Ask MetaFilter questions tagged with mentalhealth

Learning to empathize

Anonymous — Thu, 17 Dec 2009 19:49:16 -0800

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 empathytrouble@yahoo.com if you need it.

How to lose weight when meds pack on weight

Anonymous — Wed, 16 Dec 2009 10:58:40 -0800

I want to lose weight, but the drugs I take to manage my bipolar disease actually add weight. Do you have ideas on how I can lose weight? Details inside. I have been diagnosed with, Bipolar I, moderate to severe Dissociative Identity Disorder, Fibromyalgia, bursitis in both hips, and other lesser problems, and currently trying to lose weight. I weigh 336 pounds and am 40 years old and female.

Three of the drugs I take to manage the bipolarity, Lexapro, Seroquel and Zyprexa are extremely weight positive i.e. they really pack on the pounds. I was obviously overweight before starting these drugs, but now I'm on a down hill slide toward gaining weight and these drugs are pushing me down the hill.

I've been on slightly more weight neutral drugs for the bipolar, but they didn't help as well. It's to the point where my physical doctor is calling the shrink to ask for a different combination of drugs, but the shrink is unwilling to change them, because this particular cocktail works really good for the bipolar and allows treatment for the Dissociative Identity Disorder and all of its peripheral issues.

It's hard for me to walk or go to the gym due to pain, but the pool really works and I enjoy doing that. However, doing exercises in the pool doesn't seem to be enough to slow the psych drugs from throwing on pounds.

My eating is ok, could be better, I've tracked my eating habits, shared them with my doctor and he agrees they aren't a major problem. He did suggest a Lap-Band, which ties off the stomach, but in order to qualify for that, you need to be mentally sound, and being did doesn't qualify one as mentally sound.

1. Do you have any suggestion that would help me maintain weight. ANYTHING, I'm pretty much at a loss on how to do this and still literally remain sane.

2. I've heard that once the body gets over 300lbs, it's harder to lose weight, like the body reaches a plateau of sorts. Is that so?

Am I crazy or what?

Anonymous — Sun, 13 Dec 2009 18:44:24 -0800

Am I crazy or what? Not long ago, I'd voluntarily checked myself into a mental hospital for severe depression caused by a bipolar disorder of some stripe. Over the course of five days, I was given a cocktail of antidepressants and monitored (asked dumb questions) each morning.

Not knowing the limits of confidentiality, I'd mentioned owning a firearm during an early evaluation. When I decided to voluntarily check out, one of the formalities that I couldn't avoid was signing my gun over to a friend for thirty days. I did this, and reclaimed it after a month, as was allowed per the explanation of my case manager.

I'm assuming that because my stay was voluntary, and the remission of the firearm temporary, that I am not considered to have been committed to a mental institution, or adjudicated as mentally ill.

One of my favorite hobbies is taking a big group of friends to the shooting range. That's why I bought a gun, and all my friends own them as well. I didn't buy it so I could snuff myself out or hurt anyone else. What I'm unsure of is whether it's legal for me to own this weapon, and whether I'm eligible to purchase another, or to apply for things like ATF pyrotechnic licenses.

If you wanna lecture me, go ahead. I appreciate the concern, but am not really interested in ditching one of my few joys.

Tell me about your experience on Citalopram (Celexa / Cipramil).

SebastianKnight — Wed, 18 Nov 2009 06:58:53 -0800

I'm about to start a course of Citalopram (Celexa / Cipramil). What should I know in advance? Despite some serious misgivings I've decided to try antidepressant medication for some ongoing depression/anxiety issues. I've been prescribed 20mg of Citalopram to be taken every morning and will be seeing my GP (in the UK) for supervision at regular intervals. I'm hoping that after a few weeks my sleep pattern will be back under control and my judgement less impaired by low mood, anxiety, and exhaustion. If that works out then I'll be in a better position to tackle any underlying issues and generally stop making so many dumb decisions. Here's hoping, anyway.

If you have any experience on Citalopram (Celexa) or similar SSRIs, is there anything you wish you'd known before starting? I'm aware of the potential side-effects and withdrawal symptoms and at this point I'm prepared to take my chances. I'm most interested in your thoughts on the first 8 weeks or so of being medicated. If you'd like to add a comment anonymously, send me a mefimail and I'll paste it in below.

I'll take the first dose this Saturday after asking a GP friend for a second opinion. Can you think of anything I should ask that hasn't been covered above?

(I'm not seeing a therapist, but I am going to start working through Feeling Good as soon as I can. Previously I've used online CBT but found it overwhelming. If you want to talk about therapy, could we do that by mefimail instead? My diet and exercise regime are okay and pretty crappy, respectively. My family/social support network is good.)

Tell me how to choose a child/family therapist.

Anonymous — Tue, 17 Nov 2009 08:05:56 -0800

Should I go for the in-plan, cheap co-pay therapist or pony up more cash for the therapist who seems a better fit for my family? Would it be bad to switch therapists shortly into the process? My family needs some help from a therapist. Specifically, my daughter needs some help. She's young (in elementary school), and she was adopted into our family a few years ago. It was a huge trauma for her, and we're all still dealing with the after effects, including huge and frequent tantrums and bedwetting that would be more typical in a child much younger than she is (among other issues). She's still grieving and she's really suffering.

