How Do I Give Myself a Chance to Get Better?
July 14, 2009 9:17 AM   Subscribe

After a long and losing battle with depression, I am going to a short-term (10 day) partial hospitalization program at McLean Hospital near Boston. I need advice on how to convince myself that there’s hope for me and get into the kind of frame of mind that will allow me to benefit from this kind of program, despite its short length and limitations.

I have struggled with depression since early adolescence, but felt like I was on the road to managing it and leading a healthy, happy life until a serious breakdown about 9 years ago, when I was 26.

I desperately want to live life differently and get better, and that’s what’s given me the ability to plug along over the last decade or so, trying new therapists, new doctors, new medications, and all kinds of lifestyle maintenance and changes (i.e. diet, exercise, supplements).

I’ve taken all the classes of anti-depressants, drugs for bipolar disorder, atypical anti-psychotics, thyroid supplements, stimulants, drugs old-fashioned and cutting-edge, 21 sessions of ECT. Mostly, they didn’t help. When it did, the effect soon wore off.

I was tested for everything: diabetes, vitamin deficiencies, thyroid problems, adrenal problems. Fancy doctors from various sorts of prestigious institutions tried looking at the problem from all kinds of angles, applying new diagnoses that might shed new light and help me get better, including bipolar disorder and borderline personality disorder, but the new diagnostic lenses and alternative approaches didn’t yield any results.

While much of the McLean program will have a diagnostic bent, it’s also supposed to have a therapeutic element, insofar as these 10 days will be a time-out and a potential physiological and psychological reboot.

I don’t know how much of the program's benefits depend on my ability to try to maintain a attitude that is at least open-minded (if not outright positive). But if there’s any chance at all that being able to feel less despair will improve my chance to get more out of the program, I desperately need to do so. I’m also afraid of getting written off as having a negative attitude by the program staff.

The trouble is that after years of encouraging myself, trying to maintain a positive attitude, and trying to get better, I can’t bring myself to believe that something else is possible. In another Askme on depression, a user here once wrote about how depression “ruins you inside,” and that’s a pretty accurate way of describing the effect this has had on me.

Not long after the breakdown, I picked up Andrew Solomon’s The Noonday Demon, hoping to find some insights into what I was suffering. It terrified me so much I couldn’t finish it: the book was replete was stories of people who had struggled with depression for years and whose lives were lunar landscapes of pain and failure. Nine years later, I have become one of those people.

Hope seems fundamentally irrational, and I feel like an idiot trying to improve my situation despite all the evidence that shows that I can't be helped. I know that McLean doesn't have access to some kind of special magic potion, and I don’t know what kind of new information they could get that might help provide a new diagnostic or treatment angle to my condition.

Psychiatry treats despair and hopelessness as if they were irrational, or symptoms of an illness, but right now they feel pretty damn logical, insofar as it no longer seems logical to believe I can live differently. Yet somehow I need to muster the ability to believe that this can help me. I don’t know how to do that.

I am very grateful for your ideas and feedback as to how to increase my chances of benefiting from this program and giving myself an opportunity to get better.
posted by anonymous to Health & Fitness (23 answers total) 11 users marked this as a favorite
I don't know if there's anything you can actually do to get ready for this. Your feeling of hopelessness is part of the symptoms they will be treating. You can focus on how positive it is that you're doing this for yourself. That in and of itself is a big step--you pulled it together enough to get yourself some more help and even though you are unsure of the outcome of the treatment you're doing it anyway. That may not sound like hope on the surface, but there's an undercurrent there. You want to get better and you are taking steps to do so. That shows great promise.

Also, people who live with long-term depression usually have brain chemistry issues and it's possible that this program will help find the right medication to help you feel better all the time. So just be open to their advice and unwaveringly honest with how what they are doing is actually affecting you. The more quality feedback they get, the easier it will be for them to fine-tune your treatment.

Good luck!
posted by Kimberly at 9:30 AM on July 14, 2009

I'm wondering if you've had a sleep study somewhere along the way. You don't have to be an overweight snorer to suffer from apnea.
posted by availablelight at 9:34 AM on July 14, 2009

Kimberly's point is a really good one-- you're going to this program because of the symptoms that are keeping you from fixing your depression, with the assumption that they'll be able to help you. McLean's a pretty damn respectable institution, so while it's by no means a magic bullet, just remember that you'll be in good hands.

