Three-year-old judge decides right and wrong

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

child

Child.
Photo courtesy of Pixabay.com

6 ways to tell right from wrong.

Preschool kids seem to be so very good at telling what is right or fair. They tell us often enough – “That’s not fair!” So how come they so often do things that we say are wrong? Maybe we should appoint three-year old’s to the Supreme Court? Is the understanding of right and wrong something people are born with or do they learn it? And if they learn moral values, how do they learn it?

In the early grades the ways in which kids decide the difference between right and wrong starts to change, at least for some of them. It is important to understand how it is that people learn right from wrong. Why some don’t seem to learn might also be a good thing to find out.

People who study child development probably learned about some theories of how an understanding of right and wrong developed. Counselors are often taught about the stages of moral reasoning, in some developmental classes and then seem to promptly forget it once they start working with real clients. But isn’t right and wrong, and conflicts over how that should be decided one major reason we see clients in counseling?

Lawrence Kohlberg researched and wrote about moral development. So did Lickona who wrote a very readable book “Raising Good Children.” I would recommend it to any parent struggling to teach their child the difference between right and wrong. Somehow all this work is getting forgotten despite the constant reports of high crime and failure of discipline in the home and school. We spend a lot of time these days emphasizing math and science in schools, but less and less time in our homes and schools is spent on right and wrong. So how is a sense of right and wrong likely to develop? Let me give you a brief description of Lickona’s ideas as I remember them. For the full details you might want to look for the book but here is my short version of the 6 stages of moral reasoning as I understand them. Lickona numbers the stages zero to five. The fact that he arranges them this way does not mean everyone agrees that a lower numbered stage is, in fact, better than another stage with a larger number.

0. Getting what I want is fair!

This is the default way of deciding right and wrong. It’s not fair – I wanted ice cream and I didn’t get any. Some people seem to be able to go through their whole life thinking this way. They take what they want and that is fair to them. Some of them go to prison. Some learn to hide what they are doing. Some of these folks end up elected to public office or working on Wall Street. These folks make lawyers rich when they try to get out of trouble for doing what they want. If we don’t want more of these folks around we need to work on teaching kids the more advanced ways of deciding right from wrong, or we need to build more prisons.

1. The teacher said – the authority approach.

Some kids learn this at home before they go to school, for a variety of reasons. Most kids learn this in school. It starts by learning to do what the teacher says. Eventually, the appeal is to some higher authority like the principal. Some people get really legalistic. It says on the page — of the revenue code, that I can do this so it must be right. In some places, with statute law, if there is no law against it, you can do it. In most places in the United States, we have the common law which says you should use common sense unless there is a law otherwise. Then we have lots of layers of appeals courts because we are so short on common sense. We see lots of people who appeal to religious writings as their rule book, sometimes to good effect and sometimes to some awful results. The problem here is not especially with the particular religious writing, but some of the bizarre ways people can interpret those writings. The philosopher, Charles Shultz once reported, something to the effect that “There is nothing in the book of Leviticus that prohibits the wearing of contact lenses.” See how hard I am trying to be politically correct here?

Some people would separate “The Teacher said.” part, from the “The rule is.” Both are resorting to authority but one is putting your faith in a person and the other in some specific set of rules.

2. One hand washes the other.

This commonly heard, usually, in business, expression says right and wrong is something we trade.  We take turns. Most kids learn this on the playground really fast. If you don’t take turns with the ball you may not get to play at all. In Congress, this is called trading votes. You vote for my bill and I will vote for yours. It is pragmatic, gets things done. But is it the best way to determine right and wrong? We need to study this. Send me a million or so in federal money and I will be glad to work on this approach. At a million dollars a year we may need years of study. See how problematic trading one thing for another might be as a way to separate right from wrong?

3. I want you to like me.

So if I want you to like me I should do what you think is right. This is the “what will people think of me” approach. This type of social conformity can keep people acting in a socially positive manner – sometimes. The issue here is what people’s opinion do I care about? This goes to the discussion of peer pressure which I wrote about in an earlier blog. Take a look at that one – now if you want, it’s ok. I can wait here while you look.

You back? So you see that if my peers are good law-abiding people I probably will follow the law. But if my social circle includes convicts, murders, rapists, bankers, politicians, and other undesirables, I might decide that stealing your money was an acceptable thing to do, so long as I steal it using the same methods as my peers.

So using other people’s behavior as a guide to right and wrong may reduce the conflict we have in life, but it is no sure way to figure out right and wrong or to stay out of prison. Ask the group from Enron.

I may be a little hard on this stage. It is great to be a good son or daughter or a good parent. But that may not be enough, especially if you didn’t have good role models. This step in the development of morals is mostly about your relationships with people close to you.

4.  What is best for all of us?

This is the stage where people may do things that have personal costs because it is the thing that is best for our society. This stage of moral reasoning gets people to join the military or become volunteers. This is an altruistic stage, most of the time. It is also a way of moral reasoning that has been used to excuse some horrific atrocities.

Today in America we value diversity. Some of us do anyway. But can you see how someone in another place and time could do some awful things and justify it as “what is best for us?” Think genocide here. Could someone do that thinking it was what was best for their group? The difference between being a volunteer to work with the poor and trying to run a minority out-of-town hinges on who you define as us.

5. Some things are right just because they are right.

This is an easy one to explain in theory, until you are faced with the choice, then it is easy to default to an earlier stage of moral reasoning. Sometimes people are faced with things going on in their society that are just not right. And often it costs to do the right thing at these times and for sure there is nothing in it for you when you do the right thing at these times. This is about respecting everyone just because they are.

