Category Archives: Mental Health

Where do you belong?

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

Family of teddy bears.

Belonging.
Photo courtesy of Pixabay.com

“I don’t belong here.”

Lots of people say they don’t belong here. Have you ever felt that way? Sometimes people who say and think that, mean here, now, in the present situation or place. Sometimes they mean on this earth.

When you don’t feel like you belong it is hard to be motivated, to have a purpose. Some people despair of ever finding a place where they can belong.

We talk about our “belongings,” the things we own. But feeling like someone’s possession, that can’t make us feel like we belong. Feeling that you are where you should be is not about things.

For some people belonging is about being tucked safely and securely in a close affectionate group. It might also mean feeling like we are the same as those around us. For other people belonging is being surrounded by people who accept us for who we are and encourage us to be ourselves even if that self is different from the self they have.

Some kids who have moved a lot tell me they feel this lack of belonging. People from families that never accepted them for whom and what they are; say they don’t feel like they belong also. If your family does not affirm you or if you have no friends it is not likely you can feel that you belong there. But where do you belong?

When you are always moving, starting over with new friends, new routines, it is hard to feel like you fit in. Some people find that right place, that time they fit in, early in life. Some of us spend our lifetimes looking for that place.

It is not just kids; adults say the same thing. They have spent their lives looking for that one place they fit in, that belief, cause, or activity that makes them feel that this is their one special place, the place they belong, the place they ought to be.

Sometimes it is a relationship where we belong, which gives out lives meaning. But relationships can end and then we ask if we still belong.

Elizabeth Lesser in her book Broken Open says it this way. “The first time I assisted at a birth, I had that feeling that I belonged exactly where I was, that there was nowhere else I would rather be.”

Some of us grow up not knowing where we ought to be. We may travel the world only to return to the place where we started and find there the place we always belonged, the place we needed to be.

Others of us travel and somewhere in those moves we find a place where we finally can say this is where I belong.

People will tell us that they find that belonging feeling in a spiritual place, a church, temple, mosque, or a clearing in the woods. We might find the place we belong in a cause or political movement. Why it is that one person feels at home in one place and another in a quite different setting I cannot say.

Recovering people have told me that the first time they ever felt at home, like they belonged there, was in a twelve-step meeting, among other people who understood their struggles and who welcomed them home.

Many among us will work their whole lives at a job so that they can finally retire and go on their quest for the place they belong, the thing that gives their life meaning. Others find that calling early in life and belong doing what they do their whole life. Sadly some people never do find that place where they belong.

Have you found that place where your life has meaning and purpose, a place where people accept you, that one place where you belong?

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

Think yourself sick – Nocebo Effect

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

Woman thinking

Thinking.
Photo courtesy of Pixabay.com

The Nocebo Effect.

Did you know that thinking you will get sick, can make it so? Most of us are familiar with the Placebo effect in which someone who thinks they are taking powerful medication will get better even if the pill has nothing in it. There is an opposite but not so equal effect called the Nocebo effect in which we can make ourselves sick when the risk factors say we should not have gotten ill.

In one study of women with a family history of heart disease, women who expected to have heart problems – eventually developed them.  Thinking they were prone to heart disease made them four times more likely to develop the disease than those who did not think they would get it. That difference persisted even when we compared the results of diet, exercise, weight, blood pressure, and cholesterol.

This does not mean you should give up efforts to control your weight or improve your health. What it does tell us is that while positive thoughts can make you happier, negative thoughts can kill you.

Doctors have known about the existence of the Nocebo effect for a long time. Surgeons know that people who do not expect to survive an operation are much more likely to die. If the patient has had a loved one who died recently and they want to be with that loved one, the risk of death increases dramatically even when the operation is not that risky. Still, it is hard to measure something that makes the body sick but is centered in the mind, not the body.

Is this a new idea? No, not really. We have all talked or thought about someone who “makes me sick.” Brian Reid wrote an interesting article called The Nocebo Effect: Placebo’s Evil Twin for The Washington Post on April 30, 2002. He is not the only one to tackle this subject. Penny Sarchet discussed research on the ‘Nocebo’ effect in her winning essay for the Wellcome Trust science writing prize in November of 2001. There have been lots of other references to this phenomenon but it hasn’t been widely noticed.

One reason is that we like to give people credit for healing themselves through their beliefs or positive thinking but we are reluctant to criticize someone for having negative thoughts. Depressed people, for example, can’t be positive. Acknowledging the Nocebo effect feels like blaming the victim.

Many of the side-effects reported for medications may be the result of Nocebo effects. Burns, Meichenbaum, and others have talked about the way in which beliefs about the effectiveness of a medication or negative beliefs about the med can change the results of studies even when there are no active ingredients in the pill. For example, always buy multi-colored capsules if you can; they work better than white tablets regardless of what is in them.

