Should you be happy?

Posted on February 3, 2012 by David Joel Miller

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

Happiness.
Photo courtesy of Pixabay.com

Are you comfortable feeling happy?

There are lots of articles on the net and lots of blog posts about depression and anxiety, but not much being written these days about being happy. We can’t blame those people who are focused on their depression or anxiety for this state of affairs.

If you ask people what makes them happy, many people can’t answer that question. Most people have never even thought about what might make them happy. In therapy sessions, I often ask people to describe some basic emotions, things like happy, sad, afraid, or mad. Most people in crisis can’t tell what makes them feel the way they do. They just know they are in pain and turmoil.

When I ask them what would make them happy, they often sit and look at me for a long time without an answer. The question stumps them. They have never considered just what it would take to make them happy. Usually, the pain is so acute that just ending the pain is all they can think about.

Loss of pleasure is one of the symptoms of Major Depressive Disorder, that I know. Yes, sure, in my practice I work with many people who are so depressed or anxious that they can’t even think about happiness just now. What surprises me the most is that most of them have never stopped to think about what it would take to make them happy. Many times they are not even sure they should be happy. What would you say if I asked you that question?

Do you deserve to be happy?

There are those people who hold the religious view that the time on earth is a trial and they expect to suffer. They tell me they expect to suffer. Unfortunately, they frequently mean that they want everyone else to suffer. I see their kids in therapy after the kid has given up on life and wants to die. Please, if suffering makes you happy, try to do it in a joyous manner and let those around you have the happy life they deserve.

Now I know there are lots of challenges in this world. There are families that live in poverty. There are single parents struggling to provide for their families on one low paying income. Families have sick children. Sometimes one or both parents are ill. Sometimes awful things happen to these people. Some people suffer horrifically.

The surprise here is that sometimes in two houses, side by side, both undergoing hardships, one family is happy and the other is miserable. Why?

How is it that some people can go through life’s trials and still values their existence while another person will suffer terribly?

One major difference between those who walk through a trial and continue to be happy and those who are overwhelmed is the mental attitude they have. I know that this is so easy to say and so very hard to do. Fortunately, there are people who are willing to help you change your view of the world if you are willing to change. I am not just talking about professional counselors and therapists here, though that is their job in my opinion. There are also self-help groups, books, and support systems of friends. The key is to be willing to give up our attachment to suffering and to embrace the idea that it is possible to have a happy life.

There are at least three things that can move you towards a happy life.

1. Give up the notion that you need to suffer and embrace the idea that it is possible for you to be happy and that you deserve this happiness not because of what you do or have but simply because you are the one unique you. Embrace the quest for a happy life. A happy life is not all about pleasure. Drugs and things are not likely to make you happy.

2. Change your thinking. Most of us have a whole pack of must’s, should’s, and have-to’s that we hold onto. Being able to let go of things and move on is critical.

3. Nurture your resilience, that ability to bounce back. This is a real life. It has its ups and downs. I can guarantee that things will happen to you that you will not like. But then if you keep on track those good things will happen also. So if you keep looking at the failures you will grow them. Learn from life’s trials but grow from them also.

You and I both know that if you are down right now all this is hard to do. When you lose your job, end a relationship, become homeless, or are struggling with sickness it is easy to get down and depressed. It is easy to get into fear and worry. Look for help. Find someone that you can talk to that will understand and support you.

In future blog posts, I want to talk to you about all these issues and many more. As our country struggles with a great economic illness we seem to have neglected the mental and emotional health of our people. Do all you can to fight mental and emotional illness by carving out all the happy life you can. And share that happiness. Happiness shared is not diminished it is multiplied.

More depression these days?

Posted on February 2, 2012 by David Joel Miller

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

Depression.
Photo courtesy of Pixabay.com

Is there more depression now than they used to be?

More anxiety? More ADHD or PTSD? In fact, could we say there are more diseases like cancer now than in the past? Is the increase in disorders the result of chemicals or toxins or something else?

Let me be radical and suggest something here. Now remember I am coming at this from a therapist’s, this therapist’s to be more precise, viewpoint. I am not a medical researcher and I do not have data to back up this viewpoint, though I can cite some authorities in those fields who seem to explain this issue.

There are probably less of most diseases than ever before! Does that surprise you? What has changed is the salience of diseases. Salience is a new word, relatively. It first started being used in 1836. FYI the word allergy did not make the dictionaries till much later. Before 1900 presumably, no one had allergies because there was no word in the dictionary for this. Lots of people had hay fever though. So does changing the word for something change the number of people diagnosed with a condition, yes. Does changing a name alter the amount of human suffering, I think not. What about mental illnesses and depression in particular?

The ancient Greek writers talked about bile and humors. One-color made you sad and depressed another made you overactive and impulsive. The descriptions remind me of depression and mania. I suspect there was a lot of depression during the great ice age but they didn’t blog about it.