So there is my explanation of stages of moral reasoning as I understand them. Can you see how hard it is to figure out the right thing to do sometimes? Some parents are able to teach their children right from wrong despite all the influences around them to the contrary, but what about the other kids? It feels to me like we should spend more time in our society on the ways to determine right and wrong and less on some celebrity’s outrageous behavior. But that’s just my opinion. What do you think about how we learn to tell right from wrong?

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

Thanks – I think

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

Counselorssoapbox.com

Thanks – I think

Even when I don’t agree with someone I appreciate their interest in my blog. Links are even better. I think it was La Guardia that said, it does not matter what you say about me, just spell the name right, or in this case get the link right. But still – something that happened today shows how easy it is to be misleading when you quote someone else. In this case, they were sort of quoting me.

My blog about our tendency to take the easy way out and give kids lots of meds instead of the personal connections they need to develop was quoted on a website about Medicare. That was nice, only the picture they ran with my blog post did not come from my blog which might make it misleading.

Just so everything is clear, I am very much in favor of parity laws. Paying as much to treat mental illness and drug addiction as we do for physical illnesses is an idea whose time has come. I am also in favor of anything that makes sure health care coverage is available to all.

People who do not have health care end up at free county hospitals and most of the time they don’t get to the emergency room until they are critical. People with untreated mental illnesses are clogging up our jails and prisons and medical hospitals. We pay for all this treatment whether the people have insurance or not. So some form of national healthcare preregistration just makes the system more efficient and manageable.

It seems clear that the country cannot retreat to the days of family farms and paying the doctor with chickens. Our future also does not involve making more things for cheaper prices. Our future as a country does depend on developing minds. We need more Ph.D.’s not more press wood furniture.

Some people seem to think that teachers, especially college ones are a waste of resources. They don’t want to pay for medical services for anyone but themselves. If this country is to stay a world leader we need more teachers, more doctors, and more professionals who work in mental health and substance abuse. We also need more engineers and scientists. Developing these specialties requires easily accessible education as well as physical and mental health care.

All of these things, like the military and the coining of money, are things that need to be undertaken by the government for the good of all. The majority of promising candidates for the service industry do not come from the rich. The best and brightest minds come from among the ninety-nine percent and they need the government at all levels to promote the growth of the service industries and education.

The future is in the areas of ideas and services. The government needs to take the lead in growing these sectors. I am not opposed to businesses having a large role in this effort. Non-profit companies are especially good at efficiently providing these services. But the mentally ill, the drug addicts, and the homeless don’t have money to pay for their care and we all pay for it one way or another.

So the association of a picture of President Obama superimposed with a communist flag was not my sentiment. If anything, I think this administration has been too conservative in accommodating the role of large businesses in the economy.

We made progress in the space race because the administration at that time led the country into a new area. Hopefully, our leaders will lead again into the new service-oriented economies of the next few centuries.

The one bright spot in all this, to my way of thinking, is that at least a couple of Republican candidates for our highest office are now sounding like they are more liberal than the current administration. Maybe this veer in the liberal direction will get our nation back on track.

The hummingbird picture came from Wikimedia. It has nothing to do with this post but then the picture someone attached to my last post quoted on their website had nothing to do with my post. So now things are about even.

Hoping you all have a happy and mentally healthy holiday season.

David 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

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Is your child taking too many meds? Are you?

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

Drugs

Medications.
Photo courtesy of Pixabay.com

Is your child taking too many meds? Are you?

Ever wonder about the amount of medication, especially heavy psychiatric medication, which is being prescribed to very young children, especially foster children? I know I do. How did we get so many children who need that level of medication? What should you think if your child or the child you care for was prescribed that kind of medication?

There was an article on the internet this morning about the large number of prescriptions for antipsychotics to foster children.  These kids were being given not one medication but multiple medications and many of those medications have serious long-term side effects. Some of these side effects do not go away even after the medication is discontinued. So is all that medication really necessary?

The usual warning applies here. No matter what you and I think, it is unwise to stop, start or alter the dose of a medication without talking with your doctor first. If you are not confident with that doctor’s opinion get a second opinion. It is not safe to play doctor and change the meds yourself. But you should question things if the medications are not working or if it appears to be creating serious side effects.

So why so much medication in children? And why foster children in particular?

Now we have been hearing tales about facilities that overmedicate residents to keep them manageable for a long time. Mary Jane Ward in her book “Snakepit” describes patients in a mental hospital who were heavily medicated primarily to keep them from causing the staff problems. We also hear stories about jails and prisons using lots of meds to keep inmates from causing trouble. But is that sort of thing happening to kids? And why foster kids?

Maybe the reason is that foster kids are the ones that have the most problems? Are children in foster care more likely to have serious mental illnesses? There are two reasons to think this is not true.

The study reported that when kids in foster care were compared to other kids who were receiving Medicare the foster kids got a lot more medication that the kids who were not in foster care. Secondly, the kids in foster care should be the ones who would respond to a secure home situation. Foster care is usually looked at as a housing problem, not a mental health problem. So the seriously mentally ill children should and often do end up in group homes and institutions where they can be managed with less, not more medication. So what is going on here?

One problem is that as a society we are increasingly relying on medications, drugs if you will, to fix all our problems. Despite all our programs to get people off drugs, there are countless commercials that try to convince us to go to the local drug store and get some pills to cure all that ails us. Try counting the number of pro-drug ads on the television on any given night and then tell me that we as a society are opposed to drugs. In this country we love drugs so much, are so convinced there is a chemical that can cure whatever is wrong with us that we now want all our children to take all the drugs they can. We just want them to get their drugs from a drug store not a drug dealer in an alley.

So why are children being given so many drugs? To relieve suffering? Not a chance!

Kids are getting prescribed drugs to make them smarter and to make them behave.

