Category Archives: Mental Health

Drug kills your mental health before it kills your body.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Full ashtray

Smoking cigarettes.
Photo courtesy of Pixabay.com

Nicotine  – The killer drug.

Of all the drugs out there, legal or illegal one drug alone accounts for the bulk of the drug-related deaths each year. That drug is Nicotine and the predominant ways it gets into your body is by smoking or second-hand smoke.

We have known for 50 years or more that Tobacco and smoking were harmful to our physical health but we are only now seeing the extent of the connection between smoking and other societal problems such as mental illness and homelessness.

For every one person that dies of an illegal drug Nicotine kills 200 people. That is not an argument for legalizing other drugs. We have seen highly publicized drug deaths recently from illegal drugs. Heroin and prescribed Opiates can kill quickly and with alcohol in the bloodstream the overdose death rate sores.

Deaths from tobacco happen far more slowly. There is a gradual progression of a variety of diseases before the final death.

What we have been overlooking in all of this is the significant connection between mental illness, other drug addiction, and smoking. Mental health treatment providers have been slow to recognize the connection and slower yet to attempt any form of smoking cessation treatment with the mentally ill clients.

While in withdrawal from Nicotine clients can become agitated, restless, and harder to manage. Providers have suggested that they needed to work on the “bigger” issues of drug withdrawal, alcoholism, depression, and other mental disorders.

What has been missing from this approach is a clear view of the ways in which Nicotine may be causing and maintaining a mental illness.

Research studies have suggested that between 44% and 50% of all the cigarettes consumed in America are smoked by those with a mental, emotional, or behavioral health diagnosis (a DSM diagnosable condition.)  Researchers have detailed the efforts of the Tobacco companies to market to the mentally ill (Prochaska, Hall, & Bero, 2008; Lasser et al., 2000; Apollonio & Malone, 2005, cited in Wigand, 2009.)

One consequence of the heavy smoking by the mentally ill is that they commonly live twenty years less than those without a long-term mental illness.

Despite the apparent connection between Nicotine and the creation and maintenance of mental illness most providers have been reluctant to include smoking cessation in their programs.

This connection between smoking and mental health issues is particularly problematic among women. Jessup Et al. on their study of women smokers reported “Smokers had significantly higher rates of Post Traumatic Stress Disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders.

Jessup further reports that women who smoke two packs per day are more than twice as likely to suffer from Major Depression. Those with Post Traumatic Stress Disorder were 4-5 times more likely to be heavy smokers. In this study, smoking women were much more likely to be unemployed than nonsmokers and even if they lived with a partner the smokers were more likely to not have enough money to meet their basic needs.

The connection between smoking, drug, and alcohol use disorders, and mental illness has been reported in study after study.

Those disorders that seem to be highly correlated include substance use disorders, PTSD, Depression, Anxiety disorders, and Psychosis. There have been some suggestions that smoking has helped those with serious mental illness manage their symptoms, even though this is at the cost of a shortened lifespan. The research seems to report that smokers report more, not fewer, symptoms of mental illness. The “smoking solution” is making symptoms worse, not better.

This connection between smoking, mental illness, and a substance use disorder also resulted in increased rates of unemployment, no medical insurance, and a high need for treatment. Those at the highest need of physical health services were the least likely to be receiving those services other than through free programs or hospital emergency rooms.

Studies have also reported that smokers are twice as likely to have had recent thoughts of suicide as non-smokers.

One difficulty with adding smoking cessation treatment to substance abuse, mental health, and co-occurring treatment programs is that the majority of people in treatment are in the stage of change we call “precontemplative” meaning they had not even thought about quitting. For this group, the most effective intervention may be education about the connection between smoking and their other co-occurring issues.

We are hopeful that the expansion of health care will result in more services for those who have co-occurring disorders and that smoking cessation treatment may be included in those services.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Emotional healing takes several tries

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Emotional healing.
Photo courtesy of Pixabay.com

Emotional Healing.

Some pain and trauma are just too intense to get past the first time around.

Getting over things is a process. Some things need time to heal. It is hard for others to sit and watch you suffer but sometimes you just need that space to get past it. What you can’t do is pretend it never happened and hope the pain will go away.

People come for counseling and they expect the pain to end right away. It can’t always happen that way. We find that pain, from trauma or grief and loss, takes time, and repeated attempts to get better.