Sapolsky tells us that one reason for the increase of certain disorders is that we are living longer. When the average lifespan of Americans was 40, most people did not live long enough for us to worry about cancer or Alzheimer’s. Many of our current physical health issues are the result of people living long enough to be diagnosed with diseases of old age. For the record, they may not have had Alzheimer’s way back when but my great-grandmother died of senile dementia. Not sure what the difference is but I want to live long enough to find out.

When half the people in town die one summer from the black plague no one worries about the person who killed themselves as a result of depression.

Depression is a new name. In older books, they wrote about Melancholy (literally black bile.) But that disorder was usually reserved for the upper or aristocratic class. Poor people were too busy dying of dysentery and milk sickness to live long enough to be depressed.

If you read journals of the early American settlers you would find plenty of stories about suffering, just back then we all accepted suffering as inevitable, just part of God’s will. People began to distrust that bad things might be part of some higher powers plan and started thinking that we just might be able to reduce human suffering without challenging the power of the Almighty. Then we started looking for cures to conditions that might have been considered normal in the past.

Until this last century, we thought mental illness was incurable. There were only two choices, pray over them and hope or chain them to the wall. Then we discovered that there were medications that could turn previously “crazy” people into functioning members of society. This discovery took mental illness out of the demon possession category and moved it over into the treatable illness category.

There are still some people, politicians mostly, that think that people with mental illnesses are faking it to get out of work and just need to snap out of their disorder. Other times they will tell you that these people are really just criminals and need to be locked up. There are lazy people and there are criminals for sure, but that is a different group than the mentally ill, though sometimes a person can have two or three conditions.

For sure there are toxins and environmental hazards. Some of these things have increased the rates of specific illnesses. But I can’t blame them for depression or anxiety.

The last century was a turning point in the fight to control diseases. We began to use antibiotics, vaccines and now we have advanced diagnoses and treatment. The next century holds promise for the integration of mental and emotional disorders into the mainstream of care. Let’s hope that the increased awareness and detection of mental health and substance abuse disorders increases society’s willingness to tackle these sources of human suffering.

So for the record, I don’t think there is significantly more depression or more of most other diseases. The numbers of people diagnosed with a particular illness do go up and down. But as we are able to see them, the diseases become more important. But isn’t ending suffering, both physical and mental a part of having a happy life?

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.

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

Best of Blog Recap – January 2012

Posted on January 31, 2012 by David Joel Miller

Counselorssoapbox.com

Thanks to all of you that read this blog. Some of you have been with me from the beginning and some just joined. I appreciate each and every one of you. This month has marked a change in the blog. My original plan was to increase the number of posts from one or so per week to at least three. Along the way, the comments came in both on the blog and off, so did a lot more likes. It is always nice to be liked and to know that what you are trying to do is of interest to someone. As a result, this month I wrote some articles that turned into series and the final result was a lot more than the three a week I had planned on. We will see if time permits me to keep up the writing at this level.

The theme of this blog continues to be – having a happy life. That topic includes issues related to mental health, substance abuse, parenting, recovery, and resiliency.

Here are the top read blogs of the last month.

1. How does therapy help people?

2. Stages of Change – Early action

3. Is relapse a part of recovery?

About the author and Bipolar – misdiagnosed or missing diagnosis? Where close to the top also. Thanks for all your interest.

From the last year the top posts were:

1. How does therapy help people?

2. Treatment for teen’s risky behavior

3. Post Traumatic Stress Disorder – PTSD and bouncing back from adversity

4. 7 “new drugs” parents should be aware of.

Over time lots of you have viewed the home page and “about the author” page also.

Thanks to all my readers for being part of this effort.

Next month we will explore some other topics and see what we come up with.

Till next time, David Jole Miller, LMFT, LPCC.

How many mental illnesses are there?

Posted on January 30, 2012 by David Joel Miller

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

Mental illness.
Photo courtesy of Pixabay.com

How many mental illnesses do you know about?

Most people are familiar with a few mental illnesses. We have an official book called the DSM-4-TR which lists all the ones that are currently recognized, but professionals all know that sometime very soon there will be a new list and then this will all change (UPDATE now the DSM-5). Sometimes, as with manic-depressive disorder, we change the way people think about an illness by changing the name. The new name for this is Bipolar Disorder and that lets us start drawing small distinctions between people who get the same diagnosis but their symptoms are so very different. Then there are a lot of things we might call “problems of daily living.” These problems send more people to counseling than most of the well known mental illnesses.

Now in addition to this, there are a lot of things in the back of the DSM (pick an edition here) that are only recognized in a particular culture. There is also a long list of diagnoses suggested for further research, which means some professionals think it should be a disorder and other professionals don’t.

So currently the DSM lists about 400 give or take mental, emotional, or behavioral disorders. Even professionals forget to use all these codes a lot of the time.

When I teach classes in substance abuse counseling, I try to give prospective substance abuse counselors an overview of all these disorders. We don’t expect them to learn to diagnose disorders, just to recognize when a problem might be a mental illness and need a referral to a mental health professional. Here is that very oversimplified way of understanding mental illnesses. We will reduce that list of 400 to about 6. For the rest of the list read the book or better yet go to a professional.

