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How to be human: how do I tell my spouse I need a psychiatrist?

How to be human: how do I tell my spouse I need a psychiatrist?

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Leah Reich was one of the first internet advice columnists. Her column "Ask Leah" ran on IGN, where she gave advice to gamers for two and a half years. During the day, Leah is Slack’s user researcher, but her views here do not represent her employer. You can write to her at and read more How to be Human here.

Dear Leah,

I feel stuck. I have been married since last June and have been living together with my now wife for the past six years. Things have been pretty good, at least on the outside. However, there have been some sources of conflict. I suffer from quite a bit of anxiety and a binge eating disorder. I'm prone to really focusing in on negative things and have racing thoughts about bad things happening, and that anxiety feeds right into my already uncontrollable need to eat food, and so the spiral continues. So I went to see a therapist, and after several visits she recommended me to a psychiatrist. My wife put a full stop on me going.

I don't know how to navigate this. She's just worried that they're gonna, and I quote, "load me up on drugs." I feel like I really need to see a specialist about this, it's really starting to ruin my life, but she refuses to allow me to start the treatment I feel I need, saying she won't support it at all because I haven't tried every naturopathic option before turning to the medical system. How do we reconcile this? I love my wife, but this really has been straining our relationship.


Confused & Sad

Hey C&S,

Oh, my friend. Anxiety and eating disorders are hard things to deal with. They're hard on so many levels that even saying "they're hard" feels like such a silly, useless thing to say. I'm sorry you're going through this.

I'm also very sorry your wife isn't being supportive of what you need to get better. If I may, she's being selfish and unfair. For someone with anxiety, that sort of behavior from a loved one can make the anxiety even worse. Yes, I know, I don't know what she's been going through, and I don't know her perspective on what it's been like to watch you suffer. So maybe I should be fair! Maybe this is how she manages her anxiety about the situation! Maybe she's trying her best and this is how she thinks she can help! But I'm worried about you, because this is serious stuff, so right now we can't care about what's going on with her.

You need help, C&S. I'm glad you know this, because that puts you in a much better place than if you weren't ready to reach out. In fact, you've already reached out! You went to a therapist and started getting help. That should be applauded. I like that your therapist recommended the psychiatrist after a few sessions. It shows she got a sense of what's going on with you before she said "let's get you on medication." This doesn't sound like a rush to drug you up, it sounds like a carefully considered recommendation to get you the help you really need.

I recognize medication is a scary thing to people, whether the person who has to take it or the person who's worried their loved one will change. I also recognize there's a lot of concern over whether people are overmedicated, whether doctors overprescribe. But I want to set that aside because I don't think we can rage against the medical machine while helping you. So let's focus on the first one.

Medication is a tool — it may require learning and supervision

Yes, medication seems like a big thing. And it can be! You can have weird side effects! It can be wildly helpful but also a bad experience! I'm not going to pretend medication is super easy and always great. But it's like medication for lots of health problems. One might give you a rash, another might give you diarrhea, a third could give you a yeast infection, and a fourth could make you feel like the thing that's making you better is actually making you want to die. Medication is a tool. It's like any tool, too. Maybe it turns out you grabbed the wrong one, or maybe it turns out you need a different size, or maybe it turns out you don't need that tool to get the job done. And anyway, you shouldn't use that tool without some learning through therapy and without supervision. If the medication is wrong or is too much, you have support in changing it. And that way, you use the medication to help you make changes in therapy that your brain might otherwise be struggling to make.

Let me pause here to say something about doctors and patients. It's a complicated relationship. Some doctors are incredible, and some aren't. Some patients are wonderful, and some aren't. The healthcare system here is byzantine and frustrating. Unlike C&S, who's found a therapist he likes, a lot of people don't feel supported by their therapists or psychiatrists, which is a terrible thing. They give up because it seems like finding one who they like is impossible.

Try to find doctors you trust, who are responsive and who listen to you when you advocate for yourself. This is hard, I know, but it's your life! Be communicative and clear about what you need, and make sure you have doctors who listen and support you in return. Doctors, I know you're wildly busy and patients can be frustrating (it's true, we can!) but when you are empathetic and willing to listen, even when your schedule forces you to to rush to a solution, it makes a world of difference.

Exercise, meditation, yoga, all of it: do these things!

Let me also say that I think a lot of methods in the non-Western medicine canon are hugely important and useful for dealing with mental health issues. Exercise, meditation, yoga, all of it: do these things! But I think they, like, Western medicine, are different tools. Some tools will work better for you than others, and you need to assemble your own kit that will get you healthy. I've dealt with anxiety for decades, and my toolkit hasn't featured medication for a number of years now. But that's what (currently) works for me. You've got to find the things — whether Western or Eastern or Northern or Southern or otherworldly — that work for you.

Now, C&S, I don't know what you mean by your wife put a full stop on you going. You're an adult. You know what is best for you and your well-being. If your wife is not going to support you, that is not okay. If she's going to leave you, that's worse. But she can't stop you from going to the doctor. And to be very frank with you, a person who loves you just wants you to get better, no matter what it takes.

Sit down with her and tell her that your anxiety and eating disorder are scaring you. Your health is not good, and you need help. But you need help you are comfortable with, help that you will get you to a better place. You can't spend any more time trying out naturopathic options — you've tried plenty, and it's not working. You know she's worried about you being drugged up, and you acknowledge you're worried about it too. But you have to do what feels best to you, and you hope she'll support you in getting better. It's the outcome you should both be focused on, not the tools that will get you there.