Kids are being prescribed powerful stimulants for ADHD. Even kids with mental retardation and developmental delays are getting ADHD medication. This makes me question the accuracy of some ADHD diagnoses. And if the pills make one kid smarter shouldn’t all children take them?  Here is hoping you read that blog post also.

The other reason kids get so much psychiatric medication is to make them behave. I thought not always behaving properly was a symptom of childhood? Can’t we teach them to behave without sedating medications?

Children are being given lots of sedating antipsychotics mostly because their behavior is causing some adult a problem. Some of my colleagues will argue that if the child does poorly in school or gets in trouble for bad behavior they will end up suffering so by giving them medication we are preventing suffering. For me, that would make sense if there were no other alternatives. But there are other options.

Many of the problems of children for which we give them medication can be controlled, even cured by giving them attention in the proper way. Therapy and counseling are especially helpful for treating many emotional problems. ADHD can be treated by training parents as I wrote about in a previous blog. But far more kids get a prescription for a medication than are getting a session with a caring adult.

Yes, there are professional counselors and therapists; I do that for a living. But the benefits of other adults in a child’s life should not be underestimated. Teachers, grandparents, natural or foster, and friends all are helpful in a child’s learning emotional regulation. So why do we reach for meds first instead of human contact for all the emotional and behavioral problems?

Some people have suggested that counseling is just too expensive. I am not buying that argument and you won’t either if you see how much agencies are spending on medications.

Despite all the things we have learned over the last couple of centuries about the benefits of counseling in overcoming life’s problems we as a society still seem to think that if something bothers you there should be a drug to fix that.

My conclusion from all this is that a lot of kids and some adults are being given lots of medication instead of human contact. It appears that we as a society and some people individually just don’t care enough to bother with anything more than a pill to make the kid behave.

So what do you think? Could we try another approach? Are kids and adults taking too much psychiatric medication because we don’t care enough to do better?

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

6 Rules for surviving your teen

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

Teens

Teenagers.
Photo courtesy of Pixabay.com

When the teen years arrive, armed combat begins.

How do you survive your teen unharmed?

Sometime between eleven and thirteen that cute cuddly kid turns into an unrecognizable scratching clawing creature. Once in a while, the parent gets away unharmed but not often.  Parents say they don’t know what happened to their child. They don’t recognize this kid. So what happened?

How do you survive the teen years and is there a life after teens? Here are some ideas; maybe we could call then rules for those years.

1. Don’t try to hold the lid on the boiling pot.

You have spent a decade on more raising a generally civilized child, as the teen years approach and the emotions boil parents often make the mistake of clamping down. Suddenly the cute little daughter who everyone likes – well – the everyones who likes her, are no one you would want around. The result is trying to keep her in. “No dating till you’re thirty,” the parent says. Then the battle ensues. Parents try bolting the windows in her room shut, but like a magician, she somehow gets out. Parents put kids on monitoring. Call me every hour. The kids retaliate with more excuses than a congressman.

Controlling a teen, especially an older one by force is likely to wear you out and have no effect. Sometimes parent’s efforts to make the kid behave turn into violence. Sometimes the parent resorts to hitting the child, always a bad idea. You may discover you no longer have it in you to go ten rounds with a younger and stronger opponent. I have seen parents seriously hurt by their kids. The other, more serious problem with using force on a child is it teaches them to use force and there is no end to how far this will go. So rather than trying to keep the steam in the kettle by holding the lid down, try directing the steam where you want it to go.

As the teen approves adulthood parents may need to learn to discuss and even negotiate things with their offspring. I am not saying let the kids take over the house, but you do need to teach them how to handle more adult responsibilities. By sixteen or seventeen you should have taught your child the difference between right and wrong. If you haven’t it is probably too late and someone with more control than you will need to take on the job, someone like the police or parole. You need to keep up hope that the child will survive, unharmed, the episode of moral amnesia that so many of them experience.

2. Do not try to overprotect them!

You spent ten or more year protecting your child, every “good enough parent” does. Suddenly the experts tell you to stop trying to protect them. I know they will be sixty and you will still feel protective towards them but the teen years are the time for loosening the restrictions, not tightening them. You had to let them ride their bike without your hand on the seat, now you need to let them try some more adult things.

Every night in crisis centers around America we see kids whose parents have always been supportive or permissive, who suddenly engage in a life or death struggle for control with their teen. Kids who had no curfew now chaff as the parents set limits.  Parents worry about drugs, alcohol, driving, and mostly sex. They try to keep their kids safe by keeping them away from the risks – that won’t work.

One day they will turn eighteen and then they will be allowed to make all their own decisions. Some kids start before that. There is no magic cloak of maturity you can give them on that occasion.  You need to begin now teaching them how to be responsible adults and one way they learn that is to try things and see what works and what doesn’t. Increasing rules and restrictions may feel like it is protecting your child but it may also be delaying the growth of maturity.

3. Notice when your child does something right.

Many kids report the only time their parents notice them is when they are correcting them. Constantly finding fault with teens is not likely to make them perfect. It often results in kids who are highly anxious, afraid to do anything because they are sure they will never be able to do it right, or you get kids who give up trying. If the only way to get your attention is to mess up, they will mess up on a daily basis. They are after all giving you what you are requesting. You will get more of whatever you attend to.

Now I am not suggesting hollow praise here. Kids can see right through praise that was given to increase self-esteem but which they see as just something everyone is able to do. What I am suggesting is that you need to pay close enough attention to your child to know when they do something noteworthy and then let them know that you noticed and approved of that.

4. Be their parents, not their friends.

Kids should be kids and parents should be parents. Sharing your drugs with your child does not make for a good relationship. It makes for a child who does not know how to observe boundaries. And even worse are the parents who flop back and forth. One day you want to be the kid’s best friend, maybe even keep a secret from the rest of the family, the next they come down on the kid with all their force because the kid is not doing what they want.