1. Problems of daily living.

These are the most common. That does not mean they are the least important. This includes adjustment disorders and relationship problems. Job loss, breakups, and divorces, and parenting issues are common but they can be fatal. Ever hear of a person going through a divorce who kills themselves or others? These adjustments to life’s changes can throw people for a loop and result in severe disability. They result in the majority of referrals to therapists in private practice. Despite the fact that these problems can cause death, violence, and lots of suffering, not all insurance covers this kind of counseling. Publicly funded programs for adults often require that you actually try to kill yourself before they will treat you. Kids get a break most of the time. We need to make therapy and counseling more available but you knew I would say that. Didn’t you?

2. Anxiety disorders.

Does it surprise you that anxiety is in second place? It would be the first place in those disorders most programs are set up to treat. Lots of anxiety out there. PTSD (Post Traumatic Stress Disorder) is on the rise. Lots of shades of anxiety from phobias like fear of snakes to panic attacks.

3. Mood disorders.

This includes depression, bipolar disorder, and a whole bunch of other labels we use less often. I have written several blog posts on these disorders and how we fail to catch them early. If you feel that you or someone around you have emotions that they can’t control, seek professional help.

4. Substance use disorders.

This includes addiction or substance abuse and dependence as we are now calling it. Some of you will argue that this is not a mental illness. Taking drugs or drinking is a choice right? Well not exactly. Think of substance abuse in the same way we might look at type two diabetes. This has been characterized as a “disease of excess calories.” So if you exercise more and eat less you may not get it. But the truth is that whatever the reason you got it, voluntary or not, once you have it, you have it.

Substance use disorder is like that. It is characterized by an increase in tolerance to a drug, a physical or psychological withdrawal, and a loss of control over the amount the client uses once they start using. Once they get it they need treatment or help to stop.

P.S. on this – in the DSM-5 there is more emphasis on the cravings that go with chemical and behavioral disorders.

5. Psychoses.

Most people would immediately think of a “paranoid schizophrenic” as an example of this. That would be wrong. Most people would also have started the list with this one. People think psychosis is a lot more common than it is. For the record, there are lots of psychoses other than Schizophrenia. Not all paranoids have schizophrenia by the way, and not all people with schizophrenia are paranoid.

Psychosis is a distortion of reality, sometimes referred to as a loss of touch with reality. That sounds more like a politician than a mentally ill person to me.

6. Problems of kids and growing up.

Things like developmental delays and mental retardation show up most often before a child goes to school. Learning disabilities and ADHD get diagnosed in the early grades and behavioral problems get diagnosed in middle school most often. This is not because these problems develop then but because as the child ages our expectations of them change and we notice different problems. Autism, Asperger’s Disorder, and Pervasive Developmental Delay NOS also get diagnosed most often when the child is young. Of course, most any of these conditions could show up in adulthood if they had not been spotted before. A group of issues we call attachment disorders could show up here but many adult clients are just now dealing with issues that began when they were very young. Things like abusive or neglectful parents. They have just managed to hide and put off dealing with these problems until a life stressor brings then out.

P.S. on that one also. In the DSM-5 we see a recognition that while something like ADHD may be first recognized in childhood it can continue your whole life. Just cause you never got this diagnosed in childhood should not keep it from getting recognized and treated later in life.

So there you have them – 6 broad categories of mental illnesses. I am sure I have left some other things out but these are the biggies that bring lots of suffering and drive people to therapy or meds. If any of these issues are affecting you or someone you care about, consider therapy, counseling, or possible meds. There is help out there and most of the time suffering in silence does not make the pain go away.

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.

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

Do drugs cause mental illness?

Posted on January 29, 2012 by David Joel Miller

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

Drugs.
Photo courtesy of Pixabay.com

What is the connection between drugs and mental illness?

By drugs here I am talking about illegal or street drugs, though prescription drugs can be misused and create the same effects. The relationship between drug use and mental illness is not so clear-cut as first glance would suggest. Not all mentally ill people use street drugs and many of them did not try street drugs until after they had an episode of mental illness.

1. Drugs can cause a mental or emotional problem.

There is a clear connection between some drugs of abuse and some mental emotional and behavioral disorders. We call these problems “substance-induced disorders.”

That connection can include emotional problems caused by prescription medications. Stimulant abuse, especially Methamphetamine can cause full-blown psychosis. Currently, we think there are several connections between Marijuana and psychosis. That would be a subject for another post, maybe even a book.

Drugs of many kinds can cause or exacerbate depression and other mood disorders. They can also cause or increase anxiety. There are several ways drugs can cause an emotional problem.

A. Intoxication. People may behave differently when under the influence. Alcohol is an easy to see case of this. So is Phencyclidine abuse. People who rarely have caffeine may have an intoxication reaction if they suddenly ingest a large amount.

B. Withdrawal – They may have problems when they are withdrawing from drugs. Heroin or opiate-dependent people get very physically ill. Meth users crash, become depressed, and sleep for extended periods of time.

