Are you Hyperthymic?

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

Hyperthymia person

Are you Hyperthymic? Photo courtesy of Pixabay.

Recently I read an article in a peer journal about Hyperthymia. Here is an interesting point of view on the question of whether the mentally ill are really different from “normal” people. Maybe people with a diagnosed illness are on a continuum and just have more or less of the characteristics the rest of us take for granted.

I am inclined towards the idea of continuums, not discreet illnesses despite the fact that I need to give people a diagnosis to get insurance to pay for treatment. That says to me, some people’s problems keep them from having jobs, friends, or being happy and they need help. Other people get along fine as they are and don’t need help. For example, 70% of people report having at least once in their life heard a voice calling their name but when they looked there was no one there. Does this say that hearing “voices” is normal or that the other 30% are lying?

Bipolar disorder is especially troublesome. There are degrees of symptoms and as we have talked about in past blogs lots of people get another diagnosis first and then it gets changed later on, often when the antidepressants make it worse, not better. What if parts of Bipolar disorder are just normal personality characteristics? Could there be milder forms of bipolar disorder that are not getting recognized or does that start to pathologize everyone?  Some authors have suggested we need a Bipolar 3 and Bipolar 4 to capture milder forms of the disorder.

Hyperthymic temperament is a description given to people with 7 specific characteristics.  Sometimes the list is longer or shorter. It is currently seen as a personality characteristic which means it is not generally recognized as an illness. Most mental health professions avoid working with and diagnosing personality disorders as these are often seen as just the way a person is and not likely to change or as needing lots of treatment to change. Dialectic Behavioral Therapy is used to treat some personality disorders and long-term psychotherapy is used for treating aspects of personality that might be considered neurotic or psychotic personality features. Most of the time professionals leave this one alone.

People with this personality style do develop problems of living everyday life that result in them coming to counselors for treatment. Maybe it should be a disorder?

Here are the 7 characteristics of Hyperthymic Personality described by Glick. With MY explanations of how they might be recognized.

1. Cheerfulness

Hyperthymic people are annoyingly cheerful, cheerful to a fault. Hard to understand how someone could be too cheerful but I have learned to be suspicious of overly cheerful people. What are they up too?

2. Exuberance

This is clearly pathological, especially before I have had my coffee in the morning. These people are often described as needing a “chill pill.”

3. Meddlesomeness

To my detractors, I will say I am not meddlesome. I am just helpful even when you don’t realize you need my help. If this does not explain things try the “chill pill” described in 2 above.

4. Lack of inhibitions

Why can’t people just let last year’s New Year’s Eve party go? Occasionally letting your hair down is a good thing. However if this has resulted in more than one arrest, we are thinking you are beyond uninhibited.

5. Overconfidence

What I shouldn’t run for president? Have you seen who else is running? Now that is overconfidence.

6. Grandiosity

Genius is never recognized in its own time.

7. High energy levels.

Not sure about this one. I can be as energetic as almost anyone right after my nap. So there are people with high energy all morning?

So are there people who meet most or all of these characteristics? Sure. Do they sometimes get in trouble and have problems, yes again. Should this be another condition we diagnose and treat? The jury is still out on that one.

What do you think? Is Hyperthymia a legitimate issue? Does it need treatment? Are we making too many things disorders and trying to treat people just for being who they are?

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

Bipolar or Major Depression?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Since episodes of depression are a feature of Bipolar Disorder, how would we know if this is indeed Bipolar Disorder? And does it really matter?

Yes, it does matter. People who have Bipolar Disorder are more likely to have major problems in many areas of their life. Certainly, depression is debilitating, it causes more disability than lots of physical disabilities but Bipolar cases more noticeable and life-threatening problems. Treating someone who has Bipolar Disorder for depression may result in creating manic episodes and make the condition worse. No professional ever intends to make the patient worse, at least I hope not, but not seeing the signs of Bipolar can result in incorrect treatment. Now in fairness to doctors and other professionals often the client, not knowing the differences, fails to report symptoms that might have helped in getting the correct diagnosis. Here are some things that might indicate that the condition under treatment was, in fact, Bipolar Disorder and not Major Depression.

1. Sudden onset of episodes.

Clients with Bipolar are more likely to have sudden episodes of depression and sudden remission of depressive symptoms. Major Depression is more likely to creep up on you. And Major Depression rarely just goes away suddenly without treatment or some other reason. Bipolar Disorder may strike suddenly and it may switch to an elated mood or mania all of a sudden.

2. Early age of first onset.

There was a time when we thought little kids did not get depression, not anymore. Very small children do indeed experience episodes of depression. One way we have found this out is that more and more people who struggled with depression or Bipolar Disorder as children have become professionals.