Clients who have suffered a severe loss, someone close to them has died, find it hard to talk about that person at first. In the beginning, it is mostly about the pain of the loss and the tears.

Over time, the process of recovery is like the way you might peel an onion. You strip away an outer layer and then you cry. Then as your tears dry you strip away another layer. Eventually, you reach the core.

In the early stages of grief, all you can feel is the pain. What can happen if you keep working on the process is that with time you can let the pain recede and begin to remember the good things, the treasured memories, you have of that person.

People mean well when they tell you to just get over it but what they often do not understand is that getting over it is a process, not a destination. Some things in life we never get over, not completely, but we can reach a place of peace with what happened.

In counseling, we find that to push the client to talk about things before they are ready can cause more trauma rather than aid healing. Some clients come for a while, go as far as they can, and then go off to live their lives for a while. Some find that they need to return to continue or finish the process. Others have the drive to get the painful part over with as soon as possible. You may find that the pain keeps reminding you that help is needed and you can’t let it go until you finish the project.

Either way, I hope that if you are feeling the pain of a loss, a death, a trauma, a life disappointment, that you will find someone to work with on this issue that helps you move through the pain by leading you along not by forcing you to go faster than you are ready to go.

Therapy should heal the emotions not create new wounds.

If you are only partway along in your healing process, keep moving forward and know that eventually, you can reach a point of finding the meaning in the loss. Not having someone now should not take all those happy memories from you. Having suffered a terrible trauma need not rob you of your future.

The road of recovery can be difficult, but recovery is worth the effort.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Does smoking cause mental illness?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Does smoking cause mental illness?
Photo courtesy of Pixabay.com

The evidence is starting to pile up that smoking may be a cause of some mental illnesses.

We have known for some time now that the mentally ill were heavy smokers. Those with psychosis, schizophrenia, in particular, are frequently two pack a day or more smokers.

We also have seen studies that report from 44% to over 50% of the cigarettes consumed in America are consumed by those with a mental, emotional, or behavioral disorder. Alcoholics and Drug Addicts are frequently heavy smokers.

Fully one in three adult smokers has some form of mental illness.

What most researchers have been reluctant to conclude is that smoking may be the cause of some of these mental illnesses. That is beginning to change.

One problem with the past studies has been the way the samples were drawn. A survey of the population can tell you how many people have a mental illness and how many smoked, but not which caused which or were they both caused by some third factor like poverty or trauma.

One particularly convincing study was done in Norway (Petersen et al. 2008.) They have good data on who was treated for what and why. This study was able to follow a large sample of youth beginning at age 13 and lasting 13 years until they were 27. They looked at who smoked at age 13, when they started, and the results. They were also able to follow the person’s health and mental health treatment.

This longitudinal study allowed them to compare those who had a mental illness at age 13 with those who did not and those who smoked at age 13 with those who did not. Their data tells us that those with an early onset of mental illness were at high risk to become daily smokers with a nicotine dependency.

What was more startling was that those who had no mental health diagnosis at age 13 and smoked were more likely to develop a mental illness. Smoking appears to have preceded the development of the mental illness. Even more, evidence that a mental health issue is caused by not is the cause of, smoking was found in the effects of levels of nicotine dependency.

Those youth who were heavy smokers (nicotine-dependent) developed more mental health problems regardless of the age at which they first started smoking. Someone who became a heavy smoker at age 20 with no history of mental illness was at high risk to have a mental illness at age 27.

Further evidence of the connection between smoking tobacco and mental illness comes from a study from South Australia (Bowden et al., 2001) which found that the more severe the level of mental illness the more likely the person was to smoke. The most seriously mentally ill had a smoking rate in excess of 51%.

This leads to the inescapable conclusion that smoking increases the risk of developing a mental illness in addition to the physical ones we already knew about.

How might smoking be increasing these risks?

One way smoking may increase the risk of developing a mental illness is Nicotine’s effect on the serotonin regulation in the brain. Nicotine impairs the serotonin function of the brain. Low serotonin has been postulated to be a major factor in Major Depressive Disorder. Selective Serotonin Reuptake Inhibitors (SSRI’s) that slow the breakdown of Serotonin and thereby increase the levels of serotonin in the brain are commonly used to treat depression. One antidepressant is also currently being marketed to help people stop smoking.