C. Substance-induced disorders. They may also develop long-term issues as a result of drug use. Meth-induced psychosis is becoming more common in my area. The central valley of California was described in a recent news article as “The Meth Capital of America.” It is clear that people under the influence of meth can be psychotic. It is also beginning to be clear that the psychosis does not always go away once they stop using Meth. The way in which Meth damages some parts of the brain more than others, those changes on brain scans, are making some researchers look at specific structures in the brain as possible causes for many cases of psychosis.

There is a difference in the hallucinations experienced by drug abusers and those reported by people with psychosis. People with Schizophrenia most often report hearing voices, auditory hallucinations. Meth-induced psychosis is most often visual. They see Meth monsters or pet shadow puppies. Meth users also report that their visions do not go away when they close their eyes. So while the two types of psychosis are similar they are not identical. Maybe future research will answer all these questions.

2. People with a mental or emotional problem may be more attracted to a particular drug.

People with chronic episodes of depression may be attracted to stimulants. The quick lift of caffeine or cocaine can make your depression more manageable – temporarily, very temporarily. Freud, the father of modern psychiatry experimented with Cocaine as a way to treat depression and produce overall happiness. What we found out was that while there might be a lift of mood, there was always a crash afterward. So the use of stimulants is no longer accepted practice because it leaves the user in a worse state than where they started.

Other examples of ways in which people with particular mental illness might be attracted to a particular drug are the way in which people with psychosis, meaning schizophrenia, schizoaffective disorder, sometimes Bipolar disorder, etc. are highly attracted to smoking. The nicotine may have some effects on the disorder. I am not suggesting anyone should take up smoking; the bad health results far outweigh the current pleasant feelings.

While we are on the subject of smoking, however briefly, I need to mention one report I read that said that more than half the cigarettes smoked in America are consumed by people with a DSM-4-TR diagnosis. Some writers have suggested that cigarette companies have deliberately added things and marketed their products to people with mental illness and substance abuse disorders. I do not know if that is true but I do know many clients with severe mental illnesses and substance abusers are heavy smokers. Remember this blog is called counselors soapbox for a reason.

In residential substance abuse facilities, we find that many clients entering treatment had the symptoms of a mental or emotional disorder before they ever started abusing substances. One theory to explain this is that some substance abusers are “self-medicating.”

3. Giving up your drug of choice can result in severe depression, anxiety, and other emotional problems.

Most long-term users get closer to their drug of choice than to other people. All their friends are involved with the same drug. So once they quit they are very alone.

This process of giving up your drug of choice is a lot like grieving over the loss of a family member or friend. The alcoholic might tell you that women come and go but “Sherry is always there.” The Meth user describes their effort to quit as “Crystal is always there.” And they remind us that “She,” whichever she that is, is jealous and didn’t want them having any other relationships.

So there you have some thoughts on the relationships between drugs and mental illness. There are other relationships but I need to stop for now.

Hoping to hear from you about your thoughts on the topic of the connections between drugs and 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.

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

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

Planned Accidents The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How do antidepressants work?

Posted on January 28, 2012 by David Joel Miller

Counselorssoapbox.com

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

Here is the best way I have found to explain the way in which antidepressants help. Remember this is an analogy, not a scientific explanation. In a previous post, I talked about the way in which thoughts are moved around in the brain by neurotransmitters and the way in which they might regulate thoughts and emotions.

The most commonly prescribed antidepressants these days are SSRI’s. That stands for Selective Serotonin Reuptake Inhibitor. Complicated name but let’s try to make the idea behind it simpler.

One thing that happens after a message is moved from one neuron to another by a neurotransmitter is that the neurotransmitter needs to be released from its receptacle. The key needs to be removed from the lock otherwise that neuron could never receive that message again. The released neurotransmitter starts floating around and eventually it gets eliminated from the body. If you only got one use out of a neurotransmitter then you might start running out of them really fast. So your brain has a recycling department. The used neurotransmitter is recycled by enzymes and other “stuff” that breaks it down and lets the brain reuse it.

Think of this analogy.

Once in my younger days, maybe more than once, I had this car that kept overheating. I would fill the radiator up and drive as far as I could until it started getting hot. Water leaked out of that old rusty radiator in several places. To go all the way to work or school I might need to carry water or stop a few times to refill the radiator. It was a hassle. A friend of mine suggested I try this product he called “slow leak.” Something like that. You put it in the radiator and it found the places that were leaking and plugged them up. It did not eliminate the leaks completely but I got a lot more miles from my car before I had to stop and put water in it.

An SSRI kind of works like that. It keeps those “packman like” enzymes from finding my brain’s serotonin and recycling it before I am done with it. It does not put more serotonin in your brain but it helps you get more mileage out of what you have there.

A cognitive-behavioral therapist, (wait a minute, that’s me!) might argue that diet, exercise, and good thinking could help you make and release more serotonin. Brains like cars differ. Some brains can get more mileage out of their serotonin. Some brains might “leak” the stuff out or overheat and boil it off. You with me so far?

