Law School Cold Calls and Mental Health
August 16, 2019 12:42 PM Subscribe
My husband has been struggling with severe anxiety since attending law school, where merciless cold calls were the norm. Two years after graduating, he panics when he knows he'll have to speak publicly--even if it's in a meeting with twenty coworkers and all he has to do is say his name and position. Could this be some form of PTSD? Most of all, how do we treat this?
The past two years have been tough ones for my husband. In law school, he could avoid situations that would peak his anxiety: after 1L, he avoided classes with professors known to cold call, and he could drop out of any classes that would require presentations. However, after starting his career at a big, prestigious law firm, he found that he couldn't avoid situations where he would have to speak in public.
At the firm, he became increasingly anxious and had difficulty sleeping. He was paralyzed by the expectation of perfection at the firm, and he grew so anxious that he had to start writing scripts of what to say for phone conservations and would grow incredibly flustered if he had to go off script. His main fear on the phone was having his brain freeze so he couldn't think of anything to say, stuttering, having his voice shake, and going through a very awkward moment. In one meeting with a group of ninety or so coworkers from his year, he had to say his name and practice area and became so nervous that he forgot what he was supposed to say, couldn't remember his practice area and was visibly shaking. He says his heartbeat was so loud that he couldn't focus on anything else.
During this time, my husband started seeing a therapist, but he only wanted to go to obtain medication. The meds helped somewhat, but he still felt anxious, hated being on it and was concerned that he would never be able to function without it, imperfect solution though it was. He has since moved on from this job into a much friendlier environment and is a lot happier, but he still gets incredibly nervous before small group meetings. He takes his leftover Klonopin or Propanolol before meetings but still feels anxiety to the point that he tries to come up with medical excuses to not have to attend meetings, and he has to write out a script of what he'll say: "Hi, my name is X and I do Y." In the days leading up to the meeting, he has trouble sleeping (like waking up at 2am and being unable to fall back asleep until 4am) and becomes much more irritable and anxious.
I don't know how to help him or what exactly this could be. His doctor said it was anxiety, but I think it's more than that, and I think it's tied to his experience with cold calls in law school. I didn't know him before law school so can't speak to what he was like, but by his own account, he had no fear of speaking in public and even pursued opportunities to speak in front of people. I've encouraged him to attend therapy (beyond just getting medication) and to start exercising to perhaps help him feel more control over his heartbeat, but I have not managed to convince him to actually do these things.
He has started attending a public speaking group, but he's considering dropping out because he doesn't think they're helping. I'm encouraging him to keep attending because they might be helping, but I think he's looking for a magic button solution that will, hey presto!, make these problems disappear. He stopped taking the medication and seems much happier generally since he started his new job, but he is considering medication again in the hopes of it treating his public speaking fear. I'm on board with meds if they help, but I don't think they are a magic button and don't know how to convince him to try longer-term, slower solutions that may help him manage this anxiety.
What could this be? How can we fix this? If we can't fix it, how can we manage it--and how can I convince him to manage it?
The past two years have been tough ones for my husband. In law school, he could avoid situations that would peak his anxiety: after 1L, he avoided classes with professors known to cold call, and he could drop out of any classes that would require presentations. However, after starting his career at a big, prestigious law firm, he found that he couldn't avoid situations where he would have to speak in public.
At the firm, he became increasingly anxious and had difficulty sleeping. He was paralyzed by the expectation of perfection at the firm, and he grew so anxious that he had to start writing scripts of what to say for phone conservations and would grow incredibly flustered if he had to go off script. His main fear on the phone was having his brain freeze so he couldn't think of anything to say, stuttering, having his voice shake, and going through a very awkward moment. In one meeting with a group of ninety or so coworkers from his year, he had to say his name and practice area and became so nervous that he forgot what he was supposed to say, couldn't remember his practice area and was visibly shaking. He says his heartbeat was so loud that he couldn't focus on anything else.
During this time, my husband started seeing a therapist, but he only wanted to go to obtain medication. The meds helped somewhat, but he still felt anxious, hated being on it and was concerned that he would never be able to function without it, imperfect solution though it was. He has since moved on from this job into a much friendlier environment and is a lot happier, but he still gets incredibly nervous before small group meetings. He takes his leftover Klonopin or Propanolol before meetings but still feels anxiety to the point that he tries to come up with medical excuses to not have to attend meetings, and he has to write out a script of what he'll say: "Hi, my name is X and I do Y." In the days leading up to the meeting, he has trouble sleeping (like waking up at 2am and being unable to fall back asleep until 4am) and becomes much more irritable and anxious.
I don't know how to help him or what exactly this could be. His doctor said it was anxiety, but I think it's more than that, and I think it's tied to his experience with cold calls in law school. I didn't know him before law school so can't speak to what he was like, but by his own account, he had no fear of speaking in public and even pursued opportunities to speak in front of people. I've encouraged him to attend therapy (beyond just getting medication) and to start exercising to perhaps help him feel more control over his heartbeat, but I have not managed to convince him to actually do these things.