But there is more.

Smoking reduces the levels of oxygen in the bloodstream and the brain. This reduced oxygen is a factor in the presence of chronic pain and now appears to also be a factor in increasing depression and anxiety.

Social factors may also account for some of the differences in depression in non-smokers versus smokers. With societies shift to preferring nonsmokers, there are restrictions on smoking in public places. Smokers are finding it harder to get jobs and to be able to get off duty during the workday to smoke.

Not having a job, having few social friends, and being socially undesirable all add to the reasons a smoker is more likely to be depressed than a nonsmoker.

In future posts, we will explore the connection between smoking and specific mental illnesses and look at how and when you should quit if you want to maximize your mental wellness.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is it like to have an invisible illness?

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What is it like to have an invisible illness? It is hard for others to understand when you have depression, anxiety, Lupus or any of a host of other illnesses for which the symptoms are not clearly visible.

Just came across a post titled “The Spoon Theory” by Christine that explains this issue.

Hope you find this as informative as I did.

Ugly nose and face or Body Dysmorphic Disorder

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Body dysmorphic disorder?
Photo courtesy of Pixabay.com

Can someone be too ugly to get a job or be loved?

There is a group of people in our society who believe very deeply that there is something wrong with their body which makes them so ugly that no employer will hire them and no other person could stand to be in a relationship with them. They often seek medical help to change their appearance but that help rarely results in them feeling acceptable.

There is a range of appearances. Some people are frankly better looking than others. We value celebrities based on their looks. So how far from that ideal level of beauty do you need to fall before you conclude that you are ugly and no one can possibly love or accept you?

Some people believe that they are ugly even when others around them cannot see the “flaw” that makes them believe they are undesirable. This belief that your body is flawed in some way, while others do not see the flaw is called Body Dysmorphic Disorder.

Body Dysmorphic Disorder can center on beliefs that any part of your body is defective but the most common things that are the focus of this belief are the skin, hair, and nose. Stomach, weight, breasts, or chest and eyes also cause significant numbers of people to feel bad about themselves.

Researchers believe that the prevalence of Body Dysmorphic Disorder is greatly underestimated. The number of people who suffer from this emotional problem is probably far greater than our statistics are reporting. Estimates of the number of people in the United States with Body Dysmorphic Disorder range from 2 million to in excess of 15 million people. The number of cases you see depends on where you look.

Most people with Body Dysmorphic Disorder do not come to mental health systems because of their excessive focus on their appearance. They often first present at a plastic surgeons office requesting an operation to change that part of them that they feel is making them ugly.

Annual expenditures for plastic surgery surpassed 10 billion dollars in 2008. This was an almost 900% increase over 1992 and this figure continues to grow. Unfortunately, people with Body Dysmorphic Disorder are most likely to feel that their operation was “botched” and as a result, sue the doctor or request a second or third operation. One study reported that 44% of plastic surgery patients were repeat clients. Some clearly were happy with the results and having more done but those with Body Dysmorphic Disorder are likely to undergo repeated operations because the problem lies in their thinking that they are ugly rather than in any particular objective problem with their looks.

So how does this Body Dysmorphic Disorder manifest in those who have the disorder? Suffers typically spend 3 to 5 hours per day looking at themselves in the mirror. They are highly sensitive to minor flaws in people and can spot defects in others readily. Many become housebound, afraid to go out and socialize because they believe that they are so ugly no one will like them. A deficit in social skills predisposes them to believe that their lack of friends and romantic partners is the result of their appearance rather than their lack of social skills.

Since those with Body Dysmorphic Disorder blame their lack of friends and jobs on their appearance they are unlikely to present for counseling or therapy. One way they enter treatment with a mental health professional is when their depression, anxiety, or other emotional problem brings them to the notice of the mental health system.

Almost half of those with Body Dysmorphic Disorder have been hospitalized in a psychiatric hospital. As many as 82% have had thoughts of suicide and one in four is likely to have attempted suicide. Most are young, single, and unemployed. They frequently have eating disorders, Obsessive Compulsive Disorder, or another psychiatric problem in addition to the Body Dysmorphic Disorder. Skin picking and religious or sexual preoccupation are also common. Many go on to develop Avoidant Personality Disorder.

They are also at risk to miss many days of work or school and many social events as a result of their feelings that they are physically ugly. Many of those with Body Dysmorphic Disorder drop out of school to avoid being seen by others.

