Category Archives: Mental Health

What is Dissociation?

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

Confusion.

Confusion.
Photo courtesy of Pixabay.com

Does Dissociation really happen? What causes it?

Personally, I think there is more misunderstanding around this condition than most other mental health issues. First off Dissociation is way more common than most people realize. It comes in varying intensities; much of it is mild and goes unrecognized, denied and undiagnosed.

Dissociation, particularly Dissociative Identity Disorder has so much stigma around it that when we see it in clinical practice, I believe most clinicians call it something else more acceptable, like stress or Posttraumatic Stress Disorder, and let it go at that. This leaves people with more severe cases of dissociation with less than adequate treatment.

My view is that milder forms of dissociation are a normal protective behavior for most vertebrates, humans included. Under stress, the brain stem engages the “F’s” and takes over the functions of the brain to ensure survival.

Dissociation in its milder forms is, as I understand it, a functional survival mechanism. It is a close cousin to daydreaming and alcoholic blackouts.

Some simple examples of Dissociation.

I am driving along, I am thinking about something I need to do tonight. In my mind, I am picturing a set of slides that I want to create for the PowerPoint. I realize all of a sudden that I am miles past my freeway exit and I have no memory of driving this way. My mind has blanked out.

At this point, I turn around, drive as fast as I can, and reach my destination. Do I tell everyone about my “zoning out?” Not a chance. I make some lame excuse about traffic and getting off work late.

Next example, more severe

A woman who was gang-raped in the past is walking around downtown. She sees some men who are wearing gang colors and look kind of like the men that assaulted her. She becomes frightened and crosses the street, she begins walking fast to get away. A few minutes later she slows down. Her panic is subsiding. She looks around and finds she is walking through a neighborhood and she has no idea where she is or how she got here.

So now we can see a mechanism by which someone who is upset might do actions like run away and be functioning essentially on autopilot. High levels of stress, like high levels of alcohol in blackouts, might shut off the connection between current functioning and memory.

Does that mean this woman has some form of Dissociative Disorder?

Maybe, maybe not. The new DSM-5 lists five major kinds of Dissociative Disorders plus some specifiers and or sub-types.

This woman, now upset because this past problem, memories of the rape, is messing up her life and also a lot worried because she ended up in a strange neighborhood with no memory of how she got there comes to see a therapist.

She begins to talk about her experience. She had an experience that brought back memories of her rape (Intrusive thoughts.) She tried to avoid things, ran away (avoidance, yes.) She has been anxious for several nights since and has lost sleep over this. Maybe even had a nightmare and this has been affecting her home life and her relationship.

At this point she gets assessed, a treatment plan created and treatment begins.

She was embarrassed so she left out the part about walking for a while and having no memory how she got there.

Her diagnosis – it’s likely to be Posttraumatic Stress Disorder.

In clinical settings, stress-related disorders get diagnosed a lot more than dissociative disorders. Sometimes it is a judgment call. Which disorder are this woman’s symptoms more like? But I think we professionals may be overlooking a lot of dissociative symptoms. The result may be that in outpatient settings we are under-diagnosing Dissociative Disorder and over-diagnosing PTSD.

In carefully controlled research the prevalence of Dissociative Disorders of all 5 types exceeded 5% of the population. That makes dissociation up to 17 times more common than Schizophrenia.

Dissociative Disorders are the next chapter over in the DSM-5 from stress-related disorders. We see a huge overlap between those two groups. There is also an overlap with Borderline Personality Disorder another misunderstood condition.

If we think of all these conditions as reasonable responses to stress given the person’s biology and experiences we can see how some of the things that occur to a person with dissociation make sense.

Dissociative Disorders are most commonly found in the aftermath of traumatic events. Some of the symptoms of dissociation are embarrassment, confusion, and a desire to hide the existence of your symptoms. If you are the victim of trauma and let on how much the trauma affected you, this might put you at risk to be revictimized.

People under stress will have gaps in their memory. People with dissociation may also not know they have those gaps until someone asks about something they can’t remember. This is referred to in the literature as “amnesia about the amnesia.”

Dissociative Disorders, all 5 of them according to the DSM-5, include both positive and negative symptoms. In the past the only other disorder that I remember being described that way was Schizophrenia, but as I think about them other disorders have both also.

Positive and negative symptoms do not mean they are good and bad. What this means is that people with a disorder lose the ability to do some things others can do. This loss is called negative symptoms.

They also develop symptoms that others do not have. These added symptoms are called positive symptoms.

Since I believe people can and do recover I think that these areas of altered functioning can vary in intensity and can get better or worse depending on time, traumas, conditions, and treatment. More on negative and positive symptoms in future posts.

Another area of concern in talking about dissociation is something called state or trait theory. Trait would imply that once you got it you always got it. So if you dissociate then you are a goner and who wants to believe that. But if dissociation is a state then you can move into and out of it.

One other cause of Dissociative symptoms are efforts to reprogram or expose someone to “thought reform.” This mental reprogramming, like brainwashing, results in a brain that at some level believes two contradictory things. Can you see how that brain could pop in and out of contact with others?