My understanding is that children who were adopted do best when dealing with therapists who understand adoption and how that can hurt a child years after the actual adoption, and so I would like a therapist who has worked with similar issues and similar kids.

I have a pretty good health plan for mental health issues. However, in my area, there are only one or two therapists who are in network, with a reasonable co-pay (around $15), who work with kids and who seem to have knowledge about adoption. I haven't spoken with any of them yet.

There's another practice in my area which specializes in dealing with adoption and dealing with kids who are in foster care or who were adopted. They work with everyone in the adoption triad (ie adoptive parents, kids, birth/first parents). They are out-of-network. My insurance company would cover some of the fees, but we might be looking at $60+ per session.

My inclination is to go right to the therapists who specialize in adoption. But should we give an in-network therapist a try first? Being able to have a low copay would probably mean we could afford much more therapy for much longer.

Will it mess up my daughter if we start with one therapist and switch?

I'd welcome any advice you have on choosing a therapist, especially one who works with kids. Thanks.

too bad it isn't just a babelfish

Anonymous — Tue, 17 Nov 2009 05:27:16 -0800

Physical problem or mental problem? I have a friend (I know you're not her doctor) who has a history of of mental illness. Paranoia, delusion, etc. She has been in a mental health facility twice in the past. Once, we visited where she had her breakdown and just being there, I saw this unreasonable paranoia coming out. Today she came by and said that she had a hole in her eye and that yesterday she saw something fly out of her nose. Also that she hocked a lougie and three little orange things came out.

There are two options. One, that there really is a parasite (or something) and she needs to get it checked out (uninsured, but she's working on figuring out how to get to a doctor), and the other option I can see is that she's having some sort of relapse.

I'm worried about her. I've been busy lately and haven't seen her for the past few weeks, but she has other friends who she does spend time with, and they've got her back (and are keeping an eye on this).

My question is twofold.

1) Do you know of any parasite that does this 'burrow into the eye and fly out the nose' thing, and if so, what would her symptoms be? She looked ok to me, but I know I have felt pretty sick before and looked fine.

2) I'm distrustful of the California mental health care system. Although I have no experience with the mental health care system at all, I worry that it can often be as much of a problem as a solution. I have this image of it as under-funded and that over-prescribing, and my desire to protect a smart and vibrant friend from something that wouldn't necessarily make her better comes into play.

It's late at night. I hope this was coherent and that I didn't leave anything important out. Thank you in advance for your advice and experiences.

Help me help a friend struggling with long-term depression.

Anonymous — Thu, 12 Nov 2009 07:09:12 -0800

Friend with depression (treated with meds), seems to have plateaued with any progress and still occasionally thinks of suicide. I am there for him as much as possible but it kills me to see him like this. Is there anything I should know, or that I could do or say at the right time to help him move forward? Asking anonymously because he knows I use this forum.

A bit of background:
he's suffered depression (chemical and situational at first) for about five years now.
He is a good person with a good amount going for him, but, of course, he doesn't see that - however, should he be able to come out of this, he's got a lot of raw goods that can help him live a happy, productive life.
He is on medication, but not in therapy - he was in the past, but it was only a finite amount of visits as allowed by his insurance. (If he would go back, I don't know - I am considering trying to get him to think about it, but know it would be a slow process if he would ever agree.)
He seems to want to get better sometimes - he's adopted a few behaviors that help (meditation when overwhelmed by anger, for example, much better communication with a very few friends).
Clearly, he's got one of the things he should be doing (meds) down, and maybe some of these other things point to good signs for wanting recovery - but he's not doing anything else I know of (regular sleep, good food, exercise, reaching out to more than just me) to help.
And he's still thinking of suicide - not imminently, I believe, but there was a plan recently, and I think he's just delayed that plan.

Basically, he's mostly functional, but obviously still struggling so much and for so long that something's got to give - either he's going to do everything he can to feel better, or he's going to give up. I have no idea which it will be.

Also, I live very far away - I cannot be with him, as much as I want to be, so our contact is limited (and obviously non-physical, so no touching, hugging, eye contact, etc).

I have never struggled with something this deep, so my question is this: are the signs pointing to him wanting to get better or not (or can one even tell from this)? Should he be receptive to suggestions/advice, what should I bring up? I'm completely clueless about what he should do to eliminate this despair (I've suggested omega 3's/B vitamins in the past to augment the meds, and obviously exercise, eating right, etc, but I'm fairly sure he's followed none of these things on a regular basis, just giving in to the lows instead), but am desperate for him to take the right steps.

Is there anything I can do that I might not be doing?

I realize this may turn out to be a situation where I have to just let him know I'm there for him and hope he makes a positive choice. It's agonizing, but I will do it, as I have done in the past. But if there is absolutely anything in the world I can do for him, I will do it. Please help me help him.

(Also, if you just have an anecdote that might calm me a bit, I would sincerely appreciate it. He knows I am always available for him, but there are times when not being proactive just drives me insane with worry. Despite my efforts, there are days when this interferes with my own life.)

I am living a wasted life. Tell me how to live.

