Learning to empathize

December 17, 2009 7:49 PM

How can I understand, and empathize, with my fiancee's psychological issues? And other difficult-to-articulate questions.

Posting anonymously as this is a fairly private issue I'd rather not have linked to my username.

Background info: I'd say I'm a well-adjusted, psychologically healthy male. I was raised believing in the power of the mind, with "anything's possible if you put your mind to it" as the family mantra. I'm a positive thinker and my own life has been shaped by discipline and self-control. I'm pretty stoic and always try to keep my emotions in check (I rarely cry or get angry, but I'm also upbeat and happy most of the time). Because these values have been reinforced and proven effective for me so many times over, I consider them virtues. I'm a big proponent of setting audacious goals, following my dreams, and being a self-made man.

The downside to this mindset is my difficulty empathizing with my fiancee. She takes two different medications, one for ADD and one for anxiety. This is probably a topic for another AskMe, but these two ailments are things I've always been skeptical of. I guess it's because I have no firsthand experience with them. I tend to agree with people like Thomas Szasz and the "anti-psychiatry" movement that these conditions are real but not necessarily best treated medically. Perhaps they're conditioned by upbringing, compounded by years of self-fulfilling diagnoses, special ed assignments, overstimulation, and psychosomatic confirmation bias. I realize this is controversial, and I don't want to debate it in this thread. Just trying to paint a picture of where I'm coming from.

My instinct, my deep desire, is to try to wean my fiancee off her meds (which she freely admits to hating for a number of reasons) and transition to a better-structured, calmer lifestyle. To help her rein in her issues sans pharmaceuticals. I feel some urgency, because doing nothing is unsustainable in the long term -- she continues to increase her dosage every few years just to get the same effects. How can someone follow that trajectory for a lifetime? It pains me to see her chemically addicted to mind-altering drugs that, as far as I can tell, only mask the symptoms instead of addressing the underlying cause. I'm particularly concerned about side effects that may manifest when we try for kids in a few years.

Anyway, that's a discussion for another time. Let me get to my real question.

When we talk about going off the meds, my fiancee agrees with my motivations but is terrified at the thought. It's not just the addiction talking -- she's fully convinced that her issues are 100% chemical and that there are no viable alternatives to prescription drugs. This is where I find it very hard to put myself in her shoes: she insists that she has no self-control, that it's clinically impossible for her to take any responsibility for her actions. This is contrary to everything I've ever believed about free will and sounds to my ears like pessimism or defeatism. She's playing the victim and refusing to even TRY to resist whatever urges pop into her head. She feels like it's out of her control but I have trouble believing it really is.

An example... something unexpected happens and her anxiety flares up. I try to calm her down. "It's okay," I say softly. I put my arm around her and breathe slowly so she can synchronize with me. I remind her that it's not the end of the world, that we can improvise and work around the obstacle. Her reaction is unexpected to me. She gets angry. "I can't calm down," she snaps. She pulls away from me sharply and does erratic things. It's like my attempts to help are useless, anything I do or say only aggravates the problem. Later she apologizes and tells me that her "brain was going very fast" and she simply couldn't process any stimuli at the time. Trying to help only snowballed the problem and she got angry with me for adding to the noise in her head.

She spends a lot of time angry or worried, even on her medication. I desperately want to help her get past these emotions, which will eat her up inside and make her miserable; training myself to overcome them was one of the best decisions I ever made. I want my fiancee to share my optimism and desire for adventure. I love her and just want to see her happy, not just momentarily but as a general frame of reference for her outlook on life. It's just healthier, for both of us as we head into marriage.

We've done pre-marital counseling, which I thought was great. But all of the counselor's advice built off my supposition that talking through issues in a logical, respectful manner is effective. Unfortunately, in the heat of the moment, clear-headed discussion is impossible (which frustrates me to no end, because I try endlessly to work through every bump in the road, just as was recommended, and seem to end up worse for my efforts).

I'm sorry this is so long. I don't really know how to frame this as a question but I'm getting exasperated. How can I help my fiancee? How can I come to understand her feeling of powerlessness? How can I actually make progress toward helping her overcome it?

My mind is open to new ways of looking at mental health, but it's still difficult for me. I feel that on some subconscious level, she's just lacking confidence in herself, being stubborn, and refusing to take responsibility for her behavior. She's not doing it intentionally, I know. If you think I'm wrong (and I'm sure many here will), how can I internalize the fact that some people literally cannot will themselves through adversity the way I've always done? It's almost impossible for me to accept, as it flies in the face of a lifetime of personal experience and seems ludicrous to me.

Any advice or related info is much appreciated. Throwaway email at [e-mail] if you need it.

posted by anonymous to health & fitness (65 answers total)

It sounds like, while your heart may be in the right place, you want to take the place of her her medications, which seems a little bit controlling. I think you need to respect her autonomy. She gets to decide if she takes medications, even if she can't articulate a clear philosophy on it right now.

Also, this: "endlessly to work through every bump in the road" sounds exhausting for the both of you. I advise that you decide what constitutes a good-enough relationship and relax and enjoy each other when you've reached that point.
posted by zinfandel at 8:01 PM on December 17, 2009 [8 favorites]

I missed the part in this where you mention your medical degree.

That wasn't snark: you really have no business trying to "wean" her off medication, argue with titration levels, or debate the existence of the conditions these medications are treating without consulting with a doctor first.
posted by availablelight at 8:04 PM on December 17, 2009 [38 favorites]

How can you help your fiancee? Really? That's what this question is about? You want to help her? Or do you, in some way, want her to become you?

I think the problem is that you are stuck in your own head. You are stuck in your own thoughts, and approaches, to the world. When you look at your fiancee, you have a hard time being in her shoes or even wanting to be there. This doesn't just apply to her anxiety issues but across all issues. You really don't know what it's like to be another person and it sounds like you don't want to either.

You have an all encompassing faith in the power of the self. The problem is that you've never struggled like your fiancee is. You've never had to deal with what she's dealing with. And what you're discovering is that your fiancee's personal tribulations are, overall, completely challenging apart of the background of who you are which is a ego-centric view of yourself. I don't think you really want to help her because the only way she can be helped is if you stop being you. Are you willing to go that far? Are you willing to put the effort into doing that? Are you able to change yourself to the point where, when she suffers an anxiety attack, you ask "what does she need to calm down" rather than "what do I need when I calm down"? Are you able to do what you should be doing as you plan on entering marriage - i.e. putting herself above you? To love her at the expense of yourself?

And if you really believe in the power of the mind, that should be easy to do, no?
posted by Stynxno at 8:13 PM on December 17, 2009 [44 favorites]

There's a whole theme in "Men Are From Mars, Women Are From Venus" (laugh if you will but it has some interesting premises) about men trying to play Mr. Fix-It when what their female partner really needs is a sounding board. I'm seeing a whole lot of Mr. Fix-It in this thread. I'm not on any medication, but I'd probably punch you in the face if you "spoke softly" and tried to get me to "synchronize my breathing" when I'm angry. I'm not an idiot, and I'm guessing your fiance isn't either; when I'm angry, I don't need someone telling me stuff I already know. You assume that she could do things the way you do if she really tried, but did you think that maybe she doesn't do things your way because she isn't you? My advice for you is to step back from trying to fix your partner, and work on just living with your partner. Assume right now that she's never, ever going to change; that the only one whose behavior you have control over is you. Now what? What are you going to do? If you can't respect her frame of mind as-is, then I would question whether it's really a good idea for the two of you to be together.
posted by ThePinkSuperhero at 8:15 PM on December 17, 2009 [27 favorites]

I think, as much as I hate to say it, that the basic issue here could be a fundamental lack of respect. Honestly, when someone says something that's really very clear: "I can't calm down, my brain is going very fast, and I cannot process any stimuli" and you do not simply accept that, then I genuinely think the issue is with you. You either respect this woman and the words that come out of her mouth, or you don't.

Someone having a panic attack is not really capable of rationally analyzing the phenomena in the midst of the experience. It's engulfing. If you can't accept that, this is going to be an ongoing source of conflict.

Having said all of that, you might suggest CBT as an excellent therapy for dealing with escalating anxiety. It can be very effective. She may then, after a period of time that will be vastly longer than you would probably like, feel confident enough to consider going off her meds with the support of a qualified therapist.
posted by DarlingBri at 8:15 PM on December 17, 2009 [14 favorites]

Perhaps they're conditioned by upbringing, compounded by years of self-fulfilling diagnoses, special ed assignments, overstimulation, and psychosomatic confirmation bias. . .

This is contrary to everything I've ever believed about free will and sounds to my ears like pessimism or defeatism. She's playing the victim and refusing to even TRY to resist whatever urges pop into her head. She feels like it's out of her control but I have trouble believing it really is.

Wow. Perhaps conditions like ADHD and Anxiety are compounded by the invalidating behavior of people like you? It’s great that your “can do” worldview has worked so well for you but you need to consider how denying your fiancées conditions impacts her.
posted by mlis at 8:16 PM on December 17, 2009 [10 favorites]

I tend to agree with people like Thomas Szasz and the "anti-psychiatry" movement that these conditions are real but not necessarily best treated medically.

It would be perfectly appropriate for you to make decisions based on this philosophy for your own treatment, as long as it was having outcomes you desired, but not for someone else's. Not ever for someone else.

I agree that you're overstepping your bounds. This isn't about you. You seem very much involved in her problems and seem to think you need to help her in working through them. It's actually her work to do; you can't do it - it's not possible - and by getting involved, you put a strain on your relationship. You can best help her by just encouraging her to do what she needs to do, as defined by her and her professional helpers, and then being supportive.


how can I internalize the fact that some people literally cannot will themselves through adversity the way I've always done? It's almost impossible for me to accept, as it flies in the face of a lifetime of personal experience and seems ludicrous to me.


One of the shocking things about life is the profound understanding that our own experiences are not the be-all and end-all; they aren't a signal of truth. We are all seeing through a glass, darkly. So I advise you to just accept it. You can see that not all people can "will themselves through adversity." Perhaps you are more fortunate than others in having more skills or more sources of support or better early life lessons; more naturally gifted; or just less afflicted with problematic personality difficulties which are, nonetheless, quite real to others. You are very lucky to feel so strong (though of course, over-reliance on self can cause problems too!). But not everyone is graced with your abilities. Not everyone will live up to your standards or adhere to behaviors which you endorse. People aren't controllable by others.

