Mom at her wit's end / Therapy in San Diego
November 23, 2009 11:49 AM   Subscribe

My mom has always had high anxiety, been prone to fear and pessimism, and has tended to focus on her fears in a very repetitive, verbal way that is often tiring to those around her. Her situation has worsened recently for several reasons. I want to help her find help. This question is both about therapy in general and for recommendations in San Diego in particular.

I've been thinking about writing this question to metafilter for several months. This was pushed over the edge this morning when, upon arriving to visit for thanksgiving, my mom opened the floodgates to me, telling me that she now wants to finally take antidepressants after resisting for many years. I told her that I'd like her to at least consider trying alternatives beforehand, particularly cognitive behavioral therapy and meditation techniques, as I (and in the case of the latter, her former therapist) have been encouraging her to for many years. I think both of these hold a lot of potential, as her current method for coping with stress largely involves focusing an incredible amount of mental activity on the problem, usually spinning it out to catastrophic fantasies, and telling stories about both the facts of the situation and her imagined scenarios repeatedly to family members, friends, etc. She seems open to cognitive behavioral, but is skeptical about meditation, as she thinks it is useless because she can't stop thinking when she tries to meditate. When I tell her that is exactly WHY she should keep trying, she gives me a tired look. Part of the problem here, really intertwined with all of the problems I'm talking about, is that I know my mom is a perfectionist and cannot stand the thought of failing at anything. She'd usually rather not try.

I love my mom deeply and don't want to understate my empathy. In the past, it seemed that she had a tendency towards what some call "destructive emotions," forming perceived rivalries with co-workers, losing friends and allies (professionally and personally) through acts that she (often understandably) perceived as deeds based on good principle, and being constantly hurt and dismayed through these processes. It's one thing to be stubborn, quite another to be stubborn AND insecure about people's perceptions of you at the same time.

Recently events have pushed her stress to a boiling point. Her brother died last year at 61 years old of lymphoma. Even though she was never very emotionally close to him, and in fact considered him worth a large part of the blame for the development of her insecurities (he really wasn't a very nice brother when they were young, in terms of self-esteem - putting her down, excluding her, etc.), she says that she still cannot stop thinking about her grief, primarily because she cannot accept that she will never speak to him again. These events have also combined with the condition of my 91-year-old grandmother, living in a condominium in Florida, who seems to perhaps be finally entering a real cognitive senescence, probably not coincidentally as her friends and other points of social contact progressively die and move away. My mom feels great guilt at leaving grandma out there, does not know if she can afford to take her in, and is disturbed by some dementia-like events, such as grandma becoming convinced that her son's (my mom's brother's) body was misplaced and that he is somewhere other than his grave.

I almost hesitate to even describe the next. About two weeks ago, my mom found my dad nursing a bottle of vodka in the garage. He had apparently been going like that (not every night, but consistently) for 2-3 years. Dad called me and my brother to tell us he had a problem, but has insisted to mom that he resolve this on his own, in private. In general, dad is not very emotive (this is largely due to his having a very abusive father), which does make he and my mom an odd couple in many ways. I do not agree with his method and plan to talk with him about possibilities such as AA, as I take his alcoholism to be related to a self-isolation that he should deal with more head-on (an issue perhaps worth its own mefi question, but not just yet.) In the meantime, mom also tells me that my life choices have been grieving her. In particular, as a PhD student, I have taken up field research on the US-Mexico border. Suffice to say for now that I think I have taken the right precautions, but she thinks the whole endeavor is unnecessary, that I am naive, and that it is appropriate on her part to respond by staying up at night worrying about me. Regardless of the impact of each of these individual factors, she tells me that she can barely get to sleep at night these days, and she shows many signs of fatigue and emotional fraying.