Reid also pointed out in his article that doctors don’t like to warn patients about potential side effects because telling the patient about that side-effect makes the patient much more likely to have that side effect.

We know that thoughts are transmitted in the brain chemically. Now with various sorts of brain scans, we can see what happens in the brain. Tell someone that the medication they are taking will have a painful effect and the parts of the brain that process pain will light up.

We also know that what you are thinking, good or bad has an effect not just on your thoughts and mood but also on the production of chemicals that make you better or worse.

Have you ever awakened one morning and thought you were going to have a bad day? Have you known someone who was always negative and expected the worst? How does it usually turn out? Expecting the worst increases the chances that you will experience it.

Thinking is not a substitute for proper medical treatment, but your attitude towards that treatment may influence the effectiveness of the treatment no matter what your doctor does. Your thoughts can influence the results.

So how do you banish Nocebo?

Try to keep your thoughts positive. Read inspirational books. Spend time with friends. Having positive people around you can make you more positive. If you don’t have a positive support system, develop one. Go to religious services, do hobbies and activities where you might see people and make friends. Having good friends can lengthen your life.

Pay more attention to the benefits of things than the negative. Whatever you focus on you will get more of. Constantly worrying about side effects will make them larger. Focusing on any progress no matter how small will magnify that progress.

If something is concerning you, capture that thought, write it down, type it on the computer whatever it takes to get it recorded, and then out of your head. Trying to remember for a month all the things you need to discuss with your doctor will keep you focused on your pain and symptoms. Writing it down gets the disturbing thought out of your head and gives you something to take with you when you talk to your provider.

Work with a counselor or therapist on improving your outlook. Self-help groups, religious leaders, and trustworthy friends can also be helpful in banishing negative thoughts.

Be aware of the Nocebo effect and don’t become its next victim.

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

Blaming obese older parents.

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

Older people

Elderly couple.
Photo courtesy of Pixabay.com

Do overweight older parents produce kids with birth defects?

There have been a lot of articles recently telling us that older parents are more likely to have children with autism, schizophrenia, and birth defects. Is this true? And if it is true how do we explain what is going on here. Clearly, not every older parent has a child with a mental illness or birth defects. Nor do all offspring from obese parents develop autism or schizophrenia, not by a long shot. But the studies suggest an increased risk here. What is really going on? Here is my oversimplified counselor – metaphor explanation.  For a more scientific explanation, you may want to talk with or read doctors and geneticists explanations.

My grandmother would be horrified with the thought that there could be such a thing as a baby or a mother being too fat. In her time skinny babies died a lot more than plump babies. Skinny mothers died more often too.

She was right about that, as far as it goes. Women who are significantly underweight from poverty, illness, or an eating disorder are more likely to have a miscarriage, a low birth weight baby, or a child with birth defects. Not eating as a result of anxiety or depression can cause these problems also. But too skinny mothers are not the major source of problems. Not in this century anyway.

Grandma also had lots of aunts and cousins who had very large families. Women had children starting as young as they could and kept it up as long as they were fertile. That was before birth control. She just might have been right about baby’s needing to have some weight on their bones to survive. But there were some things grandma didn’t know.

Grandma wasn’t near as concerned about the age of the parents either. Older men marrying a very young woman was the norm and for good reasons. In colonial days there were forty sometimes fifty or more men for every woman. So the day that a woman began to have her period the men started calling on this marriage prospect. Lots of women married much older men because the men were financially secure. They married older men and then outlived them and married again.

Men remarried a whole lot more then than now also. People didn’t need to divorce then, their partners kept dying.

Women used to be a lot more delicate than they are now. They died in childbirth and they died every spring of the milk sickness. There were also food shortages and epidemics. Skinny people died a lot. Hence the belief that fat was healthy. Now we know that is not the whole story.

We have long suspected that the father’s age was a factor in some things like schizophrenia or autism. This became more of a theory as there were plenty of young men and fewer old men on their third fourth or fifth wife. Women did not use to have so many children late in life. Now with birth control, postponing children, and fertility treatments there are, percentage-wise, more children born to older mothers. That has started us wondering if the mother’s age matters also.

Grandma would have said that healthy kids and long life were in the genes. She would have been partially right.

Genes are not the whole answer! The same gene can do different things at different times in your life. So there are genes and there is gene expression, how the gene acts when in a certain time and place. Think of this as manners for genes.