5. Know the difference between rewards and punishments and bribes and abuse.

Lots of people in our society don’t seem to know this one. From the way we see celebrities and politicians acting you would think they are the same thing. They are not.

Rewards and punishment should be directly related to the person’s actions. For adults, this is easy to explain. If I show up for work on time and do my job I get a check. If I am late, I get docked some pay. If I keep coming in late I may lose my job. Parents get this confused and send the child to their room for getting bad grades. Bad grades should get more study time. Going to your room should be a punishment for not behaving around others. See there is some connection between the two.

Do I need to say that some of the punishments I see require me to report the parent to child protective services? Don’t ever let the punishment get out of proportion to the action. When it does it can turn into abuse. This is especially true of physical punishment and name-calling. Calling your child stupid will not improve their grades; it will make many of them stop trying.

6 Pick your battles

Parents, especially of late teens begin to get desperate. Time is running out to teach your child how to behave, especially if you have a strong feeling they should behave exactly the way you want them to. So every day becomes a battleground. The chances that your child will turn out perfectly are not especially good. They all have their flaws. So do their parents.  Unless you really like to fight, day and night, I suggest you reserve your line in the sand efforts for the really big things. Which is more troublesome, your teen’s messy room, or their drug habit?

Like all advice, these rules are easier to say than to do. My hope is that this is helpful to someone out there. If you have comments or suggestions please comment on this blog.

So there you have them, 6 rules for surviving your teen.

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

Am I a quart low on serotonin?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Low on Serotonin?

There has been a lot of talk about the way in which neurotransmitters affect the brain. Some of this has been helpful in understanding mental illness and some have not helped at all. On common expression has been that someone had a “chemical imbalance in the brain.” I wanted to talk about that and some other issues related to psychiatric medication in today’s blog. Please keep in mind that this is a highly simplified explanation. Remember I am a therapist and counselor, not a doctor so I need to find simple explanations for clients and myself without misleading them. If you have a background in biochemistry or research skip this blog now. If the doctor has told you to do or not do something please follow the doctor’s instructions or at the least talk with your doctor about these issues. The rest of you let me know if this helps explain things.

The expression chemical imbalance is a bit misleading. The frequent use of that expression has resulted in a lot of people coming in and asking to be tested to see if they have a chemical imbalance and if so what chemical do they need more of.  They get quite upset when we say that we can’t do that kind of test. Here are some of the problems with that approach.

Thoughts in my brain and yours also, are carried from one nerve (brain) cell to another by chemicals. So when I think something, anything, my brain sends out chemicals to carry that message. Once the thought has come and gone the chemicals are broken down and reused or disposed of. So as fast as I can think of something my brain chemistry is changing.

Now different brains may make, transport, and use chemicals at varying rates but we all use chemicals to move thoughts. This is why talk therapies like Cognitive Behavior Therapy can help to change someone’s thinking which results in a change in their brain chemistry. Now medication can also help and research seems to show that doing both medication and therapy for your problems can result in changes that are more rapid and longer lasting than either treatment alone.

Most everyone has heard of anti-depressants. So they think that if I am short on a brain chemical I should be able to take a pill, replace the missing chemical, and – presto – I am cured. Wish it was that simple. Let me give you one exaggerated example of how an antidepressant might work.  The most well known and widely prescribed antidepressants right now are ones called SSRI. SSRI stands for Selective Serotonin Reuptake Inhibitors. This has resulted in a lot of people thinking that the reason they are depressed is a shortage of Serotonin. Let me try to explain how this works. You will need to unpack your imagination for this one.

I once drove a car that had a leaky radiator. At the time money was tight, still is a lot of the time but that is another story. So I kept putting water in the radiator. This is sort of like the way my brain might try to keep putting serotonin into use. But as fast as I filled the radiator the water kept leaking out. So my engine overheated. When I get low on Serotonin my brain overheats (not really don’t get the thermometer to check for depression) and then I get depressed.

So every few miles I had to find a place to stop and put water in the radiator and still it didn’t last long, kept overheating.

So this friend of mine tells me there is this thing you can get at the auto store that stops the radiator from leaking. I get some, put it in the radiator and the leak slows down. A second dose and the radiator stops leaking altogether, well almost stopped but at that point, I only have to put water in the radiator once a week, not every day.  So it wasn’t the amount of that stop leak stuff that mattered. I didn’t need to fill the radiator up with it. It just helped me get more use out of the water I had already put in my radiator.

The SSRI works that way on our brains. It doesn’t put more serotonin in the brain but it slows down the leak so we get more miles or smiles out of the serotonin we already have.

Now, let’s say for illustration purposes here, I am bragging to my friend about what a great job that stops leak stuff did and he doesn’t believe me. So I do a demonstration. I get my trusty old shotgun out. Point it at the radiator and let it rip. Now the radiator starts to leak again. So out comes a can of stop up the radiator stuff and I pour it in. Only this time the stuff doesn’t work. The radiator keeps right on leaking.

This is exactly what happens to the brains of people who are on SSRIs or other antidepressants and then they drink alcohol. Alcohol, remember, is a depressant substance. Why we so rarely call it a drug is beyond me, given that it causes more problems with abuse, dependence, and suicide than all the other drugs. But that is just the way it is.

So the point of this story is that the problem for most people is not that the brain is low on serotonin but that the things we do to our brains use up the serotonin way to fast.  A good diet, plenty of sleep, avoiding drugs, and alcohol can all help you produce more serotonin. So can changing your thinking because happy thoughts release more neurotransmitters into the brain. But calling this problem a chemical imbalance shouldn’t take away the responsibility to get our thinking and our living fixed.