Body Dysmorphic Disorder frequently begins in the early teen years and gets progressively worse. The mean age of onset of the Body Dysmorphic Disorder is between 14 and 16. Those with the disorder will cover their faces in various ways, spend excessive amounts on clothing or cosmetics or resort to extreme methods to try to alter their appearance.  Frequently those with Body Dysmorphic Disorder have been teased or bullied.

The mean age of onset of the Body Dysmorphic Disorder is between 14 and 16. The DSM-5 tells us that the most common age for onset of Body Dysmorphic Disorder is 12 to 13 years old.

This disorder is not restricted to females. Many young men develop the notion that they need to have huge bulging muscles to be acceptable and develop a related condition called Muscle Dysmorphic Disorder. Males are also at risk to believe that their genitals are too small resulting in avoiding dating and sexual relationships.

Those with Body Dysmorphic Disorder may also show up in weight loss groups where despite their low to normal body weight they will be focused on changing the shape of one part of their body that they see as defective.

Our understanding of Body Dysmorphic Disorder continues to change. In the DSM-4 Body Dysmorphic Disorder was included in the section on somatoform disorders, those disorders where emotions make you sick or make your illness worse. In the new DSM-5 Body Dysmorphic Disorder is included in the Obsessive-Compulsive disorders because of the time people with this disorder spend on concerns about their appearance.

There are effective treatments for Body Dysmorphic Disorder. The difficult part is getting those with the disorder to come for treatment. Since they firmly believe that their problems are the result of some physical defect they do not see how counseling can help them, and will often insist that they are not “crazy” or “mental.”

Treatment of other issues, depression, anxiety, and suicidal thoughts and actions are often the first step in engaging those with Body Dysmorphic Disorder in treatment. Cognitive Behavioral Therapy, Antidepressant medications, Narrative therapy, and skills training are all thought to be effective in treating Body Dysmorphic Disorder.

So if you or someone you know has no friends, no romantic partner, or no job and you think this may be because of looks, consider working with a counselor on your social skills, career counseling, and self-esteem before you conclude that the problem is your looks.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Why do people act in Passive Aggressive ways?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Passive-aggressive.
Photo courtesy of Pixabay.com

Why must they act Passive Aggressive?

Passive Aggressive Personality Disorder used to be a recognized mental illness. Then in the DSM-4, it was reduced to a condition that may need more study, and most recently it has simply disappeared from our way of thinking of mental illnesses.

Remember that there are times when a person gets criticized for adopting this form of behavior, maybe even referred for psychiatric care and then other people may be praised for adopting some form of passive reaction to an injustice.

So let’s look at why some people may adopt Passive Aggressive Behavior and why we are no longer so sure that it should qualify as a mental illness.

There are legitimate reasons people do not just come out and say what they mean. There are also reasons people may choose to say nothing but fail to carry through on things they were told to do. Passive-Aggressive behavior can be the result of some of those reasons.

People become Passive Aggressive when they have no power or control.

Children, especially if they are in an abusive or non-loving home, may not feel they can say no to their parents. They get out of things, not by saying no or discussing things but by taking excessive time or doing things wrong. If they break enough dishes mom may stop asking them to do the dishes.

The same behavior makes sense in the boss and employee situation. Sometimes you can’t tell the boss no, so you just do not get around to doing things that would be a waste of time anyway. Not everyone does this. Some employees are very conscientious, but the worse the boss in terms of giving arbitrary orders and not allowing people to disagree the more likely this becomes.

Some people use Passive Aggressive behavior more often than others.

If you came from a family where it was not acceptable to disagree with the parents or worse yet where you were not supposed to have any feeling unless they were sanctioned by the adult, you are more likely to hide your anger and then express it in Passive Aggressive ways.

Mental health clinicians used to think that there were things we called “Personality Disorders” and the presumption was that people who had these were always like that and that they were hard to treat and never changed. These premises have recently been called into question. Turns out that people can change their behavior when the situation changes.

One other thing that cuts against the validity of there being such a thing as Passive-Aggressive Personality Disorder is that it is mostly used in situations where there is a weaker person who is unable to disagree with a stronger person or in a close situation like a marriage where sometimes we want to avoid both doing what the other person told us to do and also avoid making this into an argument.

