Lifelong struggle with mental illness - what else can I try?
September 17, 2014 6:07 AM   Subscribe

I've been in and out of therapy my entire adult life (over twenty years) and am currently in treatment with a psychiatrist. The past few days I have been plagued with horrible feelings of hopelessness and worthlessness which culminated in crying uncontrollably this morning and unable to leave the house and go to work, and I barely managed to let my office know I wasn't coming in. I haven't been able to focus and I am sure everyone at work can tell how much my performance is slipping. I feel like a complete mess. No matter how good I can wind up feeling for a while, I always wind up back to this state. If I haven't managed to get to a good place in my life by now, how can I ever hope for improvement? Do I need more intensive treatment? What would that even look like?

I can't ever remember being happy growing up. Both of my parents came from families with extreme dysfunction - drug abuse and alcoholism (a good number of my relatives have died very young from drinking), physical and emotional abuse, sexual molestation, and just a great deal of trauma. My parents were teenagers when I was born (unplanned) and had never lived outside of their parents' home before becoming parents themselves, and neither of them have ever received treatment for any of the abuse they suffered. There was a great deal of emotional abuse in my home, but my parents always painted us as a healthy family because no one was being beaten or passed out drunk.

The only thing I've ever been able to succeed at is getting good grades at school, but have never been able to translate them to real life skills. When I left home for college I was completely unprepared and while I got good grades, I felt completely lost and cried constantly. By my junior year, I eventually hit a point where I couldn't leave my dorm room and sobbed uncontrollably and had to take a month off, and my GP at home put me on anti-depressants for the first time. I graduated with a great GPA but no clue how to function in life and had to move back in with my parents and worked a menial job because I just had no idea how to do anything else.

Here I am 20 years later and my adult life has been marked by just as many failures - continued disordered eating, bankruptcy, years of domestic violence and multiple sexual assaults, divorce, and perpetual underemployment in pink collar jobs that make me miserable. But in every job I've had, I can barely focus or keep it together, and wind up with days like today where I just can't leave the house. So I don't trust that I could find any better of a job if I'm already this much of a mess. And the fact that I've been struggling and stuck for so long means that I don't trust myself to ever improve. I can even have a year or so where I feel pretty good, but I always wind up back to feeling worthless and empty and a burden on my whole family.

Additionally, I developed a pretty intense marijuana habit over the past few years that provided some relief - it calmed my anxiety and got me out of my head and it distracted me from my self loathing - but it was also making me even less able to focus or get motivated and was exacerbating my depression. So I quit smoking this summer and that also felt good for a while, but now I keep wanting to do it again to quiet the critical voices in my head.

I am currently seeing a psychiatrist (for about a year) who has also been providing me with counseling sessions. I'm on Lexapro for anxiety and depression and Concerta for ADD and for a while I was feeling good, but I also haven't felt like I've connected well with him at all. I've always had a problem being open with therapists and I find myself wanting to impress them with how much I've improved. I can't seem to open up on a deep level and I feel like I don't know how to take anything from the sessions and apply them to my daily life.

I feel like I've hit a crisis and I clearly need something more, but what? The only therapy I ever felt like I got some practical use out of was a DBT group I attended years ago, but I had to leave since I moved out of the area. I feel like I need more in-depth and more intensive treatment to make any progress, but I don't really know what my options are. My job is full time and I have a 2-3 hour commute a day, and I have a hard enough time fitting my current treatment into that schedule. And I'm the primary breadwinner while my husband has been trying to find work after being laid off himself, so I feel like trying to take any more time off or giving any hint of my mental health problems would jeopardize my job at a time where I really can't afford any mistakes. But even when I'm at work, I'm still not getting anything done because I can't think straight - so maybe I'm already jeopardizing it.

Anyway, I am seeing my shrink in a few days and I need to tell him that I need more help, but I don't know what to suggest. And I'm afraid that I'll be feeling okay in the moment in a few days and will clam up and not say anything to the doctor. During my last appointment I wanted to say something but couldn't bring myself to open my mouth.