See how keeping the serotonin in my brain longer might improve its performance. That “leak stopper stuff” did a great job on the radiator so some SSRI just might work on my brain.

Now back to that old wreck of a car. You can trade in a car and get a newer one. So far we don’t have brain transplants so we need to take the best care we can of the brains we have.

My car was so much better. I could make it all the way to school without stopping to put water in the radiator. My friends were impressed.

One day some of my buddies were over to the house and I was bragging about that “fixum leaks up” stuff I had discovered. They said they were impressed. From the looks on their faces, I could see they were skeptical. So let’s say I go into the house and get my dad’s old shotgun. Play along with me here. The shotgun is not to scare my buddies; it is to demonstrate the effectiveness of my “Leak fixer-upper stuff.”

I fire that old shotgun right at the front of the radiator. Just as expected the water pours out. I now get out the “leaker solver” can and put some in the radiator. Only this time it no work so good. The thing continues to leak.

Some of you are now asking – who would do a thing like that? Stay with our analogy here. Lots of people do just this thing. After taking all that medication to reduce their depression, they go and drink some alcohol. Alcohol is a depressant drug. So drinking alcohol undoes all the effects of the antidepressant.

Now some of you are arguing about alcohol being a depressant drug. You will tell me that it makes you more energetic. With alcohol in you, you want to party, at least until you pass out. The truth is that you only think that alcohol perks you up. It shuts down the functions of the frontal lobe of the brain and some other parts also. So under the influence of alcohol the part of the brain that tells you “hey stupid – don’t do that!” is not working.

I hope this little tale has offered you a way to understand how an antidepressant might help with depression while not instantly erasing it. Hopefully, you also see how mixing psychiatric meds with alcohol and street drugs might be a bad idea.

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.

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

Chemical imbalance?

Posted on January 27, 2012 by David Joel Miller

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

Memory.
Photo courtesy of Pixabay.com

Some of the ways mental illness is described disturb me. Chemical imbalance and minimal brain damage are especially troublesome. This post is about the whole idea of mental illness being the result of a chemical imbalance. I can see how these ideas got their start and why they continue to be popular, but they can be way misleading also. Below is a very oversimplified explanation of this issue.

One reason these ideas gained popularity was that it explains why some people were not able to “just snap out of it” even when they tried. We began to believe that mental illness was not a choice or a moral flaw but an illness. And if it was an illness then we should be able to find treatments for it. We also started to think there were risk factors and protective factors. Not everyone with a particular gene gets a particular disorder even when the gene increases the risk.

When I first studied physiological psychology way back in the dark ages of the 1960’s we studied mostly electrical potential and structure of the brain. There were a total of two neurotransmitters that were of any importance in that class. Forty years later I took a class on the effects of drugs and alcohol on the body and the brain. In that class, the text reported there were over 200 neurotransmitters in the brain and that brain chemistry was way more important than anyone had thought until that time. The book also suggested that there were probably another 200 or so neurotransmitters that had yet to be identified and named. That number has grown since.

One thing this diversity of chemicals in the brain might explain is the way in which drugs of abuse might work. There is one theory called the “lock and key” theory that says that drugs of abuse while not the same chemical as a neurotransmitter are shaped just like one and so they fit in the receptors, the locks, in the brain and these chemicals make the same things happen that happen when neurotransmitters move only way more so.

We now know, or think we know, that messages in the brain are carried within a nerve cell, called a neuron, by electrical charges. But from one neuron to another they are carried chemically. The role of the neurotransmitters is to move messages about. But there are other chemicals present also and they do many other things. It is a complicated world inside our brains.

We discovered that a medication that changed the way a neurotransmitter, serotonin, for example, was made, moved around, broken down, and recycled, could also impact mental illness symptoms. So the shorthand for this became that someone who had depression might have a shortage of serotonin. The expectation was that give this person a medication that increases serotonin and they should be cured. It has turned out to be more complicated than that.

The belief that a shortage or surplus of a neurotransmitter was causing a particular mental illness gave rise to the idea that in time we would be able to take a sample of the fluid in someone’s brain, decide which neurotransmitter or enzyme was out of balance, and then by adding or subtracting neurotransmitters they could be cured. People still come into our office and want to be “tested” to find out which chemical in their brain is out of balance. So far this hasn’t worked out. Let me suggest why.

Thoughts are carried from nerve cell to nerve cell chemically. You have lots of thoughts, conscious and unconscious. Hunger is a thought, so is tired. We may feel these long before we know that consciously. A depressed person might have a happy thought, might even laugh at a joke. The brain chemistry will change. They think about their depression or a bad experience their brain chemistry changes again. So the chemicals in the brain are constantly changing. We also find that changes in thinking can change your mood. That is the basis of conative therapies. Changes in muscles are also controlled by chemicals so that might explain why behavioral therapies work also. But psychiatric chemicals, like anti-depressants, do work also.

