2 large reasons for your fear

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

Fear.

Fear.
Photo courtesy of Pixabay.com

Reasons you are afraid.

Fear is everywhere. Some people achieve great things in spite of their fear while other people are paralyzed into inaction by those very same fears. We establish a relationship with every one of those fears and anxieties.

What is your relationship to your fears?

Fear, like anxiety, can be either a protector or a bully. Some fear is protective. It reminds us that we are not immortal, bad things can happen to us. Lack of fear in dangerous situations can put us at risk of serious injury or death. Fear can also keep us a prisoner in our own minds.

No one is totally fearless. We each have some fear lurking there in our brains, hard-wired into our psyche, the result of generations of living with the dangers of the world. Brave people act in spite of fear.

If you live with a person you get to know them over time. You talk with them, ask them questions, and sometimes question what they say. Have you questioned your fears?

It is said that all our fears fall into two principle classes: Fear of losing something we have and fear of not getting something we want.

Fear of losing something we have.

Being afraid of death or serious bodily injury is reasonable, but some people are so afraid they might lose what they have they never loosen their grip on the things in their life. When your hands and life is full of things there is no room left to add something new.

People come in for counseling all the time, terribly afraid of losing a job. They hate the job, don’t like or respect the place they work, yet they just can’t bring themselves to leave. Often they are afraid that they are going to be fired or laid off. They are stuck in fear of being without a job, so stuck in that fear, they become paralyzed.

Eventually, something happens. One day they become angry and quit or that dreaded firing occurs. Then they are forced to look for a new job. There is frequently a period of suffering. Money is tight, but most often they get a new job and when they do they report they like the new one so much better. They wish they had made the change earlier.

When I see these clients I try to remind them that the best time to look for work is when you have a job. But fear can keep you frozen until you are forced to make that change.

Sometimes the new job pays less or requires relocation. They start off saying they just can’t cut their bills, can’t move away from their family or friends, but eventually, they do just that. The impossible becomes doable. Running from fear makes it grow; facing your worst fears can shrink them.

The lessons I learned from this is to keep my options open, keep doing my best and never say I can’t do something. Do not let the fear of losing something keeps you from finding what just might make you happier than ever before.

The same principle applies to unhappy or violent relationships, people hold on to a relationship trying to make it be something it will never be. Judith Viorst in her book Necessary Losses talks about the way in which we may have no room for new relationships until we end the old.

Is the fear of losing something you currently have, preventing you from creating the happy life you deserve?

Fear of not getting something we want.

Ever want something so much you were unable to take the steps you needed to take to secure your goal? The fear that we won’t be able to do something keeps so very many people from ever trying in the first place.

Students tell me they could never take a particular class or complete a certain degree. “Too old” is the most common reason. I know from very personal experience that “too old” is never a valid excuse. More and more people are returning to school for a career change. That master’s degree I had always wanted to complete and never did. The one I put off because I need to work and support a family? The one that I told myself I was too old to try for? I completed that degree forty years after my first day in college. Please don’t tell me it is ever too late or that it is taking too long to get that degree.

People tell me I will be thirty, forty, or fifty when they finish. That it may take them six or ten years to get this done. They say they will only be able to work for twenty or thirty years at this new field. How much older will you be in ten years if you do not try?  Will you be any younger if you don’t try?

How many people know what they want out of life at 18. How many students train for careers they never work in? What if the career you trained for ceased to exist like the Cordwainers and Redsmiths?

Age and experience can be such a plus.

People are afraid to apply for a job, take a test, or ask someone out on a date for fear they will not get what they want. They can sink into depression and hopelessness while never even taking the test or making the effort.

How old is too old to have a loving relationship? People say they can’t try again. I have sat and watched people in their “golden years” down in the desert in the winter. Those gray-haired elders, every day you see a couple of them meeting and dating just like they were sixteen again. Please don’t think there is some point in your life when you have to settle for unhappiness.

Have you experienced fear keeping you from a happy life? Are you done letting your fears of losing something you have and your fears of not getting something you want, keep you from the life you should have?

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

Is Dysthymia better in the morning or worse?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Which depression is worse in the morning? – Morning Question #14

Having more depressive symptoms in the morning is a characteristic of “Atypical features” of a mood disorder. Atypical does not mean unusual it means “not melancholy.”

Atypical features include the hibernating-like-a-bear symptoms, overeating, sleeping too much, and being tired and grouchy in the morning. With atypical features, the person may be able to feel better temporarily if something they really like happens, but the happiness does not last long. They may also feel better in the evening but by morning the depression comes back.