One characteristic that has been used to differentiate Passive Aggressive behavior from something like passive nonviolence is the level of anger or hostility that the person using passive-aggressive behavior is experiencing.

When the non-doing stops being a way of avoiding conflict and becomes a way to harm someone else without having to accept the responsibility that hidden or veiled aggression can drive the most rational person to open hostility.

One aspect of Passive-aggressive behavior that has received a lot of attention is the times when it appears to be motivated by contrariness or oppositional motives. When a youth adopts the position that they will avoid doing whatever the adult asks them to do just for the sake of asserting that the adult cannot control them this can escalate to severe problems.

Frankly, much of what was getting called Passive-Aggressive Personality Disorder looks way more like Oppositional Defiant Disorder when we see it in youths.

Passive Aggressive Personality Disorder shared so many features in common with other personality disorders and with depression and anxiety most professionals only used it when a parent or spouse said that was what the client was doing.

Most of the things we have been thinking of as personality disorders include a lot of antagonism towards others. Sometimes this is because the person’s life experiences tell them that they will not be treated fairly if they openly disagree or resist the will of others.

So while you will still read about Passive-Aggressive people, mental health has largely concluded that this is not a mental illness but is a way that some people cope with not being able to express disagreement. In other words, Passive Aggressive behavior is a symptom of some other problem rather than being a particular treatable disease.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Are you the Passive Aggressive type?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Couple fighting by not fighting

Passive-aggressive.
Photo courtesy of Pixabay.com

Who is the Passive-Aggressive?

There has been some discussion recently on the internet and elsewhere about people who are “Passive-Aggressive” how you deal with someone who is Passive-Aggressive and so forth.

What exactly is a “Passive-Aggressive Person” and how might this passive-aggressive personality be affecting you?

Turns out there are at least two somewhat different activities going by the name of Passive-Aggressive behavior.  On the subject of Passive-Aggressive Personality, psychology and mental health are not on the same page. There are not just separated and divorced on this one but living in different time zones.

Psychology has studied the way people may behave and do they have Passive characteristics or Aggressive characteristics. They used to think of these two as on opposite poles of the same axis.

Then it was suggested that some people combine both into a Passive-Aggressive style of dealing with conflicts. There were also some studies of whether these were stable traits, people did this all the time, or were these states, that the person might use a particular way of behaving in response to a specific situation and at one time but not another.

Mental health started looking at this as a potential mental illness, Passive-Aggressive Personality Disorder, which was causing problems in people’s social lives or in their work settings. The result of these two different perspectives is that the two fields came to differing views about Passive-Aggressive personality.

How did we get to a place where some professionals are writing about Passive-Aggressive people as if we all know what that is and why, while other groups have told us to drop the idea altogether?

Is a passive-aggressive person all bad or are there times when this is a useful way of behaving?

The idea that there are “Passive-Aggressive people” seems to have originated during World War Two when officers noticed, and then they complained, that they might give orders but the men just did not get around to doing what they were supposed to do. The result of this behavior was that the men got out of doing things and sometimes they communicated to a superior officer that they did not like that officer.

One example of this might be an officer who had the men dig a ditch one day and then had them fill it in the next. I suppose that the officer could argue that this is teaching discipline and is keeping the men active and fit, but the men soon caught on and found that there was no reason to put much effort into this ditch to nowhere.

This concept, of the person who is told to do something but then deliberately does it poorly or not at all, has also been applied to employees in the work setting. Some bosses like to think of themselves as generals or in other military terms. They talk about commanding their employees. You can make a good argument for the need of people in the military to carry out an order regardless of whether they agree with the order or not. It is harder to see why bosses give some orders that just make life harder for their employees and do not create any extra production.

The result of these irritating directives from management can be work slowdowns, stoppages, or people who just forget to do things. Sometimes it is hard to tell the difference. Some jobs take longer to do than planned. Sometimes people do forget. So the interpretation of “is this a Passive-Aggressive act” has to do with the motivations or intent of the employees, not with the resulting action or inaction.

This Passive-Aggressive idea was expanded to include children who did not do what adults asked. I still see this version in articles about our educational system. The student is told to move something but they drop and break it. Or they get the instructions wrong and go to the wrong place. Sometimes is as simple as them saying yes to doing something but then just sitting in their seat and doing nothing. The complaint by teachers is that the student may be saying yes but their actions are sabotaging the outcome.