Now that I have aired an incredible amount of dirty laundry: do people think that I am right to suggest that she try other things before antidepressants? My main issue is that I see a coping problem. I think my mom is deeply, problematically "in her own head," and that if she could spend time with someone skilled at disassembling her kneejerk emotional pathways, that maybe she could begin to deal with her problems differently, find more empathy with others, take solace in what she has, and not dedicate so much mental energy to catastrophizing. She has always been an extremely high-stress person; she has also alienated herself from people, for as long as I can remember, due to her way of turning social interactions into a forum for a sort of firehose-let-me-tell-you-about-all-my-problems activity. (Her immediate family members deal with this differently. She considers me the only one who consistently listens and actively talks with her about it. My dad and brother both tell me that they frequently tune out because they feel unable to grapple with all of it.) It seems to me that this is about more than antidepressants, and that if she took more time to step outside her normal pathways of mental storytelling, maybe she could gain perspective and deal with these things differently.

So, depending on your answer to the question about antidepressants, I wonder if anyone has advice on therapists in the San Diego area who might be good for this situation, whether because they specialize in cognitive behavioral therapy, work on mindfulness techniques, or something else. I thank you for even considering the situation and apologize for the lack of succinctness. It's a tough one for me.
posted by anonymous to Human Relations (9 answers total) 6 users marked this as a favorite
do people think that I am right to suggest that she try other things before antidepressants?

For many people, under medical supervision, antidepressants can be a very good, even life-saving thing. I've seen enough good come from people in my life taking the step of going on antidepressants, that I wouldn't reserve it as a last ditch thing. However, I have also seen people prescribed antidepressants without suitable follow-up mental health care, which can be problematic. Would it be enough of a compromise for you to encourage her to see a psychiatrist (i.e., not her GP) for an evaluation and prescription, or for you to encourage her to see a therapist for an evaluation and then go to her primary care physician for a prescription? It seems like a positive step that she is finally considering doing something even if it's not exactly the thing you'd want her to do.
posted by Meg_Murry at 11:59 AM on November 23, 2009 [2 favorites]

I could go on and on but basically you seem to have my family. Except my parents divorced when I was young so my dad still drinks and my mom is still anxious. The whole floodgates thing rang a bell for me. I think realistically if your mom is open to any change at all I'd just be encouraging. Sounds to me that something more like an anti-anxiety medication might be more helpful than an anti-depressant but that's something for her and her doctor to think about. The way I see it, getting the [what my Mom calls] "squirrels in her head" out of the way she can have some calm space to actually think about her life and her actions and her choices that she's making or not making.

So, yes, this is about more than anti-depressants. That said, anti-depressants [or whatever] are one of a lot of possible first steps and a totally reasonable choice at that. Mindfulness and CBT are both great options [and hey maybe the Feeling Good Handbook is worthwhile] but they're tough to get started with when you can't even really stop and process and think. Really, you don't live with your Mom. Let her try the option that she feels decent about if it's one likely to work.

And as an aside: don't let your mom's guilt become your guilt. While it's nice that you're trying to be helpful her especially since the rest of the family has checked out somewhat, her being unable to sleep is not directly your concern and only intrudes on your life to the degree that you let it. This is a lesson it took me a long time to learn personally and even though I have a more distant relationship with my high anxiety mom, it's much improved because I don't take her personal "what is wrong with everyone in the world and why it makes me unhappy" drama home with me. Good luck to you and your mom.
posted by jessamyn at 11:59 AM on November 23, 2009

I think that you are undervaluing the action she's already taken, which is to decide to seek help. The ultimate form that helps assumes is way less important than seeking it.

You also seem to be assuming that antidepressants and therapy are mutually exclusive, that she can't take both. It seems to me that both may be in order.

Ultimately, that is up to her and her doctor. Encourage her to go to the doctor and ask for one or both of therapy referrals or an antidepressant prescription. If she's unwilling to go to a therapist, a prescription will help a great deal. If she's willing to do both, that's probably the best outcome.

Whatever you do, discouraging her from seeking help, in any way, is probably not going to accomplish good things.
posted by contrarian at 12:05 PM on November 23, 2009 [4 favorites]

do people think that I am right to suggest that she try other things before antidepressants? My main issue is that I see a coping problem.