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

ADHD Cure- – Treat Parents

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

Sad child

ADHD?
Photo courtesy of Pixabay.com

Could we cure ADHD or depression in children, especially preschool children, by treating the parents?

Just read a report that concluded that the epidemic of ADHD in preschool children can be very effectively treated by training the parents in Parent Behavioral Therapy (PBT). This raised a lot of questions. Why the increase in ADHD? Why in Preschool children? And most importantly how could treating the parents – cure the children?

The Press Release about the report by the McMasters Center can be found here. 

The McMasters center report suggested a different way of viewing ADHD and the older ADD. As I understand their concept they are convinced there is one larger umbrella disorder – Disruptive Behavior Disorder meaning the kid is doing things or not doing things that cause the adults problems.  This more general description, which is a recognized diagnosis in the DSM-4-TR they then subdivide and refine into ADHD in all its varieties, Optional Defiant Disorder, and finally the most severe form Conduct Disorder.

This makes sense to me since most of the referrals for ADHD screening begin with things like – he won’t stay in his seat, is not doing his work, etc. These are complaints teachers and parents have, not things a child, especially a preschool child would complain about. Hence the child’s behavior disrupts an adult’s life and the diagnosis. They report that this disorder began with the label of “minimal brain damage” but when no one could find the specific brain damage we dropped that label.

Further, the study says that ADHD should be thought of as a spectrum disorder. So it might vary from no problem, through milder forms to “for sure you got it” forms. This like so many other mental illnesses are not a case of you got it or you don’t but rather how much of this disorder do you have. Also, there is no medical test for ADHD. We use screening tests and other ways of diagnosing this but the truth is who gets the diagnosis depends on who does the diagnosing.

So why an increase in ADHD cases in preschool children?

Calling them preschool children does not mean that they do not attend school. ADHD and related problems first began to be recognized about 1902 when most children on earth began to attend mandatory universal education.  Now a large number of children are attending preschool – hence lots of preschool-age children are attending school. The report on effective ADHD treatments included all children under six in the preschool group. They especially noted that at this age it is difficult to separate the effects of a condition like ADHD from normal maturation.

I think young children – by definition are immature, so we don’t diagnose “too young” as a condition unless they don’t act like we want them to then they have some kind of disruptive behavior disorder. Some countries in Europe have children wait until they are at least six to start school on the premise that before six they are too immature to benefit from school. In America, we go the other way and start them out at age two or three on the premise that the younger we start pushing them the sooner they will grow up.

So who gets diagnosed with ADHD?

Most new diagnoses of ADHD occur when children begin to attend some form of formal education and are asked to sit still and concentrate on things the adults want them to learn instead of the things kids want to learn. The majority of diagnoses are made between the ages of five and ten years of age. Diagnoses of ADHD after the sixth grade drop sharply and those first diagnosed after age eighteen are even rarer.

The majority of those diagnosed are boys. In fact, boys in the primary grades are four times more likely to get the diagnoses than anyone else. In my own experience, the time children are more likely to get referred for assessment for ADHD is when they first start school, preschool, kindergarten, or first grade. The next big surge in referrals is between the third and fourth grade when there is a shift from learning to read to reading to learn, and the poor readers get really bored.

The number of adult cases is half of those in children, so either a lot of people outgrow this condition with or without treatment or it is not so much of a problem once you are out of required school.  Or maybe a lot of kids get the diagnosis because they are bugging someone in the position to make a diagnosis.

The poor, especially those on Medicaid are much more likely to be diagnosed, but the rich (higher Socio-economic status) are much more likely to receive medication. The poor are more likely to stop taking meds after one prescription. For much the same reasons the poor are much more likely to drop out of parenting education programs.

When meds work for someone it is wonderful, unfortunately, the only way to see if a med will work for you or your child is to try it and there are side effects to worry about. Note that any meds may have side effects but some are worse than others.

In very young children – under the age of six, treatment with a stimulant ADHD med is likely to reduce the ADHD symptoms, but it increases the depression and other mood symptoms. Or maybe the sadness was always there but it becomes more noticeable when the child is able to sit still. The meds also suppress growth, something that a forty-year-old who is overweight might hope for – but not something we want to see in a child under six. And there is another problem.

In one well-documented study children who took a placebo – a non-active pill – did almost as well on managing their ADHD as children who took the real med. When the meds were stopped, 97.5 % of the kids on ADHD meds did not have a relapse, pretty impressive. But of the kids on a placebo who were treated with nothing resembling a drug other than the pill form it was given in, well a full 88% of these non-medicated kids did not relapse either. The conclusion here could be that the thing that helped the kids was the extra attention involved in treatment, not the medication.

Now, why not just send all these kids for therapy? Well as much as that helps some kids, and remember I am a therapist, there is a limitation on therapy. We see the kid for one hour a week. What happens the other 167 hours? So when parents take a class in Parent Behavioral Therapy or work with the therapist on how to help their child, they are able to maintain the treatment all week not just in the therapy hour.

Now if your child is on meds, please do not suddenly take them off, talk to your child’s doctor or psychiatrist first. But for very young children consider approaches other than medication.

The moral of this story? The more we adults work on our skills the more we can help kids with ADHD, with or without medication. So if your child has ADHD or depression or any other emotional problem, consider participating in therapy and learning new skills that might help your child.

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

“Speeding up” the third grade

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

Sad child

ADHD?
Photo courtesy of Pixabay.com

There must be a connection between Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder, and behavioral problems like Disruptive Behavior Disorder. If they are not connected why do I see so many children who progressively get all three diagnoses?