The younger the child is when they first experience a mood disorder episode the more likely they are to go on and develop Bipolar Disorder. Now we are not saying that the child is to blame for being moody. If they are able to control the mood swings then it is not Bipolar or Depression. We are also not talking about that day-to-day moodiness or event-triggered moods that all children experience. Each type of mood disorder, depression, Dysthymia, Cyclothymia, Bipolar one, and two each have a minimum length of time that is needed. This separates the events of living from a true episode of a mental illness.

3. Presence of Psychosis

With Bipolar Disorder there is almost always some disturbance of reality. This does not mean that the client is hallucinating. Psychosis also includes delusions, irrational thinking, and lots of grandiosity. During manic episodes, people with Bipolar simply try to do way too much. And they believe they can and should be able to do these things.

There is also a diagnosis of Major Depression with Psychotic Features, so the boundary between Depression and Bipolar gets blurry the closer you look. The good news is it doesn’t matter which label you get, the treatment is about the same. The bad news is that by sticking with the treatment for depression sometimes the diagnosis and treatment of Bipolar Disorder gets delayed. If you or those around you say you have thinking problems, grandiosity or delusions make sure to tell the professional who is treating you. If you don’t have someone treating you and experience delusions, seek help quickly. The sooner you get help the better the prognosis.

4. Presence of “Psychomotor retardation”

During episodes of depression some people get so tired they have trouble moving. Sometimes they literally can’t get out of bed. These extreme levels of impairment may signal that this is Bipolar and not Depression.

5. Having “Atypical features”

Many people with depression become very agitated. They can’t sleep and they can’t eat. People with atypical features are just the opposite. A shorthand way of explaining Atypical features is like a bear hibernating for the winter. These clients eat all they can. They may be over hungry at certain times of the day. Then once they get to bed they want to, need to, sleep far beyond what other people do. During extreme episodes of depression with atypical features, a client will be unable to do anything but sleep and eat.

These “Atypical” features can be seasonal as in Seasonal Affective Disorder or they can come and go with the rhythms of the year.  Having an episode of depression with atypical features increases the chances that an episode of mania or hypomania is just around the corner and with that episode comes a diagnosis of Bipolar Disorder.

6. Having a sudden overwhelming improvement in depression mood when given an antidepressant.

Antidepressant medications need time to work. Usually, the effects of antidepressants build up slowly over time. Antidepressants are not “happy pills” they do not suddenly make someone happy. They should usually be coupled with some form of therapy or addressing life’s problems.

When people with Bipolar Disorder take antidepressants they are sometimes propelled from depression to mania. A sudden huge response to antidepressants needs to be monitored for possible mania or delusional thinking. Too much response to an antidepressant suggests that this is, in fact, Bipolar disorder.

If you are unsure about this or think you may have Bipolar instead of depression talk with your doctor, psychiatrist, or therapist before making any changes in your meds. Your doctor needs to know what is happening in order to monitor your condition and there can be adverse results to suddenly stopping or changing a medication.

7. Family history of Bipolar Disorder, Psychosis, Schizophrenia, or excessive irrational behavior.

The more people on your family tree with an issue, especially close relatives, the more likely you are to have problems. Being Bipolar has had some advantages in some situations. Many people with Bipolar disorder are highly creative and productive as long as they can keep things on track.

Some families have avoided getting professional help and so there may be no formal diagnoses but most families have their stories about family members with mental health issues. Family trees with lots of depression in them seem to produce more people with a genetic risk factor for depression. Families with lots of people who had hallucinations, delusions or mania increase the risk for Bipolar Disorder. Lots of substance abuse in your family tree increases risks for substance abuse and mental illness, for a variety of reasons. Remember however that risk factor does not equal an illness. Lots of people grow up in high-risk families and have no problems, other people are the first in their family to get a diagnosis or have a problem. We are still trying to figure out why this happens.

Hope this was food for thought for you and that it encouraged some people to go for the professional help they need.

Till next time this is David Joel Miller, LMFT, LPCC saying so long.

If you have any thoughts on depression or Bipolar Disorder and the differences between them, please leave a comment on this blog.

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

Creating an underachiever

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

Mistakes and errors

Mistakes.
Photo courtesy of Pixabay.com

We hear there are a lot of underachievers in our society. Our schools and workplaces seem to be designed to create them. If you want to turn someone with a natural talent into an underachiever the process is simple. Here are the steps you will need to take to create an underachiever.

Your child does something cute, it may not be perfect but that first burst of effort gets noticed. You give them lots of praise. What they did was adorable. You tell them so. They love all the attention. In school, the child may put in extra effort to study and do well on a test. For this example let’s say it was a math test. But it could be a sports skill, art, or anything where superior performance would be noticed. They are rewarded with acknowledgment, a good grade. Everyone is happy. They should be motivated to continue putting in the effort. But they don’t. Why?

On the job site, there might be a critical project, a report that needs to be out right away. This is something that takes extra effort. The employee puts in a burst of effort to get the task done. They get the task completed and they get some praise. They feel good about their effort. Then something goes wrong, very wrong.