My genes gave me that nice dark hair when I was young. Somewhere along the way, they decided I was old enough I needed to look the part so now they give me gray hair. I am pretending they are not turning the gray to white. The Same gene for hair color but different age and different hair color. If I had a child at this age they could inherit the dark black hair of my youth but I am stuck with the old man color for no better reason than that I am getting – well older.

Now no cell is made to last forever. Cells like people need to reproduce. I hear that cells replace themselves every seven years. For argument’s sake let’s say that this is true. Why do cell mutilations keep happening? Why do cells have birth defects?

Think of this as the “copier theory of cells.” Every time a cell reproduces it makes a copy of its self. Have you ever made a copy and then when you can’t find the original had to make a copy of a copy? The more generations the copy goes through the more chance it will be fuzzy and someone will read it wrong. Older cells may get fuzzy also. The more copies the more chance for changes – mutations to creep in. Some of those changes in humans may be good things, adaptive changes. But most gene changes cause birth defects.

So what does being overweight or drinking alcohol have to do with birth defects? Alcohol for the record causes more preventable birth defects than anything else. Why is this?

Ever seen someone mark up an original before copying it? Imagine with me an original with white-out on it and some highlighter marks. Now before this stuff can dry the person puts the original on the copier glass and makes their copy. That messy stuff gets all over the glass. Every copy we make now has all those marks on it. They are all hard to read.

So when there are chemicals in the parents’ bloodstream, like alcohol, the copies that get made are fuzzy. More alcohol and the copies get worse. We know alcohol and drugs blur the mother’s contribution to the child’s genes. We also suspect that some chemicals may blur the father’s contribution also.

We used to think that if the mother took in too few calories bad things happened to her and the potential baby. Excess calories were stored as fat in the mother. No harm to the baby there right? Not so fast.

If the mother develops diabetes that high blood sugar could have an effect. So could all sorts of other hormones. So we think that the more overweight the mother the more the risks to the child. Now, remember risks do not equal disease. You can have a risk factor for a disorder and not get it. Strenuous excesses and severe dieting during pregnancy or when you are trying to get pregnant are not recommended. But the mother’s overall health, her efforts to keep her blood sugar under control, and to avoid toxins, especially alcohol, just may increase the chances of a healthy child.

Being older or overweight may not be reasons to avoid having children but the increase in risk factors may explain why we are seeing more children born with certain mental and physical illnesses like autism, psychosis, and ADHD.

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 can’t we forget the painful past?

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

Why can’t we forget the painful past?
Photo courtesy of pixabay

Are there some things you just can’t get over?

Why is it so hard to forget the pain of the past and so hard to remember times when things go well? Your brain is hard at work here, reminding you of your mistakes, not letting you get over the past. Why can’t we forget?

It is as if the brain stores memories in two different ways. Pleasant experiences, our successes in life get filed in boxes somewhere in the back of the brain. They take work to find. Not so with the pain.

Pain is grooved into the brain, great deep gashes in our consciousness. That one argument, that one mistake, and your mind just won’t let you forget. The unhappiness just doesn’t want to let you go.

There are good reasons for the brain to store memories that way. By emphasizing pain, keeping it close to the surface where it can be easily found again, your brain is trying to protect you from making the same mistake again. We should learn from our mistakes. Learn from what happened but not be controlled by the past.

This also means that if you are under the influence of drugs or alcohol you may not remember the pain, your brain was anesthetized.

Say you eat a hot-fudge-sundae. You will probably eat a number of those or some similar treat, in your lifetime. Think back on the times you ate one. Can you remember which one was better? How did the tenth one taste? The eleventh?  Pleasure is stored in the brain in a general way.

Unfortunately, most of us store our successes in the same way. We can’t seem to remember anything positive about our lives. It takes work to find that happy life events file.

What if something bad happens? Say you are driving along the freeway that takes you to work. You have driven this way every day for years. Can’t remember which day was sunny and when was that day you saw the deer up on the hill as you drove by. But one day there is an accident, you see people hurt, maybe killed. Will you forget that day? Not likely.

Painful memories are stored in extra easy to find files. Sometimes they aren’t filed away at all. They lay there open. You see that accident over and over in your mind. Some small details you may never be able to forget even when you try.

Your mind may remind you of that one day and the crash so much the memories intrude on your sleep. Some people will become so fearful that they will no longer take that freeway. They may decide to avoid freeways altogether. They may only use surface streets. Some people give up driving altogether. These extreme reactions to trauma take on a life of their own. If the fear and efforts to avoid things that remind you of the event last a long time this may become Posttraumatic Stress Disorder.

If you were in a war zone, were abused or neglected as a child, this makes sense. Treatment for PTSD is available but it is not a one size fits all treatment. Some people need to talk it out, some people get worse when forced to talk about horrific experiences. This calls for professional help.