Last, despite all the press about extreme cases of dissociation and the recurrent belief that this is something that only happens to women, the research tells me it is, in fact, more common among men than women. I have some theories about why that might be but that like the rest of this needs to wait till another post.

Dissociative disorders vary from person to person and from time to time. Nothing I can say will fit everyone and there is a lot to be said for listening to the “lived experience” of those who have these disorders. More to come on this topic, but in the meantime what do all of you think about this?

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 Multiple Personality Disorder really exist?

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

personality disorder

What Causes DID Disorder?
Photo courtesy of Pixabay.com

Are Multiple Personality Disorder, Manic-Depressive Disorder, and Addiction real illnesses?

There have been some books, articles, and blog posts recently saying that many things we are calling illness either do not exist or if they do exist they are not really illnesses but choices people make.

Some of the arguments these people are making seem to have some merit on the face, but when I look deeper there are some serious flaws in this kind of reasoning. All good lies have some truth in them and so these misconceptions about illnesses take some sorting out. Most of these efforts to deny the existence of a particular illness are cases of – if I do not believe in this it can’t hurt me.

Let’s look at some examples of ways people try to deny the existence of mental disorders.

1. Change the name and the illness ceases to exist – Denial one.

“There is no such thing as Consumption. When people believed in consumption they got it and died. No one gets it now because we know it does not exist.”

You buying that?

Consumption is the old name for Tuberculosis. Yes, people still get T. B. and die from it. We do have medication to treat it, but if you take no meds, you still can die from this illness. Changing the name did not erase the disease.

What about Manic-Depressive Disorder? No such thing right?

Well, we changed the name of that one to Bipolar Disorder so in that sense there is no such thing as Manic Depressive Disease. No difference really in the condition. Still, a serious illness and still needs treating, but not in the strictly literal sense, there is no such thing as Manic Depressive disorder anymore at least not in the DSM.

Which brings us to Multiple Personality Disorder.

The name misled a lot of people into thinking that everyone who had this issue would look like Sybil.  The truth is that there are lots of variations. The new name is “Dissociative Identity Disorder” so while technically, semantically, Multiple Personality Disorder no longer exists, there are still millions of people living with exactly these symptoms; we just call this condition by a new name.

Watch for an upcoming post on Dissociation Disorders. (Yes, there are more than one of these creatures.)

2. Second denial – There is no such thing as mental illness.

The argument runs – mental illness is not a “real disease” these are just people who think or behave differently from the rest of us and we want to force them to act and think like the rest of us.

A lot was made of this a few years back. Again in a strictly semantically way, this has some truth to it. Just enough truth to be misleading.

One definition of illness or disease is a process of an organism, bacteria, or virus, invading the body, and damaging cells. The proponents of this “no mental illness” idea argued that if mental illness was a real illness we should be able to find the bug that caused it and a drug that removed this infection from the body.

Newer research on the brain is chipping away at this one. There are lots of changes that nerve cells undergo that cause a change in functioning. Thoughts and traumatic experiences can change the wiring and the chemistry of the brain.

Most mental issues are correctly referred to as “disorders” not technically diseases. The specific definition of a disorder is essentially something that causes you a thinking, feeling, or behavioral issue.

So if the emotional, mental, or behavior problem cause you to have impairment in Social functioning, (You can’t get along with family and or friends) occupational functioning (the ability to hold a job) of subjective distress (You say it bothers you) then we diagnose it as a mental disorder. The DSM-5 adds “other important area of functioning” I am still not sure what all that might be but if we find that we can give you the diagnosis also.

So while there does not appear to be any Dissociative Disorder germ, I still think that the effects of trauma can alter your emotions sufficiently that we can say you have a disorder.

3. Denial three – I do not believe in Dissociative Disorders so they do not exist.

I take this to be the funniest reason of all to pretend that disorders do not exist. Still, some people cling to the notion that there was no evolution or that the sun does, in fact, revolve around the earth.

Personally, I have taken to believing that Arizona does not exist. California just runs all the way to New Mexico. Those of you that think you live in Arizona knock that foolishness off and start sending your taxes my way.

People have denied the existence of addiction for years saying those people just chose to be that way. Some of them say the same thing about schizophrenia. Now the medical people are saying almost all medications including prescribed ones can cause tolerance and withdrawal so they all met the old definition for addiction.

We are getting around this one by eliminating addiction – it is no more. All of you that thought you knew someone with an addiction you were wrong – there is no such thing as addiction – We will, however, be treating a lot of people next year for substance use disorders and the key characteristic of that disorder will be a loss of control over their use of a substance.

See how this works.

4. Straw man argument.

The way this one goes is: When you talk about Multiple Personality Disorder or Dissociative Disorder what you really mean is –

They then proceed to spend the rest of their post arguing about things that you never said and wouldn’t have said, but it makes them feel better to win an argument even if they need to misrepresent what you think to win one.

Oh, my – another long post. So in the future let’s talk some more about all the things that we have been learning about stress, trauma, and dissociation.

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

Recovery starts when you stop falling.

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

Ball recovery

Recovery and Resiliency.
Photo courtesy of Pixabay.com

Recovery begins when you stop getting worse.