He has started attending a public speaking group, but he's considering dropping out because he doesn't think they're helping. I'm encouraging him to keep attending because they might be helping, but I think he's looking for a magic button solution that will, hey presto!, make these problems disappear. He stopped taking the medication and seems much happier generally since he started his new job, but he is considering medication again in the hopes of it treating his public speaking fear. I'm on board with meds if they help, but I don't think they are a magic button and don't know how to convince him to try longer-term, slower solutions that may help him manage this anxiety.
What could this be? How can we fix this? If we can't fix it, how can we manage it--and how can I convince him to manage it?
I'm a psychologist with expertise in PTSD research and treatment.
Per the DSM, events cannot produce PTSD unless they involve actual or perceived threats to physical integrity/life threat or sexual violence. When symptoms arise following a stressor that does not meet these criteria, they would more appropriately be diagnosed as an anxiety disorder or an adjustment disorder. These disorders can be just as severe and impairing as PTSD.
CBT has the strongest evidence for treating both anxiety disorders and PTSD. Therapists who do evidence-based treatments for these conditions are typically able to resolve symptoms of these conditions within 12-20 weeks. Such therapists can be hard to find, but I'm happy to help you look if you memail me. Please note that you might hear from others that EMDR is a good idea, but it's only supported as a treatment for PTSD, and there's evidence that it can make some anxiety disorders that aren't PTSD worse.
Please note that I am not commenting on what diagnosis your husband has or what treatment would be appropriate for him specifically- just commenting on how the diagnostic criteria work and the kinds of treatments that have evidence for these conditions. IANYP.
posted by quiet coyote at 1:18 PM on August 16, 2019 [17 favorites]
Per the DSM, events cannot produce PTSD unless they involve actual or perceived threats to physical integrity/life threat or sexual violence. When symptoms arise following a stressor that does not meet these criteria, they would more appropriately be diagnosed as an anxiety disorder or an adjustment disorder. These disorders can be just as severe and impairing as PTSD.
CBT has the strongest evidence for treating both anxiety disorders and PTSD. Therapists who do evidence-based treatments for these conditions are typically able to resolve symptoms of these conditions within 12-20 weeks. Such therapists can be hard to find, but I'm happy to help you look if you memail me. Please note that you might hear from others that EMDR is a good idea, but it's only supported as a treatment for PTSD, and there's evidence that it can make some anxiety disorders that aren't PTSD worse.
Please note that I am not commenting on what diagnosis your husband has or what treatment would be appropriate for him specifically- just commenting on how the diagnostic criteria work and the kinds of treatments that have evidence for these conditions. IANYP.
posted by quiet coyote at 1:18 PM on August 16, 2019 [17 favorites]
I do not think this needs to be more than anxiety, and in particular, I do not think that cold-calling as a practice is traumatic to people who don't have a preexisting tendency towards anxiety. Unpleasant, yes. Traumatic, no. That doesn't mean it wasn't traumatic for him personally, but I don't think it's useful for you to think of this as something where cold-calling is uniquely to blame for his current situation.
I have been through the law school thing, mind. I have had similar kind of speaking anxiety sort of stuff, and can say that the CBT thing is not perfect but that it helped a lot. He ought to be able to get more Propranolol at least from a GP, it's not a controlled substance--it clearly isn't perfect but the phrase "leftover" makes me think he might be rationing them in a way that is probably not helpful. (Again, from personal experience.) A therapist would be great, but you can totally get books on CBT and work on it on your own and see if it seems to resonate in a useful way, and I would suggest that this might be a good starting point for him.
You as a plural do not do this, though. He does this, if he wants to do this. But if it helps and you aren't going to show him this thread as a whole, by all means, tell him that you saw someone on the internet talking about having had similar issues, including in law school, who got a lot of benefit from the CBT practice. I will say that I also got a lot of benefit from switching to a different career--if he genuinely wants to do this, great, but it's not the worst option to put on the table. I'm still a person with anxiety, but I'm a much happier one now.
posted by Sequence at 1:20 PM on August 16, 2019 [8 favorites]
I have been through the law school thing, mind. I have had similar kind of speaking anxiety sort of stuff, and can say that the CBT thing is not perfect but that it helped a lot. He ought to be able to get more Propranolol at least from a GP, it's not a controlled substance--it clearly isn't perfect but the phrase "leftover" makes me think he might be rationing them in a way that is probably not helpful. (Again, from personal experience.) A therapist would be great, but you can totally get books on CBT and work on it on your own and see if it seems to resonate in a useful way, and I would suggest that this might be a good starting point for him.
You as a plural do not do this, though. He does this, if he wants to do this. But if it helps and you aren't going to show him this thread as a whole, by all means, tell him that you saw someone on the internet talking about having had similar issues, including in law school, who got a lot of benefit from the CBT practice. I will say that I also got a lot of benefit from switching to a different career--if he genuinely wants to do this, great, but it's not the worst option to put on the table. I'm still a person with anxiety, but I'm a much happier one now.
posted by Sequence at 1:20 PM on August 16, 2019 [8 favorites]
I want to highlight your statements "...severe anxiety since attending law school" paired with "I didn't know him before law school so can't speak to what he was like, but by his own account, he had no fear of speaking in public and even pursued opportunities to speak in front of people."
