Starting Over

August 24, 2013 4:36 PM

I wanted to ask others what they would do if they were losing their mental abilities? I have seen a therapist for about seven years and I have frequently told him that other people can do things that I just don't understand. He has always normalized this by telling me that it is simply practice and that if I persist that I will be able to do what others are able to do. If you were seriously on the decline in the mental health aspect of your life, what would you do? My thoughts are that medication cannot solve everything. I am lucky to have a job right now, but I don't know whether I will be able to continue to work unless something starts getting better in the mental area such as my memory.
posted by nidora to Health & Fitness (26 answers total)

You go see a medical doctor and let him or her run tests. A therapist may not be qualified to test what you feel you are having issues with. Let that be a first step.
posted by St. Alia of the Bunnies at 4:39 PM on August 24, 2013 [4 favorites]

You need a neurologist. Bad memory affects your mental health but is not generally caused by a psychological issue, and you're describing cognitive (thinking, processing, learning) problems that need to be addressed by a medical doctor.
posted by Lyn Never at 4:42 PM on August 24, 2013 [8 favorites]

I would start to keep a journal, and using it as a record of the memory errors and thinking errors that I noticed in myself. Be systematic about it: write at the end of each day, and record the problems you noticed. You can write other stuff, too :-)

The act of writing something down makes it more memorable for me. I have also noticed that memory seems to require practice and reflection, and a journal is a good place to exercise that. Finally, a journal is an external aid to memory: I often use mine to check on time and dates and events and things that have happened to me.
posted by the Real Dan at 5:03 PM on August 24, 2013

What mental abilities do you feel you are losing? Can you give an example?

I do know that one exacerbating factor in depression is rumination and it sounds like your having the idea that others can do and remember lots of things that you cannot do or remember, and trying to compare yourself to figure out if you are okay might be an example of you ruminating.

Are you quite sure that your present mental abilities (not sure what this encompasses) don't already measure up? Are there any others besides your therapist who might be able to help you, if you feel that it's not working out between you and him?
posted by mermily at 5:10 PM on August 24, 2013 [2 favorites]

By the time you notice consistent memory problems, it's high time you give thought to what you are going to do about them. Good luck with seeking advice and help from medical doctors on the issues involved, but for many people noticing their own cognitive declines, medicine has no real help that can reverse or even prolong your current capabilities. You may have to quickly weigh your options for various futures, and come to a decision that is right for you, before your capabilities decline to the point that you are not otherwise capable to do so.

From your previous posting history, it appears that you are 37 to 38 years old, which is pretty young for classic organic causes of memory impairment, like Alzheimer's disease. Thus, it is worth your time and money to seek a medical diagnosis for your issues, but there is no guarantee that such investigations will result in treatments that offer favorable results. Good luck with your outcome, and whatever decisions you can take while you are still able.
posted by paulsc at 5:20 PM on August 24, 2013 [3 favorites]

You should see a medical doctor. You should also get a new therapist.
posted by jaguar at 5:24 PM on August 24, 2013 [1 favorite]

You mentioned being ADHD previously. I had the memory of a goldfish until I got onto a medication cocktail that worked for me. I now have no significant problems with this. It's not really a problem with retention; my brain just wasn't attending enough to the information to get it recorded to actually recall it later. Medication can't always fix everything, and finding that right balance is a tricky thing, but it made woooooorlds of difference once it was right. Not that this proves that there can't be another cause, but please don't dismiss the necessity of getting that part figured out. It will get better when you're able to get things back under control.

As a teenager, I got into huge screaming fits with my parents about not having done things they'd asked me to do that they didn't believe I'd forgotten. Today I rattled off most of a conversation that my boss and I had last week and *he* hadn't remembered it. So: Hope!
posted by Sequence at 6:14 PM on August 24, 2013 [3 favorites]

How is your sleep? There have been a bunch of studies recently about the compounding, serious effects of sleep deprivation on memory formation and general mental acuity. Sleep deprivation is defined as getting six hours of sleep or less a night. Studies indicate the effects are reversible with short-term deprivation--the jury's out on long-term, since no studies have been done that are longer than a few weeks.
posted by Anonymous at 6:29 PM on August 24, 2013

First and foremost, I will cast another vote for seeing a medical doctor, including a referral for a neurologist if you can get one. Make sure you're able to describe exactly what type of problems you're having (i.e. forgetfulness, difficulty communicating thoughts, difficulty with mental tasks like simple arithmetic, etc.)

