Dear Dr. Schultz:
My 27 year old son has been diagnosed with anxiety and depression. He lives with me, so I can see first hand that he is not getting better. He feels hopeless, wishes he was never born, and has pains in his mouth from the anxiety that causes him to lose control. I don't know what to do. The Dr. prescribed ativan to help with his symptoms, but he has to take it too often. He's convinced that he has diseases and won't accept that the pain is a symptom of his anxiety. Earlier today, I called a hotline at Kaiser because he was so bad. They wanted him to do a web visit with a therapist, but he declined. He won't take advice from me or anyone. He's really in a dark place. He says he doesn't have plans to harm himself or anyone, but I'm still so afraid for him.
I sympathize greatly with this challenging situation, for both you and your son. As a parent, I can imagine how painful it is to see your son struggle and suffer, and to find that there are such significant limitations in what you can do for him. For those who suffer from anxiety and depression, reassurance tends to be of limited value, and suggested solutions are often met with resistance.
From your son’s perspective, the daily terror of believing that his body is under siege from a variety of medical concerns and symptoms, and his feeling of helplessness to combat such maladies, is truly a living hell. With other forms of anxiety, such as those that focus on the fear of other people or external situations, avoidance of these stimuli, although harmful in the long run, can at least offer the afflicted individual temporary relief from the object of their distress.
With health and medical anxiety, however, the source of the concerns is primarily internal, providing the sufferer with no ability to escape the feared stimulus. Imagine having a phobia of snakes wherein the snakes live inside your body! Seeking unnecessary medical interventions and performing research into the nature of the feared illnesses or symptoms can sometimes bring relief in the form of momentarily felt control, however the worry and anxiety typically return quickly, and usually stronger. Also, insight into the fact that anxiety may be responsible for even some portion of the perceived symptoms tends to be lower among individuals afflicted with health anxiety than it is among those with, say, panic disorder, generalized anxiety disorder, or most phobias.
To best assist you and your son, I offer the following suggestions:
First, if your son has not already undergone a complete medical exam, with a focus on his current symptoms, it is recommended that he do so. This will demonstrate appropriate respect and validation for your son’s feelings, reduce his resistance, and identify any actual conditions in need of treatment. It will also in help him understand the degree to which there is a medical basis for his symptoms.
Second, you can explain to your son that individuals with a wide variety of medical conditions can benefit from psychotherapy and counseling in addition to medical treatment. Indeed, anxiety can exacerbate most medical conditions by weakening immune functioning, and by increasing the levels of stress hormone circulating within the body. Working with a therapist does not therefore mean “it is all in his head,” but will assist him in reducing his stress level and promoting adaptive self-care, thereby providing an ideal internal environment in which physical healing can take place. In addition, attention to nutrition, physical exercise, social involvements, and spiritual pursuits can all be quite useful in this regard.
Finally, it is important for you to know that people seek help on their own schedule, based on their personal level of motivation to make change, and their perceived cost-benefit of suffering versus seeking assistance. Your son may not be ready to accept treatment today, but he might be in a day, in a week, or in a year. You can continue to let him know that you will assist him in accessing treatment when he is ready, but that you will respect his judgment and not force the issue in the meantime. You will also find it useful to refrain from challenging him about his concerns and symptoms, or trying to disprove his beliefs, as doing so may unintentionally strengthen his anxious position.
I hope that some of what I have written is of use to you. Please do write again if you have any additional questions, or to keep me abreast of the situation. Hearing how you and your son have navigated this challenging situation may be of great help to other readers.