For now, maybe planning some things you'd like to do after you leave McLean would be a good use of your time, even if you don't end up following through with them. Find some cool museum exhibit or something that you can use as a sort of reward for yourself for taking such a proactive step in improving your life. I personally find bribing myself to do things I'm apprehensive about to be a great, if unsophisticated, motivating tool.
posted by oinopaponton at 9:40 AM on July 14, 2009

Anon, your post sounds almost like you're picturing the stint at the hospital as one of complete isolation. You don't have to cure yourself all by yourself. That's what the doctors, therapists, and nurses are for. They are there to help. (I speak as someone who's been in a psych ward before and has, coincidentally, never had a terrible experience with any MH professional and therefore is inclined to trust them. I realize mileage may vary.) Assuming your stay will include some talk therapy, maybe you can find a therapist to bond with who can offer some insights ... news you can use. :-)

Also, at the risk of sounding like a cloying idiot...the way you feel can be changed. The way you react to events can be changed. I agree completely with Kimberly that hopelessness is one of the symptoms of depression and the thought patterns that go with long-term depression. (Believe me, I know.) And I also agree about the brain chemistry issues. IANAD or MHP, but if memory serves, the current thinking is that a combination of meds and talk therapy is the best predictor of success in chronic depression.

You're taking a step in the right direction by checking in. I hope it helps you. Let the staff help you too. Best of luck.
posted by scratch at 9:41 AM on July 14, 2009 [3 favorites]

Forgot to mention--you said you want to change and get better. Motivation is a huge, well, motivator. Keep trying, even while it seems pointless. Please accept help in all its various forms (even from the green).
posted by scratch at 9:43 AM on July 14, 2009

I hear so much 'I should be in a positive state' in your post. Trying to maintain a positive attitude while depressed can be exhausting! Maybe you could try to go into the program focusing on having no attitude at all. Letting go and resting your brain, allowing them to take care of it for you.
posted by Vaike at 9:43 AM on July 14, 2009 [4 favorites]

Your eloquence in pain and despair is the hope I have for you and wish it was the hope you had for yourself. It is another day and another day--all I want to say is do not give up--for years you have managed the often unmanageable and tomorrow is another day--please manage it. No one knows what might work, or if anything might work, but after thirty five years as a MH professional I saw such profound changes in medication and intervention I have realistic hope for you and many others. And for goodness sake--do not demand of yourself that you be or feel other that what you are. what you experience and what you hope.
posted by rmhsinc at 9:52 AM on July 14, 2009 [2 favorites]

I can already see the hope you don't think you have (and it's not irrational at all to want to live a better life than what you are living now). You have persisted through the hell of all of these treatments, and you are still trying. Not a lot of people with severe, treatment-resistant depression can maintain the kind of strength you have maintained, and I don't blame you for being exhausted and feeling as though hope is irrational. But you have been the one to take control of your depression and push yourself to get through what you have needed to get through, and that's such an incredible accomplishment and a testament to your internal strength. FWIW, in my experience (and in the general experience of all clinicians who work with people living with depression), inpatient treatment tends to be most successful for people who go in both voluntarily and with the attitude of wanting to have an opportunity to get better and get the most out of the experience. You absolutely have both of these things going for you already.
posted by so_gracefully at 9:58 AM on July 14, 2009 [1 favorite]

When I've been deep in the pit, I find it helps to focus on little things. Don't plan, don't anticipate. Do the one thing that's right in front of you. Make the bed. Take a shower. Go to the meeting. Whatever. Use this time to recharge. Let your brain yammer away, but don't bother listening to it. Just do whatever is front of you, one little thing at a time. Good luck. You can get better. You will get better. It won't happen overnight. But it will happen.
posted by BitterOldPunk at 10:15 AM on July 14, 2009 [1 favorite]

Print out what you wrote here and give it to the people at McLean. Don't give up!
posted by mareli at 10:17 AM on July 14, 2009 [1 favorite]

Though I know where you're coming from, I think if you had zero hope, you wouldn't be going. So there's a seed of hope to start with. And if the program didn't help a good many of the people who tried it in some way, it would likely be scuttled. So there's some fertilizer for your seed. It sounds like you've tried so many things that haven't worked, and this one might not either. But you won't know until you go. And it has less of a chance of helping if you're intent on staying where you are. Don't waste your time if you won't give it a chance. This scenario is at least a cousin of that cliche of "Whether you think you'll succeed or not, you're right." Believing it will work may not make it work, as the thousands of actors waiting tables in LA can attest, but believing it won't is likely to undermine it.