But if this constant negative thought is the result of your focusing only on the pain and forgetting the positive then there are many things you can do about it.

In marriages, we believe that the couple needs seven or more positive experiences for every negative one. The brain has trouble remembering the good times. For children we tell parents to “catch your child doing something right” you won’t spoil them and they need that much positive attention from you to offset the times you will need to tell them they did something wrong.

What if your parents didn’t tell you that you had ever done something right? How about those who are their own worst enemies and never give themselves a break? Being over hard on yourself is not likely to make you try harder. Constant criticism can cause people to give up and stop trying, even when the blame comes from within.

Give yourself a pat on the back for anything you do well. Keep a list in a journal of all the things in your life large or small you have done well. Say positive self-affirming things to yourself every day. Post those affirmations in places you will see.

If you can’t remember a time you succeeded, when it is really hard to give yourself credit, ask yourself what would your best friend say? Don’t discount the praise you get. Accept the compliments and praise without discounting it.

While you may never be able to forget the pain of the past completely, focusing on the positive in the present and future will shrink those old memories.

This post was featured in “Best of Blog – May 2012”

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

Getting emotionally better

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

Life pie

Healthy Pie of Life.
Photo courtesy of Pixabay.com

How do we get better emotionally?

There are so many people telling us we should do this or not do that it is hard to know what to do to really see an emotional recovery. Which method works best?  Recovery is a process. So is resilience. Most of the self-help blogs and books focus on one of the things you need to do to get better but not many integrate all three processes.

1. Become aware that you are feeling something.

This is the providence of mindfulness. Dan Siegel calls this “monitoring.” People who had unhappy experiences in early childhood, we sometimes call this “attachment problems” – they often are numb. Ask someone with emotional numbness what they are feeling and they can’t tell you. So the first step in emotional recovery is simply to become aware that you are feeling something.

Ask yourself where in your body are you feeling this sensation? Is it pleasant or unpleasant? It is not important to name this feeling just yet. Sit with the feeling a while. What else is associated with this feeling? Is it memories? Do you see pictures from your past? Maybe the feeling is part of a story in your head.

In anger management or impulse control treatment this is a common first step. Often people react to an outside event with no realization that they have had a feeling that propelled them into action.

There is also an important connection between feelings and thoughts. We interpret events based on a “schema” or blueprint that is stored in our nervous system. We rarely recognize that this emotional blueprint was created a long time ago and has been biasing our reactions in one direction or another.

Becoming aware of your feelings can involve a variety of data collection techniques. Mindful meditation, thought records and journals, can all be used to capture the fact that you are having feelings. Not sure what you are feeling? Try drawing a picture of your feeling. Crayons are not just for our kids anymore.

2. Find a label for what you are feeling.

In group therapy, particularly with men’s only groups, we find that people have a limited vocabulary to describe their feelings. Developing a larger vocabulary for feelings allows you to discriminate between the various shades of feeling. Many groups use a chart that shows drawings of people’s faces that portray a variety of feelings; all neatly labeled under the picture with a name we can call this expression.

Many people have only three names for their feelings, good, bad, and pissed off. Good and bad are judgments about the feelings not really names of feelings. Does good mean content or excited? There is a world of difference between those two. People have a need for security but too much security may become boredom. We all like a little excitement but too much coming at us can be terrifying.

3. Transform or modify the feeling

This is the tricky part. As long as you insist that you don’t feel but that others “make you feel” you are in a reactive victim place. It is likely that there are some feelings that are primary biological functions but our responses to those sensations are learned. CBT therapists tell us that our thoughts heavily influence our feelings.

For example, when your stomach has a non-pleasant sensation we try to do something to relieve that feeling. Most people who have that feeling think they are hungry and they eat. Research has shown that more than a third of people who think they are hungry are in fact thirsty, they are dehydrated. If they learn to try drinking water first, wait a while, say thirty minutes, many times what they thought was hunger goes away, dissolved by the water.

We learn to interpret body sensations and we also learn to interpret emotional ones. If we have limited names for these feelings we start putting the wrong label on the feeling and we respond incorrectly.

Narrative therapists think we create stories for ourselves about how we “should be” or how things “are.” Creating new stories for ourselves allows us to do new behaviors. So if the schema or blueprint in our head is fuzzy we need to take another look at how it was drawn, correct the faulty parts, and develop a new way of relating to our feelings.

Most thinking is done with words. The more words you know the more potential thoughts you might have. Most of us have learned a lot of technical words, about our jobs, sports, and hobbies. But we lack the vocabulary to talk about feelings.

This three-step process, feel, identify, and transform can go a long way to help us heal from emotional pain.