How do you measure recovery from anxiety, depression, stress, or trauma? The whole concept of recovery is relatively new to the mental health field. Substance abuse people have been thinking in terms of recovery for a long time. But if you have anxiety, depression, PTSD, or another mental illness how do you know if you have begun to recover?

There are those who question the whole notion of recovery. Once you have a disorder, addiction, or PTSD, they say you are stuck with it forever. I do not believe that. I have seen too many people recover to buy that myth.

In addiction treatment, there is a saying that you “hit bottom” when you stop digging. The belief is that there is no set level of pain and suffering you need to endure before you begin the journey of recovery. Once you decide to stop doing things that are not healthy the process of recovery begins.

Recovery to me does not mean a cure. If you have been in an accident, been injured by things others did to you, or by things you did, the scars may fade but never go away completely.

What recovery does mean is the ability to live your life in the best way possible regardless of whatever you chose to call your challenge.

How might someone with a stress-related disorder know when they are moving in the direction of recovery?

For someone with a mental health challenge, recovery might begin at the point when they get stable, when they stop sliding farther down.

For people who suffer from “complex trauma” a cousin of PTSD, caused by repeated traumatic experiences, one way of describing the beginnings of recovery is reaching a place of safety.

Najavits in her book “Seeking Safety” talks about the need for people in recovery from stress and anxiety issues to create a safe place, to get stable, as the way to begin your process of recovery from complex trauma. People with depression or substance abuse issues may call this a “supportive environment.” What follows is my version of her ideas from the book and from some published journal articles on Complex Trauma. I hope I have not harmed them in the transformation.

Recovery requires the creation of safety in three different areas of our lives, our thinking, our behavior, and our relationships.  Professionals, like Najavits, might refer to these areas as cognitive, behavioral, and interpersonal domains.

Safe thinking supports recovery.

A saying you might hear in recovery groups is “when I am in my own head I am in a really bad neighborhood.” It is common to collect a lot of really scary negative thoughts that we find it hard to let go of.

In a previous post, I wrote about the need to do some “neighborhood cleanup” so that your head can be a safe neighborhood to live in. Recovery begins with changing your thinking. Often this is hard. You do not know what you do not know and you may believe some things that made sense in the past but are no longer working for you. Working with a professional or a supportive person can help you figure out which of these thoughts you need to toss and which you need to revise and renovation.

Safe behavior builds recovery.

If you want your life to change you need to create safe environments and safe actions. This may involve avoiding certain people, places, and things or it may mean learning to set better boundaries in the places and relationships you find yourself.

Using drugs or alcohol to cope often puts people in a much riskier position. Some behaviors will make your symptoms worse and some will make you feel and be safer. Learning from experience and close observation (sometimes referred to as mindfulness) will help you in your effort to stay safe while still getting out there and enjoying life.

Safe relationships nurture recovery.

Some people are safe and supportive. Some are dangerous and disaffirming. There are a whole lot of others in between these poles. Recovery can involve avoiding or limiting unsafe relationships. It can also mean working on improving those relationships that are supportive.

Friends and recovery supporters do not automatically appear when we need them. Developing good friendships requires effort. I see many clients who pursue a romantic interest actively even when others around them see that this is an unhealthy relationship. If you want healthy relationships you need to seek them out and spend time with those friends just as you might spend time with a new romantic partner. Time together builds a closer relationship.

Recovering people also need to learn that there must be degrees of trust and closeness. Some people are fine to spend time with, in short segments. We have work friends and hobby friends but only a few of these people may become “over to the house” friends.

So if you are setting out on the path of recovery from an emotional problem, a mental illness, or a behavioral issue. Make certain that you work on creating safe thoughts, behaviors, and relationships. A happy life awaits you.

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

Support Groups for people with PTSD or Complex Trauma.

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

Group.
Photo courtesy of Pixabay.com

Anyone know of support groups for people with PTSD?

This question came in from a reader. They were specifically asking about local support groups here in Fresno. I did not come up with much and so I thought I would offer a few suggestions and then ask those of you out there if anyone else knows of any other resources.

Unfortunately, most of my suggestions may not help the person who asked the question, the resources are limited.

1. Try on-line groups.

I am familiar with some groups or communities on the internet. More and more the specialized groups are becoming self-help or peer-run groups on the internet.

One, in particular, is Trauma and Dissociation which is a Google+ community. You have to have a google+ account to access this but opening an account is easy and free.

You can also try the WordPress Blog: http://traumaanddissociation.wordpress.com/

2. Larger insurance providers may have something to offer if you have private insurance. Kaiser for one has offered some groups. Can anyone add to that list?

3. Your insurance provider may be able to refer you to a private therapist and some of them specialize in PTSD an even smaller number may offer group formats.

4. If you are in substance abuse recovery some A.A. and N. A. groups, while not specifically devoted to people with PTSD can be supportive places for people in substance use recovery who have PTSD or another mental health issues also. Check out the group and make sure you feel comfortable with them before divulging the details of things other than the official topic.

5. VA has some groups and more likely to come in the future as so many veterans are returning from multiple deployments with PTSD and the related MST (Military Sexual Trauma.)

6. Those people who are receiving services through their local Community Mental Health Department should check with them for available groups. In Fresno County, if you have no insurance there are county-run programs for those on Medi-Cal and those with no or very low-income.