The child who got lots of recognition begins to be thought of as good at math. The teacher stops spending time with the child on his lessons. There are other students who need her help more. The parents may slack off on helping the child with his homework. He doesn’t need help, right? He is good at math. This time the child gets no help. They study, for sure, just not as hard. No one seems to care about them and they are identified as good at math. Then their grade slips, maybe on the first test, maybe slowly over time. No one notices until the grade gets back to the level of the rest of the class. Suddenly everyone notices.

The employee, who got that report out on time, now gets assigned a lot of reports to do. They are good at report writing, aren’t they?  But now the recognition and the praise stop coming. They are expected to always do better so they start getting assigned more work. Now if that employee gets a raise or a better office that may continue to be rewarding. But often they get taken for granted and the work piles up. Until one day they turn out a report that is not very good or they turn it out late. Then the boss has a talk with them.

Now in both cases, the person is now getting noticed again. The child may study extra hard for the next test. The employee may work extra hard on the next report. They both get a renewed round of attention for their renewed efforts. But this second round of notice fades faster than the first. What is the lesson these people learn from this?

In both cases, they learn that there are more rewards from occasional flashes of brilliance than from persistent good performance. So they learn to hold back most of the time and then occasionally do a superior job which is always rewarded by being noticed. They have learned the advantages of underachievement. If people have low expectations of you, you get rewarded for good work, but if people expect a lot from you, you might occasionally fail and that will be punished.

This procedure is not the only one that encourages people to fail.

The child wants to please his mother. She tells him to come to help with the dishes. So the child finishes what he is doing and then comes to help. He tries really hard. At the end mother thanks him for the help and then adds that back-handed compliment – “But you could have come sooner.” The lesson learned – no amount of effort is good enough. Maybe they start to think they are not good enough.

Another child may study really hard for the math test. They get ninety-nine correct out of the one hundred questions. Is the parent happy? No! They say to the child “Why did you get that one wrong? You knew that!”

No matter how much that child or that report writing employee do, it will never be enough. Pretty soon the connection between their efforts and success or failure doesn’t look to be working. They may develop a connection that Martin Seligman calls “learned helplessness.”  You might want to check out his book called “Learned Optimism.”

So what is the solution to this problem? If you are that child’s parent or teacher, don’t take superior achievement for granted, keep positively reinforcing it. You don’t need to praise the child every time, but over time you need to vary the intervals between praise so the child knows you are still noticing their efforts. If you are the boss or supervisor of a good employee make sure you don’t take them for granted and pile extra work on them while letting the less able employees slide. The rewards need to match the effort and the work output.

What should you do if you are that child or employee and people no longer notice your efforts? What if you were not rewarded as a child and grew up as an underachiever? Are you doomed? Not at all!

In all these examples the problem for the person who is no longer getting rewarded is that they needed reinforcement from external sources. If you can learn to have what we might call an “internal locus of control,” if you can learn to do things so that you can be proud of yourself, then that lack of reinforcement may not affect you so much.

So it would appear that one of the secrets of having a happy life is being happy with the life you are leading.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How does therapy help people?

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

People ask just how it is that therapy or counseling works.

The short answer is that there are many ways, not just one way in which therapy may work to help someone. Professionals all have their own preferred theory of therapy which is the basis of their practice. What they do is highly influenced by the theory they use, though the truth be told most of us borrow from other theories if we see a procedure that might help a client.

The way counseling might help also varies with the problem the client brings to the office. In the early days, there was one profession that largely dealt with problems of the mind, psychiatrists. Today there are many specialties that work to help people with their problems of living. A caveat here, I have my preferred way of trying to be helpful. This is my opinion so I won’t pretend to fully explain all the procedures.

Therapists are empathetic, non-judgmental listeners.

There are some things people don’t feel comfortable talking to their families and friends about. One school of therapists, Rogerians, believe that most of us have the answers to life’s problems we just need to talk them out. Being able to talk through urges and fantasies helps people to understand themselves and may lead to an improved ability to control their behavior. Clients sometimes say their therapist just sat there, listened, and didn’t tell them anything. If you want or need more than listening, discuss that with your counselor.

Therapy can be a corrective emotional experience.

Many clients tell me they have trust issues. Often this is because there has been no one in their lives they could trust or because they were not trustworthy themselves. If their family was never very affirming, a positive therapist can help them to learn to affirm themselves. Group therapy is especially good at teaching people how to deal with interpersonal problems by allowing them to experiment with new behaviors.

The counselor can provide reality testing.

Clients may come to therapy with incorrect perceptions. People think they are fat when they are normal or below in weight. They think of themselves as too old or too dumb when they are in fact at a normal developmental point in their life. People make plans that they do not have the skills or resources for, they have expectations of others that are not realistic. Having someone to “bounced ideas off” can help ground plans in the real world.

Counselors help people change life stories.