Sorry for all this length, but I'm just at such a loss, and as much self-loathing as I'm suffering from, I don't want to give up. Can you think of anything I can try that might help me start pulling myself out of this?
posted by anonymous to Health & Fitness (15 answers total) 14 users marked this as a favorite
Bring this. Show it to him.
There are tons of options and FMLA may be an option for you. It is okay too need intensive treatment. River Oaks and two rivers (new Orleans and Kansas City) have wonderful trauma programs focused on stabilization and skills to handle trauma anxiety and feelings (ptsd). I'm not sure that is what you have but it is specialized treatment that could be worth it. It seriously improved my life.
posted by AlexiaSky at 6:13 AM on September 17, 2014 [6 favorites]

Typing things out ahead of time is a good plan, generally. However, I think you need to take a step back from all this talk about your life generally and whether you feel like a failure and whatnot, and look at the actual specifics of your current situation. The past few days I have been plagued with horrible feelings... The past few days. Your life did not suddenly change in the past few days. Your mood did, to the point where you cannot get to work. You need to call your psychiatrist, like, now and see if they can move your appointment up if at all possible, and you need to make sure to look into whether your employer is FMLA-eligible, because this is totally the sort of thing that you're allowed to take time off for as long as you follow all the procedures. Mostly, though, I just want to remind you that a sudden change of mood for the worse, in the absence of something having happened to trigger it, is not normal and not a sign that your therapy needs changing so much as that there may be a problem with your medication. (If your therapy wasn't working, things would either have been generally blah for awhile, or else gradually getting worse, not all at once. It might also need to change, but not as a first priority.)

I totally know how you feel about all of the rest of it, it's just important to keep perspective about what actually changed to get you feeling this way. It might ease up in a few days, but I wouldn't want to take chance. If you need someone to talk to, MeMail me.
posted by Sequence at 6:24 AM on September 17, 2014 [8 favorites]

Yes, you can grow up like this for years and eventually find lasting relief.


My path included lots of alternative stuff like acupuncture. Like you, there was a lot of trial and error, hit & miss. The difference is that today there are so so many more clinical treatments available, but even 10 years ago, I had to kinda piece together my own "wellness program."

EMDR is another therapy technique that springs to mind.

Hey! You know what? I still have days where I'm over-sensitive and need to cry a lot.

The difference is that when I feel low and hopeless I know that it is just a feeling, that I should cry if I want, and that very soon the feeling will pass.

Sometimes I think the overwhelm comes from within my own life, sometimes I think it's just something "in the air," but my antenna is so fine tuned that I pick up the signals and internalize them, leading to despair and overwhelm.


I'm going to give you one tip while you wait for doctors appointments and new treatments to kick in ....

You say you have a 2hr + commute? Perfect!!

Load up your audio device with tons of positive talks, audio books, and podcasts. I liked Wayne Dyer especially back in the day, but you do you;)

During your commutes, listen to positive input, only. These are discussions about how to process, heal, improve - so even if you are only passively listening - they will help you. Part of the problem is the running monologue in your head, so listening to different speakers talk about re-framing situations and overcoming hardships will really really help you be successful at whatever treatments you pursue.


In the end, I think recovery from abuse and trauma is like peeling back the layers of an onion. The problems cycle back around periodically, but once you expect that to happen, and you have techniques in your toolbox to help you cope with those times, the duration and acuteness of the reoccurrences lessen.

What you're going through right now is normal, IMHO. It's extraordinary that you are able to ask this question.

This is a new chapter in your recovery. Good luck.
posted by jbenben at 6:50 AM on September 17, 2014 [12 favorites]

Like Sequence, I also wondered if there wasn't something wonky with your meds and thought you should call your psychiatrist ASAP.

Just FYI, in case you were thinking of putting that step off - please don't.

Make the call.
posted by jbenben at 6:55 AM on September 17, 2014 [1 favorite]

but I also haven't felt like I've connected well with him at all

After a year? You might want to try a different therapist -- though you can keep your psychiatrist for the medications. May I recommend looking someone up in Psychology Today directory whose treatment orientation is "psychodynamic" or "psychoanalytic" and who has been in practice at least 15 years?