It remains to be seen if these groups will be expanded. Personally, I think specialty groups for people with specific issues can be especially powerful. I anticipate that as more people become eligible for services in the government-run systems we will increase the number of groups run by both peers and professionals.

Any other suggestions?

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 does being sad say about you?

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

Sad child

Sad.
Photo courtesy of Pixabay.com

What do you tell yourself when you are sad?

Many of us can’t bear to let ourselves be sad. Not because the feeling is so unbearable but because we tell ourselves that if I feel that way there is something wrong with me. That insistence that we should not feel what we feel or that feelings are negative, can keep you from learning the lessons that feeling are trying to teach you.

Those things we tell ourselves to try to avoid feeling what we feel can keep us stuck in those negative feelings a lot longer than if you let yourself feel and then decided what you wanted to do about that feeling.

Do you tell yourself these things when you feel a sad emotion coming on?

1. If I am sad that means I am weak.

Sad or even depressed does not mean weak. Feeling sad means you are normal, especially if the sad is for what you see happening to others. Only a psychopath can see a child being harmed and not feel sad. So unless you are aspiring to become a psychopath let yourself feel sad when things happen that should make you sad.

Being sad is not weak, it is realistic. What you need to do is not stay stuck in the sadness but look for ways to be kind and compassionate to those that suffer.

That list of people who you need to be kind to – your name should be up at the top of the list of people deserving kindness.

2. Do you think being sad is pitiful?

Pity is a looking down on other’s emotions. Why are you looking down at yourself?

Be compassionate with yourself. Beating yourself up or telling yourself not to feel what you feel will undermine your ability to use feelings as a reliable guide to life events. It is not pitiful to be you.

3. If I let myself be sad I am a basket case.

It is not people who feel that end up in emotional trouble. People who try to hold things in eventually meltdown or they become dead inside.

Some feelings have to be felt before you can move on. If someone dies feel the grief. Be sad when sad things happen.

Do not let sad or your efforts to not feel sad take over your life.

4. Being sad makes me inferior.

Being sad is a normal human emotion. Everyone can and does feel sad some of the time. What matters is what you do with that feeling. Do you get sad when you should and then let it pass or do you get stuck there?

You do not need to be less feeling and more numb than others to think of yourself as acceptable.

It is not the feeling sad that defines you, it is what you do with that emotion once it has visited you.

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

Complex Trauma, Stress and PTSD

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

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

What is Complex Trauma and how is it connected to other emotional problems?

Most therapists recognize the existence of a “thing” that might be called Complex Trauma. We are pretty sure it exists. We see clients with it all the time.  Only it looks different in different people. Sometimes it looks like a stress disorder, sometimes it looks more like Post Traumatic Stress Disorder (PTSD) other times it looks a lot like depression or anxiety.

We, professionals, are just not sure what to call this thing and worse yet we are not all sure how to treat it.

This confusion is aggravated by the problem that there is was no diagnosis for this thing, this complex trauma monster, in the DSM-4. Worse yet, even with the increased attention to stress caused disorders in the new DSM-5 Complex trauma did not make the new book either.

The result is that we have a disorder that we all see in our clients but it looks different in a different light and we give it different names depending on who has this issue.

This problem, this idea that multiple, complex trauma is different from single trauma and that the results of multiple traumas are not a case of two plus two equaling four is not new. With complex trauma two plus two maybe six or even seven.

We know this from reading books and articles on zoology. Humans are not the only creatures who suffer more from repeated traumatization. Other creatures can recover from a single large trauma but when subjected to repeated traumas they lose the ability to adjust.

Let me attempt to explain this problem by using a far-fetched analogy.

Complex Trauma is kind of like a hurricane or monsoon.

Most of us know what a hurricane is, sort of. The wind blows really hard. It damages things and knocks things down. A tree may blow over and smash your roof or the wind may break some windows and blow over some things breaking them. But that is not all.

With the wind comes a lot of rain. The rain fills up creeks and small rivers and then they overflow. Your house may get flooded.

That tree may miss your house when it falls and hit a power pole. That pole may start a fire and your house could burn down. If you live near the coast the tide from the ocean may become a tide surge and sweep your home away.

All of these things are the consequences of the hurricane, but the effect on you and the way your insurance company sees things may be very different depending on whether your house is damaged by a falling tree, flooded, swept away by the tide, or burns due to a falling power line.

Complex trauma is a lot like that. Different people are affected differently. Some get depressed, some get anxious, some people dissociate and others think of harming themselves or others. All of these possibilities and more are the result of the stress or trauma but each person experiences them slightly differently and they all may get different diagnoses.

A different diagnosis may result in a different treatment which means some people are way more responsive to a particular treatment.

We used to think that there was a discrete number of mental illnesses, two, neurosis, or psychoses. Then a hundred or so and in the DSM-4 about 400. Now we are thinking that if we keep splitting up these problems of living we are going to end up with one diagnosis per person. So we are trying to think more in terms of a continuum. Some people are only a tiny bit depressed occasionally and others are major depressed all the time.

This variation in features is also impacting the way professionals see and respond to stress-related problems.