Your fiance is having good success pursuing treatment. It's her life and her job to work on her issues. Be supportive, but don't try to get involved in her treatment. Keep your hands to yourself. It matters very little what you think about her path. What matters is whether you can love her and live with her as she is, even if she never changed from the way she is today. If that's not true, if you couldn't accept her without her changing in ways you approve of, you might want to reconsider that 'fiance' status.
posted by Miko at 8:21 PM on December 17, 2009 [13 favorites]

Sometimes when people are angry, they don't want to be told to "calm down." I find this infuriating myself. Rather, they want validation. "You sound really angry" can go a lot further than "Calm down." You're jumping ahead to problem solving while she's still in the midst of dealing with her strong emotions over the issue.

I feel for your fiancee. She's engaged to someone who thinks her major health issues can pretty much be overcome by the power of positive thinking.

It sounds like counseling worked for you... did it work for her? I wonder if it might be of some benefit for you all to talk to someone who understands what she's dealing with and who can help interpret that for you.

Ultimately, this seems like a relationship-ending conflict. But if you really want to work through this, I think the first thing you need to do is trust her.
posted by bluedaisy at 8:22 PM on December 17, 2009 [5 favorites]

Meds are between her & her medical support. Based solely on what I've read here, you're attempting to fix her, as mentioned above. You can't, and it'll infuriate her to no end when you try.

To be honest, I'm not sure why she'd stay with someone who saw her mood disorder and ADD as character faults. I strongly sense if her issue was schizophrenia you'd feel differently about psychiatry.

Don't try to fix it, or fix her. If you really can't deal with the medical issues that she has, do the both of you a favor and find a partner you can accept for who she is, not someone you think she could be.
posted by Salmonberry at 8:25 PM on December 17, 2009 [3 favorites]

I've had a pretty close relationship with someone who suffered from depression and anxiety, and I have to say, on this one the best thing you can do is to just be supportive of her. She probably has triggers that upset her or make things worse (for my acquaintance, touching was one of them, so the arm around the shoulder wouldn't have been helping), what you want to do is work out what they are and avoid them. When she's anxious or getting worked up, talking about how you'll work around the problem is probably something that has to wait for a little bit, don't focus on that immediately, focus on giving her what she needs to relax (again, this is something you'll need to learn, in my friends case it was just being quiet, and maybe verbally reassuring her that she'd be okay, instead of trying to talk more about what was upsetting her.)

Let me just say right now, when you think your fiance is choosing to be the victim, within my experience people do not choose this! It is difficult and frightening and it can kill their self esteem and drive their loved ones away. In the same way that when people with depression just can't bring themselves to get out of bed, it's not because they're lazy.

I'm afraid that I couldn't tell you how to understand what she's going through, because I could never quite understand it myself. What you need to understand instead is that this is a very real thing which does affect her life, and is a lot harder for her than it is for you. You need to understand is that it's not about you, and it's not your fault, but it's there and you can't just reach in and take it away by being extra nice to her. I really wish you could? But I'm afraid that's not how it works.

In the case of my friend, after some changes in her life (pretty major ones) she happened to run out of medication while on a holiday, and discovered that in the days where she wasn't taking them any longer she was no longer experiencing the anxiety or depression that had caused her to first get the prescribed. So she simply never got them refilled, and has never been happier. I really hope that this will eventually happen to your fiance as well, but it has to be when she's ready. My friend had been on pills for nearly three years when this happened and when she ran out of medication previously the difference had been obvious and incredibly upsetting for her and those around her. If your fiance needs them now, then I assure you she DOES need them, and isn't just taking them out of a spate of teen angst.
posted by emperor.seamus at 8:28 PM on December 17, 2009 [4 favorites]

I'm with ThePinkSuperHero on this one. Speaking as a female who takes SSRIs (anti-anxiety drugs), I can tell you that when I'm upset about something, I don't want someone telling me to calm down. The best thing that my husband does is listen. He doesn't offer advice, or constructive criticism, at least not right away. He nods his head, gives verbal indicators that he's listening, or finds some aspect of my issue that he can agree with. If he can't agree with me, he can at least say something like, "I can see why that might upset you."

You say you want to empathize. That is easy -- you just do it! When someone is freaking out, all you have to do is listen, and do NOT disagree with anything the other person says. If you do disagree with a particular point, just don't acknowledge that point at that moment. Wait until things have calmed down (maybe an hour or more), and bring up those discussion points at that time.

Nothing helps me get over a bad mood, batch of anxiety, or whatever, faster than my husband basically agreeing with me and kissing my butt for just a little while (as little as 10 minutes of butt-kissing and I'm one happy woman!).

I hope this helps. I also agree with others' posts that indicate that it's YOU that needs to adapt to HER, and let her decide when and if she can ever get off of her meds. Best of luck!
posted by wwartorff at 8:38 PM on December 17, 2009 [2 favorites]

Trying to wean her off of her medications without full support from her doctor is an awful, awful idea.
posted by kylej at 8:40 PM on December 17, 2009 [1 favorite]

My instinct, my deep desire, is to try to wean my fiancee off her meds (which she freely admits to hating for a number of reasons) and transition to a better-structured, calmer lifestyle. To help her rein in her issues sans pharmaceuticals.

This is inappropriately controlling.

Have you asked her, in a calm time, what you could do to help her? You're assuming you know better than she does.
posted by liketitanic at 8:40 PM on December 17, 2009 [8 favorites]

If and when your girlfriend decides she's ready to fight her internal battles without meds, it'll be her decision, not yours. Until then, respect her right to choose to take the meds. You do not need to understand it. You need to respect it and stop judging her.

Use the massive amount of will power you suggest you possess to change YOUR thoughts about this. Remind yourself that you are not inside her head. You do not know how she feels because your reality is separate from hers. You have not experienced the same things she is experiencing because no two people ever can. Therefore, you cannot impose your methods of super-powered self control onto her.

Telling someone in a panic state to relax is actually pretty insulting. Don't you think she would take a deep breath and relax through it if she could? Do you really think she's just being stubborn? I assure you that she does not enjoy having anxiety attacks. And she probably doesn't enjoy experiencing your judgement and (probably from her perspective) condescension when it happens either.

Ask her what she needs from you when she's having an anxiety attack. Your throwaway email handle is "empathy trouble" and you're exactly right. Empathy is the thing you are missing and probably the thing she needs most. Here's the thing about empathy: You don't have to understand the context of a person's emotions in order to validate the content. What she's experiencing is horribly and scary and painful. You understand horrible, scary, and painful, right? There's your empathy.
posted by dchrssyr at 8:40 PM on December 17, 2009 [13 favorites]

This doesn't sound like it will end well.

Putting aside your dubious dubiousness about medical problems that a doctor would be better equipped to diagnose and treat, this is very similar to tonnes of those "I thought they would change!" threads.

They ain't gonna change, and it's not your job to try and change em. You may feel that you want a happy girlfriend because happy is good, or simply because it would make you happy, but you need to accept what you have or move on. If you can't support her, maybe you shouldn't be together, because over a long relationship things will definitely be worse than they are now at some points.
posted by smoke at 8:42 PM on December 17, 2009

Maybe this can help you empathize. Look, we're all different. None us look the same, sound the same, move the same, act the same, etc. We're all from different places with different upbringings and different experiences. No two people are the same. And no two brains are the same. The brain is a crazy, scary, wonderful thing and there are still some things that even the most genius experts don't know about it. So to say that certain conditions aren't possible is truly ignorant. Don't invalidate your fiancee because she doesn't see the world through your eyes.
posted by MaryDellamorte at 8:43 PM on December 17, 2009 [1 favorite]

Let things just be. Pay more attention to your own needs and back off. It sounds like she is your project. When you back off you'll both be happier and she will most likely be less anxious. You cannot "fix" her. You cannot inject her with confidence or rewire her brain.

Instead of preaching, support. In highly anxious times, you probably don't need to speak, just be there if you sense she would desire your presence. Watch and listen instead of rushing in to save her from herself. Instead of pretending that you have it all figured out, show some vulnerability and admit that you're not as well-adjusted as you claim. Be a friend above all else. Nobody needs a life coach for a partner.
posted by Fairchild at 8:47 PM on December 17, 2009 [1 favorite]

I feel that on some subconscious level, she's just lacking confidence in herself, being stubborn, and refusing to take responsibility for her behavior.

Are you sure this is only subconscious?

I have a suspicion that she is reading these beliefs loud and clear, which is, speaking as someone who has struggled with depression/anxiety, the worst thing for her to hear right now.

When people are depressed, suffering an anxiety attack, or in the throes of ADD, most of the time they know exactly what it is they should be doing. If they're depressed, they should just go take a walk or talk to a friend. If they're anxious, they should just take deep breaths and gain some perspective on their fears. If they're suffering through ADD, they should just make and follow a list of their tasks for the day. What do all of these disorders have in common? They affect motivation, that essential tool that helps you bridge the gap between knowing you should do something and actually doing it. For whatever reason, your fiance's brain is not currently equipped to provide that motivation, and I can guarantee you that it already weighs on her deeply. This is not a personality deficit, laziness or stubbornness; it is a problem that should be taken seriously, and dealt with by trained physicians, psychiatrists and therapists.
posted by sarahsynonymous at 8:49 PM on December 17, 2009 [11 favorites]

You'll find the best persuasion to be leaving her alone until she's figured it out on her own.
posted by Ironmouth at 8:50 PM on December 17, 2009

*sigh* When I read your question I knew you were going to get attacked immediately.

I totally agree with you about having to 'look inside yourself' first, realizing that making yourself angry or worried isn't making you feel better, etc. And I agree with whoever above said that girls (and maybe guys too?) just want to complain and don't always want their problems fixed.

But your question is how to fix the problem if you're not allowed to fix it, right? I don't know how to answer your question. The only thing I can say is get her to exercise if she doesn't. The couple of friends I have who are on anxiety or depression meds say that they felt so much better when they exercised and ran, but they don't do it because they're too anxious and depressed and taking charge of your condition is a no-no, apparently. So yea, go for a hike with her or something, get her to be active WITHOUT telling her this this is you trying to fix her.

But like most have said, this problem might not go away, and the best you might be able to do is listen, and once in a while express your concern over the meds (and upping the dose, eek!) because you care about her.
posted by KateHasQuestions at 8:58 PM on December 17, 2009

How can I understand, and empathize, with my fiancee's psychological issues?

