Tag Archives: Anxiety

Chemical imbalance?

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

Brain

Memory.
Photo courtesy of Pixabay.com

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

“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

Great New Training on Mental Health

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Counselorssoapbox.com

Mental Health First Aid (MHFA) is a great new training. If you are not familiar with this training you should check it out. Designed for the non-professional, it teaches you how to react and how to be helpful if you encounter someone who is having a mental health crisis. Created in Australia the program has now come to the United States. The two-day, twelve-hour interactive class covers the major kinds of mental illnesses and how to help a friend, family member, or someone you might meet who is experiencing mental health problems. Sponsored by the Maryland Department of Health and Mental Hygiene, Missouri Department of Mental Health, and The National Council for Community Behavioral Healthcare there are now certified trainers throughout the United States.

Here in California’s central valley, there are over a hundred certified trainers. Certified trainers in Fresno have put on numerous trainings over the last year. I became so enthusiastic about this program that I took the training and became a certified trainer. So far I and a co-facilitator have completed three trainings. All of our trainings were enjoyable to do and well attended. In the coming year, we plan to offer the training at least three more times. We are currently looking for a larger room or a sponsoring agency. If you want more information on my trainings please email me or watch this blog for posts on upcoming trainings.

If you are not near Fresno you can check the Mental Health First Aid USA website at http://www.mentalhealthfirstaid.org/cs/program_overview/ for a listing of courses in your area. The training comes with a detailed book for reference after the class. So whether we see you in one of our trainings here in Fresno, or you take it from another trainer, this is one class well worth taking.

Thanks to all of you who are reading this blog, subscribing, and passing it on.

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

Anxiety is like a cat!

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

Stray cat

Feral cat.
Photo courtesy of Pixabay.com

Anxiety is like a cat!

What exactly is anxiety? And what is an anxiety disorder?

Well to some people it looks like a kitten.

And to others, it looks like a lion.

A little anxiety can feel like a small cat rubbing on your leg, a bit of an annoyance but nothing you can’t handle. It can push you to try harder. It is the stage fright that keys up the performer to go all out and give the performance of their life.

For others, Anxiety is the lion that keeps you off the stage of life. It is a terrifying disorder that tries to eat you alive.

Anxiety disorders are the most common emotional problem in America. In any one year, approximately one in five Americans will have an episode of anxiety that is severe enough to interfere with their everyday functioning, an episode so severe they should go for treatment.

Dictionaries define anxiety as a feeling, worry, nervousness, agitation, fear, or apprehension. The symptoms can interfere with every system in the body. Anxiety symptoms are often mistaken for physical illnesses and send millions of people repeatedly to the doctor looking for a physical cause of an emotional problem.

Now if you have a physical problem, by all means, see your doctor. But if the problem keeps changing, if the doctor can’t find anything wrong with you, then the problem may be emotional. That does not mean the problem is “all in your head” it is there, but it is everywhere in your body also, and there are treatments for anxiety.

Robert Sapolsky wrote a really cool book, called “Why Zebras Don’t Get Ulcers” which explains how your fears can essentially hijack your body and show up by making you sick. I highly recommend this book to counselors and therapists who want to understand anxiety and want to help people with this problem. But what if you or your child is suffering from anxiety. And I do mean SUFFERING? What if you just want to get your life back?

There are ways to turn the volume down on anxiety, shrink that cat down to a manageable size. I am not saying to get rid of anxiety altogether. If there is a real live lion chasing you, or a gang banger with a gun, some fear and anxiety is a good thing. Under those circumstances, anxiety might save your life. If your fears are keeping you from having a life, what then?

A good counselor or therapist can help you shrink those fears. There are self-help books that help also. A good counselor can help you learn and practice skills to stop anxiety in its tracks. The difficulty here is they will probably see you an hour a week, now you got 167 hours to go before your next appointment. What now? This is where a good self-help book can help, especially if you talk it over with a professional and practice the skills. A book is also helpful if you need to help a child get over their anxiety.

One book that I find helpful for managing anxiety is Tamar Chansky’s book “Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries, and Phobias.  She has lots of good techniques for reducing and controlling anxiety. She does some creative things like using a “Fear Extinguisher” and a “Fear Thermometer” as well as some of the standbys like creating incompatible emotion states by using humor or relaxation to reduce anxiety.

So is anger a problem for you? How do you reduce or control your anger? And if you are a counselor and work with clients with anxiety – What do you find the most effective approach?

There will be more on this topic to come, and please feel free to comment on this or any other topic in my blog. Till next week. 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