You claim to have evidence that you can't be helped. But what you actually have is evidence that you have not yet been helped. It could happen tomorrow and then wouldn't you feel silly for thinking you were such a knowitall. Other people have come out of it after a long time - you've read their stories. They didn't expect it and then something finally worked. You know that that could be you as easily as anyone and you know that you can't predict it.

What you're doing by predicting that it won't work is defending against potential pain. Since you can't fail at something you don't earnestly try, you on some level feel safer sabotaging your efforts so that you never leave the launch pad. If you hope and then it doesn't work out, you'll feel you've been suckerpunched, and you feel like you can't handle getting punched anymore. But if there's one person who can take a punch at this point, it's you. You've endured so much more pain inside than most people and the fact that you're still here says you've learned to handle it at a necessary level. I know it doesn't feel like it, but you are the proof. So if you risk hope on this treatment and it doesn't help, and your hope leads to hurt, you'll survive. It's not like feeling the pain of one facepunch makes the second or tenth punch not hurt (well, maybe a bit of numbing). But getting punched in the face a lot does show you that you can survive it, and lets you know what to expect with each new punch. Still sucks, still messes up your face a little, but you don't have to fear it so much because you know you'll survive.

It's sort of like trusting people. If you trust no one, nobody can ever hoodwink you and you never have to feel that hurt. Yet if you trust no one, you never form real relationships, which ultimately hurts much worse than getting tricked once in a while. So as with trusting people, it makes sense to risk hope on things that can be good for you rather than never hope at all. Echoes of the loved-and-lost cliche as well.

If this thing doesn't work out, you'll try something else. But for now, this is what you're doing. So give it a chance. By now you've learned that your own thoughts can poison you, so turn them off for now. Be here now. Don't think about what it may mean if this doesn't work. Don't think about potential pain. Don't think about what's next. Show up and do this and give it a chance and observe how it progresses. When it's done, you'll reflect, take stock, and make choices based on wherever you are then. It's not time for that yet.

Minor point - don't worry about the staff or their opinions of you. Your visit is about you. Their jobs are about you. You don't win or lose anything by pleasing them personally or disappointing them personally. From their perspective you are a puzzle, a challenge, an experiment. They're not looking to be your pal or pass out gold stars or demerits. They also recognize that your behavior and feelings are the very things they're trying to work on. They have loads of experience with people in your situation. They know you wouldn't be there if you were sunny and rosy. They expect not only your despair and the things associated with your disorder, but also things like resistance and negative attitudes and self sabotage. They know more than you. Let them practice their profession. Open up and let them work on you.

Sending good thoughts your way.
posted by kookoobirdz at 10:29 AM on July 14, 2009 [2 favorites]

Having lost a good friend very recently to suicide as a result of depression, I'm very glad to read your question and see that you're taking action. Others have made good points - that the way you feel is not a constant - today's emotions don't have predictive powers for future events. I would add that you may not realize, as he didn't, how many people are around you ready to support you. Many may not know your pain, or its scale. The more people that are informed the better base of support you'll have.
posted by odinsdream at 10:33 AM on July 14, 2009

You've said you've been tested for everything - so I assume you've had a brain MRI? Just to check for an arachnoid cyst in your frontal lobe - or anything else in there. If you want to pay for an article discussing such things, it's here. Best of luck.
posted by meerkatty at 10:36 AM on July 14, 2009

Your comments about hopelessness and wasted years made me think about this comment from a recent thread about alcoholism.
posted by fermezporte at 10:36 AM on July 14, 2009

Hmm. This is a tough one, I know. When I was growing up, my father struggled a lot with depression; it's something that I've dealt with myself in some degree, too. I know that it's painful, that it comes on you with no warning and holds you in its grip.

