This week is a series of posts about depression, anxiety, family issues, and other brainweasels, for the people who have come on over from CaptainAwkward.com's various open threads. Hello, welcome, and feel free to comment here.

There is an open thread for anxiety sufferers over at Captain Awkward's place right now. The Captain and her moderators are generally very cool kitties about this stuff; if you want to talk to someone about it, or just lurk and try to figure out how other people work, I recommend you click on over and have a look.

Somewhere down in the 500-some odd commens, a few people start talking about CBT. In context, this is "cognitive behavioral therapy" -- I have been on the internets long enough to know that there are other things that acronym means, which are probably not used much by reputable therapists -- and it's one of the first-line treatments for anxiety disorders. Cognitive behavioral therapy, at its root, is really about detangling your thought processes, and then changing the ones that annoy you. It can be a lot of help, but big points in Buzzword Bingo these days, and it's turned into one of those 'if all you have is a hammer...'  things, especially in the hands of an over-zealous counseling student.

I've found that professional CBT mostly makes me a lot worse. The last time I tried it I spent a couple of months crying my way home from a weekly appointment before I fired the therapist. The main problem is that CBT people tend to think "I can't do that," means "I find this very scary and I need you to hold my hand and push me into it," rather than, "I lack the ability to do what you are demanding," and I have never found a way to convince them otherwise.

For example, not eating is a symptom of a whole bunch of different brainweasels for me, and also a symptom of a bunch of purely physical things. If I'm not eating because of depression (or because I'm all PMSy and uncomfortable, or because I've been invaded by a load of inconsiderate cold germs, or because I haven't had anywhere near enough sleep), it's because I have no appetite. I don't have enough energy and I don't have any drive to eat, so I don't have any real motivation to go hunt the mammoth, kill the mammoth, skin the mammoth, hold the mammoth parts over a fire, etc., and then go to all the trouble of actually chewing and swallowing the completed mammoth project. If presented with food as a fait accompli, however, I can usually pick at it enough to not die.

I used to not tell people this. I still generally don't. I had it banged into my head as a kid that things like not eating were things people did "just to get attention" and they were self-centered drama llamas and this was a stupid and annoying thing to be bothering other people with. If I don't have the energy to eat, then I really don't have the energy to defend myself against accusations that I'm flouncing off like a diva, shouting about not eating so that people will hurry over and flutter about taking care of me, so while I was growing up I learned to just say nothing.

It turns out that this is not at all the way normal human beings operate. You have to actually do the flouncy thing, and then get peevish that your slaves are running behind with your divan chair and fans, before people assume you're not eating because you want them to notice your wilting special flowerhood. It's still very uncomfortable for me to tell people, and I typically just blurt it out like a tactless twit, but by bludgeoning myself with a lot of CBT techniques, I was able to pick apart why I thought I should be keeping this secret, identify that a lot of the things I worried about weren't actually going on, and remind myself to change the way I thought of this enough so that I can at least tell a couple of the people who like to play Feed The Genius (Mog's phrase, for once, and not mine), "Hey. I'm not eating things. Please either drag some food over, or bug me about this to the point where it is easier to heat up some goddamn Spaghetti-Os than it is to fend you off."

Not eating is also a symptom of my anxiety. I have no appetite and lack the wherewithal to microwave food-like objects from the nearest Tedeschi, but it's less of a pressing problem, because if it's due to anxiety then I can't eat, even if I'm handed pre-prepared food directly. It's physiological -- my body is in "running from sabre-tooth tiger" mode, and digestion is just not a happening thing. The fact that everything tastes disgusting is a warning that it will taste equally disgusting when it comes back up in a few minutes. I don't like vomiting any more than anyone else does, and probably rather less than some, so I generally refuse food and subsist on juice and ginger ale until either I calm down on my own or my Xanax kicks in.

I cannot self-monologue my way out of that one. It would be like a diabetic psychoanalyzing her blood sugar back to normal. The dominant narrative in CBT is that the physical symptoms of things like anxiety are directly traceable to wacky brain tricks, and that if you change the wacky brain tricks, your symptoms will go away. I talk myself out of panic attacks, not into them, and my main problem seems to be that there is something b0rked about whatever mechanism is supposed to ramp me down out of a panicked state -- there is no talking down to be done, and no amount of thinking will make me not toss my cookies when I try to shove things into my cake hole.

People who think CBT is the One True Way do not believe that I have no control over this. They think that if they spend enough time patiently explaining to me that the notation by which we describe the mathematics of gravity is merely an arbitrary social construct, shit will stop falling down when I drop it. I can write it out any way I want, but the Earth is still way bigger than me, spacetime is still curved, and if I want the airplane I'm in to stay aloft, there still need to be a couple big Pratt & Whitneys attached to the wings. Constantly pushing me to do the impossible, and then "gently" reminding me that I'd be all better if I just did the thing I can't do, is one of the larger reasons I moved across the damn country without leaving my relatives any forwarding address. I'll be damned if I'm going to pay a therapist to do it on purpose.

In conclusion, CBT is great when it works, but there's stuff it doesn't work on, and don't let your therapist browbeat you into continuing if you've got one of the latter things. It's big right now partly because American insurance companies are sometimes willing to pay for it, but "available" and "appropriate" are two entirely different things.

Comments

  1. [hug] I'm insulin dependent, and there are times I must eat. I keep some emergency almost food and anti nausea tablets to hand. My Worst case backup is tinned creamed rice, which comes back up pretty much as it goes down if the worst comes to the worst.

    I learnt the hard way that chewing my way through a packet of mint flavoured antacids does not solve nausea, the hard way. Vomit should not be minty fresh...

    And seconded on Ginger Ale, without which I may not be here.
    '

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    1. I've discovered that there is no such thing as quick-dissolve anti-nausea medication. This is ludicrous. There's such a thing as quick-dissolve Benadryl, also an anti-emetic and from whence they derived the stuff sold as Dramamine over here, the go-to stuff for motion sickness. You would think that as soon as someone worked out how to deliver medication p.o. without making you swallow solid objects, someone would have thought to sell it to people puking up their own kidneys, but no. Transdermal patches are apparently unavailable without a prescription. Wankers.

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  2. Weirdly, my mum has quick-dissolve antinausea tablets. She sticks them under her lip, apparently this is the suggested method for these particular pills.
    Country differences, perhaps?

    My old flatmate could make a lasagne so good it tasted fairly reasonable in reverse gear too. Not that I wanted to make a habit of experimenting with that theory, but... I do miss his lasagne.

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    1. The stuff may be available here, but only with prescription. The US is weird and paranoid about introducing new OTC medication, even if the active ingredient is known to be safe to anyone who isn't a total moron and determined to eat an entire box of it. The "quick dissolve" Benadryl is in the form of those saliva-soluble plastic-y strips otherwise used for instant mouthwash. They taste like slightly-off toothpaste, but are otherwise much less objectionable when you can't keep any solids down.

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