treatment

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.

Medical red flags

Content warning: this post contains graphic descriptions of medical ableism. Proceed with caution.

snouted replied to your post:

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.

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.