Recently a child was referred for assessment. The parents were concerned their child might have ADHD. They had been sent by the third-grade teacher with a stern warning that they needed to get this child help before it was too late. The teacher pointed out that she had been teaching for a great many years, she had seen many ADHD children, and that she knew a child with ADHD when she saw one. She was certain that this child had ADHD and needed medication. The teacher had told the parents she was sure of this because the child was in the bottom third of the class.

This troubles me. Now I know that there are people who suffer from ADHD. I have worked with adults who were unable to stay focused enough to succeed on a job without their medication. I have seen children with ADHD who have been struggling in school and then they get put on the right medication. It can work miracles. But this was different. If we are going to refer every child in the bottom third of the class for medications what does that say about us and our educational system? Really does that mean one in three children has ADHD? I find that hard to believe.

Now if this was an isolated incident I could explain it away. But this sort of thing is happening more and more.  Another parent shared with me that they were pressured to have their child evaluated for ADHD. The school had said that the child did not stay in their desk or do their work. Further, the parents were told that if the child continued to ignore the teacher and not do their work they might have to be placed on homeschooling. This parent took the bold step of talking to other parents in the class. Turns out that in this class of about thirty students more than half were on ADHD medication, most of them referred by the teacher and principal.

Have we reached the point where test scores are so important that we need to put a third of a class on stimulant medication to get their test scores up?

And if taking pills to get smarter really works, if drugs make kids smarter, than why only the bottom third? Aren’t we then cheating the top third by not giving them the drugs so they can do better also?

What also bothers me is the number of children who are diagnosed with ADHD who are subsequently suspended, sometimes expelled for fighting and violent behavior. I know from my work with substance abusers that when they abuse stimulants they are more likely to become violent or otherwise act impulsively. So could a stimulant ADHD med increase the child’s level of violence and result in him being expelled for behavioral problems? I asked a couple of psychiatrists about this issue. I was told that yes a side effect of some ADHD medications is an increase in violence.

On interesting new development in the field has been the availability of several newer drugs that are non-stimulant ADHD medications. While every medication has its side effects, and these meds are no exception, if the medication we are giving a child is making the problem worse not better shouldn’t we consider other options? I would if it was my child.

Now, remember here I am a therapist and not a doctor so if this gets you thinking how about talking with your doctor? And please don’t just suddenly stop giving or taking meds without consulting your doctor.

Here is another example of this problem. A child was referred for assessment. Please hold your CPS dialing finger till you read to the end. The caregiver, an older sibling, was trying to help her younger brother. He was constantly in trouble at school. Did not do his homework, daydreams in class, and would not stay in his seat. The teacher (different teacher this time) was sure this was another classic case of ADHD. The sister told me she tried to do what she could but she and her baby’s father were living with friends in a motel room and there was no place for this young man. Still, she was his school contact and she came to help him when she could. His primary care doctor had prescribed ADHD meds, but the minor still was not doing his homework and was not paying attention. His meds had been increased and still no improvement. What to think?

So I interviewed the young man. He reported his father was not around. Bio Father was in prison and would not be released for a few more years. He was staying with his mother but she was in jail right now and would not be released until Monday. So in the meantime, he had been staying with relatives. He had slept on the couch, several different couches for that matter, different relatives on different nights, and most of these homes were small and overcrowded. He had not slept well or eaten well since mom had been arrested. He was sad all the time and nothing made him feel better anymore. So was my diagnosis ADHD? Not on your life. Clearly, this young man was suffering, and I do mean suffering, from depression. The end of the story is, mom was released, the minor, and mom found a safe place to stay and the child is in counseling. I hope mom gets some counseling also.

Did I mention the referral for ADHD whose father was just deported and dad will not be allowed back in the U. S.again? He refuses to do his homework, will not listen to the teacher, and – Well you get the idea.

In each of these cases and so many, more, the first diagnosis was ADHD because of poor schoolwork, inattention, and not following rules, like being out of their seat. Later when the medication did not fix them they get diagnosed with some kind of disruptive behavior diagnosis. But in most cases when we look really carefully there was also a lot of depression and sometimes eventually a manic episode occurs and the diagnosis changes to Bipolar Disorder. Not every child who does not do homework has ADHD.

If you have had an experience with this issue or thoughts you would like to share please contact me. So much for my thoughts on Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder, behavioral problems like Disruptive Behavior Disorder, and Depression.

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

Am I Bipolar?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Am I Bipolar?

Occasionally I get asked this question. More often the person asking the question is asking if their child, spouse, or friend is Bipolar. Almost no one ever asks me if they are depressed. Why the difference?

Most of us know when we are depressed. We know that we can be a little depressed and get over it naturally or we can get a lot depressed and need help. It is also easy to see that there is a difference between being a “little depressed” and suffering from Major Depressive Disorder which is the technical term we professionals use when we diagnose clinical depression that needs treatment.  We also have some other lesser degrees of depression we can diagnose like Dysthymic Disorder. Not so much with bipolar disorder.

Even my more liberal colleagues are uncomfortable with the idea that people could be “a little bit bipolar” even though all people have some of the characteristics of bipolar from time to time. It would be more comfortable to think that there are “those people” meaning the mentally ill – over there and then “us people” the normal ones over here. Forget for a moment that our friends and family may think we belong with the over-there folks. Why is it so hard to accept that most of the symptoms of mental illness are on a continuum from a few to a lot?

With depression, we all accept that if someone in your family dies – say, grandma, for instance, you should be sad. That is assuming, of course, you like grandma. If someone close to you dies we expect you to be sad, depressed even, we have a special name for that – Bereavement. But if five years later you are still stuck at home, too depressed to go to work because of this loss, then we think there is something excessive going on here and you will be diagnosed as depressed, probably diagnosed with Major Depressive disorder. So why don’t we do that with Bipolar disorder?