Another thing we are starting to read about in the popular accounts of scientific research is the way in which neurotransmitters may act differently in different structures of the brain. We also find that there is a lot more than one model of a neurotransmitter. If serotonin were like a car, say a sedan model, there would be two-door and four-door models and various colors. Turns out there are multiple varieties of neurotransmitters. So the more we learn about brain chemistry the more refined the medications become but the more questions there are that need answers.

Rather than being just a simple case of a chemical imbalance, it may be that some brains get more mileage out of one chemical than another. Some brains come with superchargers and need higher octane fuel and others stall on the same mix. Forgive the repeated use of the car analogy but it comes the closest of any I can think of as to why we can’t just test for a chemical imbalance and why some people respond well to a medication and other people do not.

So remember that it is not just a shortage of or surplus of a chemical that throws brains out of balance. The things you do and the thoughts you think also influence your brain chemistry. In future posts, I want to talk about minimal brain damage and the ways in which psychiatric medications like anti-depressants might be working. Remember this is coming from a therapist and counselors point of view. Before you make any changes in your medication, starting or stopping, please talk with your doctor. But in my world, it never seems to hurt if you add some counseling to the medication.

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.

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

Side Effects

Posted on January 26, 2012 by David Joel Miller

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

Drugs.
Photo courtesy of Pixabay.

What about those drug side effects.

The other night as I was walking by the Television in the family room I heard a frightening commercial in which they described a long list of possible side effects for a medication they were advertising. This experience combined two things that I try to avoid, television and commercials that interrupt my train of thought. Fortunately, I recovered enough from the trauma to start thinking about what they were portraying in their commercial. Here they had paired a positive commercial with a quick legal disclaimer of all kinds of possible side effects. They also had a “call to action” saying “ask your doctor” if you should be taking our med.

With that graphic warning would anyone buy this medication? Then it occurred to me that yes indeed people were buying the med despite some pretty extreme side effects. I won’t give the name of the med but here is what I remember of the list of side effects. Remember I was walking by the family room when I heard this so I may have gotten some of these side effects wrong.

This med may cause sexual impotence, sudden death, and the loss of body parts, presumably because after taking this drug sometimes arms and legs or other members fall off. It also has caused blindness, deafness, and loss of memory. These side effects alone caught my attention, though the list was considerably longer. Could any possible benefit outweigh a side effect like death and impotence?

This drug was not a warning for some illegal drug. I know that people might take a drug that causes their teeth to fall out and their skin to develop scabs along with the loss of home and family. Illegal drugs like Methamphetamine result in these kinds of effects all the time. But why do legally prescribed drugs have so many terrible side effects and get prescribed anyway? Here are some thoughts about how side effects are discovered and what the risks are.

Let’s say for example sake that a company approached the college where I teach and offered the students a chance to test some new drugs that had been shown in lab tests to increase concentration and intelligence. Set aside for a second the ethical issues about should we do this test and let’s say that someone thinks that testing this drug is worth the ethical risks. Maybe it also prevents cancer. So we do the test.

There are two things we want to know. Does it work? Is it safe? For the does it work issue we want to know if it improves test scores and makes students more alert in class. For the “is it safe issue” we want to know if there are side effects, like death, that outweigh the benefits. So we do two things, we give some students one drug and the rest another drug. Preferably we make them look-alike so no one knows who is taking which drug. An even better procedure might be to make up a third test group that gets a pill with no drug in it. During the test we also want students to record any health problems they develop.

So if we test these drugs on thousands of students what might happen? During the course of the test could any students have nights where they could not sleep? Sure. Would other students have a night where they were so tired they fell asleep early? Some of the students would gain weight during the semester and some might lose weight. There might be people who got constipated or who got diarrhea. Some students would also catch colds and flu during the test.

At this point we might have a list of side effects that reads like this:

May cause insomnia or drowsiness

May cause constipation or diarrhea

May cause weight gain or loss

May cause repertory symptoms

Now we need to check a few things. Did one drug produce more of any one side effect than the other? Even more importantly how did the side effects of the two active drugs compare to the side effects reported by people who were taking the inactive pill?

So in considering whether to take a drug and run the risk of the side effects, you also need to know how much the drug increases the risk over the risk from not taking the drug. So rather than relying on what you hear about a drug’s side effects on a brief commercial or even by reading about side effects on blogs of people who have taken that drug you also need to discuss the risks and benefits with your doctor.

Sometimes people tune out the warnings about side effects thinking that the benefit is so great that they are willing to run some risks. We all like to think that bad things won’t happen to us. If you want to be an informed consumer it pays to consider the risks also.

In my thinking, you need to balance the risks and the benefits and your doctor can help you do this. Getting two minutes extra sleep a night may not be worth the risk of a sudden heart attack. Some people avoid psychiatric medication because of weight gain, but the risk of the weight gain, even if you end up with diabetes may be worth it if the med keeps you out of the psychiatric hospital and lets you have a life. Don’t be scared off from a potentially helpful medication by the list of side effects, but please, do discuss the med with your doctor and decide if the risks are worth the benefits for you.

And do I need to say this? Don’t ever take a med that was not prescribed for you!

