Advice on dealing with a mental health issue

December 15, 2008 6:16 AM

I'm generally a pretty nervous person. Lately (over the last two months), it's become worse. I jump whenever someone enters the room. I'm quite stressed about everyday things (a disagreement, a social event, my future), and nearly every day my stomach or chest or shoulders ache from these worries. I recognise that my response to this is overblown and irrational, and that maybe I need to seek medical attention. But that's the problem. Can you help me gather the courage to see a doctor?

I've been physically well for so long that I can't remember the last time I went to a doctor, so I don't have a doctor that I have a rapport with. I'm quite uncomfortable with the idea of picking someone out of the phone book and blurting out that I'm being irrational and/or want medication. I feel like it would be easy to perceive me as a silly hypochondriac or a doctor shopper (someone who finds a new doctor when the old one refuses to prescribe). I think I am quite a private person, and the prospect of disclosing my daily epic fails at life seems an insurmountable task.

FYI: I've done the Burns book (Feeling Good) and quite a few others based on cognitive behaviour therapy, or positive thinking and so on, and this stuff just isn't working anymore. Also, the doctors in the phone book for this area are not grouped as specialists in mental health, but rather as general practitioners. Regarding the inevitable "seek therapy" suggestion - it is possible that the doctor will be able to refer me to a psychologist where the first three visits will be free - but the referral has to come from a doctor for this to work. If you think I'm a total loser for even posting this question, your opinion of me can't be lower than mine is.

Can you help me gather the courage to see a doctor? I can't seem to make myself do it.

posted by anonymous to health & fitness (15 comments total)

See your GP first for bloodwork to see if you're having thyroid or adrenal issues...and then you've got your referral (and a foot in the door that doesn't involve saying "I'M IRRATIONAL AND WANT MEDICATION", if that makes it easier).
posted by availablelight at 6:48 AM on December 15, 2008

You don't need to get any more jacked up about going to a doctor for this reason than you would for an ear infection or pain in your knee or anything else. Anxiety and depression are really common, GPs and family doctors are totally equipped to handle it. There's nothing about this you need to be afraid of, and there's help available as you've noted in a bunch of different forms (CBT, therapy, meds, etc.)

So, this is just a health issue like any other health issue, and you'll do the responsible thing for yourself and go see a doctor. You don't have to have an awesome rapport with the doctor, it's nice if you do, but it might help for you to view this as dispassionately as possible--it's a health issue. And it's not some weird freaky hide beneath the bed thing either---it is incredibly common and treatable, and you don't have to experience anxiety about the anxiety. As for your self-esteem issues, I think taking some initiative in dealing with the anxiety will help you feel a little more empowered, and then you can move on to those larger issues.
posted by A Terrible Llama at 6:51 AM on December 15, 2008

You're not irrational for wanting to feel better. Chemistry changes in your brain are the cause of overbearing irrationality, anxiety, sadness and other feelings that oppress your life--not personal weakness or worthlessness. In other words, you don't really have much of a say in if this happens to you, much like you wouldn't if you got an ulcer or the flu. It's hard to overcome, but please try and ignore the stigma and see your doctor. If you feel like things are out of control, tell that to your doctor. Don't try and make your own diagnosis.
If you are a female, and you feel more comfortable with your gynecologist who does your annual well-woman screenings, by all means see that doctor. More and more women go exclusively to a gynecologist as their primary care provider.
By the way, cognitive behavioral therapy is not the same as positive thinking. CBT changes how you think about your actions and feelings in order to change them. It can be useful in overcoming mild and moderate depression, anxiety and OCD, but it is not everyone's style, and some people find they are better with medication alone.
It sounds like you have attempted to solve the problem on your own, you have come to the conclusion that you can't... so please go see a professional. Best of luck to you.
posted by FergieBelle at 6:55 AM on December 15, 2008

I'm quite uncomfortable with the idea of picking someone out of the phone book and blurting out that I'm being irrational and/or want medication.

If you haven't been to the doctor in a long time, you should probably go in for a checkup just to make sure you're not ignoring any long term health problems. You're healthy now, but to stay healthy you'll want to detect and prevent health problems before they happen. As for finding a good doctor, asking people you know for recommendations is usually the best way to go, but you could also try a site like RateMDs that has reviews of doctors from other patients.

