Tag Archives: Depression

More depression these days?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Is there more depression now than they used to be?

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

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

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

Best of Blog Recap – January 2012

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Counselorssoapbox.com

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

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

Here are the top read blogs of the last month.

1. How does therapy help people?

2. Stages of Change – Early action

3. Is relapse a part of recovery?

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

From the last year the top posts were:

1. How does therapy help people?

2. Treatment for teen’s risky behavior

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

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

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

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

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

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

How many mental illnesses are there?

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

Confused brain

Mental illness.
Photo courtesy of Pixabay.com

How many mental illnesses do you know about?

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

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

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

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

1. Problems of daily living.

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

2. Anxiety disorders.

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

3. Mood disorders.

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

4. Substance use disorders.

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

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

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

5. Psychoses.

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

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

6. Problems of kids and growing up.

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How do antidepressants work?

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

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

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

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

Think of this analogy.

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

Why does the doctor keep changing my meds?

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

Drugs

Medications.
Photo courtesy of Pixabay.com

Why is med compliance important?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

Are you Hyperthymic?

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43

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

Hyperthymia person

Are you Hyperthymic? Photo courtesy of Pixabay.

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

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

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

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

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

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

1. Cheerfulness

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

2. Exuberance

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

3. Meddlesomeness

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

4. Lack of inhibitions

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

5. Overconfidence

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

6. Grandiosity

Genius is never recognized in its own time.

7. High energy levels.

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Bipolar or Major Depression?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

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

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

1. Sudden onset of episodes.

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

2. Early age of first onset.

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

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

3. Presence of Psychosis

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

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

4. Presence of “Psychomotor retardation”

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

5. Having “Atypical features”

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

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

How does therapy help people?

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9

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

Therapy

Therapy.
Photo courtesy of Pixabay.com

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

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

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

Therapists are empathetic, non-judgmental listeners.

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

Therapy can be a corrective emotional experience.

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

The counselor can provide reality testing.

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

Counselors help people change life stories.

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

Counselors teach clients new skills.

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

Counselors help clients get in touch with themselves.

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

Psychotherapy can assist in changing personality.

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

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