Atypical features can occur during episodes of Dysthymia, Bipolar one or two Disorders, and Major Depressive Disorder. In practice, the only time I remember seeing this on a file is as part of the diagnosis of a Major Depressive Disorder but having atypical features increases the risk that this will eventually turn into a Bipolar disorder.

If your mood is customarily worse at a particular time of day, make sure you are eating and sleeping well, that there are not environmental problems like relationship issues that are causing this, and then seriously consider consulting with a medical doctor or psychiatrist. If the doctor rules out any medical problems then some counseling should help.

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

Is anxiety a mental illness?

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

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

Anxiety is a disease? – Morning Question #13.

Anxiety can be either a normal emotion or a mental illness. A little bit of anxiety is protective. It alerts you to danger. If they are shooting at you, get nervous and take cover. Bravery is not a lack of anxiety it is taking action in spite of your fears.

Anxiety as a mental illness is the result of having your “anxiety volume” turned up too much. If fear of everyday things or excess fears about things that have a low probability of happening is interfering with your life then you might have one of the diagnosable anxiety disorders.

Anxiety becomes excessive if it keeps you from having a productive life. If your anxiety is preventing you from holding a job, doing positive activities, having friends or if it is making you miserable you may have a treatable condition called an anxiety disorder. That is the time to see a professional and find out about your condition and to get help.

For more on anxiety disorders:  Anxiety

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

Relapse on anxiety, depression or another mental illness?

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

Urge Surfing Prevents Relapses.

Urge Surfing Prevents Relapses.
Photo courtesy of Pixabay.com

Can you relapse on anxiety, depression, or another mental illness?

Relapse is a concept that has been borrowed from substance abuse treatment. It is easy to think in terms of an alcoholic drinking again as a relapse, but do people with a mental illness relapse? What would a relapse for anxiety or depression look like and what can we do to prevent a mental health relapse?

We are starting to view mental health and wellness as a continuum so people can move from well to less well to unwell and back again. In that respect, a mental health relapse seems to make sense.

A lot of people experience a mental illness at least once in their lifetime. Estimate run from 25% in any one year to 50% at some point in a lifetime. For an Anxiety Disorder, the estimates run from 10% to 20% and may even be higher than that when we consider the increase in PTSD.

In a previous post, we talked about Bob and Ellen who were treated for anxiety disorders, social phobia and specific phobia using systematic desensitization sometimes called exposure therapy. This is a proven effective treatment for specific phobia. As we last saw Bob and Ellen, after getting better they had both relapsed and were having symptoms of anxiety again. This is not surprising.

From one-third to two-thirds of everyone treated for anxiety disorders relapses, despite the fact that we know why this happens and how to prevent it.

Anxiety is fear-based.

It shrinks when approached. We tend to avoid scary things but the more you avoid them the harder they become to face the next time. Once people complete treatment they tend to stop thinking about the thing they feared. Over time the gains they made fade away. Substance abuse treatment tries to avoid this problem by encouraging people to continue with self-help groups to maintain the growth that has happened. Self-help groups for emotional issues are much harder to find.

Treatment for fear in the office does not equal less fear out in the backyard.

A recovery skill needs to be practiced in many settings so that it is usable at any time or place. Fear is worse in new novel situations. Learning, to be useful, needs to “generalize” into many settings. People who are in treatment for an anxiety disorder need to practice their skills in as many situations as possible.

Many people use medication to reduce or manage symptoms.

As soon as the symptoms are reduced they discontinue the medication. Discontinuing medication too soon is likely to result in relapse.

If there is an actual injury fear is more likely to return.

Getting treated for irrational fear is likely to stick but if you were in an accident you have good reason to be afraid of the same thing happening again. You should expect to use extra caution in dangerous situations if you have been injured in the past. Anxiety is meant to keep you safe. The goal is to manage the anxiety not to completely eliminate it.

If nothing else happens fear tends to return with time.

Treatment for anxiety needs occasional “boosters” to prevent its return.

Other emotional issues increase the risk of a return of anxiety.

An untreated depression greatly increases the risk of a relapse of anxiety, so does substance abuse. If you have multiple problems, anxiety, and depression or anxiety, and substance abuse you need to be working on all the issues at the same time. Leave on issue untreated and the risk of relapse for the others increases.

Continue to work on your recovery to prevent a relapse of anxiety, depression, or another mental illness.