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

Put the head back on!

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

Confused brain

Mental illness.
Photo courtesy of Pixabay.com

Mental illness versus physical illness.

For a very long time, physical health practitioners have ignored the connection between mental and physical illness. When someone suggested that the way in which we think can cause physical illness they have been disregarded, or worse. Traditional western medical practice has looked for the cause of physical illnesses everywhere but in our thoughts. That may be about to change.

As I write these words I am getting very nervous. The pictures in my head of cancer patients giving up their meds to participate in some sort of thought workshop scare me. I am not suggesting that some “psychic energy transfer” ought to replace conventional treatment.

But the research, good scientific research, by reputable researchers, keeps pointing to the connections between physical illness and mental illness. No less an authority than the Robert Wood Johnson Foundation has published a report on the subject.

Their conclusion is that the connection between mental health and physical illness is overwhelming and it has huge implications for the direction and cost of healthcare in the future.

Why?

Among those with a diagnosed mental illness in the U.S, almost 70% have a chronic long-term physical illness. That might not sound so significant until we notice that in any given year about 25% of the U. S. population has a mental illness. Their conclusion is clear. Those people with a mental illness are not just faking things. The problems are not just all in their heads. The mentally ill are much more likely to develop chronic long-term diseases. But that is only the beginning of the problem.

Almost a third of those people who have a chronic long-term physical illness develop a mental illness. The connection between physical and mental health and illness runs in both directions.

In typical scientific fashion they tell us so far we can’t be sure if mental illness causes physical illness or physical illness causes mental illness. There may even be a third thing that is causing both. What we do know for sure is that very often the two exist at the same time in the same person.

There is a circle or maybe a spiral of risk going on here.

A medical condition with a “high symptom burden” such as migraine headaches or back pain is a risk factor for, which means it is likely to lead to, depression. But the spiral does not end there. Depression is a high-risk factor for heart disease. See how mental illness and physical illness are intertwined?

There is a bigger societal problem in the making here. There are extremely high rates of “uninsurance” among the mentally ill. We also know that many people with chronic medical conditions may lose their coverage if they are unable to work.

Treatment for one problem can make the other worse. Medication for a psychiatric illness like depression or psychosis can result in weight gain making the person’s diabetes worse. Medications for many physical symptoms can make a person’s mental health conditions worse.

In the elderly, and these are the people where we would expect chronic physical conditions to be at their worse, we also have the problem of multiple meds. One hospital study found that among patients who are taking 8 or more meds there was a 100% chance two of these meds were interacting and producing unwanted results. In assessing for cognitive decline in the elderly, a therapist always wants the prescribing doctor to take another look and tell us if part of the problem might be the medications not the client’s loss of mental ability.

Now regardless of how you swing politically, the bottom line here is that those people with mental illness or chronic physical illnesses are at high risk to develop the other condition and then to be unable to work. One way or the other this group of people will end up in hospital emergency rooms and those who can’t pay – well those of us who are still working – we get to pay that bill. This will only get worse as time goes on.

I suppose we could just stop paying for those who are too sick or old to work and pay for their own medical care. It sounds like some are advocating that approach these days. I for one would not care to live in a society that was unwilling to provide care for those who are least able to care for themselves. I also have enough faith in my fellow Americans to think it will not come to that.

But there is another option and support for this option is growing not just in treating the uninsured but also in treating those with the best of insurance coverage. This other option which is growing in popularity is to integrate the treatment of physical and mental health.

Consumers who are less depressed take their heart meds more often and end up in the emergency room less. The reintegration of the two specialties is overdue.

We need to stop treating medical patients as headless bodies and but the head and the feelings back in the equation when it comes to treating the whole person.

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

Sharing made me a new person – group therapy.

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

Support group

Group.

Group therapy can be very helpful.

The group really helped me, sharing made me a new person. The client was trying to describe the way that being in group counseling had benefited them. I am a believer in group therapy. I have seen the things that happen when a group is on task and working. The clients can see it also.

There is a saying in groups that “we are only as sick as our secrets.” One powerful way in which groups can help people is to allow them to tell their stories in a supportive environment.  When it works it can be magic.

Twelve-step groups are self-help group’s not professional therapy. But in the addiction field, we quickly learned the value of being in a group that understood what you are going through and who were all supportive of your recovery. In mental health groups, we see the same results. People all sharing about their life struggles makes us feel more connected and less alone. Powerful things happen in peer support groups.

Some professionals are leery of groups. They have suggested to me that group counseling is a lesser sort. They tell me that “real therapy” takes place with one client and one therapist in the room. I try to avoid arguing. Then why do we do couples counseling and family counseling if it is best done in an individual session I ask? I try to listen politely to their answers.