This sounds to me like at least one of the following:
a. his mental health stuff changed due to aging and the passage of time. A lot of people have psych issues that start in late adolescence and early adulthood, even if nothing much happens in those years.
b. his mental health stuff changed because of intensely bad experiences while law school was happening. personally I'd shelve stuff that wasn't remotely like cold calls, like the death of a loved one or a stalking problem here. It's not the only factor, and if it is PTSD/trauma/grief that doesn't change much about the situation, short or long term. But if either of you feel like something must have happened to cause this, it's possible you're right.
c. the symptoms related to public speaking and social interactions are new, but the underlying neurochemical/cognitive patterns aren't. If he previously dealt with like test anxiety, perfectionism, or things like that, this might be a new verse to an old song.
In any case, I have suggestions on next steps:
1) IME, exposure to a thing one is struggling to cope with is likelier to worsen the struggles than improve them when the struggling person feels like the exposure is not something they can control. The anxiety/trauma drumbeat of "I Have To Do This Correctly OR ELSE" may be amplified by external pressure to keep trying or "stick it out." If he doesn't think the public speaking group is helping, I think he should stop. Why do you think that they "might" be helping?
2) This sounds like a collection of thoughts and feelings that isn't going to get better on its own or with drugs by themselves. If unstructured or unscripted social interaction is presently a source of anxiety, it's likely to be harder for him to find talk therapy or other psych modalities that work for him. That said, it's possible to buy DBT books and do those exercises alone, or research other strategies in similar ways. He got through law school; I feel like he can read a textbook and write about it. It's also possible in some areas, with some insurances, to do talk therapy over IM or video chat.
3) It might help you and him for you to step back a bit, emotionally. Like, many people's acute mental health stuff is better at some times and worse at others for reasons we don't understand. You probably shouldn't be trying to hold him or yourself accountable for the severity of his symptoms. He has a responsibility to care for his own mind and body to the best of his ability, but if the stuff he does is not effective that doesn't mean he failed or did it improperly. Depending on how stressed you are about this and other life stuff, you might want to locate a therapist of your own.
Feeling powerless against panic or terror that is happening to someone else really sucks.
posted by bagel at 1:22 PM on August 16, 2019 [4 favorites]
This sounds to me like at least one of the following:
a. his mental health stuff changed due to aging and the passage of time. A lot of people have psych issues that start in late adolescence and early adulthood, even if nothing much happens in those years.
b. his mental health stuff changed because of intensely bad experiences while law school was happening. personally I'd shelve stuff that wasn't remotely like cold calls, like the death of a loved one or a stalking problem here. It's not the only factor, and if it is PTSD/trauma/grief that doesn't change much about the situation, short or long term. But if either of you feel like something must have happened to cause this, it's possible you're right.
c. the symptoms related to public speaking and social interactions are new, but the underlying neurochemical/cognitive patterns aren't. If he previously dealt with like test anxiety, perfectionism, or things like that, this might be a new verse to an old song.
In any case, I have suggestions on next steps:
1) IME, exposure to a thing one is struggling to cope with is likelier to worsen the struggles than improve them when the struggling person feels like the exposure is not something they can control. The anxiety/trauma drumbeat of "I Have To Do This Correctly OR ELSE" may be amplified by external pressure to keep trying or "stick it out." If he doesn't think the public speaking group is helping, I think he should stop. Why do you think that they "might" be helping?
2) This sounds like a collection of thoughts and feelings that isn't going to get better on its own or with drugs by themselves. If unstructured or unscripted social interaction is presently a source of anxiety, it's likely to be harder for him to find talk therapy or other psych modalities that work for him. That said, it's possible to buy DBT books and do those exercises alone, or research other strategies in similar ways. He got through law school; I feel like he can read a textbook and write about it. It's also possible in some areas, with some insurances, to do talk therapy over IM or video chat.
3) It might help you and him for you to step back a bit, emotionally. Like, many people's acute mental health stuff is better at some times and worse at others for reasons we don't understand. You probably shouldn't be trying to hold him or yourself accountable for the severity of his symptoms. He has a responsibility to care for his own mind and body to the best of his ability, but if the stuff he does is not effective that doesn't mean he failed or did it improperly. Depending on how stressed you are about this and other life stuff, you might want to locate a therapist of your own.
Feeling powerless against panic or terror that is happening to someone else really sucks.
posted by bagel at 1:22 PM on August 16, 2019 [4 favorites]
This advice is as unscientific as it gets but one of my good friends SECRETLY joined an improv theatre group about 5 years ago, to try and deal with his crippling anxiety. We're not in regulat contact, but last year he invited all his friends to a play he was in, so it looks like it helped?
I have a very similar reaction to cold-calling (I quit a fundraising job after 1 day because it made me too anxious to call people 8h/say), scriped and unscripted presentations, as your husband, and I found practicing with friends very valuable. Especially with kind & friendly acquaintances who know me a bit but don't feel the need to be unconditionally uncritical, you know?