Till next time, wishing you a happy life.

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.

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 does the doctor keep changing my meds?

Posted on January 25, 2012 by David Joel Miller

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

Medications.
Photo courtesy of Pixabay.com

Why is med compliance important?

More than once in my career as a therapist I have been asked to talk with a client about a subject that professionals call “Medication compliance.” The doctor wants us to be sure that the client is taking the medication as prescribed. People respond differently to different medications. There are reasons why clients might not take meds as prescribed. There are excellent reasons why the doctor wants their patients to take meds as prescribed.

I can’t give you advice on meds or counseling here, this is a blog, not on-line treatment, but maybe I can provide some general information on the issue of meds and why the doctor might change them.

There are five principle steps I see doctors go through in the process of deciding what meds a client should take. I am sure doctors think about a lot more than these steps but let me walk you through this process. If this raises questions about your medication please talk with your healthcare provider.

This blog post is about med management from the professional’s viewpoint. Next time some thoughts about side effects and other reasons clients don’t take meds as prescribed.

A. The doctor needs to do a thorough initial assessment. Sometimes they ask questions that sound like they are irrelevant. The doctor has their reasons. They need to establish a working diagnosis. You wouldn’t want to be prescribed cancer treatment if you didn’t have cancer, would you? They also need to know what your symptoms are and their severity. You want them prescribing meds that have some chance of helping with your problems and they need to know what your problems are to be effective at this.

B. The doctor who prescribes your psych meds needs to know if you have any other health issues and they need to monitor you for other problems and side effects. More than half of all psychiatric meds are prescribed by primary care physicians who know your medical history. The more complicated situations are usually managed by specialized doctors called psychiatrists. They will probably want lab work before prescribing medication. If you have high blood pressure they may avoid a drug known to raise blood pressure. If you have type two diabetes your psychiatrist may avoid drugs known to raise blood sugar levels or cause weight gain. I say may, because sometimes your psychiatric symptoms may be so severe that the benefits of a med will outweigh the potential risks. If a doctor does this he will probably be monitoring the effects that drug has on you. Sometimes the doctor will order regular tests, such as blood tests, to make sure the drug is doing what it is supposed to do and is not causing other problems.

At this point, the doctor will “start” a patent on a med. This initial med may not be the final med you will end up on. The doctor may need to change your med. Some meds need to be started high and then they may be reduced. Other meds may have side effects that go away over time so the doctor might choose to start with a low dose and raise it over time.

So now you are on meds, the problem should be controlled and all is well, right? Probably not. A lot of clients report that at this point the doctor starts changing meds. Why? And what makes them make the changes they do? Most often the changing starts because the problem is not under control. Either the client reports the med is not working or there are other symptoms that are causing problems. So the doctor might do three things in this order.

1. Increase the strength or dosage of the med the client is taking and or vary the time of day or number of doses. If the doctor feels the diagnosis is correct and that the med should be helping, the first option is usually to increase the dose. If there are side effects like being sleepy during the day or not sleeping at night the doctor may choose to have the client take the meds at a different time of day. Nightmares might be another reason to move the dose to the morning instead of the night. The doctor may try increasing the dose several times to see if more of the preferred med is going to work.

2. If one or several increases in dose don’t help the doctor may try switching meds. Many doctors have a preferred med. This may be one they studied in school or did research on. It also might be a med they have used a lot and gotten good results from. Since not everyone is the same sometimes this first choice med does not work or causes other problems so the doctor tries switching. After the med switch, they may have to increase the dose of the new med. They may need to repeat the switch and adjust the dose process several times to find one that works for this client. This is frustrating for the client. It might frustrate the doctor also. He wants to help the client and nothing seems to work. This might be the point where he asks the therapist to have a talk with the client and see if the client understands and is taking the med as prescribed. Let’s say the client understands, is willing and able to follow directions, but none of the meds have worked. What might a doctor do next?

3. The doctor might at this point decide to try several meds in combination. This is a tricky one. He needs to select multiple medications from all the ones available and adjust doses of multiple meds. This process may continue for a long time as new meds are added, doses are adjusted and some meds may be discontinued. After a while, a discontinued med might get added back if it looks like the client was better with that med than after it was discontinued. During the process of juggling multiple meds, it is very important that the client is following the directions, telling the doctor about any effects and side effects experienced and it is also important that the doctor is hearing what the client is telling the doctor about their med experience.

I hope that this blog post helps you understand some of the things a prescribing doctor might consider or do in the process of trying to find the med that will help their client.

You are welcome to post comments on your experiences with meds. Just remember that as a therapist, I can’t give you specific advice about meds or prescribe any.

Another time some thoughts on side effects and why clients aren’t always able to take meds as prescribed.

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.

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

Willpower Shortage

Posted on January 24, 2012 by David Joel Miller

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

Willpower.

Willpower Shortage.

Of late it has become standard practice to decry the shortage of willpower here in America, maybe the shortage of willpower on planet earth. How did this worldwide shortage develop?