Over the next few weeks as time and space permits, I want to talk more about complex trauma, how it develops and why it is sort of like PTSD, anxiety, and other named disorders, and why it is enough different from those other disorders that clinicians are developing specialized treatments for this issue.

People can and do recover from complex trauma so stay tuned and we will talk about the steps to recovery from this misunderstood disorder.

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 are so many children being diagnosed Bipolar?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Early Onset Bipolar Disorder.

Bipolar diagnoses in children have increased 40 fold in the ten-year period from 2000 to 2010.

What is behind the increasing number of children and teens who are being diagnosed with Bipolar Disorder?

We are learning more about the risk factors for early-onset all the time. Still, as we learn about what may be causing this increase in the number of cases of early-onset Bipolar Disorder, the picture of how to treat or prevent early life Bipolar Disorder is getting less clear.

If we could detect symptoms of Bipolar Disorder early, presumably we should be able to treat those symptoms and reduce the incidence of Bipolar Disorder or at least reduce the severity of the disorder.

Unfortunately, there is often a lag of ten years or more from the first symptoms until the child has a manic or hypomanic episode that qualifies them for a diagnosis of Bipolar.

I have written in past blog posts about how many of the things that cause people to think of someone as Bipolar are in fact not necessarily symptoms of the disorder. Being moody does not make you Bipolar.

What does help define the Bipolar condition is the ability to sleep only a few or no hours per night and still have plenty of energy. That along with excessive energy, being driven to do things, and being impulsive are the hallmark features of Bipolar Disorder.

Here are some of the possible causes of the increasing number of Bipolar diagnoses in children.

1. Taking Stimulant ADHD meds or antidepressants can set off a manic or hypomanic episode.

One huge risk factor for developing a Manic or hypomanic episode, the key factor in a Bipolar Disorder diagnosis is having taken either a stimulant or antidepressant medication.

Having been treated with a stimulant ADHD med seems to correlate with developing mania. Not all children treated for ADHD develop Bipolar and not all people with a Bipolar Disorder diagnosis were first diagnosed with ADHD but the overlap is disturbing.

In one study of adolescents with Bipolar Disorder, 98% had been diagnosed with ADHD and treated with stimulant meds first.

This points to the need for psychiatric diagnosis to be reviewed by psychiatrists and in children by a child psychiatrist.

2. Abusing substances increases the risk of developing Bipolar disorder.

Over 40 % of children who receive the Bipolar Disorder diagnosis have been abusing substances. In their lifetime, 60% of all people with Bipolar Disorder will develop a substance use disorder.

This is not limited to just stimulant drugs. There is a high overlap between Bipolar Disorder and alcohol abuse as well as developing problems with excessive use of Marijuana.

3. Being the victim of physical or sexual abuse or neglect.

Abuse or neglect increases the risk of developing Bipolar disorder. This also accounts for the difficulty in many cases of distinguishing between Bipolar disorder and Borderline Personality Disorder. It is possible for people to have both illnesses.

There is also an overlap between trauma-induced problems, stress disorders like PTSD, dissociation and the like, and Bipolar Disorder. We would like to think the boundaries between genetic disorders and those that are the result of life experiences that were easy to find. In practice those lines are blurry.

4. Poor diet and lack of exercise are risk factors for Bipolar Disorder.

Poor diet, particularly diets deficient in some vitamins and minerals can increase the risk of getting a Bipolar diagnosis. Hard here to tell which came first. People with depression or mania, both symptoms of Bipolar Disorder neglect their diet. Poor diet increases the risk and around the circle goes.

Lack of adequate exercise has resulted in an explosion in weight-related problems. There is the thought that this lack of exercise and poor diet is also contributing to the increased prevalence of Bipolar Disorder.

5. Genetics is a Bipolar Disorder risk factor.

If you have one parent with Bipolar Disorder the risk you will develop Bipolar Disorder is 33%. Two parents with Bipolar Disorder and the risk goes up to 70%.  Add to that the difficulty that parents who have an emotional problem have in parenting and you can see how the interplay of genetics and environment increases the risk dramatically of your grow up with a Bipolar, substance-abusing parent.

6.  A changing environment may make Bipolar Disorder more noticeable.

Some of the characteristics that we today call Bipolar Disorder would have had survival benefits in the past. Fast processing speed and jumping to conclusions might save your life in the woods but can get you into trouble in the classroom.

People with milder varieties of bipolar disorder enjoy the hypomania – for a while. Even full-on Mania can be fun until those impulsive decisions get you into trouble. Bipolar Disorders are often associated with overspending, excessive sexual activity, and substance abuse. All things that damage relationships and can cost you your job.

The increase in children receiving the diagnosis of Bipolar disorder will continue to result in more adults with those labels as these early life cases age. If your child is having problems consider family therapy to help everyone find simple solutions to these problems.

If you or someone you know has Bipolar Disorder or another emotional problem that might look like Bipolar Disorder consider getting help. Therapy can be effective in helping you to learn how to control your symptoms. Medication can also be useful in keeping your moods within bounds.

People can and do recover from the symptoms we call Bipolar Disorder.

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 really causes Mental illness?

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

Could you be mentally ill?

What Causes Mental Illness?