He should feel a little bit of pressure (so it's real) and a lot of support (understanding, kind words), and they should be capable of giving him kind & constructive feedback.
posted by ipsative at 1:54 PM on August 16, 2019
I have a very similar reaction to cold-calling (I quit a fundraising job after 1 day because it made me too anxious to call people 8h/say), scriped and unscripted presentations, as your husband, and I found practicing with friends very valuable. Especially with kind & friendly acquaintances who know me a bit but don't feel the need to be unconditionally uncritical, you know?
He should feel a little bit of pressure (so it's real) and a lot of support (understanding, kind words), and they should be capable of giving him kind & constructive feedback.
posted by ipsative at 1:54 PM on August 16, 2019
It sort of doesn't matter if the cold-calling in law school is responsible for his anxiety or not (and it likely still falls under anxiety, even if it has that direct of a cause). There's a sense that people have that if you identify the root cause for a mental health problem, that problem will go away. In my experience, this is not accurate - I have health anxiety, and I can tell you the precise moment in my life in which I acquired it, but that knowledge doesn't really mean anything.
You say he wants to go back on medication, so it's clear that he does want to do something about this. Honestly, depending on how often he finds himself in these situations, a medication for acute anxiety might be all he needs. Like, I take an ativan every time I fly, and I'd be pretty comfortable doing that for the rest of my life, because how often am I really going to fly? But if he has these meetings all the time, he might want to look into something more steady, like an SSRI, to manage his baseline level of anxiety.
posted by Ragged Richard at 2:00 PM on August 16, 2019 [3 favorites]
You say he wants to go back on medication, so it's clear that he does want to do something about this. Honestly, depending on how often he finds himself in these situations, a medication for acute anxiety might be all he needs. Like, I take an ativan every time I fly, and I'd be pretty comfortable doing that for the rest of my life, because how often am I really going to fly? But if he has these meetings all the time, he might want to look into something more steady, like an SSRI, to manage his baseline level of anxiety.
posted by Ragged Richard at 2:00 PM on August 16, 2019 [3 favorites]
Oh and just because I realized my post above needed more context: I also take SSRIs, do talk therapy and folow a CBT manual. Not sure what my friend does in that respect, but I gues what I'm trying to say is: find help and dare hope it can get better. Public speaking may never become his favorite activity, but he'll learn to speak *and* cope a lot better.
posted by ipsative at 2:14 PM on August 16, 2019
posted by ipsative at 2:14 PM on August 16, 2019
I'll second Internet Fraud Detective Squad and bagel's analysis of the significance of cold-calling vs. the general high-pressure, toxic atmosphere of law school and big law. It took me two years to really get over my experiences at a large firm and they weren't the worst out of my class.
That said, the way you wrote about medication really jumped out at me. I can't tell you what will help your husband, but I can tell you that this won't:
I'm on board with meds if they help, but I don't think they are a magic button and don't know how to convince him to try longer-term, slower solutions that may help him manage this anxiety.
If I had to guess, I'd say this has more to do with your discomfort about psychiatric medications than anything else. You say you're on board with medications if they help. Well, they have helped! That's one of the reasons he's considering going back on them. You say you don't think they're a magic button. How is that relevant? Does he think they are a magic button? He has first-hand experience with medication not being a magic button. And even if he's hoping it is a magic button this time, that's no different from any person suffering from a disease who hopes that they'll get lucky and respond well to a new treatment. You say you want to convince him to try longer-term, slower solutions. Medication is often a longer-term, slower solution. It does not preclude other treatment options and often improves them. And besides, why on earth would anyone want to try a longer-term, slower solution if a faster one worked just as well?
None of that is to say he shouldn't try talk therapy, DBT, exercise, or whatever, but it isn't as if he's been sitting on his hands doing nothing. He changed jobs(!), he's sought professional medical advice, and he's joined a public speaking group. Even if the results have been mixed, he's not avoiding treatment and you say he's a lot happier. He's even going back to something that helped in the past: medication. It wasn't a straight cure, but neither are exercise and talk therapy.
If that's overinterpreting, I apologize. Take it instead as a warning that there is a very common and very harmful belief that taking medication is lazy, cheating, a second-best shortcut for those who aren't up to the task of longer-term, slower solution of self-improvement through diet, exercise, meditation, etc. I cannot count the number of times I've been told as much since I started taking what turned out to be life-saving psychiatric medication in my 2L year. Medication isn't inherently better or worse than any other treatment methods. It can be a cure, a stop-gap, or an adjunct to other treatment, but it's morally neutral on its own. There are no medals when we die for suffering through a path of greater resistance.
I'm not a doctor, just a well-medicated crazy person. I have no way of knowing whether medication is an answer in this case. There are risks to taking medication---just as there are risks to not taking medication---but the decision one way or another shouldn't be moralized.
posted by This time is different. at 2:58 PM on August 16, 2019 [12 favorites]
That said, the way you wrote about medication really jumped out at me. I can't tell you what will help your husband, but I can tell you that this won't:
I'm on board with meds if they help, but I don't think they are a magic button and don't know how to convince him to try longer-term, slower solutions that may help him manage this anxiety.
