Maybe you’ve finally pinpointed it. Maybe, like me, you’ve realized that all the screaming and yelling — especially at your kids — wasn’t you turning into a rage monster or developing a sudden anger management problem. You’ve realized that instead of being angry, you’re actually terrified. Like my psychiatrist explained it, you’re deeply anxious, your anxiety leads to stress, and that stress spills out as anger. In private, I’ve punched walls. I’ve screamed at my kids over the most trivial things, like spilling a water glass. I was terrified all the time. I needed help.
But what do you do when you figure out you may have an anxiety problem manifesting as anger — an issue serious enough to affect your family life and your children?
Make Sure You’re Safe
First, make sure this realization doesn’t bring up any dangerous thoughts of harming yourself. If it does, that’s okay — you aren’t crazy — but there are some steps that you absolutely must take. Wherever you are in the U.S., day or night or crack of dawn, call the National Suicide Prevention Lifeline at 1-800-273-8255 (international numbers listed here). They are trained to help you deal with thoughts of self-hatred and self-loathing so deep you feel you have no other option than suicide. Remember that those thoughts aren’t you; they’re the anxiety talking. You do not deserve to die. You are not a bad person. You may have done some not-great things, but you were not in full control of yourself and you don’t need annihilation, you need help.
There are three paths you can take when it comes to getting help. You can contact your family doctor. You can find a therapist. Or you can go straight to a psychiatrist.
Your Primary Care Provider
Your primary care provider will likely be able to see you the soonest. They will assess you for depression and anxiety, and most likely send you away with their first line of defense: medication. One in 6 Americans now take some form of psychiatric drug, mostly antidepressants, though family docs are less likely to prescribe the heavy-hitting, risk-of-addiction benzodiazepines such as Xanax and Klonopin (the only things that help my anxiety and rage).
This sounds pretty good, but it can be a problem. Patients getting medication from primary care providers were less likely to be in psychotherapy — which can be extremely beneficial. And according to the American Psychological Association, antidepressants aren’t as effective as we’re lead to believe. Steven Paul, MD, a neuroscientist who heads the Appel Institute for Alzheimer’s Research at Weill Cornell Medical College in New York City, explains, “Medication treatment is but one way to treat depression. It’s not necessarily the best way or the only way.” In many cases, the APA argues, psychotherapy could be as effective as a drug.
Finding a Therapist
So you need to find a therapist. The easiest way is to ask friends and family. You can also ask your PCP, if you’ve decided to go that route; they likely have a coterie of therapists they prefer. If you mesh well with your doc, you’ll likely mesh well with one of their therapist picks. I found my sainted psychiatrist via an OB-GYN — another avenue if you’re newly postpartum.
You can also use online services to find a therapist. While there are many services offering “on-call” therapists you can see for a certain (high) fee per month, other pages also contain lists of therapists in your area. I particularly like Psychology Today’s therapist finder, where you can search by city, insurance, and mental health issues. I found many therapists for anxiety in my own small town — men and women, with lots of experience and without, all of which took my insurance.
Remember, a therapist isn’t there to provide you with medication, but to help you change your behavior and thought patterns. That way you can better cope with negative thoughts and stop negative actions. Research and meta-analyses (or studies of studies) have proven again and again that cognitive behavioral therapy (CBT) is the most effective means of accomplishing this. Dialectical behavioral therapy, a form of CBT, also has a great track record in helping to reach these goals. While these aren’t the only types of therapy, they’re good places to start.
Finding a Psychiatrist
But maybe you feel like you need something more than a therapist and a PCP — you need both wrapped into one. That’s the choice I made, and I’m deeply, deeply glad I made it. I see a wonderful psychiatrist, one who fits me in during rare emergencies, and other than that who sees me on an every-other-month basis for a baseline check and some psychotherapy. She prescribes my medication and knows about medication because it’s her job. I was a particularly difficult case to treat, and she finally found the magic dose that would work for me (currently two Klonopin in the morning and one in the afternoon if needed, plus Wellbutrin). She also discovered my ADHD, which wasn’t helping anxiety at all, and treats that too.
The best way to find a psychiatrist is the same as finding a therapist: Ask for a referral from your PCP, which your insurance may need to cover the visit. You can also canvas family and friends and check the internet. Lifescript’s doctor directory gave me some good results, but only names and numbers — not pics or therapeutic orientations. But it’s somewhere to begin, at least, especially if you’re in a small town.
So How to Pay for This?
The Affordable Care Act guarantees mental health care parity. That means that insurance has to cover “behavioral health treatment, such as psychotherapy and counseling, and mental and behavioral health inpatient services.” Moreover, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The limits covered by parity protections include: “Financial — like deductibles, copayments, coinsurance, and out-of-pocket limits; Treatment — like limits to the number of days or visits covered; Care management — like being required to get authorization of treatment before getting it.”
So if you have insurance, you should be able to get care if you can find someone to take your insurance. Many do not. My doc, for example, does not take insurance at all, and we have to pay out of pocket and then get reimbursed. It may require some phone calls and some paperwork — ask about sliding fee scales that many mental health care providers offer.
If you absolutely cannot pay for mental health care, you can look into options. Medicaid covers women with children under 6. There are free clinics available, and many of them offer mental health care services. There are also community mental health clinics, which you can find by contacting your local government. If absolutely none of these are an option, you can look for support groups, which while not optimal, can be a band-aid in the short term. And remember: Many, many therapists have a sliding-scale fee program even if they don’t advertise it. It never hurts to ask.
In the meantime, watch out for natural cures that may not work. Essential oils, gut detoxing, homeopathic treatments, and the like may help some people, and may help with some of the physical symptoms (headaches, nausea, tense muscles), but they are not a cure for the mental illness. Don’t be fooled into paying money you don’t have for a cure that’s suspicious at best. If your funds are limited, then they are far better served being spent on professional help versus homeopathic products.
And don’t fall prey to the Big-Pharma-Is-Evil lie either. Psychiatric drugs have saved many, many lives, including my own. With the right drug at the right dose, you will not turn into a zombie or wake up in the middle of the night to snarf the contents of your fridge. If you need them, drugs can work wonders.
You can get help. You are not your anger. You are not your anxiety. You are strong and brave. You can fight this and can get back to a life without constant fear and rage. You are not a bad mother. You are a mother fighting as hard, hard, hard as she can for her babies. You’ve realized your problem — that’s the first step in the fight. Now take the next.