I feel like it would be easy to perceive me as a silly hypochondriac or a doctor shopper

You have a problem that's seriously affecting your life, so it's completely normal to ask a doctor for help. If you had back pain, would you feel embarrassed to ask for help? If medications might help you with a problem, no matter what the problem is, doctors will take you seriously and help you figure out your options, that's their job.
posted by burnmp3s at 7:00 AM on December 15, 2008

Every time you have anxious thoughts about visiting the doctor, think to yourself: I have an anxiety problem. This makes me think anxious thoughts repeatedly. My thoughts are not always connected up to reality and I know it. Therefore, my anxious thoughts about the doctor are probably also not representative of reality.

Knowing that, and reminding yourself of it regularly, can you then make yourself go to the doctor's despite your anxious thoughts about it? Think about other unpleasant experiences that you got through and survived. Think, OK maybe when I go I will feel physically uncomfortable and have a high heart rate and an achy chest. I may have unpleasant thoughts about what the doctor is thinking. I may find it difficult to get my words out and be embarrassed. But maybe I can go anyway and sit through all those things for maybe 20 minutes, because this is what it will take to make me better.

If you are anxious about individual steps such as making the appointment, see if you can break the overall task into small steps and tackle them one at a time. First just pick a doctor. Only once you've done that, make an appointment, and so on.

See if you can try to describe your problems to yourself objectively; "Sometimes my anxious thoughts prevent me from going to regular social events that I used to attend", instead of "I am an abject failure who lets down my friends", or whatever loaded language your internal monologue uses that causes you to feel so horrible about things.
posted by emilyw at 7:10 AM on December 15, 2008

I found a good doctor by asking people.

I actually asked a woman once, who at one time had been in at steno-pool(!) at a local hospital. She told me horror stories of the way some doctors dictated information about their patients, but also knew who was good. If you ask people that you like or trust, that can be a good way to do it.

And I agree with others, tell the doctor when you get there. At some point in the examination, they usually open up and ask if you have any questions or things you want to discuss. They are very competent at dealing with anxiety. They can refer you too, and help with medication. And I totally support getting a good physical. I went through hell for several years, having a low thyroid, and not knowing it. It wouldn't have mattered how much CBT I did, the only fix was the medication.
posted by chocolatetiara at 7:52 AM on December 15, 2008

I agree with chocolatetiara that asking other people is a good way to find a good doctor - that's how I found my current GP, who is awesome. I also agree with burnmp3 that if you haven't been in a while, you need a checkup anyway.

If you're worried about coming off as a hypochondriac, how about practicing a little speech? Something like, I dunno:

"One of the things that's been concerning me is that lately I've been getting very anxious over things that I know aren't worth getting that worried over. [Describe your problems as you did above, with examples.] [Explain how you've tried some of the DIY CBT techniques, etc, and the results.] At this point I really think I need a referral to a mental health professional to get to the bottom of this, and I'd also like a physical that will find any abnormalities that could be causing this."

Obviously the doctor is going to cut in at some point and you'll go off script, but if you feel really comfortable with what you want to say and what you're supposed to ask, you can still keep on point and get your ideas across.

Best of luck, by the way. If you can, do let us know how it all turns out.
posted by bettafish at 9:03 AM on December 15, 2008

2nd emilyw. you're going to have to want to fix this. It will probably take a fair amount of willpower to a) make an appointment in the first place, and b) actually going through with the appointment. I went through something similar about 2 years ago, and the appointment was nowhere near as bad as the anxiety I experienced just before. In fact, I almost drove out of the parking lot with out ever seeing the doctor, but I had had enough of feeling like that all the time. Is there someone you know & trust that can go with you, or at least drive you there?
posted by ArgentCorvid at 9:16 AM on December 15, 2008

I would maybe even suggest having a friend help you jump over this first hurdle. The first hurdles are always the hardest. Once you get on medication, you'll be able to jump the next hurdles on your own. But don't feel badly if this one seems too daunting to take on your own.
posted by polyester.lumberjack at 9:50 AM on December 15, 2008

It's a quality-of-life issue. You wouldn't try and limp around on a broken leg, even if you could somehow withstand the pain. Life is not an endurance test.

emilyw's advice is right on target: anxiety is not representative of reality. (I would add, "very rarely" - if you are being chased by a tiger, you're right to be fearful.)