Since you're a woman and you mention a history of sexual abuse and trauma, you may want to try a female therapist.

Do not be afraid to try a couple of them for a session or two to see which one you do connect with.
posted by shivohum at 7:09 AM on September 17, 2014 [2 favorites]

Yes, definitely look into FMLA. I have an intermittent one now that I can use when the black cloud gets too heavy for me to function properly at work. Nobody will know what exactly it is for other than your HR department, and they aren't allowed to tell your boss/supervisor/coworkers. I also have a psychiatrist who I see strictly for meds-I don't particularly like him and feel incredibly uncomfortable talking to him about anything.

My therapist is my lifeline. It took me about a dozen tries to find her, but I finally did. I can tell her anything-and I feel safe. I see her once a week. I actually was matched up with her through our Employee Assistance Program after there was a shooting in front of me at my place of work.

Call your doctor now, don't wait. It can be better. It WILL be better. You've taken a massive first step just writing this. Just one more little step with that phone call now. You CAN do it.
posted by notaninja at 7:21 AM on September 17, 2014 [1 favorite]

More intensive treatment can simply mean the same number and frequency of sessions but you pushing yourself out of your comfort zone a bit and not trying to "present well" for the therapist/psychiatrist. Some of that is going to require a good relationship with the therapist, but given that you're saying you tend to "present well" in all areas of your life -- which is a good thing for some areas of one's life, but not so much for the mental-healthcare parts of it -- it may require more pushing of yourself on your end to be willing to say, "I feel like I'm falling apart, and I don't know what to do" to your doctor.

Anyway, I am seeing my shrink in a few days and I need to tell him that I need more help, but I don't know what to suggest.

You don't need to know what to suggest, actually -- that's the therapist's job. Your job (and it is a job -- it's work, and it's not always pleasant) is to be as honest as possible about how bad you are feeling and to let the therapist help you carry that. That may require your writing things out when you are feeling bad so you don't clam up, or leaving voicemails (if you can) at his office when you're feeling bad, or in some way documenting the negative feelings when you're having them so you can give him a more realistic picture of how you're doing.

It is so ok to ask for help. It just often requires us to set aside that part of ourselves that wants to protect us from scrutiny or prevent us from being a "burden" on people who are actually willing to help.
posted by jaguar at 7:24 AM on September 17, 2014 [5 favorites]

Something that's probably hard to see right now: you talk about repeated downswings, which makes sense because pretty much every mood disorder (and a lot of people's ADHD too) is cyclical and/or seasonal, but then you beat yourself up for it by not meeting linear standards.

Downswings are going to happen, and they are not personal failures. The whys tend to have more to do with biological factors - hormones, changes in sleep/weight/sunlight exposure, plain old neurochemical fluctuations. This is the sort of thing that medication adjustments are for, so please do talk to your prescribing doctor and let him know you're are feeling some kind of effectiveness gap right now.

I need to tell him that I need more help, but I don't know what to suggest

You don't have to know this, that's what he's for. You do not have to do all the work by yourself. All you have to do is wave the flag that things are not okay and you need help so that he knows.

This will vary depending on where you are, but DBT is getting a lot more common as a thing, and if you haven't looked lately for a therapist or group you may be surprised at the local availability.

But just start by leaving your p-doc a voicemail saying you've had a noticeable drop over the last few days and you don't feel okay.
posted by Lyn Never at 7:45 AM on September 17, 2014 [2 favorites]

I agree with others that your first step should be to check your meds with your psychiatrist and see if that's the issue. You might also consider treatment with someone trained in Acceptance and Commitment Therapy (ACT). They have search function for therapists, though I don't know how complete it is.

ACT has a big research base and has been shown to work with anxiety and depression symptoms. Basically, they're not going to get these feelings to go away or stop the negative thoughts, but will teach you how to go on living and doing the things you want to do despite or alongside the feelings and thoughts (using mindfulness tactics and acceptance of the good and bad in life; it's not far off from what Lyn Never is saying, actually). It seems at first like these are fluffy ideas that couldn't possibly work on serious anxiety or depression, but the research base indicates otherwise. I would recommend others look for ACT over CBT or other DBT options given my experience with both.
posted by parkerjackson at 8:31 AM on September 17, 2014 [3 favorites]

I am not your therapist, but I am a therapist.

the critical voices in my head. Here is a book recommendation: "There Is Nothing Wrong With You" by Cheri Huber. To help you get some distance from those awful voices.

Another thing: I have not found many psychiatrists who are particularly good at counseling/therapy. That's not what they're trained to do, unless they have received specialized training after they completed their residencies. I agree with posters who have recommended you find a therapist. It might be possible, since your time is limited, to find somebody who would be willing to do mostly phone sessions with you after getting to know you. You haven't said how much psychotherapy you've had in your life, but, given your ups and downs, it really seems that you need more "talk therapy" than you're getting.

And: I would definitely call the psychiatrist. That's what you have hired this person to do: monitor your emotional functioning and adjust medication as necessary. And, as a number of other posters said, it's not your job to suggest things to your doctor, and I'd like to add that the very fact that you think it is is a telling sign of how difficult it must be for you to ask for help. It would be great if you could get some more resources together so that you don't feel so terribly alone when your mood plummets.

Along those lines: If you can find a support group somewhere for people with mood disorders, that would be great. It really helps people to have a consistent group with similar problems who understand what you're going through and are sympathetic. I hope any of this helps.
posted by DMelanogaster at 8:33 AM on September 17, 2014 [9 favorites]

Mental Health issues can be like the flu. But they can also be chronic disease.

You are surrounded by people managing life-long conditions.

There is an entire area of healthcare devoted to management - diabetes, for instance.

Doing what you've done for your entire adult life - managing your problem - makes you the hero of the story. Having a bad patch and needing to tweak your plan does not mean you failed.
posted by Lesser Shrew at 9:17 AM on September 17, 2014 [4 favorites]

Nthing that you need to talk to your doctor about your medications. You were de facto self medicating with marijuana for a while and you are not now. You may still be suffering withdrawal from that and, regardless, the fact that you did self medicate suggests you aren't really getting what you need here from your provider. You need to communicate that you aren't getting what you need here.

One of the things you might consider: Your lack of focus at work might be more about being ADD than about needing therapy. If you can get the right medication for your ADD that helps you stay on task at work, that might alleviate a lot of stress from worrying you will get fired and whatever. It also might feel less crappy to see it as a side effect of ADD rather than of abuse. Some people find it helpful to have a useful handle of that sort instead of feeling like they are just broken or bad.

This is an online option and it is apparently free: I haven't used it but it's right there, it's free and maybe talking anonymously with someone would help some. Maybe that would help you open up a bit. It can be less scary to do it anonymously.

Some things I found useful (or still find useful):

I kept a dream journal when I was in therapy. I kept a notebook on my nightstand and I wrote down my dreams when I first woke up, before I got out of bed. Over time, it turned into a good window on my subconscious and it helped me root out a lot of things. As a child, I had nightmares every night. Figuring out what my bad dreams were telling me helped me sort out problems and put a stop to the cause of those nightmares. I rarely have bad dreams anymore.

"Count your blessings." Sit down and make a list of what you have accomplished. Give yourself credit for completing a degree, holding down a job, etc in spite of not really getting your issues adequately addressed. I had a pink collar ghetto job for a time and I wasn't making enough money but I was making better than minimum wage and there were ways in which my pink collar ghetto job was better for me than a meatier would have been, in part because I just didn't have more to give, so a more demanding job would likely have not been sustainable. So I kind of suspect that you probably make better than minimum wage. Okay, you are legitimately frustrated that you aren't doing better, but I know my life would have been much, much harder had my job only paid minimum wage or been more demanding. So when I had that job, I did at times remind myself that, even though I am not making enough money, it would be even worse if I did not have any college and did not have the typing/writing/whatever skills I have and was thus working more physically hard for less money. So even if it's only "half a loaf," give yourself some credit here. I still do this when things are making me crazy and it is often a real sanity saver. You are fighting an uphill battle. Obviously, if you had gotten more support, you would be doing a lot better. Some of that is on other people/the world, not on you.