That being said, things you can start doing immediately on your own? Start doing mental exercises. Do the daily crossword and sudoku in the newspaper. Go on sporcle and start doing some of their quizzes. There's a lot of evidence showing how mental exercises can stave off things like Alzheimer's disease and keep your mind sharp. Just like the muscles in your body, if you don't make the brain work, it's going to waste away.
posted by Flashbullzeye at 6:31 PM on August 24, 2013

If I were extremely worried about my memory because I had just barely enough to get by as it is there are many things I would do because there are so many things under your control (or theoretically under your control) that influences this. For example meditation, exercise, yoga, eating very healthfully (though given that what some people think is healthy is not this is a general statement), getting lots of real social interaction, reading (books rather than things on the internet that don't really require thinking), learning and doing new things, etc. If meditation seems intimidating (as it was to me) doing yoga for a year or two first really, really, helps make it more approachable. Sitting with no distractions at all and being forced to pay attention to my own mind for even a couple of minutes had me feeling a deep need to flee until I got comfortable with yoga. Also, of course figure out if there are any "physical" or "mental" health issues that might be contributing and get that sorted from all angles too.
posted by Blitz at 6:32 PM on August 24, 2013

Memory is a faulty thing even for healthy people and ideally shouldn't be an important part of your workday life. Take notes, develop a system to capture stuff and stick to it and review frequently so nothing gets lost in the various shuffles of work life.

Also what seems like early onset memory problem is often a problem at encoding. People in their important adult years have a lot more on their minds and are running around in circles being busy and this competes with laying down solid memories. Slow down and actually focus on the important things.

[ The consensus opinion of research neuroscientists is that brain training makes you good at brain training. There is as yet no evidence of spillover effects to other parts of life. You are probably better off using that time for going out to dinner with some friends.]
posted by srboisvert at 6:51 PM on August 24, 2013 [3 favorites]

No idea what mental issues you're having, but my memory was scarily awful when I was depressed. Depression isn't just sadness, it also screws with the way your brain works. Things have improved a lot as I have improved.
posted by zug at 6:59 PM on August 24, 2013

A few years ago, I was having many cognitive and memory problems. I was almost diagnosed with ADHD. Turns out, it was sleep deprivation. Both ADHD and sleep deprivation can cause severe cognitive and memory issues if not controlled.
posted by instamatic at 7:08 PM on August 24, 2013 [2 favorites]

It's not clear that you've seen a psychiatrist who is willing to look at the physical, mental, and possibly psychosocial issues that may be affecting your health. That is, I's sure your therapist is great, but suggest you take a step back and have someone with a different set of eyes and training review your situation.

I'd try to find a psychiatrist who doesn't just want to give you meds, but is willing to seriously consider a variety of reasons for what you are describing as long term impaired functioning.
posted by anitanita at 7:50 PM on August 24, 2013

A lot of what you've written sounds anxious. Anxiety affects memory and the ability to be present. Mindfulness meditation helps you to be more present and less anxious.

Depression also affects memory. So too does ADHD. So too putting a tremendous amount of pressure on yourself to 'be normal' and to never, ever make mistakes ever. And to know everything. Which no one can.

So, I think your therapist is trying to get you to go easier on yourself and to make you realise that it's perfectly normal to forget stuff. Most people do. If you don't want to be like most people, then become more methodical with lists. If you want to learn how to do something, then learn how to do it. Think about how you learn - listening to people, doing it yourself, reading from a book, etc? Do whatever is easiest for you. And, yes, most of it is just practice. And going easy on yourself.

If you really feel there is a serious impairment that is getting worse, go down the path of seeing a neurologist.
posted by heyjude at 8:54 PM on August 24, 2013 [2 favorites]

Your questions are so short on specifics that it's hard to know what difficulties you're having, which in turn lets people here either read too much or not enough into your questions.

For example, you say: I have frequently told him that other people can do things that I just don't understand.

Like...you can't do simple mental arithmetic? You can't estimate how long a task you've done before will take you? You can't figure out which way to go when you get off the subway? You can't remember the lyrics to the national anthem? You've forgotten you have a meeting at 2 pm when you agreed at 1:45 pm to meet in 15 minutes?