One caution is in order.  DO NOT ATTEMPT THIS AT HOME! Diagnosis is not a do-it-yourself project. This blog is meant to be informative and as you will see below most of this is not a matter of yes or no answers on a questionnaire. Some “clinical judgment” needs to be used, which is why even professionals sometimes need to consult with other professionals on close calls.

Let’s look at the criteria for Bipolar and see how someone might have all the signs or symptoms and still not qualify for the diagnosis. Some of you who read my earlier blog about Bipolar Disorder will remember that the main difference between depression and bipolar disorder is the occurrence, at least one time, of an episode of large mania or small mania (Hypomania.) I have simplified these descriptions so if you want the long-form, check the DSM.  After the 7 criteria will come the big stuff.

Here are the 7 criteria:

1. Inflated self-esteem or grandiosity.

So this sounds like an occupational disease. Wouldn’t all politicians, entertainers, and sports personalities fit this description? So thinking a lot of yourself could be good self-confidence or it could be grandiosity depending on whether you win or not. Certainly, people with bipolar disorder may be attracted to these kinds of occupations but not everyone in those fields should be diagnosed with bipolar disorder. As with all the other symptoms, this is not a yes or no answer, it is a matter of degree.

2. Decreased need for sleep.

Many people experience a night or two when they are doing something exciting and they get by on less than normal sleep for a day or two. As a society, we like people who get a lot done. But eventually, the novelty wears off and the need for sleep returns. Bipolar people have extended periods of high activities with a reduced need for sleep.  Parents with bipolar children report the child never slept that much. Though most parents don’t think their child sleeps enough when the kid keeps waking you up at night. So again the sleep issue is a matter of degree.

3. More talkative than usual or a pressure to keep talking.

Now we have all met people who talk a lot. And when you are with someone who has not seen you for a while you both may feel the need to say a lot. Some kids are so needy for attention that once the mouth opens they will talk nonstop. None of these things meet the criterion of it only happens occasionally. To really be bipolar disorder the person needs to have an out of control need to do these things.

4. Racing thoughts.

This is from the client’s point of view. They feel that even they are having difficulty keeping up with their own thoughts. Writers have this happen sometimes; the muse strikes and we have trouble getting it down on paper. That is not the same thing. Being a writer does not make you Bipolar. (We are not all bipolar are we?) These fast thoughts are also called flights of ideas, hard to stay on track when your ideas jump from subject to subject.

5. Distractibility.

This involves being pulled away easily or getting stuck on irrelevant things. Now, this is perilously close to ADHD. Kids with bipolar disorder are sometimes given an ADHD diagnosis the first time until the symptoms of bipolar disorder become clearer. More on ADHD at another time.

6. An increase in goal-directed behavior.

This is also a tricky one. If it means studying a lot and getting all “A’s” or making lots of money we may let this go. But if you are really good at having sex with lots of people or working so many hours you forget where you live – then you get diagnosed.

7. Excessive involvement in pleasurable activities that may cause you pain.

The official guide lists too much sex, buying sprees, sexual indiscretions, and foolish business investments. This leaves out gambling, substance abuse and some other impulse control problems.  What is a foolish business investment is also open to question. Should we dump the internet stock and invest in a sound carriage manufacturer’s stock? So see how some interpretation is needed?

Now all the above notwithstanding, for anything to be diagnosed – yes you heard me right – for anything to be diagnosed as a mental illness it must cause one of three things.

A. The problem keeps you from having or keeping a job. For kids, this includes going to school. In fancy-speak, we call this interfering with occupation functioning.

B. It keeps you from having good relationships with your friends or family this is called social functioning.

C. It causes you pain. So if the problem is causing you pain we are much more likely to think it is a mental or emotional disorder than if you and your friends are OK with your difference and you can keep a job.

More next time on some of these problematic diagnoses and on some other relationship issues that you have emailed me about.

Bye for now

David Miller, LMFT, LPCC

Bipolar doesn’t mean moody

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Bipolar doesn’t mean moody.

Three psychiatric diagnoses (ADHD, Bipolar, and Schizophrenia) have left the scientific literature and taken up residency in the media and in everyday conversation. The problem with these usages is it devalues the term and pretty soon it is being misused more often than it is used correctly. Bipolar is one of those terms.

Kids report that their peers call them or others “Bipolar.” We hear about it on talk shows. Sometimes parents call their children or their partner Bipolar with no clear idea what the term means. Children are being diagnosed with bipolar disorder at younger and younger ages. Early diagnosis and treatment is a good thing; it may reduce a lifetime of suffering. Referring every kid in first grade who is irritable for a bipolar evaluation is probably not warranted.

Lots of parents want their child “tested” for bipolar disorder. I wish there was a simple test, say blood or urine that would detect the disorder. There may be physical signs or markers, but so far no one seems to be able to detect bipolar disorder other than by a psychological evaluation that involves descriptions of mood and behavior. When many parents want to know if their child is bipolar, what they really mean is the child is irritable or difficult and they need help.

People refer to others who are moody as Bipolar. Bipolar disorder does not mean moody! Some people are naturally moody others get moody when something upsets them. Lack of sleep makes most anyone moody and grouchy. Not everyone with sleep disturbances has bipolar disorder by any stretch of the imagination.

When we talk about bipolar disorder we are talking about a condition, not a person. A person may have bipolar disorder that does not make them “bipolar.”

So what is Bipolar – really? It used to be called Manic Depressive disorder. I see client questionnaires where they report they have family histories of both manic-depressive disorder and Bipolar. I won’t go into the politics behind the name change but it is important to note two things. Bipolar is a mood disorder so it is in the same “family” or chapter as Depression and other mood disorders. The second characteristic is that for the problem to be bipolar it must include Mania or its cousin Hypomania.

