“This isn’t working out for us. The way you…”.

Marcy said this was a repeated conversation between her and Eric. They had been dating for a couple of years. Although Eric was my new patient today, Marcy came with him to clinic to explain.

“He is so anxious and doesn’t get it.”

Apparently it had taken a, “do this or else,” push to get Eric into clinic as Marcy was about “to walk.” This is sometimes described as “rock, paper, scissors.”

I adjusted my posture. The tension in the room wrapped around me like numerous threads and I needed to gain some freedom of body and mind. “Do this or else” packages smell like stink to anyone in their space, but sometimes they are what gets people to “open a window” into what otherwise would continue to feel entrapment.

In her effort to balance this out, Marcy described all the great features in Eric’s persona. He was attentive and faithful. This meant a lot to her, who survived many dramatic abandonments. He was kind. And so forth. But…

Eric and Marcy went back and forth trying to explain to each other what they needed from the relationship and why they did what they did in it. Marcy needed Eric to make more decisions, to socialize, and, in general, proceed with less fear through life. Eric needed Marcy to take him as he was. He did not perceive that these behaviors were problematic. He did not connect that several of his previous relationships had ended for related reasons. He thought Marcy was being unreasonable, projecting her own personality onto his. They were different people after all.

This is what the anxiety-story sounds like. Over and over I hear it. It is familiar and common. Most of my patients think that they are unique in this condition, once they accept that it is a problem, that is. I tell them in a bit of a joke that it is, in fact, so very common, that it populates enough to develop into its own medical specialty.

I asked Eric a few basic questions:

1. Do people think he is a “worry wart?”
2. Is the worry distracting to him? Feel like “white noise” in his head? 
3. Does the worry keep him from connecting with his own self, and others?
4. Does it affect the way he makes decisions?
5. Does it affect his quality of life? What he considers life worth living for?

I didn’t ask these question like this. They were more open ended, but this is some of what I was trying to glean. There were a few more questions that anyone can look up under the DSM-V and are certainly interesting to read about. In the end, Eric had to come to decide if the problems from his worry were greater than the problems he feared from medical treatment.

Eric explained that his dad would be very upset at him if he chose to medicate. No one “uses drugs” in his family, apparently. (And you know how I feel about calling medications drugs. It’s misdirecting.) I believe that I was supposed to smile at this reference to “the less extreme”, and through empathy, suggest a different nonpharmacologic (healthier) and less confrontational option – such as a weed that grows out of the ground, or cucumbers with cream cheese and dill, maybe.

It’s true that there are many other options to medications to treat emotional illnesses. However, we are talking about medical illnesses. In this case we refer to – anxiety is to the brain, much like diabetes is to the pancreas, cancer is to the replicating cell, or hypertension is to the diseased kidney. And like these other medical diseases, psychiatric illnesses are also potentially improved by other paradigms of treatment. But why in the world would we put science and medicine as an either or to these other options? Can’t someone eat a cucumber with cream cheese and dill, and also take a treatment that has been studied, that has separated from placebo in these studies, and that has gained indication for treatment through the Food and Drug Administration (FDA)? Forget the prejudice against pharmaceutical company profits and pick something extremely generic if you prefer. But please don’t exclude medical care. It reminds me of my aunty who thought to treat her colon cancer with clean eating, various body cleanses, and faith. And then some months later when the cancer had progressed and she was running out of life-time, she decided she wanted to treat medically after all. That’s a sad ending story that we are still grieving. 

Back to Eric and Marcy. He is still weighing his options. She is still complaining about his “limitations.” It’s a pretzel.

So I turn this over to you. How do you recommend we work through this? What could better dispel prejudice against treatment and bring people to a place of less suffering?

Please speak! Keep on!