Talk therapy is not necessarily going to help with any of this - unless it's all tied up with depression and anxiety, which are often co-morbid and which can really fuck with your ability to process and remember, in which case it might, and you might need meds.

So. Go to your primary care doc if you need a referral to a psychiatrist and/or neurologist. Write down things you have trouble with that other people don't seem to have trouble with. Be really specific - way more specific than you are here. Take what you've written to your PCP and subsequent docs. Take notes when they ask you stuff and tell you stuff.
posted by rtha at 9:04 PM on August 24, 2013 [2 favorites]

If you're located in the U.S. and you develop a mental health condition that does impair your ability to work, you may qualify for a Social Security Disability Insurance income supplement.

If this were to be the outcome, you would need to be able to demonstrate that you sought medical care and tried out the conventional medical therapies that were possible. So definitely keep working with the therapist and if your health insurance depends on your current job you probably should seek out other medical treatment ASAP: find a psychiatrist as others have suggested to begin trying out medications and involve your physician so that her or his records mention your symptoms and so that any other avenues for treatment are explored.
posted by XMLicious at 9:09 PM on August 24, 2013

Unless your therapist is a qualified clinical psychologist they aren't qualified to diagnose and treat/help you compensate for cognitive impairments, so take their advice with a pinch of salt.

However, depression and other mental illnesses certainly can affect cognitive functioning, and so can being under stress and pressure generally. Srboisvert may be thinking of the same study as me that suggested that 'memory decline' in middle age is actually most likely to do with being stressed and having a lot to remember - that's normal.

Srboisvert is also correct that when I looked at the literature a couple of years back, the opinion on cognitive training was that it only helped with the skills you practiced. So do crosswords if you want to get better at doing crosswords. Practice learning shopping lists if you want to get better at that. For more complex tasks, compensatory strategies will be more helpful.

I agree with all the suggestions to try to get a neurology referral but do this as a precaution rather than as a priority.

As you sound very concerned, it might also be worth trying to see a clinical psychologist to a) see if your cognitive skills really are outside normal limits and b) see if there are any compensatory strategies they can suggest. Until then, diaries, list making, note-taking and checking will help. There's a website designed for younger people with cognitive problems associated with MS that I think is rather good: Staying Smart . I'm not saying you have MS, I'm saying some of the tips might help.
posted by kadia_a at 12:04 AM on August 25, 2013

Start with your physician. Describe what you've been experiencing. Provide examples of how your memory and cognitive functions are impacting you. In the lead up to your visit, take notes so that you don't have to worry about forgetting what you want to convey to the doctor. Bring a list of all medications (both prescription or over the counter) and dietary supplements you take. Take a loved one with you who is aware of what is going on so that person can listen and provide additional insight.

Your physician may do a rudimentary neuro-psych evaluation such as asking you to draw some basic geometric shapes and/or the face of a clock. You may be asked to repeat back to the doctor a series of words, to say the alphabet backwards and a number of other seemingly odd tasks. You'll be asked if you're having difficulty with basic math as well. You physician may also ask for some lab work to be done. A blood count will be used for checking if your thyroid function is off, for example. The test results may lead to a referral to a neurologist or a request for a full neuro-psych evaluation which is a multi-hour affair.

The physician will look to identify the cause of your memory and cognitive issues. It could be a large number of things and many are VERY treatable. For example, depression can cause dementia-like symptoms. So can a hypo-active thyroid. I know that I was starting to have mental fogs and short-term memory issues before my thyroid issues were diagnosed and treated.

You're not saying it directly and maybe I'm reading too much into your post, but it sounds like you're worried you may have a progressive condition like dementia. Don't assume the worst. Ask your physician for help and know that you most likely don't have a disease that causes dementia.

Full disclosure: I write Dementia be Damned, a blog about my sister's early on-set Alzheimer's. You're welcome to contact me directly for more information or support.