Try volunteering with the disabled or the homeless. It seems as though you had an excellent upbringing and were instilled with a lot good values. However, you never seemed to learn that not everyone is like you or will live up to your values and that that is ok. Not everyone was told that "anything is possible if you put your mind to it," in fact some were repeatedly told the exact opposite since they were kids. Not everyone is "well-adjusted" or "psychologically healthy" and frankly until you've seen and truly understand that some people aren't and are still worthy of love and respect, then you're not going to be able to help your fiancee.

To put in it more simplistic terms: Lots of people like pecan pie. I can't stand it. People telling that I should like pecan pie doesn't do a damn thing to make me like it, all it does is annoy me and push me further away because they're clearly not accepting of my view on the subject. Their insistence that their view is the only view implies that I am somehow wrong or something is wrong with me. I imagine that's the feeling is similar to the one your fiancee is feeling when you try to make her conform to your world view. Don't do that. Give her the space and time she needs to cope with things in her own way and if you can't handle that, then maybe this marriage isn't for you. I don't say that lightly, but I do believe it's something worth thinking about.

If you can't understand someone, how can you truly love them enough to want to spend the rest of your life with them?
posted by Brandon Blatcher at 8:59 PM on December 17, 2009 [6 favorites]

People are treating you with kid gloves. Both your beliefs and your actions are totally off the wall, and I pity your fiancee.

You believe that your fiancee's medical issues are "in her head" because of some shallow No Fear-esque beliefs in your own ability to supposedly "will yourself" through adversity. You ignore decades of medical research and endorse the views of a fringe movement because it supports your beliefs. That's like someone believing that cancer is God's punishment for non-believers because you're a Christian and you're cancer-free.

Also, you want to override your fiancee's doctor and take control of her mental health. If she was suffering from, well, cancer (hate to use the same metaphor twice, but whatever), would you drag her out of the hospital and take her to a faith healer? Would that sound like normal behaviour?

An example... something unexpected happens and her anxiety flares up. I try to calm her down. "It's okay," I say softly. I put my arm around her and breathe slowly so she can synchronize with me. I remind her that it's not the end of the world, that we can improvise and work around the obstacle. Her reaction is unexpected to me. She gets angry. "I can't calm down," she snaps.

As you note, this is not a rational response. Doesn't that indicate to you that there is a serious underlying issue beyond "lack of confidence"?

It pains me to see her chemically addicted to mind-altering drugs that, as far as I can tell, only mask the symptoms instead of addressing the underlying cause.

Wow, you sure can tell a lot considering that none of this is happening to you. You've superimposed your belief in fringe psychology to determine the effectiveness of drugs you know nothing about.

If you think I'm wrong (and I'm sure many here will), how can I internalize the fact that some people literally cannot will themselves through adversity the way I've always done? It's almost impossible for me to accept, as it flies in the face of a lifetime of personal experience and seems ludicrous to me.

Perhaps stop being so arrogant that your presume to know everything about life and they way it should be lived, and recognize that there are many things you know nothing about. Or else move on....
posted by hiteleven at 9:01 PM on December 17, 2009 [34 favorites]

I am a rational logical linear thinking person. I am stubborn. I too believe in the power of the mind first, drugs second. One of the differences between your theories and mine is that I think a person only has so much discipline at one time. If I need to be on a diet, I can easily, but I usually lose my discipline in another facet of my life. I married a woman who has depression and anxiety issues. One of my children has clear social anxiety issues.

I tell you all this because, quite frankly, my relationships have suffered because of my stubborn belief that the way I am wired is the same way either everyone is or everyone could be. It works for me, why not them? NOT. I have no specific advice other than sounding like my father when I say take it from me, do not impose your thinking on someone who is not a believer. Either retrain yourself to live with it or accept that while you love this person, you will be in conflict a lot. I have lived with it for so long, I now grapple with the thought that it is really my problem not hers because I am the one not willing to change and look at it differently.

What I am trying to say is, you may be right in some theoretical sense, but in the real world of your fiancee's head, you are so wrong and have no hope of changing it in a time frame that you can imagine.
posted by JohnnyGunn at 9:01 PM on December 17, 2009 [1 favorite]

My instinct, my deep desire, is to try to wean my fiancee off her meds (which she freely admits to hating for a number of reasons) and transition to a better-structured, calmer lifestyle. I feel some urgency, because doing nothing is unsustainable in the long term -- she continues to increase her dosage every few years just to get the same effects.

You have absolutely no right (or basis) to try to force this kind of medical decision. You are effectively trying to take on the role of her prescribing doctor/therapist/whoever, without the knowledge, training, or objectivity to be anything like an appropriate person for this role.
posted by advil at 9:08 PM on December 17, 2009

how can I internalize the fact that some people literally cannot will themselves through adversity the way I've always done? It's almost impossible for me to accept, as it flies in the face of a lifetime of personal experience and seems ludicrous to me.

I don't know how old you are, but you sound very young and/or very sheltered. Any experience with someone struggling from alcoholism, mental illness or drug addiction would disabuse you of that rosy mindset pretty quickly Just because you haven't experienced it, doesn't mean it's not real. That's what you have to accept.

You might find this informative: Understanding the Anxious Mind. People have different anxiety baselines. This isn't about willpower, it's something about neurological development that we're just beginning to understand.

It sounds like not so much a lack of empathy, but a lack of respect - if not for your fiancee, then for what she's struggling with. You have no experience dealing with this, ... and yet you think that she wouldn't need the medication if she'd only get a grip?

Stop trying to immediately to calm her down when she's anxious. Have you asked her what she thinks would help in this situation? Maybe she can suggest a more helpful response. Even starting with something like, "You sound really upset. Can I do anything to help?"

she's fully convinced that her issues are 100% chemical and that there are no viable alternatives to prescription drugs. This is where I find it very hard to put myself in her shoes:

Does she believe she functions better on the medication than off? Unless you believe otherwise, take her word for it. You don't need to put yourself in her shoes, you need to trust her that she knows her own mind.

She might benefit from CBT - my opinion (and what I've read and experienced) is that the medications enable someone to do the hard work. They're not a panaceaa, they just give you the mental space to start actively working on your issues - preferably with a trained professional. I'm assuming if she's on those meds that she's already seeing someone semi-regularly? (hoping a counselor and not just the prescriber) Does she feel that's helping her?

Does she feel like she spends a lot of time anxious or upset? If this is how she is for the rest of her life.. are you okay with that? Could you make a life with her? Do you feel that she's working at improving her coping skills?

Please do not get married until you can answer all of those questions affirmatively - particularly the last one. This is not going to be a quick fix - and it will only happen if she is actively working on it - and if you believe her and support her on her terms.
posted by canine epigram at 9:10 PM on December 17, 2009 [7 favorites]

I happen to be a woman who has been diagnosed with general anxiety issues and ADD. I take meds/have taken meds for both. It's a bad scene. The anxiety meds fog up your brain and the ADD meds ramp up your anxiety levels. But, at this point in my life, I've found it difficult to function without the support of several medications.

My husband, on the other hand, does not have any of the same issues mentally. He is adept at dealing with his problems as you say you are. However, he has an incredibly different approach to my mental difficulties. Perhaps it is because he was dating me when I was initially diagnosed with them? I don't know.

He is, as always, my main support structure when I am feeling particularly anxious or having difficulty focusing. He's always there when I need him but doesn't reach out unless I initiate it. He's never made me feel bad about the fact that I take medications or that I have these conditions which makes it a hell of a lot easier to confide in him and seek support when I am feeling stressed. I can't see your fiance having an easy time approaching her with her problems to work on them with you if you are refusing to even really acknowledge them.

You need to do some research on strategies for calming and focus that are used by actual sufferers of ADD and anxiety. Read some books on the subjects. I personally found "Driven to Distraction" an absolutely fascinating read. I discussed all my findings with my spouse so he could understand better. My parents, on the other hand, refused to read it when I offered it and remained solid in their opinion that most of my problems were "made up". I don't seek my parents help with controlling my issues; I do actively seek out my husband. You need to support your future wife "in sickness and in health" as the churchy phrase goes. The first step for providing this kind of support is understanding the issues your wife has.

Feel free to MeMail me with any questions and so on. I'm also a medical professional (who's exhaustively researched most meds for both conditions due to having them) and can speak with some knowledge on the subject, however, IANYNurse.
posted by nursegracer at 9:15 PM on December 17, 2009 [4 favorites]

BTW CBT got me off my anxiety meds. It worked where normal psychotherapy stopped working. Totally worth trying in my opinion. I agree in many cases the meds should not be a permanent solution. Side effects suck, they are expensive, they cause you to worry about having them or not....but if you need them, you need them for now.
posted by nursegracer at 9:18 PM on December 17, 2009

I'll add this: you and your fiance are together because you two are very much alike.

You have anxiety issues: I desperately want to help her get past these emotions, which will eat her up inside and make her miserable; training myself to overcome them was one of the best decisions I ever made.

You have a highly-structured mechanism for dealing with them, a sort of rationally-optimized system of denial. Her attempts to cope clash directly with your high-maintenance system. You have an obvious strong need to have her abandon her system of coping and adopt yours. That signals that you might be aware of some disadvantages of your system. Let me put it this way. Your coping system is based on an academic movement against another method of coping. This suggests to me a strong fear of that coping system and feeling the emotions that go with it.

Normally I usually would say that as readers we really have no idea what's going on but you wrote a lot more about your system of dealing with these feelings than hers. Indeed your description of her system is highly colored with descriptions couched in your belief system and side of the argument.

I'm going to suggest something radical--that in a controlled and safe environment, you let yourself try her method of coping--riding out the difficult parts while feeling things. You'll get a great perspective on what she's doing and start to understand that far from being disadvantageous, her system in some respects posseses some advantages over yours. Don't be afraid, she has a lot to teach you.
posted by Ironmouth at 9:21 PM on December 17, 2009 [7 favorites]

But your question is how to fix the problem if you're not allowed to fix it, right? I don't know how to answer your question.

He can't - and shouldn't try. Rather, he should find a way to support and encourage her and decide if who she is right here and now is who he wants to marry.

One of the most painful lessons I've learned was from a relationship with someone suffering from chronic depression whom I loved very much.

You can't save anybody but yourself.
and if you keep trying to 'fix' your partner, what does that say about you?
posted by canine epigram at 9:21 PM on December 17, 2009 [2 favorites]

Your attempts to help her in the moment (and long-term) aren't helping her because she is flawed, they aren't helping her because you're not very good at coming up with techniques to help her, or responding to her feedback by changing your behavior.

