Tag Archives: Mental illness

What should I do?

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

Counseling questions

Counseling questions.
Photo courtesy of Pixabay.com

Wondering what to do with your life?

When you came home from the hospital that first day of your life, did you get a guide to life, where to go, and what to do? I didn’t get mine either. People frequently come to counselors for the answers from that book. Unfortunately, there are no such books. There are some lessons we have learned from living our lives but I am not sure we should recommend those to you. Your life is after all yours. So how could you decide what to do? Let me suggest some options.

There are some guides to having a good life, those general things on proper living, like the Ten Commandments and ethical principles. But it is hard to apply that instruction to daily life, like jobs and children. People look for guidance everywhere. Some people visit fortune tellers and some read columns by economists. The hope is the same; that some expert will be able to tell us what will happen and what we should do.  These sources of information may inform your choices but they won’t tell you what to do. It’s your life and you need to make the decisions. Sorry to have to tell you that. So how might a counselor help you with a decision?  What are the things that the counselor should do and what are the parts of this process you should do yourself?

What are your values?

What are your religious or moral values? How strongly do you hold these concepts? Is the course of action consistent with these values? How will you feel about that choice after you have made it? A counselor can help here by letting you “talk this out.” You can explore conflicts between what you are thinking of doing and what you value. Many people have never looked carefully at their values. Do you believe this or is this something that you learned from a parent or authority figure? Though shalt not kill is a good value – unless you are in the army or on the police force.

What if you learned that money is all-important. Make money your family told you when you were young. Now you have the chance to do something you truly love but the pay is not so good. Which values are more important to you?

No one in the helping professions should impose their values on you. Some counselors firmly believe that a couple should always stay together, no divorce no matter what. Another counselor may be a “feminist” or a strong believer in woman’s rights. They may encourage all their clients to divorce. As a profession, most counselors believe we should not make those decisions for you. If we have strong opinions one way or the other we should tell you at the start. We can work with you on improving the relationship if that is what you want. We might also work with you on a safety plan to protect you and the children from domestic violence.

What are your options?

People often stay trapped in a bad situation because they have become stuck and hopeless. They don’t know they have choices. Career changes are a good example of this. The counselor should help you learn to find answers not find them for you. This issue causes a lot of frustration among clients. Some counselors are so reluctant to impose any idea on their clients they listen to them talk about their unhappiness but never think to point to the answer even when the counselor knows where it is. An example might help here.

You are stuck in a low paying job you hate. You can’t find anything better and you become depressed and angry with your family as a result. You could work on your anger and your depression. That might help. You could also learn some new job search skills. There are online resources that a career counselor might tell you about where you could look at pay scales and requirements for other careers. There might be one that is perfect for you, just what you want, but you need more education. So the counselor might tell you about schools that offer this training and were to go to research them.

If you were homeless would you want a counselor that listens to your pain or one that gave you the number of an agency that could find you a place to stay? Maybe you would want one that did both. So a good counselor will show you how to find options but won’t tell you which one to choose. It is your life after all.

Many counselors strongly believe in an approach called “Bibliotherapy.”  They will recommend books for you to read and then discuss what you read with you. Did the ideas in the book help you make a decision? What else do you need to know?

The counselor should help with reality testing. So what is that?

When people are very angry, depressed, or fearful, Ideas come to them that sound like a possible solution to their problem. Suicide and Homicide are extreme examples of this. But there are milder possibilities. Someone who just had a fight with their boss may be in a hurry to quit their job and tell their boss off. When upset we humans seem to lose the ability to think things over and are prone to act impulsively. That is not an excuse for bad behavior, only the truly “legally insane” can’t tell right from wrong.

Say a person comes in and tells their counselor that they feel that God is punishing them for their sins. That, they say, is why they are having all these troubles. If this is consistent with their beliefs the counselor needs to consider the client may really believe this. Who am I to decide what God is up to?

So this client decides to quit his job, give up his family, and become a Missionary to Burma. Here is where reality testing kicks in. There is a process in most religious groups for selecting missionaries. Is he willing to go through the selection process? Does he speak the language?  How will he support himself? Who will take care of his family? So the idea to drop everything is probably not reality. If he is a doctor and is willing to go through a several-year process, this is a lot more possible than if he works in fast food and wants to start tomorrow.

Should the counselor and the client discount this idea altogether? Maybe not. He might decide to donate money to a group that is already working in that area. He might support literacy efforts or a medical program. He could decide to volunteer at a nonprofit near home.

So there you have it, for now. Three ways in which counseling could help you decide what to do without imposing the counselor’s values and will on you.

Hope you are moving towards a truly 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

New Bipolar drug trial

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Person with masks

Bipolar.
Photo courtesy of Pixabay.com

In past blog posts, I mentioned that one difference between people with Bipolar disorder and people with unipolar depression was the way that people with Bipolar Disorder sometimes react suddenly and dramatically to medications, especially anti-depressants. I came across this article on a new trial of drugs being conducted by the National Institute of Mental Health. Thought this might be of interest to some of you. But please folks, don’t try this at home. New drugs should only be tried after consulting with your current provider and medication should always be supervised by a medical professional. If any of you are involved in this trial or hear more about it let us know what you find out.

NATIONWIDE RECRUITMENT–BIPOLAR DISORDER RESEARCH STUDY: ANTIDEPRESSANT RAPID EFFECTS OF KETAMINE

Individuals who have been diagnosed with bipolar disorder may be able to participate in a trial designed to understand the causes of depression and rapid antidepressant response. Specifically, this study is testing whether ketamine, a drug that affects glutamate in the brain, will improve symptoms of depression within a matter of hours.

Individuals between 18 and 65 years of age who have been diagnosed with bipolar disorder and previously failed to respond to treatment may be eligible for an inpatient trial designed to bring about a rapid antidepressant effect. After completion of the study, the participant is transitioned back to a clinician in the community. In addition, all research participation is without cost and NIMH will cover all transportation costs from anywhere in the United States. Compensation is provided for study procedures. To find out more information, please call 1-877-MIND-NIH (1-877-646-3644) or email moodresearch@mail.nih.gov. For more information on research conducted by the National Institute of Mental Health in Bethesda, MD click here http://patientinfo.nimh.nih.gov.

The photo above is from Wikimedia and is not the drug they are talking about for the study. You will probably need to cut and paste the link above. Short post tonight but more is on the way. Until next time, have a happy life. David Miller, LMFT, NCC.

Two kinds of fear

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

Fear.

Fear.
Photo courtesy of Pixabay.com

Underneath many of life’s problems is an ancient enemy – fear.

It is at the bottom of most negative emotions, the ones that infect our lives and undermine our happiness. Fear is at the bottom of anxiety, depression, and the problems of daily living that keep knocking us off the road to happiness. Whatever disguise fears are wearing, we each have our own special boogeyman, there seem to be two primary species of fear. This is not a new idea, I heard it a long time ago in a self-help meeting, but the more I have thought about it, the truer it seems to me.

We are usually either afraid of not getting something we want or afraid of losing something we have.

Most often we are afraid of not getting something we want. The fear that you will not get your needs or desires met is a powerful one. Unfortunately the more we have the more we need.

Think about stalkers here. They become obsessed with wanting someone, usually someone that is out of reach. I know there are stories about someone who pursued a romantic interest over a long time and much difficulty and in the end, the relationship happened. But once your intended romantic partner has gotten married, had children, and gotten a restraining order against you, it is time to give it up.

Some people try so hard for a particular job only to fall into a deep depression when it doesn’t come through. Wanting a career is wonderful. Pursuing your dream is great. But what will happen if that doesn’t pan out? You might be surprised at how many kids tell me they plan to go into major league sports. Most don’t make it. Some can’t make it and it ruins their whole life. What is really sad is when they become so fearful about failure that they self-sabotage and destroy their chances.

Ever hear the story of – well the name doesn’t matter – He was so sure his girlfriend was going to break up with him that he broke up with her first. Do you ever do that? Let your fear get control of you and destroy your chances before they began?

Therapists see some very sad cases of this fear. We see people who are not happy when alone, jump into a relationship because they are afraid that they will never be happy without a partner. Often they settle for a partner, any partner, and a relationship that is far short of what they wanted or deserved. Not surprisingly, to their counselor, they find that their partner is not happy either. Two unhappy people rarely make a happy relationship.

The second big cause of fear: We can be so in fear of losing something we have we forget to notice what we do have.

We old people have trouble keeping up. Two kids are sitting on a bench, each busily texting, neither one is speaking. I look over their shoulders. What could be so engrossing they don’t have time to talk? They are texting each other. I remember a time when my grandparents got a phone. Not everyone in the town had one. They felt lucky to be one of the first families to have one. I see a teen come into the psychiatric hospital, she cut her wrists, her parents had taken away her cell phone and she felt she had nothing to live for.

An old saying, only the rocks, and the hills are forever. Today with strip mining that may not be true. But we can get so into fear of losing something we miss out on the joy of having it. Remember in a hundred years not very many people, maybe no one will remember. For everything we have, we probably gave up something else that could have been.

Yes eventually that old car of yours, the one you saved to buy, it will break down. Keep it in the garage and never drive it and it will not get wrecked until your descendants take it out and drive it if it still runs then.

So have your fears controlled you? Do you fear you won’t get something you want and does that lead to anger, depression, or anxiety? Is that fear keeping you from trying?

Do you fear losing something so much that you can’t enjoy what you have? Is it time to challenge your fears? Don’t let fear keep you from having a happy life.

More on this is at 2 large reasons for your fear and Anxiety

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

Wall Street is crazy!

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

Mental Health or Mental Illness

Mental Health or Mental Illness?
Photo courtesy of Pixabay.com

Have you noticed that Wall Street has gone crazy?

Not the prices or the up and down of the market, more the way they are talking. I used to think all the “loony tunes” were in Washington. Have they moved to Wall Street?

Have you noticed they keep stealing our words – depression, schizophrenia even bipolar have turned into market terms.

I noticed it the other day. I was looking for articles on Major Depressive Disorder. Every article I came up with was about the economy. Suddenly depression is about a slow economy and not about a mental illness. Who do they think they are fooling?

With the exception of the “Great Depression” of 1929 past economic slowdowns were not called depressions. Even that one got the term because of the widespread sadness in the country as a result of the economic slowdown.

I even got a nasty comment on my blog, which I did not approve thank you very much, from a broker who was upset that we called sadness – depression. He did not like the idea that people could be sad. Investments – yes. People – no.

I read about the “occupy movement.” I can understand why they might want to occupy some places. Anyone for occupying Hawaii? But really guys – why occupy Wall Street? Would you occupy a VD clinic? Aren’t you afraid of catching something while on Wall Street? Something for which there is no treatment?

Let me remind those financial types that business slowdowns used to be called “Commercial Revulsions.” Look it up on Wikipedia if you doubt me. The idea was that purchasers became repulsed by the goods offered for sale. If you have looked at some of the cheap, tacky stuff in your local “Walleye World Store” or the “Cheaper Than a Buck Place” you would know what I mean. Some of that stuff makes me sick. In fact, I got so “commercially revulsed” that I wanted to vomit.

After “Commercial Revulsion” some smart ad man went to calling these downturns “Panics” they had a whole bunch of “Panics” up until our financial leaders decided that having a biannual “Panic” might not be good for consumer confidence.

We called them recessions off and on but that designation got to be so watered down we were having annual rescissions every time some retailer did not make a profit projection. So this time around they decided to borrow some mental health terms to explain why so many people are out of work and sad. In therapy we call these problems “Adjustment Disorders,” so far Wall Street hasn’t stolen that name. They are not used to adjusting to anything that is not their way but give them time.

We also used to have lots of bubbles. Remember the South Sea Bubble? (See Wikipedia again.) I remember sales on Arizona swampland and Florida homesites that were underwater. Wait a minute did that just happen again? Is this a rerun? This time underwater means they owe more than the stuff is worth. Last time it meant there was seawater on your home site. Another way to fleece a –

They have also taken to calling some CEO’s and CFO’s schizophrenic because they can’t seem to make up their minds. There is more to schizophrenia than indecisiveness. There are auditory hallucinations and there are things we call negative symptoms. Come to think of it some of those Wall Street types must have been hearing voices all through the housing boom. And now they have started making me real negative. Still not sure they should get the diagnosis of schizophrenia though.

And when did bipolar get to mean moody? I wrote a post about that but still, some stock guy wants us to think that today’s up and down market price is a sign of bipolar.

Next week I expect to read about a stock with “Dissociative Identity Disorder” or a CEO who has an “attachment disorder.”

Could you Wall Street types leave our vocabulary alone?

Could it get any worse? I just e-searched for more depression articles. Our depression word has been hijacked by a group of meteorologists. There was a whole page of articles on “Tropical Depressions.” What is so sad about going to the tropics it would make a meteorologist depressed?

Until next time, safeguard your illness from theft and have the happiest life you can.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

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

Story Bureau.

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

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

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

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

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

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

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

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

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

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

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

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Should you be happy?

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

Happy faces

Happiness.
Photo courtesy of Pixabay.com

Are you comfortable feeling happy?

There are lots of articles on the net and lots of blog posts about depression and anxiety, but not much being written these days about being happy. We can’t blame those people who are focused on their depression or anxiety for this state of affairs.

If you ask people what makes them happy, many people can’t answer that question. Most people have never even thought about what might make them happy. In therapy sessions, I often ask people to describe some basic emotions, things like happy, sad, afraid, or mad. Most people in crisis can’t tell what makes them feel the way they do. They just know they are in pain and turmoil.

When I ask them what would make them happy, they often sit and look at me for a long time without an answer. The question stumps them. They have never considered just what it would take to make them happy. Usually, the pain is so acute that just ending the pain is all they can think about.

Loss of pleasure is one of the symptoms of Major Depressive Disorder, that I know. Yes, sure, in my practice I work with many people who are so depressed or anxious that they can’t even think about happiness just now. What surprises me the most is that most of them have never stopped to think about what it would take to make them happy.  Many times they are not even sure they should be happy. What would you say if I asked you that question?

Do you deserve to be happy?

There are those people who hold the religious view that the time on earth is a trial and they expect to suffer. They tell me they expect to suffer. Unfortunately, they frequently mean that they want everyone else to suffer. I see their kids in therapy after the kid has given up on life and wants to die. Please, if suffering makes you happy, try to do it in a joyous manner and let those around you have the happy life they deserve.

Now I know there are lots of challenges in this world. There are families that live in poverty.  There are single parents struggling to provide for their families on one low paying income. Families have sick children. Sometimes one or both parents are ill. Sometimes awful things happen to these people. Some people suffer horrifically.

The surprise here is that sometimes in two houses, side by side, both undergoing hardships, one family is happy and the other is miserable. Why?

How is it that some people can go through life’s trials and still values their existence while another person will suffer terribly?

One major difference between those who walk through a trial and continue to be happy and those who are overwhelmed is the mental attitude they have. I know that this is so easy to say and so very hard to do. Fortunately, there are people who are willing to help you change your view of the world if you are willing to change. I am not just talking about professional counselors and therapists here, though that is their job in my opinion. There are also self-help groups, books, and support systems of friends. The key is to be willing to give up our attachment to suffering and to embrace the idea that it is possible to have a happy life.

There are at least three things that can move you towards a happy life.

1. Give up the notion that you need to suffer and embrace the idea that it is possible for you to be happy and that you deserve this happiness not because of what you do or have but simply because you are the one unique you. Embrace the quest for a happy life. A happy life is not all about pleasure. Drugs and things are not likely to make you happy.

2. Change your thinking. Most of us have a whole pack of must’s, should’s, and have-to’s that we hold onto. Being able to let go of things and move on is critical.

3. Nurture your resilience, that ability to bounce back. This is a real life. It has its ups and downs. I can guarantee that things will happen to you that you will not like. But then if you keep on track those good things will happen also. So if you keep looking at the failures you will grow them. Learn from life’s trials but grow from them also.

You and I both know that if you are down right now all this is hard to do. When you lose your job, end a relationship, become homeless, or are struggling with sickness it is easy to get down and depressed. It is easy to get into fear and worry. Look for help. Find someone that you can talk to that will understand and support you.

In future blog posts, I want to talk to you about all these issues and many more. As our country struggles with a great economic illness we seem to have neglected the mental and emotional health of our people. Do all you can to fight mental and emotional illness by carving out all the happy life you can. And share that happiness. Happiness shared is not diminished it is multiplied.

See also:

Finding happiness

How to be happy

Buying happiness

13 ways to make yourself miserable

Till next time. Wishing you the happy life you deserve.

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

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

How do antidepressants work?

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Counselorssoapbox.com

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