Good luck!
posted by onhazier at 7:44 AM on August 25, 2013

Response by poster: This is very frustrating, because I have told my therapist a long time ago that there was something off with my memory. When I used to work in a job where I had to indicate where people were in a particular rooms, I would do my walk and take the papers with me and mark down who was where when I was actually in the room with them. Then I noticed that my peers would walk through all of the rooms without taking any sheets with them and remember who was in what room without any problem. When I brought this up to my therapist, he minimized it saying that my memory was okay. Here is the thing, I spent a boatload of money on a cognitive battery of tests to make sure that everything was okay with me about four years ago. The test results came back okay. Some working memory issues, and some long term memory issues as well for particular tests. I know that there are EF issues as well.

I just feel overwhelmed right now. Instead of doing research which is something that I was doing a while back, I am now back in the food and beverage industry. When I used to work in this area when I was back in college it took me a while to get it, but I eventually caught on. Not now, everyone is so much damn faster. It's like people have skills that I cannot compete with. I do my best, but it's not enough. I realize that everyone has their problems, but I truly could be let go on any particular day, and then I haven't the slightest idea what I would be doing.

I keep trying to think of something optimistic like Viktor Frankl's - Man's Search for Meaning, but his ability to learn was never compromised. He never had to look someone in the eye and be told by someone above him that he's still not getting the job done right. I don't know what to do. My options are running out. I wouldn't even put up a fight right now if someone were to tell me that I am not where I should be, but I don't know how to compensate in a way that would allow me to gain some small victories and start building up some confidence. If I get let go from this job, I don't know what to do next.

A human being's capacity to learn is probably one of the most important things that they posses, wouldn't you agree?

I never thought all of these things would happen to me, but they are happening.
posted by nidora at 9:04 AM on August 25, 2013

Your history of AskMe questions are consistent with someone with massively undertreated/untreated Major Depressive Disorder. One of the symptoms of Major Depressive Disorder is a decreased ability to concentrate. Your previous questions and answers also seem to indicate that your therapist is not addressing your depression. You need to find a new therapist.
posted by jaguar at 9:16 AM on August 25, 2013 [3 favorites]

Make a list of all of the issues you are experiencing. Be very clear about the consequences to you, your job, your finances, your health, your relationships.

Examples:
- I was removed from a project at work because I was unable to learn how to use the software for the project, even after I took the training 3 times (others did 1 training)
- My roommate has told me not to use the stove anymore because I have repeatedly left the house with the oven on, in one case causing a small kitchen fire

Focus on what is happening and what the consequences are to your life. Ask your close friends and family to help you. If they have seen changes in your behavior, get it on the list. If they remember incidents where you were acting unusually, it goes on the list.

I can't know what the real issue is here or who can best help you, but I'm a firm believer in being assertive about your health care. Use the list when you talk to your therapist and your primary care doc. Your providers will be better able to help you if they have the full picture.

If you are likely to forget the list, email or fax it to them.
posted by bunderful at 9:20 AM on August 25, 2013

Just saw your most recent update. Agree with jaguar that it may be time to change therapists. Also talk to your primary care doc.
posted by bunderful at 9:23 AM on August 25, 2013

Are you on any medication? Blood pressure meds, antihistamines, pain meds, sleeping pills, antidepressants? Anything?
Check the package insert for side effects. Talk to a physician about dosage/switching meds, don't just discontinue. Talk to a physician about your symptoms.
posted by travelwithcats at 11:58 AM on August 25, 2013

I am bipolar and have ADD. I am not suggesting that you you have these conditions. I can tell you that when I'm on my depression cycle, my memory is terrible and even simple tasks seem overwhelming. At one point I really did wonder if I was going into the first stages of Alzheimer's. Fortunately, I'm not. I just have very severe ADD.

A neurologist may decide to order a neuropsychological assessment that can pinpoint cognitive and emotional problems you might have. The test takes 3-4 hours. The ordering neurologist will get the report. In addition, make sure your psychiatrist gets a copy too. Bring your psychiatrist's office information, including fax number to the test, if you take one. You'll have to sign a release. It's important that the psychiatrist gets the report because if your problems are rooted in emotional issues (which they may or may not be), the report should be important to him or her.

You may find, like I did, that you haven't slipped nearly as badly as you might think you have. Good luck.
posted by double block and bleed at 2:50 PM on August 25, 2013 [1 favorite]

Edit window fail: "should be important" should have been "may be very useful". Sorry about that.
posted by double block and bleed at 3:02 PM on August 25, 2013