You don't have to know how to calm her down or fix her life. I presume you have your own job, skills, talents, responsibilities. Therapists (and other mental health professionals) also have their own job, skills, talents, responsibilities. You can't do what you do and be a qualified and talented therapist. That's why your efforts aren't working. At this point, you are not just lacking empathy, but knowledge and skills.

If you want to read books about ADD, they're out there. Try Driven to Distraction. It was written by two doctors who went to Harvard Medical school, and they have ADD. They probably know more than you do about the subject. Again, you have your own realms of knowledge. They have theirs. It has personal anecdotes from people who have ADD which I found helpful as a way to learn about the way that ADD "feels". Maybe that would help you?

I do sympathize about the medications ever increasing--but she will not be able to get the confidence to change her treatment if you disbelieve her, insist on "helping" her in ways that she has told you do not help, and otherwise act as though she is incompetent to help herself. It will not help her to proactively change her treatment. Instead, it will lower her confidence in her own judgment, and drive her to listen to the person who seems to know the most. That is obviously not you, it is her doctor. That is why she is listening to her doctor instead of considering her options with an open mind (if, indeed, that is what she's doing).

In the end, empathy is an action--you express it in various ways. Try looking up active listening, ask her what will help her and doing it, and as I mentioned above, reading more and educating yourself about the experience of people with ADD.

And, as someone who takes meds for ADD, they've helped more than anything else I've done--therapy doesn't work when you can't organize your thoughts, say what you want to say (word retrieval difficulties), remember to go to the appointment, figure out how to get insurance to pay, etc.
posted by kathrineg at 9:29 PM on December 17, 2009 [1 favorite]

"Your attempts to help her in the moment (and long-term) aren't helping her because she is flawed, "

Should read, your attempts to help her in the moment (and long-term) aren't helping her--not because she's flawed; they aren't helping her because you're not very good at coming up with techniques to help her, or responding to her feedback by changing your behavior.
posted by kathrineg at 9:32 PM on December 17, 2009

I feel that on some subconscious level, she's just lacking confidence in herself, being stubborn, and refusing to take responsibility for her behavior. She's not doing it intentionally, I know.

I think you need to grasp, perhaps by individual discussions with a social worker or other counselor, that mental illnesses are not character defects and do not merely go away if one chases external goals hard enough/ works longer hours/ somehow fits a particular stereotype of the self-made individual. There may well be many other things in life that one can obtain merely by "wanting it enough," but mental health is not one of them.

You were raised to be self-confident and responsible, but it doesn't sound like compassion was considered of equal virtue, and your beliefs about your fiancee's condition are tinged with contempt on first reading-- "she doesn't work hard enough/ she doesn't act like I do, therefore it's wrong and bad of her to feel anxious and have problems with concentration."

Also, Szasz is often an apologist for Scientology and helped them with the foundation of their "Citizens' Commission for Human Rights." As a self-made man yourself, surely you're not a big fan of false "religions" that rely on scams and slave labor to make their way in the world?
posted by fairytale of los angeles at 9:34 PM on December 17, 2009 [5 favorites]

i too had, and grew up with, the same philosophy that you did…until the day i found myself in a deep depressive episode that lasted for months and took nearly a year todeal with. since then, i have had another episode lasting almost a year and a half. i have also developed severe anxiety at times and been diagnosed with ADD. i don't think that i am being facetious when i say that medication (and therapy) saved my life. and while i am doing fine now, my anxiety attacks still happen occasionally and i fear my next depressive episode. i am still on medication and am very cautious about doing the things that help with depression.

i was (and still am) a very positive and optimistic person whose discipline and strength has gotten me through a lot of difficulties growing up so it was very difficult for my friends to understand my depression. in fact, the first time it happened, my two best friends told me to just "get over myself"—as if i was choosing to be unhappy and not get out of my bed every day. my illness is a result of both psychological issues and chemical imbalances. like you, my family does not understand either but unlike you, they at least have the respect not to pressure me about how i am dealing with my illness and that it is somehow wrong.

you're not helping your fiancée by insisting this is all in her head and that if she just got over herself, she'd be all better. if that was true, i would not have depression/anxiety and ADD that is sometimes almost crippling. in fact, your pressuring her is probably only adding to her anxiety.

respect that you have a different pyscho-biological make-up than your fiancée. she's dealing with it in a way that is working for her as best she can. be supportive rather than continuing with the belief that you can somehow "fix" her.
posted by violetk at 9:34 PM on December 17, 2009 [4 favorites]

Seconding a lot of the answers here.

I used to be vehemently anti-medication (for myself) until I got so severely, completely anxious that no amount of talk therapy was going to fix it by itself. And it's not from laziness or a lack of responsibility or self-confidence (though certainly the anxiety does a number on self-confidence). If I'm too terrified to get out of bed in the morning, it's not that I don't realize this is irrational. I am perfectly aware there is nothing dangerous out there. But that doesn't stop me from feeling terrified.

But I get up anyway, because I have to take the dog out. And on the way outside the dog starts barking, and one of my neighbors comes out to ask me if I could please move the dog along faster, because they're trying to work. (This of course makes the dog bark more.) A healthy, rational person would shrug this off, perhaps feeling mildly guilty, and get on with their day. Not me. Oh my God, they hate me. My neighbor hates me. My neighbor is thinking horrible things about me right now. They all hate me. I'm such a failure. I have to get away. I'm going to have a panic attack right now. I have to get inside. I can't breathe. My hands are going numb. My face is going numb. Oh god oh god I'm dying. My chest hurts. I can't breathe.

Of course I know this is not rational, and that makes it even worse. Of course I know it's not really the end of the world. But I feel like I'm dying and I can't fucking think about anything else, okay? Imagine there's a tiger after you or something. That's how I feel.

(Some people might like the hugging and the breathing advice. It doesn't sound like your girlfriend is one of those people. If you're really determined to help her when she's been having a panic attack, ask her what you can do... but ask when she's not having a panic attack. And try to be okay with it if she says there's nothing you can do. Because maybe there's not.)

It is possible (I am told), with enough therapy, to get to the point where you can not have the thoughts that lead to your triggers. To get to the point where it doesn't feel like the anxiety's got you and you're having all these stupid, horrible, over-the-top reactions to everything, and then as a bonus the anxiety makes you depressed. But if the drugs are working right, they make it a little better. They make you not want to kill yourself today, and maybe they help you not overreact when you make a mistake. Some of us can't just will ourselves through adversity. The medication is there to help. (And be glad she's found medication that works for her. I am jealous.)

I am not your girlfriend's therapist or prescriber, but one of the ways medication is commonly used for anxiety is to lessen it so that the talk therapy (CBT, DBT, EMDR, mindfulness, whatever) can fix the underlying problems, after which the medication can be titrated down. It doesn't sound like your girlfriend's there yet, and she's sure not gonna get there by you telling her to calm down.
posted by sineala at 9:34 PM on December 17, 2009 [5 favorites]

If something's wrong with the way your brain works, you can't use your brain to fix it.
posted by you're a kitty! at 9:36 PM on December 17, 2009 [35 favorites]

Something I learned when dealing with depression and anxiety: It's damn hard to pick yourself up by your bootstraps when there are no damned bootstraps anymore.

I'm from the Midwest. I'm German. I know about being stoic and muscling through things. Sometimes that can be really fucking harmful. Telling someone to suck it up (even if it's you telling yourself to suck it up), and to essentially ignore the problem (which is what my own stoicism meant) isn't fixing the problem, or even putting a band-aid on it. It's stuffing it down for the time being, until it re-emerges and is even stronger.
posted by runningwithscissors at 9:44 PM on December 17, 2009 [2 favorites]

I try endlessly to work through every bump in the road, just as was recommended, and seem to end up worse for my efforts

I think you need to back off and stop trying to "manage" her problem. I can't think of many people who wouldn't find that extremely patronizing.

I think your anxiety about her anxiety is a form of empathy, and just as you should give her room to work through hers, so should you make room to look at yourself and question some of these "truths" about yourself that you seem to take for granted.

how can I internalize the fact that some people literally cannot will themselves through adversity the way I've always done?

By recognizing that so far you've failed to will yourself (as well as her) through this particular problem. Seriously, you've tried your way, and it hasn't worked. Remember that the next time you feel yourself stepping forward to lead the way.
posted by hermitosis at 10:12 PM on December 17, 2009 [1 favorite]

How can I come to understand her feeling of powerlessness?

Let's start with: This is where I find it very hard to put myself in her shoes: she insists that she has no self-control ...

An anxiety attack is a physiological response triggered by any number of things. It is the body preparing itself to enter a fight or flight situation. The heart starts racing, and the body releases adrenaline. Once you are in that state, no, you can't calm down until the episode is finished. It would be like trying to tell someone to calm down while he or she was being chased by a lion -- it's ridiculous and unhelpful. Also, as someone prone to panic attacks, I can say that logical thinking plays no part in it whatsoever. I mean, when I'm having a panic attack, I'm certainly aware that I'm having one and that, y'know, having to go to work or pay the phone bill or interact with people at the grocery store are, obviously, logically, not good reasons to have a fight or flight response. It is a physiological thing, not a matter of choice.

I have found that CBT has helped me quite a bit with anxiety issues. After three years, I'm down from at least one attack a week to maybe only three or four over the past six months.

But, yes, you need to understand that these are real things with which she has to deal all the time, not some sort of lack of mental fortitude or faulty decision making. Failing to acknowledge this is, at best, insulting.
posted by The Great Big Mulp at 10:13 PM on December 17, 2009 [2 favorites]

Look; you can know something intellectually, which covers everything you articulated at length about mental health -- but emotions and physical reactions to those emotions are not something that can be INTELLECTUALIZED away. Seriously. How else could you explain things like phantom limb pain, multiple personalities, schizophrenia and PTSD?

You can't understand why she needs the meds because you haven't been in the physical and emotional states of distress she's been in yourself.

There was a time in my life when I was so stressed out I was always dialed to 11. As in, if I fell asleep for a nap before going out on a Friday and woke up 10 minutes later than the alarm was set for because I had accidentally turned the volume down too low to hear it, I'd jump out of bed and rip my bedroom door off the hinges.

This actually happened. I had been dead asleep less than 5 minutes before. And I was ALWAYS this angry, nervous, panicky; I had been for so long, had slept so little, eaten poorly and had nightmares so frequently that I literally was vomiting and screaming until I lost my voice and all kinds of crazy shit that would've shamed anyone in their right mind, especially at work. If your lady has ever been pushed to 11 for a prolonged period of time, and is now able to function normally due to the medication she's on... well, I've been there.