Update – In the DSM-5 they did away with the term “mood disorders.” More and more professionals are thinking that Bipolar and Major Depressive Disorder are for-sure two separate things. You may have periods of depression for a while before the mania but we need to be careful to separate the Bipolar from the Major depression.

So what is mania? I won’t repeat the whole DSM-4-TR criteria here if you want that please go to the source. But a couple of things that separate mania and therefore bipolar disorder are important. For some clients, this looks like someone on Meth – without the drugs. This is not a little bit thing that comes and goes. When it occurs the person is debilitated.

Mania involves a period of time where the client’s behavior is elevated, expansive, or irritable. In short, they are “off the hook” and this is not deliberate but uncontrollable. During this time frame, they have a bunch of behaviors that are far too excessive. The DSM lists 7 characteristics and the person should have the majority of these symptoms. Not sleeping and not needing to sleep is a red flag. They are up all night doing things and they don’t even feel tired. They are likely to show grandiosity and excessive self-esteem. They talk faster than those around them can listen and they think faster than they can talk. But the thoughts may make sense only to the person with bipolar disorder. They are likely to get “stuck” on things, too much work, buying sprees, excessive sexual activity, and other risk-taking activities.

Since mania is seductive, who wouldn’t like to be able to have fun twenty-four hours a day and not need to sleep, during manic episodes the client with bipolar may be strongly attracted to stimulant drugs like methamphetamine and cocaine. Alcohol abuse is also common which increases the crash when the manic episode ends. And it always ends.

Most people who truly have bipolar disorder are first diagnosed with depression. One indicator that makes me suspicious is when a depressed client takes an anti-depressant and recovers suddenly and now is “better than ever.” A manic episode is about to occur.

So far talking about Bipolar disorder, with its depressive and manic symptoms makes it sound like the person runs from manic (which is not happy by the way) to depressed. That’s not the whole story. Kay Redfield Jamison writes about what we might call mixed states. It is possible, probably more common than we might think, to have both mania and depression at the same time. Think of the shifting moods like a tire on your car. When it is parked we could mark one side of the tire and call that the back, the other would be the front. But once the tire starts to move you don’t drive on the front or the back but the whole tire. So the person with bipolar may experience a mixture of depression and mania at the same time.

Another feature of Bipolar disorder that separates it from moodiness and depression is the tendency for the elevated thinking to become first delusional and then it may progress to include hallucinations. So the person with bipolar disorder is not only thinking odd thoughts but is very irritated with others that they don’t “get them.”

Hope this explanation got you thinking about Bipolar disorder. If you would like more information, check out the Depression and Bipolar Support Alliance.

As always your comments are welcome. If you like this blog spread the word. If not let me know what might improve it. Till next time.

David Miller, LMFT, LPCC

Are you a rat?

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

Truth or lie

Separating truth from lies is hard work.
Photo courtesy of Pixabay.com

Should you ever rat? When is it OK to tell on someone?

We tell kids to talk to the teacher if someone bullies them. We tell them no one likes a tattletale. Teenagers are vehement that it is never OK to tell on your friends. Parents of teens wish someone would tell them when their child is in danger. What things might your child be doing you would want to know about? What things do you hope your friends are keeping secret?

In a previous post, I wrote about the way in which kids will tell their friends and their friend’s parents about things they would never tell their own parents. When you hear those things, what should you keep to yourself, and what is so important you need to tell? Should we accept the rule that we should never rat? Should it be OK if our kids keep those things secret?

Wouldn’t it be nice if there were all or nothing rules for behavior in life? Some people try to make absolute rules, for themselves and for others. They are mighty sure what the right thing to do is until you call one of their actions into question.

Most of the time in life, things are on a continuum, from good to less good to a little bad to a lot bad. Telling a friend’s secret to someone else is on that continuum.

As a parent, I would want to know if my child was thinking of killing themselves. Wouldn’t you? Could your child feel good about themselves if their friend confided to them that they were suicidal and they did nothing? People who talk about suicide may want to be talked out of it, to be reassured that there is someone who cares enough to intervene and stop them. Would you want to be the kind of person who saved a life or the kind who let someone die?

How would you explain to the parents of a murdered child that you knew someone was going to kill their child but you didn’t want to tell? Could you live with yourself after that? How would you feel if your friend bullied someone and they killed themselves?

It is a good idea to talk with your child about morality and ethics before they have to make those tough decisions.

If a teen is endangering their life with drugs and drinking and driving do you owe it to them to talk to them about it? If they don’t want to stop and continue to endanger their life it is permissible to tell someone else who is in a position to stop them.

Every year we hear about a local teen that is killed by driving drunk, being a passenger of a drunk, or being hit by a drunk driver. Does not trying to stop that when you know about it make you a bad friend? Would you rather be a good friend who kept a dead friend’s secrets or a bad friend who saved their life?

Professional counselors and therapists have legal constraints on secrets. We can’t tell things we might like to such as having a client tell us about past crimes. The counseling relationship has a high level of trust and if we violate that trust we keep clients from coming for the help they need.

But there are other things that counselors are legally and ethically required to talk about, like intervening if a client plans to kill themselves or someone else. We also can intervene when someone does not know how to care for themselves even if they want to be left alone.

Knowing when to keep a secret and when you need to tell to protect that friend, others and society is one of the tasks people need to learn to be adults. A parent’s major job is to help their child grow up. That sometimes it is OK to tell is a lesson we all may need to learn.

P. S. I know that tame rats can, in fact, make good pets. I have no idea why we call people who tell on each other rats. Rats don’t tell on each other. At least I don’t think they do.

I know there are some of you who won’t agree with me on this, you are entitled to be wrong.

Still feel free to comment on this or any other blog and feel free to like, forward and recommend to your heart’s content. Till next time, David 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

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