Page 1 of 1

Mental Health

Posted: Mon Jul 31, 2023 12:06 am
by HVB
Hi guys! I don't know if anyone comes here anymore or if anyone will read this, but I figured I would ask anyway.

If I recall correctly, some of you have mentioned struggling with mental health issues or knowing people who have currently as well as in the past.

I have been watching someone important to me struggle with their mental well-being for years and it seems to be getting worse. I'm not sure how to help or how to approach the issue without coming off as sounding insensitive or combative.
I don't know what kind of medical help to search for and I can't necessarily force someone to see a specialist or take medication so I feel like my hands are tied.

I have been in a similar situation before and the results of not getting the person help were disastrous and irreparable. I don't want the same thing to happen to this person, so I'm trying to get advice from anyone I can as to how to get help or at least approach the matter of trying to get the person to accept help.

Any input that anyone has to offer is much appreciated. I feel like I am constantly walking on eggshells because I don't want to do anything to make matters worse. Feel free to message me as well if you think that is best.

Thanks if anyone sees this and can help.

Re: Mental Health

Posted: Tue Aug 22, 2023 8:31 pm
by Talanall
Hey. I've been living with major depressive disorder since I was about 13. I'm in my 40s now, and for most of the approximately 30 years that I have lived with my illness, I was untreated.

Mostly, that was because I'd watched close family members have a string of bad experiences with mental health professionals, and I was nervous about subjecting myself to the risk of similar difficulties. I'll talk a bit about why I was untreated for so long, and what led me to finally seek treatment, and then talk a little more generally about what I think my experiences might mean for your approach to your loved one.

Eventually, I did seek help from my primary care provider and a therapist. I wish I could say that it worked out well, but it didn't. My therapist agreed to treat my depression through an evidence-based approach called Cognitive Behavioral Therapy, but then proceeded to deliver a mode of therapy that was other than what we had agreed. He also insisted on questioning me about self-loathing as an explanation for my illness, despite my indication that this was not going to be fruitful because I actually like who I am. I quickly ended the therapeutic relationship because he refused to actually listen to me.

Simultaneously with that debacle, my physician prescribed me several different medications to treat my depressive symptoms. It didn't go well. My first medication was kind of effective for my depression, but the sexual side effects that came with it were excruciating. Most people who experience sexual problems on an antidepressant lose their libido. Mine was supercharged, with a side of anorgasmia. I was always fired up, but unable to . . . you know. It suuucked. From there, I cycled through a couple of other meds. Once I got off of the first one, the overactive libido calmed down, although it was almost a year before my anorgasmia resolved. I moved on to a different medication that basically didn't do anything, good or bad. And then I moved to a third medication that I had to stop almost immediately because it kept me awake for over 50 hours at a time. It was dangerous and crippling.

The episode of depression that prompted all of this stuff resolved on its own, and I didn't try again for another five or six years. At that point, I had another serious depressive episode, and I gave in to my wife's entreaties and sought a new therapist about 18 months ago, and that has been more fruitful. I didn't make the improvements from therapy that I hoped to gain; it wasn't useless, but I've been meditating and have been philosophically a Stoic for decades. There wasn't a lot of juice to be squeezed from that lemon, in terms of learning new coping skills.

It was worthwhile from the perspective of having someone work with my on unpacking and making sense of some dysfunctional things about my upbringing and family life, and my wife and close friends have indicated that they think it has made a difference based on my behavior since starting.

My therapist and wife both talked me into speaking to a psychiatric provider, as well. It was not a happy discussion, especially between me and my wife--she is a physician, and she did a really poor job of being empathetic with my justified fear of going through another experience like my last attempt to get medicated for my depression. I felt (and still feel) that she dismissive of the risk of long-term negative effects from being prescribed antidepressants, especially in the face of what had genuinely been a really uncomfortable and frightening prior experience on my part.

She and I don't fight often--I can think of maybe two or three really serious, acrimonious disagreements between the two of us over the 15 years that we've been a couple. But it was a very difficult moment in our relationship.

Eventually, I gave in because my therapist furnished me with a referral to a psychiatric provider, promising that I would not be pressured to do anything I wasn't comfortable with. A blood panel administered by this provider showed that I suffer from a vitamin deficiency that likely contributed to my sense of depression, malaise, and poor motivation, so I'm now on a steady diet of D3 supplements. I also was started on an unconventional medication to address my depression; its primary use is as an anti-epileptic medication. It has been helpful, and I am less anxious about taking it, compared to more conventional antidepressants, because it has a very short half-life in the human body. If I stop taking it cold turkey or miss a dose, I can't experience withdrawal problems.

So. I guess there are a few takeaways here.
  • If someone is afraid of being treated for mental illness, that anxiety feels very real from the inside. If you don't treat it like it's real, you risk alienating your loved one.
  • Finding a therapist with whom you can build a rapport is crucial if therapy is to have any benefit.
  • You may have to go through several therapists to find one with whom you can build that rapport. It's emotionally and mentally exhausting.
  • Cycling through medications trying to find something that works and that you can tolerate is utterly soul-sucking. You may not be able to sleep. Or you may puke a lot. Or you might not be able to have/enjoy sex. It may make your symptoms worse instead of better. It's a lot.
  • Being mentally ill saps your capacity for executive function. Trivial stuff like calling a therapist's office to make an appointment, filling out the intake paperwork, etc. can seem utterly exhausting.
When you talk to someone who is suffering from a mental illness about their illness, it's helpful if you are careful to avoid saying things that attribute intention or assume knowledge of their internal state of being. It's better to confine your observations to outwardly observable facts, and invite them to tell you what's going on.

For example, "I think you've been feeling depressed lately. Is there something I can do to help?" is well-meaning . . . but not great. It ascribes an emotional status to your loved one that may or may not be accurate.

Another example: "You've been really quiet lately. Do you want to talk about what's bothering you?" This is a little better, but it presupposes that something is bothering them. That may be true, but people often don't respond positively because of that.

A better option: "I've noticed lately that you've seemed kind of withdrawn when I talk to you. Lots of one-word answers to questions, and you don't volunteer information as often as I'm used to seeing from you. I'm concerned about you, and I'm wondering if you feel comfortable talking to me about how you're doing."

When someone divulges a mental health challenge in response to this kind of questioning, it helps a lot if you reply in a fashion that avoids "I know how you feel" and similar phrasings. Instead, it's a good practice to say something like, "That sounds like it must be stressful," or "It sounds like you're struggling with <thing>. Is that right," or "It sounds like you feel <emotion> because <reason>. Am I understanding you properly?" The idea here is that you aren't telling them you understand. You are saying what you understand the situation to be, and inviting them to correct you.

At that point, you can move to stuff like, "Would you be open to talking to a professional about <thing>? I'm willing to help you find one to try out, if you'd like," or "What do you think about getting a professional to talk about better ways to cope with <thing>?"

I hope this helps.