Most of life is about relationships. We are wounded in our relationships and most often we are healed by a helping, supportive relationship. Sometimes that relationship is a counselor, sometimes it is a group.

Not all groups are safe places to tell your most painful life events. In therapy groups, it is up to the leader to make groups a safe place. In self-help groups, it can be riskier. We talk about confidentiality and anonymity but that is no guarantee that someone will not break the rules and repeat what another person said. The longer the group has been together the safer people feel but it is never without risks.

What I often see happen is that people try to keep things secret in group, that everyone else in the group knew already. When someone is arrested for a DUI it is in the paper but when they come to a group, they hint vaguely about a self-control problem and demand confidentiality.

More than once a client has told me something in a private session and then a few weeks later their courage now turned up a notch, they tell the whole group. In almost every case the result was that the group understood and supported them in their disclosure and the person, now having publicly admitted their defects of character, finds they have unburdened themselves and are no longer kept in pain by that secret.

Some of us have spent our whole life’s trying to hide our true selves from others. There is something very freeing about opening up and sharing about our total selves, warts and all. People who have to hide themselves from others not only cover up their flaws, they cover up their endearing qualities also.

Sharing who you really are can indeed make you a whole new person.

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

Not everyone who hears voices is psychotic

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

All radios

Not everyone who hears voices is psychotic.
Photo courtesy of Pixabay.com

Did you hear that?

People in our society tend to think that hearing voices means you are crazy. We tell stories about this and we laugh at jokes, sometimes not too nice stories and jokes. It makes some of us feel safer to think that those who hear voices are not like us. We say that, even when we have heard the voices.

The truth is that most people hear voices. Sometimes we count the voices towards a mental illness and sometimes we don’t. The counting makes something a problem and other things, not so much.

The majority of all teenagers hear and have heard voices. One author says as many as 70% of all teens hear voices. Don’t be so quick here.

Have you ever thought you heard someone calling your name, looked over your shoulder, and saw no one there? Did you shrug it off? Did you pretend it didn’t happen? Some people think if they don’t admit they have symptoms then they are all right.

Truth is our brains sometimes try to help us out and sometimes they are wrong when they do it. You hear a sound. You can’t make it out. Your brain turns it into the closest thing to something it recognizes, tells you someone is calling your name. Sometimes it may only be your own thoughts but if you are concentrating on something you forget which is in your head and which is in your ear. Your brain makes up a story to help you out. Sometimes the brain is wrong.

Sometimes we get thoughts in our head. It is like someone is telling us to do this – no don’t. Some people interpret this as an angel on one shoulder and the devil on the other or maybe it was your conscience. For a moment the voices sound real. But when you try to get them to stop can you make them shut up? People with a psychosis like schizophrenia can’t make the voices stop when they try.

Ever see or hear a dead relative come back to talk with you? How about an angel or a religious figure? One rule psychologists follow is if this thing you see or hear is religious in nature or if you are grieving then we tend to disregard that experience. It happens a lot, you should get over it on your own. If not seek help.

If the thing you see or hear is all good and encourages you to do well, we are not so worried here. Unless it bothers you or the voices get too loud for you to think. But if the voice in your head tells you to kill people or break laws, we think this may be a big problem.

Ever been lying in bed and thought you saw or heard something in the room? When you are about to fall asleep or if you are asleep and start to wake up, images, and experiences from your dream world can get dragged into the conscious world. We have special names for this, hypnogogic and hypnopompic hallucinations. We don’t count those experiences as a mental illness either, not most of the time because most normal people have these.

I should also mention that most hallucinations involve hearing things. Most of the time when people see things it is drug or alcohol-induced. People with mental illness usually hear things, at least in the early stages.

We should also mention here that auditory hallucinations caused by mental illness are about the rarest kind of mental illness. There is much more depression and anxiety out there than schizophrenia. Not all people with schizophrenia are paranoid and not all people with paranoia have schizophrenia. Not by a long shot.

So aren’t people with schizophrenia violent and scary. No, not really. People with a mental illness are no more likely to get violent than anyone else. If someone is hearing voices give them some room, don’t crowd them, and for sure call for some professional help.

So don’t people who hear voices scare me? Not half as much as the person who just found out their spouse was cheating on them and now they have brought their gun to work to fix this situation.

There is a great training on what to do if you encounter someone with a mental health crisis. That program is called Mental Health First Aid. Have I mentioned that before? Check my other posts for more info. This was just a quick look at the whole area of hallucinations and mental illness. If you or someone you know has a problem in these areas please seek out professional care.

