doctors

Therapy is better without true believers

Anonymous said:

I was wondering if you/ any of your followers have thoughts on mindfulness as a treatment for anxiety? It seems to be recommended by a lot of doctors where I live as something that always works and has no side effects.

realsocialskills said:

It sounds like you’re encountering a lot of true believers. 

“Always works and has no side effects” is not true of anything. That’s true believer talk; someone who is giving you medical advice ought to be giving you a more nuanced view of your options and the potential risks and benefits involved. If you can, it’s worth putting in effort to get a doctor who is willing to proactively take a frank and nuanced approach to treatment decisions. (Some doctors start acting that way if you ask them enough good questions. Some don’t. Finding good doctors who take your insurance can sometimes be hard.).

Mindfulness is one legitimate approach to managing anxiety that works very well for some people. It doesn’t work for everyone, and it’s not the only legitimate approach. I don’t have any way of knowing whether it’s something that you should try. (Both because I don’t know you and because I’m not an expert on helping people make that kind of decision.)

There are approaches other than mindfulness that some people find helpful. Eg: CBT, various types of medication, general psychodynamic therapy, art therapy, or working to accommodate sensory issues better so that you have less background stress. No approach is universally effective; no approach is universally safe. They all work to a significant extent for a significant percentage of people. They all also have risks and drawbacks.

Nothing is 100% effective, ever. No treatment or approach works consistently for everyone. People are complicated, and many things about the brain and body are still not well-understood. For many issues, there are wide ranges of legitimate and possibility-legitimate approaches. Trustworthy doctors and therapists are honest about this.

Further, everything that is powerful enough to have good effects is powerful enough to have side effects. Some people have this weird misconception that if something doesn’t involve medication or surgery, then there are somehow no risks. In reality, there is no risk-free approach to improving the way your mind and body are functioning. Anything that’s powerful enough to cause good changes runs the risk of causing bad changes. (The risk is not always high, and even high risks are often worth taking.) 

Does anyone want to weigh in with experiences with mindfulness? What are some things you wish you’d known, or that you think it would be helpful for the person who asked about this to know?

tl;dr Mental (and often physical) healthcare decisions are complicated. Some approaches work amazingly well for some people. No approach is effective for everyone. Every approach has risks and drawbacks. If you are seeking professional help, it’s worth looking for someone who is realistic and honest about likely outcomes, potential risks, and the range of treatment options.

a perspective on doctors and therapy

thegreatgodum replied to your post “thoughts on good therapy”

I think of doctors/therapists as expert consultants, like a tax agent. their job’s to do a lot of specialised research & be able to summarise it for ppl who don’t have the time or ability to do it themselves so those ppl can make informed decisions.

realsocialskills said:

I think that’s a good way of looking at one way doctors and therapists can be helpful. There are also a few other things:

Good doctors and therapists often have a lot of experience working with a lot of people who have similar problems.  That can lead them to develop a lot of useful intuitions that you can’t get just from reading research even if you have a lot of time to devote to it. 

They also often have access to supervisors with more professional experience and wisdom who can help them to check their perspective. 

(The intuitions of the doctors and therapists you might consult are not infallible and can go badly wrong. The same is true of their supervisors. But they can also be very, very useful).

Also, if you have a chronic condition, mental illness, or neurological disorder, you will probably often deal with doctors who are less familiar with the current research on your condition than you are. This is particularly the case if your condition is relatively rare. Doctors/therapists can still have useful expertise in other ways in that situation, for instance:

  • Someone who doesn’t understand why an IUD is necessary treatment for your condition may still know how to insert one safely
  • Someone who doesn’t know anything about autism might still know useful things about recovery from trauma
  • Someone who doesn’t know why one medication is a better treatment than another for your condition might still know how to monitor for toxic side effects and interactions with other drugs

In any case, no matter why a doctor or therapist is helpful to you, they’re an expert you’re consulting. If they start acting like a brain slug and try to prevent you from thinking or acting for yourself, that’s a major red flag.

medical red flags

Content warning: this post contains graphic descriptions of medical ableism. Proceed with caution.
snouted replied to your post: Anonymous said to realsocialskills: …

Oh man yes and anyone who pushes you with THEIR goals (instead of working w you to push your OWN goals) is bad news.

realsocialskills said:

Yes, and that’s not mental illness specific either. Most conditions of any sort involve choices and tradeoffs.

For instance, if you go to a doctor for help with a functional issue and they keep pushing normalization-oriented surgery unrelated to your actual goals, that’s bad news. (“Here’s how we can make you look more normal” is not a good answer to “I’d like this to stop hurting.”)

If someone ignores your concerns about side effects, that’s also bad news. (Sometimes they will be entirely right that the benefits outweigh the drawbacks. But if they’re not listening or respecting you, that’s bad news.)