I weaned off after 11 months by tapering down my meds gradually, learning self-hypnosis and CBT. You can suggest that and help her and support her continuing with non-medication based therapy, but you cannot force her to do it; she must agree. And you need an excellent therapist, too. TAPER SLOWLY, she could have a seizure. Boy, you'd feel like a jerk then with all this "it's in your head" talk if she seized; then she'd NEVER want to try and stop the meds... but anyway. That's not going to happen because you both know better.

Part of me hopes you never understand what she feels emotionally or physically, but being dismissive is not helpful. Nobody wants to be sad, isolated, anxious, afraid or ashamed. Nobody chooses to feel unfocused and anxious and depressed, especially not frequently (or with a dubious significant other being unsupportive about it).

I don't know how you're going to develop empathy. Have you seen her have a panic attack before? Have you seen her go for days without bathing, eating, crying, etc. until she is sick from apathy or depression? You don't know what she's like unme. Those things could happen once she stops meds. Clinical depression is real; people kill themselves, people that have everything and should be happy. Wouldn't they choose not to, if they could resist the urge -- logically? But they can't.

You might find out the hard way that both of you are happier with her on the medications, but seeing both a psychologist and a CBT specialist who agree in their independent diagnoses and treatment protocols can be very reassuring to all parties.

I certainly agree with you that it's worth trying to wean down medically and try alternate therapies for her issues, but you should discuss openly (and agree) as a couple what will happen if these efforts fail. If you can't live with her being on medication for the long term, are you willing to end the relationship? Bear in mind that one of the basic tenets of love is acceptance (within reason, of course).
posted by Unicorn on the cob at 10:13 PM on December 17, 2009 [3 favorites]

I agree with you that all of these psychological issues are just made up. I always did. They're not real. Uuuuntil they happen to you. Then they are, and you're like WTF is this? And then you're like ohhh no. Ohhh no. I told all those people they needed to just quit whining and now I see. Oh crap, oh crap. Having the problems is bad enough - there's so much frustration and shame wrapped up in even admitting you have them and then living with them - and then you've got the guilt for being such a self-assured jerk about it and invalidating other people's realities like you had any clue what they were going through. You feel so arrogant and you can't go back and fix it. That is all just to say I've been where you are. And when you say you don't understand, you are 100% right - you don't understand because you couldn't possibly understand until it happens to you. It's not real until it does.

Your initial question was how can you understand and empathize with her issues. I'm of the opinion that you can't. But I think there is a way for you to deal with the situation.

The first requirement is trust. Trust that she actually feels the way she says she does. I see your reasons for doubting it and they're understandable. Maybe she wasn't given the right guidance, maybe doctors are just dominating her or not paying close enough attention to her as an individual, or she's slipped into bad patterns or whatever. But for the sake of finding a system that works, just go ahead and accept on blind faith that she has actual problems and they make her feel just like she says they do. Put that behind you.

Secondly, since you can't understand, what you need is a placeholder. If you were dealing with a clone of you, you could say, well you're not making any sense - see here... You'd explain your logic and your clone would go - yes, I see now. That's not going to happen in this case. You need to stick a placeholder where this particular chunk of logic would normally go. When she behaves a certain way, and it gets to the part you don't understand, your placeholder will be there to fill the gap. It's just an empty block - there's nothing to understand. It's just a bridge that allows you to get from point A to point B over an obscured pit of unknown depth or contents. Essentially this is just acceptance. "This is the way my fiancee is in this kind of situation." Don't try to go further than that.

At that point, see all of the good advice above about how she has to self-direct on this, YANAD, your job is to support, etc.

In regard to her thought that there is no alternative to prescription drugs, it's possible she's right in her particular situation, but also possible that there are other options. Some people have mentioned exercise, diet, therapy, CBT, etc. It's possible those things could be used in concert with meds or instead of them. If she wants to try those things, support her and help her with them. If not, you have to take what you get or take a hike.

You're probably right that your upbringing and life experience have left you with a healthier outlook and better coping skills. So to the degree you can always give her encouragement about persevering and looking on the bright side and all that, that's great. She'll continue to grow just like anyone and you'll be a major influence on her life. She'll watch you go through tough times and see how you handle it and over time that may help alter her perspective. Maybe. CBT could probably aid in that transition too.

But as canine epigram mentioned upthread, people's anxiety baseline is hardwired at least in part. If it was just something that people developed over time as they grew up, it could perhaps be explained by them not getting good guidance or losing self confidence or whatever. But when the differences are noticeable even in infants or as some mothers would say even in very young babies, there's clearly something more going on than just outlook, and it gives weight to the idea that there are chemical/neurological things about us that just are. We didn't choose them and we didn't invent them. Good luck.
posted by kookoobirdz at 10:14 PM on December 17, 2009 [9 favorites]

Everyone has already given you really good advice, but let me give you some more good advice:

You are not a doctor. You are not a psychologist. STOP TRYING TO MAKE DECISIONS ABOUT YOUR FIANCEE'S HEALTH CARE. You can be a support person, you can offer advice WHEN SHE ASKS FOR IT, but someone who is trying to force their will on their partner about how that partner should do health care--when the health care is gold-standard modern health care practice--is being inappropriate at best, abusive at worst.

If your fiancee had diabetes, would you insist that she just needed to exert enough willpower to control her symptoms 100% through food choices and exercise, so she could get off that pesky insulin? Maybe you would, but if you would please realize that that is fucked up and controlling.

Some people can manage ADHD and anxiety without medication. You have no idea about whether or not your fiancee can, and therefore you need to LEAVE THAT DECISION UP TO HER AND HER DOCTORS.

You know who needs therapy in this relationship? You. For your insane control needs. This is fucked up and you need to stop it. You need to stop trying to control your fiancee before she is your wife, and you need to get a handle on your control issues before you have kids.
posted by Sidhedevil at 10:15 PM on December 17, 2009 [7 favorites]

Whoops, unme - unmedicated. It's late :(
posted by Unicorn on the cob at 10:16 PM on December 17, 2009

You know, it might help to consider that anxiety is neither good nor bad, but just something that's part of the human experience, and for some people, part of growing. Anxiety isn't something to be conquered or endured. Sometimes it's just to be experienced and explored, because there's something important about understanding the things that scare you, and why they scare you. Sometimes it's just living with the fact that due to genes or socialization, anxiety is just something you just have to learn to live with. And no one else can do that for you. At best, it might help if you stop being the coach/therapist, and just take up being the partner and witness, with good boundaries.

I'm not here to bash you - clearly you want to help. (And I personally think that partners and loved ones are good people to question clinical diagnoses and treatments, including medications and medication efficacy - because they are some of the most up close and personal folks to the person experiencing the situation/taking the medication. And I also think questioning doctors is super healthy.)

All that said, perhaps in more of a witness/partner with good boundaries role, you can reflect back to her that it doesn't seem like the medication is particularly effective, and ask her her views on it. Maybe she needs to switch up her dosage or medication. Maybe she's frustrated that the medication isn't working up to her standards either. Reflecting to her this gives her agency, to take your data point, and add her own, and her doctor's and come up with a response that works for her. (medication and otherwise) In fact I find almost everything about encouraging the person you care for to find their on way of taking care of themselves to be the best option.

Personally, my brother gets super annoyed at situations like you are describing, so when his girlfriend seems to be going down that anxious path, he listens as long as he can, tells her he is confident that she can manage this, and goes and does his own thing. He does not try to talk her out of it - instead he manages his own boundaries. He asks if she needs help, he's responsive if she asks for something specific, but he goes and does his own thing, because watching her dig herself into her own hole is exasperating for him.

But that's normal too. I find many people are not good at watching other people suffer. Or make mistakes.(I know I'm not). With the exception of the horror movie fans, being around someone who is miserable or suffering - and perhaps has a hand in making themselves so - makes people very uncomfortable. Or mad. Or frustrated. Or filled with an overwhelming desire to push the other person out the way and fix it for them. But this isn't something technical, like being better at setting up a new laptop - she's going to have to learn how to manage her anxiety herself. Maybe while she's learning that (or not), maybe you can walk you own path and continue to do what you're doing, which is to learn how to manage your possible feelings of uncomfortableness when someone you love is hurting, and you can't fix it for them. That's an important lesson too, and no one else can do that for you, either.
posted by anitanita at 10:20 PM on December 17, 2009

Maybe it will help you to try to learn about what it is like to have ADD and anxiety disorder. There are many books that describe, from personal experience, what this can be like. Of course it's hard for you to empathize with something you have never experienced. My advice is that you read as many personal, lived testimonials as you can, and educate yourself about the medical bases for the diagnosis. You can say a diagnosis is given out too often or too freely, but at bottom, some people have brain chemistry that is just different and will power doesn't fix that any better than it fixes broken bones.

In case it helps, let me describe one of my panic attacks for you. I was lying in bed trying to fall asleep. I felt very anxious. I became increasingly aware of my breathing. I felt that I was not getting enough air. I also felt that something wasn't right about my heartbeat - either it was beating too fast, or too hard, or both. I don't know if you've ever been seriously injured or very seriously ill, but there is a feeling you can get at such times that something is wrong in your body. I had that feeling of something being wrong. I started yawning to get more air, but I still felt that I wasn't getting enough. I knew, rationally, that I was getting all the air I needed and that nothing was wrong with me, but my emotional state was as though something were seriously wrong. I went to the window and opened it to get more air. I was sweating, my hands were shaking, and I was filled with utter panic. I thought about where the phone was and how close the closest person to me was and tried to plan out what I would do if my heart stopped or I felt myself begin to pass out. My eyes filled with tears. I felt terror crushing me like a great weight. During this time I never lost the intellectual awareness that I was OK, but this did not affect my emotional state very much, except that it kept me from actually dialing 911 or otherwise calling for help. After some time passed, I began to calm down. The physical symptoms I felt, or thought I felt, were very real to me, and I was not able to "turn them off" merely by thinking positive thoughts at them. The panic I felt was extremely powerful, actually more powerful than what I felt when, once, I lost control of my car on the highway (in the left fucking lane, lucky to be alive).