No, personally, I don't think you're right, precisely because antidepressants can actually help in developing coping skills. I endured 20 years of clinical depression and anxiety, and it took a combination of antidepressants, therapy, and yoga to help me develop the skills I now have to lead a more productive, less emotionally unstable life. But none of that would have been possible had I not gone on meds in the first place. Like your mom, I tend myself toward catastrophic mental storytelling. Antidepressants helped lower the volume of that voice in my head. They didn't stop the catastrophic storytelling altogether -- it took years of therapy and yoga to unlearn that habit -- but the meds were absolutely Step 1.

Antidepressants (under the proper medical supervision) are a perfectly reasonable and responsible step for your mom to take. I would encourage you to support her in this step, while at the same time encouraging her to consider additional, complementary steps. Please don't discourage her or denigrate her attempts to help herself.
posted by scody at 12:10 PM on November 23, 2009 [10 favorites]

Oh, and speaking as someone who also has a very difficult, high-anxiety mother: I would recommend that you try to let go of even framing the issue as one of "being right." Right or wrong is unlikely to be a productive way of looking at it; it's about what works -- for you, and for her.
posted by scody at 12:15 PM on November 23, 2009 [3 favorites]

I am not on anti-depressants, and I generally don't advocate for them, but I think your mom may know what she needs. As I understand it, anti-depressants help alleviate depression just enough to allow the depressed person that wherewithall to make other changes. Although, from your description, it may be that anti-anxiety medicine may be more appropriate. Your mom has a LOT going on right now, she knows she can't handle it, so it may be best to give her some relief first of all before diving into the more time and energy consuming methods.
posted by The Light Fantastic at 12:20 PM on November 23, 2009

Your mother is in dire straits. She is open to antidepressants, but is closed to CBT or meditation. The math on this is not hard. It may not add up the way you would personally be the most comfortable with, but this is not about you - it's about what she's comfortable with right now.

She's taken a big step and you would be well advised to support her in the way she's clearly and articulately asking you to. Other things will (or won't) come later.
posted by DarlingBri at 12:33 PM on November 23, 2009 [10 favorites]

You are deeply involved, and it would probably be healthier for you to allow for a little bit more distance. Your Mom has finally agreed to get medical help for her anxiety. It might not be the precise help you want her to get, but why not step back and let her get the help her doctor recommends.

Turn it around. If you were going to use CBT and meditation to deal with anxiety of your own, would you want your Mom to say, Great, I'm here to support you in whatever way I can? or No, do it my way?
posted by theora55 at 3:04 PM on November 23, 2009 [1 favorite]

I like what scody suggested about reframing. I think anyone who's willing to take one step in the right direction should be commended. So if anti-depressants are where she's at, then that's where she's at, and that's where she starts. Perhaps she gets to meditation a bit later.

I will also share that I found the book The Highly Sensitive Person good reading as a reframing tool: Less, you've got this really unhelpful behavior and you need to fix it, more: you sort of have a particular, wonderful temperament, and combined with your upbringing, and a couple of personal life choices, it's kind of manifested itself in some really unpleasant, unhelpful ways. Here is an overview of the whole range of strategies you might explore more deeply on your own to address them. It seemed a very soothing way to think about it, because it appreciated the good (perhaps you worry because you want the best for people around you), and acknowledged the bad (...and perhaps that shows up as you continually questioning other people's choices which makes them want to avoid you). How do you cherish the first and not get sucked down by the second, because that caring really is a gift.

Some might find the approach too 'gentle' or 'precious', but I found it very soothing. Someone acknowledging that my anxiety, etc., came from a place of great caring took the edge of defensiveness off. And it was then easier to take up those coping skills, because at my core, I didn't feel broken, but perhaps misunderstood (by myself). In that context meditation became useful, to learn about myself - not as an abstract tool to 'calm myself down'. Which works as well as telling yourself not to think of elephants.

Anyway, best of luck to you and your mom - you're very generous to try to do what you can to help her. I'm sure in her own way, she really appreciates it.
posted by anitanita at 3:07 PM on November 23, 2009

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