I've had panic disorder since about seventh grade. My threshold for anxiety is lower than other people's. Medication brings it to around a normal level, so I can function. I've seen half a dozen doctors and not one has suggested that I suck it up or that I'm a hypochondriac drug seeker. They were all genuinely concerned that my anxiety was profoundly affecting my life.

You can be afraid and still do something - that's what courage is. Pick up the phone without thinking about it and call a doctor. Right now, all you need to do is make an appointment. The rest will come later.
posted by desjardins at 10:28 AM on December 15, 2008 [1 favorite has favorites]

I like polyester.lumberjack's advice: ask for help from someone you know. Just like you wouldn't walk to the hospital on your broken leg, it makes sense that you need help even in getting help. Is there a friend, parent, sibling, or even a coworker that you trust? If it's someone you don't feel comfortable sharing with, you don't even necessarily need to disclose all the details, you could just say something like "I am finding it impossible to get a doctor. I know this is simple, but I have a block with it. Could you walk me through how you'd do it?" If you feel uncomfortable requesting a favor, you could even offer to trade them something, like help with some personal weakness of theirs (organizing their closet), or any other offer you think they'd like that wouldn't stress you out (cooking them lasagna or pie, babysitting).
posted by salvia at 10:54 AM on December 15, 2008

I had some similar symptoms as yours and after an interesting couple weeks of bigtime life change events (breakup, death of family member, possible serious illness of another family member and new job), had a couple anxiety attacks and was prescribed Lexapro. In the 6 or 7 weeks since, my general anxiety is down significantly. I'm by no means an advocate for 'medicate first' or any similar philosophy, but this brain pill has seemed to do the trick for the most part.

As for finding a doctor, ask nurses. They deal with tons of doctors and they talk to each other a lot. You'll quickly suss out the good from not-so-good doctors after a couple conversations with nurses.
posted by skechada at 12:53 PM on December 15, 2008

There may be a support group in your area that keeps a list of "mental health friendly" doctors.

Something I find helpful is to switch my focus from the process to the outcome i.e. think about finally experiencing relief from your anxiety, rather than going over blow by blow your consultation with the doctor.

Also, if they are unhelpful, or give you the impression they see you as a hypochondriac then they're a dick. Their problem, not yours. You're free to walk away and find a decent doctor who will treat you with skill and care.
posted by sarahw at 5:05 PM on December 15, 2008

I'm so sorry to hear you're going through this. I am like you, in that setting up a plan to get medical care can cause as much or more anxiety than just living with whatever the problem is. Here are some things that worked for me.

Break the task of finding a doctor into really small steps - ask friend for a recommendation, get phone number from phone book, call to make appt, make appt, tell friend you made appt, ask friend to accompany you, go to appt. Allow yourself to do one step, then quit, if you want. Tell yourself, just do this one thing, then you can stop, no big deal. Even at one step a day, you'll have an appt and a plan for help made in a week.

If it makes it any easier, if you're going to a new doctor, then you can just tell the receptionist/appt scheduler that you need an appt "to establish care". They don't need to hear the details, and that may help with maintaining your sense of privacy.

In the time between making the appt and going, keep a list of things that concern you. "my heart is racing", "I feel pain in my shoulders" - you can describe them as purely physical symptoms. Take that list to the doctor. After the initial routine stuff, say "I've made a list of a couple things that are concerning me. Can I read it to you?"

I did that. I got screened for a couple different things, got the help I needed, and I feel tons better. In my case, it was a combination of physical problems and mental stresses exacerbating one another. It's possible that's the case for you, too, and that a GP can help you in ways that a psychologist/counselor couldn't.

This is something you can do, even if it scares you. You don't have to be all cool and collected about doing it for it to work. I can tell you more about my experiences if you want, my email is in my profile. Please take care of yourself, your current low opinion of yourself doesn't mean you deserve to be unwell.
posted by donnagirl at 6:26 PM on December 15, 2008

This was me. I made the appointment, the doctor was lovely, and organised anti-anxiety medication and a referral to a psychologist, both of which has helped a lot. This thread certainly had a huge influence in me being able to actually make the appointment and go to the doctor and I just wanted so say thanks, thanks for being kind and understanding and for the very useful advice.
posted by b33j at 2:00 PM on February 27