There are things I have been able to do over time to manage this problem, but none of them are of the "just do it" variety. It takes a lot of time and practice to find, for each person, what coping mechanism will help them. This can't come from the outside (you) and be imposed because there isn't a right solution - only the solution that helps. You need to decide what is more important: for this woman to be happy on her own terms, or for her to do things your way. I understand why your way is attractive, since it works for you, but that doesn't mean it will work for her.

It sounds to me like you think your fiance is weak and chooses to avoid doing what's necessary by hiding behind a bullshit diagnosis. That kind of contempt would be a dealbreaker for me in a relationship. I agree with everyone above who has cautioned you not to marry her if you can't accept - and embrace - the possibility that she will never change.
posted by prefpara at 10:30 PM on December 17, 2009 [3 favorites]

There are plenty of answers here, so I'll try to avoid piling on, but it sounds like your techniques are giving her more anxiety and self-doubt about her anxiety and self-doubt. That is not what you should be doing.
posted by ishotjr at 10:32 PM on December 17, 2009 [4 favorites]

It sounds to me like you think your fiance is weak and chooses to avoid doing what's necessary by hiding behind a bullshit diagnosis. That kind of contempt would be a dealbreaker for me in a relationship. I agree with everyone above who has cautioned you not to marry her if you can't accept - and embrace - the possibility that she will never change.

Bingo.

Also, you talk about her behavior, but you don't give any examples. Are you talking about her saying mean things and snapping at you, or temper tantrums with throwing and hitting? Cause if it is the latter, she needs to find a new doctor.

Also, shame doesn't work on someone with anxiety/depression. Rest assured, they feel plenty of it on their own.
posted by gjc at 11:34 PM on December 17, 2009 [7 favorites]

: "My instinct, my deep desire, is to try to wean my fiancee off her meds"

Do not attempt this, or let her attempt it, without the guidance and direct instructions of a physician, whether a psychiatrist or not. Some anxiety and ADD meds can kill you or cause severe withdrawal if you stop them suddenly or do not wean correctly.
posted by IndigoRain at 12:27 AM on December 18, 2009

From what you've written, this seems to be not just a problem of empathy; it is a problem of humility. In a nutshell, it's not that you happen to have one belief about mental health and that your girlfriend has another belief; it's that you believe you know better than your girlfriend and anyone else who is like your girlfriend. And it is on that score that I submit to you the radical notion that you are mistaken.

Empathy -- and its attendant quality, compassion -- can only start with humbly understanding that each of is every bit as human as everyone around us. It comes from setting aside (or at least in the struggle to set aside) our egos, pride, stubbornness, impatience, and contempt... and to sit with the fact that we ourselves are imperfect and simultaneously worthy of acceptance just as those around us are imperfect and simultaneously worthy of acceptance. Your girlfriend is imperfect; she has an anxiety disorder; she still deserves love and respect. You are imperfect; you failed to develop empathy while you were growing up; you still deserve love and respect. See how that works?

If you strip away your mistaken notion of your own superiority (which, as others have noted, carries the risk of ultimately poisoning your relationship), only then you can open up the door to developing empathy. So I would suggest that you put your mind to two things: first, immediately drop all attempts to solve your girlfriend's problems for her, particularly the attempt to force her to adopt your point of view about mental health, medication, etc. (This will probably entail eliminating sentences beginning with such words as "You should..." or "you need to...")

Second, take all that energy and focus that you've been spending trying to solve your girlfriend's problems and turn it into understanding and mindfully addressing your own, through introspection rather than intellectualizing. A good place to start might be reading The Lost Art of Compassion.

Empathy and compassion are gifts we give to others, and to ourselves, on account of us all being human. I hope you will be generous with yourself and with your girlfriend on this score.
posted by scody at 12:45 AM on December 18, 2009 [12 favorites]

Consider this: take ADD and anxiety out of your question, and say that your fiancee has heart disease, and you'd like her to go off her meds...she should control it with exercise and diet.

You're demonstrating a very ugly case of controlling behavior and if you truly believe everything you posted, not only do you need help to understand that people are actually wired differently, but you are undoubtedly causing your fiancee untold anxiety.
posted by dzaz at 2:39 AM on December 18, 2009 [2 favorites]

Agreed with most of the people here that you're probably hurting your fiancee more than helping her with your inability to understand that she really and truly can't will her way out of this.

However, you asked how you can better understand how she could really feel this way, and I have a suggestion. I speak as somebody who basically always thought like you until I was dealing with a mental health situation that I couldn't just "will" my way out of.

Some metaphors:

Imagine yourself on drugs. Any drugs, but the stronger, the better. If it's a hallucinogen, you're seeing bugs crawling the walls. If it's marijuana time has gone all wonky and strange. If it's alcohol things are spinning a bit and everything has that weird sorta-bright tint and everything is way funnier than it should be.

Or, forget the drugs. Have you ever been really sleep deprived? I mean, no sleep for 50+ hours level of sleep deprived? Where you sort of feel like you're walking through molasses, and no matter how hard you try to concentrate the world is just a bit disconnected from everything you do?

Or have you ever been very very feverish? So feverish you can't really control your thoughts and they go around and around and around, or you start seeing things when you close your eyes?

The thing that all of these states have in common with your fiancee's situation is that in none of those situations can you will your way out of them. You can't go up to somebody who is tripping, or very feverish, or incredibly sleep deprived, and tell them to feel normally. With an immense effort of will they might be able to mimic normality for a small amount of time, but it only works very briefly, and often they can't even do that. That is what it feels like to fight your brain chemistry. That is why reasoning with your fiancee -- particularly not when she's in that state -- doesn't work, and in fact is probably very damaging to her self-concept. She is trying to fight something her brain is doing, and sometimes you just can't do that: not from the inside, and especially not while it is happening.

So when you get frustrated with your fiancee, realise that this is where she is coming from. She can't will herself out of her brain chemistry any more than you can will yourself to not feel tired when you haven't slept for 50 hours, or not be drunk after having had 10 beers.
posted by forza at 2:47 AM on December 18, 2009 [12 favorites]

How to empathize? Listen to her. She's the one who has anxiety and ADD; she knows what's helpful to her and what's not.

Someone close to me has very similar problems; luckily, she's very articulate and is able to explain what does and doesn't help.

People's instincts in dealing with these problems are often wrong-- counter-productive, dismissive, and infuriating. Very likely she gets angry because you're trying to "fix her", and she needs support, not one more obstacle to fight against.
posted by zompist at 4:32 AM on December 18, 2009 [1 favorite]

So much good stuff above, but one thing I don't think has been addressed has been that it seems as if your fiancee's anxiety meds are a bigger problem for you than they are for her. This suggests to me that the real problem here is yours, not hers; your worldview is threatened by the fact that things that work for you don't work for her. I mean, if these ideas you so dearly believe in are not universally applicable, then maybe they're complete bunk? Maybe they'll fail you too someday? That's some scary shit, and you come up agaist it every time she pops a pill. So when you're putting an arm around her and asking her to calm down, you're really trying to comfort yourself. And she can smell the bullshit.

Anyway, take that out for a spin and see how it rides.
posted by jon1270 at 5:16 AM on December 18, 2009 [4 favorites]

My husband is a tiny bit like you in his worldview, OP -- he's got a bit of instinctive bias against meds and has a strong belief in the power of certain mental exercises (meditation, for instance) to make changes in our functioning. He has never experienced mental health issues himself.

About a year ago, I went to the doctor about my monthly bouts of depression and anxiety and was prescribed an SSRI for premenstrual dysphoric disorder. My husband's initial response when I told him about the pills was something like what you have been saying -- do you really need medication for that, can't you control it on your own? I say "initial" response, because I gave him a severe talking-to, and he never once criticized the medications again. The way he has behaved since then has been exemplary and very helpful to me, so I'd like to describe it to you.

As it happens, the last year was very stressful for us, and I ended up having more depression issues. When I was having a bad night, my husband would do things that he'd seen me appreciate in the past -- little things, like bringing me cookies. They were pleasant gestures, and non-condescending, and did not cure the problem (obviously) but they made me smile at the moment.

At a certain point, though, it was clear that I was not doing well in general. My husband picked a good moment and sat me down for a conversation. He said that he could see that I wasn't happy, and that it looked to him like I needed to make a big change in my life. If it were him, he'd take off for a year and go away -- trekking in the Himalayas, say. We had enough money, he could hold down the fort if I wanted to go.

Did this idea appeal to me? Not at all, frankly. And I didn't end up doing any such thing. However, what he communicated was extremely important: that he'd been seeing me, that he'd been respecting me enough to keep his mouth shut and let me try to deal with the problems my own way, that he cared deeply for my happiness, and that he was willing to support me even if I needed to do something drastic.

Although I didn't want to go to Nepal, I could see that he was right about how poorly I was doing. Feeling supported and slightly kicked into action, I made a number of small changes to my life that have ended up really helping. A friend even suggested a book on meditation for depression, and I worked my way through the program. I started getting more exercise.

You know what? For me, these things worked: I am now medication-free. There were several times when I said to my husband something like "holy crap, practicing meditation has really given me control over my moods", and he's responded "yes, I've always believed that we can affect our minds and bodies a lot when we put our minds to it." Through my own experiences, I came around to his point of view, at least as far as my own mental health is concerned.

But if my husband had told me at the beginning of all this "oh, just meditate and you'll be fine", I would have been incredibly pissed, since I would have (correctly) felt like this opinion wasn't respectful enough of my own difficulties, of the realities of my problems. This is exactly the attitude that all the commenters above have picked up on, OP.

Let me try to summarize:

1. Don't criticize her choices
2. Offer your unconditional support
3. Feel free to express your concern for her
4. Maybe you're right, maybe you're not. She'll have to come to that conclusion on her own.
5. It's possible for you to do all of these things even while believing that you're right. Just suck it up and do them.

(Also... feel free to memail me if you'd like to talk about this.)
posted by wyzewoman at 6:40 AM on December 18, 2009 [2 favorites]

Consider this: take ADD and anxiety out of your question, and say that your fiancee has heart disease, and you'd like her to go off her meds...she should control it with exercise and diet.

This. Or use cancer instead of heart disease. It seems to me that your life experience has confirmed exactly what you have been looking for it to confirm. Try doing some research independent of your own experience, as others have suggested.

If someone (honestly) tells you they are in pain, they are in pain even if you can't understand it or see an obvious cause for it. You don't have an MD or a PhD in psychology, so you shouldn't be trying to treat her. You obviously don't agree with and can't wrap your mind around her frame of reference. If this is the way you feel and you don't see it changing, do both of yourselves a favor and don't get married. This issue won't go away.