Many people have a “story” about themselves that started in early life and which they have been unable to alter. People with call themselves “a loser.” This personal story, saturated with problems, may keep them from trying new things because they expect to fail at any new effort.  Narrative therapists help people create a new story.  Cognitive therapists would call this a “thinking distortion” and use various methods to get the client to challenge this belief and create a new belief about themselves that was more adaptive. Instead of thinking of themselves as a “loser”, the client may begin to see themselves as a “survivor” who has continued to try in spite of obstacles.

Counselors teach clients new skills.

A substance abuse counselor would teach a client refusal skills. A career counselor might teach his client how to use online career inventories, interviewing skills, or resources to use to conduct a job search. Marriage counselors may teach couples communication skills. Family counselors may teach parenting skills. Skills-based approaches may involve recommendations for books to read and real-life homework to increase skills. School counselors primarily work on academic issues, what classes to take, and how to succeed in school.

Counselors help clients get in touch with themselves.

Exploration of the self, personal growth, and discovery are all legitimate reasons to see a counselor. Counselors don’t make decisions for clients, but they can teach clients decision-making skills and encourage clients to practice these skills. Therapy can help clarify values and assist clients in evaluating choices. People may come to counseling confused and in need of help in gaining clarity.

Psychotherapy can assist in changing personality.

Psychotherapists often focus on basic personality characteristics. Psychologists can give and administer personality tests while psychotherapists can spend time working through personality characteristics the client may wish to change.  Changing an underlying personality characteristic takes more time and effort than the crisis-driven techniques but it can result in long-term changes in coping skills. Psychodynamic therapists work on the unconscious. More cognitive therapists would approach personality issues by trying to help the client gain a new worldview. “Getting a new pair of glasses” results in seeing the world and problems differently.

There are sure to be more ways in which counseling is helpful. What do you think? Are you a client who has been helped? What was helpful? If you are a therapist, what do you think helps clients?

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

Why ignoring them doesn’t work- or does it?

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

Bad behavior.
Photo courtesy of pixabay

8 rules for extinguishing bad behavior – Part 4 in our changing others series.

Parenting coaches tell parents to ignore bad behavior. They call this process “extinguishing.” They warn that paying too much attention to the child who is misbehaving only rewards them and increases the targeted behavior. Professionals tell parents to use extinguishing a lot. Many parents say it doesn’t work. Why?

Parents hate it when their child throws a tantrum. They try lots of things to make the kid stop. Fresh from the therapist, they decide to take the professional’s advice. The kid starts to scream. They ignore him. Eventually, he has to stop right? Four hours later the parents give up on the extinguishing method as their child is still screaming.

Rule 1: Bad behaviors are likely to get worse before they get better.

Most parents give up before the bad behavior ends. Kids can be a whole lot more stubborn than most parents. Isn’t it the reasonable person in a relationship that ends up giving in to the unreasonable one?

Rule 2: Kids will pick a place for their bad behaviors were you don’t want to make a scene.

If you chose to try to extinguish a bad behavior, in the early stages avoid places where you won’t be able to stick to your guns. Taking the kid with you to the store is sure to result in a tantrum in the early stages. It is easier to extinguish bad behavior at home than at the in-laws.

Rule 3: While extinguishing a bad behavior, make sure to reward any behavior change.

Just make sure not to fall into the bribe trap by offering positive rewards for stopping the bad behavior. We all have urges to do something positive to distract the misbehaving person, but if the distraction comes to close to the bad behavior it looks like the bad behavior got the reward. Wait till the child stops the tantrum for twenty seconds or so and then reward them for stopping.

Rule 4: Be sure you are not extinguishing a desired behavior.

A child crying can be annoying at times but they should cry when in pain. Make sure you check that there is no legitimate reason for the “bad” behavior before you decide to try ignoring it and play your “extinguishing” game.

Rule 5: If you want to stop something you need to always stop it.

Of and on actions are called intermittent reinforcement. But out food once for a wild animal and it will come back for a while until it is convinced that there will be no food. But if you feed it off and on it will keep coming back almost forever. People are like that also. If you want to extinguish bad behavior, don’t give in, not even once. If you are not consistent the person you are trying to change won’t know which answer to expect and they will keep trying forever.

Rule 6: This is not a one-person job.

If one person in the home tries to extinguish a behavior but the rest of the family gives in it will not work. Make sure all the people who might reinforce the bad behavior are on board with the effort to extinguish the bad behavior.

Rule 7: There will be ups and downs.

Bad behavior that has been extinguished may return after a time. Why shouldn’t a child, or adult for that matter, try something again that had worked in the past. The person who has lost the advantage of their previously useful bad behavior is also likely to get frustrated. Sometimes they even get aggressive or violent. A tantruming child who is ignored long enough, may up the ante and come over and hit you. Consider how you will respond if the aggression increases.

Rule 8: Good behavior extinguishes also.