If I had to guess, I'd say this has more to do with your discomfort about psychiatric medications than anything else. You say you're on board with medications if they help. Well, they have helped! That's one of the reasons he's considering going back on them. You say you don't think they're a magic button. How is that relevant? Does he think they are a magic button? He has first-hand experience with medication not being a magic button. And even if he's hoping it is a magic button this time, that's no different from any person suffering from a disease who hopes that they'll get lucky and respond well to a new treatment. You say you want to convince him to try longer-term, slower solutions. Medication is often a longer-term, slower solution. It does not preclude other treatment options and often improves them. And besides, why on earth would anyone want to try a longer-term, slower solution if a faster one worked just as well?
None of that is to say he shouldn't try talk therapy, DBT, exercise, or whatever, but it isn't as if he's been sitting on his hands doing nothing. He changed jobs(!), he's sought professional medical advice, and he's joined a public speaking group. Even if the results have been mixed, he's not avoiding treatment and you say he's a lot happier. He's even going back to something that helped in the past: medication. It wasn't a straight cure, but neither are exercise and talk therapy.
If that's overinterpreting, I apologize. Take it instead as a warning that there is a very common and very harmful belief that taking medication is lazy, cheating, a second-best shortcut for those who aren't up to the task of longer-term, slower solution of self-improvement through diet, exercise, meditation, etc. I cannot count the number of times I've been told as much since I started taking what turned out to be life-saving psychiatric medication in my 2L year. Medication isn't inherently better or worse than any other treatment methods. It can be a cure, a stop-gap, or an adjunct to other treatment, but it's morally neutral on its own. There are no medals when we die for suffering through a path of greater resistance.
I'm not a doctor, just a well-medicated crazy person. I have no way of knowing whether medication is an answer in this case. There are risks to taking medication---just as there are risks to not taking medication---but the decision one way or another shouldn't be moralized.
posted by This time is different. at 2:58 PM on August 16, 2019 [12 favorites]
I, too, am uninclined to think that cold calling "by itself" could do this, but, honestly, who cares? Law school is stressful. Law firm life is stressful. It's not like you can single out one circumstance, yell "J'accuse!", and have the anxiety go away.
Medication is very much a "magic button" if it works to interrupt a spiral of panic and allows the person the breathing space to bring other tools to bear. I don't know what's right for your husband, but there is no reason to reject something categorically if the benefits outweigh the drawbacks. "Meds seem like cheating" is a prejudice, not a drawback. Additionally, for consistency, I should add that, short of behavior that is truly harmful to himself or to others (including you), you need to trust your husband to manage his own anxiety. You can't do it for him. There's literally no way. You're not in his head.
posted by praemunire at 3:06 PM on August 16, 2019 [4 favorites]
Medication is very much a "magic button" if it works to interrupt a spiral of panic and allows the person the breathing space to bring other tools to bear. I don't know what's right for your husband, but there is no reason to reject something categorically if the benefits outweigh the drawbacks. "Meds seem like cheating" is a prejudice, not a drawback. Additionally, for consistency, I should add that, short of behavior that is truly harmful to himself or to others (including you), you need to trust your husband to manage his own anxiety. You can't do it for him. There's literally no way. You're not in his head.
posted by praemunire at 3:06 PM on August 16, 2019 [4 favorites]
Law school and being an attorney in a large firm will absolutely make a normal, well adjusted person an anxious, irritable, exhausted mess. Wish I could unlearn "thinking like a lawyer" every day of my life, and I never worked for a big firm, I went straight to government.
When I was in law school (and after) almost everyone was using some kind of substance to manage their out of control stress response/anxiety/depression/insomnia. Some of us were in therapy and used relatively harmless substances, and others were addicted to dope or cocaine, or were angry, chain-smoking alcoholics. But everyone had something.
He should get a full time propanolol prescription, even if he has to take it every workday; that's a great way to manage physiological anxiety, and it's a safe, affordable drug that isn't habit forming or narcotic. If he still has to go to meetings or make cold calls, he can try adding in an SSRI or more as-needed anxiety meds. He should get into therapy rather than going to a public speaking group. I did a lot of CBT right after law school and took SSRIs for a period of time and it helped re-calibrate things.
But as others are saying above, you can't do this for him. He has to figure out what works for him on his own.
posted by zdravo at 3:52 PM on August 16, 2019 [1 favorite]
When I was in law school (and after) almost everyone was using some kind of substance to manage their out of control stress response/anxiety/depression/insomnia. Some of us were in therapy and used relatively harmless substances, and others were addicted to dope or cocaine, or were angry, chain-smoking alcoholics. But everyone had something.
He should get a full time propanolol prescription, even if he has to take it every workday; that's a great way to manage physiological anxiety, and it's a safe, affordable drug that isn't habit forming or narcotic. If he still has to go to meetings or make cold calls, he can try adding in an SSRI or more as-needed anxiety meds. He should get into therapy rather than going to a public speaking group. I did a lot of CBT right after law school and took SSRIs for a period of time and it helped re-calibrate things.