That doesn't make you a bad guy.
posted by Silvertree at 6:52 AM on December 18, 2009

So many people have responded here with good advice. Many people have said things very similar to what I came here to say.

But I wanted to add something, because you and I are very similar. I've faced a lot of adversity in my life, far more than the average person my age, and through that, I've developed coping techniques and a strong will. For a lot of my life, I was anti-meds, especially when not accompanied by talk therapy. I looked with a little contempt at people who couldn't use simple self-control to get through problems in life.

But then I grew up some, met people with mental illness, and realized all the privileges that I've had. I had strong support structures, good schools and rolemodels, never had to worry about money, I had an awkward, but stable, home life. But my #1 privilege was my well-balanced brain chemistry.

It's arrogant and ableist to assume that coping mechanisms borne from experiences of a healthy mind will necessarily work for someone who's brain isn't functioning properly. The first thing you need to do is to educate yourself on her mental illnesses. Anxiety and ADHD are very real illnesses, as real as cancer or diabetes. You believe in mental illnesses like schizophrenia, right? The mental illnesses your girlfriend experiences may not be as extreme as that, but they are still just as real.

There's other issues here, about trust and respect, but the path to dealing with those is to first learn humility and realize that your coping mechanisms are probably not effective enough to help her deal with her problems.
posted by Tooty McTootsalot at 7:15 AM on December 18, 2009 [2 favorites]

You might read this question.

They say "judge not, lest ye be judged." To me, this means that the same part of you that judges her judges yourself, which can be a huge burden. Compassion you develop for her will be compassion you can give to yourself if you ever need it. (And vice versa.) If ever there comes a time when you can't will yourself out of your emotions, and inmost people's lives, unfortunately, this happens at some point, you will have a harder time receiving the help you need because you'll be telling yourself you shouldn't need it. Developing the strength and solidity to accept weakness with compassion will allow you to give your own self more compassion later in life. I'd move forward by honing in on why what she's doing bothers, even threatens, you so much, and then try being gentle, empathetic, and accepting to that part of yourself.
posted by salvia at 8:22 AM on December 18, 2009

[To be read in a "we're shooting the shit over coffee" tone, not a "how dare you" tone]

You seem like you've put together a well-crafted life for yourself, and that's very commendable. Question: What happens when you run into crazy-ass shit? A natural disaster, a sudden accident, something completely senseless and unexplainable -- something out of your control. I'd argue that resiliency is way more important than being calm.

The kind of things you've described as your coping mechanisms don't really sound like coping mechanisms so much as a way to keep everything on a smooth path. And that's great, because we'd all like to know that things are going to be okay. But when I read what you wrote, it reminded me a lot of some of my friends who come from alcoholic families. Don't upset the apple cart; keep everything calm. Don't question them, because that would make things blow up; just try to calm everything down. Calm, calm, calm.

There are other ways of maintaining calm, though. One of the blessings of going through some difficulties in my own life (yes, there are many blessings) is that I've become a much more compassionate person. It's easier for me to let things go -- and thus stay calm -- because I know that other people have so much more going on in their lives than what I might see. Chronic physical pain, taking care of a family member, working three jobs, current or past abuse, dealing with the serious illness of a loved one... all that. Understanding them on their terms helps me be a better friend, coworker and partner.

Resorting to medical intervention with mental health issues doesn't mean that you lose self-control or cede your authority over your situation. If I had broken my leg, I wouldn't go straight to physical therapy. I'd see a doctor, get crutches, get surgery if I needed it, take some painkillers so I don't walk funny and make my OTHER side go out of whack, and generally monitor myself. Same goes for mental health. Studies show that a comprehensive approach that involves both counseling and medication works best.

I take an antidepressant and a nonstimulant ADHD medication. I've had the experience of clearly needing pharmaceutical intervention, and I've also had the experience of being on what is absolutely the WRONG medication. I've had to be a "self-made woman" in some very difficult circumstances, but ultimately my self-awareness has made me so much better than I've been before. I've learned to take care of myself in other ways and what my triggers are.

Most of all, I've benefited by having a partner who supports me by listening and respecting me and my boundaries. Let me tell you, you don't realize how controlling some relationships are until way after you leave them.

Please let her do this on her own terms.
posted by Madamina at 8:25 AM on December 18, 2009 [2 favorites]

I'll try not to repeat too much of the excellent advice that has been given above. I'll also try not to seem really, really angry, which is how I felt after reading the question.

You can't tell her "It's okay" during a panic attack because IT'S NOT OKAY. A panic attack does NOT feel okay, it feels horrible. Even if you think the fear is irrational, it's not logical to use reason to combat an irrational fear. If reason worked, the irrational fear wouldn't exist in the first place, would it? Like others have said, ask her what she needs you to do when she's upset. Some people don't want to be touched. I do. We're all different and you can't presume to know. If trying to calm her down makes her angry, STOP TRYING. That in itself is irrational behavior.

OK, maybe she's not doing everything she could be doing to manage her anxiety. But you sound really, really smug and arrogant. Is there nothing at all just a tiny bit "wrong" with you? Maybe you overeat? Smoke? Waste time online? Almost all of us could take better care of ourselves in some way.

You know, I spent a lot of years trying to power through my day. Will myself through adversity, as you put it. Going to the grocery store was a major ordeal. Guess what, it's not anymore, and that didn't change because I magically had more willpower - trust me, anyone will tell you I'm extremely stubborn - but because medication altered my instaneous physiological response to fear. "Mind altering drugs"? Thank god, because the way my mind works without them feels like hell.

Re: weaning her off her medication. A few people have said this, but it bears repeating. Do not, not, NOT do this without a doctor's approval. Some medication can cause seizures and death if you go off it too quickly. At the very least, there WILL be withdrawal no matter how slowly you wean off of it.

As her future husband, you are her major source of support. Treating her in this fashion is at best condescending and at worst a type of abandonment. I imagine she must feel very lonely if the person closest to her cannot really listen to what she is going through. I'm glad you're willing to rethink your views, and I hope this thread has helped, but if you still find yourself questioning her, please just let her go. She needs someone who can be a true partner to her, not someone who pretends to support her by controlling her.
posted by desjardins at 9:01 AM on December 18, 2009 [10 favorites]

I'd say I'm a well-adjusted, psychologically healthy male. I was raised believing in the power of the mind, with "anything's possible if you put your mind to it" as the family mantra....

I'm a big proponent of setting audacious goals, following my dreams, and being a self-made man...

How can I internalize the fact that some people literally cannot will themselves through adversity the way I've always done? It's almost impossible for me to accept, as it flies in the face of a lifetime of personal experience and seems ludicrous to me.

First off, here's an analogy. Let's say I've spent my whole life thinking that all apples are red, because all I've ever seen are red apples. Then some day, a friend of mine shows me a green apple. Should I deny that this green thing is an apple, or should I consider that maybe I was wrong about apples always being red?

You have spent your whole life thinking that anything is possible if you put your mind to it. And now your fiancee has blown your mind by showing you a green apple. Wait, two green apples. The first is that she cannot work through her problems without the aid of medication. And the second green apple is that YOU can't make her better. All that "follow your dreams, anything is possible" stuff you've believed your whole life? You're staring something in the face that's forcing you to evaluate whether it's true or not.

If you want to empathize with your fiancee, the first step is admitting that you're wrong that a "can-do" attitude is all it takes, because if that WAS all it took, your can-do attitude would have fixed all of your fiancee's problem's already, right?
posted by 23skidoo at 10:16 AM on December 18, 2009 [1 favorite]

We've done pre-marital counseling, which I thought was great. But all of the counselor's advice built off my supposition that talking through issues in a logical, respectful manner is effective. Unfortunately, in the heat of the moment, clear-headed discussion is impossible (which frustrates me to no end, because I try endlessly to work through every bump in the road, just as was recommended, and seem to end up worse for my efforts).

Forget couples counseling for the time being. You need to find yourself a psychiatrist for YOURSELF. So you can talk about YOU. Not your partner. Print out your entire Askme post and take it to a new psychiatrist and see what they have to say. Your hang-ups in this relationship are beyond the scope of Askme and you need to talk directly to a professional. The fact that you are posting this suggests that you haven't disclosed all of your own opinions about the situation. If you want this to work you’re going to have to disclose your entire world view to the counselor. So print this Askme post and give it to your own therapist. Does that make you uncomfortable? If so why? You’re going to have to do it if you want this relationship to work. If you refuse to involve mental health professionals when addressing these problems this relationship will fail.

You are going to have to talk about your own issues. You appear to be approaching this problem like you are infallible and think any potential problems in this relationship will be only her fault. This is not a healthy way to think about a relationship.
posted by Procloeon at 11:13 AM on December 18, 2009

I'm presently med free but lived through a time when I truly needed them.

My husband used to feel a bit like you do. Until one day he had a period of time-not sure how long it was but it was probably less than an hour-where he literally experienced the same emotional state I did which necessitated the meds.

He won't even speak of that time, it was so bad. His take was that God was showing him what it was like to be me. (I also had the same thing happen with another friend of mine, altho that friend had always been really supportive.)

The only way you will truly ever know how wrongheaded you are being with your lady is if you have a similar experience. And you may. Another lady I know who was pretty close to your way of thinking experienced her first major depression in her early seventies. And she made a point to come to me and apologize to me as she'd felt she hadn't been very understanding to me during my struggle.

Maybe it would be easier if you just believe what other people tell you. And I will tell you that as good and valuable as good mental hygiene is, and as much as I do practice it, it won't see you thru an attack from a true chemical imbalance. Trust me on that.
posted by St. Alia of the Bunnies at 5:50 PM on December 18, 2009 [1 favorite]

I've had to walk away from this question for almost a week because of all the feelings and thoughts that it brought out. I read a bunch of the answers, but not all. I'm just going to give some perspectives:

* I was raised by someone like you, who had always gotten through adversity on their own by willpower. Or, at least that was the claim when I was growing up. Later they acknowledged the others who'd helped them, and the times they'd failed. They saw the failures sometimes as a lack of courage or knowledge, but did make peace with them finally and didn't obsess over them. And I must say, given their upbringing, they did a very good job of not repeating a lot of what went on in their childhood.