Good behavior that is not reinforced will start to fade quickly. While trying to get someone to cut down on or stop bad behaviors, you need to keep praising good actions or the good things stop also.

Our series on changing other people’s behavior focused here mostly on children is about to change direction. We talked about getting more good behavior and we have talked about how to reduce or stop an undesirable or bad behavior. But what do you do when the behavior you want from someone is a whole new action? How do you get them to start doing something they have never done before?

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

Rewards gone wild

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Need to change

Time for you to make a change?
Photo courtesy of Pixabay.com

Changing others part 3.

By David Joel Miller, LMFT, LPCC.

Sometimes positive reinforcement goes wild. Instead of increasing desirable positive behaviors, positive reinforcement incorrectly applied can create more negative behaviors. Let’s look at some examples.

It is Super Bowl Sunday. Dad wants to watch the game. The kids who are bored to death start getting loud and thrashing around. Dad decides to get this to stop and gives the kids some money and sends them to the store. They don’t interrupt the big game. But then over time, something begins to happen. Dad notices that now every time he wants to watch a game on T. V., the kids get loud and rambunctious. He brings them to the therapist because they are “disrespectful.” What has gone wrong?

It is way too easy to positively reinforce bad behavior. Once you reward bad behavior it begins to expand. Often we do this without noticing that this is what we have done.

Another example. The child, in the store, begins to wine. Mom is getting tired and so she decides she has had enough. She leaves the store and goes home. The problem of whiny kid solved, for now. But over the years mom notices she has a very whiny kid. She can no longer go anywhere the child does not want to go or the whining begins. Another example of how a quick response to a misbehaving child can result in positively reinforcing bad behavior.

A more adult example. Dad can’t find his keys. He is late for work. He begins to swear and yell. Mom goes running and helps dad find the keys. Problem solved for today. But over time if mom runs every time dad is frustrated and yells, dad will yell and swear more. Mom is unknowingly training dad to yell and swear. Sometimes these cases end up in counseling. More of them should. After a while, we start to believe that it is others that are making us mad and of course when mad we should vent our frustration. Anger management classes which include cognitive-behavioral methods may be needed to break the cycle of anger, yelling, and swear words.

But it can get worse. Even if you do not reinforce bad behavior in your child other people may. I worked with one client who had older sisters. They lived in a poor part of town where there were lots of gangs. They used to dress their little brother up as a gang banger. At three it looked “cute” when he reached thirteen and became a real gang banger they were surprised. They shouldn’t have been. They had positively reinforced his looking like and acting like a gang member so much it was natural for him to become one.

This is one reason it worries me when people dress little girls in sexy or “trampy” outfits. Then when she gets to be a teen they try to clamp down on her clothes and behavior. She has been so thoroughly positively reinforced for acting in a sexualized manner why would she change? Besides she is not home now for you to change her behavior. She is out on an overnight date with that “cute” gang banger.

But other people, sometimes with good intentions, also undo our efforts to help children. A child who is shy and feels lonely often begins to avoid others and hide in the corner. So all the staff starts going over to talk to the child. Soon the child is getting lots of attention, which is what the child wanted. So does the child come out of their shell and start being less shy? Not on your life. All that attention for the “shy behaviors” was so completely positively reinforced that the shyness increases.  The right approach would have been for all staff to have watched the child and when they looked over to smile. Positively reinforce any outgoing behavior no matter how small and it might increase. But one staff member can unintentionally undo the work of all the others. So in the home how often do family members, knowingly or unintentionally undo the change efforts of the rest of the family?

It is very important that all the adults in a child’s life be on the same page when it comes to behavior modification. It is also important to be consistent.

Here is hoping that this series is helping you in your efforts to change both yourself and those around you. More to come.

For more on the process of change see the blog post series “Stages of Change”

There is also a series of posts on helping others change, under the heading of “Changing Others.” and “Creating the Change you need.”

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

Improving Relationships – Changing Others Part Two – Encouragement

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

Couple

Relationship.
Photo courtesy of Pixabay.com

Using Encouragement to create change.

One way to improve relationships is to encourage others to do the things we want them to do. This is true whether the relationship we are talking about is a romantic one or the parent-child type. Last time we started to talk about the use of rewards to increase positive behavior. Professional behavior modifiers call this approach the use of positive reinforcement. When we say rewards, lots of people think of tangible things. But positive reinforcements include lots of things that are not physical, like praise and encouragement.  There are some guidelines for using positive reinforcements. Correctly used they are powerful but incorrectly applied they will disappoint.

Marriage counselors stay busy with couples whose main ways of trying to change their partner is to argue, fight, and complain. Researchers like the Gottman’s tell us that for a relationship to be satisfying the positive interactions need to outweigh the negative by a wide margin. But not all positives are created equal.