Here are a few coping strategies that I hope will help:

  • It's easy to convince yourself that depression is a part of you; resist that temptation. We often come to identify ourselves with our problems; this prevents us from actually fixing them and getting rid of the painful things that are weighing us down. You seem to believe you are ‘a depressive person,’ someone who is quite naturally depressed and always will be. There is no such thing.

  • See your malady for what it is: a condition brought on by some cause rather than an indelible character trait. You say:

    Hope seems fundamentally irrational, and I feel like an idiot trying to improve my situation despite all the evidence that shows that I can't be helped…Psychiatry treats despair and hopelessness as if they were irrational, or symptoms of an illness, but right now they feel pretty damn logical, insofar as it no longer seems logical to believe I can live differently. Yet somehow I need to muster the ability to believe that this can help me. I don’t know how to do that.

    I appreciate the situation; I've felt that feeling. But you need to recognize that it's not even an issue of hope; hope is a feeling, an emotional response based on a desire for a certain outcome.

    To be perfectly, coldly rational about it, to really see it for what it is, you have to realize that being depressed is not a natural part of human life in general or your life in particular. Nature doesn't intend for you to be so unhappy; it's not practical, and it certainly doesn't perpetuate the species. I say this not to point out that ‘you're unnatural’ but to demonstrate to you that depression has causes, and removing those causes will remove the depression. That's not an object of hope; it's a logical fact.

  • Approaching this as a problem to be solved and an effect to be prevented rather than a condition to be lived with is really the first step; and it's clear that you're avoiding this. For example, you don't mention why you're depressed, or what the character of your depression is. Is it an angry depression? Is it a mopey depression? Is it simply a paralyzing depression? Yes, I understand that the reason you don't really mention these things is because you don't know what causes your depression; but the fact is that something does. The fact that you don't mention your history (your family life, your friendships, your occupations, etc) indicates to me that you've lost sight of this. What are the roots of your affliction? Does this depression come from your parents? From a painful event in your childhood? From something that happened to you when you were 26? What precipitated that breakdown? Yes, I know that you've probably thought about this and come up with nothing. But there has to be a reason, not because it would be nice or pleasant or hopeful for there to be a reason, but because things don't happen in the world unless something causes them to happen. You mention that you've been “encouraging myself, trying to maintain a positive attitude, and trying to get better” for many years, but this fails partially because you seem to think that ‘staying positive’ is the key to getting better. You don't have to be positive—you don't have to make the effort to be positive, no matter what self-help books may tell you—and thank god, since everybody knows how hard it is to be consistently positive in a world like ours. No; what you have to do is remember the way the world works: diseases and psychological problems have causes, and they only go on as long as you don't confront the cause; and, of course, once you confront the cause and deal with it, it's logically impossible for them to go on. Since this is a simple fact, a fact that's apparent as long as you think about it for a moment, it doesn't require the obnoxious effort that ‘staying positive’ does.

  • I don't want to seem as though I'm assuming I know everything about what you're going through, but it also seems telling to me that you emphasize that you've tried everything while not even mentioning what thought you've given to what's causing this. Know that you will continue to feel this way, no matter what ‘solutions’ or ‘therapies’ you try, until you confront the root of the problem and discover what's causing your depression. “Fancy doctors” and “prestigious institutions” don't cure psychological afflictions like this. A doctor can strap someone to a bed and cure their infection, even forcibly if he so chooses, but psychological afflictions are different precisely because they require the participation of the patient—in fact, you're the one who has to take a primary role in discovering what's going on. I don't say that to put weight on your shoulders but to remind you that you do have the power to do this. Just look for the cause, and the rest will come to you.

  • Your whole outlook seems to be derived from a particular frame of mind that you've settled into, a habit you've taken on of constantly reminding yourself that you will always be depressed. That's a habit you need to break. Imagination will help—it will be good for you to realize that people have been through worse than you have and still come out happy, and that you are no different from them and can access that happiness yourself. And a good first step on that road is revising the way you talk about certain things.

