Prescriptions don't fix everything
We have to do some things ourselves
I’m 41 and I keep friends a long time. I’m forgiving. I sometimes need forgiveness. I try to approach things with empathy, but I wasn’t always that way.
I have one friend that has been with me through thick and thin. We’ve even had a break up that lasted a couple years. We met in second grade. People change and go through a lot in the 33 years we’ve been friends.
She’s always battled anxiety that can sometimes be crippling and at times has affected her quality of life. But, she’s been to different doctors, tried different therapies, taken different medications . . . and her anxiety persists. When we were younger I didn’t understand it. Then, after my dad died I went through a period of depression accompanied by a super fun side of social anxiety. I realized then that I had been incredibly insensitive to her anxiety and her emotional needs. My approach had always been “Couldn’t you just [insert statement of significant insensitivity about positive mindsets]?” I realized that sometimes that option doesn’t exist. It gave me the opportunity to empathize with her experience. My situation was a fortunate one. I could take some medication temporarily and do some talk therapy. Her condition is clinical and lifelong.
I’ve learned to take a different approach. “What do you need?” “Tell me more about this.” “Did you feel this same way about this yesterday?” We recently were discussing attachment styles and behavioral therapy. None of her therapists had discussed either of these with her. I’m not a therapist and attachment styles aren’t scientific. But, attachment styles can be a sort of stepping stone for people to understand their own reactions, how they fit into an environment, how their friendships and other relationships function.
Considering my insensitive responses in the past, I feel honored and loved because she still feels enough safety and connection to continue to come to me when she needs some support, or just someone to spot her when she has to do some emotional heavy-lifting.
She’s one of the most talented people I’ve ever met. She’s an incredible dancer, a singer, an actor. She finished her bachelor’s degree in three years, with honors. She’s smart and introspective. She’s a good teacher, too.
She recently saw a posting about auditions for a theater program. She signed up!
She called me this weekend. She was completely in fight or flight mode. Her anxiety was through the roof. I could hear the stress in her voice. Her adrenaline was putting her into a tail spin of anxiety. She didn’t want to do the audition anymore. She “hates auditions.” Her words. So, I asked her questions:
Why did you sign up for this?
When did you start feeling this way about the audition?
What part of auditioning do you hate?
If you don’t get the part will it negatively affect your life?
She talked the whole thing out herself while I listened: She hates the idea of not doing well, the idea of bombing. She feels like someone else will be better than her in their audition. Eventually she pinpointed her own fight or flight mode.
We talked through it rationally: This theater performance would be a hobby. Only one person will hear “yes” and everyone else will hear “no.” Someone might not be as good as her, but could still get the part if they’re what the production team has envisioned for the role. She might get the role over someone better than her if she’s what the production team has in mind for the role. Given the odds of hearing “no” is it fair to take that as a rejection of her and her talents and abilities? Does that mean that every single person who wants the role is being “rejected” when they don’t get a call back?
We talked about how her fight or flight response was really her brain looking at this like it was life and death. This was her sabretooth tiger. But, is an audition as dangerous as a sabretooth tiger? It is when it creates an emotional trauma response.
She gave me an update after her audition today. She said she went in with a completely different mindset, reassuring herself that this wasn’t going to have a negative impact on her life if she didn’t get the role. She said she thinks she could have performed better during her audition, but that she was just happy that she didn’t let her anxiety overtake her.
My best friend applied behavioral therapy tools and changed the scenario from a sabretooth tiger to just an audition. This was a big deal because this has been a challenge for her.
Doctors are quick to prescribe anti-anxiety and anti-depression medication. The fine tuning of those medications sometimes takes months or years. But, here’s what her doctors haven’t done:
Discuss talk therapy with her
Discuss behavioral therapy with her
Listen to her
We can be medicated to the point of being numb. We can suffer side effects of those medications, suffer withdrawals when a prescription change is indicated. But, her emotional and mental journey from point A to point B isn’t going to change without behavioral therapy.
Behavioral therapy is hard work. It takes lots of practice to master, but she had a great first experience using it mitigate anxiety. I’m really proud of her for her accomplishment.
So, while I do think that medication is really important for the healthy and effective treatment of anxiety and depression, I think it’s irresponsible and neglectful to prescribe these medications for long term use without also requiring patients to seek talk therapy. We can’t solve everything with a prescription. Sometimes we have to do a little work. You can’t “prescribe” someone back to full physical ability after a critical injury, you have to send them to physical therapy. We need to stop treating our mental wellbeing as a taboo. Let’s think about it the same way we think about physical wellbeing.