The shortage does not seem to be of recent origin. Writers from the Plymouth Colony, writing shortly after the founding in the 1620s expressed their concern that people could not display significant willpower to avoid breaking the laws. I am told that there are passages in the Bible about a lack of willpower though I am not sure if it is found in the book of Leviticus or not. Presumably, this worldwide shortage of willpower has been going on for thousands of years.

If we can find oil deep under the sea and rocks on the moon why is it that there has been no significant discovery of additional willpower in all these millenniums? Perhaps we have been looking for the wrong thing in the wrong places. Behaviorists, like Martin and Pear, believe they have discovered the source of the willpower shortage. They say there are in fact two very different creatures that we are calling willpower and that we keep looking for the wrong one in the wrong place. Could that be?

Determination.

Willpower One might more properly be called determination. This is the willpower required to do something that we know would be good for us but that is unpleasant or painful while we are doing it. Exercise is a good example. We all know we should do more exercise. It has all those positive benefits, like losing weight and being healthier. But it is hard to think about doing something that involves effort and possible unpleasant pain when there is that nice warm comfy couch sitting there and there are 36 new movies on the cable that begs to be watched.

It takes a special brand of willpower to give up a current pleasure or reward, sitting on the couch and watching movies, to secure far-off benefits like weight loss and improved health. To continue to engage in this effort for a deferred gain we need lots of positive encouragement and reinforcements. This is why people who exercise in groups where they encourage each other are more likely to succeed than those who try to do an exercise program alone.

The problem with shortages of this first kind of willpower is that the current negative of the action does not seem to have much connection to a far-off positive result like weight loss. It is hard to make yourself do something today for a gain a long time from now. This kind of willpower deficiency also accounts for the lack of retirement savings of many citizens.

One way to offset this is to turn the negative into a positive. Instead of exercising, pick a hobby that involves activity. Square dancing comes to mind. You get some positive people interactions coupled with the advantage of exercise and it could be fun.

Self-denial

Will Power Two, maybe we should call this self-denial, is the kind of willpower needed to get ourselves to give up something that we know is not good for us but is so much fun. In this type of willpower, the problem is to skip those extra goodies that put on the pounds. We know that obesity is bad. And we know that eating a few extra calories will over time pack the pounds on. But it is hard to connect in our minds the extra pounds and the health impairment a year from now with the one extra cookie. Usually, the one extra cookie wins out.

In trying to cut down on things like extra cookies or cigarettes the challenge is to give up a current pleasure for a far off good. Addictions fall in this class of shortage of willpower. One behavioral approach is to create a script that you say to yourself. Behaviorists call this self-instruction. You might say to yourself that you do not need that drug or that cookie and that you are looking good. Substance abusers find that the more time they spend with people who encourage them to stay sober the more likely they are to succeed.

At this point, we are almost a month into the year. How many of you have given up on your New Years’ resolution? Did you read my series on stages of change? Think about where you are in this change process and how you might start moving forward.

If you are short on willpower, what positive things could you use to reward yourself for doing those hard to do things? What could you do to make giving up those current pleasures to secure a long-term goal feel less like a sacrifice?

Anyone out there have an experience to share that involves making a change and increasing your willpower?

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.

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

counselorssoapbox

Counseling, Therapy, Recovery and having a Happy Life

Should you be happy?

Are you comfortable feeling happy?

Do you deserve to be happy?

There are at least three things that can move you towards a happy life.

More depression these days?

Is there more depression now than they used to be?

Best of Blog Recap – January 2012

How many mental illnesses are there?

How many mental illnesses do you know about?

1. Problems of daily living.

2. Anxiety disorders.

3. Mood disorders.

4. Substance use disorders.

5. Psychoses.

6. Problems of kids and growing up.

Do drugs cause mental illness?

What is the connection between drugs and mental illness?

1. Drugs can cause a mental or emotional problem.

2. People with a mental or emotional problem may be more attracted to a particular drug.

3. Giving up your drug of choice can result in severe depression, anxiety, and other emotional problems.

How do antidepressants work?

Chemical imbalance?

Side Effects

What about those drug side effects.

Why does the doctor keep changing my meds?

Why is med compliance important?

Willpower Shortage

Willpower Shortage.

Determination.

Self-denial

Are you comfortable feeling happy?

Do you deserve to be happy?

There are at least three things that can move you towards a happy life.

Share this:

Is there more depression now than they used to be?

Share this:

Share this:

How many mental illnesses do you know about?

1. Problems of daily living.

2. Anxiety disorders.

3. Mood disorders.

4. Substance use disorders.

5. Psychoses.

6. Problems of kids and growing up.

Share this:

What is the connection between drugs and mental illness?

1. Drugs can cause a mental or emotional problem.

2. People with a mental or emotional problem may be more attracted to a particular drug.

3. Giving up your drug of choice can result in severe depression, anxiety, and other emotional problems.

Share this:

Share this:

Share this:

What about those drug side effects.

Share this:

Why is med compliance important?

Share this:

Willpower Shortage.

Determination.

Self-denial

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