But as others are saying above, you can't do this for him. He has to figure out what works for him on his own.
posted by zdravo at 3:52 PM on August 16, 2019 [1 favorite]
As a point of clarification:
Some of the responses here appear to be interpreting the phrase "cold calling" to mean that OP's husband is required to make unsolicited telephone calls in an attempt to sell goods or services to the called parties.
Based on the context of the question, I think that "cold calling" here instead refers to the practice by some law school professors of questioning students (who did not raise their hands or the like) about the course material in class in front of everyone else. Naturally, quite a few people find this upsetting, especially when they are not satisfied with whatever answer they are able to come up with when it happens.
posted by Juffo-Wup at 4:48 PM on August 16, 2019 [7 favorites]
Some of the responses here appear to be interpreting the phrase "cold calling" to mean that OP's husband is required to make unsolicited telephone calls in an attempt to sell goods or services to the called parties.
Based on the context of the question, I think that "cold calling" here instead refers to the practice by some law school professors of questioning students (who did not raise their hands or the like) about the course material in class in front of everyone else. Naturally, quite a few people find this upsetting, especially when they are not satisfied with whatever answer they are able to come up with when it happens.
posted by Juffo-Wup at 4:48 PM on August 16, 2019 [7 favorites]
My anxiety is not as severe as your husband's, but I can get pretty anxious before making presentations. I've found propranolol to be very helpful. Your husband probably doesn't need to go to a psychiatrist to get a prescription. My primary care doc has no problem writing a prescription for me -- though in truth, I use it less than once a month. (Note to those who don't know: Propranolol is a drug that blocks the effects of adrenaline, so you don't get that horrible panicked feeling where your "fight of flight" reaction kicks-in. It is not a sedative, or tranquilizer, and it is not addictive. A lot of musicians and actors use it to control stage fright).
I also have some experience with benzodiazepines, like Klonopin, Xanax, Librium, etc. My advice is to stay away from those drugs. They are potentially addictive and can have seriously bad side effects, especially if you take them over the long term. I also found that they don't work nearly as well as propranolol for the short-term control of anxiety in social settings.
posted by alex1965 at 5:13 PM on August 16, 2019 [1 favorite]
I also have some experience with benzodiazepines, like Klonopin, Xanax, Librium, etc. My advice is to stay away from those drugs. They are potentially addictive and can have seriously bad side effects, especially if you take them over the long term. I also found that they don't work nearly as well as propranolol for the short-term control of anxiety in social settings.
posted by alex1965 at 5:13 PM on August 16, 2019 [1 favorite]
Is it possible he hates practicing law?
posted by A Terrible Llama at 6:22 PM on August 16, 2019 [4 favorites]
posted by A Terrible Llama at 6:22 PM on August 16, 2019 [4 favorites]
This sounds not too far off the level of anxiety I (a non lawyer fwiw) have about public speaking. Speaking in a meeting of twenty coworkers would absolutely have me fretting and scripting out my introduction in advance and then mentally rehearsing it.
Things that have helped the most were some CBT exercises (self taught from a book at first, later discussed with a therapist) and having both a daily SSRI and an as needed Ativan prescription. I only end up taking one pill every couple of months these days, but just knowing I have it as a fallback helps a lot.
I would suggest meeting your husband where he is. Right now he's willing to try more meds and he's in that speaking group - your most effective way to help is probably to encourage him in both those things. Longer term you can encourage therapy but that may be an easier step to contemplate once he's on an effective stable dosage of anti anxiety meds.
posted by Stacey at 8:42 PM on August 16, 2019
Things that have helped the most were some CBT exercises (self taught from a book at first, later discussed with a therapist) and having both a daily SSRI and an as needed Ativan prescription. I only end up taking one pill every couple of months these days, but just knowing I have it as a fallback helps a lot.
I would suggest meeting your husband where he is. Right now he's willing to try more meds and he's in that speaking group - your most effective way to help is probably to encourage him in both those things. Longer term you can encourage therapy but that may be an easier step to contemplate once he's on an effective stable dosage of anti anxiety meds.
posted by Stacey at 8:42 PM on August 16, 2019
My father was a lawyer, and for as long as I remember he practiced in a small firm consisting of just he and his brother. I assumed when I was young that that was just they way things were. But I learned later that, coming out of law school, he had been in a huge, prestigious firm, on a partner track... but was vomiting every morning before work and generally irritable. He consulted with his brother, who was in another big firm, and they decided to throw in together. They had a successful practice together for many many years.
There may be psychological and pharmacological solutions out there, but there is another possible solution, which is to change the environment. It's not as exciting, perhaps, in a small firm doing commercial law, conveyances, and wills and the like, but while it may be possible to force the issue in a big firm and find a way to adapt and overcome - it's not the only solution.