For positive reinforcement to work, you have to pick the right reward. Chapman wrote a book applying this principle to couples called “The Five Love Languages.” The premise is that different positive rewards say love to different people. So if your partner feels loved when you praise them and you try to make them feel good with gifts, you two are speaking different “love languages” and as a result, your positive reinforcement is not going to work. For the full list of languages and applying them, you might want to read the book.

One important rule for using positive reinforcement is to pick the right reward. Say your child really likes playing video games. He hates doing his homework. So you tell him if he does all his homework this week you will get him a gift on your way home from work Friday. One your way home you stop at the toy store and find him a gift, a new book called “Doing Math the Fun Way.” Is this likely to make him happy? Will he be likely to do his work the next time? You picked the wrong reward and it looks more like punishment, more homework, to the child.

Men are particularly prone to falling into this trap when “positively reinforcing their partners.”  If you decide to make her happy by buying her a box of candy, that might work. But if you bring her a gift two days in a row, presumably before she has eaten very much of the first box, will that be positively reinforcing? The second box will get a lot fewer results than the first. Now, what if she is on a diet and just lost some weight, should you bring candy? This is more likely to end in an argument than to increase positive interactions.  Pick the right reward.

Now there are times when a given reward works better than others. A drink of water works better when you are thirsty than when you just finished drinking something. Bars put out salted snacks for just that reason. So if someone has been without the reward for a long time it is more rewarding. After going without their phone for a while a kid is willing to do a lot more to get one than if you just took it away yesterday and they are still mad. The principle here is, don’t overuse a reward and use them at the times they will have the most impact.

You take your child out for a treat, a special time together. That should be really positively rewarding. You go to the mall and walk around. Malls are frequently very positively reinforcing for adolescents. Your child lags behind. As you offer to buy them a particularly popular piece of clothing, they burst into tears.  Trip over. You head home. Once home you set the child down on the couch, time for a talk.

You explain to the child that you can’t understand why they got so upset. You were trying to positively reward them for all that hard work and their good grades. Your child goes storming out of the room, doors slamming. You look over at your partner. What went wrong? “The new report card came in the mail today.” your partner says. “Four F’s this time.”  How did you go so wrong?

Positive rewards have to occur very soon after the action you want to increase. The shorter the time between the action and the reward, the more reinforcing it will be. You should have done the trip immediately after the last report card when there were some good grades to reward. By waiting so long you let other actions good and bad happen in between. Now the reward looks like a punishment. The sooner the reward is given the larger the result.

How long do you have to keep the positive reinforcement up? People are afraid that once they start it they may need to keep it up forever. There are two ways to get past this. Create a set of instructions that the person whose behavior is being changed can repeat to themselves. Kids learn to repeat these instructions as they do the task and then they can positively reinforce themselves with the knowledge that they did the task well. Look for natural reinforcers in the environment. Humans are social animals, we like others to like us. Once a positive behavior is created the positive reinforcement can be changed from a tangible reward to things like verbal praise. Eventually, smiles may be enough to reinforce the new likable behavior.

Positive reinforcement works not only for changing others but also for changing yourself. If you have embarked on a program of self-change remember to give yourself frequent, positive reinforcement for the progress you are making. Sometimes positive reinforcement backfires and creates a huge negative response. Why?

More to come on behavior modification and changing yourself or others.

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

Changing Others – Part One

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

Change

Change.
Photo courtesy of Pixabay.com

Sometimes we really do need to change others.

Now I know I talked to you before about how hard changing others was and how we first need to look at ourselves. We have also looked at the way in which really lasting change happens. But sometimes we do need to try to change other’s behavior especially when it is not us they are harming but themselves and their acceptance in society. If your child is hitting other students you could wait to see if he outgrows it, but by then he may be expelled from school and you may be stuck with an unruly brat in your home all day. So sometimes teaching others to change is for their own good. There is a process for this way of changing others and it is called behavior modification.

Now I know I talked to you before about how hard changing others was and how we first need to look at ourselves. We have also looked at the way in which really lasting change happens. But sometimes we do need to try to change other’s behavior especially when it is not us they are harming but themselves and their acceptance in society. If your child is hitting other students you could wait to see if he outgrows it, but by then he may be expelled from school and you may be stuck with an unruly brat in your home all day. So sometimes teaching others to change is for their own good. There is a process for this way of changing others and it is called behavior modification.

Now I know I talked to you before about how hard changing others was and how we first need to look at ourselves. We have also looked at the way in which really lasting change happens. But sometimes we do need to try to change other’s behavior especially when it is not us they are harming but themselves and their acceptance in society. If your child is hitting other students you could wait to see if he outgrows it, but by then he may be expelled from school and you may be stuck with an unruly brat in your home all day. So sometimes teaching others to change is for their own good. There is a process for this way of changing others and it is called behavior modification.