One other place this is coming up, and here we are bordering on the mental health arena is in the field of marriage counseling.

One partner will refer to the other as passive-aggressive. Say the wife has a job interview the next day, she is busy getting ready and she asks the husband to stop at the grocery store on the way home.

He gets home late that night and reports he had a problem at work and “forgot” to stop at the store. This may lead to an argument and then either they eat leftovers or he goes to the local fast food for dinner. She is annoyed.

Next morning she goes to use the car for the job interview and finds that the gas tank is empty. She is now furious at him. Her conclusion is that he was late and left the gas tank empty to sabotage her efforts to get a job. Before long both partners may be “not doing” and “forgetting” to get their revenge on the other partner.

So from these examples, we can see why some people may do things that look Passive-Aggressive and that this can be really annoying if you are on the receiving end of this behavior.

This is also a hard thing to cope with because the person who is behaving in a Passive-Aggressive manner has all kinds of excuses for why they did not get things done or why they made a mistake.

Does that mean that someone who is acting in a Passive-Aggressive manner has a mental illness? Why do they do this and how can you get them to stop? And can Passive Aggressive behavior sometimes be a good thing, at least for the person who is using it?

Let’s take a look at all those issues in an upcoming post about the reasons people might adopt passive-aggressive behavior.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Pick your grandmas wisely – their life affects your feelings

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Grandma’s DNA may be affecting you.
Photo courtesy of Pixabay.com

What happened to grandma is affecting your life today.

Not just grandma but great-grandma has an effect on your feelings, even if you never met them, or so we are told. The more we learn about genetics and environment the more complicated it all gets.

We used to think that genes were genes and experiences; well that was what happened to you.  There has been a lot of research on which causes what. Do genes cause addiction and mental illness or do experiences sometimes described as the environment?

We have started to think that genes and experiences are both factors, risk factors for developing an addiction or mental illness. A risk factor does not mean you get the disorder, but it increases your susceptibility. We thought that genes and experiences were separate things.

What if grandma’s experiences became part of her genes?

For a long time, we thought that was not possible, now there is evidence that this may be what has and is happening.

Genes were seen as the blueprint for the way your body and your nervous system would develop. There might be variations, pigmentation for instance; one color was dominant and the other recessive so you get one-half of your genetic material from each parent. Two dominant genes or one dominant and one recessive and you still look like you have the dominant color. Two recessives and you win the different color prize. (In Humans most colors, eyes, hair etc. are the result of multiple genes so it is also more complicated than just dominant and recessive.)

We know environment can affect genes. No matter what your genes say if your grandmother grew up in a time of famine her growth was stunted. We see this in recent immigrants here in the U. S. Grandma is short but her children get more food both before and after birth and they are taller.

So after two or three generations, this family should all be reaching full height. Why then does succeeding generations keep getting taller?

Could grandma’s experience of living through starvation also alter her genes so that for a number of generations her children grow up shorter? Eventually, as time progresses that gene could change back to the full stature that was a potential in the genes but eventually that should stop.

That may not be what is happening genetically.

We were looking at genes as if they were blueprints. Not enough lumber and the house gets built smaller but the blueprints still call for a full-size house. Bringing in more lumber and the next house should match the blueprint. But what if that lack of lumber resulted in a change in the blueprint?

A new field of research, one name for this is Epigenetics, looks at how the way a gene gets expressed, the house is built, in my example, based on the experiences of the parents.

Epigenetics tells us that genes are not constant. They can turn on and off.  So that gene for black hair, that shuts off at some point and the gene begins to produce gray or even white hair. Same person, same genetics, but different hair color.

Research in mice, this is just  beginning to be replicated in human studies, found that in addition to genes and DNA there are other chemicals that can hook onto the gene and then when that gene gets reproduced the add-on gets copied also.

One of these add-ons is a methyl group. So if grandma was traumatized, raped or lived through a violent war. Her DNA could have picked up some extra molecules that shut off those outgoing genes. The result would be that as a result of grandma’s experiences your DNA is changed.

Remember that methyl stuck on is not adding to or changing your DNA, it is preventing some of that DNA from expressing itself. Depending on which part of your DNA it is stuck to, this could be a good thing or a bad thing.

