So, the Paxil thing

As I mentioned last week, I went on Paxil in December. My digestive system had not been working well for a couple of years, and what had once been an occasional annoyance turned into a full-time debilitation by last fall. As it turned out, I have the trifecta: IBS, gastritis, and esophageal reflux disease. This was going to require not only medication, time, and rest, but significant changes to my diet and cutting out alcohol. And as my gastroenterologist is one of the good ones who realizes that I am not a bunch of interconnected malfunctioning tubes, but a person, she suggested I go to behavioral health and get myself on, as she put it, “something that will help you cope without dissolving your esophagus.”

Now, here’s the thing. Every time I had gone to this doctor before with a bout of gut misery, she would ask, “Are you under any particular stress?” And I would say, “No.”

And, having seen the incredible difference that Paxil has made in my life, I was obviously wrong. Why didn’t I answer the question correctly?

Because of how it was asked, that’s why. People are notoriously susceptible to answering a question based on how it’s worded: for example, a recent study showed that more people agreed that “gay men and lesbians” should be able to serve in the military than that “homosexuals” should be able to serve in the military. Same question, obviously, but “homosexuals” sounds clinical and perverted, while “gay men and lesbians” sounds like people you know.

The question “Are you under stress?” or “Are there particular stressors in your life?” is a question that leads me to look outward, away from my emotions and to the objective circumstances of my life. And every time I did, I simply couldn’t see anything that could be, almost literally, twisting my gut into knots. My husband and I get along well. We are both in relatively good health, physically and financially. Yes, sometimes it can be difficult to juggle multiple jobs and projects, but I’ve always preferred to have a lot going on (and in this economy, having multiple sources of income seems like a good thing). I have good friends to confide in. What did I have to be stressed about?

But if she’d said, “Do you feel anxious?” — oh, I would have given a very different answer to that. Because that’s a question that would lead me to look inside, to how I felt. And I am an anxious person. Not because of my life circumstances, but because of how my brain chemicals are mixed. My flight-or-fight response threshold is ridiculously low.

And it isn’t anymore. I don’t have the off-the-chain startle reflex that I used to. I find it easier to read e-mails criticizing my work, even when they’re completely hateful, without my heartbeat going into overdrive. To my great surprise, even Milo has picked up on this. Before, if he was sitting on my lap at night while I watched TV or movies, he’d leap out of the chair and run to the window barking at the slightest noise. Now, he’s more likely to lift his head, growl, and settle back down immediately when I say “It’s just the wind, little guy.”

I’m amazed that the way a question was worded kept me from getting the help I needed for several years. I study this kind of thing: I know about cognitive biases, and the power of language and framing, and even a fair bit about temperament and brain chemistry. It’s a good lesson in staying humble and always, always, remembering to look at a situation from more than one perspective.

Going on Paxil really did a job on my dream life, too, in some fairly amusing ways. But I’ll save that for another post.

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