It seems to me that my continual argument with psychopharm providers is down to a difference in paradigm that they do not like to recognize.

I've been reading a lot about the history of pharma and mood disorders, most notably Bad Pharma, Generation Rx, and Before Prozac, off my Goodreads list, if anyone wishes to look those up. They're all badly histrionic in their own special way (Goodacre is a lot more entertaining to read as a pop-sci author, for what that's worth); The Man Who Couldn't Stop isn't -- it's an acceptably science-lite, very human memoir, written by a science journalist with OCD, who seems to have a level head -- but it was enlightening nonetheless.

The thing I have noticed is that when people ask for treatment for their depression or anxiety problem, they talk about their thoughts. They keep having these terrible thoughts that won't go away. They have the thought that they're worthless, the thought that disaster is about to strike, the thought that if they don't check and recheck and recheck all over again something catastrophic will happen and it'll be their fault. When they find medication that works, they report, with palpable relief, that the thoughts have receded. The thoughts have stopped elbowing everything else out of the way. Some of the worst thoughts have stopped altogether.

I see that in descriptions of anxiety disorders, too. Intrusive thoughts of ruin that won't back off. Therapy for anxiety disorders typically consists of taking control of your thoughts like wresting a river into a new channel, using logical thoughts to reassure yourself that nothing is going to happen. People think themselves into a tizzy, creating circles of plans within plans for every contingency, and you're supposed to think yourself out of it again, forcing your thoughts in a new direction. Mindfulness and meditation center on grabbing your thoughts by the tail and dragging them onto the here-and-now from wherever they've gone.

The idea in all cases is to get rid of, or learn to discard, the thoughts that bother you.

I do not want any of my thoughts gone. Ever. None of my thoughts bother me. If anything, the thinking part is the greatest comfort I have -- it always works pretty well even if other things are going haywire. My response to feeling like hell, in fact, is to locate a large store of semi-random information and jam it into my brain so that I can distract myself with thoughts about it. I had the honest-to-God flu one year and learned more about VCR construction and repair than anyone in the 21st century will ever need to know. I like my thoughts. My thoughts are useful. All of them, even the disreputable ones. Perhaps especially the disreputable ones. There have only been a few times in my life, ever, that my chattery brain fell silent, and every single one of them was a sign that something was catastrophically wrong with me.

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  1. I was actually just thinking about this at work last night, as one does when one is stuck by oneself with nothing to do but put clothes away for eight hours. I've never sought out drugs for my depression, but I did get talked into trying a stint of CBT in college (which I know you've talked about briefly here before) and could not convince the well meaning therapist that my thoughts were not at all the source of my issues. I have a very strong grasp of when my thoughts are lying to me, and somehow managed to teach myself the doublethink magic trick of simultaneously knowing that my brain is lying and knowing that in this moment I believe everything it is telling me and taking appropriate action. He kept trying to get me to make lists of thoughts I had that bothered me and work with him to figure out what I could do to rewire the neural pathways in my brain that gave them legitimacy, and genuinely could not understand what I was saying when I told him that my thoughts were not the problem at hand. I may have expressed myself poorly, being 20 and vaguely suicidal, but I was struck by how much he refused to deviate from his standard treatment plan.

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    1. Honestly, in my experience, that's pretty common. I refuse to do any more CBT. It always gets down to the point where they ask "are you using all the coping skills you learned", and I say yes, because I am. Then they ask "are you doing any better", and I say no, because I'm not. It is difficult, if not impossible, to get them to recognize that the problem I am actually having is that the physical reaction to overstress is preventing me from doing essential things like eating and sleeping, and if they would just give me some damn Xanax, I would be more or less fine again.

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