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

Five Axes Diagnosis Esoterica

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

Medical record

Diagnosis.
Photo courtesy of Pixabay.com

Five Axes Diagnosis Esoterica.

Update –

With the release of the DSM-5 using 5 axes may soon be a thing of the past.

Professionals will be looking for this information or most of it. We just won’t be separating it and reporting it this way. I left this post up for those who would like to see the way things used to be.

So in a previous post, we talked about some of the reasons clinicians might be reluctant to tell you about your diagnosis, how the diagnosis is based on the DSM-4 (soon to be the DSM-5) from the APA and how diagnosis are categories while people are on a continuum so sometimes people do not fit the diagnosis neatly. We left off with the ideas that there are 5 axis and that most people stop after knowing more or less their diagnosis on Axis one.

Axis One.

The DSM has over 400 diagnoses. Not just mental illnesses but all sorts of other problems that might take you in to see a counselor. They include mental illnesses, emotional and behavioral problems. This section covers about 750 pages of the DSM. My list below is VERY oversimplified

The major sections, not in order are things most of us have heard about:

1. Adjustment Disorders – life’s problems grown large.

2. Anxiety.

3. Mood disorders meaning Depression and Bipolar.

4. Psychosis, like Schizophrenia and Schizoaffective.

5. Disorders first seen in childhood – like ADHD, learning disorders, and Autism. (But NOT mental retardation!)

6. Sex, eating, and sleeping.

7. Substance abuse.

8. Dementia, physical stuff caused by emotions.

There is a section in the back where other codes, mostly the “V” codes are listed. “V” codes are largely about relationships like parent-child conflicts and partner conflicts. While counselors work in these areas many insurance plans to not pay to treat these things.

Axis Two.

The things we put on axis two are things that we used to think were untreatable – that is just the way you are stuff. This includes personality disorders and mental retardation, a strange mix. Both issues now have appropriate treatments.

Personality disorders are treated using therapies like DBT. Most women in prison are diagnosed with Borderline Personality Disorder. Sometimes in practice, the boundary between Borderline and Bipolar gets fuzzy.

Most men in prison get a diagnosis of Antisocial Personality Disorder. This is also generally treatable if the client wants to change.

Mental retardation can be treated using behavioral techniques as long as we have realistic expectations. The distinction between mental retardation and developmental delays can get fuzzy. Some people call all of these delays and avoid the politically sensitive issue of saying someone has mental retardation. It is also possible for someone with mental retardation to have an axis one problem like depression.

Axis Three

Did you know that medical conditions can cause symptoms that look like a mental illness? All good therapists like to have clients see a primary care doctor, specialists if needed, to make sure this the problem is not a brain tumor or hormone issue. Things like pregnancy, brain injury and poisoning all get confused with mental illness. In seniors, a lot of this dementia and cognitive decline is the result of the side effects of medications the senior is taking. Please, however, do not start or stop meds without talking with your doctor first. Ideally, your doctor and your therapist should be talking and on the same page if you have any medical conditions that may affect your mental state.

Axis Four – Psychosocial and environmental problems

Stressors for short. Not having friends or a family or having a poor relationship with them can cause lots of emotional problems. We also include people with social and educational problems. Being arrested or a victim of crime might get you an Axis Four diagnosis, as would not having medical care or living in poverty. We don’t always talk with clients about these issues as much as we should but these issues are at the core of client’s problems a lot of the time. Note that no matter how severe your unemployment problems are if you can’t qualify for an Axis One diagnosis like Depression you may have difficulty getting counseling for your employment or other problem.

If stressors are interacting with your mental health you might want to see a professional or clinician counselor who specializes in individual therapy centered on both these areas. In California, we call this specialty Licensed Professional Clinical Counselors (LPCC’s.)

Axis Five.

This is a summary scale. Imagine how hard it is, to sum up, a client’s whole life on a 0-100 scale. Imagine getting a pass-fail grade on your life. Imagine trying to grade someone’s life. Lots of other scales have been suggested for this. Insurance types like it because if your GAF number goes up it shows the therapy is working. This makes them happier about paying. Mostly we use this in making decisions about hospitalization or urgent care.

I don’t ever remember telling a client their GAF because it does not much matter unless there is something that needs doing right now and in that case, I want to talk about what it is we need to do now.

So there we have it in two brief posts a very simplified look at the process of diagnoses.

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 wrong with me?

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

What is wrong with me?
Photo courtesy of Pixabay.com

Ever wonder what is wrong with you?

Lots of clients ask me that question. Occasionally they want to know their diagnoses. Most of the time they are asking a whole lot more.

