F*ck Feelings (42 page)

In any case, treatment usually provides partial help; the rest is up to you, so you need to get as knowledgeable as you can in order to decide whether more help is necessary or not, and what you can get out of it (that you can't get from just reading this book).

There are many suggested methods for problem solving in this book, from the pleasant, such as exercise and kindness, to the less pleasant, such as setting limits and shutting the fuck up. And then, of course, there's treatment, including medication and talk therapy.

Treatment happens to put food on our table, but it's rarely our first recommendation for any problem; it can be expensive and time-consuming, and if you enter it with unrealistic expectations, ineffective or even damaging.

Many people think therapy is a deeply emotional, somewhat spooky process whereby a compassionate, supportive Melfi/Gandalf hybrid therapist gets patients to recognize and experience painful thoughts, memories, and feelings. People assume this therapy gets at deeper reasons for emotional pain and irrational behavior and offers a more permanent and self-reliant solution to persistent unhappiness than just popping happy pills ever could.

Unfortunately, therapy of that kind, like most treatments, is rarely a cure, sometimes totally ineffective, and frequently effective to a limited degree. In any case, insurers would rather pay for you to get a third arm attached to your back to better facilitate the scratching of your ass than cover any kind of frequent, endless, goalless therapy.

As for getting at the root of issues, that's nice when it happens, but it usually only happens in movies (that aren't good) with results that are equally unrealistic. In real life, most problems have many causes and many of those causes can't be changed, even with blinding insight or a good, snotty cry, so if you expect that treatment will provide solutions, you'll feel like a failure.

People who recognize this simple fact, however, including both therapists and patients, do not see themselves as failures when therapy doesn't work. Indeed, therapists who recognize the limits of talk therapy have developed many new ways of using questions, ideas, suggestions, and coached behaviors to accomplish specific goals. When considering therapy, it's important to recognize that you have many treatment options beyond the classic couch
scenario, ones that aren't mysterious, confusing, or interested in your mother.

Most therapies teach a specific technique for dealing with well-defined problems and have measurable goals for managing despair, eating disorders, or obsessive-compulsive symptoms. Very few invite you to describe how you feel about everything, or how your poor dating habits might be due to losing your hamster in sixth grade.

In any case, if you think you need therapy of any variety, there are simple ways to determine whether you need it, where to look, and whether it's working. Keep in mind, however, that as varied as your treatment options are, and they are extremely varied (see sidebar at the end of this section), all are limited and none guarantee a cure. If you can ask questions and figure out costs and risks, however, you can get the best out of what even we think is your last resort.

Among the wishes people express are:

• To get at the root of their problems

• To stop feeling the way they do

• To overcome depression and anxiety

• To no longer feel like they have to do self-destructive things

Here are three examples:

I often feel somewhat depressed, and have for short periods since high school, but anxiety is what's bothering me the most lately. I think it's
related to losing my boyfriend, but I don't know if it means I choose the wrong kind of person and really need to explore why, or whether there's something wrong with me that ruins relationships, or whether it's part of a bigger problem that I've had since I was a teenager . . . all of which leads me to believe that I might need to talk to somebody. The problem is, even if my issues are worth talking out (and won't just pass on their own, like they always eventually do), I don't want to end up relying on drugs that make it impossible to feel anything. My goal is to figure out what kind of treatment I need, if any.

I don't think I need treatment, but my wife insists I do. She says I seem unhappy and depressed, and that I can be loud sometimes and intimidate people. Not her, clearly, but she worries about me and thinks it's affecting the way people see me at work, and when I asked a coworker, he agreed that I seem angry and down sometimes. I trust what they're telling me, but at the same time, I swear that I feel fine, and I'm never particularly cheery. I guess now that life has me a little stressed out for other reasons, I seem particularly sour, but I'm not sure a doctor can do anything about it. My goal is to figure out what they're talking about and get help if it's the right thing to do.

My marriage hasn't been going well since the kids arrived and nudged my husband to discover how much he likes to spend his evenings at the bar with his close, close drinking buddies. Still, I don't want to break up our marriage without trying to fix it first, so I finally got him to go with me and see a couples therapist. He talks about how he feels that I nag and criticize him until getting out of the house is the only way to prevent a fight, and I talk about why I'm angry having to hold the bag and be the grown-up all the time. The therapist encourages us to air our feelings and has suggested to him that he really isn't doing his job, but he doesn't get it and says we need to find a new therapist who takes his side instead of mine. So couples therapy really isn't working, but I'm still not ready to give up. My goal is to figure out why it's not working and whether we should continue or find another therapist (who doesn't take sides, period).

If you had a pain in your leg that wouldn't go away, you probably wouldn't hesitate to go to the doctor, and that doctor would help you pinpoint the pain and give you a variety of options to deal with the pain, and hopefully one would be simple and mostly successful, and ta-da: better leg.

Sadly, persistent psychic pain is less easy to pinpoint, and the brain is basically the human body's junk drawer; science has a rudimentary idea of what you can find in there, but the exact location of most things therein is unclear. That makes it hard for the doctor to provide you with new information or definitive treatment that will cure your pain, and even harder for you to know when it's smart to go to the doctor in the first place.