Behavior modification began as largely experimental methods. It was used to change animals and later was applied to developmentally delayed clients. It has been gradually expanded to include all kinds of groups from kindergarten kids to college graduate students. And the great thing about behavior modification is that it works. But it does not involve what most people think it might include. Behavioral modification is not a shorthand name for brainwashing or manipulation. It is about helping people to change who don’t know then need to change.

Lots of behavior change methods have been criticized as manipulation. I cringe when I hear that expression. Don’t all kids manipulate? It is one way of getting your needs met when a direct method does not work. We need to teach others how we would like them to behave and then encouraging that behavior. For the “spare the rod” crowd I reiterate that physical punishment is the least effective method of teaching most of the time. It produces angry people who hit back or beaten people who stop trying. Real discipline is about training, not punishment.

Some people think the opposite of punishment is bribery. That won’t work either. If you bribe someone, particularly a kid, to do what they should do, next time the amount of the bribe will need to be increased. Eventually, the whole bribery method collapses when you can’t or won’t pay the exorbitant amounts demanded. Not sure about this, check with Washington.

The first step in changing someone else’s behavior is to get crystal clear about what behavior you want to change and why. Let’s take an example.

Mom brings in a child which we will call Clarence for want of another name. Mom is tired of getting calls from the school that Clarence won’t behave. She wants me to fix him. Sorry mom, I am fresh out of parts for that year and model. You want him changed, you as his parent need to do that. I will be glad to teach you how but you will have to do the work.  So mom what is Clarence doing? When you say he does not behave – what exactly does he do or not do?

At this point, mom pulls out her list. He won’t do his homework, does not stay in his seat, makes “mouth noises” did not clean his room, and got in a fight. The fight might be anger management, but the mouth noises, that is a whole nother thing. So I ask the mother what is the one thing, the one most important thing she wants to change about her son. With behavior modification, we need to start on one thing to change and then progress to each item on her list one at a time.

Mom picks “won’t do his homework” I feel myself starting to relax. This is a case of increasing a behavior. We have more and better tools to increase desirable behaviors than we have tools to reduce undesirable behaviors. Also, this is something specific so we should be able to tell when we are making progress.

Sometimes I get things like I want him to be friendlier. What exactly do you mean by being friendlier? Bringing home a girl?  Giving away your stuff? Or would you settle for smiling more? A specific behavior like smiling more is easier to work on than the vague friendly thing.

The fastest way to increase a behavior is to reward someone for doing the thing we want them to do. Someone in the back of the class just yelled foul. You said no bribes. No, I am not saying bribe the kid. I said reward. What is the difference? A bribe comes before someone does the act. A reward comes after and the two things are connected. So my boss pays me if I show up for work for a whole two weeks. He does not give me a bribe first and then hope I will show up. And the amount was clearly understood. It does not go up each time he wants me to show up.

Let me give you a hint here. For many kids, praise for something done well is even more reinforcing than things. Kids who have a close relationship with their families want to please their parents. Just make sure you let them know you are pleased. If my boss were to stop paying me I might get the idea he does not want me working there and I would probably stop showing up. I might also get really mad.

So next time we will need to talk about what things might be rewards and how to use these to increase positive behavior without falling down the bribe trap. Rewards are also powerful motivators in adult relationships. If you do not make each other happy more often than you make each other mad your relationship is headed for trouble. So very soon I plan to write a post about rewarding your partner to keep the relationship alive. Till next time

More on the topic of changing others can be found at:

Changing others part two 

Rewards gone wild

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

Clear Values

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

When you are struggling with life’s problems it is difficult to keep your priorities straight. People who have anxiety disorders find everything is so important they run from task to task with never a chance to rest. People with depression find any and all tasks overwhelming. Sometimes it is hard to take any action. Recovering people are often faced with the need to decide what is really important in their life. What things need to be kept and what things can be let go. We call this process “values clarification.”

“Values Clarification” is also an exercise that we sometimes run in group therapy. It goes something like this. Each member of the group is asked for two things that are important to them. We go around the group and everyone gets a chance to tell us about two things that are important in their life. I like to write this on a board or paper in front of the group as I go. Sometimes we get several things that seem almost the same and need to be lumped together. For example, one person may say my job and another says his career. I make a bigger category of employment.

These lists contain quite a variety of things. Some people nominate material items, a car, money, or a place to live. Other people list self-improvement things like education, sobriety, or achieving a life goal. Many people mention relationships, like with their wife, husband, or children. Some people include spiritual values like God or religion. And there are often nominations for global goods like peace, health, ending pollution, and saving endangered species.

Now I have found that the list I get varies a lot depending on the group involved in this exercise. People in a locked hospital because of psychosis are likely to mention basic needs of life, like food or a place to live. People in substance abuse treatment are more likely to mention things like sobriety and attending twelve-step meetings. They are also more likely to look at internal personal things as important like peace of mind and self-respect.