Why do some people get a mental illness and not others?

We have had a lot of theories of mental illness, over the years, most of which have not panned out. So what do we know or think we know at this point? Some things that were suggested as causes of mental illness in the past turned out to be only a little right and a lot wrong. Check past posts for the discussion of that part if you missed it.

Recent studies of the brain have added a lot to our knowledge of how the brain works and what is causing those processes. The picture while having more lines drawn in is far from clear.

Some people would like to think most of what we call mental health issues are the result of something wrong with the brain. Other people will argue that mental illness is caused by a person’s thinking or life experiences. Let’s try to sort this out.I believe the truth is yes to all three possible causes.

Is Mental illness a “brain disease?”

In some ways yes mental illness is a disease of the brain. But in other ways no, there is more to getting a mental illness than just something chemically wrong with the brain.

We believe that mental illness is a real illness. The principle impairments are in the area of the nervous system. So this is not something the person chooses to have or can just snap out of. Mental illness is, I think more complicated than just that statement.

Saying mental illness is a brain disease should not be taken to mean that the person was born with a defective brain. They are not subject to recall or reassignment because of some sort of human lemon law. Yes, some brains are born different, right from the start. Unfortunately thinking that abnormalities in the brain are the one and only cause of mental illness is way too simplistic.

Let’s look at how the brain works, in a grossly oversimplified way, by comparing it to something most of us use every day.

How is your brain like a car?

You call the mechanic and tell him your car is not running, it no-goes.  He tells you to bring it in. You get it towed into the garage. The mechanic checks it, you’re right, it does not start. He tells you it is a lemon, worthless car, get a new one.

Wait a second, you drove this care in the past, it went then, why not now? The analogy here is why does someone seem normal at 12 and at 20 hear voices? Was there a brain bad all that time? Or did something change? How come someone who used to be happy gets depressed? Bad brain? I do not think so.

So the mechanic notices your tires are low, puts air in them, still, the car no-goes.  You check for gas, fill up the tank, but the car still does not run. With people, we do all the stuff that is supposed to make them stop being sad, but they still are depressed.

So the mechanic changes the battery, then the starter, finally the engine turns over. You get in the car and put her in gear and – the car goes nowhere. It still no-goes.

Down the line, you find that there is somewhere in the transmission and it slips or the rear end or drive shaft is bad. It could be lots of things.

The point is that the car has lots of parts – So does your brain.

So your brain has lots of parts and problems in one part may look sort of like problems in another part. Genetics may affect the structure or the functioning of various parts of your brain.

To date, we have identified over one hundred genetic mutations that appear to contribute to schizophrenia. No one mutation explains it and you can have varying amounts of these genes and still not get it. Take these 100 genetic mutations that may relate to schizophrenia and multiply that by 400 to 800 other mental health conditions and you see where this could go.

This is not, 100 times 400 by the way, but 100 times 399, times 398, and so on. One of you math guys can run the numbers if you want but you can see this is a HUGE number.

So a portion of the brain works too fast, too slow, is too large or small, or has wires connected incorrectly. This can all increase the risks that your brain will give results that are different from the results others get.

This may mean a mental illness or it could mean creativity or novel abilities. Sometimes the symptoms we call a mental illness can be connected to something else we call a talent. All very confusing.  Some of these personal differences, like fast thinking speed, may have been adaptive when your ancestors lived in the jungle and had to run from tigers but can get you in trouble if you jump to conclusions and hit someone who was just joking with you.

There are some skill differences in driving a stick shift and an automatic. You can learn to drive both but the skills are slightly different. Unfortunately, our educational system and a lot of the rest of our society is set up as if every brain ran the same way. (Read that as a possible cause of higher rates of ADHD in some schools and not in others.)

Notice that, to belabor this analogy, fluids do not work the same way in all parts of your car. Water is good in the radiator but may be bad if it is in your electrical system or your oil. Same with your brain.

Serotonin or Dopamine or other neurotransmitters may behave differently in various parts of the brain. So saying that the brain has too much or too little dopamine, may be wrong. Saying that there is too much or too little in a particular part of the brain might be closer to the truth but not there yet.

Thoughts change the brain.

Thoughts are moved from one nerve cell to another by chemicals we call neurotransmitters. Since thoughts are carried by chemicals, what you think changes your brain chemistry. That is a major factor behind the effectiveness of talk therapies.

Experiences can change the wiring of the brain. And of course, genetics can affect the shape, size, and efficiency of any number of thousands of parts of the brain.

So your genetics can predispose you to a particular mental illness, your environment can alter those neural circuits and your thoughts can add to or reduce the problems. No one thing is the whole answer but cumulatively they add up to a lot of ways the brain can be different in one way or another. Some of these differences we define as good and some we call mental illnesses.

Someone who has parents with a particular “high risk” gene who is under stress as a child, say abuse or neglect, or who does drugs or has tragedies in their life, all those things can add up to more than this particular brain can handle.

Conclusion:

There is no one thing that causes all cars to no go. There is also no one thing that causes the conditions that we are calling mental, emotional, and behavioral illness. Genetics, at birth and as the genes express themselves across the lifespan, coupled with life experiences and learning and add in beliefs about things or attitude and all together in varying amounts may be the cause of what we are calling mental illness.