Still, even if brains are far more complicated and less understood than limbs, deciding whether you need mental-health treatment is basically like making any other medical resource decision, taking into account what you can afford, how much your problem interferes with your life, and whether obsessing about it will do more harm than good.

Perhaps because mental health treatment is misperceived as mysterious, people assume it has magical powers ranging from rooting out most kinds of unhappiness to turning you into a flake. In reality, of course, unrealistic expectations lock you into unachievable goals, so count on your own experience and judgment to decide whether treatment is meeting your expectations or likely to do so anytime soon.

If you have anxiety and depression after a loss, it's easy to assume that the loss caused your pain, and that talking with friends and healing with time is all you need. This may actually be the case if you haven't been depressed or anxious before, the loss is terrible, and there's no one around whom you can really talk to. To paraphrase R.E.M., everybody hurts sometimes, so not everybody needs to see a doctor about it.

Most likely, however, your symptoms aren't new and have persisted in spite of good talks with supportive friends and family. That's why it's wishful thinking to believe that treatment can stop symptoms quickly
or entirely and prevent them from coming back. Instead, you can expect talk therapy to provide support—help you fight negative thoughts caused by depression, anxiety, and life—and give you a tool for managing your symptoms this time and after future episodes.

Since choosing the wrong person to love is often a key part of heartbreak, look for a positive coach or therapist who can help you nail down the lesson to be learned and figure out some new procedures to help you find better partners and keep you from making the same mistake, while also fighting negative thoughts arising from depression.

As far as looking for the right therapist, do remember to actually look; too many people make the mistake of picking the first name off the list provided by their insurance company and assuming that if things aren't working with that therapist that means therapy doesn't work for them, period. Finding the right therapist takes time, and it's like picking out a good mentor. Look for someone who is interested in teaching the topic you think you need to learn and who has a positive way of motivating you while accepting your particular learning style.

As for meds, it's always your choice to decide whether they're necessary; if you think that shrinks can hold your nose and force pills down your throat, you're mistaking them for veterinarians. Sometimes, the choice to try medication is simple; i.e., if your symptoms don't let you get out of bed in spite of warm support and good coaching. It's the same choice you would make for any chronic, severe medical problem, so don't get moralistic and blame yourself for whatever decision you think is negative.

If others say you need help but you don't really see what they're talking about, congratulations for being able to experience suffering without feeling any pain. Obviously, you care about the impact of your behavior on others, even if you don't have an instinctive ability to feel it or see what it is, and would rather make your wife happy than take your talents to the circus.

Ask yourself whether your grumpiness affects the roles you value the most and in which a little misplaced anger can do a lot of damage, to your parenting, partnership, and maybe leadership. If you don't
think crankiness has much effect, then it's just an annoying-yet-harmless personality trait, like constantly soliciting high fives or ending every sentence with a question mark. If you do think being crotchety is holding you back, then look for a therapist who seems able to help you spot what you're doing when you're angry and manage your behavior more effectively.

If treatment changes your feelings and makes you less depressed and irritable, more power to you, but don't consider yourself or treatment a failure if that doesn't happen. Some people are grumpy and poor at self-observation, even when they're also smart and life is going well. If treatment doesn't change the source of your problems, you deserve great credit for deciding to improve how you manage them.

If you can't get a treatment like couples therapy to persuade your deadbeat spouse that he needs to stop drinking and come home after work, remember that your treatment goal is not to change him, because it's impossible, but rather to see whether he can be encouraged to change. And of course, despite how much your therapist might encourage sharing, remember that insults and character attacks, no matter how justified, rarely make for good persuasive tools.

In this case, your therapist agrees with your complaints but can't get through to your spouse any more than you can, even without the insults, so stop blaming yourself for feeling needy and angry and not getting your husband to see your point of view. A professional couldn't get a better result, and they needed nothing but the copay.

Now, instead of trying harder to get him to see the problem, figure out what you want to do about his faults. Find a therapist who blocks you from ruminating about could-haves and should-haves or sharing anger, helplessness, or complaints about your husband, and instead helps you build up your resources and consider your options.

Whether it's your current couples therapist or a new one, choose someone who can help you announce your intentions to your husband without further efforts to persuade, bully, or defend. Then, whether or not your announcement gets through, you'll know you've done your best to save your marriage while protecting yourself and your kids from an early-stage deadbeat alcoholic.

Try any kind of treatment you think might help, but don't try the same thing again and again or assume that it would have worked if it were done properly. Instead, use failed treatments to limit your expectations and teach you what you have to live with. Allow yourself to explore your options, whether that means different types of therapy or just different doctors.

If you've objectively assessed the severity and impact of your problem and decided it needs attention, it won't take you long to find out what you need to know about treatment, assuming you're not scared to read articles, ask questions, and weigh risks against benefits. Then you'll know what kind of expertise and personal qualities you're seeking in a doctor, as well as how to measure progress, so you can find the combination that will, ta-da, make you and your brain (mostly) better.

Here's what you wish for and can't (always) have from treatment:

• Insight to change your life and improve your behavior

• New, better, or more confidence

• A wrenching catharsis that will ease your sorrows and teach you to enjoy life, moment to moment, while you're still alive and not yet dead

• Happy, conflict-free relationships with the Assholes in your life

Here's what you can aim for and actually achieve:

• Identify how much control you have over whatever's ailing you, with or without treatment