The next step in the process involves clarifying these values. Son and daughter might be combined to make children and so on. Each member of the group is then given three votes for items on our refined list. This requires them to vote for at least one thing they did not nominate. It also allows people to change their minds and vote for things that they did not think of before. In the process of voting a strange thing takes place.

The list has some items with a lot of votes and others with few or no votes. In almost every case I have ever done this, relationships, family, and friends rose to the top of the list. So did intangibles. Peace, happiness, sobriety, and security, which beat the heck out of money, cars, and pleasure most every time. In recovery, we find that the values we hold drive our actions. It is important to be clear about what really matters.

So if relationships and peace of mind are so important to us – why do so many people spend all their time and effort on making money and getting things?

What is important to you? What do you spend your time pursuing?  Care to comment and share what you value most?

Special thanks to Irene Aparicio, LCSW, an early supervisor in my career who taught me this exercise.

Till next time, David Joel Miller, LMFT, LPCC

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

Bipolar – misdiagnosed or missing diagnosis?

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18

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Diagnosing Bipolar Disorder.

Why is it so hard for people with Bipolar Disorder to get diagnosed and treated? For mental and emotional problems, the sooner the diagnosis, the sooner the treatment begins, the less the suffering. The more entrenched the illness the longer and more difficult the recovery. We continue to have difficulty with Bipolar Disorder. Why?

Almost 70% of people with a Bipolar Diagnosis had another diagnosis first. On average they get four other diagnoses before the Bipolar one. Usually, somewhere along the line, they are diagnosed with Major Depressive Disorder, given an anti-depressant. At this point, on an antidepressant, 40% of clients with Bipolar experience an episode of mania or hypomania. Antidepressants given to people with Bipolar disorder also increase the likelihood they will become rapid cyclers.

Our understanding of this condition has changed over the years. To be honest the mental health profession’s understanding of most illnesses has changed a lot over the years. We used to call Bipolar Disorder by another name – Manic Depressive disorder. Clients continue to come into facilities and tell us that they have Manic Depressive Disorder and Bipolar, not understanding that both are the same thing, just a new name.

Currently, there are two principle camps in this debate – those who think too many people are being diagnosed with Bipolar Disorder and those who think that professionals are missing a lot of Bipolar Disorder. The controversy goes back to the first efforts at classifying anything, the lumpers, and the splitters. Some people would like a different name for every possible type of dog; other people are content to consider them all dogs, the same with mental illnesses. So what difference does it make? It could make a lot of difference.

Ira Glick, up at Stanford wrote an article a while back called Undiagnosed Bipolar Disorder: New Syndromes and New Treatments. This is not a really new article but it is important as we think about how the diagnosis is likely to change in the next few years when the DSM-5 comes out. Glick suggests that the true rate of Bipolar may be as much more than what is being diagnosed. We used to expect Bipolar Disorder to run 1% to 2 % of the population; recently it has been diagnosed closer to 7%.

We are starting to think of this condition as a spectrum disorder. So there is a range of symptoms and the ones with less noticeable symptoms are not getting diagnosed.

Does it matter if some mild cases are getting missed and not treated? Yes, it matters and the clients with the less prominent symptoms are not necessarily milder cases. Currently, we separate cases into Bipolar I and Bipolar II.  People who have Bipolar II don’t have pronounced episodes of mania. They do have other significant differences.

People with Bipolar II have way more unemployment. They get divorced more often; have more thoughts of suicide and more suicide attempts. This one disorder, according to Glick, accounts for more suicide attempts than any other mental illness, excluding personality disorders. This is a big problem since Bipolar II looks like Major Depression until the mania or hypomania kicks in.

Many people who eventually get the Bipolar Diagnosis are first seen by their primary care physician. Primary care doctors treat more than half of all the depression and anxiety. There are a lot of medical problems that are especially problematic for people with Bipolar Disorder. People with bipolar disorder are more likely to have migraines, diabetes, or obesity.

Medications for people with Bipolar are especially problematic. People with Bipolar II get antidepressants till they have a manic episode then they may get all sorts of meds. People with Bipolar I have the more pronounced psychosis and may get all kinds of heavy-duty antipsychotics. Sometimes people with depression have distorted thinking and we see psychosis. Sometimes the psychosis in Bipolar II looks a lot like Schizophrenia, Schizoaffective disorder, and a lot of other things.

We are also not sure how much of all this is a result of genetics and how much is learning. Some authors have talked about how personality traits, those supposed unchanging characteristic ways of behaving may be related to Bipolar Disorder.

In fact, there is some question as to which mental health issues are district illnesses and which are symptoms. A cough is easy to notice but what causes the cough can vary a lot from person to person.

Despite all the issues with diagnosis, Bipolar disorder in all its forms causes a significant amount of suffering. It is also a difficult disorder to manage for the client and for the professional. If there is a chance you or someone you know has this disorder get a professional evaluation. If you have Bipolar disorder become a knowledgeable client, and don’t give up hope, the treatment options continue to improve.

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