Say your great-grandmother dies when your grandmother was very young. Great-grandfather tried but he was just not able to be affectionate the way great-grandmother would have been. The result is grandma had trouble feeling affection towards your mother.  You mother with a non-affectionate mother would find it hard to show a lot of affection to you.

Some women report that they have difficulty feeling love or nurturing towards their children. Yes they could have learned this but even when they were adopted by a loving adoptive mom these women may as a result of their extra methyl group hooked onto their DNA find it hard to nurture their children.

Now if this concept holds up through more research this may explain how ancestor’s experiences have altered the way our DNA develops and the resulting impact on our mental and emotional health.

My takeaway from this is that while this may explain some things about why we are the way we are this also means that if we learn new things if we have positive experiences our children and grandchildren can be affected by their genes in a very different way. This suggests to me that we need to spend a lot more time on treatment for depressed or anxious children before they have children of their own if we want to have an impact on mental health.

There is a lot of research going on now on mutations in genes. There are a lot more mutations going on than previously thought. But even if a particular mutation increases the risk of a mental illness, what if some early life experiences could counteract that gene and produce a different emotional result?

Let’s hope that it will be possible to help more people as time goes along. For more on this subject check out the article in Discovery Magazine for May 13, 2013, titled “Grandmas Experiences Leave a Mark on Your Genes. 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

How is youth mental health treatment different from adults?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Crying child

Youth mental health.
Photo courtesy of Pixabay.com

What are the differences between youth and adult mental health treatment?

There are differences in the way a counselor might work with a child and how they might work with an adult. How to “treat” a mental health problem is a complicated subject. It needs several books to fully describe this, but let me focus here on just a few things that may influence how a professional might try to help with an emotional problem in a child.

The way a counselor works with clients is sometimes referred to as our “theoretical orientation.” How I see your issue determines how I might try to help you. I can’t speak for therapists of other theoretical orientations but I would describe my approach as largely Cognitive Behavioral Therapy, that with a dash of learning theory and occasionally a pinch of narrative therapy.

This stuff is largely “skills-based.” I figure that the client is trying the best they can but that there are things they may not know and if they knew them they could do better. I could try to tell them, sometimes that works but mostly they need some help it trying on new behaviors and seeing what works for them and what does not.

Lots of people have “stories” they tell themselves about them. By story I do not mean that this is either true or false, it just is the way that person explains themselves and their life.

That story might sound like “I am such a loser.” Or “I can’t do anything right.” Kids get one thing wrong and they may start saying that they are a failure. See how having a single story that describes you rather than the thing you were not able to do could color your life experiences?

So adults have more experiences in life and may have more ways of thinking of new stories for their life than a younger person. What I am saying is that I would try as much as possible to tailor my approach to the individual, not some specific category or label.

In career counseling, the approach would be very different in working with a person who had worked at lots of jobs and was just downsized than it might be with a client who was very young and had never had a job.

What are some considerations in creating a treatment for a specific client?

Age is only a small part of the picture.

I would want to know in addition to the client’s age something’s about their abilities and their life experiences. Age, I.Q, and developmental stages are all in the mix. So might things like learning disabilities, intellectual disabilities, and other developmental issues.

The approach for someone who has a form of Autism Spectrum Disorder might be different from a younger person who had a less severe challenge. The key, for me, is really getting to know the person and match my efforts to them rather than memorize a particular formula for a given age, I.Q. or disorder.  Here are some things a therapist might do as the child moves through the lifespan and becomes a young adult, a mature adult, and evenly an older adult.

1. Activities build relationships.

With adults, it is often possible to sit down and have a talk with them. The younger the child, the more the anxiety or the more “inside themselves” they are the more we need to work on forming a relationship.

One way to create that relationship is to do things with the client. (Yes even with a five-year-old I think of this person as a “client.”) How would I have wanted to be approached when I was that age? If I can’t remember ever being that age, I take a guess at what that might have been.

So the counselor might play a game, not to waste time but to get the client to feel comfortable. Even with very adult clients, I find they will say more about their lives when we are doing something than when they are sitting in a chair and I am cross-examining them.

2. Pictures versus words in therapy.

Very young people and some adults are better at seeing than describing, they just do not have the words to tell me their story. I ask them to draw me a picture. A rainbow tells me one thing and a tornado-like creature in black and red tells a very different story.