One way to look at it is in terms of expected value and potential risk of ruin. I think your husband, with your help, needs to do a cold analysis of what the effort is required to make the "big firm" track work and then look at the realistic probability that this work will be successful. And at the same time, consider what it looks like if it's not... could it get so bad in that environment that he could be fired? That seems to be a pretty high risk of ruin. On the other hand, the "smaller firm" track clearly wouldn't have the long-term career upside of a big firm, but there's likely to be a much higher probability that he could succeed, and comfortably.
That may be a tradeoff that it's time to consider. And even that's pretty narrow - there are all sorts of things that a lawyer can do that don't involve a high-pressure law firm environment. Corporate counsel jobs are much different than client work, for instance.
posted by mikel at 9:10 PM on August 16, 2019 [1 favorite]
There may be psychological and pharmacological solutions out there, but there is another possible solution, which is to change the environment. It's not as exciting, perhaps, in a small firm doing commercial law, conveyances, and wills and the like, but while it may be possible to force the issue in a big firm and find a way to adapt and overcome - it's not the only solution.
One way to look at it is in terms of expected value and potential risk of ruin. I think your husband, with your help, needs to do a cold analysis of what the effort is required to make the "big firm" track work and then look at the realistic probability that this work will be successful. And at the same time, consider what it looks like if it's not... could it get so bad in that environment that he could be fired? That seems to be a pretty high risk of ruin. On the other hand, the "smaller firm" track clearly wouldn't have the long-term career upside of a big firm, but there's likely to be a much higher probability that he could succeed, and comfortably.
That may be a tradeoff that it's time to consider. And even that's pretty narrow - there are all sorts of things that a lawyer can do that don't involve a high-pressure law firm environment. Corporate counsel jobs are much different than client work, for instance.
posted by mikel at 9:10 PM on August 16, 2019 [1 favorite]
Phobias are real. Phobias happen for all kinds of reasons (tv shows, bad experiences, possibility of bad experiences) the cause really doesn't matter.
What matters is that he has spent significant time avoiding and prepping to deal with this scenario to the point that it affects his activities of daily living. He's lost money (dropping classes) chosen jobs, taken days of work, and tons of time and energy managing this fear.
CBT with exposure therapy is the recommended therapy for this. Medication kind of helps, but really he can learn to get through his feelings and have the job he wants, sleep restifuly and have unscripted conversations at work again.
There may be another underlying disorder such as PTSD or OCD but that would require a full assessment by a licenced professional.
posted by AlexiaSky at 5:11 AM on August 17, 2019 [3 favorites]
What matters is that he has spent significant time avoiding and prepping to deal with this scenario to the point that it affects his activities of daily living. He's lost money (dropping classes) chosen jobs, taken days of work, and tons of time and energy managing this fear.
CBT with exposure therapy is the recommended therapy for this. Medication kind of helps, but really he can learn to get through his feelings and have the job he wants, sleep restifuly and have unscripted conversations at work again.
There may be another underlying disorder such as PTSD or OCD but that would require a full assessment by a licenced professional.
posted by AlexiaSky at 5:11 AM on August 17, 2019 [3 favorites]
Response by poster: Thanks to everyone who's responded thus far. As someone who hasn't experienced serious anxiety herself, I need all the help I can get with understanding how my husband feels. Anxiety is something my husband (understandably) doesn't enjoy speaking about, so it's very helpful to hear from others who've experienced it.
CBT/DBT sounds like a good idea. He's been reluctant to try it when I've floated the idea to him in the past, but he may be open to a book. If anyone has recommendations for a CBT/DBT book, I'm all ears.
I understand that my husband's anxiety is not something for me to fix. It is, however, something I'd love to help him with as it's affected both of our lives greatly. We moved across the country so he could change jobs, leaving my job in jeopardy, he's taken a very significant pay cut and, when he's feeling particularly anxious, he's so in his head that he's not able to help take care of our infant (he is a great and present dad when he's not particularly anxious). I'd like to not meddle with his process, but I am very invested in his feeling better and am not sure what to do.
To clarify a few points:
- As @Juffo-Wup noted, I do indeed mean a very context-specific sort of cold calling. See this video of the Socratic method in action--it's from The Paper Chase and is a pretty true reenactment of what it's like.
- My husband has already left law, thinking that it would "fix" the anxiety issue. It hasn't, so my husband is frustrated and has voiced concern that he'll never be free of anxiety.
- My husband was not a big fan of the anti-anxiety medication when he was on it because he felt like he was floating above his body. Perhaps a different kind would help? He takes klonopin for major events but is wary of the potentially addictive nature of benzodiazepines and takes them maybe twice a month. Propanolol isn't the magic drug he wants, but it does seem to help with the heartbeat issue so he takes that more often for the larger-group meetings he has to engage in at least once a week.
posted by melancholyplay at 2:02 PM on August 17, 2019
CBT/DBT sounds like a good idea. He's been reluctant to try it when I've floated the idea to him in the past, but he may be open to a book. If anyone has recommendations for a CBT/DBT book, I'm all ears.