Discussing a diagnosis with a client is a controversial thing. Some clinicians feel that a diagnosis is a label and the client is a whole lot more than their label. What a client needs right now may have very little to do with their long-term diagnosis. Someone who has the symptoms of schizophrenia may come to see the counselor because they can’t get along with their spouse. The schizophrenia may make the situation more complicated but what they need right now is relationship counseling just like any other person. I see the point of avoiding labels but don’t always agree about withholding the diagnosis.

Other people tell me that knowing their diagnosis is empowering. If you can put a name on your problem and you know there are treatments for this problem, then you have some hope of recovery. If the professionals can’t tell you what is wrong you may start to think there is no hope for you. Alcoholics Anonymous encourages its members to admit they are alcoholics. If you know that you have this disease then you know what or do. Don’t drink! But if you think you have a “lack of control” or poor willpower you can keep on trying to control your drinking while racking up more DUI’s.

I take the approach that if the client asks me what the diagnosis is then I owe them an answer and an explanation. Personally, I don’t think “Why is it important for you to know that?” is an answer. It annoys me when clinicians do that. Lots of clients tell me it annoys them when their counselor says things like that. So how do therapists come up with these diagnoses that end up in the client’s charts?

A warning here. Diagnosis is not a do it yourself program. What I am saying here is meant as general information, not a personal assessment. That said, if you have questions ask your provider. If you don’t like the answer ask for a second opinion.

Some basics first. The way in which mental illness is diagnosed keeps changing as research and our understanding changes. There are also some gray areas in which the clinician needs to make a judgment call.

Diagnosis of mental illness is most often made by using a book called the DSM-4-TR. This stands for the “Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. The DSM-5 is due out soon but so far there is lots of disagreement about the changes that may be made. This book is published by the American Psychiatric Association (NOT the American Psychological Association type APA) so while we all have to go by their book, the psychiatrists get to write the book.

There are a lot of complicated rules about who gets to hand out Diagnoses and whether or not they need to be cosigned by a Psychiatrist. I won’t try to explain all that just now.

Therapists and counselors have to take at least one master’s level class, sometimes two in using the DSM and they get thousands of hours of supervised training while pursuing their license. You would think that would take all the guess-work out of diagnoses – it doesn’t. Let me explain why.

Diagnoses are categories. The client gets a named diagnosis like Depression. People don’t always come in nice discrete categories. Everyone gets sad or depressed sometimes. When is it severe enough that we say you have depression, not just normal sadness? We have 32 different shades of mood disorders (296.xx’s) plus specifiers for each and say 6 or more other flavors tucked away in other places. (Cyclothymic, Dysthymic, Adjustment Disorder with Depressed Mood etc.)  See why your psychiatrist might have a headache even before you get to their office? See why we might each have a few “favorite diagnosis” that we use more than others? But the problem doesn’t end there.

Let’s take one diagnosis category – Major Depressive Disorder.  To hand this one out the client must meet criteria A, B, C, D, and E. AND under criteria A there are 9 “Notes.” The client needs to have note one or two and at least four other of the noted characteristics. So we interview you and you sort of have note one but not note two. Then we see you have the three of the others, but we are just not sure if you have the fourth one or not. Now we have a problem.

If we say no to either of the maybe’s you are out. You do not have depression. But if we say yes to the two questionable calls you are in – you get the diagnosis. This makes me want to scream.

In research studies, they use “strict” criteria. Any doubt and they do not give out the diagnosis. In practice, if you come close and we think you need help and that you might get worse, then you are in. If you are suicidal, does it matter how many times a week you are able to feel pleasure or how much you sleep?

We should be done now but we are not. Not by a long shot. There is a hierarchy of diagnosis. Sometimes one diagnosis trumps another, sometimes not.  You can have depression and anxiety but not depression and Bipolar disorder.

Stop screaming.

Lots of people come in and tell me they have been diagnosed with Depression, Manic Depression, and Bipolar. I nod my head yes and let it go.

Bipolar is the new name for manic depression, the same thing, new name, mostly to confuse us. Bipolar may not be any better a name than manic depression. Both make it sound like you are either manic or depressed. Kay Redfield Jamison says, and I very much agree, that it is possible to have both at once, we call this mixed states. Some psychiatrists want to take it out of the next DSM. I think it needs to stay, but who am I to argue.

Why can’t you have depression and Bipolar? Because the description of bipolar includes having one manic or hypomanic episode! Most people start out diagnosed with depression but once you have even one teensy weensy bit of hypomanic episode we change the diagnosis to Bipolar.

I want to thank DeeDee whose post suggested the idea for this post. Her post on the GAF got me started about how we keep the diagnosis a secret. It is now clear I will not get this all into one post. So watch for a future post in which we tackle the mysteries of five-axis diagnosis and other esoterica.

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