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

Can you change a mentally ill family member – Powerlessness?

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

Change

Change.
Photo courtesy of Pixabay.com

What is powerlessness?

Does powerlessness have anything to do with mental illness and family members? The more we move from a model of mental illness that emphasizes permanent disability to a wellness and recovery model the more we see terms like powerlessness applied to the recovery from mental illness process. One blog reader asked about applying Al-anon principles to their problems with mentally ill family members.

Are people really powerless over mental illness and addiction? Doesn’t saying you are powerless just breed an attitude of helplessness, a victim mentality? Not at all.

There are some things in life we have control over, there are a lot of other things that we have little or no control over. The important thing is learning which is which.

This kid was walking along texting on his phone and generally not watching where he was going. He walked straight into a cement wall. The whole situation looked humorous to me, but I am quite sure it was not a laughing matter to that teen. He became quite angry and hit that wall a good one with his fist.

That teen could stand there pounding away at the cement wall but in the end, he is likely to find he is powerless over that wall. Eventually, he may damage the wall but he is going to harm himself seriously in the process.

Now insisting that the wall is wrong, that it needs to get out of his way is unlikely to be helpful. But isn’t that what happens to so many people, especially people in recovery, every day. Despite clear indications that the current approach we are taking is not working we continue to insist that the world change to accommodate us.

Looking at that wall in an objective way it was easy to see that there was a gate only a short distance away. The teen could have taken the gate, or at the other end the wall ended and with a few extra steps he could have gone around, still, he insisted the wall change.

The alcoholic is like that. Every time they drink they end up drunk. They struggle to control their drinking. The anxious or depressed person tries to deny they have a problem. Ignore the problem and it will go away is the universal motto.

Even after untold negative consequences, alcoholics tell themselves they will find a way to keep drinking and not have problems. The sad truth is that if anything has become an addiction in your life you will never be able to control that thing again. You are powerless to make that thing do what you want it to.

We are all powerless over rain. Now anyone can take a few raindrops. But I have never been able to make it rain or not rain on command. Facing a hurricane I can walk into the storm contending that I am not powerless over a little rain but eventually the storm will get the better of me.

The surest course of action when encountering the hurricane is to admit you are powerless over the storm and take cover in as safe a place as possible. Accepting that you are powerless over hurricanes and that the storm will do what it will do is a wise use of thought. Accepting help for your emotional problem is a wise course also.

The safest thing to do when encountering a drug is to admit that the tiny little thing can whip you any day. Struggling to do a little of the drug and still not let it control you is looking for disaster. No one controls their addiction. Learning that you can say no before the first taste, that is power.

We also need to learn that we are powerless over others. All that begging and bribing, the threatening and the use of force, this approach never really gets you control of the person. If your partner is addicted do you really think you can somehow win the battle to control the substance? We are powerless over people and things.

People will struggle for years to not be sick even when an effective treatment for their problem is right in front of them.

So the idea that a family member might by some special effort get their family member to change and presumably not have a mental illness, that is the clearest sort of delusion.

A central message of Al-anon as I understand it is the same as the message to addict’s, continued efforts to pretend that we have control over others, people, or things, are an illusion. Once you admit you are powerless over the mental illness, then the person can stop trying to pretend they don’t have the problem and begin to look for help in living with their issue.

The key to helping others is to first change yourself. The serenity prayer tells us to change the things we can, mostly that is ourselves, accept the things we cannot change, and develop the wisdom to know the difference.

Absolutely spiritual principles like those of A.A., Al-anon, and other 12 step groups apply to mental illness just as they apply to addiction and alcoholism.

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

Anxiety – fears and phobias can be treated.

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

Fear

Get rid of fear.
Photo courtesy of Pixabay.com

Are you afraid of spiders, snakes, or public speaking?

If you are afraid of a particular thing or situation and go to lengths to avoid that thing you may well have a Specific Phobia. Specific Phobia involves the fear that a particular thing is going to harm you. This fear may be irrationally strong even when you have never been harmed this way before and the risk is low.

There are five types of specific phobias, Animal type, Natural environment type, medical type, places, and “other” type. Other type includes diverse things like a fear of choking and a fear of costumed characters. People with a specific phobia, except very young children, know their fear is excessive and is interfering with their life but they will go to great lengths to avoid the thing that scares them and to avoid getting treatment for their phobia.

Animal type refers to the spiders and snakes as well as any number of other creatures great and small that may scare us. Some animals may really be harmful or dangerous but a phobia is not restricted to only those things we should fear but is enlarged to fear all creatures whether they are likely to harm us or not.

Natural environment phobias include heights, weather, and water. The “medical type” includes such things as blood, needles, and medical procedures. Place phobia is best known for fear of flying and elevator fear.

A closely related anxiety disorder “Social Phobia” includes things like public speaking and eating in public. In social phobia, the fear is not of being physically injured but a fear of doing something that is embarrassing or uncontrollable.

Both social phobia and specific phobia are treatable. For some people, medication can help to manage symptoms in the short run but over time the symptoms of anxiety may reappear. A specific counseling method called systematic desensitization or exposure therapy is especially helpful for treating specific phobia and a related method works well for fear of public speaking.

If the phobia becomes excessive someone may seek treatment. Here is an example of a treatment episode for a mother; we shall call Ellen, who had a terrible fear of snakes. She was practically pushed in the office door by her husband Bob. Her son and her husband Bob both wanted to go camping and she had refused. While on vacation they had wanted to visit a zoo. Both of these activities might involve snakes and snakes terrified Ellen.

The therapist began by teaching Ellen how to relax using deep breathing and other relaxation techniques. It is impossible to be both frightened and relaxed at the same time. Over the next week, Ellen practiced her relaxation methods every time she became anxious, whether it was about snakes or just day-to-day life.

At the second session, they discussed what things about snakes provoked what level of fear. Could Ellen write the word snake on a piece of paper with only modest fear? Could she say “S-N-A-K-E.?”

For each item on the list, they assigned a number from one to ten. The goal was, to begin with, the “snake’ exposures that were the least frightening and progress to the more threatening ones. Her fear hierarchy might come out something like this.

  1. Write the word snake on a piece of paper.
  2. Say snake.
  3. Talk about snakes.
  4. Read a word book about snakes.
  5. Look at pictures in a book about snakes.
  6. Watch a video about snakes on T. V.
  7. Visit a local pet store with her son and look at snakes in the cages.
  8. Touch a snake while the pet shop owner held him.
  9. Visit the local zoo and look at snakes in the Herpetarium with her son and husband.
  10. Go on a camping trip where they might encounter a snake.

After developing the “snake fear scale” Ellen practiced her relaxation. She was then able to write down the list of “snake steps” and read them back to the counselor at the second meeting.

By the third session she was reading an article the counselor had brought in about types of snakes and some of the good things snakes can do.

Her efforts to look at pictures in a book took longer, several times she had to stop, do her relaxation exercises, and discuss her feelings with her therapist.

Ellen watched the snake video in the counselor’s office, being prompted to do her breathing and relaxation as needed. She was able to take the video home and watch it a second time with her family and reported it went well and she did not have to close her eyes even once.

By the time summer came Ellen reported to the counselor she had completed steps one to nine.

This same sort of method can be used for social phobia. A common fear is public speaking. Many people report they are more afraid of public speaking than death. The old approach to fears and phobias was the “throw them in the deep end and they will sink or swim.”  Too many people were traumatized by that approach and never went into the water again.

Turns out that Bob, (Ellen’s husband remember?) was not afraid of snakes, but he was terrified of speaking in public. His company wanted him to make a presentation later in the year at a large convention and Bob was terrified. The counselor worked with Bob for a while on relaxation techniques and then gave Bob some choices.

For those with a fear of speaking there are classes at the local college or adult education and there are clubs whose purpose is to help people overcome their fear of speaking in front of others. Working with a small group of others who are all trying to learn to speak in public can ease the tension. Building up gradually from talking around a table to standing up and speaking to the group and finally to speaking in front of progressively larger audiences can build your confidence.

Bob took the college classes. He was able to complete the class and began speaking to groups his company sent him to speak at. Things were going fine. – Sort of.

Then the counselor got a frantic call from Bob and Ellen. Despite all their efforts and all that progress, Bob was terrified of the speech he needed to give at the convention, he was thinking of quitting his job to avoid it. Ellen had been in the bedroom crying for the last week. She was not going to the convention with Bob, as much as she wanted to be supportive because that meant the camping trip after the convention and her fear of snakes had returned with a vengeance.

Why after all that work had Bob and Ellen had a relapse of Anxiety? We know systematic desensitization works to reduce anxiety.

Stay tuned for a post on what causes an anxiety relapse.

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

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Is everyone Bipolar?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Just how common is Bipolar Disorder?

There are people out there with Bipolar Disorder as we currently understand Bipolar. Some people who really have this issue never get diagnosed and miss out on the treatment they need. From some of the things on the web today it is hard to see how anyone could escape getting this diagnosis. For more on this dilemma see the post, Bipolar – Misdiagnosed or missing diagnosis?

If professionals give out a diagnosis too freely then it stops having any meaning. So just how common is Bipolar Disorder and what should we think about people who sort of have it?

Some perspective

Humans are not the only creatures on earth who act “bipolar.”

Think about some of the symptoms. Elevated expansive mood, reduced need for sleep, increased impulsivity and heightened sexuality. Hum—

It is hot here now, but only a few weeks ago it was spring. From the window in my office, I watch the birds in the trees and on the lawn. There are a lot of native doves in my immediate area. For a while, just after Valentine’s Day, those doves woke me up in the morning. They were cooing constantly and then mating – can’t describe that and stay P. G. rated. When pursuing and being pursued by mates their temperament can best be described as irritable. Are doves Bipolar? Are they only Bipolar in the spring time?

Every spring the days start getting longer, the creatures on planet earth respond by becoming more active, they and we humans with them, think about reproduction. If birds breed in February they have babies by Easter. Humans seem to breed just as fast but we take longer to get the babies done.

Then in the fall time, the doves seem to disappear. So do the humans on my block. All those exercise freaks stay indoors. As the days get shorter the mood among humans gets gloomier. This may be one reason we have so many holidays in the fall and winter, Halloween, American Thanksgiving, Christmas and New Years all in a couple of months. We do this to cheer ourselves up. We also see extra depression during those months of less light.

If birds are affected by the changes in weather, humans are affected, and other animals also, it is difficult to go on describing these mood fluctuations as a mental illness.

We know that some people are affected by the seasons more than others. The degree and magnitude of mania and depression vary from one person to another. When have we crossed the line and turned normal human emotions and feeling into a pathological disorder?

There are also milder variations in human behavior we call “personality.” Talking about personality types, wondering why we are the way we are, is an interesting study. One needs to be careful in learning about personality to not make the first year student mistake and start seeing pathology where none exists. Not everyone who is moody, sleepless, irritable, or extra sexual needs to be diagnosed and put on medication.

As a therapist, I know there are lots of folks who would benefit from talking to a counselor about their problems. We also know that insurance wants us to be sure they are mentally ill and meet the criteria for “medical necessity” before insurance pays for the treatment. The challenge is to stick to the criteria and make sure only people with a real mental illness get treated using insurance money, while still trying to help all the people we can. Professionals continue to debate exactly where the lines of a disorder should be drawn.

At this point, we have three for sure reasons why someone’s symptoms get severe enough that they get the diagnosis.

1. Your issue interferes with “occupational functioning,” which includes school, for children and volunteer work if you are disabled.

2. It interferes with “social functioning” which mainly means you have poor or no relationship with family and friends.

3. Your issue causes you “subjective distress,” meaning a whole lot of emotional pain.

Having a personality that is not as you would like it may be painful but I hesitate to throw that in with mental illness. So if you are too introverted, impulsive or have some such personality trait, you can work on that, but you are not likely to be severely enough impaired to be diagnosed with a mental illness.

Some people may have “bipolar trait” or a “bipolar temperament” these are things you may or may not choose to work on in yourself improvement projects. “Hyperthymic Temperament” and Hyperthymic Personality Disorder” is just such a condition. Hyperthymic Personality Disorder is a common name NOT a specific diagnosis. DSM Personality Disorders are far more severe than Hyperthymia.

My thinking is that if you have characteristics like this you may want to consider being screened by a profession and keep an eye out for the possible development of Bipolar Disorder.

One thing we professionals should avoid doing is turning everyone who is different, into a pathological condition.

So is everyone Bipolar? The DSM-4 reports that the prevalence of Bipolar I and Bipolar II combined is more or less 2%.  Irritable, moody, impulsive and sexual people – that is just about all of us.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

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.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

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

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is double depression?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Double Depression – Morning Question #12.

Double Depression is a common term, not a recognized mental health diagnosis. In Double Depression, someone who has Dysthymia, profound sadness, and depressed mood which does not quite meet the criteria for Major Depressive Disorder moves from a little sad and depressed to a lot sad and depressed. They develop a case of Major Depressive Disorder superimposed upon the Dysthymia. People with this condition may see the Major Depression respond to treatment but they are still generally sad. Continued treatment for the Dysthymia is recommended.

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 an adjustment disorder produce depression and mania?

By David Joel Miller MS Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

Morning Question #11 adjustment disorder, depression, and mania.

Adjustment Disorder is essentially an excessive reaction to a normal stressor. The DSM-4 currently lists 6 types of adjustment disorders. They all involve some combination of anxiety, depressed mood, or behavioral problems.

Once the reaction to the stressor becomes enough to cause symptoms of a Major Depressive Disorder that is what gets diagnosed. If there is any mania or hypomania, that would become a Bipolar Disorder.

Stress can trigger all sorts of mental health issues. Someone with a history of depression or mania or an underlying risk factor like family history could have an episode under stress.

So rather than adjustment disorder producing depression & mania, stress could cause any one of the three.

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 Mania?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

How is mania related to Manic Depressive Disorder?

Manic Episode or mania, as it is commonly known, is a mood episode, not a diagnosis. Mood episodes are used to decide which Mood Disorder a person has. For all practical purposes mania and its milder cousin hypomania are only associated with one of the forms of Bipolar Disorder.

Having an episode of mania or hypomania is the defining symptom that distinguishes Bipolar Disorders from Depressive Disorders. The connection is so strong that for a long time what we now know as Bipolar Disorder was known as Manic-Depressive Disorder. Changing the name has confused a lot of people. I still see clients who say they have been diagnosed with Bipolar Disorder and Manic Depressive Disorder. Sometimes they also tell me they have Depression.

Once you have Mania or Hypomania we forget the Major Depressive Disorder diagnosis and use the Bipolar label only.

A Manic Episode is marked by a period of time of at least a week, or less if you get so bad you end up in the hospital before the week is out, where you have a really high, expansive, or elevated mood. This is not just a little happy or full of energy but a way “off the hook” period of time. Mania is not a good time. A little may feel like fun in the beginning. People with Bipolar Disorder may like a little mania but full-fledged mania is frightening.

Typically people who are manic have grand schemes to do things. These ideas make sense to them but they sound impossible to most other people. This is not the person who thinks they can sail around the world or invent an internet program. There have always been visionaries who plan to do great things and don’t get appreciated. These are people who try to run for president, cure cancer, and beat the house in Vegas – all in one week.

They have a decreased need for sleep, sometimes getting by on three hours of sleep a night and they try to do everything until they crash. This looks like a person on Methamphetamine but they don’t need drugs to be like this. Most people who get only a few hours of sleep may be able to function, but they will be tired and drag all day until they can sleep again. The person with mania can go days on little or no sleep and they feel fine. But the longer they are manic the crazier they act and sound.

Fully manic people talk a lot, pressured speech, the sort that erupts rather than is said. This is not a normal conversation. They know what they are talking about by not many other people can follow them. Because their mind is racing they become angry and irritable when other people cannot keep up.

In full on mania they become very goal-oriented, taking on lots of projects, rushing to do many things, but not always finishing anything. They have difficulty staying on one project, jump from task to task, and sometimes get stuck on something that to others looks meaningless or insignificant.

Since they know what they have in mind they think of themselves as brilliant and important, they become full of self-importance until the manic episode ends at which point they may become depressed and regret all they have done or said. This differs from narcissism in that the episodes of grandiosity go away leaving them ashamed or embarrassed.

A common characteristic of a manic episode is getting over-involved in things that are pleasurable. They may gamble, do drugs, or drink to excess. There is a huge overlap between alcoholism and manic or hypomanic episodes. During manic episodes, they may have excessive, unsatisfiable urges for sex and engage in sex with partners they don’t know.

Someone who is experiencing a manic episode may become so impaired that they have hallucinations. These hallucinations will go away when the mania ends, unlike psychotic hallucinations that are more long-term. It is also possible to have a “mixed episode” where the person is both manic and depressed at the same time.

If someone has these kinds of symptoms we reserve judgment as long as they are able to work, have friends, and are not upset about the episode. If it starts to affect functioning then the diagnosis is given. If someone is doing drugs or has a medical problem that is causing these symptoms then we don’t think that is mania and recommend they stop the drugs or get the medical problem treated.

If you have ever had a Manic Episode I would recommend you talk with a doctor, psychiatrist, or other mental health professional. Treated early you still can have a productive life. The longer you wait to go for treatment the more the risks that while manic you will do something you can’t take back and the mania will likely get worse each time you have an episode.

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