Anonymous — Tue, 10 Nov 2009 13:56:01 -0800

I am living a wasted life. Depressed and stuck. I know this question has been asked a million times in a million different ways by a million different people. But I want to ask it myself, and hear what you say to me, because I am at the end of my rope. I am weeks away from my 33rd birthday. I am 200 lbs. overweight. I am separated from my husband of 5 years, and in the midst of getting a divorce. I never really was in love with him (he was a good friend, but not a person I ever was sexually attracted to. I am sure he was never attracted to me either). I think we married each other because we were both lost and didn't know what else to do.

I am sad over the end of the marriage, not because I fell out of love, but because it is a wake-up call that I wasted years of my life. I lived years of my life in a marraige, and now that it has ended, nothing has changed. I failed, and I am still the same paralyzed, reclusive, anxious, undependable, scared girl.

Earlier this year/late last year I was out of work for about 3 months due to depression, and luckily I still have a job. I just missed 4 more days of work. I don't know what happens to me. I am fine for months at a time, but then I wake up one morning and just. can't. get. in. the. shower. I sit in bed paralyzed with the thought of facing the day. That leads me to a downward spiral of missing days and days of work. I was suicidal late last year, I'm not now. I'm stuck.

I can't get myself to do even the most simple of things, like changing the cat litter, cleaning the apartment, answering the phone. I have mental blocks. If I have to pee, I will literally sit and debate with myself for an hour over whether to get up and go to the bathroom. I will sit for days knowing that I should get out and exercise, but instead I will watch tv, or lurk on mefi. I love food, and have an emotional relationship with food, but the thought of having to cook a healthy meal makes me tired before I even start.

While I'm at work or forced to be in a social environment, I am different. I am "on" - I talk and joke and do quality work. But it's just a shell that can be so easily broken, and has been.

I have friends but I loose them because I don't communicate with them because I can't bear the thought of leaving my home to meet with them or pick up the phone and call them.

Things you should know:

1. I am currently on anti-depressants, and see a psychiatrist about once a month for medication management. I have been on and off various anti-depressants for about 10 years and will continue to work with my current doctor to get the right combo of medication that works for me. But I also know that drugs can't solve everything.

2. I know I need to go to therapy. I KNOW this. I go, once, twice, then I stop. I think I found a good therapist, so how do I make myself go?

3. I know I need to go to bed earlier. I know I need to exercise. I know I need to eat less and eat healthier. I know I need to maintain relationships. I know I need to find activities. So far I haven't been able to do any of these things for extended periods of time.

I want your advice on how to live my life. I am like a 33 year old infant. I am completely overwhelmed. I don't know how to function as a human being. I think I will die and I will still be the same stale, lifeless person. I will have lived a wasted life. I'm really am not living, I'm only breathing. Can you tell me anything to help me?

email: wastedlife1@gmail.com

My friend has severe mental health issues and I don't know what to do.

hazyspring — Thu, 05 Nov 2009 16:13:08 -0800

Help me decide the best plan of attack with a friend who has very severe mental health issues. One of my oldest and closest friends has severe mental health issues that consist of anger, depression, anxiety, and paranoia among many other things. She is quite smart and has her masters degree. She can't hold down a job, because she can't get along with her co-workers and there is always some sort of drama. She has a history of self-mutilation and has threatened to kill herself multiple times, and was involuntarily committed once, and voluntarily committed a second time.

I live across the country from her, but I try to be the best friend I can, available when she needs to talk, and as supportive as I can even though there's only so much I can do, and I try to keep some distance from the situation because of the insanity.

Her behavior has been escalating and I think I'm going to try to push her to do something inpatient until she can really get herself better. But, I'm wondering if anyone has had any experience with a situation like this.

She has state health insurance, and seems like she has gotten very little help. Her behavior has continued to escalate, and I'm worried that the situation will end in suicide. She doesn't speak to her family and she has another close friend that feels the same way I do. She is married and it seems like their marriage is in a bit of trouble and he has just emotionally distanced himself from the situation.

Has anyone dealt with a situation like this, and how did you handle it? Is there any hope? It seems like she's constantly on and off new medication and nothing really helps. I feel like there is a careful balance of being a good friend and getting too involved in a very messy and complicated situation.

How do I get SSI/disability for mental health?

loquacious — Thu, 05 Nov 2009 11:32:34 -0800

How do I navigate Social Security to qualify for Medicaid, SSI and disability for mental health services? How do I find an advocate to guide me through the walls of paperwork and decisions? Sub-question: what are current mental health institutions like for in-patient treatment? I qualify for an array of symptoms for mental health disability - namely marked social dysfunction, severe anxiety, depression (most likely rapid cycling bipolar), persistent ideations and the inability to function normally and keep a job, set or keep goals or otherwise function at life. I have trouble maintaining all kinds of relationships. I also have an unhealthy relationship with alcohol and tobacco as self-medication.

In case it needs to be said - I also qualify financially. I have no job, no money, no property and as much as I hate to admit it I'm basically indignant and losing my housing.

I'm having a hell of a time finding services, doing my homework and wrestling with the bureaucracy while in the midst of these symptoms. How do I find an advocate, case worker or guide? This process is daunting enough without struggling with the symptoms at the same time, and dealing with the bureaucracy is aggravating the symptoms and often sending me spiking off into severe manic or depressive territories.

Also what can I expect these days if I sign myself in for in-patient treatment at a mental health facility in Los Angeles? I'm considering this as an option to get the process kick-started, as I'm more or less on the edge of crisis territory. What's the process like? What can I bring with me? What can't I bring? How much control can I expect to have over the process?

(Paging The Straigtener)

and my heart has slowly dried up

Anonymous — Mon, 02 Nov 2009 15:40:24 -0800

Another mental health, break up related question. What about me changed so quickly? I am at a loss to explain my behavior maybe you can help. I had been dating a girl (I am male) since my sophomore year of college. Upon graduation we broke up briefly, she moved to NYC, me to Boston. We got back together quickly and were genuinely happy with the long distance relationship. I became miserable at my job, decided to apply to grad school and she decided to apply to a school here in Boston (among several other places). However, now a year and a half later over the course of three weeks I completely pulled away from her, shared a bed with another girl after a Halloween party, and broke up with her via email. We have talked and she is devastated. She said to not call her for a really long time and I agreed.

I was raised Catholic and along with that developed the stereotypical habit of feeling guilty about so many things. I should be devastated but I don't feel anything. I have very loving friends and family and I want nothing to do with them. Today I was able to concentrate almost the whole day at work for the first time in months. I have been depressed in the past but nothing like this before.

How is it possible for someone to go from boy scout to fucking asshole that quickly? Was it there inside me all along? Is this biochemical? I am not looking for excuses or 'be young while you can' rationale for my behavior, I want to be the person I was at the end of September again.

Looking for a Therapist for a Friend in Richmond, VA

Anonymous — Mon, 26 Oct 2009 19:32:32 -0800

TherapyFilter: Asking for a friend of a friend—can anyone recommend a competent therapist accessible to someone living in Richmond, Virginia... especially someone especially good at handling issues of anxiety and panic? (Anonymous for the privacy of the individual[s] in question, in case someone could track them through me.)

Specifically, the friend-of-a-friend (a straight, white male in his early 20s, for what it matters) seems to be having issues with anxiety that increasingly have been manifesting in ways that resemble classic panic attacks—I'm thinking specifically the catastrophizing of physiological arousal leading to the positive-feedback cycle of anxiety that potentiates the attack. A doctor prescribed him an anti-anxiety medication of some sort, but he's considering therapy to help as well. However, to my knowledge, this doctor wasn't really able to proffer any suggestions as to who he could or should see to get some therapeutic assistance. As such, we're looking for recommendations for an excellent mental health professional to help him through his problems. I've heard that while many therapies tend to have similar therapeutic effects for many problems, panic disorders do have a history of better treatment through Cognitive-Behavioral Therapy, so maybe keep that in mind? (That being said, if you or someone you know had a positive experience with someone from a different therapeutic modality for similar problems, feel free to recommend them, too!)

(There's also a thread wherein said friend identified said friend-of-a-friend's mannerisms as rather remarkably fitting the diagnostic criteria of Paranoid Personality disorder; however, this is a Wikipedia diagnosis, neither of us are clinical professionals, and the friend-of-the-friend is interested in dealing with his anxiety, so speaking in terms of both pragmatism and respect for his own ability to manage his well-being, anxiety/panic would be the primary specialty he'd be looking for. Nevertheless, it does characterize at least some issues as an individual close to him—and, to an extent, he—perceives them, so could be relevant if you have numerous doctors in mind and someone has a relevant specialty.)

If you don't have any specific recommendations, you can still be helpful! As is evident by my asking the question, neither I nor the friend (nor the friend-of-the-friend, I would imagine) have the faintest idea of how to find a high-quality therapist anywhere, nevermind in the Richmond area. If there are any general sites or resources we can look at—especially that provide something approximating reviews—that'd be excellent as well!

If you don't feel comfortable posting here, toss me a line at mefi.richmond.therapy@gmail.com

Thank you in advance for your help!

A mental health/academic support quandary

Anonymous — Sun, 04 Oct 2009 20:30:25 -0800

I have some information which may be critical to my friend's future/safety, but I obtained it in a somewhat dubious way. I'd just like to hear your thoughts on the position I'm in. So my friend has major, chronic mental illness--major depression and probably Borderline Personality Disorder, among other things--and tends to self-destructive behavior, including one past suicide attempt and many threats. He's studying for a standardized grad school admission test, which is critical to his future (he has unique opportunities this year). He's studying using an online course, and is taking the test in just a week or two. He claims that he's reasonably far along in the materials, but that he hasn't touched any of the practice tests yet.

For various reasons (mostly past behavior and a shifty disposition on the topic), I had a very strong suspicion that he wasn't actually keeping up with his work. Anything that wrecks his chances of getting into grad school this year would be a suicide trigger for him--he's made that much clear--so I'm very concerned that on some level he's knowingly sabotaging this so that he has an alibi for desires he admittedly already contends with day-to-day.

So here's the sketchy part: I figured out the password to his online coursework, and found that indeed, he's done practically nothing, and last logged in over a month ago, but he did do the non-written parts of the initial practice test, and got something really low (around the 30th percentile). I don't necessarily take that score to mean much, because he may have just been blowing through the first test to get a feel for the difficulty level, but I am highly concerned by the fact that he doesn't seem to be studying. The only reason I sunk to this is that there's at least some small possibility that a life is at stake.

One monkey wrench is that a large portion of the study work for the course (I think a safe majority) is in the books, so it's conceivable that he's moving along OK in those and he's just lying for whatever reason about how much he's bothering with the online work. I can't think of much of a motivation for that, except that I know he wants me not to worry too much about him, so perhaps he's glossing over the details for my sake.

Eventually I will come clean with all this, but I think it's also dangerous to subject him to the stress of the revelation right now. In the future, when he's in a relative upswing in terms of mental health, I think he'll likely interpret it as a justified intervention; right now, of course, it'd probably feel like at least somewhat of a betrayal. Is there any subtler way I could try to steer this situation without blowing my cover? And, more than that, do you guys have any general thoughts about what to do from here that might be more coherent than my own?

I'm sure I'll get at least a few critical responses about what I've chosen to do so far. I myself am somewhat morally conflicted about it, but understand that there are more nuances to the background of this than I've included here, and I'm about 95% sure that my friend will ultimately be grateful that I did this.

Any private responses can go to askme.alter.oct09@gmail.com. Thanks so much in advance!

How can I get my sister help for her addiction/depression?

Anonymous — Sun, 20 Sep 2009 15:15:07 -0800

My sister has an alcohol and/or prescription and/or depression problem. What can I do to help her, and in what order? Apologies for the long e-mail, but this is anonymous so I want to get as much of the story here as I can.

My sister was in town this weekend (from 250 miles away), and did some things that really alarmed us. She is a few years older than me, in her mid-30s, married with a boy and a girl who are 6 and 3. I see her a couple of times a year. My two girls are near in age and love to play with their cousins.

This weekend, my sister drank 2 bottles of wine each night by herself while everyone else (her husband, me, and my wife) had either soda pop or one beer each. She would get progressively more angry/aggressive (verbally) as the night went on, but was never in a rage. Just noticeably sharp-tongued and at the same time boasting about herself.

Then overnight last night things got really bad. Apparently, after everyone went to bed she woke up (or never went to sleep) and snuck downstairs. She either drank more (but we couldn't find anything she could have) or popped some pills (again, not sure what they were or could have been). She was up into the night posting incoherently on her blog and on Facebook. Then on her way back to our guestroom she fell on our stairs and bloodied up her face, and fell over into a door (this was at 5:30). When her family left this morning at 8:00, her husband had to literally pick her up off the floor, then support her as she stumbled down the stairs and out the door. He flopped her down into the car and they were gone.

Talking to my parents, this is at least the 3rd time something like this has happened recently. My sister appears to be in complete denial that there is any trouble, and for whatever reason I think her husband is not willing or able to address the issue proactively (or at least not initiate action himself).

My wife and I think she needs help, now. For herself, for her kids, for her husband, and for the rest of our family. Complicating factors are that she has been generally depressed for as long as I can remember, she has MS, and she is without a job (recently) and being chased by creditors (for a long time).

I don't know if we need an intervention or a direct talk with her. I don't know if we should talk to everyone and get them on board behind her back (which could infuriate her and set her off if someone tells her) or address her first (which could set her off into a denial/aggression cycle before all the pieces are in place to convince her to get help). I don't know whether insurance will pay for rehab. I don't know whether I can or should call her own therapist and express my concern/get his advice. I've never done this before but think that my family will look to me for leadership. I am concerned that she could hurt herself; she will surely be defensive/dismissive/angry when confronted. I love my sister and want to help her. She will not be happy that this is happening.

For those who have been through this: how did you do it? In what order? With the addict's knowledge or behind their back?

Thanks for any advice you can give. Throwaway e-mail is helpmehelpmysister@gmail.com

Lipid Med Moods

AzraelBrown — Sat, 19 Sep 2009 20:13:19 -0800

I was recently prescribed simvastatin for high cholesterol. About a year ago I tried Lexapro for anxiety, but didn't do well on it and stopped after a couple months, and otherwise haven't taken any medication for anything. See inside for where the two cross: When I started taking simvastatin, it seemed to me that I had started sleeping better and had more energy when waking up in the mornings. The Wifey recently said - without having heard my thoughts - that she thinks my anxiety has been less since I've been taking simvastatin, too, although she didn't want to say anything since it didn't seem to make sense. I can't imagine placebo effect, since I, even now, don't see any reason for a statin to have any sort of seratonin-related improvement or other mental health impact. Searching for side effects only found the one my doctor warned about, joint pain that's a bad sign, which I don't have nor any other negative side effects. Also, in case you're stalking me, this all started before I started exercising, so it's not that. You're not my doctor, and I haven't brought it up to my doctor since it seems so unrelated, but are there any of you in the MeFi universe with any thoughts on why this might be?

How to stop having an intense disgust reaction?

Anonymous — Fri, 18 Sep 2009 12:04:45 -0800

I need help to stop myself having an intense disgust reaction to something that everyone else finds normal – namely, sniffing. This is making my life miserable, please help! Background: when I was little my mother smacked me every time I sniffed, and my nanny reinforced this by telling me that when I sniffed it was like drinking snot (I realise this sentence reads like I grew up in a Dickens novel, but it’s true). So I’ve found sniffing disgusting for as long as I can remember, but through the years its been getting progressively worse (I have no idea why). The sound of sniffing from some distance away disgusts me; people sniffing on the tv or at the cinema disgust me.

As soon as cough and cold season hits my life becomes hell. It’s an incredibly intense disgust reaction – the only way I could think of describing it would be the sort of reaction normal people would have to someone eating their own feces. Now imagine that in your work, on your commute you’re surrounded by people who eat their own feces every few minutes or seconds. I tense up, I get headachey, I feel sick – I’ve had to leave an important meeting to throw up because I was sat next to someone who was sniffing every few seconds. My iPod is my lifeline – I spend as much time as possible with the music turned up loud enough to drown out the sounds of sniffing (which of course isn’t doing my hearing any good).

Some of my friends know about this, and are very nice about it, but have no ideas about how to stop my reaction. I’ve asked colleagues at work to stop (very, very politely, explaining that it was a problem I had and I was really sorry for asking), and have either been ignored or been given a lecture that I had no right to ask. I find it very difficult to talk about this, because it’s such an odd thing that people have had very negative reactions (and I haven’t been demanding they stop or anything like that – I try really, really hard to tamp down how much it upsets me).

I’ve pre-existing mental health problems (cyclothymia/Bipolar II depending on which doctor you ask). But I’ve been really well recently, and everything is good – apart from the sniffing thing. It seems to me to be independent of my other mental health issues, but I could be wrong. I asked one therapist about this, and he was sympathetic but didn’t have any ideas on how to deal with it.

In general I’m not germphobic, nor am I squeamish – people throwing up, eating food that’s been dropped on the floor I’m fine with. This is an incredibly specific disgust reaction.

The couple of strategies I’ve tried:
- Rational/CBT approach. I ended up knowing a lot about the respiratory tract, and the fact that mucus makes its way down to the stomach even when you’re not sniffing. This logical, rational knowledge has made no impact on the disgust reaction.
- Hypnotherapy. Made me very relaxed, right up to the point that I heard someone sniffing again.

I hope someone can help me. Sometimes I just want to be a hermit on my own so I don’t have to feel like this.

Can't change

Anonymous — Fri, 18 Sep 2009 06:59:52 -0800

Why do I have a fear of people seeing me change or do anything out of character? I can't figure this out. I have a fear of people seeing me change (primarily my parents, whom I live with). For example, I would like to do some weightlifting, but the idea of me buying some dumbbells is unfathomable because my parents would see that I have taken an interest to changing myself. Going for a walk or brushing my hair differently is pretty well impossible for the same reason. These are minor examples, but there are other "parts of growing up" which I haven't started doing because of this fear. It pretty much blocks me from doing anything out of character, thus my life is like Groundhog day. I can't associate this with any diagnosis myself... has anyone heard of or experienced it?

P.S: I have a referral to a psychiatrist, but, being out of character, I'm hesitant to go unless I can do so without anyone else knowing. That's how nuts I am. And yes it took a lot of guts to get that referral.

Good thing I didn't lose my MeFi password...

l33tpolicywonk — Sun, 13 Sep 2009 17:28:49 -0800

Lately I seem to be losing a lot of things - the screws for a chair, the screws I bought to replace them, a screwdriver to put them in, a cheese grater, now my wallet. I haven't really had a losing things stage since I was a kid. Confirmation bias, or is there something wrong with me?

Awesome Austin Therapist?

odayoday — Thu, 03 Sep 2009 09:57:23 -0800

Austin Therapist Recommendations: A friend is looking for a therapist to work through some issues. He wants someone who is active in conversation and is willing to confront him on things when necessary. He's had therapists in the past who were nice but too passive, and just listened more than they offered ideas and suggestions. The ideal therapist would listen without judging but would help stimulate new ideas and change in his life. Do you know of anyone like this?

Am I ready to leave therapy?

Anonymous — Thu, 20 Aug 2009 08:09:26 -0800

Am I ready to leave therapy? And if so, how do I do it? I have been in talk therapy for the last 20 months. I entered when I was severely depressed due to a sudden breakup, and worked through the issues surrounding that and previous romantic relationships (I’m now in a very healthy committed relationship that will likely result in marriage). I’ve also worked through a lot of other stuff relating to my childhood and have developed much healthier boundaries with my mother and a more open and closer relationship with my father. I’ve enjoyed therapy, in the way you can enjoy something that’s sometimes really, really difficult and painful. I found it more helpful than I dreamed it could be, and I'm proud of myself for doing some really hard work. I like my therapist.

However, she’s been on vacation for two weeks, and I’ve felt SO FREE. I didn’t realize that I’d gotten to the point of kind of dredging up the same old situations over and over again and that it was starting to wear me out. During my therapist’s absence, I had a potentially very stressful visit from my mother and a continued stressful situation going on with my extended family, in which I’m sort of the one everyone else is leaning on. I handled both with a grace and strength that I wasn’t sure I possessed without having someone to talk it over with every week. I guess I sort of confirmed what I wasn’t sure I believed—that I don’t NEED therapy to handle my family anymore. I can do it on my own. I enjoyed the freedom of experiencing what was going on without analyzing it.

So am I ready to be done? I’m not sure—I’ve never left therapy before. How does it work? Do I just tell my therapist that I’m done, and that’s it? Do we schedule a termination date and work up to it? How do you say goodbye?

Obviously, I will discuss all of this with my therapist when she’s back next week, and I’m comfortable doing so, but I just wondered. It seems like everyone I know in therapy goes for years and years and years and I don’t really want that. I’m totally open to going back if I feel like I need it, or if my life changes and I get depressed again, or for pre-marital or marriage counseling or for any other reason where it seems like it would be helpful. But for now, I’d like to experience more of this freedom of allowing myself to experience and be, without being compelled to compare everything to my childhood and figure out what it means or how I feel about it.

Any advice or experience from therapists or people in my situation is much appreciated.

Is it wrong for my sister-in-law to date a retarded man?

Anonymous — Tue, 11 Aug 2009 06:45:54 -0800

My sister-in-law has started dating a mildly retarded man. This strikes me as very, very wrong. Am I a bigot, or is this a well-founded concern? She's nearly 30, and has been coddled by her parents to a degree that has stunted her growth, emotionally and developmentally. She still lives with her parents, doesn't drive, leaves the house only for her job (full-time, caring for the elderly with Alzheimer's in a retirement facility), and I suspect she's chronically depressed. My wife and I are working on her (teaching her to develop life goals, encourage her to make friends, encouraging her to seek therapy, and so in), but FWIW, she's got a college degree, she's actually pretty outgoing, and is a regular churchgoer. Fundamentally, there's nothing wrong with her that couldn't be cured with a year of living on her own and a couple of years of therapy.

This guy lives in a group home. He works at a minimum wage job at the age of 30. I'd be surprised if he had a high school degree. He's not capable of driving. You might not know he was retarded in a conversation of a minute or two, but much longer than that and it becomes clear that something is wrong with him. His two best friends have Down's syndrome; their first date involved hanging out with them (after which he immediately started referring to her as "my girlfriend"). He's perfectly nice, apparently harmless, and she thinks he's sweet.

I find this horrifying for multiple reasons, but to get to the crux of my question, this seems exploitative and utterly inappropriate. If she were dating somebody with paralysis, blindness, or deafness, I can't see why I'd have any problem with it. But to date (with marriage her single-minded goal) a retarded man is in a totally different realm, for ethical and societal reasons that I can't quite put my finger on. Should I just get over it, or is this fundamentally wrong for her to do?

How to be happy as i am

Anonymous — Sun, 09 Aug 2009 16:36:06 -0800

[neurotic teen filter] - Id like to be comfortable with my body again! I need advice on how to control an unhealthy relationship with my weight. I am not fat. But i have a tendency to think i am, and my friends look at me like im crazy if i say anything about it.

I lost a stone after going to uni, but have gained half of it back, putting me at around 8 stone atm (im 5ft 4ish) and i want to be happy with that, and stop feeling guilty whenever i eat a proper meal.

I DID go see a psychiatrist, after waiting months for an appointment, we seriously did not get along and she basically said there was nothing wrong with me. And now im waiting more months for the NHS to get back to me about conselling, tho im starting to wonder if that will even happen.

I am determined to become a reasonable human being again. Im bored of feeling fat if i put on a couple pounds, and feeling stereotypically female and attention seeking if i talk about it. Help me regain a normal perspective please!

Am I depressed, or just screwed-up?

Anonymous — Tue, 04 Aug 2009 06:31:48 -0800

So I’ve finally made up my mind to talk to my GP about the depression that I think I’m suffering from. I have a few days before my appointment and I’d like to get a clearer handle on things before I see him. Can you help me unpack some of this? Some background : Mid 20s, male, English. Although I never sought help at the time I believe that I went through quite a serious depressive episode during the year after finishing university. I was unemployed at the time and remember feeling absolutely worthless, guilty all the time, regularly crying myself to sleep, imagining what people would say about me at my funeral, thinking it would be better for everyone if I were dead, and so on. It was awful beyond words. I felt destroyed. This episode was sort of ‘cured’ by travelling abroad for six months at a family member’s insistence.

Since then I’ve never dropped so low again, but I’ve been consistently underemployed, have no friends at all, still live with my parents, have only ever had one girlfriend (whom I was with for years and years from a stupidly young age), and generally feel like a failure. However, I’ve also taken some evening classes, then part of a Masters degree, and had fun doing them. I’ve also held down an admin job and done a reasonable job at it, though I felt ashamed to be so underemployed (not helped by colleagues and family saying things like ‘but you’re so intelligent, what are you doing here/there?’). So I have some work/social/family issues mixed up in all this too, but is there also a medical element?

I’ve now been unemployed for months (previous job died of natural causes – end of contract), though I’ve been consistently going to some classes, turning papers in on time, and getting excellent grades. I’ve been applying for jobs, but not nearly as many as I should be, and I’ve been procrastinating and ruminating to a ridiculous degree. I’ve been putting off applying for jobs until the deadline passes, and I’ve been spending more time torturing myself inside over my unemployment than trying to fix the situation. For the past few months I’ve been thinking to myself that I should really go and talk to a doctor because I’ve been having shades of the feelings I used to have during the Awful Year. I kept putting it off until the end of the academic year, and since then I’ve put it off for two months longer. More recently the negative thoughts and feelings have become much more potent and frequent, but not constant. Right now I feel at a relative low, but at the end of last week I remember thinking and feeling quite well and at peace. This shift has happened a few times over recent weeks and I’m not sure how much to make of it. Maybe I’m just fooling myself on good days. Another thing I sometimes ask myself is – what if I’m just used to being depressed all the time now – what if I never really got over it before and now I just have times that are relatively better and relatively worse, but never truly well? I’m not sure I believe that. I don’t know. The more I try to figure it out, the foggier it all seems, which is partly why I’m asking for advice.

Anyway, the ’symptoms’ that I’ve been having recently are:
- Reduced activity (going out, reading, doing) and increased web-surfing and time-killing.
- Suicidal thoughts – but not of a kind that seems dangerous – I really don’t think I’d ever do anything like that. More like, if I think about my future, my career, about how I should be filling in that application form I’ve had open for days, I very quickly and fleetingly think ‘I should just kill myself’. It’s been happening much more recently (several times a day) and I think it’s more a bad thought-habit than a desire to actually harm myself. Just to reiterate – I don’t need to phone the suicide hotline or whatever. The only way I’d ever really kill myself is if I’d been bitten by a zombie, but it can’t be right to have suicidal phrases running through my mind every day, can it? I’m sure this didn’t happen so much a year or eighteen months ago.
- Irritability/anger (this is very out of character for me, I get ticked off like anyone else, but at the moment everything seems to be ticking me off, other times though I feel quite full of love and peace, but those are in the minority).
- Some tiredness and lethargy.
- Feeling tearful but not crying. My breath sometimes rattles a bit as if I had been crying (that used to happen during the Awful Year).
- The voice in my head seems slower recently and my intellectual curiosity seems diminished.
- I’ve been speaking less. I’m a quiet person anyway, but much more so recently. This used to happen during the Awful Year.
- Sometimes I feel very hopeless about the future and seem to have an uncharacteristically pessimistic and cynical outlook. Sometimes everything I hear people say seems to be a coded metaphor for my own failings.
- More generally, I seem to try not to get to know people too well because I don’t want them to see me for the failure that I am. It’s hard to really describe this. Avoiding eye-contact used to be part of it I think, but I can bluff through that now.

So really, after almost 1000 words, I don’t know what my question is any more. I suppose what I’m looking for is some clarity – does any of the above sound familiar, does it fit a pattern? If I was going to see the doctor about a pain in my knee, I’d find out all that I could about knee problems before seeing him, I'd see if the pain in my opposite ankle was related, but this is all so foggy. What do you think?

Bonus questions:
- I’ve been trying to learn a musical instrument for the last couple of weeks. I think I’ve been enjoying it. Does that mean I’m not really depressed?
- I still laugh at jokes, hard. Does that mean I’m not really depressed?
- I’ve learned some new three-ball juggling tricks over the last few months. I’m really pleased with myself for learning them. Does that mean I’m not really depressed?
- I get out of the bed in the mornings, get showered, generally drive someone to their workplace, go to the supermarket, things like that. Does that mean I’m not really depressed?
- I never miss appointments, and I got my car repaired last week (which involved multiple visits to more than one mechanic). Does that mean I’m not really depressed?

Thank you so much for taking the time to read this mess. I’m really very grateful. Anything you could offer would be appreciated.

How do I find off-the-books therapy?

Anonymous — Thu, 30 Jul 2009 09:29:06 -0800

A while ago, I asked about the implications of accessing mental health care and possibly having a diagnosis tied to me. From the answers, I've concluded that in my specific situation, any help I need will have to be "off the record." Because that's my decision, this has made it hard to obtain care. How do I go about finding it anyway? I'm located in the United States, and have the usual litany of Ask Metafilter issues: self-esteem, challenges with interpersonal relationships, maybe a dash of depression and anxiety. I don't believe I have any "major" issues (bipolar, schizophrenia, sexual or substance abuse, violence, etc.) I'm primarily looking for talk (rather than pharmaceutical) therapy, although it's plausible that what I really need is something like a life coach.

I actually have (good, even) group health insurance, but the disincentives from the previous question are so great that I'd really not rather make use of it. In a word, I'd rather go untreated than have a record of any of this.

Can I pay for therapy and counseling in cash, on some sort of sliding scale, as if I were uninsured? Use an assumed name? How do I make this as untraceable as possible, while still getting effective care?

I'm open to suggestions for informal counseling as well, although since I am a staunch atheist, religious figures and support groups associated with a religion aren't something I would consider.

Doing my part for mental health awareness

silby — Sun, 26 Jul 2009 20:45:49 -0800

I want to do something positive for mental health awareness aside from just engaging people on the subject when it comes up. Is there anyone out there I can consider donating my time or money to? In the last year or so, I have gotten a handle on my mental health situation, and while I wasn't in the direst of straits, I still feel like I have been spared a lifetime of anguish. My awareness of the possibility that I might have a problem was pretty minimal for most of my life (though I'm rather young), and I'd like to pay forward my recent strides by doing something for the cause, such as it is, of mental health awareness, perhaps specifically panic/anxiety/depression issues. Unfortunately, a lot of the public face of mental health treatment is put forward by the drug companies, and while I <3 my pills, they don't really present the most balanced or helpful information to people, nor can one volunteer one's time for Pfizer. Are there reputable nonprofits out there doing good work in this area, like a Planned Parenthood for crazy people or something?