3. Skills training is important.

You need to practice skills if you want them to be there when you need them. Adults practice golf swings. Younger people may need to practice introducing themselves, making friends, and sharing appropriately. A whole lot of people tell me right up front they have an “anger management problem” they do not seem to understand that managing anger is a skill like most other things in life and you can learn that skill.

The younger or more impaired the person the more they need help in learning appropriate skills.

4. Involvement of your support system makes a difference.

With children or youths, I like to know the involvement of the support system. The more people on your side the better your chances. Some people have a parent or caregiver that can help the client through things. Other young clients have no one on their side.

Sometimes I am working on helping the caregiver to learn to help the youth and other times I am helping the client learn how to cope with their less-than-perfect caregiver.

There are a whole lot of specialized treatments for all sorts of mental, emotional, and behavioral problems that a child may experience. This post has not even begun to look at all those possibilities but I hope it has given you some small idea of the ways in which a professional counselor might be able to help a child or their caregiver through a child’s emotional problems.

If you work with children consider taking the Youth Mental Health First Aid training when it is offered in your area.

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Are the mental health problems in children different?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Crying child

Youth mental health.
Photo courtesy of Pixabay.com

Age impacts mental health.

A reader asked “You keep mentioning children in your posts, how are their problems like or different from adult mental illness?

There are some differences between the issues children have and adults, but my experiences tell me that there are a lot of similarities.

We used to have a separate section for “Disorders usually first diagnosed in Infancy, Childhood, and Adolescence, in the DSM-4. In the DSM-5 those disorders get moved around. One problem with the old approach was that many clinicians missed the “Usually” part. We tended to think of these problems as something children get and adult problems as something only adults got.

That just is not so.

Some of these early-onset problems get missed or continue to plague people throughout their lives. Stress-related issues are a good example of this. Reactive Attachment Disorder may be easy to see in a small child but the after-effects can result in a bunch of problems that in adults we usually call by other names.

Just like the child develops, the mental health problems of that child may develop and change with time.

Also, it is very possible for children to develop problems that we used to think were only the providence of adults. Remember that “Happy childhood” myth. There must have been a few people with happy childhoods but there were a lot of people who did not get their ration of that one.

So children can and do suffer from depression, anxiety, stress, trauma, and a host of other adult looking problems.

We currently believe, I think for good reason, that the earlier in life we recognize some of these problems and treat them the better the chance that the person will not grow up to have a severe emotional disorder. That treatment, by the way, need not be medication or prolonged therapy.

Lots of other things can help these children. Anger Management and Parenting classes for unprepared parents also help. So do supportive environments like quality preschool or even grandparents or other supportive adults.

A disclaimer here – my perspective on working with children may be a bit different from other clinicians. My work with children has been largely in crisis settings, these kids were brought in because they said they were suicidal or they were way out of control. The other groups of children I worked with were substance abusing or those brought in for an assessment because someone believed this child has a serious emotional problem or a serious mental illness.

My experiences were with a group of children that may be more seriously affected by society’s problems. As a result, some childhood problems were probably not represented and others were way over-represented.

The problems that bring children to the attention of professionals change as they get older. The 3-year-old who is not talking is a way different problem than a 17-year-old girl who has been abusing drugs and is now suicidal because she found out she is pregnant by her 24-year-old boyfriend.

Both may have been the victims of abuse or neglect, so these very different “symptoms” may stem from the same or similar roots.

As a child gets older the way we should be assessing and the way we treat this “child’s” issues should get more and more like the way we treat adults. Mental health has had problems here for years as I see it. Some clinicians continue to treat adult clients as if they were mentally retarded or little kids.

One day you are 17 and you get the “now little girl” treatment and the next day you are 18 and you get the “grow up” lecture.

One other thing to consider when talking about the difference between adults and youth mental health issues is how to tell the difference between normal adolescent issues and those problems that could be the beginnings of a serious mental health issue. Just being a teen is, in and of itself, not a diagnosis.

Recently I attended a training to get certified as a Youth Mental Health First Aid trainer. I can’t begin to cover all that info here. If the issue of how to recognize mental health problems in young people interests you, you might want to check out that training.

The question about how the treatment approaches may differ between a young person with a disorder and a person who has accumulated more years, presumably an adult, that topic needs a whole other post.

Till next time, David Miller, LMFT, LPCC

Related articles

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel