Tag Archives: Mental Health

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

Do drugs cause mental illness?

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

Drugs

Drugs.
Photo courtesy of Pixabay.com

What is the connection between drugs and mental illness?

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

1. Drugs can cause a mental or emotional problem.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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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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

Why your child won’t behave

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

Sad child

Sad.
Photo courtesy of Pixabay.com

Your child misbehaves.

The number one complaint that brings parents and children to most child mental health clinics is the complaint “my kid won’t behave, won’t mind, won’t do what I tell him to, or some variation of this theme. This is so common a complaint that I am tempted to tell a lot of families “Of course he won’t mind you, he is a child and you are his parent.” But that doesn’t solve the problem, and parents, most of the time, want their children to mind.

The occasional parent who could care less if their child behaved – well those parents come in too, referred by the school or the police. The symptom checklist almost always includes things like lies, steals, argues with adults, hits, and so on. Usually, the parent wants us to find a way to get their child to behave. Sometimes they include in the symptoms “does not listen to adults, does not pay attention to what he is doing.” This could be ADHD, sometimes it is, but most of the time, the truth be told, the child is ignoring the adult. So what do most parents do about this situation and what should they do?

Children rarely grow out of bad behavior.

Lots of parents with poorly behaved preschoolers take the obvious path and do nothing. Their thinking is that the child will grow out of bad behavior. They often do grow out of it – the question is which way do they grow? Uncorrected, undisciplined, (read this as untrained not as unpunished) they grow out of it by turning into something worse, bossy disrespectful kids who tell the parents what to do. Why is it the universal nature of things for so many kids to grow disrespectful as they get older?

On simple reason for this issue is that growth in and of its self creates conflict.  The baby who can’t walk does not get into very many things, the toddler does. As children grow up they try out new things, sometimes parents like the things their child tries, but other times the child does something really dangerous or irritating. Now when the kid does something wrong there are a few ways this can go. The worst one is for the parent to do nothing, give the child the impression that whatever they do is OK with you and you could care less. If you don’t care about what your child does why should she?

Throughout the child’s life, maybe the parent’s also, the child always wants to do things they are not yet old enough or ready enough to do. Their urges are always way out in front of their skill level. Very young kids don’t get it when you tell them “don’t do that” you need to get up and make sure they stop doing that.

Your relationship with the child matters.

One important determinant of how well-behaved your child will be is how close you are to each other. In technical terms, we call this attachment. The time to start being close to your children is when they are very young. If you have a close relationship with your infant or toddler they are much more likely to want to obey and please you when they get older. Don’t worry about spoiling your child. Just because you show love and caring will not make your child spoiled. The better the parent-child relationship is the easier discipline will be.

Even if you and your child did not attach as closely as you might now wish don’t give up. One way to improve the parent-child bond is to play with your children. Some parents got the idea that playing was a time-waster that only children got to do. That is wrong. Some form of play and fun is good for humans regardless of age. Play is valuable, especially playing games with rules because it teaches the child the ability to learn rules. Rules change from game to game and they also change depending on where you are and your role in life. Kids who are good at learning new games appear to be good at learning to adapt to new situations.

Separating is natural.

Most kids will go through periods when they push their parents away. Sometimes they need to define who they are as a person separate from their parents. Other times they feel the need to align with friends and reduce their involvement with the parents. Don’t let these episodes of pushing you away be an end to your relationship. Try to stay connected and watch for a time when your child shows an interest in reconnecting.

Now some children are more resistant to discipline than others. Sometimes the parents do everything they can, play with their child, work on good attachment, praise them for successes, and still, there are discipline problems. At that point, parents turn to professionals and the professionals recommend some form of behavioral modification.

Many people misunderstand behavioral modification. They have only two tools, rewards and punishments. So there is a temptation for the rewards to turn into outright bribes. And the punishments get increasingly stringent, often to the point of abuse. Behavioral modification has lots of techniques beyond the stick and the carrot.

In future blog posts, we will talk more about modifying behavior, your child’s and your own. I also want to talk some more about recovery and resiliency. This brings us right up to the current moment.

Soon it will be New Year and lots of people will be making resolutions. How do you make resolutions you will be able to keep? How do you avoid making impossible to keep resolutions? Before we can talk about changing our children we need to talk about how we change ourselves. How does that process of change work? Stay tuned for more on changing to have a happy, resilient 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

An extra post

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

Found a really good post over at another blog and needed to pass it on.

The post was about the relationship between smoking, nicotine and mental health.

An interesting post and some good comments from consumers. Thought I would share this with you.

I left my comments over at James Claims blog so I will not repeat them here.

And just for the record, don’t get spoiled by all these extra posts, it may not happen again for a while, but then it just might.

The link is

http://jamesclaims.wordpress.com/2011/11/08/nicotine-may-help-bipolar-disorder-and-schizophrenia/

Thanks – I think

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

Counselorssoapbox.com

Thanks – I think

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

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

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

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

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

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

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

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

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

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

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

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

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

David Miller, LMFT, LPCC

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

.

Am I a quart low on serotonin?

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Low on Serotonin?

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

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

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

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

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

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

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

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

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

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

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

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

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Am I Bipolar?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Am I Bipolar?

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

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

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

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

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

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

Here are the 7 criteria:

1. Inflated self-esteem or grandiosity.

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

2. Decreased need for sleep.

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

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

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

4. Racing thoughts.

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

5. Distractibility.

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

6. An increase in goal-directed behavior.

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

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

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

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

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

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

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

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

Bye for now

David Miller, LMFT, LPCC