Next stop, after a few other things get talked about,  coming soon – What is complex trauma and how does it rewire the brain?

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 causes Mental, Emotional or Behavioral illness? We have been wrong.

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

Sad child

Sad.
Photo courtesy of Pixabay.com

Looks like a lot of the theories about what caused mental illness are wrong.

What causes mental illness? What do we know and what do we think we know?

Many of the things we thought were causing mental illness turns out to not be causes. In the process, we missed a lot of things that are impairing the mental health of our society.

There have always been people who were clearly mentally different from others. We have seen explanations for what causes mental illness to come and go. Today we know more than ever before about the human brain, how it works and some of the problems it may develop, still we are less sure than before about what is causing that thing we call mental illness.

There is hardly a day now when you can turn on the T. V. or read the news online and not hear about someone with a “mental illness” and some terrible thing they have done. This media coverage is leaving more out than they put in and the result is less, not more, understanding about mental illness.

The mentally ill and violence.

As an aside here, the mentally ill, those with serious long-term illnesses, are more likely to be victims of crime than the perpetrators. They get beat up and robbed on a daily basis. This rarely gets on the news unless the perpetrator is a police officer, and even then the sense is that the mentally ill somehow deserved it.

Personally, experience has taught me that I have more to fear from the person who was just served with divorce papers or found out their spouse is cheating and has shown up at a worksite with a gun, than from someone who has a long-term mental illness.

Emotional problems in someone who has not been identified as having a serious and persistent meant illness are the larger threat. It is easy to see in retrospect that there “had to be” something wrong with the person who came to a school with a gun. But if you follow all the people who are diagnosed with schizophrenia, for example, very few of them ever get a gun and shoot up someplace.

Parents and gun violence.

Gun violence at schools and public sites is a huge problem. We need to do something about this. but for the record, for every child killed at a school site by a gunman, 25 to 50 children will be shot and killed at home by a biological parent with a gun. The cure seems simple. Do not let bio parents raise children or own guns. See how simple solutions turn into complex problems and do not always work the way they were intended?

There have been a lot of theories, most of them very simplistic, over the years about the causes of mental illness. Some people continue to cling to the over-simplistic views despite overwhelming evidence to the contrary. But then the flat earth society and those who doubt that some form of evolution has occurred are also still in existence.

In this post let’s look at some of the things that have been suggested as causes for mental illness in a necessarily oversimplified way.

First, the things we now doubt are true about or are not causes of mental illness.

1. Are there are two kinds of people, normal and the mentally ill?

We used to separate emotional problems into two categories, Neurosis and Psychosis. That was it. So people were seen as having a psychosis, they were in effect “crazy” or they had neurosis, problems of living that might respond to talk therapy.

The more this has been studied the less reliable it has become. First, we found that there were people who sort-of had both. They got the label of “Borderlines” then we found there were a whole lot of different kinds of neurosis, like anxiety and depression and OCD. And people with psychosis can also get depressed. You can have two or more problems.

From that two problem view, we continued to study symptoms and the result in the DSM-4 was over 400 recognized mental illnesses.  Even more, possibly another 400 disorders were proposed (the DSM-5 was supposed to simplify this but we still know way less than we would like.) Today we are seeing that some of this splitting up is the result of people moving on a continuum from one level of symptoms to another. People’s illnesses can change over time and they can have more than one illness.

2. For a while we blamed the victim, some people still do.

There was that belief that mental illness was from God or the gods. Some thought that God had caused the mental illness as a punishment for the person’s sins, or the sins of the father or grandfather.

There are still people who take this approach, avoiding the mentally ill or insisting that they should just snap out of it as if being ill was a choice.

We do know that this fallacy like every good lie has some grains of truth embedded in it.

Parents provide both the environment and the heredity. Some life events, like age and use of drugs or alcohol, may increase the risk of a gene mutation. But a risk factor is not a cause, and so we find that some very poor home environments produce some mentally healthy people while “normal” homes produce some very dysfunctional people.

More on the environment versus heredity issues to come.

If the problem is that God is punishing this person somehow then the cure should be a religious conversion. The prescription for mental illness used to be, and in some circles still is, prayer, fasting, self-control or self-abuse, and the like.

Some of the evidence to challenge the “its Gods will” concept of mental illnesses comes from the sudden miraculous improvement in some mental illnesses that medication produces; that and the cases where a person lives a good part of life, often in a “Godly way,” and is suddenly struck by a mental illness. Some of these appear to be the result of the changes our bodies undergo as we age.

3. People said, “It is the mother’s fault.” Occasionally this is read “it is the father’s fault.”

This was popular for a while under the guise that the cause of psychosis was “refrigerator mothers.” We found that there was some truth to emotional problems that resulted from early life experience; we now refer to this as attachment theory.

The idea that a lack of love or poor mothering skills was primarily the cause of serious mental illness has been largely discarded. We now think that there is such a thing as “good enough” parenting. Do a halfway good job and your child should turn out fine. Abuse or neglect can increase the risk of mental or emotional problems but risk is not result.

