How do I keep my sanity and my job?
December 29, 2015 7:55 PM   Subscribe

I think I’m losing it. I got hit by a stroke of good luck and a stroke of bad recently. I've recently made some career strides but they were accompanied by what appears to be a mental health crisis that jeopardizes my career. My family and S.O. are against me getting the treatment I feel I need to function – treatment that may be out of reach if I lose my job based on erratic behavior and a significant shift in impulse control and propriety. I feel like I’m between a rock and a hard place. What do I do?

I’ve experienced the onset of something within the past few months. My therapist calls it GAD, but it seems like something more and something less at the same time – I guess what I mean by that is “something different that happens to share common symptoms with anxiety disorder”. Crazy person disagrees with mental health professional, news at 11. I had what was later diagnosed as a panic attack on the job fairly recently. It was temporarily debilitating and deeply frightening, but it was not obvious (I don’t think) nor acute, based on accounts I’ve heard from others. I feel like my boundaries between acceptable public and private behavior have come down and are alienating myself from my colleagues. I get into a state where no one is there except me and tics or my ability to alleviate physical discomfort. I reflexively curse in response to negative stimuli in a position with a customer service element. I feel like a brittle twig in stressful situations. I haven’t been brought in to discuss any of it, and I don’t know if it’s departmental fear or impending firing under “misc.” I check in periodically, but I feel like it kind of just goes into a vortex and will come back to haunt me at some unknown time when the file gets thick enough. I feel like I need quick results, and talk therapy with my current mental health provider that I sought out after an episode of strong suicidal ideation isn’t cutting it, but every layperson I’ve discussed this with is against medication. Granted, I tend to omit the more shameful and dire aspects of what’s been happening to me in conversations with them and even my therapist, which I understand is not productive. I worry that the solution’s just within reach and stigma is what’s keeping me from it, but I also worry about a decrease in mental acuity because that would also impact my job performance and because I am vain. What do I do? Is there anyone here who’s experienced the onset of mental illness slightly later in life who was able to successfully navigate it, and if so, how did you do it?
posted by anonymous to Health & Fitness (19 answers total) 7 users marked this as a favorite
every layperson I’ve discussed this with is against medication

So? They're laypeople, their opinion is not really that important. It's hard to really understand what's going on with you, but I have GAD and it can be sort of mild nervyness and weird scary white noise hyperanxiety physical stuff and it's still all GAD. It's a physical concern, and medications can be helpful with those. I'll tell you this - every doctor I see brings it up either because it's in my self disclosed history or they can see it right there in their office. This helps validate that this is a real affliction, to me.

I have absolutely been able to manage it since its worst, with things like - yoga, meditation, certain meds, LOTS of therapy, very low sugar diet and lots of exercise, the kind of diet and exercise that makes people tell you you're making them feel bad and you're obsessed and etc. I'm really well respected at work and people generally think I'm calm and chill and a great decision maker. But - this took years of work and trial and error and, well, see my most recent Ask, relapses are indeed possible. Also those are things that work (mostly) for me. It won't work for everyone, and for some people nothing works and I know that.

One thing I don't do is care about other people's shame or opinions on therapy or medication, and i tell my therapist EVERYTHING. You're right that it's not productive to withhold, they're whole job is to help you.
posted by sweetkid at 8:06 PM on December 29, 2015 [25 favorites]

every layperson I’ve discussed this with is against medication

Stop discussing this with laypersons. They don't get a vote.

Tell your therapist the truth. Write it down if you have to, or at least show them this question to start. Go to the emergency room if you have to.

Medication is there to save your life and your sanity and your job. It truly sounds like you have reached a point where you need help beyond what you can do with willpower and talking. Let qualified professionals help you before this gets any further out of hand.
posted by Lyn Never at 8:25 PM on December 29, 2015 [26 favorites]

Speaking as someone with mental illness who has a really hard time accepting that I need medication, one thing that I wanted to scream while reading your question was get some medication.

As an anecdote, my always sunny and ridiculously successful best friend started having panic attacks around the age of 30. Because she's an incredibly driven woman who doesn't give a fuck what anyone thinks of her, she immediately tackled the problem with a doctor and now takes medication daily (not sure what, sorry). One day it was a problem, and then the next time I talked to her she was like "oh yeah, the medication [plus therapy] really helped with that". God, I envy her. She didn't let herself get in the way of getting help. But that's a great example of someone who navigated mental health issues successfully and doesn't look back.

Your therapist is a professional and their job is to support you making decisions that will help you. My therapist told me that if she realizes that she can't help a patient for whatever reason, she's professionally obligated to drop them as a client (obviously after helping them find another). This helped me realize that I had no reason not to be completely honest with her. Instead of worrying about whether she would judge me, I realized that she was obligated to tell me if her judgement of me was getting in the way of her helping me. It was a great breakthrough!

If yours doesn't support you talking to a doctor about trying medication once they have the full idea of what's going on with you then you should run to another therapist, because that's bullshit on their part.
posted by the thorn bushes have roses at 8:26 PM on December 29, 2015 [7 favorites]

How do I keep my sanity and my job?

By making your sanity the overriding priority. Do whatever you have to in order to preserve that.

It takes longer and costs more to regain lost sanity than it does to regain a lost job. Keeping your job will also, in general, be conditional upon keeping your sanity. Finally, if keeping your job is incompatible with keeping your sanity, that's a job that you're frankly better off without.
posted by flabdablet at 8:28 PM on December 29, 2015 [4 favorites]

So, as someone who has dealt/deals with this type of stuff now and again, I've got some pointers for you. But before any practical advice you need to know that there is NO shame in seeing someone for this stuff. And medication can absolutely be useful, even if to just get you back up to baseline and then back off of it. Lay people really aren't qualified to dole out opinions on meds.

Okay, practical lifestyle stuff that will absolutely help with anxiety (or whatever you're actually going through):
  • Wake up at the same time every day
  • Exercise for at least 30 minutes
  • Eat a simple but nutritious breakfast
  • Listen to good uplifting music throughout day
  • Eat lunch at the same time every day
  • Check in with people you know and love regularly throughout the day about the most mundane of things
  • Exercise more after work
  • Eat healthy and simple dinner after work
  • Read a really good book (Shantaram, Shogun, Freedom)
  • Stay away from junk food, junk tv, junk arguments, junk soda, overall: NO junk.
  • Go to sleep at the same time every night

    Also, read this shiny brand new article from Harvard about calming your brain during conflict. One thing that strikes me about how you describe your problems is that you know exactly what is happening to you, and yet you feel like you don't have control. This is way better than not knowing what's different about yourself and being out of control. Mindfulness (I know, this phrase is kind of annoying at this point) and meditation can teach you to recognize that you're having legitimately negative thoughts and feelings, to recognize them, and then to just let them go. Realize that they are happening to you, but that you are under no obligation to act upon them (nor should you!). Best of luck, and send me some mail if you need some support! You can do this!!

  • posted by pwally at 8:29 PM on December 29, 2015 [17 favorites]

    If you've got sewage overflowing into your basement and all you tell the plumber is that you have a leaky sink, you're going to be out $100 and have a basement full of shit. Why would you do that? I did for a long time and I still have no idea why.

    I was diagnosed as bipolar at 27. I had been in therapy on/off since I was 5 (long story that's neither here nor there) and was on 8 different meds between 12 and 22 that I would usually stop taking. Never was honest with therapists or psychiatrists about my symptoms, either omitting things or telling them what I thought they wanted to hear to the point where I even told them symptoms I didn't have that put me medications that made things worse. I was pretty much in the position you were in before I finally went to my GP and from there directly to the ER and by 2pm that day I had a psych referral and appointment two weeks from that day. I went to a therapist my friend recommended and told the therapist every single thought in my head like I was never going to see her again. Almost four years later she's one of the best things that ever happened to me.

    As for your job, go to HR and tell them what's going on. They need to work with you on a reasonable accommodation if you request it, if you have a diagnosed disability. If you are in a customer-facing position and swearing/having panic attacks there are a multitude of ways to accommodate you.

    Your family and SO - they are not in your head, they are not experiencing your reality. If you want to do right by them then you need to take care of yourself, not do what they say or do what they want for you.

    There is no quick fix, only positive actions that move you in the right direction. I began feeling like shit in the month of October and lived until April feeling like you're feeling now. After seeking help I started therapy and meds in April and by July was pretty sure I didn't want to kill myself. I got there by taking my medication and providing honest feedback about how I felt, and doing exactly what my therapist and doctor told me to do (diet, sleep, etc.) AND AND AND if I disagreed with them about their directions I had a conversation with them about it instead of nodding that I would and then ignoring them. One of us convinced the other and we agreed on a direction and moved forward. And then I provided honest feedback about how it was working out.

    Ending the post with a nod to fladablet: turns out my job at the time of my diagnosis was incompatible with keeping my sanity, in addition to my very real mental illness. I would not have discovered this had I not sought treatment. In fact, my life would be without many of the things I cherish right now if I wasn't honest with myself and mental health professionals.
    posted by good lorneing at 8:47 PM on December 29, 2015 [13 favorites]

    I'm sorry you're not getting the support you need from your S.O. and family, and I know that in the middle of a mental health problem, the lack of support makes it that much harder to get the treatment you feel you need to function.

    (Does this comic help you reframe the idea of seeking treatment at all? Some people do get weird about mental health because they literally cannot understand what it's like to suffer from a problem, but it's all health. You wouldn't tell someone with diabetes that they shouldn't take insulin.)

    If you're looking for permission to get you past any stigma, you've got it. I, Scarnato, stranger from the Internet, believe that you know yourself best and encourage you to do whatever you need to do in order to take care of yourself.

    "Whatever you need to do" includes being open with your therapist so you can get *professional* input on what you should do. It includes ignoring the opinions of your S.O. and family as much as you can and pushing through to work with professionals on this. It includes any/all of the excellent self-care suggestions you've gotten already and will continue to get.

    You mentioned a drop in mental acuity as a worrying potential side effect of medication. You may have to do some trials with your medical provider to figure out which medication works best for you, but when you find something that works, your mental acuity goes up because all the *noise* in your mind either fades away or is much easier to deal with.

    I remember at one point after I started medication having the sudden realization, "Oh, so THIS is what it's like not to have a little voice in your head all the time telling you that you're a terrible person." The medication allowed me to establish a new normal and realize that I deserved a chance to live without that voice.

    You deserve a chance to live without everything you've described-- the alienation, the brittle feeling, the dread, the feeling that you're not in control. Please give yourself that chance.
    posted by scarnato at 8:57 PM on December 29, 2015 [2 favorites]

    Please, please, please ignore "every layperson [who's] against medication".

    I lost a son to suicide because he convinced himself he didn't need medication. Please consult one or more mental health professionals (aka psychiatrist) and follow their advice. It may take time to figure out exactly which medicine works best for you, but persevere for the sake of having a livable life.
    posted by anadem at 9:26 PM on December 29, 2015 [3 favorites]

    I spent several years telling myself that I didn't need medication. I regret every single moment of that time.

    You wouldn't deny yourself painkillers if you had a broken leg, and everyone around you would think you stupid if you did. Just because it's your brain that's hurting doesn't mean the rules are suddenly different. Take the damn meds, and screw what other people think.
    posted by Tamanna at 9:44 PM on December 29, 2015 [2 favorites]

    The last time I went to laypeople, it was two new friends in college who immediately denied and said I didn't have ADHD because "we all probably use too many smartphones" and didn't even bother listening to me. Unless they live your life, really fuck it, and real friends would listen and ask you to clarify why you would think medication would be good. A lot of people just parrot bullshit, and don't even think about the effect their words have. Don't listen to them.

    I second Tamanna a hundred million times. Mental health is still a health issue, and there is a great deal of research for it. The best therapist I ever saw told me that anti-anxiety medication helps prime the brain for recovery, which works great in conjunction with other types of therapy. This helps re-wire your brain.

    Take a medical leave, and start seeing treatment immediately for medication and more intensive therapy that is more targeted. Regaining your sanity is more important than any job, and people who have not faced such life-damaging anxiety and panic attacks wouldn't even begin to understand what it is like to be in your situation. There are better paths for you that are within your reach, and you have already been given shut doors, so turn away from them. Move towards a path that will help you heal, first. Keep us posted.
    posted by yueliang at 10:53 PM on December 29, 2015 [3 favorites]

    It sounds like you might have decent insurance through your job? You should seek out expert medical care...

    If you are under care, I believe it becomes more difficult to fire you if you are under treatment. So that's another GREAT reason to take this route...

    A third reason to see doctors is you might have other physical maladies effecting your mental state. Psychiatric meds might not be what you need, could be a zillion other equally treatable issues. Brittle and distorted emotions could be a symptom of something else. No lay person could know, including you!

    See some doctors. Ones that will look at the whole picture. Good luck.
    posted by jbenben at 10:54 PM on December 29, 2015 [1 favorite]

    Current situation in which job performance is suffering and you feel out of control and terrible VS Possible future situation in which you have decreased mental acuity due to side effects of medications (which you can then stop and try something else!) which theoretically could occur to the point where it might affect your job performance....

    To me there is an obvious choice here! You're in a real situation that's going poorly and is making you feel bad, but you're hesitating to take action to fix it because of speculation about whether the cure might have a downside.... Don't overthink things here! Anxiety is an extremely common problem. I see people suffering from it every day. Even amongst a large community of doctors of which I am a part, I have seen people struggling with this same situation (i.e. "I'm depressed and can't even get out of bed, I just don't know what to do...." or "I'm so anxious that I'm unable to function at work and it's ruining interpersonal relationships... how should I deal with this?") - always amazes me because you know these docs would recommend meds to a patient in a hot second, but because it's personal they have lost their objectivity when to an outsider, the issue is plain as day.... you need to get more professional help! My point is that you are not alone and many people from every walk of life have had these feelings. I get to see peoples' medication lists and medical histories so I have insider knowledge, but trust me - a large proportion of people you meet every day, people who are sharp and organized and happy-go-lucky - are taking antidepressants and anti-anxiety medications. This is not the sort of thing that you can tell by looking at someone.

    I also follow the Health and Fitness section here at AskMe pretty closely and I've seen so many questions about whether or not to take anxiety medications answered by a tidal wave of "please, try the meds, they changed my life for the better!" - seriously, try searching around for anxiety treatment questions and you'll see what I mean.

    jbenben also makes a good point that anxiety can be related to other medical conditions that can be easily treatable, which is another great reason to discuss this with a physician. Maybe it IS something more/less/different than GAD! (in most cases it's not, but it's worth a check!)

    Best of luck and I hope you may be able to give us an update after you discuss this with a doc.
    posted by treehorn+bunny at 11:18 PM on December 29, 2015 [5 favorites]

    Examples of questions about anxiety treatment: here, here, here, here, here. A lot of these have elements I see echoed in your question... take a look and see if you see anything that is meaningful to you!

    Then you might be interested in this one:
    How do I handle seeing a doctor about depression or anxiety medication?
    posted by treehorn+bunny at 11:28 PM on December 29, 2015 [3 favorites]

    Ignore lay people and their ignorant ideas about medication. I have a friend who was worried I'd get addicted to my SSRI, I just say "Thanks for your concern but I find it very helpful' and now I no longer mention it to them.

    Do speak to a doctor about this. I have had great success with medication for anxiety and it has been life changing. It saddens me that so many suffer when it is treatable and they wouldn't hesitate to treat something else like cholesterol or diabetes.
    posted by kitten magic at 2:52 AM on December 30, 2015

    Oh my gosh. I have been there. And my life changed 180 degrees when I started on anti-anxiety drugs.

    I don't miss being afraid of bridges, tunnels, freeways, and pretty much everything. I don't miss the sleepless nights with a million thoughts swirling in my head. I don't miss the 3 AM panic attacks that had me wondering if I was having a heart attack or going completely batshit.

    If you had high blood sugar, you wouldn't take a poll of your friends and internet strangers. You'd go to the doctor and tell her EVERYTHING about what you have been experiencing and then you'd follow the instructions you were given.

    Finding the right medication isn't always instant. I went on Prozac and it worked great, until I broke out in hives. Oh well, now I'm on Celexa and have been for years. Changed. My. Life.

    I only wish I had done it sooner.
    posted by Ruthless Bunny at 5:47 AM on December 30, 2015 [3 favorites]

    How do I keep my sanity and my job?

    By keeping your sanity. How can you stay on top of your job when you're in a bad place mentally? This is the classic oxygen mask scenario. You need to take care of your health before you are able about the stuff around you.

    I don't know if meds are the right solution for you, but neither will you unless you try. Friends and family are not skilled to deal with these sorts of problems. That's what therapy is for and while it must be incredibly difficult, you need to be honest with your therapist to see what solutions might work for you.
    posted by GilvearSt at 6:12 AM on December 30, 2015 [2 favorites]

    I nth the advice that other folks are giving you about trusting your own astute awareness that something is really wrong, and getting treatment for it.

    Also, I recommend that you be clear with your treatment providers about how important your mental acuity is to you. If a medication were to cause a decrease in mental acuity, that would simply be an "intolerable side effect" to a specific medication, just like the hives that Ruthless Bunny got from Prozac. And then you would move on to try something else, until you find what Ruthless Bunny found: a medication which is tolerable to you (as far as side effects go) and which works for the thing that you need it to work for.
    posted by seacats at 6:39 AM on December 30, 2015 [2 favorites]

    Just on a logical basis, the question can kind of answer itself: can you have sanity without a job? Most definitely. Can you have a job without sanity? Unlikely.
    posted by rhizome at 12:27 PM on December 30, 2015

    I don't know if meds are the right solution for you, but neither will you unless you try.

    I think this is really important. Medications did not work for me, I basically got every single adverse reaction that might happen, plus some that were like "huh, that's a weird one," and that was with a variety of SSRIs plus other stuff. They do not work for me and I'll never ever try one again. I'm sort of jealous of the people who say they "changed their life" because that didn't happen for me.

    All this to say: whatever side effects you have, write them down, discuss them with your doctor, and think really really hard about the balance between the side effects and the positive effects. Your doctor will probably start you on a lower dose and then raise it to the regular dose once you've acclimatized. This is when you'll feel the side effects most likely. Be very clear and careful when discussing this with your doctor - in my experience, some doctors didn't believe me when I said the side effects were terrible and intolerable. The only one I trusted was the one who brought me back down to the starter dose when the regular/maintenance dose made me have terrible side effects.

    This is absolutely not to turn you off trying meds, I just want to underline that you really won't know until you try. It might change your life, you might have my experience. I'm still glad for my experience though, because I would never want to think I didn't try everything or that I didn't do something out of shame or fear. The shame and fear is to be expected but you only do yourself a service by pushing past it.
    posted by sweetkid at 5:39 PM on December 30, 2015 [1 favorite]

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