* a side effect of this upbringing was the internal feeling that I was somehow less because I couldn't do such things. It was believed for the longest time that I had a serious medical issue that could not be diagnosed or cured, when really I was suffering from panic attacks that had physical manifestations*. At the time, any reference or suggestion that I'd benefit from counseling was met with a firm "you're not crazy!" that shut down the conversation

* a consequence of this was that I could not effectively deal with stress and/or my personal issues to the point that I was diagnosed with Clinical Depression in my 30's and put on medication for severe, debilitating anxiety. After 10 years of on and off counseling, I finally had to take medication to function.

* NOBODY likes being a slave to a little pill. This is true of cholesterol drugs, high blood pressure medication, birth control, you name it. This is not exclusive to anti-depressants or other "mental health" medication, except for the added stigma, sometimes silent, sometimes aloud, of "you're not crazy!". Or, worse: "you're crazy?"

*It may be a concern that your fiance has to take higher doses to "get the same effect", but it's not the end of the world, nor is it a sign that "it's not working, so it has to stop". It could mean she's going through a rougher patch than usual - she is, after all contemplating marriage, which is a major life change.

*"Just quitting", or "weaning" is no small thing. When I got pregnant with my first child, I quit smoking cold turkey, because it's bad for the baby. It wasn't clear then that the drug was bad for fetuses**, but the doctors were of a mind that a stable me was preferable to the alternative. About six months in, I tried to wean and then stopped entirely because I could feel the baby being "sedated" on days I was on the meds. Withdrawal side effects can be absolutely terrible and terrifying. Nowadays the drug is available as a liquid, and tapering is simpler, but back then I could only get smaller and smaller pills. I got sick of that and just stopped. Two weeks of pure terror followed.

*Moral/spousal support and communication. My husband has only had one panic attack in his life, and I'm grateful for that. One, because he knows what I deal with on an almost daily basis, an is in awe that I can function at all. Two, because it never happened again. It's not something I'd wish on anyone. Over the years I've learned to "score" my anxiety levels for him, so he knows what to expect and what to do. This is no different than if I had a physical condition, say asthma, and had to restrict certain activities or do them with help.

For example. right now, I'm in what I call a mid-level panic mode. It doesn't matter why. It was enough to get me out of bed at 4:30 in the morning and take my Xanax, mainly to keep from going to a systems lock-down. I'm typing this out as part of the exercise of calming down, and waiting for the meds to take effect. If he were awake right now, what I'd need from my husband is a long hug, a "you'll make it", and "you've got me, just tell me what you need". Confidence and support is what she needs, not "calm down, you're an idiot for thinking this is serious".***

*You don't need to help your fiance do anything but cope with life and the stresses that go with it. I just saw a bit of St. Alia's advice above. A chemical imbalance is the reality, and if you refuse to deal with it, and refuse to help her deal with it, it's going to come back and bite you both.

I don't think you'd be posting this AskMe this if it were a blood thinner or insulin. The stigma of "it's all in your my her head" is making you anxious, and you may need to take a look at that, maybe with professional help. If you're saying to yourself "I'm not crazy!", then see my first points above. You don't wait until your engine block cracks before taking care of an antifreeze leak. A mental check up is exactly the same thing.

Good luck.

===================
* complicated by an undiagnosed learning disability.
**still not absolutely clear, but not advised unless it's pretty damned serious. I'd say I was on the edge at the time. I was also watched closely for PPD.
***you'd better believe that's what you're saying when you say "It's not the end of the world, calm down"
posted by lysdexic at 3:10 AM on December 24, 2009 [1 favorite]

I was going to stay away from this because people get really het up about this topic, but just as an FYI: it is entirely possible to stay on these kinds of meds through pregnancy. Loads of people do it; Dooce is one example - she adjusted her meds when carrying her second child, and this was the result.
posted by DarlingBri at 6:54 AM on December 24, 2009

Can you live with a partner in life who freaks out over things you might consider minor (anxiety) and can't remember why she went to the kitchen (ADHD) by the time she leaves the living room? This is what these conditions are like without medications in everyday life ...and how they would affect you... Are you prepared to be supportive and tolerant when this is what your wife is likely to do day after day? If not, you will both have to keep living with the meds for whatever they are worth to prevent the above.
posted by bunky at 10:16 AM on December 26, 2009

Hmmmm...
I'm re-reading this bit you wrote:
"is to try to wean my fiancee off her meds (which she freely admits to hating for a number of reasons) and transition to a better-structured, calmer lifestyle"

It kind of sounded like you were saying she would have to come off the medication *first* before she could transition to the better lifestyle. But really, isn't she needing a better-structured, calmer lifestyle now? What's stopping you both?
Isn't that assumption a little/lot illogical? It really looks like secretly, subconsciously, you really want to blame the *medication* for her symptoms, rather than accept that she had the symptoms before, that *she* has the symptoms, that it's not the medication.
Blaming the treatment, not the disease, the messenger, not the message. I understand, it's pretty human.
It also says that you don't want to be thinking that there is something 'wrong' with her - or really, that you would be thinking that there is something wrong or inferior with *her* because of these conditions.

She's probably exaggerating. A teeny, tiny, wincy bit. Because you don't get it. You big, huge, humongous don't get it.

So, apparently I've got this ADD thing. I fought against a 'diagnosis' for years - I'm just the far, far end of a normal range, who is to say that makes a disorder?
Unfortunately, society is not structured to my particular set of skills the human range. I'm continually working on getting myself there, more appropriate job choices, newer environments more often etc, but with my current resources, I'm just not so suited to society. :P
This means I fail at things. And pick myself up, and fail at things. And pick myself up, and after a very long time of this sort of struggle, I eventually started falling into depressive episodes. Because failing a lot, and not having all the maslows needs, including social ones, can do that. It really sucked when I had the first one, because I'm just *not that sort of person*. But the subsequent ones sucked more.
And, because this sort of stuff is a spiralling shithole, and long bouts of depression lead to anxiety. I now get anxiety. And mild panic attacks.
It is... so foreign to me. I am a logical person and this is *irrational*. I feel like a *coward*. Even when I was depressed, I wasn't afraid to make changes that might get me out of it, because hey? Who cares?
So, I'm finally going to be going on 'meds' for ADD. Not because the ADD is so bad, but because the depression is, and if it helps me stave off the depression by being functional, it is *worth it*.
Each year, I get better and better at dealing with my ADD behaviours, developing strategies, workarounds, and coping tactics. Actually, I think I'm better off than some people, because despite the severity of some of the issues I have, I have better problem solving skills than many, and I think I'm actually digging myself out, slowly, with the problem solving, whereas I'm not sure they're able to deal with their problems in the same way.
It was irrational of me to resist medication for so long, because I know how I work. If I have a lot of structure in my life, am getting very regular exercise, etc etc, then I'm ok - because I have those things in place I have enough togetherness&motivation that wouldn't need meds (by my standards), but... when I fall off the wagon, when something happens, then I know I need more structure to get better but because I *don't have* the structure I don't have the togetherness&motivation needed to re-establish the structure.
It's a negative feedback loop.

Exercise is so helpful to me. If you could do something with your fiancee, even long walks, that would probably help so much.

I lose my wallets, and my cellphone regularly. So what do I do? I have my wallet chained to my bag/coat, like skateboarders, I have it in a bright colour so I'll see it better if I've dropped it, I have a backup 'wallet' at home with spare cash, ID, and an EFTPOS card, and I used to have a spare 'cellphone' so if I didn't find it before it went flat, I'd ring the phone company and ask them to switch my number over, all so that I could still receive calls, all of this so people wouldn't realise how flakey I really, really am. I just got RFID style tags for wallet, cellphone etc so now I can beep them!
Now, I mentioned the beepers to an acquaintance, because I was happy with my new solution/coping tactic, and I shouldn't have. Because he just stared at me, and then explained that he just made the 'decision' not to lose his things and to be organised, and that really worked for him, and that you just have to really *decide* to do that.
My heart fell. I felt ashamed and embarrassed by his mental picture of me.
Because... I just obviously haven't *decided* strongly enough. I haven't put enough thought, and effort into it. Maybe I'm just not *ashamed* enough of how flaky, unreliable and immature it makes me look. Maybe I just haven't spent enough thinking, and analyzing, and planning, and trying to figure out how to do *better*. Years, and years of report cards saying I was so good in class, so polite, a pleasure to have, and so smart, but why couldn't I just try *harder* to be organised? Taking them to heart so much, that well, how many other children were reading organisational books (aimed at teenagers, but still), in elementary school? And voluntarily spending each monday lunchtime in highschool with a teacher while she'd try and teach me to be more 'organised', and dropping out of highschool because I just couldn't *be* more 'organised'. And then immediately getting a job at a webdesign company, because god, in many ways I didn't have to be as 'organised' in a real job - I didn't have to do homework for one, and by boss worked out the project schedules!

Usually I hide better, cover better. With partners, they actually saw how I was, really, and sometimes it worried them. Sometimes it impresses them - my god, you're so organised! But because you are... so DISorganised!

I'm rambling, and ranting, so that you can maybe get a picture of how frustrating it is.

So. If you want to help your partner. Don't wait for her to go off medication. Ask how you can help her now. Not how you want to help her.
Exercise is good. So is ADD-friendly Ways to Organize Your Life if you're interested in concrete ways to help around the house and what 'ADD' looks like. And counselling, maybe for both of you.
Having things together helps with the annoying pattern of ADD -> Depression -> Anxiety.

If you really want to fix things and can't figure out how to empathise in a given situation, or better, she says she just wants a 'time-out', if there's anything lying un-done around that might be stressing her out, eg dishes, that's not the worst thing you could do. Please adapt suggestion to your fiancee. It might seem 'fixit-y' when what she wants is some other kind of support. I sympathise. I am a 'fixit'.
When boyfriends complained about stuff going to shit, it took me the longest time to figure out that they didn't want me to go on the internet, the phone, or pull out the stepladder and hammer to 'fix everything', but they just wanted a hug and to vent. And *then* maybe for me to fix things.

(When I was sobbing on the floor, my ex-partner wanted to help, but not so much that he actually listened to me when I said doing the dishes or making me a cup of tea might help, but please don't touch me. Continuing to try and hug me, and never once trying out the dishes suggestion was part of why we couldn't work. He couldn't get his head around *his* idea of empathy enough to listen/realise what would *actually* be empathetic.)

P.P.S. When someone is distressed, if you can't shut off fixit vibes, at least focus it on making sure they are: warm, fed/watered, comfortable, rested
You can't do the last one but you substitute with food. How long since they ate? Right. Get them a quick hot snack/drink.
posted by Elysum at 7:02 AM on December 28, 2009 [3 favorites]