If someone calls you drug-seeking when you ask for help managing chronic pain, that’s bad news. If they only care about addiction risk and aren’t at all interested in treating your pain, that’s bad news.

If someone pushes something like “quality of life” in order to dissuade you from having treatment that is clearly necessary to your survival, that’s *really* bad news. (This happens to people who need feeding tubes or tracheostomies to survive, among other things.)

Medical treatment involves choices. A doctor who doesn’t think that your choices matter is bad news.

Dealing with unwanted blushing

pinkxxkiss:

realsocialskills:

I’m not sure if this falls under social skills, but is there a way to prevent blushing? whenever I talk to people my face gets abnormally red and everyone comments on it (what’s wrong with your face, are you ok, etc) which only makes me blush more. i have social anxiety as it is, so talking to people is hard enough without my face feeling like it’s on fire. thank you
realsocialskills said:
I don’t know of a way to avoid blushing. I’m posting this in hopes that one of y’all does.
One thing that occurs to me is that maybe wearing foundation would help? The basic purpose of foundation is to be opaque enough to hide marks on your face, so maybe it would hide blushing? I haven’t tried that, but it seems like it plausibly might work.
Have any of y’all tried using foundation to hide blushing? Does it work? Do you know other things that work?

pinkxxkiss said:

Another suggestion (to foundation, which can really help, even if it’s just a light layer of powder) is to go to a Doctor. My face is super red a lot of the time and I also have pretty serious long term acne. I’ve found that when my acne is more under control (ie my medication for that is working) my face is usually far less red.

As well as acne there’s rosacea, which can be mistaken for acne, but is also very treatable. It can cause so much facial redness, but actually be treated.

So, basically, if you can go to a GP; do so. They might be able to really help you. (And there might even be other underlying, and treatable, causes they could help you with.)

Good luck! :)

stridersnakedtuesdays:

Social skills for autonomous people: omgfabulous: Social skills for autonomous people: A suggestion for…

omgfabulous:

Social skills for autonomous people: A suggestion for doctors

omgfabulous:

realsocialskills:

A lot of people have trouble talking to doctors. A lot of people have trouble raising concerns unless they’re explicitly invited to do so.

It can be helpful to ask at the…

stridersnakedtuesdays said

Also.

- Do not assume just because they SEEM calm that there is
nothing wrong with them. Some patients are too freaked out to be expressive.

- Do not insist that they see a psychiatrist the second they start showing emotion or crying, no matter WHAT their mental health history is. Being ill or in pain is scary and patients have every right to react to that fear.

- Do not walk out of the room until your patient has expressed that they are satisfied with the conclusion. Just because they’re quiet doesn’t mean they’re done, it can often mean they need a second to think.

purplecrescents:

Social skills for autonomous people: A suggestion for doctors

omgfabulous:

realsocialskills:

A lot of people have trouble talking to doctors. A lot of people have trouble raising concerns unless they’re explicitly invited to do so.

It can be helpful to ask at the end of a conversation something like “is there anything else you wanted to talk…

i’m not sure this goes along exactly with the conversation, but doctors who explain everything they’re going to do before they do it and check that you’re okay/ready for them to do it, step by step, are the best!

omgfabulous:

Social skills for autonomous people: A suggestion for doctors

omgfabulous:

realsocialskills:

A lot of people have trouble talking to doctors. A lot of people have trouble raising concerns unless they’re explicitly invited to do so.

It can be helpful to ask at the end of a conversation something like “is there anything else you wanted to talk…

Sorry, that was a vague knee-jerk response. To me this would mean doctors aught to do several things.

1. Understand white coat anxiety, don’t take it personally/shame patients for not being perfectly comfortable in a medical setting (even if they are frequently in one), and take into account that some people are hella PTSD-ing re: blood pressure, heart rate, etc.
2. Know that some medical procedures are going to hurt and frighten people even if they seem quick and easy. Believe patients when they self-advocate on this level, respect boundaries, allow for reasonable accommodations.
3. Please keep in mind that people are generally at the doctors because they are uncomfortable and feel bad. This is not a good or fun experience; incorporate that into their bedside manner.
4. Always worth a reminder: don’t blame everything on weight or suggest weight loss as a cure unless literally every other option has been utilized without success. Be conscientious of how they talk about their patients’ bodies.

There’s probably lots more to be said on this topic but those are the main ideas.

A suggestion for doctors

omgfabulous:

realsocialskills:

A lot of people have trouble talking to doctors. A lot of people have trouble raising concerns unless they’re explicitly invited to do so.

It can be helpful to ask at the end of a conversation something like “is there anything else you wanted to talk about?” or “Are you experiencing any other symptoms?”

That can make it more possible for people to say things.

Also please assume we are panicked and miserable unless you get confirmation to the contrary

What would making that assumption look like? What should a doctor who is assuming that do?