Jeckyll and Hyde. If you’re dealing with someone who’s double sided, or trying to hide a part of yourself from the world, it can feel like a never ending battle to reconcile and/or expose both halves. Occasionally, it’s worth exposing your secret side to end your own torment. Other times, it’s better to let people keep their Mr. Hydes to themselves if it means keeping their drama out of your own life.
–Dr. Lastname
Most people thing my mom is really fun, if a little flaky and emo, but they don’t see how crazy and mean she gets when there’s no one around but my brother and me (my parents are divorced). When she’s in a bad mood, she tells us we’ve been mean to her, and reminds us of things we’ve said that hurt her, and tells us how bad we are until we’ve apologized, and then she forgets it ever happened. There’s one cousin who’s seen what she gets like and I rely on him to remind me that it’s OK, she’s crazy, but the other day he seemed charmed by her and then, when I complained, he told me I had to get over her and not be so angry, and now I feel totally unsupported. My goal is to get someone to understand what’s going on.
Nothing gets people more stirred up than dramatically pitched false accusations and punishments by a powerful, inescapable, totally two-faced authority, like your mama.
The good news is that, while you’ve got the makings of a perfect soap opera, it sounds like you’re not getting swept away by it.
The trouble with soap operas, of course, is that they trap the good guys into endless rounds of angry, hurt reactions to crazy bad guys. In the process, they take up huge amounts of time and energy for tears and talk, talk, talk before, finally, there’s a glimmer of comfort and validation…before the cycle starts all over again.
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Posted by fxckfeelings on June 7, 2010
Most people panic if their mental health goes south, and if/when they find a doctor to help them recover, they assume that treatment is a mystery about which doctors know best. If you’re in that situation and disagree with your doctor’s decisions, don’t act like a helpless child challenging an all-knowing parent. Learn what you need to know to make well-informed decisions and stand by them, whether or not your doctor agrees. It’s the best way to cure yourself of panic, and it makes refuting your doctor’s advice a discussion between equals, not a pleading.
–Dr. Lastname
My psychiatrist thinks I should increase my medication, but it already makes me sleepy and has caused me to gain 10 lbs. If anything, I’d really feel better getting off it entirely, because I hate being dependent on it. For the time being, I know I need it, because I’ve barely recovered from my last depression, but even thinking about increasing the dose makes me feel depressed. I’ve seen this doctor throughout my entire illness and she’s been very good with me up to this point, but now that I don’t agree with her I don’t know what to do. I don’t want to have to take more medication.
It’s much easier to have an agreeable disagreement if you’re not pushing someone with your emotions; after all, lawyers use evidence, not tantrums, to win a case.
Still, it’s hard not to push with your emotions when the issue is personal and scary. Unfortunately, you don’t have a choice.
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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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