One new area of study is the role of “complex trauma.” A number of traumas or ongoing trauma change the brain in ways that are different from what we were looking for in the past. This complex trauma can cause more problems than the sum of its parts.  More on Complex Trauma in some upcoming posts.

4. It is just the way they are

There was a school of thought, back when the psychologists seem to offer us answers to all these issues, that mental illness was the result of “personality factors.” Again some truth here, but in my view, not nearly the whole story.

Some children are born “fussy” they are hard to soothe, cry a lot, and get on their parent’s nerves. Those kids may have a fussy temperament or they may have a physical illness. Either way, fussy kids get less care or upset the parents. Maybe the stressed parents yell at the child more. Their life experiences are different from the “naturally happy child.”

Personality can and does change over the lifetime. We can debate how much or why but the fussy child may grow into a contented child and the good child may at the onset of puberty suddenly become the problem child.

All these factors, to me, argue against the idea that mental illness is caused solely by personality.  It points in the direction of gene expression, genes act differently at different points in our lifetime. It also points out the ability of all of us to learn from life and as a result our personality shifts.

Sorry, this ran long. More on the causes and by implication the cures for our mental emotional and behavioral illnesses in some upcoming posts.

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

Will the therapist say I am crazy and lock me up?

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

Psychiatric hospital.
Photo courtesy of pixabay.

Being locked up is a fear of some people coming to therapy.

The chances of this happening are very close to zero. The fact that you came in on your own means this is highly unlikely for many reasons.

This idea of the upset person who gets “put away” in a mental hospital, usually called an insane asylum, makes for great T. V or a good novel, but in real life that does not happen, at least not very much and particularly not here in the United States.

Here are the reasons why you are not going to get locked up just for going to see a counselor.

Professionals just do not think of mental illness that way anymore.

The old notion was that there were two kinds of people, normal and crazy. If that were true we would need to lock everyone up because I do not see any normal people in my world. Some people may be more normal or less normal than others, normal being a statistical concept. Being different does not make you crazy.

Mental illness is not the same thing as being crazy.

Mental illness is on a continuum, people get unwell, then they get sick, then they move back in the other direction as they recover. Most people have times in their life when they are anxious or depressed. If someone is shooting at you please get anxious. If a family member dies, I hope you get sad. Do not let that anxiety or depression control you for the rest of your life.

People we call mentally ill get stuck at that “too sad” or “too anxious” and do not seem to get back to a better place without help.

There is a big argument about why. Watch for an upcoming post on the causes of mental illness as I see them.

The therapist expects you to have some problems, so no they are not likely to think you are over the edge just because you came for a little emotional help.

There are only three special reasons you can be confined to a psychiatric hospital against your will.

Holds for involuntary psychiatric hospitalization in this area are only written if the client is a danger to themselves, a danger to others or they are so disabled they can’t feed themselves or clothe themselves. Being poor, or homeless, does not count. I hand you a cookie and you eat it, I offer you a sweater and you put it on, you pass this test.

If you say you are planning to kill yourself then you may be detained until those thoughts pass and you recant that thought. Professionals are suspicious if you were saying you would kill yourself to the police just a few minutes ago and now you are saying that you won’t.

Saying you have thoughts, usually will not get it. You need to also have a plan for when and how you will do it or a history of attempts or some other reason for the official placing you on an involuntary hold to believe this is something you might do.

Being under the influence of drugs or alcohol is a risk factor. People who binge drink or are drunk are 55 times more likely to attempt suicide than sober people. So if when drunk you say you are going to kill yourself and the police are called you may end up in a psychiatric hospital for a very short stay.

Say you are planning to kill someone else, say you also have a gun and you may end up in a hospital or a jail for a while longer. Even then the law just does not let the police or the psych hospital keep people who might someday hurt someone else all that long.

Once the person sobers up or changes their mind, the chances are that they will have to be released even if the police still think that this person may in the future hurt someone.

While this lets some people out who may harm others it also keeps a lot of people from being locked up just because they scare someone else.

The psych hospitals are pretty full and they charge a lot of money.

The hospitals do not want to keep anyone there one minute longer than they have too. The days of years in an asylum are over and gone. Most stays now are a week or less. Stays beyond 30 days are rare.

In crisis units, the stay around here is most often less than a day.

Yes, I know the involuntary hold says 72 hours, but in practice, not many people stay that long. That 72 hours or 3 days is a maximum, not a for-sure.

Most of the complaints I hear are that people were discharged from the hospital before they felt ready, not that they were kept too long.

As soon as someone appears able to cope with life they get let out even if they will need meds or therapy to be able to cope in the future.

Counselors, in most places, are not authorized to write involuntary holds.

Even if a counselor works for the government and writes holds in their day job, they are not able to write them in their private practice. So unless your treating professional is a psychiatrist with treating privileges at the hospital there is a low chance they have that little card that lets them write holds, especially one that would let them write the hold in their private office.

What could happen is if you said you were going to kill yourself or others and you convinced the therapist that you were serious about this, he or she might call the police and get you detained until you change your mind.

There you have it. The things that bring most people to counseling are miles away from the things that might get you locked up in a psych hospital. Stop worrying about this and go get the help you need before you have to live your life in the place of unhappiness.

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

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