    Anyhow, it's really a small point, but I think it's significant: at the beginning of your question, you mention that you've been fighting “a long and losing battle with depression.” I wanted to point out that there's no such thing as a losing battle with depression;“ it's not a battle you can lose. Really. Having been alive is a net benefit; as Joe Strummer put it after Kurt Cobain killed himself, “the point of rock and roll is, it is good to be alive. It's a hell of a lot better than being dead.” Aristotle, one of the guys who's given me much guidance, says that simply existing is a source of pleasure, albeit a pleasure we often take for granted. So: you haven't lost, my friend. And, though your morbid sense of humor may respond that you can lose the battle with depression, at least if you kill yourself (I know because I have a particularly morbid sense of humor) well, even that's not true; everyone who's lived has had part of that benefit, part of that joy of existence, no matter how it ended. Ian Curtis, leader of one of my favorite bands, committed suicide at the age of 23; that doesn't take away the fact that he made beautiful and soaring music while he was alive. Suicide is a mistake, but it doesn't take away all the good of life no matter how much the person doing it wants it to.

    So: depression isn't a battle you can lose. Really, it's not a battle at all; it's an affliction. You don't have to feel as though you're at war with yourself.

  • posted by koeselitz at 10:52 AM on July 14, 2009 [7 favorites]

    You may have already read this, but I'm currently reading Depression in Context by Christopher Martell, which takes an interesting approach to the topic, and doesn't actually treat depression as something irrational at all. It was recommended to me by my current therapist, and apparently, they've had success rates better than CBT and antidepressants.

    I don't know if a 10 day program will help, I've been struggling with depression myself since about age 12. Sometimes the only thing that gives me hope is realizing that there really is no alternative. While you're alive and struggling there's always some chance, no matter how small, that you might find something that works. If you're not alive, there's zero chance.
    posted by fnerg at 10:54 AM on July 14, 2009

    Depression can feel very logical at its worst. You think, "I've felt this way for so long, and every time I think I'm better I fall right back down the rabbit hole."

    Which is one of the reasons you're about to do something different. From what I know of partial programs, there's a lot of focus on coping skills, distress tolerance and agency (the idea that you have control over how you respond to your illness). The idea is that yes, you're in a lot of pain. And it's awful. And it seems hopeless, but as others have said, the very fact that you're still trying means it's not hopeless.

    What this program should do for you is give you a set of tools you can begin to use to get your life back. Go into it with an open mind. Don't expect to get better all at once, right away. Take every single thing one moment at a time.

    Oh, and the first day of a program like the one you're going to? Almost universally sucks. But it gets better.

    I saw your post before, when you were looking for a place to stay in the Boston area. And I wanted to chime in then, to say something encouraging, but it didn't seem like the right place.

    So I'll say it now: You've got a difficult path ahead of you. But others have come through this, and you can too.

    Partial hospitalization programs are also designed to help you plan how you will return to your life in the big bad real world. As you go into this, think about what you need that you're not getting. Your social worker will be able to help you set things up so that when you leave the program you will have both good support systems and a good plan.

    Best of luck, and hugs to you.
    posted by brina at 12:29 PM on July 14, 2009 [3 favorites]

    Hope seems fundamentally irrational

    What is hope? If you mean an eagerness for a future improvement then maybe you shouldn't have hope. Just let the process happen, absent any hope OR dread. When you're in that pit simply being open to the possibility can be a huge effort and - I think - it's enough.

    If hope is a belief that things can be different, then you should remind yourself that, logically, there is every reason to believe that things can be better: most of the population manages to go on and have ups along with their downs. Obviously there's a difference between knowing something logically and feeling it, but sometimes you have to start with simply acknowledging the odds. Other people succeed in this so there's no reason to think you can't as well.

    Good luck.
    posted by phearlez at 1:07 PM on July 14, 2009

    People in this thread have already hit it on the head more or less.

    The only thing I can add is this: When I checked myself into a Mental Health Clinic at the ripe old age of 19, I had similar reservations about the fruitlessness of the treatment. As others have said, this is somewhat unavoidable because it is a symptom of the disease that has you going in the first place.

    So what I can share is what made me let go of that feeling: I substituted it with relief. If you are like me, the depression you have been living with is a constant weight, not only the internal feelings but for me the feelings of shame of trying to "hide in plain sight" in everyday society.

    So what I finally realized was that I was going to a place full of people with my same problem, and full of professionals who wanted to help me. That immense feeling of relief helped tremendously. No, it doesn't fix the root problem, but it alleviated a large part of the stress of living with depresssion and really allowed me to open up to the help I was about to be offered.

    When you are in there, try and remember: These people want to help. Go to the meetings. Don't trade your pills to someone else for smokes, take them instead, even if you don't want to. If you start feeling overwhelmed all over again and it's a critical mass type of overwhelming rather than the constant hum kind, go find someone on the staff and tell them. The more information they have, the more they can help.

    Good luck. I will be thinking about you.
    posted by lazaruslong at 2:49 PM on July 14, 2009

    Wow, your description really hits home, specifically the notion that it 'seems pretty logical'. That's exactly how I feel when I'm in the depths of it, convinced that my depressed outlook is 'reality' and that I was deluded when I was 'happy'. Also that feeling that it has gone on for so long that I'm a hopeless case.

    I guess the best advice I could give you (and I realize how wrong this may sound when your depression does seem logical) is just to try to be open to the idea that you can get better. I too struggled with the same problems, to a severe extent, but now I am happy (or at least just 'normal') more often than not.

    Second, I hope you can get some rest. Depression/anxiety for me have a 'snowball' effect where I can't sleep because I'm so upset, then I get more upset because I can't function because I'm so tired, and on and on... If you can talk to a doctor about getting some medication to help you sleep at least temporarily, you may feel at least a bit better and have some more energy to devote to getting well.

    Third, just try to keep working on it. Realize that you may go through a couple of therapists before you find the right fit and the same with medications. I've had a tendency in the past to build up hope for a new Dr. or med and then come crashing down when it didn't work. If you know ahead of time that it may take a few tries, you won't set yourself up for disappointment.

    Reach out to people who care for you and let them know what's going on. And I know it sounds easy to say this, but don't be hard on yourself. Depression takes a lot of energy to maintain and if you can just try to allow yourself to relax a bit, it will help.

    My thoughts go out to you. If you want to talk privately, feel free to send me a personal message.
    posted by mattholomew at 3:06 PM on July 14, 2009

    i used to go to a.a. meetings with a guy who couldn't scrape together more than 2 weeks to save his soul. and we're not talking about a high roller to begin with--he was jobless, pretty much friendless, little to no contact with his family, and a half step away from homelessness. emotionally he was a wreck.

    he would sit in meetings and listen to the platitudes. when it came time for him to speak, he'd say something along the lines of 'i don't have any idea what you people are talking about. all i know is that i believe that *you* believe.' he used that line whether people were talking about sobriety, a higher power, or any number of things which all boiled down to hope. he very literally clung to other people's faith & hope, repeating 'i believe that you believe.' it took me a while to understand what he meant, that he was talking about hope-by-proxy.

    he never fully embraced all the mumbo jumbo that goes along with a 12-step program, but he managed to pull himself together and string together 30 days, 90 days ... a couple of years. it was never easy for him, but when things got particularly tough, he'd fall back on 'i believe that you believe.' he still struggled, but he was finally able to secure a toolset that worked for him. i lost track of him after katrina, when he was evacuated up on the east coast somewhere, so as much as i'd like to add the 'happily ever after' tag, i can't.

    i believe you can do it. we all believe you can do it. and if you can siphon off just a little of that belief, it might help.

    best of luck. i'm pulling for you.
    posted by msconduct at 4:24 PM on July 14, 2009 [1 favorite]

    Anonymous, my heart goes out to you.

    My ex-husband suffers from depression, anxiety and OCD (undiagnosed for most of his life). Since 2003, he tried various meds, self-help books, therapists, psychiatrists, AA, all to no avail. His efforts took a toll on him. Physically, mentally and emotionally exhausted, he reached his breaking point last year and attempted suicide.

    He was hospitalized that night (ER). Once his physical health improved, they transferred him to the psychiatric ward. By all accounts, his stay in the psych ward (about a week) was short-length and limited, as you describe the program at McLean. Yet he found it tremendously helpful.

    He described it as feeling like he was genuinely part of a team for the first time in his life, surrounded by people who understood how he felt and took his mental health seriously. He's now on proper meds, finally found a therapist and psychiatrist who fit, and doing much better. From my POV, his stay there was a turning point in his getting better. I'm convinced it saved his life and his sanity.

    I need advice on how to convince myself that there’s hope for me and get into the kind of frame of mind that will allow me to benefit from this kind of program, despite its short length and limitations.

    I don’t know how much of the program's benefits depend on my ability to try to maintain a attitude that is at least open-minded (if not outright positive). I’m also afraid of getting written off as having a negative attitude by the program staff.

    Try not to concern yourself with getting into "the kind of frame of mind that will allow me to benefit." Same for your attitude. You don't need any more work right now. You don't need to worry about your attitude or whether they will write you off. For now, just take it day by day until you get yourself into McLean. The professionals there know what to do.

    I wish you the best of luck. I believe you can do it. I second the suggestion to print this and show it to the people at McLean.
    posted by Majorita at 10:38 PM on July 14, 2009

    I don’t know how much of the program's benefits depend on my ability to try to maintain a attitude that is at least open-minded (if not outright positive). But if there’s any chance at all that being able to feel less despair will improve my chance to get more out of the program, I desperately need to do so. I’m also afraid of getting written off as having a negative attitude by the program staff.

    I avoided getting proper treatment for my depression for years by taking this approach to my first two hospitalizations.

    Depression makes it so tempting to hide your symptoms. I very much wanted my doctors to like me. And letting on how much pain and despair I was feeling made me feel weak, pathetic and incredibly unlikeable. Besides, I was sure I wasn't worth their helping. On the rare occasion that I opened up a little about how much I was suffering, I immediately got this huge outpouring of sympathy — which I was convinced I hadn't earned, didn't deserve, couldn't in good faith accept, and so on. Cashing in on all that sympathy felt manipulative and slimy. Keeping my mouth shut and a vague smile on my face felt strong, responsible, honorable, friendly — oh and by the way, it also kept me from getting an accurate diagnosis, and the right meds at a high enough dosage, for almost a decade.

    Now, you're doing better than I was at asking for help, and that's really awesome. If honesty and dedication were all it took to get cured, you'd be better by now. But still — no sense starting in being dishonest now. If the purpose of this hospital stay is even partly diagnostic, don't hide information from the doctors who will be making that diagnosis. Don't make their job harder by covering up your symptoms. (And, like Majorita says, don't wear yourself out putting on a happy act.) Just relax, be yourself, and let them take care of you.

    That said...

    Hope seems fundamentally irrational, and I feel like an idiot trying to improve my situation despite all the evidence that shows that I can't be helped. I know that McLean doesn't have access to some kind of special magic potion, and I don’t know what kind of new information they could get that might help provide a new diagnostic or treatment angle to my condition.

    In my experience as a psych patient, what most of us (who aren't drug-addicted, physically ill or totally psychotic) get out of hospitalization is access to resources we didn't know existed. For some people, it's as simple as "Gee, I always thought therapy was bunk, but I guess it could help" or "You know, I didn't think there were meds that could help me, but I must have been wrong." You're savvier than that. But 1) McLean's a research hospital, and they probably know things about the meds that you don't, and 2) community resources are important too. Either way, if they introduce you to a therapy or support group that works for you, or a Harvard prof who studies cases like yours, or a doc with an experimental drug protocol that turns out to be just what you needed, or whatever, then that's just as helpful as anything that they might do during your ten day stay.

    Also, frankly, the state of the art in psychiatric diagnosis is pretty shitty. If you had a well-understood, easily-diagnosed disease, then asking for a third or fourth or seventeenth opinion would be a waste of time. But given the amount of guesswork and luck in psychiatry, and the number of different theories about how things work, it's entirely possible that diagnosis #17 or treatment plan #38 or whatever will be the one that finally gets it right.

    So, yeah, there's hope. You may not feel hopeful. And you sure shouldn't put on a hopeful act for your stay there if you don't feel it. But there really is hope.
    posted by nebulawindphone at 6:20 AM on July 15, 2009 [2 favorites]

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