There was a great deal of emotional abuse in my home, but my parents always painted us as a healthy family because no one was being beaten or passed out drunk.

My dad grew up in The Great Depression. My mom grew up in Germany during WWII and its aftermath. I basically grew up in an emotional war zone. But, as an adult, I made my peace with it because they made sure that I did not have bombs falling in my own backyard and I had serious food security, something neither of them had growing up. They did their best. It wasn't perfect, but it still had value. So I have tried hard to just let that go and appreciate that they did try hard, against great odds, and they did give me something better than they grew up with. I am a lot better off than I would have been had they not both put a very big emphasis on some basic things like putting food on the table.
posted by Michele in California at 10:00 AM on September 17, 2014 [6 favorites]

I'll be feeling okay in the moment in a few days and will clam up and not say anything to the doctor

Printing your question out and taking it with you is a good idea.

Another thing that helped me is this thought: one reason that I feel okay in that moment is because going to the doctor is one step in taking care of myself. Maybe I will feel okay in more moments if I do more things that involve taking care of myself.
posted by Bentobox Humperdinck at 10:38 AM on September 17, 2014 [1 favorite]

OMG! I love Cheri Huber and I'd totally forgotten about her!!

I've definitely listened to hours of her on podcasts. Just do a search through iTunes & then google. That's exactly the type of "positive input" I was talking about for you to try.


So much great advice above. I meant to add, too, that you should look for the vitamin and mineral deficiencies caused by the particular meds you are taking.

There are studies now that prove these pharmaceuticals may cure some symptoms, but by blocking other nutrients and hormones, they accidentally cause deficiencies that cause mood swings, etc.. That's why they seem to work for a while and then they don't.

This is a simplistic example, but I'm susceptible to iron deficiency a/k/a anemia. So, I don't eat a lot of spinach, because spinach blocks iron absorption.

Any time I've had conditions (like surgery) or meds or diets that further depleted my iron level, WHOA! was my anxiety (also lethargy & depression) through the roof. Well, less iron means less oxygen, less oxygen causes anxiety.... See where this is heading?

Just taking an iron supplement once or twice a month when I need to has made huge changes in my quality of life. I also bruise a lot less, something I mentioned to doctors all the effing time in my 20's, only to be told over and over it was no big "worry." I would usually be at the doctor complaining about fatigue and anxiety , too. Occasionally doctors would treat my anemia, or just mention it in passing when discussing my blood work, but NEVER did they connect anxiety with anemia. It's in the medical literature, they just don't think of it, I guess.

This is a long way of saying that you could also be feeling shitty for some really simple to address biological reason.

Vitamin D3 is another supplement that gets talked about on the AskMe's a lot.


Mentioning this avenue of pursuit because it's pretty basic and often overlooked.

If you google the names of your medications and words like vitamin, study, deficiency, etc., actual scientific info (not woo woo) should pop up. Often these types of side effects are known about, they're just not touted loudly.
posted by jbenben at 11:18 AM on September 17, 2014 [2 favorites]

You have received a lot of wonderful advice, and I do hope you print this out and take it to your psychiatrist, and also start looking for a new therapist. I don't know what resources there are where you live, but most cities have a Rape Crisis Center or the like which offers free short-term therapy by counselors who specialize in sexual violence.

Mostly I wanted to pop in here to say that I could have written a lot of your post, especially the employment difficulties. In 2010, I filed for Social Security Disability. While disability can, of course, be hard to get and there is often a lengthy process, I wanted to contribute some hope. I got approved for disability for my depression/anxiety on my first try, and it only took a few months. It is not a lot of money at all, but it sure beats trying to make myself hold it together at work. If you are interested but this sounds overwhelming, then I'd suggest talking to your psychiatrist or therapist about getting help with the application.

Good luck to you.
posted by mermaidcafe at 1:54 AM on September 19, 2014

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