I understand that my husband's anxiety is not something for me to fix. It is, however, something I'd love to help him with as it's affected both of our lives greatly. We moved across the country so he could change jobs, leaving my job in jeopardy, he's taken a very significant pay cut and, when he's feeling particularly anxious, he's so in his head that he's not able to help take care of our infant (he is a great and present dad when he's not particularly anxious). I'd like to not meddle with his process, but I am very invested in his feeling better and am not sure what to do.
To clarify a few points:
- As @Juffo-Wup noted, I do indeed mean a very context-specific sort of cold calling. See this video of the Socratic method in action--it's from The Paper Chase and is a pretty true reenactment of what it's like.
- My husband has already left law, thinking that it would "fix" the anxiety issue. It hasn't, so my husband is frustrated and has voiced concern that he'll never be free of anxiety.
- My husband was not a big fan of the anti-anxiety medication when he was on it because he felt like he was floating above his body. Perhaps a different kind would help? He takes klonopin for major events but is wary of the potentially addictive nature of benzodiazepines and takes them maybe twice a month. Propanolol isn't the magic drug he wants, but it does seem to help with the heartbeat issue so he takes that more often for the larger-group meetings he has to engage in at least once a week.
posted by melancholyplay at 2:02 PM on August 17, 2019
From the comment you just made, it sounds like your husband has only tried anxiety meds designed for very acute, short-term use. There are many, many meds out there that will help alleviate anxiety in a much longer-term way. I've taken both benzos and SSRI's and experienced the exact same "floating above my body" feeling on Ativan (lorazepam) that he describes.
On Lexapro/Celexa/Zoloft I don't have that feeling whatsoever - what they do do is, over a couple weeks, start to allow me to slow myself down when I am catastrophizing or ruminating over a situation. I honestly feel more like "me" on them because every decision or event in my day isn't a paralyzing moment of indecision and endless weighing all the options so that I can do everything perfectly.
posted by augustimagination at 2:44 PM on August 17, 2019 [1 favorite]
On Lexapro/Celexa/Zoloft I don't have that feeling whatsoever - what they do do is, over a couple weeks, start to allow me to slow myself down when I am catastrophizing or ruminating over a situation. I honestly feel more like "me" on them because every decision or event in my day isn't a paralyzing moment of indecision and endless weighing all the options so that I can do everything perfectly.
posted by augustimagination at 2:44 PM on August 17, 2019 [1 favorite]
Response by poster: @augustimagination, thanks for your input. I neglected to mention that the anti-anxiety med that caused him to feel like he was floating above his body was Celexa, but it may be worth exploring Lexapro or Zoloft.
posted by melancholyplay at 5:06 PM on August 17, 2019
posted by melancholyplay at 5:06 PM on August 17, 2019
Has he tried a tricyclic? They can be kind of sedating, but I've had temporarily pretty decent results on Pamelor in the past. I don't take it long-term because things are mostly pretty under control without it, but they're less inclined to take months to see if they do anything at all to help, so that'd probably what I'd ask about again if I were inclined to look for an ongoing anxiety medication.
Book-wise, for the CBT: Feeling Good by David Burns was the first big one I found and worked through. It isn't perfect, but it was a good start. A friend likes the Anxiety and Worry Workbook by Clark and Beck but I haven't poked at it myself. The big thing to remember, especially when doing it with a book, is that it's a thing you have to practice, like a muscle that needs working out before you can do the heavy lifting--the point where it's working is where you start to be able to tell the difference between anxiety/panic thoughts and objective truth, even if you haven't yet actually started to panic less. It can take awhile.
posted by Sequence at 6:24 PM on August 17, 2019
Book-wise, for the CBT: Feeling Good by David Burns was the first big one I found and worked through. It isn't perfect, but it was a good start. A friend likes the Anxiety and Worry Workbook by Clark and Beck but I haven't poked at it myself. The big thing to remember, especially when doing it with a book, is that it's a thing you have to practice, like a muscle that needs working out before you can do the heavy lifting--the point where it's working is where you start to be able to tell the difference between anxiety/panic thoughts and objective truth, even if you haven't yet actually started to panic less. It can take awhile.
posted by Sequence at 6:24 PM on August 17, 2019
This thread is closed to new comments.
His doctor said it was anxiety, but I think it's more than that
Well, this is exactly how cripping anxiety and phobia can be, so it probably is anxiety even if you can point to a specific cause for it. Even if law school was *the* trigger that doesn't necessarily mean that the treatment is wildly different.
I'm on board with meds if they help, but I don't think they are a magic button
What they might do, is help him get to the point where he can begin some kind of longer term programme. kind of like using them as crutches to get around while he does the equivalent of physiotherapy exercises. He might need meds/crutches long term, or he may get back to full use of his public speaking skills.
If we can't fix it, how can we manage it--and how can I convince him to manage it?
I don't think this is something you can fix for him. He needs insight into the effects of the problem and potential treatments. This might come from a mental health professional he trusts (eg his doctor, a therapist), it might come from researching anxiety and phobia. I've never had any luck persuading a close family member to listen to my (accurate, reasonable) suggestions.
posted by plonkee at 1:00 PM on August 16, 2019 [4 favorites]